Lumbar puncutre

Question 1

ph of csf

Answer 1

7.33 - 7.35

Question 2

function of csf

Answer 2

shock absober for cns
immunologicla funciton

Question 3

where is csf mainly produced

Answer 3

95% in laterl venticle
4th ventilce

Question 4

what produces csf

Answer 4

choroid plexus

Question 5

what is the ammmoujt of csf produced in 24 hours

Answer 5

450 - 750 mls/ 24 hours

Question 6

how much csf is proudced by new borns and peads each day

Answer 6

25 mls new born
125 peads

Question 7

what is the csf turn over

Answer 7

3 times per day

Question 8

what is the volume of csf in adults

Answer 8

150 mls

Question 9

what is the pressure in cm of csf

Answer 9

less than 15 with a mean of 10 , and between 9 - 12 in peads

Question 10

how is csf absobped

Answer 10

by arachnoid villi projectsion of the aracnoid memnare into the dural sinsus to allow csf to pass form th subarachnoid space in to the venous system

Question 11

what is the osmolatir of csf and how does it compare to plasma

Answer 11

it is the same as plasma - 295

Question 12

what cells are not prenst in csf that re in blood

Answer 12

rbc, neutrophils, eosinophils, basophils, and mast cells. P

Question 13

what is lower in csf compared to plasm

Answer 13

potasium, calcium , glucoise , proteing (signifcanlty) , albumin (signficialty) , Igg (signficilay)

Question 14

what is higher in csf compared to plasma

Answer 14

clorine, lactose and water

Question 15

what cells are seen in bacterial csf infection

Answer 15

leurkocytes, nurepils, low gluose, hihg protines, high opening pressure

Question 16

what is seen in viral csf infection

Answer 16

slightly elevated opening pressure
slightl high leukocytes
if early - nerutropils, if late lymphocytic
low glucose
high protein

Question 17

what is seen in fungal csf infection

Answer 17

high opeing pressure
mid leukocytes
lymphhoctyes
low glucose
hgigh protien
postive to cultures

Question 18

what is seen in tb infection

Answer 18

fibrin web appareach
different opening pressure
hihg lymhoctyes,
lympocytes high
low glucose
very high proin
positive for afb

Question 19

what is seen in autimmine infection of csf

Answer 19

clear liquid
normal opeingi pruss
raided lueckiphyils
lymphocytes
normal glucose
high protein
negative to cultrues

Question 20

what to check before lumbar pucutes

Answer 20

any anticogaulatis and check coagulation
look for previous surgyes
look for brain tumour - which could lead to a death if tapped
congetila abnomaleis

Question 21

what are the congential abnoralies that a spinal tap should be avoided

Answer 21

chiari malforamtion, bifida

Question 22

what posistion should someone be in for lumbar punctture

Answer 22

lateral decubitus

Question 23

what is the level of lumbar punctre in adults/ childnr

Answer 23

adults - l3, or opposite supperio illiac spine
child below l4

Question 24

conuc medual end point adults and childern

Answer 24

adults - l1/l2
child - l2/l3

Question 25

how to do lumbar punctures

Answer 25

insert needle along midline
having te point of needle of the centre
when feel pop put needle pull back to look for csf
tnrn need to venture
attachn manometer to hymb of needle and measure the pressure and collect csf fluid

Question 26

why would a lumbar puncutre be required

Answer 26

look for
tb, cns symphyisl, cns vasulitis, ms, gullian barre syndoem, tansvere myelits, menigitis, subaracnoid heamortage

Question 27

what is tharputic lumbar puncture uses

Answer 27

spinal anethetic, injection of contrat media for myelography, treatment of reaide dinternactial presu post subarnoid bleed hydrocephalus hc, treat idiopathic intracrtal hyertenison
injection of contrast media for myelography

Question 28

what is hydrocephauls

Answer 28

where there is abdnomla build up of fluid within the ventrilces of the brain

Question 29

types of hydrocephauls

Answer 29

subnomral csf reabospriton of csf overprodution

Question 30

causes of hydrocepalus

Answer 30

obstuctive - e.g. stenois of aqueduct of sylvius
communicating - defective reabospin in arachnoid granultion nomarlly due to csf overpuditon by tumorus

Question 31

tumor of choroid plexus

Answer 31

choroid plexus papillomas

Question 32

symptomns and signs of hydrocephaus in adults

Answer 32

Headache
Nausea, vomiting
Gait disturbance ( unsteady)
Papilledema, blurred vision, reduced vision
Abducens palsy
Up gaze palsy
Reduced conscious level
Urinary incontinency
Altered mental status
Poor concentration

Question 33

sympotns and signs of hydocephauls in childrne

Answer 33

Abnormal increased head circumference (OFC)
Irritability
Poor head control
Poor feeding, N/V
Bulging and full fontanelle,
Prominent forehead (frontal bossing),
Enlargement and engorgement of scalp veins
McEwen’s signs: cracked pot sound on percussing over –dilated ventricles
Abducens palsy
Upward gaze palsy ( sun setting sign)
Hyperactive reflexes
Irregular respirations with apneic spells
Splaying of cranial Sutures

Question 34

cause of congetial hydorpculs

Answer 34

chiarail malformaiton
priarmy aqueduct stenois
dandy walker malforamtin ie. atreatsi of fomraiton of luschka and magendie

Question 35

what is chiari malformation

Answer 35

where the cerebllum misformes and bulges towards the spinal canal blocking it

Question 36

etilogy of hydorpchs

Answer 36

post heamorrage, post infection, brain tumour

Question 37

types of hydrocephaulus

Answer 37

idiopathic, intracrail hyperenteniosn, female, obse

Question 38

invesigation s for hydrocephauls

Answer 38

Clinical assessment of the patient and history
Ultrasound
CT head
MRI head ( different sequences)

Question 39

treatment for hydrocephauls

Answer 39

Fontanel tap
Ommaya reservoir
External Ventricular Drain ( EVD)
Lumbar puncture
Lumbar drain
Ventriculo-peritoneal Shunt
Ventriculo-Atrial shunt
Lumbo-peritoneal shunt

Question 40

what is hte ommaya revosu

Answer 40

port just above head that has a father that isn inserted into the ventilce, alow easily table to take csf

Question 41

what is a venticlr atrail shunt

Answer 41

port from the ventilce in brain into the right arturm though father in heart

Question 42

how is shunts reguated

Answer 42

through a vavle