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AUBF > MIDTERM - CSF > Flashcards

MIDTERM - CSF Flashcards

1
Q

The brain and spinal cord are lined by the ____, which
consists of three layers

A

meninges

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2
Q

function of csf

A
  • supply nutrients to the nervous tissue,
  • remove metabolic wastes,
  • produce a mechanical barrier to cushion the brain and spinal cord against trauma.
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3
Q

three layers of meninges of the brain and spinal cord

A

dura mater - hard mother
arachnoid - spider web like
pia mater - gentle mother

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4
Q

The outer layer is the dura mater
that lines the __ and ___

A

skull and vertebral canal

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5
Q

the arachnoid is a ___ inner membrane

A

filamentous

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6
Q

the pia matter is a ___ membrane lining the ___ of the brain and the spinal cord

A

thin; surfaces

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7
Q

CSF is produced in the ____ of the TWO lumbar ventricles and the third and fourth ventricles. I

A

choroid plexuses

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8
Q

In adults, approximately ___mL of fluid is produced every hour

A

20 ml per hr

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9
Q

mnemonic for csf flow

A

come - choroid plexus
let - lateral ventricle
me - foramen of monroe
treat - third ventricle
sylvia - sylvian aqueduct
for - fourth ventricle
lunch - foremen of luschka
mamaya - foramen of magendie
sa - subarachnoid
aristocrat - arachnoid

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10
Q

In adults, we are maintaining how many ml of circulating csf?

A

90-150 ml

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11
Q

In neonates, we are maintaining how many ml of circulating csf?

A

10-60 ml

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12
Q

since the choroid plexus is producing csf of 20 ml per hr, how do we maintain a constant 90-150 ml of csf for adult and 10-60 ml for neonates?

A

it will be reabsorbed back into the blood capillaries in the ARACHNOID GRANULATION/VILLAE at a rate equal to its production

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13
Q

explain why arachnoid granulation acts as a one way valve

A

it responds in the pressure within the CNS and prevent reflux of fluid

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14
Q

how do plasma differs in csf in terms of chemical composition, even though csf came from plasma?

A

it was been filtered out by the choroid plexus. Also, when it comes to endothelial cells found in other parts of the body, it is all loosely connected, however, in the choroid plexus, it is tight fitting and will prevent the passage of unnecessary molecules

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15
Q

Tight-fitting structure of the endothelial cells in the choroid plexuses is termed the ___ that prevent the passage of many
molecules

A

blood–brain barrier

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16
Q

give an example of disease that causes disruption in blood brain barrier

A

meningitis

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17
Q

The ___ are capillary networks that form
the CSF from plasma by mechanisms of selective
filtration under hydrostatic pressure and active
transport secretion

A

choroid plexuses

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18
Q

The procedure for obtaining CSF is known as a

A

Lumbar Puncture

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19
Q

Contraindication to performing this puncture is the
presence of __at the puncture site.

A

infection

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20
Q

____ mL of CSF is slowly removed into three or four sterile tubes that are numbered sequentially

A

10–20

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21
Q

If only one tube can be collected, it must be tested first
by ___

A

microbiology

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22
Q

Tube 1 -
Tube 2 -
Tube 3 -

A

Tube 1 - Chemistry serology
Tube 2 - Microbiology
Tube 3 - Hematology

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23
Q

To maintain a volume of
90 to 150 mL in adults and 10 to 60 mL in neonates, the circulating fluid is reabsorbed back into the blood capillaries in
the ___ at a rate equal to its pro
duction.

A

arachnoid granulations/villae

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24
Q

The cells of the arachnoid granulations act as ___ valves that respond to pressure within the central nervous system (CNS) and prevent ___ of the fluid

A

one-way; reflux

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25
Q

the selective filtration of plasma to form a csf is regulated by what processes

A

hydrostatic pressure and active transport secretion

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26
Q

Maintaining the integrity of the blood–brain barrier is
essential to protect the brain from chemicals and other sub
stances circulating in the blood that could harm the brain tis
sue.

true or false

A

true

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27
Q

if there’s an elevated pressure upon collection, we must collect a sample ____

A

slowly

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28
Q

CSF is routinely collected by lumbar puncture between the ____, ___, ____ lumbar vertebra.

A

third, fourth, or fifth

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29
Q

Tube 1 is used for chemical and serologic tests because
these tests are ____introduced as a result of the tap procedure

A

least affected by blood or bacteria

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30
Q

Tube 2 is usually designated for the ___

A

microbiology
laboratory

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31
Q

Tube 3 is used for the cell count (hematology), because it is the ___ introduced by the spinal tap procedure.

A

least likely to contain cells

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32
Q

A fourth tube may be drawn for the microbiology laboratory to better exclude skin contamination or for additional
serologic tests.

true or false

A

true

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33
Q

__ that is left over after each section has performed its tests may also be used for additional
chemical or serologic tests.

A

Supernatant fluid

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34
Q

Excess fluid should not be ___and should be ___until there is no further use for it

A

discarded ; frozen

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35
Q

Ideally, tests are performed on a STAT basis. If this is not possible, specimens are maintained in the following manner:

  • Hematology tubes are ___.
  • Microbiology tubes remain at ___
  • Chemistry and serology tubes are ___.
A
  • Hematology tubes are refrigerated.
  • Microbiology tubes remain at room temperature.
  • Chemistry and serology tubes are frozen.
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36
Q

mnemonic for storing csf per section

A

csf - chem sero in freezer
mrt - microbio room temp
hr - hematology refrigerated

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37
Q

normal appearance of CSF

A

crystal clear

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38
Q

A ____appearance can be the result of an increased protein or lipid concentration, but it may also be indicative of infection with the ____ being caused by the presence
of WBCs

A

cloudy, turbid, or milky specimen

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39
Q

is a term used to describe CSF super
natant that is pink, orange, or yellow.

A

Xanthochromia

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40
Q

A variety of factors can
cause xanthochromia, the most common being the presence
of ___

A

RBC degradation products

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41
Q

colors that the xanthochromic csf can turn into

A

from pink to orange to yellow

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42
Q

a pink colored xanthochomic csf signifies

A

slight amount of oxyhemoglobin

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43
Q

a orange colored xanthochomic csf signifies

A

heavy hemolysis

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44
Q

a yellow colored xanthochomic csf signifies

A

conversion of oxyhemoglobin to unconjugated bilirubin

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45
Q

Other causes of xanthochromia
include

A

serum bilirubin, presence of the pigment
CAROTENE, markedly increased protein concentrations, and
melanoma pigment

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46
Q

Xanthochromia that is caused by bilirubin
due to immature liver function is also commonly seen in infants, particularly ____.

A

premature infants

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47
Q

Blood from a ____ will be evenly distributed
throughout the three CSF specimen tubes, whereas a traumatic
tap will leave the heaviest concentration of blood in tube 1, and gradually diminishing amounts in Tubes 2 and 3.

A

cerebral hemorrhage

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48
Q

Fluid collected from a ___ may form clots owing to
the introduction of plasma fibrinogen into the specimen

A

traumatic tap

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49
Q

Bloody CSF caused by __ does not contain enough fibrinogen to clot.

A

intracranial hemorrhage

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50
Q

conditions that will causes clot formation but not necessarily has a presence of blood, the reason behind is only because of the introduction of the plasma fibrinogen caused by the damage of the blood brain barrier

A

meningitis, Froin syndrome, and blocked CSF circulation through the subarachnoid space

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51
Q

A classic web-like pellicle is
associated with ___ and can be seen after
overnight refrigeration of the fluid.

A

tubercular meningitis

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52
Q

The cell count that is routinely performed on CSF specimens
is the ____ count

A

leukocyte (white blood cell [WBC])

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53
Q

. Any cell count should be per
formed immediately, because WBCs (particularly granulocytes)
and RBCs begin to lyse within _____ hour,

A

1 hr

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54
Q

ny cell count should be per
formed immediately, because WBCs (particularly granulocytes)
and RBCs begin to lyse within 1 hour, and ___ % of the leukocytes disintegrate after ___- hrs

A

40% ; 2 hours.

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55
Q

Normal adult CSF contains ___ WBCs/ L

A

0 to 5

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56
Q

possible causes of hazy, turbid, milky, and cloudy appearance

A

wbc, microorganism, protein

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57
Q

significance of hazy, turbid, milky, and cloudy csf appearance

A
  • Meningitis
  • Disorders that affect
    blood-brain barrier &
    Production of IgG
    within the CNS
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58
Q

bloody appearance of csf might be a cause of

A

rbc

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59
Q

significance of bloody apearance in the urine

A

hemorrhage and traumatic tap

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60
Q

causes of clotted appearance

A

protein and clotting factors

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61
Q

significance of clotted csf

A

disorder affecting blood-brain barrier
introduced by traumatic tap

62
Q

possible causes of xanthochromic appearance in the csf

A

hemoglobin
bilrubin
carotene
protein
melanin

63
Q

significance of a xanthochromic appearance of a urine which a possible cause is hemoglobin

A
  • old hemorrhage
  • lysed cells from traumatic tap
64
Q

significance of a xanthochromic appearance of a urine which a possible cause is bilirubin

A

rbc degradation
elevated serum bilirubin level

65
Q

significance of a xanthochromic appearance of a urine which a possible cause is carotene

A

increase serum level

66
Q

significance of a xanthochromic appearance of a urine which a possible cause is protein

A

disoders affecting blood brai barrier

67
Q

significance of a xanthochromic appearance of a urine which a possible cause is melanin

A

meningeal melanosarcoma

68
Q

possible cause of pellicle appearance in the csf

A

protein and clotting factors

69
Q

significance of a pellicle appearance in the urine are

A

disorders that affect blood brain barrier
tubercular meningitis

70
Q

the diluting fluid we can use for wbc count

A

3% glacial acid - to lyse rbc
add methylene blue to differentiate neutrophils and mononuclear cells

71
Q

stain used for differential count

A

wright stain

72
Q

for total cell count, Clear specimens may be counted undiluted, When dilutions are required which pipette are used?

A

calibrated pipette

73
Q

Dilutions for total cell counts are
made with ___-, mixed by inversion, and loaded into
the hemocytometer with a Pasteur pipette.

A

normal saline

74
Q

The speed of the cytocentrifuge
should be checked monthly with a ___, and the timing
should be checked with a ___

A

tachometer; stopwatch

75
Q

If nondisposable counting chambers are used, they must
be soaked in a bactericidal solution for at least __ and then thoroughly rinsed with water and cleaned with isopropyl
alcohol after each use.

A

15 minutes

76
Q

Methods available for specimen concentration include
___

A

sedimentation, filtration, centrifugation, and cytocentrifugation

77
Q

Among the concentration technique, ___ and ____ are not routinely used in the
clinical laboratory, although they do produce less cellular distortion.

A

Sedimentation and filtration

78
Q

. Most laboratories that do not have a cytocentrifuge concentrate specimens with routine centrifugation, how will they proceed?

A

The specimen is centrifuged for 5 to 10 minutes, supernatant fluid is
removed and saved for additional tests, and slides made from
the suspended sediment are allowed to air dry and are stained
with Wright’s stain.

79
Q

In addition to bacterial meningitis, increased neutrophils
also are seen in the early stages (1 to 2 days) of __

A

viral, fungal, tubercular, and parasitic meningitis

80
Q

Neutrophils associated with bacterial meningitis may contain
___

A

phagocytized bacteria

81
Q

Neutrophils with ___ indicate degenerating
cells

A

pyknotic nuclei

82
Q

NRBCs
are seen as a result of ___ contamination during the
spinal tap

A

bone marrow

83
Q

The purpose of ___ in the CSF is to remove cellular
debris and foreign objects such as RBCs.

A

macrophages

84
Q

Macrophages appear
within___ hours after RBCs enter the CSF and are frequently
seen following repeated taps

A

2 to 4

85
Q

The finding of increased macrophages indicates a ___

A

previous
hemorrhage

86
Q

They are iron-free, consisting of hemoglobin and unconjugated
bilirubin

A

yellow hematoidin crystals

87
Q

Nonpathologically significant cells are most frequently seen
after diagnostic procedures such as

A

pneumoencephalography

88
Q

what are the example of Non Pathologically
significant cells

A
  • Choroidal cells
  • Ependymal cells
  • Spindle shaped cells
89
Q

hematologic malignant cells

A
  • Lymphoblast
  • Myeloblast
  • Monoblast
  • Lymphoma cells
90
Q

Nonhematologic malignant cells

A
  • Astrocytoma
  • Retinoblastoma
  • Medulloblastoma
91
Q

nonpathological cells that Are from the epithelial lining of the choroid
plexus

A

choroidal cells

92
Q

choroidal cells - They are seen singularly and in clumps

true or false

A

true

93
Q

a nonpathological cells that Are from the lining of the ventricles and neutral
canal

A

Ependymal cells

94
Q

a nonpathological cells which have less defined cell membranes and are
frequently seen in clusters

A

Ependymal cells

95
Q

a non pathological cells that Represents lining from the arachnoid

A

spindle shaped cells

96
Q

a nonpathological cells that are usually seen in clusters and may be
seen with systemic malignancies

A
97
Q

what is the normal value of csf protein in adult , infant, and immature infants

A

○ Adults: 15 to 45 mg/dL
○ Infants: 150 mg/dL
○ Immature: 500 mg/dL

98
Q

csf proteins increase in the presence of

A

Damage to BBB (Meningitis, Hemorrhage)
Production of Igs in CNS (Multiple Sclerosis)

99
Q

decrease in csf proteins are seen in

A

CSF Leakage

100
Q

what is the major protein found in csf?

A

albumin

101
Q

2nd most found protein in csf

A

prealbumin

102
Q

alpha globulin found in csf

A

haptoglobulin and ceruloplasmin

103
Q

b globulin found in csf

A

b transferrin

104
Q

a protein that can be found in the csf but not in serum

A

y globulin - IgG and IgA

105
Q

a separate carbohydrate-deficient transferrin fraction, referred to as
“___,” is seen in CSF and not in serum

A

tau

106
Q

proteins we can’t found in csf

A

IgM, fibrinogen and lipids

107
Q

protein determination for total protein

A

1.turbidimetry - nephelometry
2. dye-binding

108
Q

protein determination

dye-binding, chons bind to dye which turn the dye to turn red to __

A

blue

109
Q

the blue color in total protein determination of dye binding signifies

A

increased protein

110
Q

a protein determination that is for the detection of oligoconal bands in g rehion which is an indicative of IgG production

A

electrophroresis

111
Q

in electrophoresis for the protein determination, the prsence of 2 or more oligoclonal bands in csf but not in serum is valuable for the diagnosis of ___

A

multiple sclerosis

112
Q

ther neurologic dis
orders including encephalitis, neurosyphilis, _____, and neoplastic disorders also produce oligoclonal
banding that may not be present in the serum

A

Guillain-Barré syndrome

113
Q

it is the protein component of lipid-protein complex that insulates the nerve fibers

A

myelin basic protein

114
Q

t is used to monitor the course of multiple sclerosis

A

myelin basic protein

115
Q

how many percent to csf glucose constitute in serum plasma?

A

60-70 %

116
Q

decrease in glucose
increase neutrophils

signifies ___

A

bacterial infection

117
Q

decrease in glucose
increase in lymphocytes

signifies ___

A

tubercular infection

118
Q

no glucose
increase lymphocyte

signifies

A

viral infection

119
Q

clinical significance of protein in csf

A
  • damage to the blood-brain barrier
  • Production of immunoglobulins
    within the CNS
  • decreased clearance of
    normal protein from the fluid
  • degeneration of neural tissue.
120
Q

a presence of lactate that is >25mg/dl indicates

A

Bacterial, tubercular,
fungal meningitis:

121
Q

a presence of lactate that is >35mg/dl indicates

A

bacteria meningitis

122
Q

a presence of lactate that is <25mg/dl indicates

A

viral menigitis

123
Q

Lymphoblasts, myeloblasts, and monoblasts in the CSF are frequently seen as a serious complication of __

A

acute leukemias.

124
Q

Lymphoma cells are also seen in the CSF and indicate dissemination from the ___

A

lymphoid tissue

125
Q

Metastatic carcinoma cells of nonhematologic origin are primarily from ___

A

lung, breast, renal, and gastrointestinal malignancies.

126
Q

Cells from primary CNS tumors include ___, ____, ___

A

astrocytomas, retinoblastomas, and medulloblastomas

127
Q

Fusing of cell walls and nuclear irregularities
and hyperchromatic nucleoli are seen in clusters of ___.

A

malignant cells

128
Q

The most frequently performed chemical test on CSF is the
___

A

protein determination

129
Q

The presence of___ in the CSF indi
cates recent destruction of the myelin sheath that protects the
axons of the neurons (demyelination).

A

myelin basic protein (MBP)

130
Q

___
techniques are used for measurement of MYB

A

Immunoassay

131
Q

is produced from ammonia and alpha - ketoglutarate by the brain cells

A

glutamate

132
Q

The normal con
centration of glutamine in the CSF is ___

A

8 to 18 mg/dL

133
Q

Elevated levels of glutamate are associated with ___ that result in increased
blood and CSF ammonia.

A

liver disorders

134
Q

bacterial culture for csf will take how many hrs or days/

A

24 hrs

135
Q

tubercular culture of csf will take how many days or weeks?

A

6 weeks

136
Q

what is the gram posistive cocci usually recovered in csf

A

Streptococcus
pneumoniae

137
Q

what is the gram negative rods usually recovered in csf

A

Haemophilus influenzae
escherichia coli

138
Q

what is the gram negative cocci usually recovered in csf

A

Neisseria meningitidis

139
Q

Test for fungal
Meningitis ( Crypto
coccus neoformans)

it uses 2 stains

A
  • India ink
    preparation
  • Grams stain =
    starburst pattern
140
Q

The gram-positive cocci __- and the
gram-positive rods __- may be encountered
in newborns.

A

Streptococcus agalactia; steria monocytogenes

141
Q

As one of the more frequently occurring complications of AIDS, ___ is now
commonly encountered in the clinical laboratory

A

cryptococcal meningitis

142
Q

___ tests to detect the presence of C. neoformans antigen in serum and CSF provide a more sensitive
method than the India ink preparation

A

Latex agglutination

143
Q

immunologic testing results should be confirmed by culture and
demonstration of the organisms by India ink, because false
positive reactions do occur.

Interference by ___
is the most common cause of false-positive reactions

A

rheumatoid factor

144
Q

Birth to 1 month common causative bacterial meningitis agents

A

Staphyloccos agalactiae

145
Q

1 month to5 years old common causative bacterial meningitis agents

A

haemophilus influenzae

146
Q

5 to 19 yo common causative bacterial meningitis agents

A

Neisseria meningitides

147
Q

> 29 yo common causative bacterial meningitis agents

A

staphylococcus pnemonia

148
Q

Infants, elderly,
immunocompromised common causative bacterial meningitis agents

A

L monocytogenes

149
Q

___ test for syphilis.

A

fluorescent treponemal antibody-absorption
(FTA-ABS)

150
Q

Neurosyphilis test

A

Venereal Disease Research Laboratories (VDRL)

151
Q

test is not
recommended because it is less sensitive than theb VDRL

A

Rapid Plasma Reagin (RPR)

152
Q
A

AUBF (29 decks)

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