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Clinical Medicine LAB - Professor Sample > Neuro - CSF and Blood Culture > Flashcards

Neuro - CSF and Blood Culture Flashcards

1
Q

CSF: Transports _______ and clears ________

A

nutrients

metabolic waste

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2
Q

CSF chloride: NL values ?

A

700-750 mg/dL

**typically it correlates with serum levels **

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3
Q

Lumbar Puncture (Spinal Tap) Contraindications: absolute ?

A

never do it

Dermatitis

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4
Q

CSF cells : WBC NL ?

A

ZERO

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5
Q

CSF protein: also used in ?

A

to evaluate for some neurologic diseases

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6
Q

Case Study:

Pressure: 120 mm H2O
Color: clear
Cells:
RBC=0
WBC=80
Differential >80% lymphocytes
Protein: 70 mg/dL
Glucose: 40 mg/dL

What do you suspect as Dx ?

A

Viral Meningitis

normal glucose should be close to serum ( 70-130)

lymphocytes - alway viral

if not viral then neutrophils and PMNs

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7
Q

Case Study

Started an IV and began fluid bolus.
Obtained a CBC, CMP, UA, UCG, Urine culture, lactate, blood cultures x 2
Given Morphine 4 mg IV and Zofran ( antiemetic) 4 mg IV
CT scan w/o contrast (stone protocol) showed right sided hydronephrosis without stone, some stranding suggesting?

A

Pyelonephritis

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8
Q

CSF decreased when ?

A

dehydrated

previous taps

nasal sinus fracture with dura tear (CSF leaking out of nose)

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9
Q

CSF protein: mild ?

A

viral

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10
Q

CSF other tests: gram stain ?

A

Guide empiric treatment for bacterial meningitis

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11
Q

Blood Cultures: test ?

A

Preliminary result in 24 hours

Final results usually within 48-72 hours

Start empiric therapy

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12
Q

Cerebral Spinal Fluid (CSF) procedure: __ tubes from one collection point ?

A

4

label each tubes in succession you drew then

**lots of blood in 1 tube but not as much for 4 - it is probably from the puncturee itself and not a true blood level in the CSF **

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13
Q

Blood Cultures: order -

A

Blood cultures x 2
-Collected from 2 different sites

Avoid an arm with an IV -unless contamination of an indwelling line is suspected

Draw before antibiotics are initiated
-If drawn while on abx, draw just before next dose is given.

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14
Q

CSF other tests: Tumor markers ?

A

if there is metastasis

not primary brain CA but mets

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15
Q

Lumbar Puncture: post-test ?

A

Immediately can lie pt prone with pillow under abdomen to slow CSF flow

Lie flat for 12 hours.

Use straw to drink fluids, encourage PO fluids

Repeat Neuro exam (*legs!)

Send test stat

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16
Q

6-18 y.o. # of cells ?

A

0-10

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17
Q

CSF glucose: increased?

A

High serum glucose

DKA

follows serum level of glucose and if it is lower than serum you gonna think infection

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18
Q

Cerebral Spinal Fluid (CSF) procedure: Insert needle between ________ lumbar vertebrae

A

3rd and 4th

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19
Q

CSF color: turbid ?

A

infection

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20
Q

CSF protein: moderate ?

A

bacteria

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21
Q

CSF LP potential complications ?

A

CSF leak (H/A sxs. - they need a blood patch )

Infxn

Herniation of the brain (get CT first)

Puncture of the spinal cord/aorta/vena cava

Postural h/a or paresthesias

**CT before LP if you suspect increase pressure **

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22
Q

LP opening pressure ?

A

opening pressure - how much pressure is inside the closed circuit ( spinecord)

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23
Q

CSF glucose: NL values ?

A

60-75 or 60% of BGL

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24
Q

Adults # of cells ?

A

0-5

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25
Q

A 22 year old female presents to the Lake Erie College clinic with complaints of headache and neck pain since yesterday evening. Pain is 10/10 now and associated with photophobia, one episode of emesis, and continued nausea.

A

she might have meningitis so you want to do an LP

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26
Q

CSF protein Nl ?

A

15-45 mg/dL

27
Q

CSF chloride: decreased ?

A

Infxn

Meningitis

so , take home point here

28
Q

Blood cultures

Preliminary report – Gram neg bacilli

Final report- E.coli

what is tx ?

A

Began Cipro 400 mg IV

29
Q

Blood Cultures: pre-test ?

A

Aseptic technique

Discard needle on syringe and use second sterile needle before injecting into blood culture media

30
Q

CSF color: red ?

A

traumatic tap or blood in CSF

could be traumatic, further tubes should be clearer and clearer, blood will clot with traumatic puncture

31
Q

CSF glucose: decreased ?

A

Bacteria

Inflammation

Tumor

32
Q

CSF: Lactic acid increased >35 ?

A

Elevated in bacterial/fungal meningitis

Associated with decreased

O2 in the brain

Not elevated in viral meningitis

increases in anaerobic metabolism cause low O2 levels

**difference between viral and bacterial **

33
Q

CSF color: yellow ?

A

old blood or increase in protein

34
Q

Neonates # of cells ?

A

0-30

35
Q

CSF cells : WBC - Lymphocytes = ?

A

viral or TB meningitis, encephalitis

36
Q

CSF other tests: culture ?

A

abs tx.

37
Q

CSF other tests: cytology ?

A

CA cells

38
Q

Lumbar Puncture: pre-test ?

A

Obtain consent

Baseline neuro eval (*pt’s legs!)

Consider CT

Consider Queckenstedt-Stookey test

39
Q

CSF other tests: Antigen/Antibody Tests

?

A

Syphillis

40
Q

CSF protein: NL to large to cross the ?

A

BBB

41
Q

CSF cells ?

A

RBC

WBC

42
Q

CSF cells : WBC - other ?

A

leukemia

malignancy

43
Q

CSF: LDH in adults ?

A

Less than 40 U/L

44
Q

CSF chloride: increased ?

A

Correlates with blood levels

Not significant

45
Q

1-5 y.o. # of cells ?

A

0-20

46
Q

CSF color: NL ?

A

typically CSF is completely clear - like purest water clear

47
Q

CSF increased pressure causes ?

A

meningitis

tumors

encephalitis

bleeds

hydrocephalus

48
Q

Cerebral Spinal Fluid (CSF) procedure: be sure to uses ______ technique

A

sterile

49
Q

CSF cells : WBC - PMNs (neutrophils) = ?

A

bacterial meningitis/abscess

50
Q

Queckenstedt-Stookey test explanation ?

A

Use gentle pressure or BP cuff to jugular vein. Rise in CSF pressure by 15-40 cm H2O, Fall within 10 seconds of release.

** blockage of the CSF is suspected ( BP cuff or hand to jugular vein and a rise of pressure 15 - 40 cm of water and a fall within 10 sec)
sluggish opening pressure then we want to do this **

51
Q

LP procedure own notes ?

A

gloves on , sterile drape and fenestrated drop

importent to feel landmarks before you put drape on

between 3rd and 4th because of spacing ( to from tops of hips and then go straight back )

obesity and no land marks you can do a US guided LP

first thing is numbing medicine and you go deeper and numb it as you go deeper and deeper ( same with epidural)
( going in with need you will feel resistance and then a pop)

pull stylet back and then see if there is fluid ( if not fluid then try again go back in)

52
Q

CSF: LDH in neonates ?

A

Less than 70 U/L

53
Q

CSF protein: what makes BBB more permeable ?

A

infection

inflammation

  • *so protein then can cross
  • *
54
Q

Blood Cultures indication ?

A

Concern for sepsis

Post-op temp > 101.5 F

55
Q

CSF NL pressure ?

A

75-200 mm H2O (<20 cm H2O)

56
Q 
Lumbar Puncture (Spinal Tap)
 indications ?
A

Meningitis

SAH

ICH

Malignancy

57
Q

CSF: _______ ml bathes the brain and spinal cord and offers protection

A

150-200

58
Q

CSF other testing ?

A

immunoglobulins

lyme

HIV ( meningeal type sxs. that occurs with HIV - cytomegalovirus (CMV))

59
Q

Cerebral Spinal Fluid (CSF) procedure: patient position ?

A

Lie on side with back arched ( knees closed to chest)

60
Q

CSF: Lactic Acid Nl values ?

A

10-25 mg/dL

61
Q

CSF Lactic Dehyrogenase (LDH) increased ?

A

Infection

Inflammation

CNS leukemia

tissue damage in the brain

62
Q

23 yo female presents with chills, nausea, right flank pain radiating to her suprapubic area x 2 days. Worsening.

Exam findings:
+right CVA tenderness
+suprapubic tenderness
Tachy HR

VS: BP 96/52 T 103.7 F R 20 SPO2 98% RA HR 118

A

she is febrile

think pyelonephritis - so get blood cultures for concern of sepsis

63
Q

Lumbar Puncture (Spinal Tap) Contraindications: relative ?

A

Increased ICP (causes brain herniation)

Decreased clotting ability

Clinical Medicine LAB - Professor Sample (36 decks)

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