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Liz's Microbiology Module 2 > PBL: Spinal Fluid > Flashcards

PBL: Spinal Fluid Flashcards

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1
Q

List the anatomy of the skull starting w/ outer → inner

A
  • Skull
  • Dura mater
  • Arachnoid
  • Subarachnoid space
  • Pia mater
  • CSF
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2
Q

CSF is produced by the ____ ____ in the 4 ventricles of the brain

A

Choroid plexus

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3
Q

CSF flows from the two ____ ventricles to the ____ ventricle and enters the ____ ventricle via the ____ ____ ____

A

Lateral; third;fourth; aqueduct of Sylvius

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4
Q

CSF is absorbed primarily by the ____ ____ through tight junctions of the endothelium

A

Arachnoid villi

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5
Q

What are the 3 types of CSF specimens an MD can collect?

A
  • Lumbar region (spinal tap)
  • Subdural (for abscesses in the brain)
  • Ventricular aspiration
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6
Q

Infectious disease characterized by the inflammation of the meninges (dura, arachnoid, pia mater)

A

Meningitis

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7
Q

A condition characterized by a lymphocyte pleocytosis in the CSF and lack of an identifiable causative agent after routine stains and culture of the CSF

A

Aspetic meningitis

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8
Q

The most common mycobacterial infection of the CNS caused by Mycobacterium tuberculosis

A

Tuberculosis meningitis

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9
Q

Inflammation of the brain

A

Encephalitis

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10
Q

Presence of meningococci (N. meningitidis) in the bloodstream

A

Meningoencephalitis (meningitis + encephalitis)

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11
Q

Meningeal inflammation that persists for more than 4 weeks; common in immunocompromised patients

A

Chronic meningitis

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12
Q

Inflammation in the meninges that persists for hours to days

A

Acute meningitis

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13
Q

____ is caused by inflammation and collection of infected material coming from local infectious source (e.g., ear infection and infection of paranasal sinuses)

A

Brain abscess

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14
Q

Increase in CSF cell count

A

Pleocytosis

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15
Q

Normal value for WBCs in CSF

A

ZERO

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16
Q

CSF is obtained by inserting a sterile hollow needle into the spinal subarachnoid space (b/w L3 and L4) in th elower back

A

Lumbar puncture

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17
Q

Used for treatment of chronic subdural hematomas, usually caused by severe head injuries
- Performed under local anesthesia, followed by partial shaving and disinfection

A

Subdural tap

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18
Q

Method used to treat conditions such as hydrocephalus which are due to excessie fluid accumulation in the ventricles
- Blood and CSF are drained to reduce intracranial hypertension

A

Ventricular aspiration

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19
Q

What is the preferred site of entry for a ventricular aspiration?

A

Right frontal cerebral hemisphere

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20
Q

Why is the right frontal cerebral hemisphere the preferred site of entry for a ventricular aspiration?

A

Due to its non-dominance for language function for 90% of patients

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21
Q

List the general signs and symptoms of meningitis

A
  • Sudden onset of fever
  • Headache
  • Stiff neck
  • Nausea
  • Photophobia (↑ sensitivity to light)
  • Altered mental status
  • Vomiting
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22
Q

List the more severe symptoms, due to the progression of meningitis

A
  • Seizures
  • Coma
  • Death
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23
Q

Signs and symptoms of meningitis in newborns

A
  • Fevere, headache, and stiff neck may be absent or difficult to see
  • Newborn appears to be slow or inactive
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24
Q

Signs and symptoms of meningitis in babies

A
  • Bulging fontanelles (soft spot on head) due to ↑ CSF
  • Abdominal reflex (restlessness)
  • Poor feeding
  • Irritability
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25
Q

2 methods to diagnose meningitis

A
  • Kernig sign

- Brudzinski sign

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26
Q

Back pain occurs when physician flexes patient’s hip and knee while extending the leg at the knee

A

Kernig sign

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27
Q

In this method, involuntary flexion of the patient’s hip and knee when the physician lifts the patient’s head flexing it towards his chest

A

Brudzinski sign

28
Q

What complications may occur in patients w/ meningitis?

A
  • Brain damage
  • Hearing loss
  • Seizures (epilepsy)
  • Hydrocephalus (buildup of fluid inside the skull)
  • Buildup of fluid b/w skull and the brain
  • Issues w/ memory
  • Partial vision loss
29
Q

What is the function of CSF?

A

To act as a cushion protecting the brain and spine from injury

30
Q

Normal values of CSF

  • Pressure
  • Appearance
  • Total protein
  • Glucose
  • WBC count
  • RBC count
  • Differential
A
  • Pressure: 70-180 mm H2O
  • Appearance: clear, colorless
  • Total protein: 15-60mg/100mL
  • Glucose: 50-80mg/100mL
  • WBC count: 0-5 (adults/children)
  • RBC count: 0
  • Differential: 60-70% lymphs, up to 30% monocytes/macrophages, other cells ≤ 2%
31
Q

Bacterial meningitis

  • WBCs
  • Glucose
  • Protein
A
  • WBCs: > 500 cells (neutrophils predominate)
  • Glucose: very low (< 40% of serum glucose concentration)
  • Protein: significantly ↑
32
Q

Fungal meningitis

  • WBCs
  • Glucose
  • Protein
A
  • WBCs: Normal; 500 lymphs
  • Glucose: < 40 mg/dL
  • Protein: 25-500 mg/dL
33
Q

Tubercular meningitis

  • WBCs
  • Glucose
  • Protein
A
  • WBCs: 50-500 (lymphs predominate)
  • Glucose: ↓
  • Protein: 150 mg/dL
34
Q

Viral meningitis

  • WBCs
  • Glucose
  • Protein
A
  • WBCs: Normal; 200 lymphs predominate
  • Glucose: normal
  • Protein: normal
35
Q

Parasitic meningitis

  • WBCs
  • Glucose
  • Protein
A
  • WBCs: Normal; 200 lymphs and/or eosinophils predominate
  • Glucose: Normal to ↓
  • Protein: ↑
36
Q

How do we route CSF tubes in the lab?

A 
#1 → Chemistry
#2 → Microbiology
#3 → Hematology
37
Q

Why does hematology get tube #3?

A

Possibility of being a bloody tap which could be clear by tube #3

38
Q

If you recieve > 2 mL of CSF, what should you do?

A

Centrifuge for 20 minutes @ 1500-3000 Xg

39
Q

If you receive < 1 mL of CSF, what should you do?

A

Vortex before processing

- Remove supernatant and vortex the sediment for 30 seconds to resuspend pellet before plating

40
Q

What primary media is set up for CSF?

A

BAP, CHOC, THIO broth, 2 gram stains

41
Q

What does THIO grow?

A

Grows anaerobes and detects small amounts of organisms

42
Q

WHat do you incubate CSF plates at?

A

CO2 at 37°C

43
Q

When do you plate CSF on an anaerobe plate?

A

If it’s a brain abscess

44
Q

How many slides do you set up for a CSF?

A

2! Gram stain them one at a time and have someone else look at the other one to confirm

45
Q

What do you do if the gram stain is positive?

A

Read 2nd gram stain and then stain w/ acridine orange. If bacteria are present, CALL MD!

46
Q

If you only have 1 drop of CSF what do you do?

A

Put it on a CHOC plate

47
Q

If GPC in clusters are seen on a positive direct smear, what is set up?

A

Tube coagulase and ANA BAP

48
Q

If GPC in chains are seen on a positive direct smear, what is set up?

A

Bile esculin, NaCl, ANA BAP

49
Q

If GNRs are seen on a positive direct smear, what is set up?

A

MAC and ANA BAP

50
Q

If yeast are seen on a positive direct smear, what is set up?

A

BAP

51
Q

If GNCB are seen on a positive direct smear, what is set up?

A

ML and ANA BAP

52
Q

What do you incubate MAC and SAB at?

A

CO2 for 2 days

53
Q

What do you incubate ML plates at?

A

CO2 for 3 days

54
Q

What do you incubate ANA BAPs at?

A

Anaerobic for 48 hours

55
Q

What are common pathogens in neonate?

A
  • S. agalacticae (Group B Strep) (GPC)
  • Listeria (small GPR)
  • E. coli (GNR)
56
Q

What are common pathogens in infants?

A
  • Haemophilus (GNR/GNCB)
  • S. pneumoniae (GPC)
  • E. coli (GNR)
  • N. meningitidis (GN diplococci)
  • S. agalacticae (Group B Strep)
57
Q

What are common pathogens in older children and young adults?

A
  • N. meningitidis (most common) (GN diplococci)

- S. pneumoniae (GPC)

58
Q

If ANY infection w/ N. meningitidis is left untreated, it can result in ____ ____

A

Waterhouse-Friderichsen syndrome

59
Q

What occurs in individuals w/ Waterhouse-Friderichsen syndrome?

A
  • Hemorrhaging into adrenal glands

- Rapidly fatal (12-24 hours)

60
Q

What are the common pathogens in older adults?

A
  • S. pneumoniae (most common) (GPC)
  • N. meningitidis (GN diplococci)
  • L. monocytogenes (GPR)
61
Q

WHat are the common pathogens in immunocompromised patients?

A

Anything listed previously plus fungi and Nocardia

62
Q

What are the common pathogens in brain abscesses?

A
  • S. intermedius (most common isolate) (GPC)
  • Anaerobes (Prevotella spp, Bacteroides spp)
  • Enteric GNRs (E. coli, Proteus spp, Enterobacter spp, etc.)
  • Nocardia spp (immunocompromised patients)
63
Q

How is CSF stored?

A

Always keep at RT (22-25°C), NEVER refrigerate!

64
Q

Common causes of meningitis

A

Bacteria

65
Q

Common causes of aseptic meningitis

A

Viruses (no growth on cultures)

66
Q

Common causes of chronic meningitis

A

Fungi

Liz's Microbiology Module 2 (11 decks)

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