Spike's Spinal Fluid Case

Question 0

What are 3 type of CSF specimens an MD can collect?

Answer 0

lumbar region (spinal tap), subdural (for abscesses in brain), and ventricular aspiration

Question 1

List Anatomy of skull starting with the outer—->inner

Answer 1

skull, dura matar, arachnoid, subarachnoid space, pia mater, csf

Question 2

Normal value for WBCs in CSF

Answer 2

ZERO

Question 3

normal value for glucose in CSF

Answer 3

40-80

Question 4

normal value for protein in CSF

Answer 4

15-45

Question 5

Bacterial Meningitis

-WBCs, glucose, and protein

Answer 5

Neutrophils, decreased, increased, and cloudy

Question 6

Fungal Meningitis

-WBCs, glucose, protein

Answer 6

Lymphs or Monos, glucose decreased to normal, protein increased to normal

Question 7

TB Meningitis

-WBCs, glucose, protein

Answer 7

Lymphs, glucose decreased, protein increased

Question 8

Viral Meningitis

-WBCs, glucose, protein

Answer 8

Lymphs, glucose normal, protein normal

Question 9

How do we route CSF tubes in the lab?

Answer 9

1 Chemistry, #2 Micro, #3 Heme

Question 10

Why does hematology get tube #3?

Answer 10

Possibility of being a bloody tap which would clear by tube 3

Question 11

If you have >1mL of CSF what should you do?

Answer 11

centrifuge and then resuspend pellet before plating

Question 12

what plates are set up on CSF?

Answer 12

SBA, CHOC, and THIO

Question 13

What does THIO grow?

Answer 13

grows anaerobes and detects small amount of organisms

Question 14

What do you incubate CSF plates at?

Answer 14

in CO2 at 37’C

Question 15

When do you plate CSF on an anaerobe plate?

Answer 15

if it is a brain abscess

Question 16

How many slides do you set up for CSF?

Answer 16

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

Question 17

What happens if you have a positive CSF?

Answer 17

Have another tech gram stain and read the second slide, call MD, and then set up plates, biochemicals, and susceptibilities

Question 18

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

Answer 18

Put it on a CHOC plate

Question 19

What are common pathogens in neonates?

Answer 19

Gp B Strep, Listeria, and E.coli

Question 20

What are common pathogens in infants?

Answer 20

Haemophilus, S. pneumo, and N. meningitidis

Question 21

What are common pathogens in young adults?

Answer 21

N. meningitidis

Question 22

What are common pathogens in older adults?

Answer 22

S. pneumo, N. meningitidis, and Listeria

Question 23

What are common pathogens in Immunocompromised patients?

Answer 23

Anything listed previously plus fungi and Nocardia

Question 24

What are common pathogens in brain abscesses?

Answer 24

anaerobes-mostly from oral flora

Question 25

Symptoms of meningitis

Answer 25

fever, headache, mental changes, photophobia, vomiting, poor feeding in infants, irritability, restlessness, coma—>death

Question 26

What is common in acute meningitis?

Answer 26

Bacteria

Question 27

What is common in chronic meningitis?

Answer 27

viral

Question 28

What is common in chronic meningitis?

Answer 28

Fungal/High mortality

Question 29

What is common in asceptic meningitis?

Answer 29

often times viral or fungal but do not detect because some labs don’t culture for these organisms

Question 30

Definition of encephalitis

Answer 30

inflammation of brain tissue

Question 31

Definition of meningocephalitis

Answer 31

inflammation of meninges and of brain tissue

Question 32

Describe Kernig

Answer 32

Lay flat, flex hips, and try to straighten leg. very painful in meningitis

Question 33

Describe Brudzinski

Answer 33

Flex head, if legs bend to compensate then likely meningitis

Question 34

When do you use acridine orange stain?

Answer 34

If increased WBCs and can’t tell if bacteria are there, this stain will cause them to fluoresce

Question 35

How is CSF stored?

Answer 35

always keep at RT, never refrigerate

Question 36

Most common bacteria involved in brain abscesses?

Answer 36

Mouth flora and anaerobes

Question 37

Most common bacteria involved in shunt infections?

Answer 37

skin flora, P. acnes