SPT, BAL, SWEAT, CSF Flashcards by Eliseo John Posion

A mixture of plasma, electrolytes, mucin and water

Tracheobronchial secretions

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Acceptable sputum specimen

<10 SEC/LPF and >25 WBCs/LPF

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Sputum is produced by

Tracheobronchial tree

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Most preferred sample for routine analysis

First morning

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Collection method for unconscious or debilitated patients

Tracheal aspiration

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Yellow or gray PIN HEAD sized material and produces foul odor when crushed

Dittrich’s plugs

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Color of sputum for old blood, pneumonia, gangrene

Anchovy sauce or rusty brown

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Color of sputum of cancer patient

Olive green or grass green

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Color of sputum with lobar pneumonia ( S. Pneumonia)

Rusty with pus

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Color of sputum of patient with congestive heart failure

Rusty without pus

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Color of sputum of patient with Klebsiella pneumoniae infection

Currant, jelly-like

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Hard concretions in a bronchus (LUNG STONE)
Yellow white calcified TB structures/ foreign material

Pneumoliths or broncholiths

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Coiled mucus strands and appear as fluff balls macroscopically

Curschmann spiral

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Colorless hexagonal, double pyramid, often NEEDLE LIKE, arise from disintegrations of eosinophils

Charcot Leyden crystals

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Seen in bronchial asthma

Charcot leyden crystals
creola bodies
Curschmanns spiral

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Pigmented cell: hemosiderin-laden macrophage

Heart failure cells

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Pigmented cells: angular black granules

Carbon-laden cells

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Colorless globules occurring in a variety of sizes and bizarre formations

Myelin globules

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It has no significance and MISTAKEN AS BLASTOMYCES

MYELIN GLOBULES

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Clusters of columnar epithelial cells

Creola bodies

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Bronchoalveolar lavage is an important disgnostic test for what parasite in immunocompromised patients

Pneumocystis jiroveci/carinii

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A BAL stain that is best for delineating the cysts of pneumocystis jiroveci

Grocott’s methenamine silver stain

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Most predominant cells seen in BAL

ALVEOLAR MACROPHAGE

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Percentage of lymphocytes seen in BAL

1-15%

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These cells are increased in BAL among cigarette smokers

Neutrophil

Specimen used to diagnose cystic fibrosis

Sweat

Pilocarpine + mild current = induce sweat production

Gibson and Cooke Pilocarpine iontophoresis

Sweat sodium and chloride values that is diagnostic for Cystic fibrosis

>70 mEq/L

Sweat sodium and chloride values that is BORDERLINE for Cystic fibrosis

40 mEq/L

Most important single component of sputum viscosity

Sialic acid

Produces CSF by selective filtration at a rate of 20 mL//hour

Choroid plexus

Reabsorbs CSF

ARACHNOID VILLI/GRANULATIONS

Protects brain from chemicals and other substances circulating in the blood that can harm the brain tissue

Blood brain barrier

Up to ___ mL CSF can be collected using a manometer attached to a spinal needle

20 mL

Method of CSF collection

Lumbar tap

Location of collection of CSF in adults

Between L3-L4

Location of CSF collection in infants

Between L4-L5

CSF tube 1 is used for what section ; storage temp

Chemistry or serology ; freezer

CSF TUBE 2 IS FOR WHAT SECTION ; storage temp

MICROBIOLOGY ; room temp for 30 mins

Tube 3 is for what section

Hematology ; ref temp for fours

CSF TUBE 4 is for what section

microbiology or serology (best)

If 1 CSF tube 1 only what is the order for each section

Micro > hema > chemistry

Normal CSF volume in adults

90-150 mL

Normal CSF volume in infants

10-60 mL

Puncture of blood vessels

Traumatic tap

Bleeding within the brain case

Intracranial hemorrhage

Uneven distribution of blood on 3 tubes

Traumatic tap

Even distribution of blood on 3 tubes

Intracranial hemorrhage

Positive for clot formation

Traumatic tap

Negative for clot formation

Intracranial hemorrhage

D-dimer positive

Intracranial hemorrhage

Supernatant of traumatic tap

Clear

Supernatant of intracranial hemorrhage

Xanthochromic (rbcs lyse in CSF after 2 hrs

Erythrophages are absent

Traumatic tap

Erythrophages are present = hematite in and hemosiderin

Intracranial hemorrhage

Pellicle CSF appearance is indicative of what type of meningitis

Tubercular meningitis

CSF cell count must be performed _____

Within 1 hour Orr immediately

Normal wbc count in CSF in adults

0-5 WBCs/uL

Normal wbc count in CSF in neonates

0-30 WBCs/uL

Clear CSF dilution

Undiluted

Slightly hazy CSF dilution

1:10

Hazy CSF dilution

1:20

Slightly cloudy CSF dilution

1:100

Bloody or turbid CSF dilution

1:10,000

WBC diluting fluid

3% acetic acid with methylene blue

This is done only in traumatic tap

Rbc count

To correct WBC count and total protein concentration

-1 wbc for every 700 rbcs seen

In CSF differential count, specimen should be ______ before smearing by using ____

Concentrated ; cytocentrifuge

What is being added in cytocentrifuge that increases cell yield or recovery and also decrease cellular distortion

30% albumin

Predominant cells in CSF

Lymphocytes and monocytes

Ratio of lymphocytes to monocytes in adult CSF

70:30

Number of monocytes in neonate CSF

80% monocytes

Abnormal condition with increased number normal cells in the CSF

PLEOCYTOSIS

Increased neutrophil in the CSF in indicative of what type meningitis

Bacterial meningitis

Increased wbc seen in cases of viral meningitis, TB, and fungal meningitis

Lymphocytes and monocytes

Normal CSF protein in adult

15-45 mg/dL

Normal CSF protein in infants

150 mg/dL

Normal CSF protein in immature

500 mg/dL

Increased CSF protein in seen in

Meningitis and hemorrhage

Most common cause of increased CSF protein

Damage to the BBB result

This is increased in CSF in the case of multiple sclerosis

CSF protein

Major CSF protein

ALBUMIN

2nd most prevalent protein in the CSF

Prealbumin / transtyrethin

Alpha globulins seen in CSF

Haptoglobin and ceruloplasmin

Beta globulin seen in CSF

Beta 2 transferrin (tau)

Carbohydrate deficient transferrin

Beta 2 transferrin

Found in the CSF but not in serum

Beta 2 transferin

Not found in normal CSF

Fibrinogen Lipids IgM

Gamma globulins found in CSF

IgA and IgG

Preferred turbidimetric method that precipitates both albumin and globulins

TRICHLOROACETIC ACID

turbidimetric method that precipitates albumin only

3% Sulfosalicyclic acid

A dye binding technique for CSF protein determination wherein the dye turns from red to blue

Coomassie brilliant blue

CSF/ serum albumin index normal value

IgG index normal value in CSF protein

<0.70 or 0.30 to 0.70

Abnormal IgG index in CSF protein

>0.70 or 0.77

Used to the detection of oligoclonal band

CSF electrophoresis

(+) 2 or more oligoclonal bands in CSF but not in serum is valuable for the diagnosis of ____

Multiple sclerosis

Better resolution is obtained using CSF immunofixation electrophoresis and isoelectric focusing followed by ________

Silver staining

Oligoclonal banding in CSF but not in serum (MNENG)

Multiple sclerosis Neurosyphilis Encephalitis Neoplastic disorders Guillain-Barré syndrome

Oligoclonal banding in serum but not in CSF (LLV)

Leukemia Lymphoma Viral infections

Oligoclonal banding BOTH in serum and CSF

HIV

Demyelinating disorder

Multiple scelrosis

Protein component of the lipid protein complex that insulate the nerve fibers

MYELIN BASIC PROTEIN

Presence of _____ in CSF indicates destruction of myelin sheath

Myelin basic protein

Specimen for blood glucose should be drawn _____ hrs prior to spinal tap

2 hours

Normal CSF glucose is seen in what type of meningitis

Viral meningitis

Sensitive method for evaluating the effectiveness of antibiotic therapy

CSF lactate

Inversely proportional to glucose

CSF LACTATE

Indirect test for the presence of excess AMMONIA in the CSF

CSF Glutamine

CSF glutamine is increased in

Reye’s syndrome

Serum LDH normal pattern

2>1>3>4>5

Flipped pattern of LDH seen in acute myocardial infarction

1>2

CSF LDH isoenzyme in Brain tissue

LD 1 and LD 2

CSF LDH isoenzyme : lymphocytes

LDH 2 and 3

CSF LDH isoenzyme : NEUTROPHILS

LD 4 and 5

CSF LDH normal patterns

1>2>3>4>5

CSF LDH neurological abnormalities

2>1

CSF LDH pattern in bacterial meningitis

5>4>3>2>1

Recommended by CDC for the detection of neurosyphilis

VDRL

Increased lymph and mono, protein and lactate and decreased glucose (+) pellicle or weblike clot formation

TB meningitis

Limulus lysate test detects ___________ in the body fluids and surgical instrument

Gram negative endotoxin

Limulus lysate test reagent

Blood of horse shoe crab

Positive result if limulus lysate test

Clot formation