CSF Final
If the CSF pressure is not in normal range less or greater, how much can be extracted?
1 to 2 mL
What is normal Lactate in CSF?
10 to 22 mg/dL
In general what is the normal range for protein in usual individuals?
15 to 45 mg/dL
What is the normal CSF pressure in an Adult?
50 to 180 mm Hg, higher in sitting patients
What is a normal CSF glucose range?
50 to 80 mg/dL
A pleural fluid pH of 6.0 is indicative of: A. Esophageal rupture B. Mesothelioma C. malignancy D. rheumatoid effusion
A
An immunoglobulin G index greater than 0.70 indicates A. intrathecal synthesis of immunoglobulin G. B. a compromised blood0brain barrier C. active demyelination of neural proteins D. Increased transport of immnoglobulin G from plasma into the CSF
A
Chemical tests primarily performed on perioneal fluid include all of the following except: A. Lactose dehydrogenase B. Glucose C. Alkaline phosphatase D. Amylase
A
During normal priduction of serous fluid, the slight excess of fluid is: A. Absorbed by the lymphatic system B. Absorbed through the visceral capillaries C. Stored in the mesothelial cells D. Metabolized by the mesothelial cells
A
How many leukocytes are normally present in the CSF obtained from an adult? A. 0 to 5 cells/mL B. 0 to 10 cells/mL C. 0 to 20 cells/ mL D. 0 to 30 cells/mL
A
Pleocytosis is a term used to describe A. An increased number of cells in the CSF B. A pink, orange, or yellow CSF specimen C. An increased protein content in the CSF caused by cellular lysis D. Inflammation and sloughing of cells from the choroid plexus
A
Which of the following Cells types are predominant in CSF during a callic case of viral meningitis? A. Lymphocytes B. Macrophages C. Monocytes D. Neutrophils
A
Which of the following proteins in the CSF is used to monitor the integrity of the blood-brain barrier? A. Albumin B. Transthyretin C. Transferrin D. Immunoglobulin G
A
Which of the following statements about CSF glucose is false? A. Increased CSF glucose balues are diagnostically significant B. Glucose enters the CSF by active transport and simple diffusion C. Decreased CSF glucose values reflect a defective blood-brain barrier and increased glycolysis D. CSF glucose values reflect the plasma glucose concetration 30-90 minutes preceding collection.
A
Which of the following statements regarding CSF is true? A. Cerebrospinal fluid is constantly produced B. Cerebrospinal fluid is reabsorbed into the blood at the choroid plexus C. Cerebrospinal fluid is essentially composed of diluted plasma D. Cerebrospinal fluid circulates through the brain and spinal cord because of active and passive diffusion processes
A
What does an Orange xanthrochromic CSF indicate?
A combination of Oxyhemoglobin, and Bilirubin
What does a CSF/Albumin ratio of 9.0 to 14.0 indicate?
A minimal impairment to the blood-brain barrier
What does a CSF/Albumin ratio of 15.0 to 100 indicate?
A severe impairment to the blood-brain barrier.
During lumbar puncture, the first collection tube of CSF removed should be used for A. Chemistry tests B. Cytologic studies C. Hematologic tests D. Microbiological studies
A. Chemistry tests
After CSF collection what should the pressure be?
About 10 to 30 mm hg less than the initial reading.
When are macrophages seen in CSF?
After a hemorrhage
A mesotheilioma cell seen in pleural fluid indicates: A. Bacterial endocarditis B. Primary malignancy C. Metastatic lung malignancy D. Tuberculosis infection
B
All of the following are characteristics of malignant cells except: A. Cytoplasmic molding B. Absence of nucleoli C. Mucin-containing vacuoles D. Increased N:C ratio
B
All of the following proteins are normally present in the CSF except for A. Albumin B. Fibrinogen C. Transthyretin D. Transferrin
B
Cerebrospinal fluid is found between the A. Arachnoid and dura mater B. Arachnoid and pia mater C. Pia mater and dura mater D. Pia mater and choroid plexus
B
Cerebrospinal fluid is produced primarily from A. Secretions by the choroid plexus B. Diffusion from plasma into the central nervous system C. Ultrafiltration of plasma in the ventricles of the brain D Excretions from ependymal cells lining the brain and spinal cord
B
Detection of the CA 125 tumor marker in peritoneal fluid is indicative of: A. Colon cancer B. ovarian cancer C. Gastric malignancy D. prostate cancer
B
Fluid to serum protein and lactice dehydrogenase rations were performed on serous fluids: A. When malignancy is suspected B. To classify transudates and exudates C. to determine the type of serous fluid D. when a traumatic tap has occurred
B
Given the following results, classify this peritoneal fluid: Serum albumin: 2.2 g/dL Serum protein: 6.0 Fluid albumin: 6.1 A. Transudate B. Exudate
B
India ink preparations and microbial antigen tests on CSF can aid in the diagosis of A. bacterial meningitis B. Fungal meningitis C. Tuberculous meningitis D. Viral meningitis
B
The recommended test for determining if peritoneal fluid is a transudate or an exudate is the: Fluid to serium albumin ratio B. Serum ascites albumin gradien C. Fluid to serum lactic dehydrogenase ratio D. Absolute neutrophil count.
B
The test performed on peritoneal lavage fluid is: A. WBC count B. RBC count C. Absolute neutrophil count D. Amylase
B
Which of the following cells can be present in small numbers in normal CSF? A. Erythrocytes B. Lymphocytes C. Macrophages D. Plasma Cells
B
Which of the following is not an analytical concern when the processing and testing of CSF are delayed? A. The viability of microorganisms B. The lability of the immunoglobulins C. The lysis of leukocytes and erythrocytes D. Alerations in the chemical composition
B
Which of the following requires the most additional testing? A. transudate B. exudate
B
Which of the following statements about oligoclonal bands is false? A. In the cSF, these bands indicate increased intrathecal concentrations of immunoglobulin G. B. the bands usually correlate with the stage of disease and can be used to predict disease progression C. The bands are often present in the CSF and serum of individuals with lympohproliferative disease D. The bands are often present in the CSF but not in the serum of individuals with multiple sclerosis.
B
Which of the following substances does not normally pass through the blood-brain barrier? A. Po2 B. Albumin C. Glucose D. Fibrinogen
B. Albumin
What are the 3 major functions of CSF?
Bathes the brain and spinal cord. Protects and supports the brain and spinal cord Provides a medium for the transport and exchange of nutrients and metabolic wastes
What does a yellow xanthrochromic CSF indicate?
Bilirubin
A differential observation of pleural fluid associated with tuberculosis is: A. Increased neutrophils B. Decreased lymphocytes C. Decreased mesothelial cells D. Increased mesothelial cells
C
All of the following except what can cause xanthrochromia? A. High concentrations of protein B. High concentrations of bilirubin C. Increased numbers of leukocytes D. Erythrocytes from a traumatic tap.
C
An increase in teh amount of serous fluid is called a/an: A. Exudate B. Transudate C. Effusion D. Malinancy
C
And additional test performed on pleural fluid to classify the fluid as a transudate or exudate is the: A. WBC count B. RBC count C. Fluid to cholesterol ratio D. Fluid to serum protein gradient
C
Another name for a peritoneal effusion is: A. Perionitis B. Lavage C. Ascites D. Cirrhosis
C
Differentiation between bacterial peritonitis and cirrhosis is done by performing a/an: A. WBC count B. Differential C. Absolute neutrophil count D. Absolute lymphocyte count
C
In CSF, which of the following findings indicates a traumatic puncture? A. The presence of erythrophagocytic cells in the CSF B. Hemosiderin grannules within macrophages in the CSF sediment C. An uneven distribution of blood in the CSF collection tubes D. A xanthrochromic supernatant following CSF centrifugation
C
The primary purpose of serous fluid is: A. removal of waste products B. lowering of capillary pressure C. lubrication of serous membranes D. nourishing serous membranes
C
When choroid plexus cells are ependymal cells are present in CSF they A. are often clinically significant B. represent the demyelination of nerve tissue C. can closely resemble clusters of malignant cells D. Indicate break down of the blood-brain barrier
C
Which of the following events dows not result in an increased CSF total protein? A. A traumatic puncture procedure B. Alterations in the blood-brain barrier C. Trauma to the central nervous system, resulting in fluid loss D. Decreased reabsorption of CSF into the peripheral blood.
C
Which of the following procedures frequently provides a rapid presumptive diagnosis of bacterial meningitis? A. A blood culture B. A csf culture C. A CSF gram stain D. Immunologic tests on CSF for microbial antigens
C
what can cause increased protein in CSF?
CSF contamination with traumatic tap Altered capillary endotheilial exchange Decreased reabsorption into the venous blood Increased synthesis in the CNS
When are malignant cells seen in CSF?
Central nervous system tumor or metastais
What does a CSF/Albumin ratio of greater than 100 indicate?
Complete breakdown of the blood-brain barrier
What are you looking for with latex agglutination in regards to CSF?
Cryptococcus antigen.
What are you looking for with India Ink for a CSF?
Cryptococcus neoformans, fungal meningitis
A milky-appearing pleural fluid is indicative of: A. Thoracic duct leakage B. Chronic inflammation C. microbial infection D. Both A and B
D
All the following are neormal cells seen in pleural fluidd except: A. MEsothelial cells B. Neutrophils C. Lymphocytes D. Mesothelioma Cells
D
Cultures of peritoneal fluid are incubated: A. Aerobically B. Anaerobically C. At 37 and 42 degrees D. Both A and B
D
Normal CSF lactate levels (less than 25 mg/dL) are commonly found in patients with A. Bacterial meningitis B. Fungal meningitis C. Tuberculous meningitis D. Viral meningitis
D
Pleural fluid is collected by: A. Pleurocentesis B. Paracentesis C. Pericentesis D. Thoracentesis
D
Production of serous fluid is controlled by: A. Capillary oncotic pressure B. Capillary hydrostatic pressure C. Capillary permeability D. All of the above
D
The membrane that lines the wall of a cavity is the: A. Vicseral B. Peritoneal C. Pleural D. Parietal
D
Which of the following best represents a hemothorax? A. Blood HCT: 42, Fluid HCT: 15 B. Blood HCT: 42, Fluid HCT: 10 C. Blood HCT: 30, Fluid HCT: 10 D. Blood HCT:30, Fluid HCT: 20
D
Which of the following cells types are predominant in CSF during a classic case of bacterial meningitis? A. Lymphocytes B. Macrophages C. Monocytes D. Neutrophils
D
an unknown fluid can be positively identified as CSF by determining the A. Lactate concentration B. Albumin concentration C. Presence of oligoclonal banding on electrophoresis D. presence of carbohydrate-deficient transferrin on electrophoresis
D
What can cause an increased glucose in CSF?
Hyperglycemia, traumatic tap but has no clinical significance.
A traumatic tap can cause what to happen to CSF protein?
Increase
What is considered a normal CSF/Albumin ratio result?
Less than 9
Delayed testing of CSF can result in what kind of errors?
Lysis of WBCs Or falsely high Lactate due to glycolysis Recovery of bacteria could be jeopardized as well.
What is a low CSF glucose indicative of?
Meningitis or tumors
What does a Brownish xanthchromic CSF indicate?
Methemoglobin
What are you primarily looking for in CSF electrophoresis?
Oligoclonal bands in the gamma region which indicate multiple sclerosis
What does a pink xanthochromic CSF indicate?
Oxyhemoglobin
What is the term for increased number of cells in CSF?
Pleocytosis
what is the significance of Choroid plexus cells and ependymal cells?
They usually arent significant, seen in patients with shunts or cisternal/ventricular taps.
Increased Lactate in CSF results from what?
Tissue hypoxia or decreased oxygenation of the brain.
What is the Myelin Basic Protein used for testing CSF?
To determine if a patient suspected of having multiple sclerosis and did not show an oligoclonal band really has MS.
What is the difference between subarachnoid hemorrhage and a traumatic tap?
Traumatic tap could have the CSF clot, blood decreases from 1st to last tube, usually no xanthrochromia, no hemosiderin. Subarachnoid CSF would not clot do to defibrination in vivo, Xanthrochromia, presence of heosiderin-laden macrophages (siderophage), even amount of blood in each tube.
Which form of meningitis can be ruled out by the Lactate evaluation of CSF??
Viral meningitis. Fungal, Bacterial, and Tuburculousis cause spikes above 30mg/dL. Where as viral rarely does.
At what point should the CSF be diluted?
When the number of cells in hemacytometer exceeds 200 or is crowded and overlapping.
How do you prevent CSF fluid that can't be tested immediately from losing its quality?
must be stored in an appropriate temperature relating to the properties being tested. Chemical: Frozen -15 to - 30 Micro: Room Temp 19 to 26 Heme: Frige 2 to 8
If the CSF pressure is within normal range, how much fluid can be extracted?
up to 20 mL
