2S [LEC]: CSF Flashcards
1
Q
Structure where the CSF is produced
A
Choroid plexuses
2
Q
Rate of CSF production in adults
A
20 mL/hour or 120-150 mL/day
3
Q
The CSF flows through which structure?
A
Subarachnoid space
4
Q
Where is the choroid plexus located?
A
Midbrain
5
Q
From the choroid plexus, where will the formed CSF flow next?
A
3rd ventricle
6
Q
After passing through the 3rd ventricle, the CSF will pass through ___
A
Aqueduct of Sylvius
7
Q
Once the CSF passes through the aqueduct, it will then go through ___
A
4th ventricle
8
Q
Two paths of CSF after passing through the 4th ventricle
A
- Entire length of spinal cord
- Meninges (Subarachnoid space)
9
Q
Volume of CSF in adults
A
90-150 mL
10
Q
Volume of CSF in children/neonates
A
10-60 mL
11
Q
To maintain the CSF volume in adults and neonates, CSF is reabsorbed back into the blood capillaries in the ___ at equal rate to its production
A
Arachnoid granulations/ villae
12
Q
Tight-fitting junctions of the endothelial cells that is a boundary between the plasma and central nervous system
A
Blood-Brain Barrier
13
Q
A method of testing intracranial pressure to determine if the patient has subarachnoid block
A
Queckenstedt test
14
Q
Condition of underdeveloped skull, leading to buildup of fluid or CSF in the ventricles, causing enlarged head
A
Hydrocephalus
15
Q
Usual location of lumbar/spinal tap
A
Between 3rd and 4th lumbar vertebra
16
Q
Usual location of lumbar/spinal tap in pediatric patients
A
Between 4th and 5th lumbar vertebra
17
Q
A method of CSF collection where the infants are extracted through the open fontanels
A
Ventricular puncture
18
Q
A method of CSF collection wherein the sub-occipital region or the back of the skull is the site of extraction
A
Cisternal puncture
19
Q
A method of CSF collection wherein the side portion of the neck region is the site of extraction
A
Lateral cervical puncture
20
Q
Usual volume of CSF collected in adult patients
A
20 mL
21
Q
Intracranial pressure intended or required when extracted CSF in adults
A
90-100 mmHg
22
Q
Laboratory section where tube 1 of CSF is used
A
Chemistry/ Serology
23
Q
Laboratory section where tube 2 of CSF is used
A
Microbiology
24
Q
Laboratory section where tube 3 of CSF is used
A
Hematology
25
Laboratory section where tube 4 of CSF is used
Microbiology/ Serology
26
The 1st tube in CSF collection should be stored ___ in terms of temperature
Frozen
27
The 2nd tube in CSF collection should be stored ___ in terms of temperature
at room temperature
28
The 3rd tube in CSF collection should be stored ___ in terms of temperature
Refrigerated for up to 4 hours
29
The 4th tube in CSF collection should be stored ___ in terms of temperature
at RT/ frozen depending on the test
30
Normal color of CSF
Crystal clear
31
How do you describe a CSF with color?
Xanthochromic
32
This phenomenon is observed by placing CSF in a clear test tube and observed at 90-degree angle, where it should sparkle against the light
Tyndall's effect
33
Give the expected appearance of the CSF based on the cause of xantochromia:
Radiographic contrast media
Oily
34
Give the expected appearance of the CSF based on the cause of xantochromia:
Traumatic tap
Bloody
35
Give the expected appearance of the CSF based on the cause of xantochromia:
Subarachnoid hemorrhage
Bloody
36
T/F: Traumatic tap is considered pathogenic
False
37
Give the expected appearance of the CSF based on the cause of xantochromia:
High protein and clotting factor levels
Clotted, Pellicle
38
Give the expected appearance of the CSF based on the cause of xantochromia:
Methemoglobin
Brown
39
Give the expected appearance of the CSF based on the cause of xantochromia:
Hematoma
Brown
40
Give the expected appearance of the CSF based on the cause of xantochromia:
Melanin
Brown
41
Give the expected appearance of the CSF based on the cause of xantochromia:
High WBC content of 200-500 wbc/mm3
Hazy, Cloudy, Turbid, Milky
42
Give the expected appearance of the CSF based on the cause of xantochromia:
High RBC content of >400 rbc/uL
Hazy, Cloudy, Turbid, Milky
43
Give the expected appearance of the CSF based on the cause of xantochromia:
Presence of microorganisms
Hazy, Cloudy, Turbid, Milky
44
Give the expected appearance of the CSF based on the cause of xantochromia:
Increased protein and lipid
Hazy, Cloudy, Turbid, Milky
45
Give the expected appearance of the CSF based on the cause of xantochromia:
Slight hemolysis
Pink
46
Give the expected appearance of the CSF based on the cause of xantochromia:
Hemolysis
Red/ Orange
47
Give the expected appearance of the CSF based on the cause of xantochromia:
Presence of bilirubin
Yellow
48
Give the expected appearance of the CSF based on the cause of xantochromia:
Rifampin therapy
Red
49
Give the expected appearance of the CSF based on the cause of xantochromia:
Melanin
Black/ Brown
50
Give the expected appearance of the CSF based on the cause of xantochromia:
Carotene
Orange
51
Usually indicates presence of RBC degradation products
Xanthochromia
52
Other possible tests to determine whether the xanthochromia is caused by traumatic tap or intracranial hemorrhage
D-dimer test
53
Common diluent in CSF if total cell count is to be done
NSS
54
Common diluent in CSF if WBC count is to be done
3% Glacial Acetic Acid (methylene blue is added as a stain)
55
CSF tube used in total cell count
Tube 3
56
Normal WBC count in the CSF of adults
0-5 WBCs/uL
57
Normal count of mononuclear cells in the CSF of adults
0-30 mononuclear cells/uL
58
Number of cells counted in the differential count of CSF
100
59
Method most commonly used in the concentration of CSF that will be used for differential count
Cytocentrifugation
60
Ratio of lymphocyte to monocyte in the CSF of adults
70: 30
61
Ratio of lymphocyte to monocyte in the CSF of pediatric patients
30: 70
62
Recommended method for differential counting
Cytocentrifugation
63
Reagent that increases the cell yield and decreases cell distortion in cytocentrifugation
30% albumin
64
The presence of increased number of the normal cells
Pleocytosis
65
If only one tube of CSF is available, in which laboratory section must it be first tested?
Microbiology
66
Give the expected appearance of the CSF based on the cause of xantochromia:
Very slight amount of oxyhemoglobin
Pink
67
Appearance of pellicle in the CSF if the patient has tubercular meningitis or the sample has been stored overnight in the refrigerator
Classic web-like pellicle
68
The microscopic finding of macrophages containing ingested RBCs (erythrophagocytosis) or hemosiderin granules are indicative of what condition?
Intracranial hemorrhage
69
The cell count that is routinely performed on CSF specimen
WBC
70
In the CSF, the RBCs begin to lyse within how many hour/s?
1 hour
71
In the CSF, how many percent of leukocytes will disintegrate after 2 hours?
40%
72
T/F: Electronic cell counters have been used for performing CSF cell counts
False (not used due to high background counts and poor reproducibility of low counts)
73
Neutrophil abnormality indicating degenerating cells
Neutrophil with pyknotic nuclei
74
Cells seen in the CSF if a patient has viral, tubercular, fungal meningitis, and multiple sclerosis
Lymphocytes
75
Reactive lymphocytes containing increased dark blue cytoplasm and clumped chromatin are frequently present in what type of infection?
Viral infection
76
Which cell is seen to be increased in the CSF of patients with HIV infection and AIDS
Lymphocytes
77
A moderately elevated WBC count with increased normal and reactive lymphocytes and plasma cells may indicate which condition/s?
Multiple sclerosis or other degenerative neurologic disorders
78
Increased eosinophil in the CSF is associated with what type of infection/s?
Parasitic and fungal infections
79
Cells that line the ventricles and neural canal
Ependymal cells
80
Spindle-shaped cells represent lining cells from which structure?
Arachnoid
81
CSF is formed by the filtration of what substance?
Plasma
82
Most frequently performed chemical test on CSF
CSF protein
83
Normal value of CSF protein
15-45 mg/dL
84
The major beta globulin present in the CSF
Transferrin
85
T/F: IgM is not normally found in the CSF
True
86
Antibodies normally found in the CSF
IgG (large amt.), IgA (small amt.)
87
Turbidimetric method of CSF protein determination that precipitates both albumin and globulin
Trichloroacetic acid (TCA)
88
Turbidimetric method of CSF protein determination that precipitates albumin only
Sulfosalicylic acid (SSA)
89
In SSA method of CSF protein determination, what reagent is added to precipitate globulins?
Sodium Sulfate (Na2SO4)
90
The dye-binding method in CSF protein determination
Coomassie Brilliant Blue
91
What is used to determine whether IgG is increased because it is being produced within the CNS or is elevated as a result of a defect in the BBB?
CFS/Serum Albumin Index
92
A CFS/Serum Albumin Index of ___ represents an intact BBB
<9
93
Used to measure IgG synthesis within the CNS
CSF IgG index
94
Method to detect oligoclonal bands
Electrophoresis
95
In electrophoresis, these represent inflammation within the CNS
Oligoclonal bands
96
Oligoclonal bands are located in what region of the protein electrophoresis
Gamma region
97
If the oligoclonal band is present in the serum but absent in the CSF, this may be indicative of what condition?
Viral infection
98
If the oligoclonal band is present in the serum and present in the CSF, this may be indicative of what condition
HIV
99
In conditions like leukemia, encephalitis, lymphoma, neoplastic disorders, and Guillain-Barre syndrome, which oligoclonal band should be present?
CSF only
100
An indication of recent destruction of the myelin sheath that protects the axons of the neurons
Myelin basic protein (MBP)
101
Approximately how many percent of CSF is glucose?
60-70%
102
If the plasma glucose is 100 mg/dL, what is the expected glucose level in the CSF?
65 mg/dL
103
Identify the cause of meningitis based on the findings:
Markedly increased CSF glucose
Increased WBC count with large percentage of neutrophil
Bacterial
104
Identify the cause of meningitis based on the findings:
Markedly decreased CSF glucose
Increased WBC count with large percentage of lymphocytes
Tubercular
105
Identify the cause of meningitis based on the findings:
Normal CSF glucose
Increased WBC count with large percentage of lymphocytes
Viral
106
Catalyzes the irreversible hydrolytic deamination of adenosine to produce inosine
Adenosine deaminase
107
Been recommended in the diagnosis of pleural, peritoneal, and meningeal tuberculosis
Adenosine deaminase
108
Stain used for Cryptococcus neoformans
India ink
109
Very accurate test for the presence of endotoxin
Limulus Lysate Test
110
Reagent used in Limulus Lysate Test
Horse-shoe crab (Limulus polyphemus) blood cells
111
Incubation conditions used in Limulus Lysate Test
1 hour at 37C
