AUBF-Lec-CSF Flashcards
1
Q
3RD major body fluid
A
CSF
2
Q
CSF is the 3RD major body fluid
Discovered by?
A
Cotugno
3
Q
Functions of CSF (3)
A
- Supply nutrients to the nervous system
- Remove metabolic waste
- Produce mechanical barrier to cushion the brain and spinal cord against trauma
4
Q
Layers of our Head (4)
A
Skin
Skull
Meninges
Brain
5
Q
3 Layers of Meninges +1
A
DURA MATER
ARACHNOID MATER
*SUBARACHNOID SPACE
PIA MATER
6
Q
What layer of Meninges?
OUTER LAYER
LINES THE SKULL AND VETEBRAL CANAL
A
DURA MATER
7
Q
What layer of Meninges?
SPIDERWEB-LIKE
FILAMENTOUS INNER MEMBRANE
A
ARACHNOID MATER
8
Q
What layer of Meninges?
BELOW ARACHNOID
WHERE CSF FLOWS
A
*SUBARACHNOID SPACE
9
Q
What layer of Meninges?
INNERMOST LAYER
LINES THE SURFACE OF THE BRAIN AND SPINAL CORD
A
PIA MATER
10
Q
DURA MATER (Latin:_____)
A
Hard Mother
11
Q
PIA MATER (Latin:_______)
A
Gentle Mother
12
Q
Specific part of the brain that produces CSF through selective filtration
A
Choroid Plexus
13
Q
Choroid Plexus
Specific part of the brain that produces CSF through selective filtration
At a rate of?
A
20 mL/hour
14
Q
-reabsorbs CSF back into the blood (if not=HYDROCEPHALUS)
-act as a one-way valves to prevent reflux
A
ARACHNOID VILLI/GRANULATIONS
15
Q
ARACHNOID VILLI/GRANULATIONS
-reabsorbs CSF back into the blood (if not=__________)
-act as a one-way valves to prevent reflux
A
HYDROCEPHALUS
16
Q
Protects the brain from chemicals and other substances circulating in the blood that can harm the brain tissues
A
Blood Brain Barrier (BBB)
17
Q
Blood Brain Barrier (BBB)
If damage, other chemicals, WBCs and proteins will enter the CSF that will lead to? (2)
A
Meningitis and Multiple Sclerosis
18
Q
Up to ______ of CSF can be collected
A
20 mL
19
Q
CSF Method of Collection: ______ Puncture (between 3rd, 4th, or 5th lumbar vertebrae)
A
Lumbar
20
Q
Method of Collection: Lumbar Puncture (between _______ lumbar vertebrae)
A
3rd, 4th, or 5th
21
Q
Normal Value of CSF in Adults:
A
90-150 mL
140-170 mL
22
Q
Normal Value of CSF in Neonates:
A
10-60 mL
23
Q
______CSF tubes are collected (sometimes 4)
A
3
24
Q
3 CSF tubes are collected (sometimes ____)
A
4
25
CSF tube 1 test
For Chemistry & Serology
26
CSF tube 2 test
For Microbiology
27
CSF tube 3 test
For Hematology and Cell count
28
CSF tube 4 test
Additional testing for Microbiology and Serology
29
CSF tube 1 storage
Frozen
30
CSF tube 2 storage
Room Temperature
31
CSF tube 3 storage
Refrigerator
32
What tube number in CSF? least affected by blood or bacteria introduced as a result of the tap procedure.
Tube 1
33
What tube number in CSF? Least likely to contain cells introduced by the spinal tap
Tube 3
34
What tube number in CSF? Better exclusion of skin contamination
Tube 4
35
Left-over_______ may also be used for additional chemical or serologic tests
supernatant fluid
36
Excess fluid should _____ and should be frozen until there is no further use of it.
not be discarded
37
Order of testing of CSF if only 1 tube of sample is available?
Micro---> Hema---> Chem/Sero
38
inflammation in the membrane of the brain and spinal cord
meningitis
39
yellow color & coagulate rapidly & with high protein, blockage in spinal circulation due to tumor
Froin syndrome
40
What is the appearance of CSF if the following is observed:
Increased WBCs (>200/uL)
RBCs (>400/uL)
Lipids, Proteins
Microorganisms
Hazy, turbid, milky, cloudy
41
What is the appearance of CSF if the following is observed:
Increased RBCs (>6000/uL)
Bloody
42
What is the appearance of CSF if the following is observed:
Meningitis: inflammation in the membrane of the brain and spinal cord
clotted
43
What is the appearance of CSF if the following is observed:
Froin syndrome: yellow color & coagulate rapidly & with high protein, blockage in spinal circulation due to tumor
Pellicle
44
What is the appearance of CSF if the following is observed:
Due to hemoglobin degradation product
PINK: slight amount of oxyhemoglobin
YELLOW: Oxyhemoglobin-🡪unconjugated bilirubin
ORANGE: Heavy hemolysis
Other causes of xanthochromia include elevated serum bilirubin, presence of the pigment carotene, markedly increased protein concentrations, and melanoma pigment, Rifampin
xanthochromic
45
Due to hemoglobin degradation product
PINK is caused by?
slight amount of oxyhemoglobin
46
Due to hemoglobin degradation product
YELLOW is caused by?
Oxyhemoglobin-🡪unconjugated bilirubin
47
Due to hemoglobin degradation product
ORANGE is caused by?
Heavy hemolysis
48
Other causes of xanthochromia include (5)
elevated serum bilirubin
presence of the pigment carotene
markedly increased protein concentrations, melanoma pigment
Rifampin
49
Traumatic Tap: DISTRIBUTION OF BLOOD ON 3 TUBES
Uneven (1 heaviest conc.>2>3)
50
Traumatic Tap: CLOT FORMATION
(+) due to plasma fibrinogen
51
Traumatic Tap: SUPERNATANT
Clear
52
Traumatic Tap: ERYTHROPHAGES
(MACROPHAGES W/ INGESTED RBCS)
Absent
53
Traumatic Tap: D-DIMER
Negative
54
Intracranial Hemorrhage: DISTRIBUTION OF BLOOD ON 3 TUBES
Even
55
Intracranial Hemorrhage: CLOT FORMATION
(-) CSF has no fibrinogen
56
Intracranial Hemorrhage: SUPERNATANT
Xanthochromic
57
Intracranial Hemorrhage: ERYTHROPHAGES
(MACROPHAGES W/ INGESTED RBCS)
Present
58
Intracranial Hemorrhage: D-DIMER
Positive
59
CSF Cell Count: Any cell count should performed?
immediately
60
CSF Cell Count: WBCs and RBCs begin to lyse within?
1 hour
61
CSF Cell Count: 40% of WBCs disintegrate within?
2 hours
62
CSF Cell Count: ______ of WBCs disintegrate within 2hours
40%
63
WBC Count
Routinely performed in CSF
Normal values:
ADULT: ______
NEONATES: _______
0-5 WBCs/uL
0-30 WBCs/uL
64
CSF Dilution: Clear
Undiluted
65
CSF Dilution: Slightly Hazy
1:10
66
CSF Dilution: Hazy
1:20
67
CSF Dilution: Slightly Cloudy
1:100
68
CSF Dilution: Cloudy/Slightly bloody
1:200
69
CSF Dilution: Turbid/Bloody
1:10,000
70
WBC Diluting fluid for CSF: ______________________
3% acetic acid with methylene blue
71
RBC Count is Done only in cases of?
traumatic tap
72
RBC Count: ______ count and ______ concentration should be corrected
WBC; protein
73
RBC Count:
WBC count and protein concentration should be corrected
Subtract (-) _______ WBC for every 700 RBC seen
(-) _______ Total protein concentration for every 10,000 RBCs/uL
(-) _______ Total protein concentration for every 1,200 RBCs/uL
Subtract (-) 1 WBC for every 700 RBC seen
(-)8 mg/dL Total protein concentration for every 10,000 RBCs/uL
(-)1 mg/dL Total protein concentration for every 1,200 RBCs/uL
74
CSF Differential Count is Performed on?
stained smear
75
CSF Differential Count
Specimen should be concentrated before smearing by using applicable methods: (4)
Cytocentrifugation
Centrifugation
Sedimentation
Filtration
76
Fluid is added on conical chamber
Cells are forced into monolayer within a 6mm diameter circle on the slide
Cytocentrifuge
77
Cytocentrifuge:
Fluid is added on _______ chamber
Cells are forced into monolayer within a ______ diameter circle on the slide
Fluid is added on conical chamber
Cells are forced into monolayer within a 6mm diameter circle on the slide
78
Cytocentrifuge: Addition of Albumin:
Increases cell yield/recovery
Decrease cellular distortion
79
Predominant Cells in CSF:
Predominant: (2)
Ocassional: (1)
Predominant: lymphocytes & monocytes
Ocassional: Neutrophils
80
Adult ratio of lymphocytes & monocytes in CSF
Adults (70:30 ratio)
70%-lymphocytes
30%- monocytes
81
Neonates ratio of lymphocytes & monocytes in CSF
Neonates (Inversed ratio)
Up to 80% monocytes is considered normal
82
Increased ____________ are seen in the CSF in association with parasitic infections, fungal infections (primarily Coccidioides immitis)
Eosinophils
83
CSF Protein:
Normal values:
Adult: ______
Infants: _______
Immature: _______
Normal values:
Adult: 15-45 mg/dL
Infants: 150 mg/dL
Immature: 500 mg/dL
84
CSF Protein: Increased in: (4)
- Damage to the BBB (most common): meningitis & hemorrhage
- Production of immunoglobulins within the CNS: Multiple sclerosis
- Decreased normal protein clearance from fluid
- Neural tissue degeneration
85
CSF Protein: Decreased in: (4)
- CSF leakage/ trauma
- Recent puncture
- Rapid CSF production
- Water intoxication
86
major CSF protein
albumin
87
2nd most prevalent CSF in protein
Prealbumin
88
Alpha globulins in CSF protein (2)
- Haptoglobin
- Ceruloplasmin
89
______ is the major beta globulin present
Transferrin
90
Gamma globulin in CSF (2)
- Immunoglobulin G (IgG)
- Immunoglobulin A (IgA)- in small amounts
91
PROTEINS NOT FOUND IN THE CSF: (3)
- Immunoglobulin M (IgM)
- Fibrinogen
- Beta lipoprotein
92
CSF Protein Determination
TOTAL PROTEIN
Turbidimetric (2)
Trichloroacetic acid (TCA)
Sulfosalicylic acid (SSA)
93
CSF Protein Determination
Dye-binding (1)
Coomassie Brilliant Blue
94
CSF Protein Determination:
preferred method (precipitates albumin & globulin)
Trichloroacetic acid (TCA)
95
CSF Protein Determination:
precipitates albumin only
to precipitate globulin, add sodium citrate
Sulfosalicylic acid (SSA)
96
CSF Protein Determination:
protein binds to dye--- dye turns from red to blue
Coomassie Brilliant Blue
97
assess the integrity of BBB
CSF/Serum Albumin Index
98
CSF/Serum Albumin Index:
Normal value: ___
Abnormal: ____
- _____= slight impairment
- _____ = moderate impairment
- _____= severe impairment
- ______= complete damage to BBB
Normal value: <9
Abnormal: >9
9-14= slight impairment
15-30= moderate impairment
>30= severe impairment
100= complete damage to BBB
99
assess conditions with IgG production within the CNS (ex. Multiple Sclerosis)
IgG Index
100
IgG Index:
Normal value: ______
Abnormal value: ______ ---> indicative of MS
Normal value: <0.77
Abnormal value: >0.77 ---> indicative of MS
101
-for detection of oligoclonal bonds (y-region)
-indicates immunoglobulin production
CSF Electrophoresis
102
CSF Electrophoresis:
2 or more oligoclonal bands in CSF but not in serum
Multiple Sclerosis
103
CSF Electrophoresis: oligoclonal bands in serum but not in CSF
Leukemia, Lymphoma, Viral infections
104
CSF Electrophoresis:
oligoclonal bands in serum and CSF
HIV
105
Demyelinating disorder
Findings:
(+) anti-myelin sheath autoantibody
(+) oligoclonal band in CSF but not in serum
(+) myelin basic protein- monitor the course of MS
Increase IgG index
Multiple Sclerosis
106
CSF Enzymes: (3)
Lactate Dehydrogenase (LDH)
Creatinine Kinase
Aspartate Aminotransferase (AST)
107
CSF Enzymes:
Lactate Dehydrogenase (LDH)
Serum LDH:
Normal:_____________
Flipped pattern (AMI): _____
2>1>3>4>5; 1>2
108
CSF Enzymes:
CSF LDH
Normal: ________________
Neurological abnormalities: ______
Bacterial meningitis: _______
CSF LDH
Normal: LD1>2>3>4>5
Neurological abnormalities: LD 2>1
Bacterial meningitis: LD 5>4>3>2>1
109
CSF LDH Isoenzymes: LD1 &2:
brain tissues
110
CSF LDH Isoenzymes: LD2& 3:
lymphocytes
111
CSF LDH Isoenzymes: LD4 & 5:
neutrophils
112
AGENTS OF BACTERIAL MENINGITIS: Birth to 1 month old
Streptococcus agalactiae, Gram-negative rods
113
AGENTS OF BACTERIAL MENINGITIS: 1 month to 5 years old
Haemophilus influenzae
114
AGENTS OF BACTERIAL MENINGITIS: 5-29 years old
Neisseria meningitidis
115
AGENTS OF BACTERIAL MENINGITIS: >29 years old
Streptococcus pneumoniae
116
AGENTS OF BACTERIAL MENINGITIS: Infants, elderly, immunocompromised
Listeria monocytogenes
117
CSF: Serologic Testing: for detection of bacterial antigens
Latex agglutination test and ELISA
118
CSF: Serologic Testing: recommended by CDC for the detection of Neurosyphilis
VDRL (Venereal Disease Research Laboratories)
