Book: CSF

Question 1

The functions of the CSF include all of the following
except:

A. Removing metabolic wastes
B. Producing an ultrafiltrate of plasma
C. Supplying nutrients to the CNS
D. Protecting the brain and spinal cord

Answer 1

Producing an ultrafiltrate of plasma

Question 2

The CSF flows through the:

A. Choroid plexus
B. Pia mater
C. Arachnoid space
D. Dura mater

Answer 2

Arachnoid space

Question 3

Substances present in the CSF are controlled by the:

A. Arachnoid granulations
B. Blood–brain barrier
C. Presence of one-way valves
D. Blood–CSF barrier

Answer 3

Blood–brain barrier

Question 4

What department is the CSF tube labeled 3 routinely
sent to?

A. Hematology
B. Chemistry
C. Microbiology
D. Serology

Answer 4

Hematology

Question 5

The CSF tube that should be kept at room temperature is:

A. Tube 1
B. Tube 2
C. Tube 3
D. Tube 4

Answer 5

Tube 2

Question 6

Place the appropriate letter in front of the statement that
best describes CSF specimens in these two conditions:

A. Traumatic tap
B. Intracranial hemorrhage

Even distribution of blood in all tubes
Xanthochromic supernatant
Concentration of blood in tube 1 is greater than in tube 3
Specimen contains clots

Answer 6

B
B
A
A

Question 7

The presence of xanthochromia can be caused by all of the following except:

A. Immature liver function
B. RBC degradation
C. A recent hemorrhage
D. Elevated CSF protein

Answer 7

A recent hemorrhage

Question 8

A web-like pellicle in a refrigerated CSF specimen
indicates:

A. Tubercular meningitis
B. Multiple sclerosis
C. Primary CNS malignancy
D. Viral meningitis

Answer 8

Tubercular meningitis

Question 9

Given the following information, calculate the CSF WBC count: cells counted, 80; dilution, 1:10; large Neubauer squares counted, 10.

A. 8
B. 80
C. 800
D. 8000

Answer 9

800

Question 10

A CSF WBC count is diluted with:

A. Distilled water
B. Normal saline
C. Acetic acid
D. Hypotonic saline

Answer 10

Acetic acid

Question 11

A total CSF cell count on a clear fluid should be:

A. Reported as normal
B. Not reported
C. Diluted with normal saline
D. Counted undiluted

Answer 11

Counted undiluted

Question 12

The purpose of adding albumin to CSF before cytocentrifugation is to:

A. Increase the cell yield
B. Decrease the cellular distortion
C. Improve the cellular staining
D. Both A and B

Answer 12

Both A and B

Question 13

The primary concern when pleocytosis of neutrophils and lymphocytes is found in the CSF is:

A. Meningitis
B. CNS malignancy
C. Multiple sclerosis
D. Hemorrhage

Answer 13

Meningitis

Question 14

Neutrophils with pyknotic nuclei may be mistaken for:

A. Lymphocytes
B. Nucleated RBCs
C. Malignant cells
D. Spindle-shaped cells

Answer 14

Nucleated RBCs

Question 15

The presence of which of the following cells is increased
in a parasitic infection?

A. Neutrophils
B. Macrophages
C. Eosinophils
D. Lymphocytes

Answer 15

Eosinophils

Question 16

Macrophages appear in the CSF after:

A. Hemorrhage
B. Repeated spinal taps
C. Diagnostic procedures
D. All of the above

Answer 16

All of the above

Question 17

Nucleated RBCs are seen in the CSF as a result of:

A. Elevated blood RBCs
B. Treatment of anemia
C. Severe hemorrhage
D. Bone marrow contamination

Answer 17

Bone marrow contamination

Question 18

After a CNS diagnostic procedure, which of the following might be seen in the CSF?

A. Choroidal cells
B. Ependymal cells
C. Spindle-shaped cells
D. All of the above

Answer 18

All of the above

Question 19

Hemosiderin granules and hematoidin crystals are seen in:

A. Lymphocytes
B. Macrophages
C. Ependymal cells
D. Neutrophils

Answer 19

Macrophages

Question 20

Myeloblasts are seen in the CSF:

A. In bacterial infections
B. In conjunction with CNS malignancy
C. After cerebral hemorrhage
D. As a complication of acute leukemia

Answer 20

As a complication of acute leukemia

Question 21

Cells resembling large and small lymphocytes with
cleaved nuclei represent:

A. Lymphoma cells
B. Choroid cells
C. Melanoma cells
D. Medulloblastoma cells

Answer 21

Lymphoma cells

Question 22

The reference range for CSF protein is:

A. 6 to 8 g/dL
B. 15 to 45 g/dL
C. 6 to 8 mg/dL
D. 15 to 45 mg/dL

Answer 22

15 to 45 g/dL

Question 23

CSF can be differentiated from serum by the presence of:

A. Albumin
B. Globulin
C. Prealbumin
D. Tau transferrin

Answer 23

Globulin

Question 24

In serum, the second most prevalent protein is IgG; in
CSF, the second most prevalent protein is:

A. Transferrin
B. Prealbumin
C. IgA
D. Ceruloplasmin

Answer 24

Prealbumin

Question 25

Elevated CSF protein values can be caused by all of the following except: A. Meningitis B. Multiple sclerosis C. Fluid leakage D. CNS malignancy

Answer 25

Fluid leakage

Question 26

The integrity of the blood–brain barrier is measured using the: A. CSF/serum albumin index B. CSF/serum globulin ratio C. CSF albumin index D. CSF IgG index

Answer 26

CSF/serum albumin index

Question 27

Given the following results, calculate the IgG index: CSF IgG, 50 mg/dL; serum IgG, 2 g/dL; CSF albumin, 70 mg/dL; serum albumin, 5 g/dL. A. 0.6 B. 6.0 C. 1.8 D. 2.8

Answer 27

1.8

Question 28

The CSF IgG index calculated in Study Question 27 indicates: A. Synthesis of IgG in the CNS B. Damage to the blood–brain barrier C. Cerebral hemorrhage D. Lymphoma infiltration

Answer 28

Synthesis of IgG in the CNS

Question 29

The finding of oligoclonal bands in the CSF and not in the serum is seen with: A. Multiple myeloma B. CNS malignancy C. Multiple sclerosis D. Viral infections

Answer 29

Multiple sclerosis

Question 30

A CSF glucose of 15 mg/dL, WBC count of 5000, 90% neutrophils, and protein of 80 mg/dL suggests: A. Fungal meningitis B. Viral meningitis C. Tubercular meningitis D. Bacterial meningitis

Answer 30

Bacterial meningitis

Question 31

A patient with a blood glucose of 120 mg/dL would have a normal CSF glucose of: A. 20 mg/dL B. 60 mg/dL C. 80 mg/dL D. 120 mg/dL

Answer 31

60 mg/dL

Question 32

CSF lactate will be more consistently decreased in: A. Bacterial meningitis B. Viral meningitis C. Fungal meningitis D. Tubercular meningitis

Answer 32

Bacterial meningitis

Question 33

Measurement of which of the following can be replaced by CSF glutamine analysis in children with Reye syndrome? A. Ammonia B. Lactate C. Glucose D. α -Ketoglutarate

Answer 33

Ammonia

Question 34

Before performing a Gram stain on CSF, the specimen must be: A. Filtered B. Warmed to 37°C C. Centrifuged D. Mixed

Answer 34

Centrifuged

Question 35

All of the following statements are true about cryptococcal meningitis except: A. An India ink preparation is positive B. A starburst pattern is seen on Gram stain C. The WBC count is over 2000 D. A confirmatory immunology test is available

Answer 35

The WBC count is over 2000

Question 36

The test of choice to detect neurosyphilis is the: A. RPR B. VDRL C. FAB D. FTA-ABS

Answer 36

FTA-ABS