CSF

Question 1

1. CSF is produced mainly in the:
   A. Bone marrow
   B. Peripheral blood
   C. Choroid plexuses
   D. Subarachnoid space

Answer 1

C. Choroid plexuses

Question 2

2. 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 2

B. Producing an ultrafiltrate of plasma

Question 3

3. The CSF flows through the:
   A. Choroid plexus
   B. Pia mater
   C. Subarachnoid space
   D. Dura mater

Answer 3

C. Subarachnoid space

Question 4

4. Substances present in the CS are controlled by the:
   A. Arachnoid granulations
   B. Blood-brain barrier
   C. Presence of one-way valves
   D. Blood-CSF barrier

Answer 4

B. Blood-brain barrier

Question 5

5. What department is the CSF tube labeled 3 routinely sent to?
   A. Hematology
   B. Chemistry
   C. Microbiology
   D. Serology

Answer 5

A. Hematology

Question 6

6. The CS tube that should be kept at room temperature is:
   A. Tube 1
   B. Tube 2
   C. Tube 3
   D. Tube 4

Answer 6

B. Tube 2

Question 7

8. The presence of xanthochromia can be B. Tube 2 caused by all of the following except:
   A. Immature liver function
   B. RBC degradation
   C. A recent hemorrhage
   D. Elevated CSF protein

Answer 7

C. A recent hemorrhage

Question 8

9. 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

A. Tubercular meningitis

Question 9

10. 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

C. 800

Question 10

11. A CSF WBC count is diluted with:
    A. Distilled water
    B. Normal saline
    C. Acetic acid
    D. Hypotonic saline

Answer 10

C. Acetic acid

Question 11

12. 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

D. Counted undiluted

Question 12

13. 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

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

Question 13

14. 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

A. Meningitis

Question 14

15. Neutrophils with pyknotic nuclei may be mistaken for:
    A. Lymphocytes
    B. Nucleated RBCs
    C. Malignant cells
    D. Spindle-shaped cells

Answer 14

B. Nucleated RBCs

Question 15

16. The presence of which of the following cells is increased in a parasitic infection?
    A. Neutrophils
    B. Macrophages
    C. Eosinophils
    D. Lymphocytes

Answer 15

C. Eosinophils

Question 16

17. Macrophages appear in the CSF after:
    A. Hemorrhage
    B. Repeated spinal taps
    C. Diagnostic procedures
    D. All of the above

Answer 16

D. All of the above

Question 17

18. 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

D. Bone marrow contamination

Question 18

19. 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

D. All of the above

Question 19

20. Hemosiderin granules and hematoidin crystals are seen in:
    A. Lymphocytes
    B. Macrophages
    C. Ependymal cells
    D. Neutrophils

Answer 19

B. Macrophages

Question 20

21. 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

D. As a complication of acute leukemia

Question 21

22. Cells resembling large and small lymphocytes with cleaved nuclei represent:
    A. Lymphoma cells
    B. Choroid cells
    C. Melanoma cells
    D. Medulloblastoma cells

Answer 21

A. Lymphoma cells

Question 22

23. The reference range for CS 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

B. 15 to 45 g/dL

Question 23

24. CS can be differentiated from serum by the presence of:
    A. Albumin
    B. Globulin
    C. Transthyretin
    D. Tau transferrin

Answer 23

D. Tau transferrin

Question 24

25. In serum, the second most prevalent protein is IgG; in CS, the second most prevalent protein is:
    A. Transferrin
    B. Transthyretin
    C. Prealbumin
    D. Ceruloplasmin

Answer 24

C. Prealbumin

Question 25

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

Answer 25

C. Fluid leakage

Question 26

27. 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

A. CSF/serum albumin index

Question 27

28. 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

C. 1.8

Question 28

29. The CSF IgG index calculated in Study Question 28 indicates: A. Synthesis to IgG in the CNS B. Damage to the blood-brain barrier C. Cerebral hemorrhage D. Lymphoma infiltration

Answer 28

A. Synthesis to IgG in the CNS

Question 29

30. 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

C. Multiple sclerosis

Question 30

31. Which condition is suggested by the following results: a CSF glucose of 15 mg/dL, WBC count of 5000, 90% neutrophils, and protein of 80 mg/dL? A. Fungal meningitis B. Viral meningitis C. Tubercular meningitis D. Bacterial meningitis

Answer 30

D. Bacterial meningitis

Question 31

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

Answer 31

C. 80 mg/di.

Question 32

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

Answer 32

B. Viral meningitis

Question 33

34. 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. a-Ketoglutarate

Answer 33

A. Ammonia

Question 34

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

Answer 34

C. Centrifuged

Question 35

36. 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

C. The WBC count is over 2000

Question 36

37. The most sensitive and specific method to detect the causative organism in meningitis is: A. Gram stain B. Culture and sensitivity C. India ink stain D. PCR assay

Answer 36

D. PCR assay

Question 37

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

Answer 37

B. VDRL