MTAP 1: AUBF (Part 2) Flashcards by Marlo Roque

Q

CFS PROTEIN DETERMINATION

TOTAL PROTEIN
Enumerate methods:

A

Turbidimetric Method
Dye binding

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Q

CFS PROTEIN DETERMINATION (Total Protein)

Reagent used in Turbidimetric method

A

Trichloroacetic acid (TCA) - 3%
Sulfosalicylic acid (SSA) - 3%

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Q

CFS PROTEIN DETERMINATION (Total Protein)

TURBIDIMETRIC METHOD
Preferred method

A

Trichloroacetic acid (TCA)

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Q

CFS PROTEIN DETERMINATION (Total Protein)

TURBIDIMETRIC METHOD
→ Precipitates BOTH albumin and globulin

A

Trichloroacetic acid (TCA)

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Q

CFS PROTEIN DETERMINATION (Total Protein)

TURBIDIMETRIC METHOD
→ Precipitates albumin ONLY

A

Sulfosalicylic acid (SSA)

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Q

CFS PROTEIN DETERMINATION (Total Protein)

TURBIDIMETRIC METHOD (Sulfosalicylic acid (SSA))
→ To precipitate globulins, ___ is added

A

Na2SO4 (Sodium sulphate)

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Q

CFS PROTEIN DETERMINATION (Total Protein)

DYE BINDING
Dyes used: ____

A

Coomassie brilliant blue dye

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Q

CFS PROTEIN DETERMINATION (Total Protein)

DYE BINDING (Coomassie brilliant blue dye)
→ Binds to protein –> dye turns from __ to __

A

red to blue

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Q

CFS PROTEIN DETERMINATION (Total Protein)

DYE BINDING (Coomassie brilliant blue dye)
→ Stronger intensity of blue dye indicates (lower/higher) concentration of proteins

A

higher

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Q

CFS PROTEIN DETERMINATION (Protein fractions)

Methods used:

A

CSF/ serum albumin index
IgG Index

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Q

CFS PROTEIN DETERMINATION (Protein fractions)

Assesses integrity of the BBB

A

CSF/ serum albumin index

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Q

CFS PROTEIN DETERMINATION (Protein fractions)

CSF/SERUM ALBUMIN INDEX:
* Normal value: __ (_______)

A

<9 (intact BBB)

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Q

CFS PROTEIN DETERMINATION (Protein fractions)

CSF/SERUM ALBUMIN INDEX:
* Abnormal value: ____

A

> 9

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Q

CFS PROTEIN DETERMINATION (Protein fractions)

CSF/SERUM ALBUMIN INDEX:
9-14: ____

A

Slight impairment

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Q

CFS PROTEIN DETERMINATION (Protein fractions)

CSF/SERUM ALBUMIN INDEX:
15-30: _____

A

Moderate impairment

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Q

CFS PROTEIN DETERMINATION (Protein fractions)

CSF/SERUM ALBUMIN INDEX:
>30: _______

A

Sever impairment

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Q

CFS PROTEIN DETERMINATION (Protein fractions)

CSF/SERUM ALBUMIN INDEX:
100: ____

A

Complete damage to BBB

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Q

CFS PROTEIN DETERMINATION (Protein fractions)

Assess conditions that results to IgG production in the CNS

A

IgG index

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Q

CFS PROTEIN DETERMINATION (Protein fractions)

Example of conditions that results to IgG production in the CNS

A

multiple sclerosis

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Q

CFS PROTEIN DETERMINATION (Protein fractions)

IgG INDEX:
* Normal value: ____

A

<0.70

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Q

CFS PROTEIN DETERMINATION (Protein fractions)

IgG INDEX:
* Abnormal value: ____ (indicates IgG production within CSF)

A

> 0.70

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Q

CFS PROTEIN DETERMINATION

Detection of oligoclonal bands in the gamma region

A

CSF Electrophoresis

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Q

CFS PROTEIN DETERMINATION (CSF Electrophoresis)

Detection of ____ bands in the ____ region

A

oligoclonal
gamma

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Q

CFS PROTEIN DETERMINATION (CSF Electrophoresis)

Conditions that have the presence of 2 oligoclonal bands in CSF but not in serum:

NOTE: MS. NENG

A

→ Multiple sclerosis
→ Neurosyphilis
→ Encephalitis
→ Neoplastic disorder
→ Guillain-Barre syndrome

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CFS PROTEIN DETERMINATION (CSF Electrophoresis) Most persistent condition

→ Multiple sclerosis

* Demyelinating disorder

Multiple Sclerosis

* Produces antibodies against the ____ of neurons

Multiple Sclerosis Myelin sheath

MULTIPLE SLCEROSIS Findings: → (+) ______ autoantibody → (+) _____ in CSF but not in ____ → (+) ________(MBP) → Increase in _____

→ (+) Anti-myelin sheath autoantibody → (+) Oligoclonal band in CSF but not in serum → (+) Myelin Basic Protein (MBP) → Increase in IgG index

○ Protein component of myelin sheath

Myelin Basic Protein (MBP)

* Measurement of CSF glucose is always performed in conjunction with ____

blood glucose

→ Blood glucose specimen must be collected ____ before spinal tap to allow for equilibration of ____ and _____

two hours CSF plasma glucose.

CSF GLUCOSE Normal values: According to Strasinger

* 60-70% of blood glucose (65% or 2/3)

CSF GLUCOSE Normal values: According to henry's

* 50-80 mg/dL

CSF GLUCOSE Increased: ____

D. mellitus (Or in any cases where there is increased plasma glucose)

CSF GLUCOSE Decreased: _____

* Bacterial, tubercular, and fungal meningitis * Alterations in glucose transport across BBB * Increased use of glucose by brain cells

T/F: Glucose is markedly increased in bacterial meningitis

FALSE; Glucose is markedly decreased in bacterial meningitis due to bacterial utilization of glucose

T/F: Glucose values are normal in viral meningitis.

TRUE

* Waste product of glucose metabolism

CSF LACTATE

→ Lactate is _____ proportional with glucose

Inversely

CSF LACTATE Normal values: ___

10-24 mg/dL

CSF LACTATE Increased:

* Bacterial meningitis * Tubercular and fungal meningitis * Hypoxia

CSF LACTATE * Bacterial meningitis (_____) * Tubercular and fungal meningitis (____) * _____(tissues are destroyed, causing release of lactate)

>35 mg/dL >25 mg/dL Hypoxia

* Product of ammonia (NH3) and α-ketoglutarate in brain cells

CSF GLUTAMINE

CSF GLUTAMINE * Product of ____ and _____ in brain cells

ammonia (NH3) α-ketoglutarate

→ Removal of ____(a waste product) in the brain produces ____

ammonia glutamine

* Indirect test for the presence of excess ammonia in CSF

CSF GLUTAMINE

CSF GLUTAMINE Normal values: _____

8-18 mg/dL

CSF GLUTAMINE Increased:

* Disturbance of consciousness * Reye’s syndrome

CSF GLUTAMINE Increased: * Disturbance of consciousness (____) * Reye’s syndrome (___ of patients have increased glutamine)

>35 mg/dL 75%

CSF Enzymes Enumerate

Lactate dehydrogenase Creatine kinase Aspartate aminotransferase

CSF ENZYMES (Lactate dehydrogenase) * LD 1 & 2: found in ____

brain tissues

CSF ENZYMES (Lactate dehydrogenase) * LD 2 & 3: found in ____

lymphocytes

CSF ENZYMES (Lactate dehydrogenase) * LD 4 & 5: found in _____

neutrophils

CSF ENZYMES (Lactate dehydrogenase) Normal LD isoenzyme distribution * In serum: _______

LD2 > LD1 > LD3 > LD4 > LD5

CSF ENZYMES (Lactate dehydrogenase) Normal LD isoenzyme distribution * In CSF: ______

LD1 > LD2 > LD3 > LD4 > LD5

* If the serum distribution is similar to the isoenzyme distribution in CSF, where LD1 is more abundant, this is known as a _____

flipped pattern

flipped pattern is an indicative of _______

acute myocardial infarction hemolytic anemia

* If the CSF distribution is similar to the isoenzyme distribution in serum, where LD2 is more abundant, this is indicative of ____

neurologic abnormalities

* If the distribution pattern is LD5 > LD4 > LD3 > LD2 > LD1 in CSF, it is indicative of ______ due to the increase in ______

bacterial meningitis neutrophils

CSF ENZYMES (Creatine kinase) Increased in:

* Stroke * Multiple sclerosis * Degenerative disorders * Brain tumors * Viral and bacterial meningitis * Epileptic seizures

CSF ENZYMES (Aspartate Aminotransferase) Increased in:

* Intracerebral and subarachnoid hemorrhage * Bacterial meningitis

CSF MICROBIOLOGY TESTS What are the major causes of Meningitis

Bacterial Meningitis Tubercular Meningitis Fungal Meningitis Amoebic Meningoencephalitis Viral meningitis

CSF MICROBIOLOGY TESTS (Bacterial meningitis) Common agents:

* Group B streptococci * E. coli and other gram (-) bacilli * N. meningitidis * S. pneumoniae * H. influenzae * L. monocytogenes

Common agents of bacterial meningitis Common cause in NEONATES:

* Group B streptococci

Common agents of bacterial meningitis Common cause in newborns to 1 month old infants

E. coli and other gram (-) bacilli

Common agents of bacterial meningitis Common cause among children >3 months

* N. meningitidis and S. pneumoniae

Common agents of bacterial meningitis common cause among 3 months to 18 years of age

H. influenzae

Common agents of bacterial meningitis common cause among newborns, adults, alcoholics, and the immunocompromised

* L. monocytogenes

CSF MICROBIOLOGY TESTS (Tubercular meningitis) AGENT/S:

Mycobacterium tuberculosis

CSF MICROBIOLOGY TESTS (Fungal meningitis) AGENT/S: ______

Cryptococcus neoformans

the most frequently isolated fungal pathogen in the CSF_

C. NEOFORMANS

CSF MICROBIOLOGY TESTS (Amoebic Meningoencephalitis) AGENT/S: ______

* Naegleria fowleri * Acanthamoeba spp. * Balamuthia mandrillaris

Amoebic meningoencephalitis agents causes primary amoebic meningoencephalitis

* Naegleria fowleri

Amoebic meningoencephalitis agents causes granulomatous amoebic encephalitis

* Acanthamoeba spp. and B. mandrillaris

CSF MICROBIOLOGY TESTS (Viral meningitis) AGENT/S:

* Enteroviruses * Arbovirus

Examples of enteroviruses are the _____, ______, and _______

coxsackievirus echovirus; and poliovirus

CSF MICROBIOLOGY TESTS (Bacterial meningitis) Increased WBC:

Neutrophils

CSF MICROBIOLOGY TESTS (Tubercular meningitis) Increased WBC:

↑Lymphocytes ↑Monocytes

CSF MICROBIOLOGY TESTS (Fungal meningitis) Increased WBC:

↑Lymphocytes ↑Monocytes

CSF MICROBIOLOGY TESTS (Amoebic Meningoencephalitis) Increased WBC:

↑Neutrophils

CSF MICROBIOLOGY TESTS (Viral meningitis) Increased WBC:

↑Lymphocytes

T/F: Protein is Increased in ALL Major causes of Meningitis

TRUE

T/F: Glucose is DECREASED In all Major causes of Meningitis

FALSE; Except for VIRAL MENINGITIS where glucose is NORMAL

T/F: Lactate is Increased In all Major causes of Meningitis except for Viral Meningitis where the lactate levels are normal

TRUE

CSF MICROBIOLOGY TESTS (Bacterial meningitis) OTHERS:

(+) Gram stain (+) Culture (+) Limulus Lysate test

CSF MICROBIOLOGY TESTS (Tubercular meningitis) OTHERS:

(+) AFB stain (+) Pellicle /weblike clot formation[2]

CSF MICROBIOLOGY TESTS (Tubercular meningitis) _____ hours or overnight standing in the ______ leads to ______

12-24 refrigerator pellicle formation

CSF MICROBIOLOGY TESTS (Fungal meningitis) OTHERS

(+) Gram stain (+) India ink (+) Latex agglutination test

Fungal meningitis stains * Gram stain shows a ______

starburst pattern

Fungal meningitis stains * _____ is a negative or an indirect stain

India ink

Fungal meningitis stains * Latex agglutination test detects antigens of _______ in the CSF

C. neoformans

CSF MICROBIOLOGY TESTS (Amoebic Meningoencephalitis) OTHERS:

(+) RBCs (+) Acridine orange stain

* Agents causing amoebic meningoencephalitis can be identified using _______, the problem is the _____ can be mistaken as the protozoans

Wright-stained smear macrophage

* ______ can differentiate between the amoebic agents and WBC

Acridine orange stain

Acridine orange stain → Amoeba stains ____ → WBC (macrophage) stains ____

brick red bright green

CSF MICROBIOLOGY TESTS (Viral meningitis) Gold standard in detecting Viral meningitis

RT-PCR

Spirochetal Meningitis * Neurosyphilis – caused by _____

T. pallidum

Spirochetal Meningitis * Neuroborreliosis – caused by _____

B. burgdorferi

Spirochetal Meningitis * _______– caused by T. pallidum

Neurosyphilis

Spirochetal Meningitis * ________ – caused by B. burgdorferi

Neuroborreliosis

Tests for the diagnosis of Spirochetal Meningitis:

* Non-treponemal tests * ELISA * Western blot

Examples of Non-treponemal test:

VDRL FTA-Abs

Among the non-treponemal tests, which is the recommended test by CDC?

VDRL

* Detects gram (-) bacterial endotoxins in body fluids and surgical instruments

Limulus Lysate Test

Limulus Lysate Test Reagent: ______

Blood of horseshoe crabs

Blood of horseshoe crabs scientific name:

Limulus polyphemus

Limulus Lysate Test Blood of horseshoe crabs: → The blood is color ____ due to presence of _____which contains ____

blue hemocyanin copper

Limulus Lysate Test Blood of horseshoe crabs: → The blood also contains WBCs which are called _______

amoebocytes

Limulus Lysate Test Blood of horseshoe crabs: → Amoebocytes release _____ in the presence of endotoxins which causes ______

lysate clumping/clot