Neuro - CSF and Blood Culture

Question 1

CSF: Transports _______ and clears ________

Answer 1

nutrients

metabolic waste

Question 2

CSF chloride: NL values ?

Answer 2

700-750 mg/dL

**typically it correlates with serum levels **

Question 3

Lumbar Puncture (Spinal Tap) Contraindications: absolute ?

Answer 3

never do it

Dermatitis

Question 4

CSF cells : WBC NL ?

Answer 4

ZERO

Question 5

CSF protein: also used in ?

Answer 5

to evaluate for some neurologic diseases

Question 6

Case Study:

Pressure: 120 mm H2O
Color: clear
Cells:
RBC=0
WBC=80
Differential >80% lymphocytes
Protein: 70 mg/dL
Glucose: 40 mg/dL

What do you suspect as Dx ?

Answer 6

Viral Meningitis

normal glucose should be close to serum ( 70-130)

lymphocytes - alway viral

if not viral then neutrophils and PMNs

Question 7

Case Study

Started an IV and began fluid bolus.
Obtained a CBC, CMP, UA, UCG, Urine culture, lactate, blood cultures x 2
Given Morphine 4 mg IV and Zofran ( antiemetic) 4 mg IV
CT scan w/o contrast (stone protocol) showed right sided hydronephrosis without stone, some stranding suggesting?

Answer 7

Pyelonephritis

Question 8

CSF decreased when ?

Answer 8

dehydrated

previous taps

nasal sinus fracture with dura tear (CSF leaking out of nose)

Question 9

CSF protein: mild ?

Answer 9

viral

Question 10

CSF other tests: gram stain ?

Answer 10

Guide empiric treatment for bacterial meningitis

Question 11

Blood Cultures: test ?

Answer 11

Preliminary result in 24 hours

Final results usually within 48-72 hours

Start empiric therapy

Question 12

Cerebral Spinal Fluid (CSF) procedure: __ tubes from one collection point ?

Answer 12

4

label each tubes in succession you drew then

**lots of blood in 1 tube but not as much for 4 - it is probably from the puncturee itself and not a true blood level in the CSF **

Question 13

Blood Cultures: order -

Answer 13

Blood cultures x 2
-Collected from 2 different sites

Avoid an arm with an IV -unless contamination of an indwelling line is suspected

Draw before antibiotics are initiated
-If drawn while on abx, draw just before next dose is given.

Question 14

CSF other tests: Tumor markers ?

Answer 14

if there is metastasis

not primary brain CA but mets

Question 15

Lumbar Puncture: post-test ?

Answer 15

Immediately can lie pt prone with pillow under abdomen to slow CSF flow

Lie flat for 12 hours.

Use straw to drink fluids, encourage PO fluids

Repeat Neuro exam (*legs!)

Send test stat

Question 16

6-18 y.o. # of cells ?

Answer 16

0-10

Question 17

CSF glucose: increased?

Answer 17

High serum glucose

DKA

follows serum level of glucose and if it is lower than serum you gonna think infection

Question 18

Cerebral Spinal Fluid (CSF) procedure: Insert needle between ________ lumbar vertebrae

Answer 18

3rd and 4th

Question 19

CSF color: turbid ?

Answer 19

infection

Question 20

CSF protein: moderate ?

Answer 20

bacteria

Question 21

CSF LP potential complications ?

Answer 21

CSF leak (H/A sxs. - they need a blood patch )

Infxn

Herniation of the brain (get CT first)

Puncture of the spinal cord/aorta/vena cava

Postural h/a or paresthesias

**CT before LP if you suspect increase pressure **

Question 22

LP opening pressure ?

Answer 22

opening pressure - how much pressure is inside the closed circuit ( spinecord)

Question 23

CSF glucose: NL values ?

Answer 23

60-75 or 60% of BGL

Question 24

Adults # of cells ?

Answer 24

0-5

Question 25

A 22 year old female presents to the Lake Erie College clinic with complaints of headache and neck pain since yesterday evening. Pain is 10/10 now and associated with photophobia, one episode of emesis, and continued nausea.

Answer 25

she might have meningitis so you want to do an LP

Question 26

CSF protein Nl ?

Answer 26

15-45 mg/dL

Question 27

CSF chloride: decreased ?

Answer 27

Infxn Meningitis so , take home point here

Question 28

Blood cultures Preliminary report – Gram neg bacilli Final report- E.coli what is tx ?

Answer 28

Began Cipro 400 mg IV

Question 29

Blood Cultures: pre-test ?

Answer 29

Aseptic technique Discard needle on syringe and use second sterile needle before injecting into blood culture media

Question 30

CSF color: red ?

Answer 30

traumatic tap or blood in CSF **could be traumatic, further tubes should be clearer and clearer, blood will clot with traumatic puncture**

Question 31

CSF glucose: decreased ?

Answer 31

Bacteria Inflammation Tumor

Question 32

CSF: Lactic acid increased >35 ?

Answer 32

Elevated in bacterial/fungal meningitis Associated with decreased O2 in the brain Not elevated in viral meningitis increases in anaerobic metabolism cause low O2 levels **difference between viral and bacterial **

Question 33

CSF color: yellow ?

Answer 33

old blood or increase in protein

Question 34

Neonates # of cells ?

Answer 34

0-30

Question 35

CSF cells : WBC - Lymphocytes = ?

Answer 35

viral or TB meningitis, encephalitis

Question 36

CSF other tests: culture ?

Answer 36

abs tx.

Question 37

CSF other tests: cytology ?

Answer 37

CA cells

Question 38

Lumbar Puncture: pre-test ?

Answer 38

Obtain consent Baseline neuro eval (*pt’s legs!) Consider CT Consider Queckenstedt-Stookey test

Question 39

CSF other tests: Antigen/Antibody Tests | ?

Answer 39

Syphillis

Question 40

CSF protein: NL to large to cross the ?

Answer 40

BBB

Question 41

CSF cells ?

Answer 41

RBC WBC

Question 42

CSF cells : WBC - other ?

Answer 42

leukemia malignancy

Question 43

CSF: LDH in adults ?

Answer 43

Less than 40 U/L

Question 44

CSF chloride: increased ?

Answer 44

Correlates with blood levels Not significant

Question 45

1-5 y.o. # of cells ?

Answer 45

0-20

Question 46

CSF color: NL ?

Answer 46

typically CSF is completely clear - like purest water clear

Question 47

CSF increased pressure causes ?

Answer 47

meningitis tumors encephalitis bleeds hydrocephalus

Question 48

Cerebral Spinal Fluid (CSF) procedure: be sure to uses ______ technique

Answer 48

sterile

Question 49

CSF cells : WBC - PMNs (neutrophils) = ?

Answer 49

bacterial meningitis/abscess

Question 50

Queckenstedt-Stookey test explanation ?

Answer 50

Use gentle pressure or BP cuff to jugular vein. Rise in CSF pressure by 15-40 cm H2O, Fall within 10 seconds of release. ** blockage of the CSF is suspected ( BP cuff or hand to jugular vein and a rise of pressure 15 - 40 cm of water and a fall within 10 sec) sluggish opening pressure then we want to do this **

Question 51

LP procedure own notes ?

Answer 51

gloves on , sterile drape and fenestrated drop importent to feel landmarks before you put drape on between 3rd and 4th because of spacing ( to from tops of hips and then go straight back ) obesity and no land marks you can do a US guided LP first thing is numbing medicine and you go deeper and numb it as you go deeper and deeper ( same with epidural) ( going in with need you will feel resistance and then a pop) pull stylet back and then see if there is fluid ( if not fluid then try again go back in)

Question 52

CSF: LDH in neonates ?

Answer 52

Less than 70 U/L

Question 53

CSF protein: what makes BBB more permeable ?

Answer 53

infection inflammation * *so protein then can cross * *

Question 54

Blood Cultures indication ?

Answer 54

Concern for sepsis Post-op temp > 101.5 F

Question 55

CSF NL pressure ?

Answer 55

75-200 mm H2O (<20 cm H2O)

Question 56

``` Lumbar Puncture (Spinal Tap) indications ? ```

Answer 56

Meningitis SAH ICH Malignancy

Question 57

CSF: _______ ml bathes the brain and spinal cord and offers protection

Answer 57

150-200

Question 58

CSF other testing ?

Answer 58

immunoglobulins lyme HIV ( meningeal type sxs. that occurs with HIV - cytomegalovirus (CMV))

Question 59

Cerebral Spinal Fluid (CSF) procedure: patient position ?

Answer 59

Lie on side with back arched ( knees closed to chest)

Question 60

CSF: Lactic Acid Nl values ?

Answer 60

10-25 mg/dL

Question 61

CSF Lactic Dehyrogenase (LDH) increased ?

Answer 61

Infection Inflammation CNS leukemia tissue damage in the brain

Question 62

23 yo female presents with chills, nausea, right flank pain radiating to her suprapubic area x 2 days. Worsening. Exam findings: +right CVA tenderness +suprapubic tenderness Tachy HR VS: BP 96/52 T 103.7 F R 20 SPO2 98% RA HR 118

Answer 62

she is febrile think pyelonephritis - so get blood cultures for concern of sepsis

Question 63

Lumbar Puncture (Spinal Tap) Contraindications: relative ?

Answer 63

Increased ICP (causes brain herniation) Decreased clotting ability