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  1. 3 mains functions of the CSF
    • provides physiologic system to supply nutrients to the nervous system
    • remove metabolic wastes
    • produce a mechanical barrier to cushion the brain and spinal cord against trauma
  2. the layer that lines the spinal cord and brain
  3. 3 layers of the meninges
    • dura mater
    • arachnoid
    • pia mater
  4. outmost layer of the meninges that lines the skull and verterbral canal
    dura mater
  5. a filamentous(spider-like) inner membrane 

    the middle lining of the meninges
  6. a thin membrane lining the surfaces of the brain and spinal cord
    pia mater
  7. where is CSF produced?
    choroid plexuses of the 2 lumbar ventricles and the 3rd and 4th ventricles
    • A. Choroid Plexus of Lateral Ventricle
    • B. Cerebrum
    • C. Choroid Plexus of Third Ventricle
    • D. Subarachnoid Space
    • E. Arachnoid villus/ granulation
    • F. Pia Mater
    • G. Arachnoid
    • H. Dura Mater
    • I. Cerebellum
    • J. Choroid Plexus of Fourth Ventricle
    • K. Spinal Cord
  8. how much CSF do adults produce?
  9. the hollow space between the arachnoid and pia mater where CSF flows
    subarachnoid space
  10. what is the amount of CSF maintained in adults?

    in children?
    • adults 90-150 mL
    • children 10-60 mL
  11. its function is to reabsorb CSF at a rate equal to its production
    arachnoid granulation/villae
  12. they function as one-way valves that respond to pressure within the CNS and prevent reflux of the fluid
    arachnoid granules/villae
  13. they are capillary networks that form the CSF from plasma by mechanisms of selective filtration under hydrostatic pressure and active transport secretion
    Choroid Plexuses
  14. True or False
    the chemical composition of the CSF does not resemble an ultrafiltrate of plasma
  15. the tight-fitting structure of the endothelial cells in the choroid plexuses that prevent chemicals, leukocytes, proteins to enter the CSF

    ** Why is it tight fit? as compared to those spread throughout the body?
    blood-brain barrier

    those spread throughout the body are loose to allow passage of soluble nutrients and wastes. this barrier was formed to prevent passage
  16. how is CSF routinely collected?
    lumbar puncture between the 3rd 4th and 5th lumbar vertebrae
  17. What is the proper intracranial pressure before lumbar puncture?
  18. in how many bottles/tubes is csf collected?

    and to what type of tests does each tube correspond to?
    3 bottles

    • Tube 1 - Chemical and Serologic
    • Tube 2 - Microbiology
    • Tube 3 - Cell Count
  19. What do you do with excess CSF fluid after all tests have been performed?
    Freeze until further use, or until it is certain that there is no more use for it
  20. How are CSF tubes maintained if it cannot be tested at once?
    • Tube 1 (Chem and Sero) - frozen
    • Tube 2 (Microbio) - Room Temp
    • Tube 3 (Hema) - Refrigerated

  21. Describe Each CSF Tube
    • 1 - Crystal Clear (normal)
    • 2 - Xanthochromic
    • 3 - Hemolyzed
    • 4 - Cloudy
  22. term used to describe CSF supernatant this pink, orange, or yellow
  23. What causes the pink, orange, or yellow color of the CSF?
    • Pink - very slight amount of oxyhemoglobin
    • Orange - heavy hemolysis
    • Yellow - Conversion of Oxyhemoglobin to unconjugated bilirubin
  24. How do you differentiate a traumatic tap from a cerebral hemorrhage?
    • Traumatic tap - heavy red at Tube 1
    • Cerebral Hemorrhage  - even distribution throughout the 3 specimen
  25. To what disease is a classic web-like pellicle associated with which can be seen after overnight refrigeration of the CSF?
    Tubercular Meningitis
  26. Do all bloody CSF clot?
    No, only when cayse by traumatic tap. an intracranial hemorrhage won't have enough fibrinogen to cause the clot
  27. In the CSF, what does the microscopic finding of macrophages containing ingested RBCs or hemosiderin granules indicative of?
    Intracranial hemorrhage
  28. What type of cell count is performed in CSF?
    leukocyte count (WBC)
  29. Will a CSF specimen produce accurate cell count if it is left to stand for more than 2 hours at room temp?
    no, WBC and RBC begin to lyse within 1 hour and 40% of the wbcs disintegrate after 2 hours

    it should be refrigerated if the cell count can not be done at once
    • A - Meningitis
    • B - Meningitis
    • C - Protein
    • D - Hemorrhage
    • E - Traumatic Tap
    • F - Hemoglobin
    • G - Bilirubin
    • H - Carotene
    • I - Protein
    • J - Meningeal melanosarcoma
    • K - Tubercular meningitis
  30. What is the normal amount of WBC found in the CSF of adults?
    0-5 WBC/uL
  31. What cells are normally found in the csf of children?
    30 mononuclear cells/uL
  32. What is the diluting fluid used for CSF total cell count?
    Normal Saline
  33. Diluting fluid used for CSF that lyses rbc
    3% glacial acetic acid
  34. Stain used for CSF WBC count to differentiate neutrophils from mononuclear cells
    Methylene Blue
  35. what are the cells normally found in the CSF?
    lymphocytes and monocytes
  36. term used for the presence of increased numbers of normal cells in CSF
    • A. Viral, Tubercular, and Fungal Meningitis
    • B. Multiple Sclerosis
    • C. Bacterial Meningitis
    • D. Early cases of viral, tubuercular, and fungal meningitis
    • E. Cerebral Hemorrhage
    • F. Viral, Tubercular, and Fungal Meningitis
    • G. Multiple Sclerosis
    • H. RBCs in spinal fluid
    • I. Acute Leukemia
    • J. Disseminated lymphomas
    • K. Multiple Sclerosis
    • L. Lymphocyte Reactions
    • M. Metastatic carcinomas
    • N. Primary CNS carcinoma
  37. What type of WBCs found in the CSF are increased in cases of HIV or AIDS?
  38. Type of WBC that is increased in association with parasitic infections, fungal infections
  39. most frequently performed chemical test on CSF
    protein determination
  40. normal value of protein in CSF
    15-45 mg/dL
  41. 2 most routinely used techniques for measuring total CSF protein
    • turbidity production (nephelometry)
    • dye-binding ability
  42. it is detected by electrophoresis which represent inflammation within the CNS
    oligoclonal bands
  43. its presence in the CSF may be indicative of recent destruction of the myelin sheath
    myelin basic protein
  44. normal value of glucose in CSF
    60-70% of plasma glucose
  45. in CSF
    low glucose + high neutrophils = a
    low glucose + high lympho = b
    normal glucose + high lympho = c
    • a. bacterial meningitis
    • b. tubercular meningitis
    • c. viral meningitis
  46. >35mg/dL of CSF Lactate = a
    <25 mg/dL of CSF Lactate = b
    • a. bacterial meningitis
    • b. viral meningitis
  47. the result of any condition that decreases flow of oxygen to the tissues in CNS
    elevated CSF lactate levels
    • A. Neutrophils present
    • B. Lymphocytes Present
    • C. Marked Protein Elevation
    • D. Moderate Protein Elevation
    • E. Markedly Decreased Glucose Level
    • F. Decreased Glucose Level
    • G. Normal to Decreased Glucose Level
    • H. Lactate Level >35mg/dL
    • I. Lactate Level >25mg/dL
    • J. Lactate Level >25mg/dL
    • K. Pellicle Formation
    • L. Positive India Ink with Cryptococcus neoformans
    • M. Positive Gram stain and bacterial Ag tests
    • N. Positive immunologic test for C. neoformans
  48. What is formed as a means of ridding ammonia from CNS?
  49. normal concentration of glutamine in the CSF
  50. in what syndrome do most children have elevated CSF glutamine levels?
    Reye syndrome
  51. formation of bacteria in culture after 6 weeks with CSF Specimen indicates what type of meningitis?
    tubercular meningitis
  52. at what level of glutamine is the disturbance of consciousness associated with?
    >35 mg/dL
  53. this test is taken alongside with CSF gram stain and culture, due to the 10% chance of the GS and CS being negative even if there is infection
    Blood Culture
  54. 4 types of bacteria frequently encountered in adult bacterial meningitis
    • Streptococcus pneumoniae (gram pos cocci)
    • Haemophilus influenzae (pleomorphic gram neg rods)
    • E. coli (gram neg rods)
    • Neisseria meningitidis (gram neg cocci)
  55. 2 bacteria frequently encountered in newborn bacterial meningitidis
    • Streptococcus agalactiae (gram pos cocci)
    • Listeria monocytogenes (gram pos rods)
  56. these tests are not routinely performed unless tubercular meningitidis is suspected
    acid-fast or fluorescent Ab stains
  57. What is more commonly found in CSF as a complication of AIDS?
    Cryptococcus meningitidis
  58. a more sensitive method than india ink
    latex agglutination tests
  59. Usual cause of false positive immunologic tests of Cryptococcus in CSF
    Rheumatoid factor
  60. what does the serologic testing of CSF detect?
    presence of neurosyphilis
  61. test recommended by the CDC for the diagnosis of neurosyphilis
  62. The functions of the CSF include all of the following except:
    A. Removal of metabolic wastes
    B. Producing an ultrafiltrate of plasma
    C. Supplying nutrients to the CNS
    D. Protection of the brain and spinal cord
  63. The CSF flows through the:
    A. Choroid plexus
    B. Pia mater
    C. Arachnoid space
    D. Dura mater
  64. Substances present in the CSF are contolled by the:
    A. Arachnoid granulations
    B. Blood-brain barrier
    C. Presence of one-way valves
    D. Blood-CSF barrier
  65. The CSF tube labeled 3 is sent to:
    A. The hematology department
    B. The chemistry department
    C. The microbiology department
    D. The serology department
  66. The CSF tube that should be refrigerated is:
    A. Tube 1
    B. Tube 2
    C. Tube 3
    D. Tube 4
  67. 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 greaterthan in tube 3
    _____Specimen contains clots
    • B
    • B
    • A
    • A
  68. 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
  69. A web-like pellicle in a refrigerated CSF specimen is indicative of:
    A. Tubercular meningitis
    B. Multiple sclerosis
    C. Primary CNS malignancy
    D. Viral meningitis
  70. 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
  71. A CSF WBC count is diluted with:
    A. Distilled water
    B. Normal saline
    C. Acetic acid
    D. Methylene blue
  72. 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
  73. 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
  74. 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
  75. Neutrophils with pyknotic nuclei may be mistaken for:
    A. Lymphocytes
    B. Nucleated RBCs
    C. Malignant cells
    D. Spindle-shaped cells
  76. The presence of which of the following cells is increased when a CNS shunt malfunctions?
    A. Neutrophils
    B. Macrophages
    C. Eosinophils
    D. Lymphocytes
  77. Macrophages appear in the CSF following:
    A. Hemorrhage
    B. Repeated spinal taps
    C. Diagnostic procedures
    D. All of the above
  78. 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
  79. Following 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
  80. Hemosiderin granules and hematoidin crystals are seen in:
    A. Lymphocytes
    B. Macrophages
    C. Ependymal cells
    D. Neutrophils
  81. Myeloblasts are seen in the CSF:
    A. In bacterial infections
    B. In conjunction with CNS malignancy
    C. Following cerebral hemorrhage
    D. As a complication of acute leukemia
  82. Cells resembling large and small lymphocytes with cleaved nuclei represent:
    A. Lymphoma cells
    B. Choroid cells
    C. Melanoma cells
    D. Medulloblastoma cells
  83. The normal value of CSF protein is:
    A. 6–8 g/dL
    B. 15–45 g/dL
    C. 6–8 mg/dL
    D. 15–45 mg/dL
  84. CSF can be differentiated from plasma by the presenceof:
    A. Albumin
    B. Globulin
    C. Prealbumin
    D. Tau transferrin
  85. In plasma, the second most prevalent protein is IgG;in CSF, the second most prevalent protein is:
    A. Transferrin
    B. Prealbumin
    C. IgA
    D. Ceruloplasmin
  86. Elevated CSF protein values can be caused by all of the following except:
    A. Meningitis
    B. Multiple sclerosis
    C. Fluid leakage
    D. CNS malignancy
  87. 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
  88. 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
  89. A CSF glucose of 15 mg/dL, WBC count of 5000, 90% neutrophils, and protein of 80 mg/dL is suggestive of:
    A. Fungal meningitis
    B. Viral meningitis
    C. Tubercular meningitis
    D. Bacterial meningitis
  90. A patient with a blood glucose of 120 mg/dL wouldhave a normal CSF glucose of:
    A. 20 mg/dL
    B. 60 mg/dL
    C. 80 mg/dL
    D. 120 mg/dL
  91. CSF lactate will be more consistantly decreased in:
    A. Bacterial meningitis
    B. Viral meningitis
    C. Fungal meningitis
    D. Tubercular meningitis
  92. 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. -ketoglutarate
  93. Prior to performing a Gram stain on CSF, the specimen must be:
    A. Filtered
    B. Warmed to 37C
    C. Centrifuged
    D. Mixed
  94. All of the following statements are true about cryptoccocal 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
  95. The test of choice to detect neurosyphilis is the:
    A. RPR
    B. VDRL
    C. FTA
    D. FTA-ABS

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2014-09-29 11:32:23
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