AUBF-READING ASSIGNMENT

CSF is produced mainly in the:

A. Bone marrow

B. Peripheral blood

C. Choroid plexuses

D. Subarachnoid space

C. Choroid plexuses

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

B. Producing an ultrafiltrate of plasma

The CSF flows through the:

A. Choroid plexus

B. Pia mater

C. Subarachnoid space

D. Dura mater

C. Subarachnoid space

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

B. Blood–brain barrier

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

A. Hematology

B. Chemistry

C. Microbiology

D. Serology

A. Hematology

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

A. Tube 1

B. Tube 2

C. Tube 3

D. Tube 4

B. Tube 2

7. 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

B, B, A, A

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

C. A recent hemorrhage

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

A. Tubercular meningitis

B. Multiple sclerosis

C. Primary CNS malignancy

D. Viral meningitis

A. Tubercular meningitis

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

C. 800

A CSF WBC count is diluted with:

A. Distilled water

B. Normal saline

C. Acetic acid

D. Hypotonic saline

C. Acetic acid

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

D. Counted undiluted

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

D. Both A and B

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

A. Meningitis

Neutrophils with pyknotic nuclei may be mistaken for:

A. Lymphocytes

B. Nucleated RBCs

C. Malignant cells

D. Spindle-shaped cells

B. Nucleated RBCs

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

A. Neutrophils

B. Macrophages

C. Eosinophils

D. Lymphocytes

C. Eosinophils

Macrophages appear in the CSF after:

A. Hemorrhage

B. Repeated spinal taps

C. Diagnostic procedures

D. All of the above

D. All of the above

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

D. Bone marrow contamination

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

D. All of the above

Hemosiderin granules and hematoidin crystals are seen in:

A. Lymphocytes

B. Macrophages

C. Ependymal cells

D. Neutrophils

B. Macrophages

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

D. As a complication of acute leukemia

Cells resembling large and small lymphocytes with cleaved nuclei represent:

A. Lymphoma cells

B. Choroid cells

C. Melanoma cells

D. Medulloblastoma cells

A. Lymphoma cells

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

B. 15 to 45 g/dL

CSF can be differentiated from serum by the presence of:

A. Albumin

B. Globulin

C. Transthyretin

D. Tau transferrin

D. Tau transferrin

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

A. Transferrin

B. Transthyretin

C. Prealbumin

D. Ceruloplasmin

C. Prealbumin

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

C. Fluid leakage

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

A. CSF/serum albumin index

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

C. 1.8

The CSF IgG index calculated in Study Question 28 indicates:

A. Synthesis of IgG in the CNS

B. Damage to the blood–brain barrier

C. Cerebral hemorrhage

D. Lymphoma infiltration

A. Synthesis of IgG in the CNS

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

C. Multiple sclerosis

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

D. Bacterial meningitis

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

C. 80 mg/dL

CSF lactate will be more consistently decreased in:

A. Bacterial meningitis

B. Viral meningitis

C. Fungal meningitis

D. Tubercular meningitis

B. Viral meningitis

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

A. Ammonia

Before performing a Gram stain on CSF, the specimen must be:

A. Filtered

B. Warmed to 37°C

C. Centrifuged

D. Mixed

C. Centrifuged

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

C. The WBC count is over 2000

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

D. PCR assay

The test of choice to detect neurosyphilis is the:

A. RPR

B. VDRL

C. FAB

D. FTA-ABS

B. VDRL

The functions of synovial fluid include all of the following except:

A. Lubrication for the joints

B. Removal of cartilage debris

C. Cushioning joints during jogging

D. Providing nutrients for cartilage

B. Removal of cartilage debris

The primary function of synoviocytes is to:

A. Provide nutrients for the joints

B. Secrete protein

C. Regulate glucose filtration

D. Prevent crystal formation

A. Provide nutrients for the joints

Which of the following tests is not performed frequently on synovial fluid?

A. Uric acid

B. WBC count

C. Crystal examination

D. Gram stain

A. Uric acid

The procedure for collecting synovial fluid is called:

A. Synovialcentesis

B. Arthrocentesis

C. Joint puncture

D. Arteriocentesis

B. Arthrocentesis

Match the following disorders with their appropriate group:

A. Noninflammatory

B. Inflammatory

C. Septic

D. Hemorrhagic

_____ Gout

_____ Neisseria gonorrhoeae infection

_____ Systemic lupus erythematosus

_____ Osteoarthritis

_____ Hemophilia

_____ Rheumatoid arthritis

_____ Heparin overdose

B, C, B, A, D, B, D

Normal synovial fluid resembles:

A. Egg white

B. Normal serum

C. Dilute urine

D. Lipemic serum

A. Egg white

Before testing, very viscous synovial fluid should be treated with:

A. Normal saline

B. Hyaluronidase

C. Distilled water

D. Hypotonic saline

B. Hyaluronidase

The color of the synovial fluid from a patient with a bacterial infection may be:

A. Yellow tinged

B. Green tinged

C. Red streaked

D. Opalescent

B. Green tinged

Which of the following could be affected most significantly if a synovial fluid is refrigerated before testing?

A. Glucose

B. Crystal examination

C. Mucin clot test

D. Differential

B. Crystal examination

The highest WBC count can be expected to be seen in patients with:

A. Noninflammatory arthritis

B. Inflammatory arthritis

C. Septic arthritis

D. Hemorrhagic arthritis

C. Septic arthritis

When diluting a synovial fluid WBC count, all of the following are acceptable except:

A. Acetic acid

B. Isotonic saline

C. Hypotonic saline

D. Saline with saponin

A. Acetic acid

The lowest percentage of neutrophils would be seen in patients with:

A. Noninflammatory arthritis

B. Inflammatory arthritis

C. Septic arthritis

D. Hemorrhagic arthritis

A. Noninflammatory arthritis

All of the following are abnormal when seen in synovial fluid except:

A. Neutrophages

B. Ragocytes

C. Synovial lining cells

D. Lipid droplets

C. Synovial lining cells

Synovial fluid crystals that occur as a result of purine metabolism or chemotherapy for leukemia are:

A. Monosodium urate

B. Cholesterol

C. Calcium pyrophosphate

D. Apatite

A. Monosodium urate

Synovial fluid crystals associated with inflammation in patients on dialysis are:

A. Calcium pyrophosphate dihydrate

B. Calcium oxalate

C. Corticosteroid

D. Monosodium urate

B. Calcium oxalate

Crystals associated with pseudogout are:

A. Monosodium urate

B. Calcium pyrophosphate dihydrate

C. Apatite

D. Corticosteroid

B. Calcium pyrophosphate dihydrate

Synovial fluid for crystal examination should be examined as a/an:

A. Wet preparation

B. Wright’s stain

C. Gram stain

D. Acid-fast stain

A. Wet preparation

Crystals that have the ability to polarize light are:

A. Corticosteroid

B. Monosodium urate

C. Calcium oxalate

D. All of the above

D. All of the above

In an examination of synovial fluid under compensated polarized light, rhomboid-shaped crystals are observed. What color would these crystals be when aligned parallel to the slow vibration?

A. White

B. Yellow

C. Blue

D. Red

B. Yellow

If crystals shaped like needles are aligned perpendicular to the slow vibration of compensated polarized light, what color are they?

A. White

B. Yellow

C. Blue

D. Red

C. Blue

Negative birefringence occurs under red-compensated polarized light when:

A. Slow light is impeded more than fast light

B. Slow light is impeded less than fast light

C. Fast light runs against the molecular grain of the crystal

D. Both B and C

C. Fast light runs against the molecular grain of the crystal

Often synovial fluid cultures are plated on chocolate agar to detect the presence of:

A. Neisseria gonorrhoeae

B. Staphylococcus agalactiae

C. Streptococcus viridans

D. Enterococcus faecalis

A. Neisseria gonorrhoeae

The chemical test performed most frequently on synovial fluid is:

A. Total protein

B. Uric acid

C. Calcium

D. Glucose

D. Glucose

Which of the following chemistry tests can be performed on synovial fluid to determine the severity of RA?

A. Glucose

B. Protein

C. Acid phosphatase

D. Uric acid

C. Acid phosphatase

Serological tests on patients’ serum may be performed to detect antibodies causing arthritis for all of the following disorders except:

A. Pseudogout

B. Rheumatoid arthritis

C. Systemic lupus erythematosus

D. Lyme arthritis

A. Pseudogout

The primary purpose of serous fluid is to:

A. Remove waste products

B. Lower capillary pressure

C. Lubricate serous membranes

D. Nourish serous membranes

C. Lubricate serous membranes

The membrane that lines the wall of a cavity is the:

A. Visceral

B. Peritoneal

C. Pleural

D. Parietal

D. Parietal

During normal production of serous fluid, the slight excess of fluid is:

A. Absorbed by the lymphatic system

B. Absorbed through the visceral capillaries

C. Stored in the mesothelial cells

D. Metabolized by the mesothelial cells

A. Absorbed by the lymphatic system

Production of serous fluid is controlled by:

A. Capillary oncotic pressure

B. Capillary hydrostatic pressure

C. Capillary permeability

D. All of the above

D. All of the above

An increase in the amount of serous fluid is called a/an:

A. Exudate

B. Transudate

C. Effusion

D. Malignancy

C. Effusion

Pleural fluid is collected by:

A. Pleurocentesis

B. Paracentesis

C. Pericentesis

D. Thoracentesis

D. Thoracentesis

Place the appropriate letter in front of the following statements describing transudates and exudates.

A. Transudate

B. Exudate

_____ Caused by increased hydrostatic pressure

_____ Caused by increased capillary permeability

_____ Caused by decreased oncotic pressure

_____ Caused by congestive heart failure

_____ Malignancy related

_____ Tuberculosis related

_____ Endocarditis related

_____ Clear appearance

B, A, A, A, B, B, B, A

Fluid: serum protein and lactic dehydrogenase ratios are performed on serous fluids:

A. When malignancy is suspected

B. To classify transudates and exudates

C. To determine the type of serous fluid

D. When a traumatic tap has occurred

B. To classify transudates and exudates

Which of the following requires the most additional testing?

A. Transudate

B. Exudate

B. Exudate

An additional test performed on pleural fluid to classify the fluid as a transudate or exudate is the:

A. WBC count

B. RBC count

C. Fluid:cholesterol ratio

D. Fluid-to-serum protein gradient

C. Fluid:cholesterol ratio

A milky-appearing pleural fluid indicates:

A. Thoracic duct leakage

B. Chronic inflammation

C. Microbial infection

D. Both A and B

D. Both A and B

Which of the following best represents a hemothorax?

A. Blood HCT: 42 Fluid HCT: 15

B. Blood HCT: 42 Fluid HCT: 10

C. Blood HCT: 30 Fluid HCT: 10

D. Blood HCT: 30 Fluid HCT: 20

D. Blood HCT: 30 Fluid HCT: 20

All of the following are normal cells seen in pleural fluid except:

A. Mesothelial cells

B. Neutrophils

C. Lymphocytes

D. Mesothelioma cells

D. Mesothelioma cells

A differential observation of pleural fluid associated with tuberculosis is:

A. Increased neutrophils

B. Decreased lymphocytes

C. Decreased mesothelial cells

D. Increased mesothelial cells

C. Decreased mesothelial cells

All of the following are characteristics of malignant cells except:

A. Cytoplasmic molding

B. Absence of nucleoli

C. Mucin-containing vacuoles

D. Increased nucleus:cytoplasm ratio

B. Absence of nucleoli

A pleural fluid pH of 6.0 indicates:

A. Esophageal rupture

B. Mesothelioma

C. Malignancy

D. Rheumatoid effusion

A. Esophageal rupture

Plasma cells seen in pleural fluid indicate:

A. Bacterial endocarditis

B. Primary malignancy

C. Metastatic lung malignancy

D. Tuberculosis infection

D. Tuberculosis infection

A significant cell found in pericardial or pleural fluid that should be referred to cytology is a:

A. Reactive lymphocyte

B. Mesothelioma cell

C. Monocyte

D. Mesothelial cell

B. Mesothelioma cell

Another name for a peritoneal effusion is:

A. Peritonitis

B. Lavage

C. Ascites

D. Cirrhosis

C. Ascites

A test performed primarily on peritoneal lavage fluid is a/an:

A. WBC count

B. RBC count

C. Absolute neutrophil count

D. Amylase

B. RBC count

The recommended test for determining whether peritoneal fluid is a transudate or an exudate is the:

A. Fluid:serum albumin ratio

B. Serum ascites albumin gradient

C. Fluid:serum lactic dehydrogenase ratio

D. Absolute neutrophil count

B. Serum ascites albumin gradient

Given the following results, classify this peritoneal fluid: serum albumin, 2.2 g/dL; serum protein, 6.0 g/dL; fluid albumin, 1.6 g/dL.

A. Transudate

B. Exudate

B. Exudate

Differentiation between bacterial peritonitis and cirrhosis is done by performing a/an:

A. WBC count

B. Differential

C. Absolute neutrophil count

D. Absolute lymphocyte count

C. Absolute neutrophil count

Detection of the CA 125 tumor marker in peritoneal fluid indicates:

A. Colon cancer

B. Ovarian cancer

C. Gastric malignancy

D. Prostate cancer

B. Ovarian cancer

Chemical tests primarily performed on peritoneal fluid include all of the following except:

A. Amylase

B. Glucose

C. Alkaline phosphatase

D. Calcium

D. Calcium

Cultures of peritoneal fluid are incubated:

A. Aerobically

B. Anaerobically

C. At 37°C and 42°C

D. Both A and B

D. Both A and B