OTHER BODILY FLUIDS (CSF ONLY) | MTAP 1 | FINALS

This is considered as one of the major body fluid that nourishes the nervous system and removes metabolic wastes

CSF

All of the following are the roles of CSF, except:

A. Nourishes the nervous system

B. Regulation of pressure within the skull

C. Removes nitrogenous waste

D. Cushions the brain and the spinal cord from injury

Write E if there is no correct answer

C

What are the three meningeal layers that protects the brain and the spinal cord (IN ORDER FROM OUTER TO INNER)

Dura mater, arachnoid mater, pia mater

This is the outermost layer out of the three meningeal layer and it is also the nearest in the skull bone

Dura mater (hard mother)

This is the middle layer of the meningeal layers

Arachnoid mater

This meningeal layer resembles a spider web

Arachnoid mater

This is the innermost layer out of the three meningeal layers

Pia mater (gentle mother)

This meningeal layer lines the brain and the spinal cord

Pia mater (gentle mother)

How many percent of the CSF is produced in the choroid plexuses?

70%

Majority of the CSF is produced in the?

Choroid plexus of the ventricles

This is a network of blood vessels in the pia mater that is located within the brain’s four ventricles

Choroid plexus

This is a counterpart of epithelial cells that lines the brain and the spinal cord

Ependymal cells

What is the main difference of epithelial cells from ependymal cells?

A. Epithelial cells have a basement membrane while ependymal cells does not have a basement membrane

B. Ependymal cells have a basement membrane while epithelial cells does not have a basement membrane

C. They do not have any difference, both of them has a basement membrane

D. They do not have any difference, both of them does not have a basement membrane

A

TRUE or FALSE.

CSF is formed from a selective secretion from plasma and not as an ultrafiltrate of plasma

TRUE

How much of CSF is produced in adults every hour?

20mL

What is the total volume of CSF maintained in an adults?

90-150mL

What is the total volume of CSF maintained in an neonates?

10-60mL

CSF flows through a space called ___ which is in between the arachnoid and pia mater

Subarachnoid space

CSF is reabsorbed in the ____ to maintain fluid balance

Arachnoid granulations

This is found in the endothelial cells of brain capillaries

Blood-brain barrier

This is formed by tightly packed endothelial cells with tight junctions

Blood-brain barrier

Blood-brain barrier is supported by?

Astrocytes and a basement membrane

This protects the brain from harmful substances in blood

Blood-brain barrier

This regulates nutrients and ion transport for neural function

Blood-brain barrier

Blood-CSF barrier is located at the?

Choroid plexus

This is composed of epithelial cells and tight junctions

Blood-CSF barrier

This regulates CSF production

Blood-CSF barrier

This selectively transfer molecules between blood and CSF to maintain brain homeostasis

Blood-CSF barrier

CSF is typically collected via?

Lumbar puncture/lumbar tap

How will you know once the spinal needle is introduced in the lumbar interspace?

Pop sound

What is the first thing to do once the needle is inserted in the lumbar interspace?

Measure the CSF pressure

What is attached to the spinal needle which measures the CSF pressure?

Mamometer

A patient should be in what position when collecting CSF sample?

Lying or sitting position

If a patient is in a lying position, the opening CSF pressure should range from?

50-80mmHg

If the opening CSF pressure of a patient is within the normal range, how much of CSF can you collect?

20mL

A patient’s opening CSF pressure shows 120mmHg, how much of CSF can you collect?

1-2mL

TRUE or FALSE.

Opening CSF pressure can be slightly lower when the patient is in a sitting position

FALSE

In CSF collection, before withdrawing the needle, what should be done first?

Measure closing CSF pressure

What is the normal range of closing CSF pressure?

10-30mmHg

If there are three CSF samples in a sterile tube, the 1st tube should be sent for what testing?

Chemical and serological tests

If there are three CSF samples in a sterile tube, the 2nd tube should be sent for what testing?

Microbiology testing

If there are three CSF samples in a sterile tube, the 3rd tube should be sent for what testing?

Cell counts and cytological studies

TRUE or FALSE.

If there are extra fluid of CSF, it should be kept at room temperature for additional tests

FALSE

If there is a low volume of CSF, the test that should be processed first is the?

Microbiology testing

If there is a low volume of CSF, the test that should be processed second is the?

Cell count and cytological studies

If there is a low volume of CSF, the test that should be processed last is the?

Chemistry and serological tests

For the CSF analysis, all requests should be ordered as?

STAT

If the CSF sample cannot be processes immediately in the hematology section, what should be done?

Refrigerate sample (4 hours only)

If the CSF sample cannot be processes immediately in the microbiology section, what should be done?

Sample should be kept at room temperature

If the CSF sample cannot be processes immediately in the chemistry and serology section, what should be done?

Freeze samples

What is the appearance of a normal CSF?

Crystal clear

This appearance of CSF may indicate infection or elevated proteins/lipids

Cloudy, turbid or milky

Appearance of CSF that may be due to slightly amount of oxyhemoglobin

Pink

This appearance of CSF may be due to heavy hemolysis

Orange

This appearance of CSF may be due to conversion of oxyhemoglobin to unconjugated bilirubin

Yellow

XANTHOCHROMIA. Pink

A. Slightly amount of oxyhemoglobin

B. Heavy hemolysis

C. Conversion of oxyhemoglobin to unconjugated bilirubin

D. Infection of elevated proteins/lipids

Write E if there is no correct answer

A

XANTHOCHROMIA. Orange

A. Slightly amount of oxyhemoglobin

B. Heavy hemolysis

C. Conversion of oxyhemoglobin to unconjugated bilirubin

D. Infection of elevated proteins/lipids

Write E if there is no correct answer

B

XANTHOCHROMIA. Yellow

A. Slightly amount of oxyhemoglobin

B. Heavy hemolysis

C. Conversion of oxyhemoglobin to unconjugated bilirubin

D. Infection of elevated proteins/lipids

Write E if there is no correct answer

C

This appearance of CSF may be due to possible traumatic tap or subarachnoid hemorrhage

Bloodstained CSF

UNEVEN BLOOD DISTRIBUTION.

Blood is evenly distributed across all three collection tubes

A. Intracranial hemorrhage

B. Traumatic tap

C. Both

D. Neither

A

What should be the additional testing for uneven blood distribution in CSF specimen

Perform RBC counts in all tubes

CLOT FORMATION.

CSF may form clots due to the introduction of plasma fibrinogen

A. Intracranial hemorrhage

B. Traumatic tap

C. Both

D. Neither

B

CLOT FORMATION.

This typically does not clot as it contains little fibrinogen

A. Intracranial hemorrhage

B. Traumatic tap

C. Both

D. Neither

A

Xanthochromic supernatant indicates blood has been present in the CSF for how many hours?

More than 2 hours

This xanthochromic supernatant in the CSF shows what?

RBC degradation

XANTHOCHROMIC SUPERNATANT

Xanthochromia is more common due to prolonged presence of RBCs

A. Intracranial hemorrhage

B. Traumatic tap

C. Both

D. Neither

A

XANTHOCHROMIC SUPERNATANT

Xanthochromia may occur if a recent hemorrhage has been present

A. Intracranial hemorrhage

B. Traumatic tap

C. Both

D. Neither

B

This is the presence of macrophages engulfing/containing RBCs which suggests an intracranial hemorrhage

Erythrophagocytosis

In microscopic examination of CSF, erythrophagocytosis suggests a/an

A. Traumatic tap

B. Intracranial hemorrhage

C. Both

D. Neither

B

In microscopic examination of CSF, this is found in macrophages further indicating hemorrhage

Hemosiderin granules

What do you call a macrophage that contains hemosiderin granules

Siderophage

For the routine cell count of CSF, this typically focuses on what type of cell count?

WBC cell count

This type of cell count is primarily done to correct for traumatic taps and are not routinely done

RBC cell count

Normal adult CSF contains how much of WBC?

0-5 WBC/ul

TRUE OR FALSE.

In children, WBC in CSF is slightly higher compared to adults

TRUE

30 mononuclear cells/ul in a CSF sample is typically seen in?

Newborns

What is used to perform accurate cell counts?

Neubauer counting chamber

A CSF specimen with high neutrophil counts may be indicative of?

Bacterial meningitis

40% of WBCs in CSF lyse at what temperature

Room temperature

WBCs in CSF will start to lyse at what hour?

2 hours

TRUE or FALSE.

When performing cell count in CSF is delayed, it should be refrigerated in order for the WBCs to not lyse

FALSE

What is the depth when performing/calculating cell count

0.1 milimeter

Diluted specimens of CSF in preparation for cell counting should be prepared using?

Calibrated pipette and normal saline

This is essential for diagnosing various conditions affecting the CNS

Differential cell count on CSF

A doctor suspects that a patient has a condition that affects his/her central nervous system, what test should be done?

A. RBC cell count

B. WBC cell count

C. Differential cell count

D. D-dimer test

Write E if there is no correct answer

C

Differential cell count helps identify the type of cells present in the CSF, which can point towards?

Infection, malignancies or hemorrhages

TRUE or FALSE.

Performing differential cell count on CSF is the same as performing differential cell count on blood samples

TRUE

TRUE or FALSE.

Performing differential cell count on a stained smear is not recommended as it can be poor, leading to possible misidentification or omission of abnormal cells

FALSE

In performing differential count on CSF in a stained smear, we should use what type of microscopic lens?

Oil immersion objective

A high neutrophil count indicates what type of infection?

Bacterial infection

A high lymphocyte count indicates what type of infection?

Viral infection

This is done to concentrate CSF specimen but is not routinely used as it is time consuming and expensive, however this can produce less cellular distortion

Sedimentation and filtration

What is/are commonly used to concentrate the CSF specimen

Cytocentrifugation and centrifugation

This is used to concentrate CSF specimen that produce concentrated monolayers of cells within a 6-mm diameter on the slide, providing the best results for a differential count

Cytocentrifugation

This is used by lab without access to cytocentrifuge equipment for concentrating CSF specimen

Routine centrifugation

After centrifugation, in preparation of concentrated specimen of CSF, what is placed onto the slide?

A. Supernatant

B. Sediment

C. Both

D. Neither

B

In preparation of concentrated CSF specimen, when using routine centrifugation, the specimen should be centrifuged for how many minutes?

5-10 minutes

In CSF specimen, after centrifugation, the ___ is used for differential counting

A. Sediment

B. Supernatant

C. Both

D. Neither

A

In CSF specimen, after centrifugation, the ___ is saved for additional testing

A. Sediment

B. Supernatant

C. Both

D. Neither

B

In preparation of differential cell count on CSF, the slide is then air dried and stained with ___ to enhance cellular visibility and differentiation

Wright’s stain