Deck 9: Cerebrospinal Fluid

Question 1

Cell counts on CSF are performed on:

A) Cells as they are counted in the hemocytometer
B) Cover-slipped wet preparations
C) Stained smears prepared from the undiluted specimen
D) Stained smears prepared from a concentrated specimen

Answer 1

A

Question 2

The average volume of CSF in an adult is:

A) 10 to 60 mL
B) 50 to 100 mL
C) 90 to 150 mL
D) 200 to 250 mL

Answer 2

C

Question 3

All of the following are functions of the cerebrospinal fluid (CSF)except:

A) Nutritional enrichment of nervous tissue
B) Transmission of neurologic impulses
C) Removal of metabolic waste products
D) Protection of neurologic tissue from trauma

Answer 3

B

Question 4

The primary disadvantage in using a cytocentrifuge to prepare CSF differential slides is:

A) Frequent bacterial contamination
B) Uneven distribution of cells
C) Cellular distortion
D) Increased cost

Question 5

CSF is produced primarily by:

A) Secretion by cells of the arachnoid villi
B) Diffusion from the plasma into the central nervous system (CNS)
C) Selective filtration of plasma in the choroid plexus
D) Excretions from the ependymal cells lining the central nervous system

Question 6

Cells seen in the CSF following pneumoencephalography are:

A) Choroid plexus
B) Lymphocytes
C) Highly vacuolated
D) Reactive mesothelial cells

Question 7

Nucleated red blood cells (RBCs)seen in the CSF indicate:

A) Recent cerebral hemorrhage
B) Acute leukemia
C) A ventricular rather than a lumbar puncture
D) Bone marrow contamination from the puncture

Question 8

A broad spectrum of reactive and nonreactive lymphocytes in the CSF is associated with:

A) Bacterial meningitis
B) Allergic reactions
C) Cerebral hemorrhage
D) Viral meningitis

Question 9

When using the cytocentrifuge,a daily control slide of saline and albumin is prepared to check:

A) The correct centrifuge speed
B) For the presence of WBCs
C) For bacterial contamination
D) The pH of staining buffer

Question 10

To determine the WBC count on a cloudy CSF specimen that contains both RBCs and WBCs,it is necessary to:

A) Dilute the specimen using glacial acetic acid
B) Dilute the specimen using saline
C) Determine the percentage of polynuclear and mononuclear cells in the counting chamber
D) Centrifuge the specimen before diluting with saline and gentian violet

Question 11

Three tubes of CSF are submitted to the laboratory.They are numbered 1,2,and 3 and show blood in all tubes but decreasing in amount as one inspects tubes 1 through 3.This observation should be interpreted as:

A) The tubes were numbered in the wrong sequence, as one would expect increasing amounts of blood
B) A traumatic or bloody tap is suspected and, in all likelihood, no pathogenic significance should be attached to the presence of the blood
C) The pathologic presence of RBCs and reported to the supervisor immediately
D) A pathologic presence of RBCs, but because the RBC morphology is normal there is minimal importance

Question 12

An increase in neutrophils with pyknotic nuclei can be seen in which situation?

A) Patient with bacterial meningitis
B) Patient with fungal meningitis
C) Traumatic tap specimen
D) Patients on medication

Question 13

The presence of hemosiderin containing macrophages in CSF indicates:

A) Fungal meningitis
B) Cerebral hemorrhage
C) Reye's syndrome
D) Multiple sclerosis

Question 14

White blood cell (WBC)counts on clear CSF specimens are performed:

A) Using centrifuged specimens
B) Only if multiple sclerosis is suspected
C) On undiluted specimens if there is no cell overlapping
D) On specimens diluted 1:200 with gentian violet

Question 15

The CSF circulates through the brain and spinal cord in the:

A) Arachnoid mater
B) Choroid plexuses
C) Dura mater
D) Subarachnoid space

Question 16

If CSF tubes numbered 2 and 3 cannot be analyzed within 1 hour,the correct procedure is to:

A) Refrigerate both tubes
B) Leave both tubes at room temperature
C) Refrigerate tube 2 and freeze tube 3
D) Refrigerate tube 3 and leave tube 2 at room temperature

Question 17

The third tube of CSF collected from a lumbar puncture should be used for:

A) Chemistry tests
B) Cytology examination
C) Microbiology tests
D) Hematology tests

Question 18

Chemical analysis of CSF shows that the fluid contains:

A) Plasma chemicals in the same concentration as in the plasma
B) Plasma chemicals in concentrations different from those in the plasma
C) More chemicals than are found in plasma
D) Fewer chemicals than are found in plasma

Question 19

CSF is formed in the _______________ and reabsorbed by the _______________.

A) Ventricles, spinal cord
B) Choroid plexus, arachnoid granulations
C) Arachnoid space, blood-brain barrier
D) Blood-brain barrier, arachnoid granulations

Question 20

A xanthochromic CSF specimen will appear:

A) Crystal clear
B) White and turbid
C) Yellow and clear
D) Red and turbid

Question 21

The normal CSF glucose is:

A) 25 to 50 mg/dL
B) 80 to 120 mg/dL
C) 60% to 70% of the blood glucose
D) 10% to 20% higher than the blood glucose

Question 22

Damage to the blood-brain barrier by Mycobacterium tuberculosis may cause the CSF to:

A) Appear blood-streaked
B) Appear xanthochromic
C) Contain a pellicle or clot
D) Contain decreased protein

Question 23

Measurement of CSF lactate is useful for monitoring cases of:

A) Multiple sclerosis
B) Bacterial meningitis
C) Reye's syndrome
D) Tertiary syphilis

Question 24

Melanoma cells in the CSF must be differentiated from:

A) Macrophages containing hemosiderin
B) Noncleaved lymphoma cells
C) Medulloblastoma cells
D) Ependymal cells

Question 25

Examination of a CSF shows 1000 WBCs,of which 75% are lymphocytes and 25% are monocytes.This finding is consistent with:

A) Normal spinal fluid
B) Bacterial meningitis
C) Viral meningitis
D) Multiple sclerosis

Question 26

When performing protein electrophoresis on CSF,why is it important to also perform a serum protein electrophoresis?

A) To determine that the correct patient sample is used
B) To determine if oligoclonal banding in the CSF is due to a neurologic inflammation
C) To determine cases of neurosyphilis
D) To determine the stage of a neoplastic disorder

Question 27

Increased CSF eosinophils are associated with:

A) Multiple sclerosis
B) Introduction of foreign material
C) Human immunodeficiency virus
D) Viral meningitis

Question 28

Conditions that produce elevated CSF protein include all of the following except:

A) Fluid leakage
B) Meningitis
C) Multiple sclerosis
D) Hemorrhage

Question 29

The normal CSF protein is:

A) 15 to 45 mg/dL
B) 15 to 45 g/dL
C) 50 to 100 mg/dL
D) 50 to 100 g/dL

Question 30

Myelin basic protein is measured in the CSF to assess the condition of patients with:

A) Cerebral hemorrhage
B) Multiple sclerosis
C) Bacterial meningitis
D) Neurosyphilis

Question 31

A slightly hazy CSF specimen is diluted 1:10 with acetic acid.A total of 50 cells are counted in five large squares on both sides of the Neubauer counting chamber.The count is reported as:

A) 50 cells/µL
B) 55 WBCs/µL
C) 250 cells/µL
D) 500 WBCs/µL

Question 32

The CSF/serum albumin index is performed to determine:

A) The amount of albumin in the CSF
B) Synthesis of IgG within the CNS
C) The integrity of the blood-brain barrier
D) If an unknown fluid is in the CSF

Question 33

A CSF specimen,in which there is uneven distribution of blood among the three tubes and clots are detected,is an indication of:

A) Meningitis
B) Cerebral hemorrhage
C) Multiple sclerosis
D) Traumatic tap

Question 34

To determine if IgG is being produced within the central nervous system,the laboratory must calculate the:

A) IgG index
B) Serum albumin index
C) IgG/albumin index
D) CSF/albumin index

Question 35

Dilution of CSF prior to performing a total cell count should be made using:

A) Normal saline
B) Deionized water
C) Acetic acid
D) Acetic acid containing methylene blue

Question 36

The presence of xanthochromia and an increased D-dimer test in the CSF is indicative of:

A) A traumatic tap
B) Multiple sclerosis
C) A cerebral hemorrhage
D) Viral meningitis

Question 37

If protein electrophoresis was performed on both serum and CSF,which of the following components would have a higher ratio to total protein in the CSF than in the serum?

A) Transferrin
B) Ceruloplasmin
C) Albumin
D) Prealbumin

Question 38

When choroid plexus cells are present in the CSF,they:

A) Are clinically significant
B) Represent demyelination of neural tissue
C) May resemble clusters of malignant cells
D) Indicate a breakdown of the blood-brain barrier

Question 39

An IgG index greater than 0.77 indicates:

A) Synthesis of IgG within the CNS
B) Alterations of the blood-brain barrier
C) Active demyelination of neural tissue
D) Increased reabsorption of IgG from the peripheral blood

Question 40

The lowest levels of CSF lactate can be found in patients with:

A) Bacterial meningitis
B) Viral meningitis
C) Tubercular meningitis
D) Fungal meningitis

Question 41

When a CSF specimen is received in the microbiology laboratory,the first thing the technologist should do is:

A) Perform a Gram stain
B) Perform an India ink preparation
C) Centrifuge the specimen
D) Streak the fluid on chocolate agar

Question 42

The presence of increased glutamine in the CSF can indicate:

A) Fungal meningitis
B) Cerebral hemorrhage
C) Reye's syndrome
D) Multiple sclerosis

Question 43

The IgG index is a comparison between the:

A) CSF IgG and serum IgG
B) CSF albumin index and serum IgG
C) CSF/serum albumin index and CSF/serum IgG index
D) Serum albumin and CSF/serum IgG index

Question 44

The primary cause of a decreased CSF glucose in bacterial meningitis is:

A) Utilization of glucose by the microorganisms present in the fluid
B) Rapid glycolysis
C) Utilization of glucose by leukocytes present in the fluid
D) Alteration of blood-brain glucose transport

Question 45

CSF electrophoresis can be used to confirm the diagnosis of multiple sclerosis and would be expected to show which of the following?

A) Increased IgG with oligoclonal bands not seen on serum electrophoresis
B) Increased IgG with oligoclonal bands similar to those seen on serum electrophoresis
C) Decreased IgG with antibody-specific oligoclonal bands
D) Decreased IgG with oligoclonal bands resembling those seen on serum electrophoresis

Question 46

A report of many gram-positive cocci on a clear CSF sample with a normal cell count may be the result of:

A) An incorrect cell count
B) Effective antibiotic treatment
C) Use of contaminated albumin in the cytocentrifuge
D) Use of recycled cytocentrifuge chambers

Question 47

Crystals with a bright yellow color seen in macrophages are called:

A) Unconjugated bilirubin
B) Hemosiderin
C) Hematoidin
D) Conjugated bilirubin

Question 48

The CSF glucose in a patient with a blood glucose of 90 mg/dL is 60 mg/dL.These results are representative of:

A) An improperly preserved specimen
B) Bacterial meningitis
C) Normal CSF
D) Damage to the blood-brain barrier

Question 49

Gram stains performed on CSF specimens are helpful in the:

A) Diagnosis of tubercular meningitis
B) Diagnosis of bacterial meningitis
C) Detection of viral meningitis
D) Detection of bacterial and fungal meningitis

Question 50

A questionable India ink preparation on the CSF from an immunocompromised patient should be further tested using:

A) A cryptococcal antigen test
B) A bacterial antigen panel
C) Counterimmunoelectrophoresis
D) An anaerobic culture

Question 51

Normal CSF protein differs from serum protein by the:

A) Presence of IgG
B) Presence of haptoglobin
C) Presence of ceruloplasmin
D) Absence of fibrinogen

Question 52

A CSF protein report of 32 g/dL:

A) Is normal
B) Indicates possible multiple sclerosis
C) Is an erroneous report
D) Should be followed by electrophoresis

Question 53

Specimens from patients suspected of having fungal meningitis should be tested with:

A) Gram stain, acid-fast stain, and India ink
B) Gram stain and India ink
C) India ink only
D) Acid-fast stain and India ink

Question 54

A CSF glutamine level is an indirect measure of CSF:

A) Lactate
B) Hypoxia
C) Ammonia
D) Creatine kinase

Question 55

An IgG index of 1.10 would most likely be seen in a patient diagnosed with:

A) Meningitis
B) Cerebral hemorrhage
C) Leukemia
D) Multiple sclerosis

Question 56

Oligoclonal bands are significant in the diagnosis of multiple sclerosis when:

A) They are seen in both the serum and CSF
B) At least five bands are seen in the CSF
C) They are seen in the CSF and not in the serum
D) They appear in both the albumin and globulin fractions of serum and CSF

Question 57

An unknown bodily fluid can be identified as CSF by determining the:

A) Lactate content
B) Albumin content
C) Presence of "tau" transferrin
D) Presence of oligoclonal banding

Question 58

Which of the following structures contain one-way valves?

A) Choroid plexus
B) Endothelial cells
C) Blood-brain barrier
D) Arachnoid granulations

Question 59

Measurement of CSF lactate levels is a valuable aid for all of the following except:

A) Preliminary diagnosis of tubercular meningitis
B) Preliminary diagnosis of viral meningitis
C) Monitoring the effects of antibiotic treatment
D) Distinguishing between viral and fungal meningitis

Question 60

India ink preparations are useful in the diagnosis of:

A) Fungal meningitis
B) Bacterial meningitis
C) Tubercular meningitis
D) Multiple sclerosis

Question 61

A patient previously diagnosed with acquired immunodeficiency arrives in the emergency room with symptoms of meningitis.A lumbar puncture is performed.
Based on the information provided,what diagnostically significant observation might be made on the Gram stain?

A) Gram-positive cocci
B) Gram-negative rods
C) Starburst microbial pattern
D) Fungal mycelia

Question 62

A lumbar puncture is performed on a 40-year-old man experiencing symptoms of blurred vision and numbness in his extremities.Results are:
Based on the information provided,what abnormality is present in the CNS of this patient if the IgG index is calculated to be above 0.70?

A) CSF leakage
B) Decreased blood-brain barrier integrity
C) Neural IgG synthesis
D) Bacterial meningitis

Question 63

Xanthochromic CSF may appear pink,orange,or yellow.

Question 64

A lumbar puncture is performed on a 40-year-old man experiencing symptoms of blurred vision and numbness in his extremities.Results are:
Based on the information provided,calculate the IgG index for this patient.

A) 0.94
B) 1.07
C) 2.1
D) 3.0

Question 65

Calculate the WBC count in the following from the information provided:
Using an undiluted specimen,100 cells are counted in the nine large squares on one side of the hemocytometer.

A) 90 cells/µL
B) 111 cells/µL
C) 901 cells/µL
D) 1111 cells/µL

Question 66

Calculate the WBC count in the following from the information provided:
Using a 1:10 dilution,64 cells are counted in five large squares on both sides of the hemocytometer.

A) 64 cells/µL
B) 128 cells/µL
C) 640 cells/µL
D) 1280 cells/µL

Question 67

A patient previously diagnosed with acquired immunodeficiency arrives in the emergency room with symptoms of meningitis.A lumbar puncture is performed.
Using the information provided,in addition to Gram stain,what additional testing should be performed?

A) VDRL
B) Electrophoresis
C) Cryptococcal antigen test
D) Differential of peripheral blood

Question 68

Neutrophils may be present in normal CSF.

Question 69

A positive fluorescent treponemal antibody absorption test (FTA-ABS)and a positive CSF venereal disease research laboratory test (VDRL)indicate:

A) A false-positive reaction
B) Neurosyphilis
C) Failure to inactivate the CSF
D) The need to perform a rapid plasma reagin test

Question 70

A lumbar puncture is performed on a 40-year-old man experiencing symptoms of blurred vision and numbness in his extremities.Results are:
Based on the information provided,which laboratory value is not needed to aid in the diagnosis?

A) CSF albumin
B) CSF IgG
C) Serum albumin
D) CSF WBC count

Question 71

A positive serum FTA-ABS and a negative VDRL on CSF indicate:

A) Neurosyphilis
B) An improperly collected specimen
C) Successfully treated syphilis
D) Outdated VDRL reagents

Question 72

Using the following laboratory results,determine whether they represent bacterial,viral,tubercular,or fungal meningitis:

A) Bacterial
B) Viral
C) Fungal
D) Tubercular

Question 73

Using the following laboratory results,determine whether they represent bacterial,viral,tubercular,or fungal meningitis:

A) Bacterial
B) Viral
C) Fungal
D) Tubercular

Question 74

A lumbar puncture is performed on a 40-year-old man experiencing symptoms of blurred vision and numbness in his extremities.Results are:
Based on the information provided,calculate the CSF/serum albumin index for this patient.

A) 0.125
B) 8.0
C) 35.0
D) 200.0

Question 75

A positive cryptococcal antigen test with a negative India ink preparation may indicate:

A) Bacterial rather than fungal meningitis
B) Tubercular meningitis
C) The failure to inactivate the CSF
D) The presence of rheumatoid factor

Question 76

A patient previously diagnosed with acquired immunodeficiency arrives in the emergency room with symptoms of meningitis.A lumbar puncture is performed.
Based on the information provided,what type of meningitis would most probably be suspected in this patient?

A) Fungal
B) Viral
C) Bacterial
D) Tubercular

Question 77

A lumbar puncture is performed on a 40-year-old man experiencing symptoms of blurred vision and numbness in his extremities.Results are:
Using the information provided,based on the symptoms and laboratory tests ordered,what disorder does the physician suspect?

A) Late cerebral hemorrhage
B) Viral meningitis
C) Multiple sclerosis
D) CSF leakage

Question 78

A false-positive CSF serologic test for neurosyphilis in a treated patient can occur if:

A) The VDRL testing method is used
B) Fluid from a traumatic tap is tested by the FTA-ABS test
C) The fluid is frozen before testing
D) Increased protein is present in the fluid

Question 79

Calculate the WBC count in the following from the information provided:
Using a 1:10 dilution,120 cells are counted in the four large corner squares on one side of the hemocytometer.

A) 120 cells/µL
B) 1200 cells/µL
C) 2000 cells/µL
D) 3000 cells/µL

Question 80

Using the following laboratory results,determine whether they represent bacterial,viral,tubercular,or fungal meningitis:

A) Bacterial
B) Viral
C) Fungal
D) Tubercular