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Duke PA CSF/Lumbar Puncture Diagnostic Methods

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Question
Answer
normal CSF pressure __ mm H2O   60-200  
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normal protein in CSF __ mg/dl   15-45  
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normal glucose in CSF __mg/dL   50-75  
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CSF contains __% of the blood glucose   60-70  
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when doing a lumbar puncture the needle is placed in the __ space of the spinal column   subarachnoid  
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CSF is made by selective secretion from the plasma by the __ in the ventricles of the brain   choroid plexus  
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CSF exists in the space between the __ and arachnoid mater   pia  
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there is about __ mL of CSF in a normal person   150-200  
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Chloride levels are __ in the CSF than in the plasma   higher  
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causes of increased intracranial and spinal pressure   tumors, infection, hydrocephalus, intracranial bleeding  
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obstruction of __ veins will increase intracranial pressure   jugular  
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causes of reduced intracranial and spinal pressure   shock, dehydration, leak from previous LP, nasal sinus fracture with a dura tear  
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if there are significant differences between beginning and ending LP pressures suspect __   spinal cord obstruction (tumor), or hydrocephalus  
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if high LP pressures are noted do not drain a normal volume of CSF because of the risk of __   cerebellar herniation  
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a cloudy appearance to CSF may indicate   increase in WBC's or protein level  
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if there is blood in the CSF no __ will occur if the blood is froma subarachnoid hemorrhage   clotting  
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if the initial CSF tube contains some blood but each additional tube becomes successively more clear, this indicates __   a traumatic puncture  
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the presence of polymorphic leukocytes (neutrophils) is indicative of __   bacterial meningitis, or cerebral abscess  
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when mononuclear leukocytes are present, __ is suspected   viral or tubercular meningitis, or encephalitis  
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leukemia or other primary or metastatic malignant tumors may cause elevated __   WBC's  
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__ is a term used to indicate turbidity of CSF because of an increased number of cells within the fluid   pleocytosis  
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the most common cause of meningitis in children   Haemophilus influenzae  
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the most common cause of meningitis in adults   Neisseria or Streptococcus  
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causes of increased protein in the CSF due to a more permeable blood brain barrier   meningitis, encephalitis, or myelitis  
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a non-inflammatory cause of elevated CSF protein   malignancy  
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because __ are not made in the CNS increased levels of these indicate increased permeability of the blood-brain barrier   albumin and prealbumin  
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a __ is usually obtained before the spinal tap is performed   blood glucose  
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a CSF glucose level <60% of the blood glucose may indicate   meningitis or neoplasm  
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quantification of __ is helpful in diagnosing bacterial meningitis   lactic dehydrogenase (LDH)  
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the source of LDH in the CSF is from __   neutrophils fighting infection  
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elevated levels of __ indicate anaerobic metabolism associated with decreased oxygenation of the brain, decreased glucose levels, or increased WBC's   lactic acid  
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because __ does not readily pass through the blood-brain barrier, elevated blood __ levels are not reflected in teh CSF   lactic acid  
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chronic cerebral hypoxemia or cerebral ischemia is associated with elevated CSF __ levels   lactic acid  
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elevated __ levels are helpful in the detection and evaluation of hepatic encephalopathy and hepatic coma. Elevated levels are also often increased in Reye syndrome   glutamine  
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failure to find elevated CRP levels in CSF appears to be strong evidence against __   bacterial meningitis  
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increased intracranial pressure is a __ to lumbar puncture   contraindication  
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post lumbar puncture keep the patient in a reclined position for up to __ hours to avoid the discomfort of potential postpuncture spinal headache   12  
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postpuncture assess the patient for __ of the extremities   numbness, tingling, and decreased movement  
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CSF is reabsorbed back into blood vessels by __ in the brain's sagittal sinus   arachnoidal villi  
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function of CSF   enhance brain nutrition, remove metabolic byproducts, protect against mechanical injury  
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indications for lumbar puncture   obtain CSF for laboratory analysis, determine spinal fluid pressure, administer radiopaque diagnostic agents (dyes) into CNS, administer drugs, remove excess CSF  
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contraindications to LP   suspected brain abscess (CSF studies usually not helpful), elevated intracranial pressure (especially if papilledema is present)  
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in children the spinal cord extends more __   caudally  
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LP risks   headache, pain, allergic reaction, infection, bleeding, paralysis, brain herniation/damage/death  
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most common adverse effect to LP   postdural puncture headache  
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attributed to leakage of CSF through the dural puncture site, decreasing CSF volume   postdural puncture headache  
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xanthochromia (yellow tinge) of CSF may be caused by   hyperbilirubinemia, hypercarotenemia, melanoma  
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normal # of cells in CSF   0-5 small lymphs/ml  
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cells that are always abnormal in CSF   granulocytes, large mononuclear cells, and RBCs  
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increased WBC's >100 are probably   infection  
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__ seen in shunt, parasitic infection and allergic reaction   eosinophils  
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__ are consistent with viral infection or other (TB, fungal, cancer)   lymphocytes  
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__ consistent with bacterial infection   PMN's  
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pressure normally drops __ mm for each ml of CSF removed   5-10  
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elevated pressure with normal CSF confirms __   pseudotumor cerebri (benign intracranial hypertension)  
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one instance where LP is done despite presence of papilledema   pseudotumor cerebri  
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not typically altered in viral meningitis, so lactate may help differentiate between viral and bacterial meningitis   CSF Lactate  
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