Urinalysis and Body Fluids 6th Edition By Susan King Strasinger -Test Bank

Urinalysis and Body Fluids 6th Edition By Susan King Strasinger -Test Bank

Chapter 9: Cerebrospinal Fluid

Multiple Choice

1. 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

ANS: B
DIF: Level 1
OBJ: 1
TOP: Formation and physiology

2. 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

ANS: B
DIF: Level 1
OBJ: 1
TOP: Formation and physiology

3. 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

ANS: B
DIF: Level 1
OBJ: 1
TOP: Formation and physiology

4. 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

ANS: C
DIF: Level 1
OBJ: 1
TOP: Formation and physiology

5. The CSF circulates through the brain and spinal cord in the:
A. Arachnoid mater
B. Choroid plexuses
C. Dura mater
D. Subarachnoid space

ANS: D
DIF: Level 1
OBJ: 1
TOP: Formation and physiology

6. 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

ANS: C
DIF: Level 1
OBJ: 1
TOP: Formation and physiology

7. 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

ANS: D
DIF: Level 2
OBJ: 2
TOP: Specimen collection and handling

8. A xanthochromic CSF specimen will appear:
A. Crystal clear
B. White and turbid
C. Yellow and clear
D. Red and turbid

ANS: C
DIF: Level 1
OBJ: 3
TOP: Appearance

9. 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

ANS: A
DIF: Level 1
OBJ: 6
TOP: Cell counts

10. 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

ANS: D
DIF: Level 1
OBJ: 7
TOP: CSF cellular constituents

11. 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

ANS: D
DIF: Level 1
OBJ: 2
TOP: Specimen collection and handling

12. Cells seen in the CSF following pneumoencephalography are:
A. Choroid plexus
B. Lymphocytes
C. Highly vacuolated
D. Reactive mesothelial cells

ANS: A
DIF: Level 1
OBJ: 3
TOP: Differential count on a CSF specimen

13. 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

ANS: C
DIF: Level 1
OBJ: 6
TOP: Cytocentrifugation

14. 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

ANS: D
DIF: Level 1
OBJ: 9
TOP: Differential count on a CSF specimen

15. 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

ANS: C
DIF: Level 2
OBJ: 6
TOP: WBC count

16. 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

ANS: A
DIF: Level 2
OBJ: 6
TOP: WBC count

17. 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
ANS: C
DIF: Level 2
OBJ: 7
TOP: Neutrophils

18. 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

ANS: C
DIF: Level 2
OBJ: 6
TOP: Cytocentrifugation

19. 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

ANS: B
DIF: Level 2
OBJ: 5
TOP: Uneven blood distribution

20. The presence of hemosiderin containing macrophages in CSF indicates:
A. Fungal meningitis
B. Cerebral hemorrhage
C. Reye’s syndrome
D. Multiple sclerosis

ANS: B
DIF: Level 2
OBJ: 5
TOP: Macrophages

21. 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

ANS: D
DIF: Level 2
OBJ: 6
TOP: Calculating CSF cell counts

22. 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

ANS: D
DIF: Level 2
OBJ: 5
TOP: Uneven blood distribution

23. 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

ANS: C
DIF: Level 2
OBJ: 5
TOP: Xanthochromic supernatant

24. 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

ANS: C
DIF: Level 2
OBJ: 7
TOP: Lymphocytes and monocytes

25. 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

ANS: C
DIF: Level 2
OBJ: 9
TOP: Nonpathologically significant cells

26. 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

ANS: C
DIF: Level 2
OBJ: 3
TOP: Clot formation

27. 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

ANS: A
DIF: Level 2
OBJ: 6
TOP: Total cell count

28. Increased CSF eosinophils are associated with:
A. Multiple sclerosis
B. Introduction of foreign material
C. Human immunodeficiency virus
D. Viral meningitis

ANS: B
DIF: Level 2
OBJ: 9
TOP: Eosinophils

29. Melanoma cells in the CSF must be differentiated from:
A. Macrophages containing hemosiderin
B. Noncleaved lymphoma cells
C. Medulloblastoma cells
D. Ependymal cells

ANS: A
DIF: Level 3
OBJ: 8
TOP: Malignant cells of nonhematologic origin

30. 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

ANS: A
DIF: Level 1
OBJ: 10
TOP: Chemistry tests

31. Conditions that produce elevated CSF protein include all of the following except:
A. Fluid leakage
B. Meningitis
C. Multiple sclerosis
D. Hemorrhage

ANS: A
DIF: Level 1
OBJ: 10
TOP: Chemistry tests

32. 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
ANS: B
DIF: Level
OBJ: 10
TOP: Electrophoresis and immunophoretic techniques

33. 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

ANS: C
DIF: Level 1
OBJ: 13
TOP: CSF glucose

34. 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

ANS: B
DIF: Level 1
OBJ: 10
TOP: Myelin basic protein

35. 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

ANS: D
DIF: Level 1
OBJ: 12
TOP: Electrophoresis and immunophoretic techniques

36. 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

ANS: A
DIF: Level 1
OBJ: 12
TOP: Protein fractions

37. Measurement of CSF lactate is useful for monitoring cases of:
A. Multiple sclerosis
B. Bacterial meningitis
C. Reye’s syndrome
D. Tertiary syphilis

ANS: B
DIF: Level 1
OBJ: 14
TOP: CSF lactate

38. 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

ANS: C
DIF: Level 1
OBJ: 11
TOP: Protein fractions

39. 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

ANS: A
DIF: Level 1
OBJ: 11
TOP: Protein fractions

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

ANS: A
DIF: Level 1
OBJ: 14
TOP: CSF lactate

41. 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

ANS: D
DIF: Level 2
OBJ: 10
TOP: Protein fractions

42. Crystals with a bright yellow color seen in macrophages are called:
A. Unconjugated bilirubin
B. Hemosiderin
C. Hematoidin
D. Conjugated bilirubin

ANS: C
DIF: Level 1
OBJ: 8
TOP: Chemistry tests

43. 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

ANS: A
DIF: Level 2
OBJ: 12
TOP: Electrophoresis and immunophoretic techniques

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

ANS: D
DIF: Level 2
OBJ: 13
TOP: CSF glucose

45. 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

ANS: D
DIF: Level 2
OBJ: 14
TOP: CSF lactate

46. 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

ANS: C
DIF: Level 2
OBJ: 10
TOP: Methodology