CM Comprehensive Exam Study Notes
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Questions and Answers

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

  • Hematology (correct)
  • Chemistry
  • Microbiology
  • Serology

Which of the following findings is consistent with a subarachnoid hemorrhage rather than a traumatic tap?

  • A clear supernatant after centrifugation
  • Clearing of the fluid as it is aspirated
  • Xanthochromia (correct)
  • Presence of a protein in the sample

Which condition is most often associated with normal CSF glucose and protein?

  • Subarachnoid hemorrhage
  • Multiple sclerosis
  • Viral meningitis (correct)
  • Malignancy

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

<p>Tubercular meningitis (C)</p> Signup and view all the answers

Which observation is least useful in distinguishing a hemorrhagic serous fluid from a traumatic tap?

<p>The formation of a clot (B)</p> Signup and view all the answers

The finding of oligoclonal bands in the CSF and not in the serum is seen with:

<p>Multiple sclerosis (B)</p> Signup and view all the answers

CSF lactate will be more consistently decreased in:

<p>Viral meningitis (A)</p> Signup and view all the answers

Elevated CSF protein values can be caused by all of the following except:

<p>Fluid leakage (B)</p> Signup and view all the answers

What is the most common cause of male infertility?

<p>Varicocele (B)</p> Signup and view all the answers

Which morphological abnormality of sperm is most often associated with varicocele?

<p>Tapering of the head (D)</p> Signup and view all the answers

What is the upper limit of normal for white blood cells (WBCs) in seminal fluid analysis?

<p>1 × 10^6/mL (D)</p> Signup and view all the answers

Which carbohydrate measurement is clinically useful when performing a seminal fluid analysis?

<p>Fructose (B)</p> Signup and view all the answers

What should be done if the specimen for semen analysis is delayed more than 2 hours?

<p>Should be frozen (C)</p> Signup and view all the answers

Post-vasectomy semen analysis should be conducted how many months after the surgery?

<p>2 Months (A)</p> Signup and view all the answers

What does a red or brown discoloration in semen indicate?

<p>Blood (C)</p> Signup and view all the answers

How should specimens for FLM testing be transported and stored in the laboratory?

<p>Delivered on ice and refrigerated (A)</p> Signup and view all the answers

Which test best correlates with the severity of hemolytic disease of the fetus and newborn (HDFN)?

<p>Amniotic fluid bilirubin (C)</p> Signup and view all the answers

Which method is considered the reference for determining fetal lung maturity (FLM)?

<p>Lecithin/sphingomyelin (L/S) ratio (B)</p> Signup and view all the answers

What accurately describes human chorionic gonadotropin (hCG) levels in pregnancy?

<p>In ectopic pregnancy, serum hCG doubling time is below expected levels (A)</p> Signup and view all the answers

Which statement about alpha fetoprotein (AFP) levels is correct?

<p>Maternal serum may be used to screen for open neural tube defects (D)</p> Signup and view all the answers

Which amniotic fluid color indicates hemolytic disease of the newborn?

<p>Yellow - Hemolytic disease of the newborn (bilirubin) (A)</p> Signup and view all the answers

What is the purpose of detecting creatinine levels in amniotic fluid?

<p>Detect maternal urine (D)</p> Signup and view all the answers

At what gestational age is it recommended to determine early treatment or intervention for Down syndrome?

<p>15 to 18 weeks (D)</p> Signup and view all the answers

What specimen collection method is used for screening neural tube defects?

<p>Amniocentesis (C)</p> Signup and view all the answers

What reagent is used in the mucin clot test?

<p>Acetic acid (B)</p> Signup and view all the answers

Which crystal is most commonly associated with gout?

<p>Uric acid or monosodium urate (A)</p> Signup and view all the answers

What type of arthritis is characterized by a synovial WBC count greater than 50,000/µL?

<p>Septic arthritis (B)</p> Signup and view all the answers

Which cells in the stomach secrete hydrochloric acid (HCl) and intrinsic factor?

<p>Parietal cells (B)</p> Signup and view all the answers

What is the highest level of serum gastrin usually found in?

<p>Zollinger-Ellison (Z-E) syndrome (A)</p> Signup and view all the answers

What type of gastric tube is inserted through the nose?

<p>Levine tube (C)</p> Signup and view all the answers

Which type of crystal causes pseudogout?

<p>Calcium pyrophosphate dihydrate (A)</p> Signup and view all the answers

What type of fluid is collected by thoracentesis?

<p>Pleural fluid (C)</p> Signup and view all the answers

How many days will hCG in urine disappear after ectopic pregnancy?

<p>3-7 days (C)</p> Signup and view all the answers

Which animal source is used for anti-hCG in home-based pregnancy test kits?

<p>Rabbit (B)</p> Signup and view all the answers

What change in urine is an indicator of pre-eclampsia?

<p>Albuminuria (D)</p> Signup and view all the answers

What reagent is used in the Apt test?

<p>Sodium hydroxide (D)</p> Signup and view all the answers

Which factor will NOT interfere with the reagent strip test for leukocytes?

<p>Nitrite (A)</p> Signup and view all the answers

Which of the following statements about sputum is true?

<p>Produced by the tracheobronchial tree (C)</p> Signup and view all the answers

What is the renal threshold for glucose?

<p>160-180 mg/dL (B)</p> Signup and view all the answers

What is the renal threshold for potassium?

<p>Potassium has no threshold (B)</p> Signup and view all the answers

What is the most likely etiology of urethritis in a patient with dysuria, urgency, and urethral discharge?

<p>Neisseria gonorrhoeae (D)</p> Signup and view all the answers

Which condition is associated with urinalysis results in a patient with lupus erythematosus?

<p>Chronic glomerulonephritis (D)</p> Signup and view all the answers

What is the identity of the object pointed by the arrow in the microscopy image?

<p>Cholesterol crystal (A)</p> Signup and view all the answers

Which microscopy technique is depicted in the provided image?

<p>Interference contrast (B)</p> Signup and view all the answers

Identify the types of cells shown in the microscopy image.

<p>Transitional epithelial cells (C)</p> Signup and view all the answers

What type of fecal occult blood test (FOBT) kit is shown in the image?

<p>Guaiac-based (B)</p> Signup and view all the answers

Which cell type is indicated in the microscopy image?

<p>Sertoli cell (B)</p> Signup and view all the answers

The crystal observed in the image below is soluble in which of the following substances?

<p>A and B (C)</p> Signup and view all the answers

Flashcards

CSF tube 3 department

Hematology is the department where CSF tube 3 is routinely sent for analysis.

Subarachnoid hemorrhage

A subarachnoid hemorrhage is characterized by the finding of xanthochromia in CSF.

Normal CSF glucose & protein

Viral meningitis is most often associated with normal CSF glucose and protein levels.

Web-like pellicle in CSF

A web-like pellicle in refrigerated CSF suggests tubercular meningitis.

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CSF cell count (clear fluid)

A clear CSF fluid's cell count should be counted undiluted.

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Oligoclonal bands CSF

The presence of oligoclonal bands in CSF without serum bands is associated with multiple sclerosis.

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CSF lactate in viral meningitis

CSF lactate levels are consistently lower in cases of viral meningitis.

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Neurosyphilis detection

The VDRL (Venereal Disease Research Laboratory) test is the preferred method for detecting neurosyphilis.

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Normal Sperm Concentration

The minimum concentration of sperm per milliliter considered normal for semen analysis, it's 15 million per milliliter.

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Varicocele's Effect on Sperm Morphology.

A varicocele, a vein enlargement, is commonly associated with tapered sperm heads.

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Sperm Viability Stain

Eosin Y is used to stain sperm to assess their viability.

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Abnormal Semen Volume

A semen volume of 1.0 mL is considered abnormal.

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Semen WBC Limit

The upper limit of white blood cells (WBCs) in a healthy semen sample is 1 x 10^6/mL during analysis.

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Semen Carbohydrate

Fructose is the clinically significant carbohydrate to measure in semen analysis.

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Frozen Semen Handling

Storing semen samples for analysis in cases where they are delayed over 2 hours should involve freezing to preserve the semen quality.

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Post-Vasectomy Analysis Timing

Post-vasectomy semen analysis should be performed two months after the surgery.

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Uric acid crystals

Crystals found in gout, appearing yellow/blue under polarized light.

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Calcium pyrophosphate crystals

Crystals associated with pseudogout, appearing yellow/blue under polarized light.

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Septic arthritis

Arthritis caused by infection; synovial WBC count typically >50,000/µL

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Thoracentesis

Procedure to collect pleural fluid.

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EDTA

Anticoagulant used for synovial fluid chemistry tests.

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Rice bodies

Macroscopically resemble rice, microscopically containing collagen and fibrin. both statements are true

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Pernicious anemia

Condition caused by anti-intrinsic factor/anti-parietal cell antibodies, leading to achlorhydria and anacidity.

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Parietal cells

Secrete hydrochloric acid and intrinsic factor in the stomach.

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HDFN severity test

Amniotic fluid bilirubin level is the best test to evaluate the severity of hemolytic disease of the fetus and newborn (HDFN).

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Fetal lung maturity (FLM) reference method

Lecithin/sphingomyelin (L/S) ratio is the reference method to determine fetal lung maturity.

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hCG in ectopic pregnancy

In ectopic pregnancy, the serum hCG doubling time is below expected levels.

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Maternal serum AFP use

Maternal serum alpha-fetoprotein (AFP) is used to screen for open neural tube defects.

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Amniotic fluid creatinine detects

Amniotic fluid creatinine is used to detect maternal urine contamination in amniotic fluid samples.

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Down Syndrome testing window

A crucial window for evaluating Down Syndrome is between 15 and 18 weeks of gestation.

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Neural tube defects specimen

Amniocentesis is the specimen collection procedure for detecting neural tube defects.

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Alternative L/S ratio test (contaminated)

Aminostat is an alternative test to detect phospholipids for fetal lung maturity when samples are contaminated with blood or meconium.

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Endocervical glandular cells

These cells are found in the lining of the endocervical canal, which is the lower portion of the cervix.

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Type II pneumocytes

These cells are responsible for producing surfactant, a substance that reduces surface tension in the alveoli, allowing for easier breathing.

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hCG in urine after ectopic pregnancy

Human chorionic gonadotropin (hCG) levels typically decrease within 3-7 days after an ectopic pregnancy.

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Animal source of anti-hCG

The anti-hCG used in home pregnancy tests is obtained from rabbits.

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Sputum production

Sputum, a mixture of mucus and cells, is produced by the tracheobronchial tree, the airways of the lungs.

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Apt test reagent

The Apt test, used to differentiate fetal from maternal blood, uses sodium hydroxide as a reagent.

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Bence-Jones protein coagulation

Bence-Jones protein, a hallmark of multiple myeloma, coagulates at temperatures between 40-60°C and dissolves at 100°C.

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Urine test least affected by standing

Glucose levels in urine are the least affected by standing or lack of preservation.

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Urethritis Etiology

The most likely cause of urethritis in a young man presenting with dysuria, urgency, and urethral discharge is Neisseria gonorrhoeae.

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Urinalysis Findings and Lupus

Urinalysis results showing proteinuria, hematuria, and red blood cell casts are often associated with chronic glomerulonephritis in patients with lupus erythematosus.

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Microscopic Object

The image shows a cholesterol crystal, often found in urine sediment.

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Microscopy Type

The image was taken using interference contrast microscopy, which enhances the contrast of translucent specimens.

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Urine Cells

The image shows transitional epithelial cells, commonly found in urine.

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FOBT Kit Type

The image shows a guaiac-based FOBT (fecal occult blood test) kit.

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Cell in Image

The image points to a Sertoli cell, a type of cell found in the testes.

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Microscopic Finding Significance

The microscopic finding of red blood cells in the urine sediment indicates glomerular bleeding.

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Study Notes

CM Comprehensive Exam Study Notes

  • CSF Labelling and Department: CSF tubes labeled 3 are routinely sent to Microbiology.

  • Subarachnoid Hemorrhage vs. Traumatic Tap: A clear supernatant after centrifugation, and the presence of xanthochromia are more indicative of a traumatic tap than a subarachnoid hemorrhage, which is associated with clearing of fluid. Protein in the sample is not a useful differentiator.

  • Conditions with Normal CSF Glucose and Protein: Viral meningitis is most often associated with normal CSF glucose and protein levels.

  • Pellicle in Refrigerated CSF: A web-like pellicle in refrigerated CSF suggests tubercular meningitis.

  • CSF Cell Count: A total CSF cell count on a clear fluid should be reported as normal in the absence of additional factors or symptoms.

  • Hemorrhagic Serous Fluid vs. Traumatic Tap: The formation of a clot in the CSF, rather than clearing, suggests a hemorrhagic serous fluid as opposed to a traumatic tap. A diminished RBC count in successive aliquots is also less useful to distinguish these.

  • Oligoclonal Bands: The presence of oligoclonal bands in CSF but not in serum is associated with multiple sclerosis.

  • CSF Lactate: Viral meningitis is more consistently associated with lower CSF lactate levels compared to other causes like bacterial meningitis.

  • Neurosyphilis Test: The test of choice for detecting neurosyphilis is the VDRL test.

  • Elevated CSF Protein: Elevated CSF protein values are seen in conditions like meningitis, multiple sclerosis, and fluid leakage, but not always in CNS malignancy.

  • CSF Differentiation: CSF can be differentiated from serum by the presence of globulin.

  • Spermatozoa Maturation: Spermatozoa maturation occurs in the seminiferous tubules.

  • Semen Enzymes: Enzymes for semen coagulation and liquefaction originate from the seminal vesicles.

  • Temperature for CSF: The freezing temperature is a factor routinely sent to the CSF tubes labelled 3.

  • Time for Semen Liquefaction: Liquefaction of a semen specimen should take place within 1 hour.

  • -glucosidase Measurement: This enzymatic measurement aids in detecting disorders related to the seminiferous tubules, epididymis.

  • Motility Rating: Rapid, straight-line motility is recorded as 4.0

  • Common Cause of Male Infertility: Varicocele is the most common cause of male infertility.

  • Sperm Concentration: The lower limit of normal sperm concentration is 15 million per milliliter.

  • Sperm Morphological Abnormality: Tapering of the sperm head is the most frequent morphological abnormality associated with varicocele.

  • Semen Analysis Results: Abnormal results (volume, liquefaction, pH, motility) suggest analysis variation and should be verified.

  • Seminal Fluid Analysis WBCs: The upper limit of normal for WBCs in seminal fluid analysis is 1 x 106/mL.

  • Carbohydrate Measurement in Semen Analysis: Fructose level is clinically useful when performing a seminal fluid analysis.

  • Reagent Strips: When using reagent strips, maintain the strips at room temperature, and store in dark airtight containers; blot on tissue following use and do not expose strips to moisture.

  • Other Tests: The information discusses several other clinical tests, conditions, and factors relative to a comprehensive exam.

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Description

Prepare for your comprehensive exam with these detailed notes on cerebrospinal fluid (CSF) analysis and related conditions. This review covers important distinctions between subarachnoid hemorrhage and traumatic tap, normal CSF glucose and protein levels, as well as indications of various meningitis types. Ideal for medical students and exam candidates.

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