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Questions and Answers
What is the primary concern when blood is present in the sample collected for examination?
What is the primary concern when blood is present in the sample collected for examination?
- It causes inaccurate results for all tests.
- It only affects the serological tests.
- It has no impact on the examination.
- It affects all tests except for chlorides. (correct)
What is the recommended amount of fluid needed for a complete examination?
What is the recommended amount of fluid needed for a complete examination?
- At least 12 cc.
- At least 5 cc.
- At least 10 cc.
- At least 8 to 10 cc. (correct)
Which test can be delayed several hours after collecting the fluid?
Which test can be delayed several hours after collecting the fluid?
- Cell count and examination for bacteria.
- Qualitative protein tests.
- Serological and biochemical tests. (correct)
- Bacteriological examination.
How should the first drops be handled during the collection process?
How should the first drops be handled during the collection process?
In what scenario should the fluid collected with blood be used?
In what scenario should the fluid collected with blood be used?
What should be added to tubes 2 and 3 if the fluid is xanthochromic?
What should be added to tubes 2 and 3 if the fluid is xanthochromic?
What is the estimated normal amount of daily fluid production per pound of body weight?
What is the estimated normal amount of daily fluid production per pound of body weight?
What condition might cause an increased amount of fluid due to congestion of the meninges?
What condition might cause an increased amount of fluid due to congestion of the meninges?
What is the method to ensure that the spinal fluid is mixed properly before transferring?
What is the method to ensure that the spinal fluid is mixed properly before transferring?
Which step is crucial for preparing clean glassware before handling spinal fluid samples?
Which step is crucial for preparing clean glassware before handling spinal fluid samples?
What is the purpose of the 11th and 12th tubes in the procedure?
What is the purpose of the 11th and 12th tubes in the procedure?
What is the main purpose of Pandy's Test?
What is the main purpose of Pandy's Test?
Which of the following statements about the interpretation of Pandy's Test is correct?
Which of the following statements about the interpretation of Pandy's Test is correct?
What is the required temperature for heating the solution during the test procedure?
What is the required temperature for heating the solution during the test procedure?
What indicates a normal reaction in the tubes during the analysis?
What indicates a normal reaction in the tubes during the analysis?
What is the preparation step before adding spinal fluid in Pandy's Test?
What is the preparation step before adding spinal fluid in Pandy's Test?
What is a key characteristic of protein levels in aseptic meningitis?
What is a key characteristic of protein levels in aseptic meningitis?
Which reagent is used to conduct Pandy's Test?
Which reagent is used to conduct Pandy's Test?
What is the first step in calculating the number of cells in a counting chamber?
What is the first step in calculating the number of cells in a counting chamber?
What should the 12th tube show after one hour as part of the sensitivity control?
What should the 12th tube show after one hour as part of the sensitivity control?
Which condition directly affects the sensitivity of the solution as it is boiled?
Which condition directly affects the sensitivity of the solution as it is boiled?
Which method is noted as the easiest yet least satisfactory for cell concentration?
Which method is noted as the easiest yet least satisfactory for cell concentration?
What does a positive result in Pandy's Test indicate?
What does a positive result in Pandy's Test indicate?
In Noguchi's Test, to what substance is spinal fluid added to initiate the procedure?
In Noguchi's Test, to what substance is spinal fluid added to initiate the procedure?
What is the correct procedure after boiling the solution until a cherry red color appears?
What is the correct procedure after boiling the solution until a cherry red color appears?
What additional step must be taken when the total cell count is low or moderate?
What additional step must be taken when the total cell count is low or moderate?
What modification is made to stabilize the color in Noguchi's Test?
What modification is made to stabilize the color in Noguchi's Test?
Which technique is suggested as superior for sedimenting cells directly onto the slide?
Which technique is suggested as superior for sedimenting cells directly onto the slide?
Which of the following values represents a normal range of protein levels in spinal fluid?
Which of the following values represents a normal range of protein levels in spinal fluid?
What is the overall dilution factor represented by the multiplication factors when counting cells?
What is the overall dilution factor represented by the multiplication factors when counting cells?
What is necessary to confirm an increased cell count?
What is necessary to confirm an increased cell count?
Which method is considered less accessible for sedimentation of cells?
Which method is considered less accessible for sedimentation of cells?
What is a potential consequence of a deficiency in digestive enzymes?
What is a potential consequence of a deficiency in digestive enzymes?
Which color of stool may indicate upper gastrointestinal bleeding?
Which color of stool may indicate upper gastrointestinal bleeding?
What condition is associated with pale yellow or gray stool?
What condition is associated with pale yellow or gray stool?
What is the role of bile salts in digestion?
What is the role of bile salts in digestion?
Which of the following substances can lead to a false diagnosis of red stool?
Which of the following substances can lead to a false diagnosis of red stool?
What type of diarrhea is associated with incomplete breakdown of food?
What type of diarrhea is associated with incomplete breakdown of food?
What is the main component entering the digestive tract daily?
What is the main component entering the digestive tract daily?
Which enzyme is NOT involved in the digestion of proteins?
Which enzyme is NOT involved in the digestion of proteins?
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Study Notes
Spinal Fluid Analysis
- Important: Collect at least 8-10 cc of fluid for a complete analysis. Separate the fluid into 3 labeled tubes:
- Tube 1: First drops, may contain blood. Only use for bacteriological examination.
- Tube 2: 7 cc for serological, bacteriological, and chemical tests.
- Tube 3: 2 cc for cell count and qualitative protein tests.
- Xanthochromic fluid: If the obtained fluid is yellow, add lithium oxalate to tubes 2 and 3 to prevent clotting.
- Important: Perform cell count and exam for bacteria and sugar immediately. Other tests can be delayed.
- Normal fluid production: Approximately 1 cc per pound of body weight, or 100-150 cc daily.
- Increased fluid production: Occur in acute and chronic congestion of the meninges due to increased plasma transudation and potentially increased permeability of the choroid plexus.
Pandy's Test (Qualitative Detection of Proteins)
- Procedure:
- Place 4 cc of spinal fluid in a test tube.
- Heat to 60-80°C.
- Add 12 drops of 33% trichloracetic acid.
- Allow to stand for 5 minutes and invert the tube a few times.
- Let stand for 24 hours and read the quantity of sediment.
- Interpretations:
- 1st graduation: 0.22 gm protein/L
- 2nd graduation: 0.44 gm protein/L
- 3rd graduation: 0.56 gm protein/L
- 4th graduation: 0.71 gm protein/L
- 5th graduation: 0.85 gm protein/L
- Normal protein value: Does not exceed 0.30 gm protein/L.
Noguchi's Test (Qualitative Detection of Proteins)
- Procedure:
- Place 0.2 ml of spinal fluid in a test tube.
- Add 1 ml of a 10% solution of butyric acid in normal salt solution.
- Interpretations:
- A bluish-white cloud forms immediately upon mixing with the reagent. This indicates increased globulin.
- Faint trace in normal fluids is considered negative.
Lange's Colloidal Gold Test
- Purpose: Measures the amount of protein in the spinal fluid.
- Procedure:
- Prepare 12 tubes.
- Tubes 1-10 contain 0.5 cc of CSF, Tubes 11 & 12 are controls.
- Add 2.5 cc of colloidal gold solution to each tube.
- Let stand overnight and read the color change in the morning (reported as a 10 digit number, 0 being colorless and 5 the most intense color).
- Interpretations:
- Normal reaction: 0000000000
- Increased protein in aseptic meningitis, Froin's syndrome, and Guillain-Barré syndrome.
Cell Count
- Procedure:
- Use a special graduated tube (21 cm long, 7 mm diameter).
- Bottom graduation is 0.2 cc, the topmost is 4 cc.
- Important: Increased cell count must be confirmed by a stained smear and differential count.
Preparation of Smear for Differential Count
- Methods:
- Centrifugation: The easiest but can damage cells.
- Sedimentation: More accurate, but requires specialized equipment.
- Sedimentation directly onto the slide: A superior method.
- If using centrifugation, smear the sediment as you would a drop of blood.
Fecal Analysis (Fecalysis)
- Purposes:
- Early detection of GI bleeding, liver, biliary duct disorders, maldigestion/malabsorption syndromes, and inflammation.
- Detection and identification of pathogenic bacteria and parasites.
Physiology of Digestion
- Important digestive enzymes: Trypsin, Chymotrypsin, Amino Peptidase, and Lipase.
- Bile salts: Produced by the liver and aid in fat digestion.
- Maldigestion/Malabsorption: Deficiency in any of these substances leads to incomplete digestion and absorption, which can increase undigested/unabsorbed material in the stool.
- Fluid intake: Approximately 9000 ml of fluids enters the digestive tract daily (saliva, gastric, liver, pancreatic and intestinal secretions).
Causes of Diarrhea
- Infectious diarrhea: Caused by various bacteria, viruses, and parasites.
- Osmotic Diarrhea: Incomplete breakdown or reabsorption of food leads to increased water and electrolyte retention in the large intestine.
Macroscopic Stool Characteristics
- Black stool: Possible causes:
- Bismuth (antacids)
- Iron Therapy
- Charcoal
- Upper gastrointestinal bleeding
- Red stool: Possible causes:
- Lower gastrointestinal bleeding
- Beets or food coloring
- Rifampicin
- Pale yellow, white, or gray stool: Possible cause: Bile-duct obstruction
- Green stool: Possible causes:
- Biliverdin
- Oral antibiotics
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