Lumbar puncture - Quiz
Lumbar puncture
  • 1. What is the most common complication following a lumbar puncture?
A) Infection at the puncture site
B) Immediate paralysis
C) Post-dural-puncture headache with nausea
D) Severe back pain
  • 2. Which of the following is often effective in treating post-dural-puncture headaches?
A) Intravenous caffeine injection
B) Use of antibiotics
C) Immediate lumbar surgery
D) Strict maintenance of a supine posture for two hours
  • 3. What might indicate a CSF leak from the lumbar puncture site?
A) Nausea without headache
B) Headache relieved by lying down
C) Immediate relief after fluid infusion
D) A headache that occurs only when sitting up
  • 4. What is an effective treatment for a persistent CSF leak?
A) Antibiotic therapy
B) Increased physical activity
C) Epidural blood patch
D) Immediate lumbar surgery
  • 5. How does the use of 'atraumatic' needles affect the risk of headache?
A) Has no effect on the risk
B) Only affects success rate, not headache
C) Reduces the risk significantly
D) Increases the risk significantly
  • 6. What sensation might occur if a spinal nerve root is contacted during lumbar puncture?
A) Loss of consciousness
B) Severe back pain
C) Immediate paralysis
D) Anomalous sensations (paresthesia) in a leg
  • 7. What is the normal ending level of the spinal cord?
A) T12
B) L3/L4
C) Inferior border of L1
D) C7
  • 8. Why might a lumbar puncture be contraindicated in patients with severe psychosis?
A) It leads to severe headaches
B) Because it causes immediate paralysis
C) Due to the risk of back pain exacerbation
D) It increases the risk of infection
  • 9. What is a rare but serious complication of lumbar puncture?
A) Immediate recovery without complications
B) Frequent need for analgesia
C) Perforation of abnormal dural arterio-venous malformations
D) Common occurrence of infections
  • 10. What should be performed prior to lumbar puncture if an intracranial mass is suspected?
A) Intravenous antibiotic therapy
B) Immediate lumbar surgery
C) Strict bed rest
D) Computed tomography (CT) of the brain
  • 11. What might cause post-dural-puncture headaches?
A) Immediate fluid withdrawal
B) Use of aseptic technique
C) Proper needle placement
D) Inadvertent puncture of the dura mater
  • 12. Why might serial lumbar punctures be used in the treatment of idiopathic intracranial hypertension (IIH)?
A) They prevent uncal herniation
B) They may improve symptoms by reducing cerebrospinal fluid pressure temporarily
C) They permanently cure IIH
D) They are the primary and most effective treatment for IIH
  • 13. What is a potential risk of performing a lumbar puncture in patients with increased intracranial pressure?
A) Immediate cure for idiopathic intracranial hypertension
B) Uncal herniation
C) Permanent relief from headaches
D) Improved vision permanently
  • 14. Under what condition is a lumbar puncture contraindicated due to bleeding risks?
A) Increased intracranial pressure without any other conditions
B) Normal pressure hydrocephalus
C) Coagulopathy or decreased platelet count (<50 billion/L)
D) Focal neurological signs
  • 15. Which symptom is NOT characteristic of normal pressure hydrocephalus?
A) Urinary incontinence
B) Dementia
C) Headache
D) Altered gait
  • 16. Why might a lumbar puncture be contraindicated in patients with vertebral deformities?
A) Deformities do not affect the procedure
B) It is always safe regardless of the physician's experience
C) It may pose risks if performed by an inexperienced physician
D) Lumbar puncture can correct vertebral deformities
  • 17. Which condition might be temporarily relieved by removing cerebrospinal fluid through lumbar puncture?
A) Normal pressure hydrocephalus
B) Idiopathic intracranial hypertension
C) Increased blood pressure
D) Coagulopathy
  • 18. Which of the following is a common indication for performing a lumbar puncture?
A) Kidney stones
B) Gallbladder inflammation
C) Suspected meningitis
D) Peptic ulcer
  • 19. Who first introduced lumbar punctures in 1891?
A) Heinrich Quincke
B) Edward Jenner
C) Alexander Fleming
D) Louis Pasteur
  • 20. Which condition can be detected in infants through lumbar puncture due to their higher rates of it?
A) Meningitis
B) Eczema
C) Diabetes
D) Asthma
  • 21. What technology may increase the success rate of a lumbar puncture?
A) X-ray
B) CT scan
C) Ultrasound
D) MRI
  • 22. How much cerebrospinal fluid (CSF) do adults typically have?
A) 300–350 mL
B) 50–75 mL
C) 200–250 mL
D) 125–150 mL
  • 23. What is the term for the bundle of nerve fibers below the termination of the spinal cord?
A) Cauda equina
B) Conus medullaris
C) Lumbar cistern
D) Arachnoid granulations
  • 24. What is the recommended position for a patient during a lumbar puncture?
A) Sitting on a stool with head and shoulders forward
B) On their side, approximating a fetal position
C) Standing upright
D) Lying flat on their back
  • 25. What indicates that the needle has pierced the dura mater?
A) The patient feels a sharp pain
B) The needle encounters resistance
C) Cerebrospinal fluid immediately flows out
D) A second 'give' is felt as the needle enters the lumbar cistern
  • 26. What imaging technique can be used if a lumbar puncture is difficult due to spinal deformities?
A) Fluoroscopy (continuous X-ray imaging)
B) Ultrasound
C) CT scan
D) MRI
  • 27. What method involves removing the stylet of the spinal needle once it has advanced through the dermis?
A) Cincinnati method
B) Boston method
C) Miami method
D) Denver method
  • 28. What should CSF specimens be sent to immediately after collection?
A) A refrigerator
B) The laboratory
C) An autoclave
D) A storage room
  • 29. At what temperature should CSF be stored for culture purposes?
A) Refrigerated
B) Heated
C) Frozen
D) Room temperature
  • 30. What does the presence of white blood cells in cerebrospinal fluid indicate?
A) Hemolysis
B) Pleocytosis
C) Erythrophagocytosis
D) Gram staining
  • 31. What is the gold standard for detecting bacterial meningitis?
A) Antibody-mediated tests
B) Polymerase chain reaction (PCR)
C) Gram staining
D) Microbiological culture
  • 32. Which test has high sensitivity and specificity for many CNS infections?
A) Polymerase chain reaction (PCR)
B) Microbiological culture
C) India ink test
D) Gram staining
  • 33. Which test is more sensitive for detecting meningitis caused by Cryptococcus neoformans?
A) India ink test
B) Gram staining
C) Cryptococcal antigen (CrAg) test
D) Polymerase chain reaction (PCR)
  • 34. What can be diagnosed using rapid tests for antigens in CSF?
A) Viral infections
B) Fungal infections
C) Leukemia
D) Common bacterial pathogens
  • 35. What percentage of peripheral circulation glucose level is usually found in CSF?
A) About 80%
B) About 40%
C) About 60%
D) Equal to peripheral levels
  • 36. What condition is associated with a glucose level of less than one third of blood glucose levels and low CSF lactate?
A) Multiple sclerosis
B) De Vivo disease
C) Hereditary mitochondrial disease
D) Diabetes
  • 37. What does an increased level of glutamine in the CSF often indicate?
A) Bacterial meningitis
B) Diabetes
C) Hepatic encephalopathies
D) Viral infections
  • 38. Which condition is NOT typically associated with increased lactate levels in CSF?
A) Hypocapnia
B) Bacterial meningitis
C) Heritable mitochondrial disease
D) Cancer of the CNS
  • 39. Low or absent orexin levels in CSF are typically indicative of which condition?
A) Hydrocephalus
B) Multiple sclerosis
C) Diabetes
D) Narcolepsy type 1
  • 40. Oligoclonal bands detected in CSF but not in serum suggest what?
A) Peripheral infection
B) Normal immune function
C) Diabetes
D) Intrathecal antibody production
  • 41. Who first described a technique for accessing the dural space?
A) Johns Hopkins
B) Heinrich Quincke
C) Walter Essex Wynter
D) Arthur H. Wentworth
  • 42. In what year did Walter Essex Wynter develop his technique?
A) 1891
B) 1889
C) 1893
D) 1920
  • 43. Who brought the lumbar puncture procedure to the United States?
A) Walter Essex Wynter
B) Arthur H. Wentworth
C) Johns Hopkins
D) Heinrich Quincke
  • 44. In which year did Arthur H. Wentworth publish his paper on diagnosing cerebrospinal meningitis?
A) 1889
B) 1920
C) 1891
D) 1893
  • 45. When did modern non-invasive neuroimaging techniques become prevalent?
A) 1970s
B) 1980s
C) 1890s
D) 1920s
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