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