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Lumbar PuncturePlease print, complete and hand in this quiz at the start of the Lumbar Puncture seminarName: _________________________________________The imaginary line connecting the posterior superior iliac crests crosses what spinal interspace?L1 -L2L3-L4L5-S1L4-L5The number and type of white blood cells in normal CSF is?<5 WBC/mm3 all polymorphs<10 WBC/mm3 all lymphocytes<5 WBC/mm3 all lymphocytes<2 WBC/mm3 of any typeWhich of the following patients does?not?need a CT-scan prior to lumbar puncture?A well patient with new onset right arm weaknessA known cancer patient with headache and new onset right arm weaknessAn acute trauma patient with headache and bilateral let weaknessA twelve year old boy with normal exam but fever and nuchal rigidityWhich of the following is an absolute contraindication to lumbar puncture?Uncorrected coagulopathyNuchal rigidityInability to visualize a patient’s fundiA concussion two months agoLumbar puncture is?not?used to diagnose which condition?Subarachnoid hemorrhageCerebral abscessMeningitisIdiopathic intracranial hypertensionWhat needle type is best used for reducing the incidence of post lumbar puncture headache?Small blunt tipped needlesSmall cutting tipped needlesMedium sized blunt tipped needlesMedium sized cutting tipped needlesWhen advancing the lumbar puncture needle, it should be parallel to the bed and aimed towards the patient's _______________SternumSymphysis pubisUmbilicusNeckWhich of the following is not a complication of lumbar puncture?Local back painEpidermoid tumour implantationOlfactory disturbancesPost lumbar puncture headacheWhich of the following is not a way to reduce post lumbar puncture headaches?Using a blunt tipped spinal needleReplacing the stylet in the lumbar puncture needle prior to the needle's removalKeeping the patient on their back for 4 hours after the lumbar punctureUsing a smaller spinal needle?Correctly orienting the bevel of a cutting type spinal needle can reduce the incidence of post lumbar puncture headache. In a patient in the lateral decubitus position, the notch of the stylet should point ____________Up at the ceilingAt the patient's right shoulderTowards the patient's headTowards the patient's feet?In an adult, the spinal cord may reach as low as what vertebral body?L4L2L5L3Which of the following gives the correct order of tissues penetrated in a lumbar puncture?Skin , subcutaneous tissue , ligamentum flavum , intraspinal ligament, duraSkin, supraspinal ligament, dura , ligamentum flavum, arachnoid materSkin, intraspinal ligament , supraspinal ligament, ligamentum flavum, duraSkin, supraspinal ligament , ligamentum flavum, dura, arachnoid mater?The ‘pop’ that is often felt in performing a lumbar puncture is caused by the penetration of what tissue?Ligamentum flavumSubarachnoid spaceIntraspinal ligamentSupraspinal ligamentIf bony resistance is encountered while performing a lumbar puncture, bring the spinal needle back to the skin and direct it more towards the ___________RightFeetParallel plane of the backHeadWhich of the following is not routinely ordered on CSF samples?Gram stainAlbuminGlucoseCell countXanthochromia is caused byLysis of red blood cellsLysis of white blood cellsHigh concentrations of organisms in the CSFAcutely traumatic lumbar puncturesA cell count in viral meningitis might demonstrate<5 WBC/mm3 and all lymphocytes>5 WBC/mm3 and all polymorphs>5 WBC/mm3 and all lymphocytes>5 WBC/mm3 and a mix of polymorphs and lymphocytesThe colour of normal CSF isCreamy yellowSlightly pinkClear straw colouredCrystal clearThe position of a patient for lumbar puncture should beBack arched out with hips and shoulders perpendicular to the bedBack straight with hips and shoulders perpendicular to the bedBack arched out with shoulders rolled towards the bed and hips perpendicular to the bedBack straight with shoulders rolled towards the bed and hips perpendicular to the bedA patient with fever, nuchal rigidity and a normal neurological exam requires a CT scan prior to lumbar puncture.TrueFalse ................
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