#6 CNS

Question 1

SXS of complicated migraine: (4)

Answer 1

1- Basilar artery migraines
2-Confusional Migraines
3- Hemiparesis
4- Monocular blindness /ophthalmoplegic migraines

Question 2

RF for febrile SZ reoccurrence: (4)

Answer 2

1- fam hx
2- SZ after having fever for only a short period of time
3- SZ with modest temp elevation
4- 1st febrile SZ before 18 mos. of age (50% reoccurrence for if <12 mos of age)

Question 3

Pathogens involved in Meningitis infx in 0-2 mo. old: (4)

Answer 3

Group B Streptococci
Gram negative Enterobacteriaceae (E. Coli)
Listeria
HSV

Question 4

Pathogens involved in Meningitis infx in >2 mo. old: (3)

Answer 4

S. pneumoniae
Neisseria meningitides
H. influenzae b (Hib)

Question 5

Neonates less than 2 mos of age with temp >100.4 OR hypothermia:

Answer 5

sepsis until proven otherwise

Question 6

Avoid LP in meningitis w/u if: (5)

Answer 6

• Suspicion of increased ICP (bradycardia, HTN, irregular respirations)
• Prolonged seizures
• GCS <13
• Papilledema
• Suspicion of brain abscess / lesion

Question 7

Any SXS of increased ICP in meningitis w/u rq:

Answer 7

CT/MRI imaging

Question 8

meningitis TX <2 mo:

Answer 8

Cefotaxime + Ampicillin / Aminoglycoside

• -Duration ranges 7 -21 days based on organism
• -Repeat LP?

Question 9

meningitis TX >2 mo:

Answer 9

Ceftriaxone +/- Vancomycin

• -Duration ranges 7 -21 days based on organism
• -Repeat LP?

Question 10

meningitis 2/2 HSV TX:

Answer 10

IV acyclovir

Question 11

meningitis immunocompromised TX:

Answer 11

likely carbapenems and ID consult

Question 12

Pathogens in Aseptic meningitis: (6)

Answer 12

Viral causes MC
1- Enterovirus
2-Mosquito borne arboviruses
3-Measles, Mumps
4-HSV
5- VZV
6- Coccidiodes and Histoplasma in endemic areas

Question 13

CSF glucose <40, CSF protein > 140, CSF WBC >1200 would likely point towards this DX:

Answer 13

Septic meningitis

Question 14

GBS TX for progressive disease with respiratory compromise:

Answer 14

Therapeutic Plasma Exchange and IVIG (MC 1st line tx)

Question 15

“Dancing eyes and Dancing feet” associated with this DZ

Answer 15

Paraneoplastic “Opsoclonus-Myoclonus” Syndrome

Question 16

Voigt’s Triad in Tuberous Sclerosis:

Answer 16

Epilepsy, Adenoma Sebaceum, Mental deficiency

Question 17

Primary DX Criteria for Tuberous Sclerosis:

Answer 17

Adenoma Sebaceum (90% by 4 years of age) – facial angiofibromas

Question 18

Secondary DX Criteria for Tuberous Sclerosis: (4)

Answer 18

• Shagreen patches (subepidermal fibrous patches)
• Ash leaf spots (hypopigmented macule) - infancy and glow with UV light
• Ungual and gingival fibromas – puberty
• Mental retardation