April 2017

Question 1

What are the incapsulated bacteria?

Answer 1

YES some killers have pretty nice capsules

Yersinia Pestis
E.coli
Streptococcus pneumonia
Samonella
Klebsella
H. Influenza
Pseudomonas arugenosia
Neisseria meningitis
Cryptococcus

Question 2

ddx petechiae

Answer 2

THINK: Normal Platelets vs Low platlets

Normal:

• Vasculitis - HSP
• Viral - enteroviral
• Trauma
• Direct pressure

Low

• ITP/TTP
• DIC
• Sepsis
• Meningococcemia
• Malignancy

Question 3

What are 10 causes of non-bacterial meningitis?

Answer 3

Viruses
Enteroviruses
Herpes group
Arbovirues (WNV)
Mumps
HIV

Fungi
Cryptococcus
HIV/AIDS
Histoplasma
Coccidiomyocosis
Candida
Blastomyces

Drugs
Septra, Sulfasalaziine
Isoniazid, IVIG
NSAIDs
Carbamazapine
Systemic disease

Collagen vascular d/o
Sarcoid
Behcets
Kawasaki’s

Neoplastic
Leukemia, Carcinomatous

Parasites
RMSF
Inflammation from surroundings

Question 4

What are the common bacterial causes of meningitis in:

1. neonate 2. Children 3. Adult/elderly 4. Trauma/NSx

Answer 4

1. Neonates (<4 weeks):GBS, E.coli, Listeria
2. Children: Strep pneumo, Neisseria meningitidis, H. influenza
3. Adult/Elderly: Strep pneumo, N. Meningitidis, Listeria (elderly)
4. Trauma/NSx: Staph Aureus, Coag Neg staph (S.epidermis), GNB

Question 5

What are 3 findings for LAD occlusion on ecg?

Answer 5

1. STE V1-V3
2. De Winter T waves (STD, large peaked T waves, upright V1-V3) = STEMI equivalaent –> Cath lab
3. Wellens
   - Type A Biphasic
   - Type B TWI
   - means critical LAD lesion and is seen on resting asymptomatic ecg. If pt has chest pain may see pseudonormalization.

Question 6

What are 8 ecg findings for syncope?

Answer 6

1. ACS
2. Arrythmias/AVB
3. PE
4. WPW
5. Long/Short QT
6. ARVC/ARVD
7. Brugada
8. HCM
9. Electrolytes (K, Ca)

Question 7

What is the benefit from studies with administrating amiodarone in refractory VF/Vt?

Answer 7

Incr survival to hospital admission but when comparing to lidocaine and placebo there is no difference to survival to hospital discharge.

AHA 2015 says consider after 3 shocks, after 2nd Epi but the overall benefit is uncertain.

Question 8

What is the Bazett formula for QTc?

Answer 8

Qtc = QT (ms) /square root (RR)

RR = 60 div bpm

Question 9

What is the incidence of aneurysms in general population?

Answer 9

2%

Question 10

What are RF for SAH? name 5

Answer 10

PCKD
HTN
Collagen vascular d/o
Cocaine
Smoking
Binge drinking
Exertion

Question 11

what are 7 complications of SAH?

Answer 11

1. Rebleed
2. Vasospasm
3. Hydrocephalus
4. Seizures
5. Cardiac complications
6. Pulmonary edema
7. Hyponatremia

Cardiac complications thought to be related to centrally mediated release of catecholamines within the myocardium because of hypoperfusion of the hypothalamus

Question 12

What is the sensitivity of CT for SAH <6 hours?

what are the caveats that may not allow us to apply this to all institutions?

Answer 12

7.7% SAH incidence
100% sensitive (CI 97-100)

Read by neuro rad, 3rd generation CT scanner

Question 13

Case: patient >6 hours, CT negative do LP and have RBCs.

What are 2 approaches to determining if RBC is secondary to SAH vs. traumatic tap?

Answer 13

1. RBC count < 2000 in last tube can r/o SAH (with absence of xanthrochromia)
   - Sn 100% (CI 74-100)
   - this rule isnt good enough so would talk to NSx
2. RBC clearance - studies all over the map 25% clearance have still been shown to have SAH. Study clearance of 70% ruled out SAH.