CIS 1: Neuro Case

Question 1

When evaluating a sick child what should be established to help evaluate the child as he/she recovers?

Answer 1

Developmental baseline

Question 2

You should be extra concerned about about any sick child with what behavior?

Answer 2

Prefers to be left alone and doesn’t want to be moved

Question 3

What can a high fever w/ tachycardia cause in a child secondary to increased cardiac output?

Answer 3

Flow murmur

Question 4

In a young child how should urine for culture always be obtained?

Answer 4

Catheterization

Question 5

When collecting urine for culture from child via catheterization why may RBC’s be seen in urine?

Answer 5

Trauma from catheterization

Question 6

Why does a “left shift” occur?

Answer 6

Immature neutrophils (bands) are being pushed out of marrow to fight something like an infection

Question 7

Which ratio can be helpful in determining the presence of an infection?

If >______, then it is likely an infection is present.

Answer 7

• I/T ratio (Immature neutrophils/Total neutrophils)
• If I/T ratio >0.2 = likely infection present

Question 8

3 most common bacterial causes of meningitis from birth to 2 months old?

Gram stain/morphology of each

Answer 8

1. Group B strep (Streptococcus agalactiae) = gram + bacilli
2. E. coli = gram - bacilli
3. L. monocytogenes = gram + bacilli

Question 9

3 most common bacterial causes of meningitis from 2-12 yo?

Gram stain/morphology of each.

Answer 9

1. S. pneumoniae (gram + diplococci)
2. N. meningitides (gram - diplococcci)
3. H. influenzae (gram - coccobacilli) –> decline since vaccine

Question 10

2 most common bacterial causes of meningitis in age >60?

Gram stain/morphology of each

Answer 10

1) S. pneumoniae (gram + diplococci)
2) L. monocytogenes (gram + bacilli)

Question 11

Which Abx is given for meningitis due to L. monocytogenes in a pt >60 yo?

In newborn to 2 month old?

Answer 11

• >60 yo = Ampicillin
• Birth to 2 months old = Gentamycin

Question 12

Which cause of meningitis is associated with normal glucose levels?

Answer 12

Viral = >40mg/dL

Question 13

Main inflammatory cell type found in CSF due to bacterial meningitis?

Answer 13

PMN’s

Question 14

What are the levels of protein in the CSF like in viral causes of meningitis?

Answer 14

Normal or elevated (<200mg/dL)

*Normal should be <50mg/dL

Question 15

In labratory examination of the CSF in suspected meningitis which 2 etiologies will have (+) cytology?

Answer 15

• Fungal
• Neoplastic

Question 16

Which etiology of meningitis is associated with normal/slightly increased opening pressure (<300 mmHg)?

Answer 16

Viral

Question 17

What may artificially elevate CSF protein findings?

Answer 17

• Large # of RBCs as seen in intracranial hemorrhage
• Traumatic taps

Question 18

If a pt has significantly altered mentation, focal neuro signs, papilledema, hx of seizure within previous week, or impaired cellular immunity what should be done prior to LP?

Answer 18

CT scan

Question 19

How do you perform Kernig sign test and what is positive findining?

Answer 19

• Flex pt’s leg at both the hip and knee, and then straighten (extend) the knee
• Positive = ext. of leg at the knee when hip is flexed 90° elicits PAIN (not just discomfort!)

Question 20

What is a positive Brudzinski’s sign?

Answer 20

Flexion of the neck elicits a reflex flexion at the hips

Question 21

At what age does a childs fontanels close/sutures fuse so that “typical” signs of ICP associated with meningitis will be present?

Answer 21

3 years old

Question 22

At which age is fontanelle check done in suspected meningitis and which is the last to close?

Answer 22

• Children <2 y/o
• Anterior fontanelle is last to close at ~2 y/o

Question 23

In ill patient with suspected meningitis when should Abx be administered?

Answer 23

• Get a blood culture and give Abx!
• DO NOT DELAY!

Question 24

Emperic Abx treatment for suspected meningitis?

Answer 24

Vancomycin + Ceftriaxone + (add ampicillin if >50 yo and concerened for Listeria)

Question 25

If suspicious of HSV encephalitis what Abx should be added onto the empiric treatment of meningitis?

Answer 25

Acyclovir

Question 26

Debatable evidence shows that the administration of what drug prior to antiobiotics can aid in decreased hearing loss and neurological sequaelae?

Answer 26

Dexamethasone (a glucocoritcoid)

Question 27

Why may a woman’s body temperature be higher or lower when she is ovulating or having her menstual period?

Answer 27

Body temp is very sensitive to hormone levels

Question 28

What temperature is considered a fever in an adult when taken both orally and via rectum/ear?

Answer 28

• Orally = 100.4 F (38 C)
• Rectal/ear = 101 F (38.3 C)

Question 29

What temperature is considered a fever in a child when taken via rectum?

Answer 29

100.4 F (38 C) or higher

Question 30

What is the most accurate way to measure temperature?

Answer 30

Rectal (closest to core)

Question 31

What is an even more accurate assessment of body temperature that has been used in some patients that are critically ill?

Answer 31

Bladder temperature via foley catheter w/ probe

Question 32

Is OMM indicated in the acute setting of (pediatric) meningitis?

Answer 32

Contraindicated

Question 33

Once a pt with meningitis is stable and on Abx, what type of OMM techniques are indicated for the cervical spine?

Answer 33

Indirect or direct inhibition (more gentle overall)

Question 34

Dermatome level of umbilicus?

Answer 34

T10

Question 35

Dermatome level of big toe?

Answer 35

L5