CIS 1: Neuro Case Flashcards
When evaluating a sick child what should be established to help evaluate the child as he/she recovers?
Developmental baseline
You should be extra concerned about about any sick child with what behavior?
Prefers to be left alone and doesn’t want to be moved
What can a high fever w/ tachycardia cause in a child secondary to increased cardiac output?
Flow murmur
In a young child how should urine for culture always be obtained?
Catheterization
When collecting urine for culture from child via catheterization why may RBC’s be seen in urine?
Trauma from catheterization
Why does a “left shift” occur?
Immature neutrophils (bands) are being pushed out of marrow to fight something like an infection
Which ratio can be helpful in determining the presence of an infection?
If >______, then it is likely an infection is present.
- I/T ratio (Immature neutrophils/Total neutrophils)
- If I/T ratio >0.2 = likely infection present
3 most common bacterial causes of meningitis from birth to 2 months old?
Gram stain/morphology of each
- Group B strep (Streptococcus agalactiae) = gram + bacilli
- E. coli = gram - bacilli
- L. monocytogenes = gram + bacilli
3 most common bacterial causes of meningitis from 2-12 yo?
Gram stain/morphology of each.
- S. pneumoniae (gram + diplococci)
- N. meningitides (gram - diplococcci)
- H. influenzae (gram - coccobacilli) –> decline since vaccine
2 most common bacterial causes of meningitis in age >60?
Gram stain/morphology of each
1) S. pneumoniae (gram + diplococci)
2) L. monocytogenes (gram + bacilli)
Which Abx is given for meningitis due to L. monocytogenes in a pt >60 yo?
In newborn to 2 month old?
- >60 yo = Ampicillin
- Birth to 2 months old = Gentamycin
Which cause of meningitis is associated with normal glucose levels?
Viral = >40mg/dL
Main inflammatory cell type found in CSF due to bacterial meningitis?
PMN’s
What are the levels of protein in the CSF like in viral causes of meningitis?
Normal or elevated (<200mg/dL)
*Normal should be <50mg/dL
In labratory examination of the CSF in suspected meningitis which 2 etiologies will have (+) cytology?
- Fungal
- Neoplastic
Which etiology of meningitis is associated with normal/slightly increased opening pressure (<300 mmHg)?
Viral
What may artificially elevate CSF protein findings?
- Large # of RBCs as seen in intracranial hemorrhage
- Traumatic taps
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?
CT scan
How do you perform Kernig sign test and what is positive findining?
- 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!)
What is a positive Brudzinski’s sign?
Flexion of the neck elicits a reflex flexion at the hips
At what age does a childs fontanels close/sutures fuse so that “typical” signs of ICP associated with meningitis will be present?
3 years old
At which age is fontanelle check done in suspected meningitis and which is the last to close?
- Children <2 y/o
- Anterior fontanelle is last to close at ~2 y/o
In ill patient with suspected meningitis when should Abx be administered?
- Get a blood culture and give Abx!
- DO NOT DELAY!
Emperic Abx treatment for suspected meningitis?
Vancomycin + Ceftriaxone + (add ampicillin if >50 yo and concerened for Listeria)
If suspicious of HSV encephalitis what Abx should be added onto the empiric treatment of meningitis?
Acyclovir
Debatable evidence shows that the administration of what drug prior to antiobiotics can aid in decreased hearing loss and neurological sequaelae?
Dexamethasone (a glucocoritcoid)
Why may a woman’s body temperature be higher or lower when she is ovulating or having her menstual period?
Body temp is very sensitive to hormone levels
What temperature is considered a fever in an adult when taken both orally and via rectum/ear?
- Orally = 100.4 F (38 C)
- Rectal/ear = 101 F (38.3 C)
What temperature is considered a fever in a child when taken via rectum?
100.4 F (38 C) or higher
What is the most accurate way to measure temperature?
Rectal (closest to core)
What is an even more accurate assessment of body temperature that has been used in some patients that are critically ill?
Bladder temperature via foley catheter w/ probe
Is OMM indicated in the acute setting of (pediatric) meningitis?
Contraindicated
Once a pt with meningitis is stable and on Abx, what type of OMM techniques are indicated for the cervical spine?
Indirect or direct inhibition (more gentle overall)
Dermatome level of umbilicus?
T10
Dermatome level of big toe?
L5
