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Clinical Medicine 4 > CNS infections, concussion > Flashcards

CNS infections, concussion Flashcards

1
Q

Meningitis inflammation of what?

A

Meninges of brain of spinal cord

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2
Q

2 types of Meningitis

A

Bacterial and Aseptic

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3
Q

MC Etiology of acute bacterial Meningitis?

A

S Pneumoniae

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4
Q

Where is Meningitis bacteria and how it penetrate?

A

Encapsulated bacteria in naso-oropharynx which penetrated intravascular space

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5
Q

Most sensitive sign on bacterial Meningitis?

A

Fever

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6
Q

Kernig’s Sign in Meningitis

A

Can’t straighted knee with hip flexion

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7
Q

Brudzinski’s sign in Meningitis

A

Neck flexion produces knee/hip flexion

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8
Q

Are Brudzinski and Kernig signs sensitive for Meningitis?

A

No!

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9
Q

Neck and light in bacterial Meningitis

A

Nuchal rigidity, photosensitivity

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10
Q

HA in bacterial Meningitis?

A

“Dull”, described unlike others

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11
Q

Onset of sx in Meningitis?

A

Rapid over 24h

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12
Q

Definitive dx in Meningitis?

A

LP

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13
Q

What to do and check before LP in Meningitis?

A

CT! Check ICP and brain shifting. LP can reduce pressure too quickly and cause herniation.

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14
Q

Where to do LP in Meningitis?

A

Laying down, L3 and below (corda equina).

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15
Q

How much CSF to draw for analysis in Meningitis?

A

4-8mL for PCR

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16
Q

Glucose level in bacterial Meningitis?

A

Markedly decreased (<40)

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17
Q

If glucose normal on LP in Meningitis then what etiology?

A

Viral

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18
Q

Viral Meningitis d/t enterovirus in which seasons?

A

Summer/early fall

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19
Q

What is most common Meningitis

A

Aseptic d/t enterovirus

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20
Q

Petechial rash in bacterial Meningitis d/t which bacteria?

A

N Meningitidis

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21
Q

Tx of bacterial Meningitis 18-50y/o

A

Ceftriaxone + Vancomycin

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22
Q

Tx of bacterial Meningitis if >50 y/o?

A

Amp + Ceft + Vanco

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23
Q

When to give steroids in bacterial Meningitis?

A

Prior or with abx!

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24
Q

Tx for elevated ICP?

A

Mannitol, mild hyperventilation, hypertonic saline

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25
Q

Tx for viral Meningitis?

A

Antivirals, symptomatic outpatient care

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26
Q

Encephalitis inflammation of what?

A

Brain parenchyma

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27
Q

Encephalitis etiology?

A

Viral. HSV and Enterovirus MC in immunocompetent. Measels MC in world.

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28
Q

Encephalitis virus causes what sort of reaction?

A

Hypersensivitiy reaction

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29
Q

Which brain matter affected more in Encephalitis?

A

Gray matter more than white

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30
Q

Class sx of Encephalitis?

A

Fever, HA, AMD

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31
Q

Encephalitis sx speed of onset?

A

Rapid

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32
Q

What is Primary Manifestation of Encephalitis?

A

URI sx, kinda sick

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33
Q

When is Secondary Manifestation of Encephalitis?

A

1-3 weeks after URI

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34
Q

Dx of Encephalitis?

A

CSF or serum WNV IgM Ab. Can be positive 1-3 months.

35
Q

Tx for Encephalitis?

A

Supportive. Acyclovair 10mg/kg IV q8h.

36
Q

Vector of Rabies Encephalitis?

A

Mammals. Raccoon, fox, coyote, skunks.

37
Q

Which animals are not vectors for Rabies Encephalitis?

A

Small rodents

38
Q

How long incubation until sx in Rabies Encephalitis?

A

2-8wk

39
Q

Tx of Rabies Encephalitis?

A

Prophylaxis if rabid animal

40
Q

Major manifestation of autoimmune Encephalitis?

A

Psych manifestations

41
Q

Tx for autoimmune Encephalitis?

A

Immunosuppressants.

-IVIG, IV Methylprednisolone

42
Q

Define concussion

A

Brain injury with complex pathological process affecting the brain, induced by trauma biochemical forces. From direct or indirect blow.

43
Q

Hallmark of concussion sx?

A

Confusion and amnesia

44
Q

Concussion functional or structural disturbance?

A

Functional

45
Q

Sx from frontal concussion?

A

Irritability, inappropriate tearfulness

46
Q

Sx from parietal concussion?

A

HA, nausea

47
Q

Sx from occipital concussion?

A

Dizzy, disequilbrium, visual sx

48
Q

When does Secondary Injury manifest in concussion?

A

Minutes to hours

49
Q

When does Secondary Injury occur in concussion?

A

Happens immediately

50
Q

concussion Secondary Injury d/t what?

A

Neurochemical cascade

51
Q

4 categories of concussion sx?

A
  1. Physical
  2. Cognitive
  3. Emotional
  4. Sleep
52
Q

Dx for concussion?

A

Clinical. No diagnostic test.

53
Q

Sideline evaluation of concussion called?

A

SCAT3=13+ y/o

Child SCAT=5-12 y/o

54
Q

Maddocks questions assess what?

A

Neuropsych. Part of SCAT3.

55
Q

BESS tests for what in concussion?

A

Balance test at rest and then exertional if rest is normal.

56
Q

What is GCS immediately after concussion injury? When improve to 15?

A

3-15. Improve to 15 w/n 2h.

57
Q

ER tests for concussion? How long to observe?

A

Neuro exam q30min. Observe 4h.

58
Q

When to Non-Con CT concussion?

A

Only if LOC or amnesia with neuro deficit or sx. Does not reveal concussive brain injury and not routinely performed.

59
Q

Tx goal of concssion?

A

Minimize imbalance of energy supply and demand at brain cellular level

60
Q

Rest until when in concussion? About how long?

A

Until ASx. About 7 days.

61
Q

2 types of rest in tx of concussion

A

Cognitive and physical rest

62
Q

Avoid daily activites which do what in concussion tx?

A

Increase HR

63
Q

Tx HA in concussion?

A

NSAIDs and APAP

64
Q

Nausea tx in concussion?

A

Zofran (SE=HA, drowsy)

65
Q

Tx of sleep disturbances in concussion?

A

Good sleep hygiene, melatonin, trazadone

66
Q

How long to concentrate on tasks with return to learn in in concussion?

A

30-45min

67
Q

When can return to play in concussion?

A

When tolerate full school day without sx!

68
Q

Minimum of how many days before return to competitive play in concussion?

A

5d

69
Q

Define Post Concussion Syndrome

A

Physical, cognitive, emotional, and sleep sx which persist beyond 4-6wk post-concussion

70
Q

Does severity of concussion injury correlate with Post Concussion Syndrome?

A

No

71
Q

Tx for pych and cognitive sx in Post Concussion Syndrome?

A

donezapil, psychotherapy, antidepressants, anoxiolytics, methylphenidate

72
Q

Tx for HA in Post Concussion Syndrome?

A

Amitriptline

73
Q

What is Second Impact Syndrome?

A

Death or devastating neurological injury due to massive brain swelling when second head injury occurs before full recovery from first

74
Q

What happens to brain in Second Impact Syndrome?

A

Massive swelling

75
Q

When does Second Impact Syndrome happen?

A

Second head injury occurs before first heals

76
Q

Mortality rate in Second Impact Syndrome?

A

50%

77
Q

Most used and valid computerized concussion evaluation system?

A

imPACT testing

78
Q

When it imPACT testing done?

A

Baseline and q2y, again immediate post-concussion

79
Q

Who does Chronic Traumatic Encephalopathy occur in?

A

Atheletes who suffer multiple concussions over course of career

80
Q

Are mood, behavior, congitive, and somatic sx permanent in Chronic Traumatic Encephalopathy?

A

Yes they are permanent

81
Q

Which protein builds up in Chronic Traumatic Encephalopathy?

A

Tau protein

82
Q

Tau protein associated with what old age dz?

A

Alzheimers

83
Q

What are two severe sx from Chronic Traumatic Encephalopathy?

A
  1. Parkinson symptoms

2. Dementia

84
Q

Dx for Chronic Traumatic Encephalopathy?

A

PET

Clinical Medicine 4 (10 decks)

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