CNSInfections_PretestStepup

Question 1

FEVER + HEADACHE + PHOTOPHOBIA/PHONOPHOBIA +/- N/V points to what category of inflammation?

Answer 1

BRAIN INFLAMMATION

Question 2

Ddx of FEVER + CHRONIC HEADACHE + FOCAL NEUROLOGIC DEFICIT (2)

Answer 2

ABSCESS

CANCER

Question 3

What are the 3 main categories of CNS INFECTIONS?

Answer 3

MENINGITIS
ENCEPHALITIS
ABSCESS

Question 4

What are the two + physical exam manuevers/tests for MENINGITIS?

Answer 4

Nuchal rigidity has 2 positive signs - KERNIG/BRUDZINSKY

Question 5

When do you decide to do an LP with a suspicion of a CNS INFECTION?

Answer 5

2 out of the 3 criteria:
HA
FEVER
CONFUSION

Question 6

What is the long-term sequelae associated with BACTERIAL MENINGITIS in children?

Answer 6

1. REGRESSION OF MILESTONES/ MENTAL RETARDATION
2. Loss of cognitive fn (loss of neurons in dentate of hippocampus)
3. HEARING LOSS
4. SEIZURES
5. SPASTICITY/PARESIS

Question 7

Child has a 2week history of headache and FND. Now has fever. what does child have? What are important predisposing factors for this?

Answer 7

ABSCESS = fever + ha + fnd

Important pre-disposing factors = congenital heart disease + recurrent sinusitis

Question 8

How do you distinguish between TICK BORNE PARALYSIS and GBS?

Answer 8

Both have ABSENT DTR + ASCENDING PARALYSIS.

TICK BORNE: - Autonomic dysfn, - Abnormal CSF findings, ABSENCE of FEVER/sensory findings

GBS: + Autonomic dysfn (70% - tachy, arrhythmia, urinary retention), + abnormal CSF (elevated protein, normal WBC), + FEVER/ mildly abnormal sensory findings

Question 9

What is the most appropriate step of management in a pt with suspected TICK-BORNE PARALYSIS?

Answer 9

METICULOUS SEARCH FOR THE TICK

Question 10

Presence of 14-3-3 protein in CSF indicates what pathology?

Answer 10

CJD

14-3-3 = prion protein

Question 11

Impaired vibration/proprioception + instability during romberg test + diminished pain/temperature sensation (nerve root involvement) + Reduced/absent DTR + LANCINATING PAIN (brief shooting/burnin pain in face, back or extremities) + pupils that constrict poorly to light but constrict normally when instructed to look at a finger near the nose tip

Answer 11

TABES DORSALIS - NEUROGENIC urinary incontinence is possible + ARGYLL ROBERTSON PUPILS

Question 12

Difference between INFANT BOTULISM and ADULT BOTULISM (Source, Tx) resulting in DECREASED Ach release from presynaptic motor neurons

Answer 12

INFANT - Ingestion of spores from environmental dust, Tx = HUMAN-derived botulism Ig

ADULT - Ingestion of PREFORMED C.botulinum toxin, Tx = EQUINE-derived botulism Ig

Question 13

How does one distinguish CONGENITAL MYASTHENIA GRAVIS from INFANT BOTULISM?

Answer 13

INFANT BOTULISM: + Autonomic Sx (CONSTIPATION, DROOLING), progressive descending paralysis

CONGENITAL MG: - Autonomic Sx (constipation, drooling), fluctuation generalized hypotonia