Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

EM quiz readings > Headaches quiz - Ch 148 > Flashcards

Headaches quiz - Ch 148 Flashcards

1
Q

What are the life threatening central nervous system infections that we are worried about in the ED

A
  • bacterial meningitis
  • viral encephalitis
  • brain abscess
  • spinal epidural abscess
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is aseptic meningitis

A

when inflammation of the meninges is due to causes other than bacterial infection such as drug rxn, rheumatologic conditions, or nonbacterial infections (viral/funal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the MCC of aseptic meningitis

A

enteroviruses and echoviruses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the clinical triad of meningtisi

A
  • fever
  • neck stiffness
  • AMS

less than 1/2 of paients present with all three initially!

headache is also a common symptom

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what physical exam findings should you look for in CNS infections

A
  • nuchal rigidity
  • kernigs sign (pain in back and legs w flexion of hip and ext knee)
  • brudzinski’s sign (flexion of hips w passive flexion of neck)
  • cranial nerve palsy
  • skin for petechiae, splinter hemorrhages (systemic infection signs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is encephalitis

A

infection of the brain parenchyma that causes inflammation ithin the CNS. often caused by VIRAL infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the most treatable cause of encephalitis

A

herpes simplex virus (HSV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

pts w encephalitis may mimic what other diagnosis? what additional symptoms should you look for to differentiate these?

A

may mimic meningitis (neck stiffness, fever, headache, AMS)

look for other symptoms such as:
- cognitive deficits
- psychiatric symptoms
- seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the diagnostic study of choice for suspected meningitis or encephalitis

A

lumbar puncture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

when is CT brain indicated in suspected encephalitis or meningitis

A

when AMS, new onset seizures, immunocomp pts, focal neuro signs, or papilledema are present.

order BEFORE LP in these scenarios due to risk of CI to LP such as occult mass or signs of brain shift/herniation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

when are blood cultures particularly helpful in the diagnosis of meningitis and encephalitis

A

to identify bacterial pathogens when empiric antibiotics are given prior to LP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

in patients 50 years old or less with suspected bacterial meningitis, what is the empiric treatment?

A

3rd gen ceph (ceftriaxone(rocephin)) + vanc

add dexamethasone to decrease mortality and nero probs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what patients are at risk for listeria monocytogenes meningitis and what is the empiric treatment for these patients

A

50+years, pregnent, alcoholic, immunocomp

tx:3rd gen ceph (ceftriaxone(rocephin)) + vanc + ampicillin

add dexamethasone to decrease mortality and nero probs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the empiric treatment for patients with suspected encephalitis

A

IV acyclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

if CSF analysis comes back + for encephalitis and the cause is CMV, what is the treatment

A

IV ganciclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

if CSF analysis comes back + for encephalitis and the cause is not CMV or HSV what is the treatment

A

supportive. no evidence of any antivirals impacting tx outcome.

17
Q

what is protocol for all patients with bacterial meningitis or encephalitis

A

admission to hospital for IV antimicrobial agents and further care

18
Q

what is a brain abscess and what causes it

A

bacterial infection of the brain parenchyma composed of a central purulent cavity ringed by a layer of granulation tissue and outer fibrous capsule

19
Q

what are presenting signs/symptoms of brain abscesses

A

nonspecific but may include:
* HA
* neck stiffness
* fever
* vomiting
* confusion
* AMS
* s/s may reflect origin of infection (eye/ear/sinus pain)
* symptoms may be present 1-8 weeks prior to dx

20
Q

what is needed to make the diagnosis of a brain abscess?

A

imaging:

  • CT noncontrast can be used
  • CT w contrast more likely to identify it
  • MRI also good

this was so nonspecific, plz read to interpret for yourself

21
Q

what should be avoided in brain abscesses

A

LUMBAR PUNCTURE

22
Q

what is needed to guide the management of brain abscesses after the diagnosis has been made

A

blood cultures or cultures of other sites of infection

23
Q

what is the treatment for otogenic brain abscesses

A
24
Q

what is the treatment for odontogenic brain abscesses

A
25
Q

what is the treatment for sinogenic brain abscesses

A
26
Q

what is the treatment for penetrating trauma causing brain abscesses

A
27
Q

what is the treatment for brain abscesses after neurological procedures

A
28
Q

what is the treatment for brain abscesses from unknown sources

A
29
Q

what is a spinal epidural abscess

A

rare infection consisting of pyogenic material that accumulates in the epidural space.

30
Q

where do up to half of epidural abscesses originate from? where do they most often occur?

A

hematogenous spread of bacteria from soft tissue, urine, or respiratory sources.

most occur in thoracic and lumbar spine

31
Q

what is the classic triad of spinal epidural abscesses

A
  • back pain
  • fever
  • neurological symptoms

present in only a minority of patients, but back pain is found in 70-90% of cases.

fever is also common

32
Q

what are the typical stages of untreated epidural abscesses

A
  1. back pain, fever, localized spinal tenderness
  2. spinal irritation w radicular pain, hyperreflexia, nuchal rigidity.
  3. fecal or urinary incontinence plus focal neuro deficits
  4. motor paralysis of lower extremities
33
Q

what are risk factors you should assess for when considering spinal epidural abscess

A
  • immunocomp
  • IVDU
  • spinal surgery
  • recent LP or epidural procedure
34
Q

what are PE findings for epidural abscess

A

midline spinal tenderness to palpation or percussion

35
Q

what neurologic findings should you look for that suggest cauda equina syndrome over epidural abscess

A
  • decreased rectal tone
  • decreased perineal sensations

this was an odd sentence. read for yourself plz.

36
Q

what laboratory studies may be helpful in the diagnosis of epidural abscesses

A
  • CBC
  • ESR
  • CRP
  • blood cultures (+ in 40%, helpful for tx after dx)
37
Q

what is the imaging modality of choice for epidural abscess? what is second line?

A

1st - gadolinium MRI
2nd - CT w myelography if MRi not possible

38
Q

when should you give emperic abx therapy in epidural abscess suspicion? what abx are used?

A
  • empiric tx indicated if neuro dysfunction, signs of sepsis/systemic illness, or immediate surgery is not available.
  • use Vanc + ceftazidime/cefipime +/- gentamycin

EM quiz readings (43 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions