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WI18 Neuro > Howell 2 > Flashcards

Howell 2 Flashcards

1
Q

what organisms cause the purpura rash of meningitis

A

-N. Meningiditis (MC)
-Strep. Pneumoniae
H. Influenzae

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2
Q

the neurologic complications that may occur if this patient’s ICP is permitted to rise?

A

Seizures
Focal Neurologic Deficits
Papilledema

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3
Q

meningitis labs

A

CBC w/diff, CMP, Coag’s, Blood Cx’s x 2

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4
Q

when to CT meningitis before LP

A

Immunocompromised state

History of CNS disease (mass lesion, stroke, or focal infection)

New onset seizure (within one week of presentation)

Papilledema

Abnormal level of consciousness

Focal neurologic deficit

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5
Q

What does Rifampin protect against?

A

Meningicoccal

H. Influenzae

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6
Q

How are other organisms tx’d (prophylactically)?

A

There is no targeted tx

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7
Q

normal ct in meningitis… what do you do

A

you LP!!

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8
Q

LP what position

A

lateral recumbent position

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9
Q

meningitis tx

A

Dexamethasone (+/-), Vancomycin and Rocephin

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10
Q

What is important about the dexamethasone and the abx?

A

Give the Dexamethasone First!

Or at least the same time as the abx

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11
Q

symptoms that differentiate meningitis and encephalitis

A

AMS

focal deficits

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12
Q

most likely source of encephalitis in healthy pt

A

HSV

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13
Q

most likely source of encephalitis in unhealthy pt

A

VZV and CMV

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14
Q

What virus typically manifests with challenges in swallowing and hydrophobia?

A

Rabies virus

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15
Q

Why when considering Encephalitis do you concern yourself with the history and labs?

A

disttinguse acute arboviral encephalitides as the other acute viral encephalitides, especially HSV encephalitis (HSE) and varicella-zoster encephalitis

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16
Q

normal CSF

Pressure (mmH2O)
Appearance
Protein (mg/dL)
Glucose (mg/dL)
WBC
A

P: 50-200
A: Clear, colorless
P: 10-50
G: 50-80

<5 – all mononuclear

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17
Q

bacterial meningitis LP findings

A

cloudy (torpid grey)

increased protein and decreased glucose

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18
Q

most common bacterial etiology of community-acquired meningitis in adults of all ages

A

Streptococcus pneumonia

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19
Q

encapsulated organisms

A 
Streptococcus pneumoniae
N. meningitidis 
H. influenzae 
Group B streptococcus 
E.Coli
Klebsiella
Salmonella

this is important bc no spleen = increased

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20
Q

organism to suspect in pts with meningitis following vp shunt

A

gram - bacilli

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21
Q

What are the most common cause of neonatal meningitis?

A

Group B streptococcus andEscherichia coli

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22
Q

Where is the MC source of this for the baby, when less than 6 days?

A

Vertical Transmission

Maternal transmission, MC during delivery. Screening after: 35-37 weeks and providing abx during delivery.

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23
Q

What is the MC cause of disease in neonate after 7 days?

A

Nosocomial

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24
Q

age/organism

>1 month and < 3 month

A

Group B strep

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25
age/organism >3 month and < 3 years > 3 years and 10 years > 10 yrs and < 19 years
Group B strep | N. Meniningiditis
26
Infants 1-3 months old receive what regimen
Ampicillin and Cefotaxime
27
Children > 3 months old receive what regimen:
Ceftriaxone and Vancomycin
28
tx of Everyone up to 50 y/o
Ceftriaxone and Vancomycin + Ampicillin
29
Aseptic Meningitis
HA subacute presentation consider HIV
30
causes of Aseptic Meningitis
Viruses, Fungi, Spirochetes, and even Autoimmune/Vasculitic and Hypersensitivity reactions have been reported.
31
how do you determine potential cause of aseptic meningitis
epidemiologic setting recent medication use
32
every pt with aseptic meningitis must be tested for
HIV
33
What viral infections occur in the Summer or Fall and is the MC cause of viral associated meningitis?
Enteroviruses (Coxsackie, Echovirus, and Non-polio Virus) ****
34
What is the treatment of choice for most viral meningitis patients?
Symptomatic management/supportive care.
35
What virus getting treated with targeted therapies (in meningitis)?
HSV, VZV, and CMV (Acyclovir and Gancyclovir)
36
What form of Meningitis presents as: This CSF Normal appearance. Proteins were approximately 40 mg/dL and CSF: Serum ratio of glucose was > 0.6; < 1000 wbc’s…mostly Eosinophils
Coccidoidal (Aseptic Meninigitis with Eosinphils)
37
What medications are most commonly associated with aseptic meningitis?
NSAIDs, Sulfa Based, IVIG, Antiepileptics
38
why did the median age of meningitis switch?
H Flu and Strep pneumo vax
39
What vaccination is provided to those living in dorms, and generally provided to those 11-16 y/o? How many in series?
Answer: MCV-4 How many in series? Answer: 2 shots
40
What vaccine is provided as routine childhood immunizations, four shot series (2,4,6, 12 months) and is not generally needed after the age of 5 y/o?
Hib (H. Influenzae Type B) + Prevnar 13
41
Which vaccination is for those who are > 65 y/o or for those with poor health?
PPSV
42
Why is Pneumovax so important for meningitis prevention?
It is the MOST COMMON Bacterial cause of meningitis “broadly”
43
risk factors for meningitis
Asplenia and sickle cell disease Complement deficiency Alcoholism, IV drug use HIV infection --- immunocompromised; opportunistic pathogens Recent infection Crowding Recent head trauma Immunosuppression, diabetes mellitus, renal or adrenal insufficiency, cystic fibrosis, glucocorticoid excess Recent travel to areas with endemic meningococcal disease such as sub-Saharan Africa
44
N. Meninigitidis MC
crowding and recent travel to areas endemic
45
diskitis work up
Labs- ESR/CRP, CBC, CMP, Blood Cx. lance that and obtain a wound cx plain film and ultimately MRI CT guided bx
46
academic difference of Diskitis and Osteomyelitis?
Disc vs. Bone
47
how is Diskitis tx?
Vancomycin and Rocephin Pain mgt. IV therapies, as well as bed rest and brace. -- In bed physical therapy
48
epidural abscess s/s+pathoge
Bladder, bowel dysfunction and paralysis + organisms staph
49
LP and epidural abscess
no use in doing it
50
epidural abscess tx
Vancomycin + Metronidazole + | Either Cefotaxime, Ceftriaxone, (or Ceftazidime if considering pseudomonas)
51
what is the difference between a spinal and intracranial abscess
Intracranial epidural abscesses (IEAs) are less common than spinal epidural abscess, and less acute in their evolution IEAs tend to be slow-growing, rounded, and well-localized
52
how do IEAs look onCT
Biconvex
53
The most frequent intracranial locations
``` Frontal-temporal Frontal-parietal Parietal Cerebellar Occipital lobes ```
54
brain abscess on MRI
Ring Enhancing Lesion
55
mc organism of brain abscess
polymicrobial
56
early stage of brain abscess
cerebritis
57
tx for brain abscess
1. Surgical Debridement with Neurosurgery (aspiration dx vs excision) pends on size 2. Abx: Vancomycin and Rocephin, and Metronidaxole
58
steroids and brain abscess
decrease antibiotic penetration into the abscess slow encapsulation of the abscess site reduce contrast enhancement on CT increase risk of ventricular rupture
59
What are the two variances of meningitis determined by the CSF?
Bacterial and Aseptic
60
Why is it that the host defenses are lacking in the CSF?
Lack of functional opsonic and bactericidal activity
61
meningitis based on timeline What is Acute
Answer: Under 24 hours, MC this is bacterial
62
meningitis based on timeline | What is Subacute
1-7 days, MC this is viral
63
meningitis based on timeline What is Chronic
More than 7 days, this lasts longer than 4 weeks

WI18 Neuro (16 decks)

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