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ACR: Test 2 > Meningitis/HA > Flashcards

Meningitis/HA Flashcards

1
Q

What are symptoms of meningitis

A 
Fever 
chills 
nausea 
vomiting 
headache 
nuchal rigidity
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2
Q

What are PE exams you can do to evaluate meningitis

A

Kernig

Brudzinski

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3
Q

What diagnostic studies would you order to work up meningitis

A

LP

CT

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4
Q

Describe what the CSF and bacterial meningitis may show

A 
Very high opening pressure 
cloudy appearance 
elevated protein (~418)
decrease glucose 
80% neutrophils 
70% bacteria Gram stain 
CSF wbc >1000 
culture positive 65%
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5
Q

Describe what does CSF may look like with a septic meningitis

A 
Pressure slightly high 
clear or cloudy 
elevated protein 
normal or low glucose 
mostly lymphocytes 
gram-negative stain 
CSF wbc 25 to 1000 
negative bacterial culture
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6
Q

How do you treat bacterial meningitis in:
Child <1 mo?
Person >1 mo?
Age >50?

A

Ampicillin + cefotaxime or ampicillin + aminoglycoside

Vancomycin + ceftriaxone

Ampicillin + vancomycin + ceftriaxone

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7
Q

How do you treat a aseptic meningitis

A

Supportive
antipyretics
IVF
anti-emetics

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8
Q

What are some vaccines that can prevent bacterial meningitis

A

HIB
PCV 13
MCV4
PPSV23

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9
Q

If the Neural exam is normal do you need to CT before LP

A

No

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10
Q

When must you get a CT before LP

A 
Immunocompromised patient 
history CNS disease 
new onset seizure 
papilledema 
abnormal level consciousness 
FND
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11
Q

What are headache red flags

A 
Worst headache of their life 
sudden onset 
fever 
nuchal rigidity 
thunder clap 
focal neuro signs
papilledema 
Triggered by cough or exertion 
worsening pattern 
personality change 
Older than 50 
new onset with pregnancy 
tenderness over temporals artery
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12
Q

What is the snoop acronym for Headache red flags

A 
S: Systemic sxs (fever, weight loss)
S: 2ndary RF (HIV, CA)
N: neuro sxs (confusion)
O: onset abrupt
O: older
P: prev ha hx
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13
Q

What are important history questions you may want to ask a person with a headache

A 
Number of headaches per month 
triggers 
trauma 
associated symptoms (aura diplopia nausea vomiting)
medications (OCP)
 environmental factors
Comorbidities
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14
Q

What PE systems should you check in the work up of a headache

A 
Head: Trauma, temporal bruits
Eye: Acuity, Perla, papilledema, EO MI
Neck:Rigidity bruits
CV/pulm
Neuro: Mental status testing, CN exam, motor/reflex symmetry, cerebellar, sensory test
Gait exam
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15
Q

What is the criteria for migraine without aura

A

5 episodes consisting of;

At least 2;

  • Unilateral
  • moderate to severe
  • pulsatile
  • aggravated by movement

At least 1

  • Nausea
  • photophobia and phonophobia
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16
Q

What is the criteria for migraine with aura

A

Criteria same as without aura but headache is preceded by >1 neurologic symptom

  • visual: scintillating scotona, fortification spectra, photophobia
  • sensory: numbness, paresthesia
  • other: weakness, aphasia
17
Q

What is the acute abortive treatment for migraines

A 
NSAIDs 
acetaminophen 
triptan’s (sumatriptan)
opiates 
anti-medics (promethazine)
18
Q

What are preventative treatments for migraines

A

CCB
beta blocker
tricyclic antidepressants
OCP

19
Q

What are non-pharmacologic treatment for migraines

A

Lifestyle modifications
headache diary to ID triggers
stop smoking

20
Q

What is the criteria for tension headache

A

At least 10 episodes <1 day/mo
>30 min-7 days

At least 2 of the following

  • bilateral pressing or tightening
  • mild to moderate
  • not aggravated by routine exertion

Both
- No nausea vomiting photophobia phonophobia

** frequent as as above but >1 but <15days/mo x3mo

21
Q

What is the acute treatment For tension headaches

A 
Aspirin 325-1000mg q4-6hrs
acetaminophen (same^)
ibuprofen 400-700 q6hrs
naproxen 250-500 bid
Excedrin
22
Q

What is the chronic treatment for tension headaches

A

Amitriptyline
fluoxetine
Tizanidine

23
Q

What are non-pharmacological treatments for tension headache

A 
Stop smoking 
relaxation 
acupuncture 
PT 
exercise
24
Q

What are the signs and symptoms of a cluster headache

A 
Sharp pain around the eye 
sudden onset 
rhinorrhea 
lacrimation 
triggers
25
Q

What is the Acute and chronic treatment for cluster headaches

A

Acute: Oxygen, ergotamines

Chronic:

  • Corticosteroids
  • verapamil
  • topiramate
  • valproic acid

ACR: Test 2 (10 decks)

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