Meningitis + Parkinsonism Flashcards

1
Q

What is Brudsinki’s sign

A

neck flexion causes hip and knee flexion when supine

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2
Q

Most common pathogens causing meningitis
a) generally
b) in neonates, alcoholics, immunosuppressed, DM
c) infants (1-23months)
d) most common viral

A

a) Strep pneumonia, N. meningitides, TB, e coli, H influenza B, listeria
b) listeria, e coli, group B strep
c) strep pneumonia, H influenza, n meningitidis
d) HSV

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3
Q

RF for meninigitis

A

RF: immunocompromised, malignancy, diabetes, HIV, alcohol use, recent neurosurgery, head injury, recent abdo surgery, neonates, Indigenous, students in residence

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4
Q

Sx of meningitis

A

HA
Fever
Neck stiffness
N/V
Poor feeding
Altered MS, irritability

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5
Q

Kernigs sign

A

Kernig’s - pain with passive extension of flexed knee

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6
Q

Ix + results for meningitis

A

Blood cultures
CT
LP
Bacterial: high WBC (500-10K), reduced glucose ration, high proten, neutrophils, gram stain
Viral: WBC (10-500), lymphocytes, moderately increased protein

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7
Q

Empirical abx for ages:
0-4 wks
1-50yrs
>50yrs

A

0-4 wks: ampicillin + cefotaxime
1-50yrs: vancomycin + cefotaxime
>50yrs: vancomycin + cefotaxime + ampicillin

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8
Q

Other Rx for meningitis

A

Abx
Dex
Contact public health + ensure prophylaxis for family

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9
Q

Targeted antimicrobial therapy for
S pneumo
N meningitidis
Listeria
S agalactiae
H influenza
E coli

A

Targeted antimicrobial therapy
S pneumo: Ampicillin
N meningitidis: ampicillin
Listeria: ampicillin
S agalactiae: ampicillin
H influenza: ampicillin
E coli: cefotaxime

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10
Q

Complications of meningitis

A

HA
Sz
Cerebral edema
Hydrocephalus
SIADH
Deafness
Death

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11
Q

Signs of PD

A

Tremor
Rigidity
Akinesia or Bradykinesia
Postural Instability
Shuffling Gait
Decreased Arm Swing
Cogwheeling
Masked Facies
Hypophonia
Dysarthria
Bradyphrenia
Micrographia
Depression
Dementia
Psychosis
Sleep Disturbances
Autonomic Dysfunction

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12
Q

Rx for PD (classes + names for each)

A

MAO B Inhibitors e.g. rasagiline
Dopamine Agonists e.g. levodopa, pramipexole or bromocriptine
Anticholinergics e.g. benztropine
Antivirals e.g. amantadine
COMT Inhibitors e.g. tolcapone

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13
Q

Clinical phenomena seen when treating PD

A

“On-Off” - a switch from proper mobility to dyskinesia or even immobility
“Wearing Off” - symptoms start appearing again before the next dose is due

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14
Q

Sx of PD

A

Resting tremor
Stiffness
Bradykinesia
Imbalance
Gait disturbance
Rigidity
Postural instability

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15
Q

DDx of PD

A

Parkinsonian Syndrome
AD
Multiple cerebral infarcts
Drug induced (APs, lithium, metoclopramide)
Multiple system atrophy
Progressive supranuclear palsy

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16
Q

Non-pharm management of PD

A

Deep brain stimulation of subthalamic nucleus or globus pallidus interna
PT/ OT/ SLP

17
Q

Meds for prevention of meningitis in family

A

rifampin, ciprofloxacin, ceftriaxone

18
Q

What is a normal opening pressure for CSF?

A

6-25cm H20

19
Q

CI to LP

A

coagulopathy, rash at site, herniation, shock