Meningitis, TIA, stroke

Question 1

incidents that can lead to bacterial menigitis (3)

Answer 1

• skull fractures
• surgical procedures (local to area)
• ear/sinus/tooth infections

Question 2

which type of menigitis is a more urgent situation?

Answer 2

bacterial

Question 3

how do we prevent bacterial meningitis when we do brain surgery?

Answer 3

prophylactic antibiotics

Question 4

bac meningitis has a high mortality rate if untreated within _____

Answer 4

24hrs

Question 5

if a patient recently had enterovirus, arbovirus, has HIV, had mumps, or chickenpox, what might they be at risk for?

Answer 5

viral meningitis

Question 6

patient presents with severe headache, fever, nausea and vomiting, and a peticheal rash. what else would I want to check to make a guess at diagnosis?

Answer 6

kernigs and bruudinski’s sign, are they photophobic? do they have nuchal rigidity

Question 7

what is the main complication of menigitis?

Answer 7

decreased LOC eventually leading to coma

Question 8

three dx for suspected meningitis

Answer 8

• blood cultures, CT scan, lumbar puncture and analysis of CSF (to confirm!)

Question 9

when do we start antibitocis for meningitis?

Answer 9

Immediately as soon as we suspect it, even if it ends up being viral!

Question 10

should a patient be on universal precautions for meningitis?

Answer 10

No, they will be on transmission precautions for 48hrs after abx initiated

Question 11

three types of drugs besides abx for bacterial meningitis

Answer 11

steroids (dex), antipyretics, anticonvulsants

Question 12

how long can a TIA last?

Answer 12

typically 30-60 minutes, but can last as long as 24 hrs

Question 13

what should someone do when they have a TIA?

Answer 13

follow up with their dr to prevent future stroke

Question 14

how do we assess risk for stroke following a TIA?

Answer 14

ABCD - age, (>60), BP (>140/90), Clinical TIA features, Duration of syptoms

Question 15

what is a NIHSS score?

Answer 15

NIH stroke scale score

Question 16

what are four stroke-preventing drugs?

Answer 16

platelet inhibitor (clopidogrel), anticoagulent (riveroxaban), antihypertensives, statins

Question 17

two surgeries for recurrent stroke or high risk

Answer 17

transluminal angioplasty, carotid endarterectomy

Question 18

what is ESSENTIAL during carotid endarterectomy?

Answer 18

BP management!

Question 19

a patient is eligible for stroke treatment within _____ hrs

Answer 19

6

Question 20

what happens if someone with a stroke is beyond the 6 hr point?

Answer 20

if under 24 hrs, risk v benefit of tx to be determined by stroke specialist

Question 21

what are the two main interventions available for stroke?

Answer 21

fibrinolytics, endovascular interventions

Question 22

whats the most important reason to know someone’s medication hx if they are presenting with stroke symmptoms?

Answer 22

because if its hemorhagic and they’re on anticoags, we may need to reverse them

Question 23

what street drug increases risk of stroke?

Answer 23

cocaine

Question 24

if a patient is to receive fibrinolytics, what is the recommended time since symptom onset?

Answer 24

maximum 4.5 hrs

Question 25

during tPA infusion, how often do we do vitals?

Answer 25

q 15 for first hour, q 30 for 6 hr, etc. on ICU

Question 26

what should BP be maintained at during tPA tx?

Answer 26

<185/110

Question 27

during tPA, what should we NOT do?

Answer 27

insert a tube, give IM injectinos

Question 28

three available endovascular interventions for stroke

Answer 28

• intra-arterial thrombolysis with tPA
• mechanical embolectomy
• carotid artery angioplasty with stent placement

Question 29

pt teaching when d/c after a stroke

Answer 29

will be on anticoags, teach signs of bleeding, if on warfarin, teach about regular blood tests

Question 30

treatment for hemorrhagic stroke (intracerebral)

Answer 30

repair bleeding vessel and remove blood, treat for IICP

Question 31

whats the key thing to prevent with subarachnoid hemorrhage?

Answer 31

vasospasm!

Question 32

what is the most common cuase of subarachnoid hemorrhage?

Answer 32

aneuryms

Question 33

when is a vasospasm most likely to occur?

Answer 33

4-14 days after bleed/stroke

Question 34

what’s the magic drug for vasospasm?

Answer 34

nimodipine - a ca channel blocker

Question 35

why would we give nimodipine?

Answer 35

to prevent or treat vasospasm

Question 36

besides nimodipine, how do we treat vasospams?

Answer 36

maintaining fluid and electrolyte status