Module 2 Flashcards
all meningitis has
increased WBC in CSF, symptoms of meningeal irritation
most cases of infectious meningitis caused by
virus
most common virus to cause meningitis
enterovirus
higher incidence of meningitis in
spring and fall
signs, symptoms of meningitis
fever, headache, and stiff neck, usually accompanied by vomiting, lethargy, confusion, seizures, or coma
Brudzinski’s sign
(hip and knee flexion when the neck is flexed), positive with meningitis
Kernig’s sign
(inability to fully extend the legs) positive with meningitis
A computed tomography (CT) examination of the head should be performed before LP in cases of
an abnormal neurologic examination (alteration of consciousness, focal findings, papilledema) to assess risk for herniation with LP.
early sign of hydrocephalus
drowsiness, headache, double vision (from cranial nerve six palsy), and confusion.
later sign of hydrocephalus
decreasing levels of consciousness; hemiparesis; pupillary changes; and Cushing’s triad of hypertension, bradycardia, and respiratory changes.
most common causes of encephalitis
virus
neurologic signs and symptoms of encephalitis are usually preceded by
other signs of viral infection, such as fever, malaise, muscle aches, rashes, gastrointestinal disturbances, or respiratory symptoms.
pt presentation encephalitis
confusion, altered LOC, meningitis symptoms
risk of shingles increases
with age
Varicella-zoster virus is most often found in the
sensory ganglia of the ophthalmic division of the trigeminal nerve and in the dorsal root ganglia of the mid to lower spinal cord
shingles symptoms
pain along dermatome 48-72 hours before eruption of classic rash (vesicular, starts as erythema, changes to popular lesions that rapidly form vesicles, develop for 3-5 days)
hutchinson sign
Ocular involvement is more common in patients who have concurrent lesions at the tip of the nose (shingles)
shingles tx
antiviral, steroids, calamine, tight wrap
post herpetic neuralgia
persistent pain resulting from shingles that lasts more than 3 months after the disease has run its course. PHN rarely occurs in individuals younger than age 40, is more severe in individuals older than age 50
trigeminal neuralgia
excruciating facial pain that usually lasts 3 seconds, disabling, on cranial nerve V. stimulated by triggers
more frequent in women, risk increase with age
trigeminal neuralgia tx
carbamazepine or gabapentin, TCA
TENS, ablation
bell’s palsy
an idiopathic cranial nerve seven palsy causing lower motor neuron facial paralysis, typically occurring on one side of the face
self limiting, complete recovery in weeks- months
Bell’s phenomenon
(the eyeball turns upward when the patient tries to close the eyelid)
bell’s palsy tx
steroids within first few days of symptom onset
protect eye, esp during sleep
Guillain barre syndrome
acute monophasic immune-mediated polyradiculoneuropathy. It is usually an ascending paralysis most often beginning in the legs and then progressing in an ascending fashion. Sensation can be involved, and patients usually report tingling in the extremities. Back pain and autonomic dysfunction are also common
Guillian Barre syndrome tx
IV gamma globulin or PLEX
Myasthenia Gravis
disorder of the neuromuscular junction.
targets receptor for acetylcholine
muscle fatigue, weakness associated with use
MG tx
anticholinesterase agents
Multiple sclerosis
chronic and potentially disabling demyelinating disease of the CNS that begins most commonly in young adulthood. Common symptoms include visual changes (unilateral vision loss, double vision), weakness and numbness, and loss of balance.
most common cause of disability of young adults
3 classifications of MS
relapsing remitting
primary progressive
secondary progressive
first symptoms of MS occur
between 20-50 years, median onset age 30
most common presenting MS symptoms
weakness of the legs, bladder and bowel dysfunction, ataxic gait, paresthesias in the extremities, and optic neuritis
Transverse myelitis
(spinal cord inflammation) causes bilateral weakness, numbness, spasticity, and bladder dysfunction.
For a diagnosis of MS to be made,
two or more areas of the CNS must be involved at two different periods of time.
CSF in MS
lymphocytes, oligoclonal IgG bands
McDonald criteria
are used for definitive diagnosis of MS (Polman et al., 2011). A clinically definitive diagnosis of MS requires either (1) evidence from history of two episodes at least 1 month apart, signs of one lesion on examination, and evidence from evoked responses or MRI of other lesions or (2) evidence from both history and neurologic examination of more than one lesion.
most URIs caused by
viruses
On average, children have approximately
three to eight URIs per year
The incubation period for most viral URIs is
1 to 4 days.
coryza transmission in adults
Hand-to-hand transmission, however, is probably the most common mode of transmission in adults, underscoring the importance of frequent hand washing in the prevention of new cases
influenza symptoms
usually abrupt, with fever, chills, malaise, myalgia, headache, nasal stuffiness, sore throat, and sometimes nausea. A nonproductive cough is usually present and occurs early in the course of illness. The fever may be as high as 103°F
lasts 1-7 days
most common complication: pneumonia
common cold symptoms
headache, myalgia, nasal congestion, watery rhinorrhea, sneezing, foul breath, and a “scratchy throat.
management of flu, common cold
symptomatic
type a influenza tx
antiviral (tamiflu, relenza) within 48 hours of symptoms
Treatment of laryngitis includes
complete voice rest, steam inhalations, codeine or nonnarcotic cough suppressants for cough and pain, and a liquid or soft diet.
For the management of croup
, racemic epinephrine and dexamethasone are indicated, and intubation may be needed in severe case
Pneumonia is typically an
acute inflammation of the lung parenchyma, usually infectious in origin. The lung tissue typically becomes consolidated as alveoli fill with exudate. Gas exchange may be impaired as blood is shunted around nonfunctional alveoli.
Community-acquired pneumonia (CAP) occurs
outside the hospital or is diagnosed within 2 days after hospitalization in a patient who has not resided in a long-term care facility for 2 weeks or more before the onset of the symptoms.
most common cause of community acquired pneumonia
streptococcus pneumoniae
most common cause of nosocomial pneumonia
gram negative bacteria
pneumonia presentation with percussion
dull
Lobar pneumonia involves
an entire lobe of the lung
interstitial pneumonia is a
patchy or diffuse inflammatory process throughout regions of the interstitium
pneumonia lung lobe most commonly affected
lower lobes, d/t gravity
Pneumococcal pneumonia typically includes four responsive stages of infection:
engorgement, red hepatization, gray hepatization, and resolution
engorgement phase pneumonia
alveolar capillaries become congested, bacteria and exudate pour into alveoli from alveolar capillaries, and the bacteria multiply without inhibition
red hepatization phase pneumonia
continued engorgement of the capillaries, with diapedesis of erythrocytes giving the lungs the gross appearance of liver
gray hepatization phase pneumonia
As the leukocyte count increases in the exudate, it compresses the capillaries and causes the lung tissue to assume a gray color