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P3.2 > Nero CIS > Flashcards

Nero CIS Flashcards

1
Q

causes of syncope

A
  • neuro-cardiogenic (vasovagal, carotid sinus syndrome, valsalva)
  • vasomotor (inability to maintain peripheral tone)
  • cardiac
  • other- seizure, TIA, psychogenic
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2
Q

seizure- generalized vs partial

A
  • generalized- complete loss of consciousness

- partial- altered consciousness but wakefulness is retained

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3
Q

seizure- potential causes in adults

A
  • metabolic
  • drug induced
  • drug withdrawal
  • CNS pathology (CVA, head trauma, space occupying lesion, infection)
  • endocrine- hypo/hyperthyroidism
  • systemic conditions
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4
Q

seizure- drug induced

A

-Tramadol and Bupropion lower seizure threshold!!

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5
Q

seizur- drug withdrawal

A

-alcohol and benzodiazepines- abrupt withdrawal!!

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6
Q

CNS infectious etiologies in pts with HIV/AIDs

A
  • toxoplasmosis
  • HSV encephalitis
  • CMV
  • Cryptococcus neoformans
  • JC polyomavirus (PML)
  • CNS tb
  • neurosyphilis
  • neurocysticercosis (T solium)
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7
Q

CD4 count <200- what infection, treatment?

A
  • Pneumocystis jiroveci

- TMP/SMX

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8
Q

CD4 count <100- what infection, treatment?

A
  • toxoplasmosis

- TMP/SMX

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9
Q

CD4 count <50- what infection, treatment?

A
  • mycobacterium avium

- Azithromycin

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10
Q

TST (tb skin test) > 5 mm induration- what infection, treatment?

A
  • TB

- isoniazid

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11
Q

Toxoplasmosis- caused by?

A

Toxoplasmosis gondii (obligate intracellular parasite)

  • reproduces in intestinal tract of CATS- oocytes in their feces
  • fecal-oral route!- humans acquire thru ingestion
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12
Q

Toxoplasmosis- presentation, Diagnosis, Tx

A
  • symptomatic when immunocompromised host acquires a primary infection or reactivation of latent infection
  • altered mental status, fever, headaches, seizures, focal neuro deficits
  • clinical sx, IgG anti-toxoplasma, MRI RING ENHANCED LESIONS!!
  • sulfadiazine + pyrimethamine + leucovorin
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13
Q

Toxoplasmosis- prophylaxis when??

A
  • CD4 count <100

- TMP-SMX!!

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14
Q

long term use of methadone- does what?

A

inc risk of long QTC- at risk for torsade de pointes, cardiac death

  • risk inc when used with other 3A4 substrate medications
  • antiviral medications to treat HIV/AIDS are 3A4 substrates!
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15
Q

treatment for cerebral edema

A

(main goal- pressure < 20mmHg)

  • osmotic diuretics
  • IV mannitol
  • induced hyperventilation (causes resp alkalosis- aid in buffering post-injury acidosis)
  • head elevation
  • invasive- decompressive craniotomy, ventriculostomy
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16
Q

IV mannitol

A
  • draws water out of cells/tissues- excreted by kidneys
  • also causes vasoconstriction- dec intracranial blood flow
  • can cause hypernatremia and acute tubular necrosis!
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17
Q

CSF in bacterial infection- opening pressure, WBC, %PMN, glucose, protein, gram stain, cytology

A
  • pressure >300 mmHg
  • WBC >1000
  • PMN >80%
  • glucose <40
  • protein >200
  • gram stain- positive!!
  • cytology- neg
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18
Q

CSF in viral infection- opening pressure, WBC, %PMN, glucose, protein, gram stain, cytology

A
  • pressure <300 mmHg
  • WBC <1000
  • PMN 1-50%
  • glucose >40
  • protein <200
  • gram stain- neg
  • cytology- neg
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19
Q

CSF in neoplastic infection- opening pressure, WBC, %PMN, glucose, protein, gram stain, cytology

A
  • pressure 200 mmHg
  • WBC <500
  • PMN 1-50%
  • glucose <40
  • protein >200
  • gram stain- neg
  • cytology- POSITIVE!
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20
Q

CSF in fungal infection- opening pressure, WBC, %PMN, glucose, protein, gram stain, cytology

A
  • pressure 300 mmHg
  • WBC <500
  • PMN 1-50%
  • glucose <40
  • protein >200
  • gram stain- neg
  • cytology- POSITIVE!
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21
Q

weakness/fatigue/tremor/falls- etiologies

A
  • neurologic- parkinson’s, alzheimers, lewy body dementia, benign familial tremor
  • cardiac- arrhythmia, valvular
  • metabolic- anemia, electrolyte disturbance, thyroid, EtOH use
  • musculoskeletal- DJD, OA, joint laxity
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22
Q

resting tremor

A
  • skeletal m activation is not necessary

- enhanced by cognitive tasks or motor tasks with other body parts

23
Q

postural tremor

A

-occurs in an attempt to hold a body part motionless against gravity

24
Q

action tremor

A
  • occurs during voluntary contraction of skeletal m
  • finger-to-nose, heel-to-shin, reaching, drawing, etc
  • isometric tremor- m contraction against a rigid stationary object
25
Q

Parkinson tremor (vs benign essential tremor)- age of onset, gender, fam hx, asymmetry, character, where, assoc features

A
  • > 50
  • M>W
  • > 25%
  • +++
  • at rest, supination-pronation
  • hands, legs, chin, tongue
  • bradykinesia, rigidity, gait difficulty, postural instability, micrographia
26
Q

benign essential tremor (vs parkinson dz)- age of onset, gender, fam hx, asymmetry, character, where, assoc features

A
  • 2nd and 6th decade
  • M=W
  • > 50%
  • +
  • postural, kinetic
  • hands, head, voice
  • deafness, dystonia, parkinsonism
27
Q

parkinson’s triad

A
  • tremor (pill-rolling, resting)- starts in arm, progresses to contral arm; alcohol improves tremor
  • bradykinesia- unsteady gait
  • rigidity (resistance to passive movement)
28
Q

parkinsons- clinical diagnosis

A
  • triad (tremor, bradykinesia, rigidity)
  • response to L-DOPA
  • order CT or MRI to ensure no underlying structural abnormalities!!
29
Q

parkinsons- treatment

A
  • levodopa- inhibits peripheral DA decarboxylation, crosses BBB, precursor for DA in CNS
  • dopamine agonist (younger pts or in advanced PD)
30
Q

parkinson’s- improve quality of life

A
  • PT/OT consult
  • exercise regimen
  • changes to diet
  • therapy (pyschologic components in PD!!!)
  • support groups
  • family counseling
31
Q

indications for use of warfarin, INR target

A
  • atrial fibrillation- 2-3
  • DVT/PE- 2-3
  • bioprosthetic valve- 2-3
  • mechanical valve- 2.5-3.5
32
Q

most common cause of supratherapeutic INR

A

-interactions with warfarin and its metabolism!!

33
Q

elevated INR- risk? management of supratherapeutic INR

A

bleeding!

  • > 5- lower dose of warfarin
  • 5-9- omit 1-2 doses of warfarin, could admin vit K
  • > 9- hold warfarin, admin vit K
  • if bleeding present- hold warfarin, admin vit K by IV infusion, supplement with prothrombin conc or fresh frozen plasma
34
Q

pt who has fallen and on blood thinner- why use a non-contrasted CT head?

A
  • contrast will obscure blood

- make sure pt doesnt have a brain bleed!!

35
Q

mini-mental state exam- questions?

A
  • orientation
  • registration
  • attention and calculation
  • recall
  • language
36
Q

mini-mental state exam- score

A
  • normal- 24-30
  • mild dementia- 18-23
  • moderate dementia- 10-17
  • severe dementia- <10
37
Q

pediatric H&P- do what?

A
  • esta their developmental baseline
  • ask about pregnancy, delivery, nursery course
  • any sick child that prefers to be left alone and doesnt want to be moved- be concerned!!!
  • high fever with tachycardia cn cause flow murmur
  • urine for culture- obtained via catheterization!!
38
Q

CBC- what is included?

A
  • WBC
  • RBC
  • Hg
  • hematocrit
  • MCV
  • MCHC
  • platelet
39
Q

CBC with differential- what is included?

A

-neutrophil, lymphocyte, monocyte, eosinophil, basophil

40
Q

CBC- left shift- indicates what?

A

-elevated white count + left shift= infection!

41
Q

what is a left shift?

A

-immature neutrophils (bands) are pushed out of marrow to fight an infection

42
Q

I/T ratio

A
  • immature neutrophils/total neutrophils

- >0.2- infection!

43
Q

causes of meningitis- birth-2 months old

A
  • Group B strep
  • E coli
  • L monocytogenes
44
Q

causes of meningitis- 2 months- 12 yrs

A
  • S pneumoniae
  • N meningitides
  • H influenza (dec b/c of vaccination)
45
Q

causes of meningitis- adolescents

A

-N meningitidis

46
Q

causes of meningitis- >60 age

A
  • S pneumoniae

- L monocytogenes

47
Q

CSF protein can be artificially elevated by what?

A

presence of RBCs

  • intracranial hemorrhage
  • traumatic taps
48
Q

careful consideration in when doing a LP

A

suspicion of

  • inc intracranial P
  • coagulation abnormalities
  • spinal epidural abscess
49
Q

consider a CT prior to LP in pts with

A
  • altered mentation
  • focal neurologic signs
  • papilledema
  • hx of seizure within previous week
  • impaired cellular immunity
50
Q

typical signs of meningitis

A

-headache, fever, nausea, vomiting, nuchal rigidity, photophobia

51
Q

tests for meningitis

A
  • kernig sign
  • brudzinski’s sign
  • nuchal rigidity
  • fontanelle check if pt <2 yo
52
Q

kernig sign

A
  • flex pts leg at both hip and knee, try to straighten/extend the knee
  • positive- extension of knee- pain!!!
53
Q

brudzinski’s sign

A
  • flex neck, watch hip and knees

- positive- reflex flexion at hips!

54
Q

empiric treatment for bacterial meningitis

A

-vancomycin + ceftriaxone

P3.2 (11 decks)

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