Neuro CIS

Question 1

When evaluating a child, what is important to establish?

Answer 1

Some type of baseline to monitor their progress/recovery

Question 2

What is a concerning symptom for a ped patient?

Answer 2

Wants to be left alone, doesn’t move, doesn’t eat.

Question 3

What can a high fever with tachycardia cause in a ped patient?

Answer 3

Flow murmur secondary to increased CO

Question 4

How do we obtain urine for culture from a ped patient?

Answer 4

Via catheterization

Question 5

Explain an elevated white count with left shift?

Answer 5

A left shift occurs when immature neutrophils are sent out of the marrow to fight an infection.

Question 6

What ratio can be helpful in determining the presence of an infection and what is the value for an infection?

Answer 6

Immature neutrophil to total neutrophil ratio. Greater than .2 means there is likely an infection.

Question 7

Top 3 pathogens causing meningitis in 0-2 year age group?

Answer 7

Strep b, E. coli, and list mono

Question 8

Top 3 pathogens causing meningitis in 2-12 year age group?

Answer 8

Strep pneumonia, n meningitis, and h influenza

Question 9

Top 2 pathogens causing meningitis in age 60 years and older?

Answer 9

Strep pneumonia and list mono

Question 10

Top pathogen causing meningitis in teens and young adults?

Answer 10

N meningitis

Question 11

What is the opening pressure in CSF for bacteria, Viral, Neoplastic and Fungal?

Answer 11

Greater than 300, less than 300, 200 and 300

Question 12

WBC count for bacteria, viral, neoplastic and fungal in CSF?

Answer 12

Greater than 1000, less than 1000, less than 500, less than 500

Question 13

PMN % of bacteria in CSF?

Answer 13

80%

Question 14

Glucose level in bacteria, viral, neoplastic, and fungal in CSF?

Answer 14

Less than 40, greater than 40, less than 40, less than 40

Question 15

Protein levels for bacteria, viral, neoplastic, fungal in CSF?

Answer 15

Greater than 200, less than 200, both greater than 200.

Question 16

What do we need to be very careful about when we are considering a Lumbar Puncture?

Answer 16

Bleeding or high cranial pressures

Question 17

5 common symptoms of meningitis?

Answer 17

Fever, N/V, headache, nuchal rigidity, and photophobia

Question 18

What are the three special tests for suspected meningitis?

Answer 18

Nuchal rigidity, brudzinski, and kernig

Question 19

How do you perform the kernig test and what is a positive test?

Answer 19

Flex hip and knee. Slowly extend the knee. Positive test is pain behind the knee.

Question 20

How do you perform brudzinski test and what is a positive sign?

Answer 20

Flex head. Positive sign is a flexion of hips and knees in response of the flexion of the neck.

Question 21

How do you perform nuchal rigidity and what is a positive test?

Answer 21

Flex neck. Resistance to the flexion/stiffness.

Question 22

What special test can you perform for kids 2 and younger?

Answer 22

Fontanelle test.

Question 23

What is your empiric treatment for meningitis?

Answer 23

Vancomycin and ceftriaxone

Question 24

What do you add if the patient is over 50?

Answer 24

Ampicillin

Question 25

What do you add if HSV encephalitis is suspected?

Answer 25

Acyclovir

Question 26

What is considered a fever for an adult?

Answer 26

Oral 100.4, rectal or ear above 101.

Question 27

What is considered a fever in a child?

Answer 27

Rectal above 100.4

Question 28

In what setting is OMT contraindicated for meningitis patients?

Answer 28

Acute setting of pediatric meningitis