Neuro CIS Case 3

Question 1

a high fever with tachcardia in a child can cause

Answer 1

flow murmur

Question 2

how should urine for culture be obtained in young children

Answer 2

via catheterization

Question 3

I/T ratio

Answer 3

immature neutrophils to total neutrophils
can be helpful in determing the presence of an infection

if ratio is >0.2 it is likely that an infection is present

Question 4

infection that causes meningitis for birth to 2 months

treatment

Answer 4

group B strep (streptococcus agalactiae), e coli, listeria monocytogenes

-gentamycin

Question 5

meningitis age 2 months to 12 years

Answer 5

s pneumoniae, n meningities, H influenza

Question 6

meningitis in adolescents and young adults

Answer 6

n meningitidis

Question 7

over 60 meningitis

-treatment

Answer 7

s pneumoniae, listeria monocytogenes

ampicillin

Question 8

when should you be careful getting a lumbar puncture

Answer 8

increased intracranial pressure, coagulation abnormalties, suspicion of spinal epidural abscess

Question 9

what should hyou consider prior to LP in pts with altered mentation, focal neuro signs, papilledema, hx of seizure, or impaired cell immnity

Answer 9

CT

Question 10

what are typical signs of meningitis

Answer 10

HA, fever, N/V, nuchal rigidity, photophobia

Question 11

how do you perform kernigs sign

Answer 11

flex pts leg at both hip and knee then extend knee

positive = extension of leg at knee when hip is flexed 90 degree elicits pain

Question 12

brudzinski’s sign

Answer 12

as flex neck, watch hips and knees in rxn to your maneuver

-positive is when flexion of the neck elicits reflex flexion at the hips

Question 13

empiric treatment meningitis

Answer 13

vancomycin + ceftriazone (+ ampicillin if age over 50 and concerned for listeria)
add acyclovir if suspicious of HSV encephalitis