Neuro Final Review Highlights

Question 1

What are the most common causes of Meningitis and what organisms are responsible for what age groups?

Answer 1

• Viral is the most common cause of meningitis, but this usually is self-resolving: 85% enterovirus; VZV, EBV
• Bacterial: strep pneumo, Hib, N. meningiditis
  • Neonates: GBS
  • 11-17 yo: N. meningiditis
  • Adults: streptococcus pneumoniae

Question 2

What is the empiric treatment for meningitis?

Answer 2

Ceftriaxone

A 3 hour delay leads to an increase in 3 month fatality

Question 3

What are the most common causes of encephalitis?

Answer 3

• Viral: enterovirus, herpes virus, rabies virus, arbovirus

- Non-viral: acute disseminated encephalomyelitis (ADEM), rickettsia

Question 4

What is the empiric treatment for encephalitis?

Answer 4

Acyclovir

Question 5

What viruses target which brain tissue in encephalitis?

Answer 5

• HSV targets the temporal lobe

- Arboviruses (WNV) targets the basal ganglia and thalamus

Question 6

What are some characteristic findings for a grade III anaplastic astrocytoma brain tumors?

Answer 6

• Astrogliosis due to rapid synthesis of GFAP (glial fibrillary acidic protein) * this protein modulates astrocyte motility and shape
• Pleomorphism = enlarged nuclei
• Mitoses - cells with lots of mitotic activity

Question 7

What are some characteristic findings of grade IV glioblastoma multiforme brain tumors?

Answer 7

• Commonly found in adults; mean survival = 10 months

- Pseudopalisading necrosis in histology section

Question 8

What are some characteristic findings of grade I pilocystic astrocytoma brain tumors?

Answer 8

• Commonly found in children; have excellent prognosis depending on location
• Histology: rosenthal fibers (red), biphasic (loose and dense areas of cells)

Question 9

For conjunctivitis, how can one tell the difference between viral, bacterial, or allergic etiology?

Answer 9

Type of ocular discharge:

• Viral: clear with preauricular lymphadenopathy
• Bacterial: purulent, pus
• Allergic: watery with stringy white mucus; often itchy

Question 10

What is the most common organism of viral conjunctivitis? And how are these infections treated?

Answer 10

• Neonatal: HSV-1 (acute infection from mother)
• Post-natal: adenovirus, coxsackie, HSV, VZV (herpes zoster opthalmicus), EBV, etc.
• Tx: cold compress, topical vasoconstrictors

Question 11

What are the most common organisms of bacterial conjunctivitis? And how are these treated?

Answer 11

• Children: staph aureus, strep pneumo, Hib, moraxella catarrhalis
• Adults: staph aureus, strep pneumo, E. coli, pseudomonas, moraxella
• Tx: moxafloxacin (fluoroquinolone) or trimethoprim - polymixin B

Question 12

What is the most common organism found in young adult conjunctivitis? What is this condition referred to as and what is a distinct characteristic of this condition? How is it treated?

Answer 12

Hyperacute bacterial conjunctivitis
- Neisseria gonorrhoeae, or meningiditis

Characterized by copious amounts of yellow-green purulent ocular discharge, preauricular adenopathy

• Tx: systemic ceftriaxone

Question 13

What are some common causes of otitis externa?

Answer 13

• Acute localized: staph
• Acute diffuse: pseudomonas
• Malignant (invasion of adjacent bone/cartilage): pseudomonas
• Fungal: aspergillis, candida

Question 14

What are the most common causes of acute otitis media?

Answer 14

Bacterial: strep pneumo, Hib, moraxella catatrrhalis
Viral: RSV (respiratory syncytial virus), rhinovirus

Question 15

What are the empiric and additional treatments for otitis media?

Answer 15

Empiric: amoxicillin

• Can add clavulanate (augmentin)
• PCN allergy: azithromycin
• Pain management: acetaminophen or ibuprofen