Neuro High Yield HO

Question 1

neuro pediatric patients require special considerations when taking their history. name some examples

Answer 1

establish developmental baseline
ask how pregnancy/delivery/nursing went
any sick child that prefers to be left alone and doesnt want to be moved (meningitis)
high fever with tachycardia can cause flow murmor in a child secondary to increased CO
urine for culture should always be obtained via catheterization

Question 2

components of a cbc

Answer 2

WBC count 
RBC count 
hemoglobin
hematocrit 
MCV
MCHC 
RBC distrib width
platelet

Question 3

components of the diff part of a CBC with diff

Answer 3

neutrophils
lymphocytes
monocytes
eosinophils
basophils
absolute neutrophil
absolute lymphocyte
absolute monocyte
absolute eosinophil
neutrophil
 comment

Question 4

what causes a left shift?

Answer 4

elevated white count with a left shift indicates an infection
a left shift occurs when neutrophils are pushed out of the marrow to fight something
I/T ratio == immature/total neutrophils - a value .2 indicates an infection

Question 5

birth - 2mo of age most common pathogens for meningitis

Answer 5

group b strep (streptococcus agalactiae)
e coli
l monocytogenes

Question 6

2mo - 12y of age most common pathogens for meningitis

Answer 6

s pneumoniae ( gram + diplococci)
n meningitides (gram - diplococci)
h influenza (gram - coccobacil.li --> on the decline since vaccinations)

Question 7

adolescents - young adults of age most common pathogen for meningitis

Answer 7

n meningitidis

Question 8

patients over 60 of age most common pathogens for meningitis

Answer 8

s pneumoniae

l monocytogenes

Question 9

high opening pressure 
high white count
80% PMN 
glucose less than 40 
>200 mg/dl protein 
positive gram stain 
negative cytology 

what type of meningitis is indicated by these CSF findings

Answer 9

bacterial

Question 10

moderate opening pressure 
high white count 
1-50% PMN
>40 mg/dl glucose
<200 mg/dl protein 
negative gram stain  
negative cytology 
what type of meningitis is indicated by these CSF findings

Answer 10

viral

Question 11

200 mmhg opening pressure (slightly elevated) 
500 wbc 
1-50% PMN
glucose <40 mng/dl 
protein >200 mg/dl 
negative gram stain
positive cytology 
what type of meningitis is indicated by these CSF findings

Answer 11

neoplastic

Question 12

300 mmhg opening pressure 
<500 wbcs
1-50% PMN
glucose <40mg/dl 
>200 mg/dl protein 
negative gram stain
positive cytology 
what type of meningitis is indicated by these CSF findings

Answer 12

fungal

Question 13

reasons why CSF protein can be artificially elevated

Answer 13

rbcs d/t
intracranial hemorrhage
traumatic taps

Question 14

what are the absolute contraindications to a LP

Answer 14

trick question

there are none

Question 15

although there are no absolute contraindications to performing an LP, when should special precaution be taken

Answer 15

strong suspicion of increased ICP
coagulation abnormalities
suspicion of spinal epidural abscess

Question 16

when should you consider performing getting a CT before performing an LP

Answer 16

significantly altered mentation
focal neurologic signs
papilledema
hx of a seizure within previous week
impaired cellular immunity

Question 17

classic signs of meningitis

Answer 17

HA
fever
nuchal rigidity
photophobia (variable)

Question 18

how to perform a kernig sign test

Answer 18

flex pt leg at both hip and knee and then straighten (extend) the knee
+ test = pain on extension

Question 19

how to perform a brudzinski sign test

Answer 19

flex the neck, watch hips and knees for flexion

+ test = flexion at hips and knees

Question 20

pe exams that are positive for meningitis

Answer 20

kernig
brudzinksi
nuchal rigidity

Question 21

at what age will the infantile presentation of increased ICP change to the adult presentation?

Answer 21

at 3 yo the fontanelles are closed and sutures are fused

tyipcal ICP signs will be present

Question 22

if you suspect meningitis in an ill patient, should you wait for LP cultures before starting antibiotics?

Answer 22

no, treat empirically after drawing blood

draw the LP after, glucose, csf cell count, protein will be valid still

Question 23

empiric tx for meningitis

Answer 23

vancomycin and ceftriaxone

Question 24

what antibiotic should you add to the empiric tx of vancomycin and ceftriaxone in elderly patients when you are concerned for listeria?

Answer 24

ampicillin

Question 25

what antibiotic should you add to the empiric tsx of vancomycin and ceftriaxone in patients suspicious of HSV encephalitis

Answer 25

acyclovir

Question 26

glucocorticoids are debated in their use for meningitis, what glucocorticoid is typically used?

Answer 26

dexamethasone

Question 27

disorder of impaired water excretion causeds by inability to suppress secretion of what hormone

Answer 27

ADH

Question 28

siadh leads to

Answer 28

water retention - hyponatremia

Question 29

definitions of oral fever and rectal/ear fever

Answer 29

oral fever - temp abobve 100.4F (38C)

rectal/ear - temp above 101 (38.3 C)

Question 30

in children, fever threshold for ear/rectal begins at

Answer 30

100.4

Question 31

things that can cause fever

Answer 31

infection
medicine
severe trauma/injury
medical conditions such as arthritis, hyperthyroidism, DVT, some cancers

Question 32

most accurate way to take a temperature

Answer 32

rectal

Question 33

OMM to consider in stabilized patients suffering from meningitis

Answer 33

lymphatics - rib raising, st to cervical spine, venous sinus drainage
techniques in cervical spine - direct/indirect - just gentle shit
if LP was done, BLT and other gentle techniques can be done to the lumbar spine

Question 34

OMM considerations in an acute pediatric meningitis case

Answer 34

CONTRAINDICATED