Neuro High Yield HO Flashcards
neuro pediatric patients require special considerations when taking their history. name some examples
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
components of a cbc
WBC count RBC count hemoglobin hematocrit MCV MCHC RBC distrib width platelet
components of the diff part of a CBC with diff
neutrophils lymphocytes monocytes eosinophils basophils absolute neutrophil absolute lymphocyte absolute monocyte absolute eosinophil neutrophil comment
what causes a left shift?
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
birth - 2mo of age most common pathogens for meningitis
group b strep (streptococcus agalactiae)
e coli
l monocytogenes
2mo - 12y of age most common pathogens for meningitis
s pneumoniae ( gram + diplococci) n meningitides (gram - diplococci) h influenza (gram - coccobacil.li --> on the decline since vaccinations)
adolescents - young adults of age most common pathogen for meningitis
n meningitidis
patients over 60 of age most common pathogens for meningitis
s pneumoniae
l monocytogenes
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
bacterial
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
viral
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
neoplastic
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
fungal
reasons why CSF protein can be artificially elevated
rbcs d/t
intracranial hemorrhage
traumatic taps
what are the absolute contraindications to a LP
trick question
there are none
although there are no absolute contraindications to performing an LP, when should special precaution be taken
strong suspicion of increased ICP
coagulation abnormalities
suspicion of spinal epidural abscess
when should you consider performing getting a CT before performing an LP
significantly altered mentation focal neurologic signs papilledema hx of a seizure within previous week impaired cellular immunity
classic signs of meningitis
HA
fever
nuchal rigidity
photophobia (variable)
how to perform a kernig sign test
flex pt leg at both hip and knee and then straighten (extend) the knee
+ test = pain on extension
how to perform a brudzinski sign test
flex the neck, watch hips and knees for flexion
+ test = flexion at hips and knees
pe exams that are positive for meningitis
kernig
brudzinksi
nuchal rigidity
at what age will the infantile presentation of increased ICP change to the adult presentation?
at 3 yo the fontanelles are closed and sutures are fused
tyipcal ICP signs will be present
if you suspect meningitis in an ill patient, should you wait for LP cultures before starting antibiotics?
no, treat empirically after drawing blood
draw the LP after, glucose, csf cell count, protein will be valid still
empiric tx for meningitis
vancomycin and ceftriaxone
what antibiotic should you add to the empiric tx of vancomycin and ceftriaxone in elderly patients when you are concerned for listeria?
ampicillin
what antibiotic should you add to the empiric tsx of vancomycin and ceftriaxone in patients suspicious of HSV encephalitis
acyclovir
glucocorticoids are debated in their use for meningitis, what glucocorticoid is typically used?
dexamethasone
disorder of impaired water excretion causeds by inability to suppress secretion of what hormone
ADH
siadh leads to
water retention - hyponatremia
definitions of oral fever and rectal/ear fever
oral fever - temp abobve 100.4F (38C)
rectal/ear - temp above 101 (38.3 C)
in children, fever threshold for ear/rectal begins at
100.4
things that can cause fever
infection
medicine
severe trauma/injury
medical conditions such as arthritis, hyperthyroidism, DVT, some cancers
most accurate way to take a temperature
rectal
OMM to consider in stabilized patients suffering from meningitis
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
OMM considerations in an acute pediatric meningitis case
CONTRAINDICATED
