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Clin Med > Neuro: infections > Flashcards

Neuro: infections Flashcards

1
Q

typical s/s for meningitis

A 
fever 
intense HA 
sensitivtiy to light 
musc rigidity---nuchal 
\_\_\_\_\_\_\_\_\_\_\_\_
severe: 
-ams 
-seizures 
-death
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2
Q

RF for bac meningitis

A
  • sinusitis
  • otitis
  • surgery
  • systemic infections
  • head trauma
  • CA
  • ETOH
  • immunodef states
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3
Q

how do bac usually gain access to CNS in bac meningitis?

-list the progression of infection steps

A

colonizing the mucous mems of NASOPHARYNX

  • -local tissue invasion
  • bacteremia
  • infection in subarachnoid space
  • can spread to meninges via sinuses or defects in skull*
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4
Q

CM bac meningitis

A 
fever
ams 
vom
HA
neck stiffness 
photosensitivty 
seizures 
confusion
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5
Q

classic triad of CM for bac men

A

fever over greater than 38C or 100.8 F
nuchal rigidity
HA

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6
Q

PE findings for bac men

A

neck stiffness on passive flexion–
Thigh flexion on neck flexion–BRUDZINSKI SIGN
resistnace to passive extension of knee w. hip flexion–KERNIG SIGN

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7
Q

what is Brudzinski sign

A

leg raise/flexion on neck extension/bending

lift head up (neck flexion)… the PT’s hips involuntarily flex

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8
Q

what is kernig sign

A 
knee extension (hip flexion) causes pain in the neck 
(K=kernigs and K=knee)

*cant extend knee when the hip is flexed

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9
Q

DX of bac men

A

prompt LP and CSF examination

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10
Q

CSF findings for bac men

  • opening pressure?
  • appearance
  • protein
  • glucose
  • WBC
  • gram stsin
A 
opening pressure: increase 
appereance: turbid 
protein: increased 
glucose: decrease 
WBC: over 80% are neutrophils... generally elevated 
Gram stain: positive
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11
Q

CSF findings for viral men

  • opening pressure?
  • appearance
  • protein
  • glucose
  • WBC
  • gram stsin
A
  • opening pressure–normal or slightly incr
  • appearance–clear
  • protein–normal or slightly incr
  • glucose–normal
  • WBC–mostly lymphocytes
  • gram stsin–normal
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12
Q

CSF findings for fungal men

  • opening pressure?
  • appearance
  • protein
  • glucose
  • WBC
  • gram stsin
A
  • opening pressure–normal
  • appearance–fibrin web
  • protein–increased
  • glucose–decreased
  • WBC–mostly lymphocytes
  • gram stsin–normal
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13
Q 
MCC for bac meningitis in: 
Neonate: 
Children >3Mo-12yrs 
Children 10-19 
Adults up to 50 
Adults 50+
A

Neonate–GBS–S. agalactiae****

  • E. coli
  • H. influ
  • listeria

Children >3Mo-12yrs—Strep pneumo

Children 10-19—>N. meningitidis
Adults up to 50—>Strep pneumo or N. Meningitis
Adults 50+–> Listeria, SP, or NM

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14
Q

Empirix TX for neonatal bac meingitis?

A

Ampicillin + Gentamicin

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15
Q

Empirix TX for Bac men in children >3Mo-10yrs

A

Vancomycin and Ceftriaxone

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16
Q

Empiric tx for Bac men in children 10-19

A

Vancomycin and Ceftriaxone

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17
Q

emp tx for bac men in adults up to 50

A

Vancomycin and Ceftriaxone

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18
Q

emp tx for bac men in adults 50+

A

Vancomycin and Ceftriaxone and Ampicillin (bc we want to cover listeria)

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19
Q

TX for bac men

A
  1. based off age group, empiric ABX
  2. Dexamethasone–red mortality and sequalae (NO in neonates)
    * ***steroids bc meningitis causes inflammation and steroids are anti-inflammatory
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20
Q

Why is there extra precautions in regards to N. meningitis?

A

because it is VERY VERY CONTAGIOUS!

  • MC in pts who are 10-20**
  • *Droplet precaution is used
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21
Q

PTs who are 10-20 w. bac men most likely have which bac?

A

N. meingitis

V contagious

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22
Q

for close contacts with prolonged exposure to PT with bac men due to NM… what is the prophylaxis tx?

A

Ciproflaxacin 500mgx1
OR
Rifampin 600 PO q 12H for 2

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23
Q

vaccines avail for which strains of bac for bac men?

which age group is vaccined for which one?

A
  1. H. influenzae–>2-15 MO
  2. N. meningitidis–>11-12 YO..booster at 16YO
  3. S. pneumoniae—>adults 65+ AND 2-15MO
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24
Q

is the head CT scan done before or after LP for bac men?

A

PRIOR TO LP!!

-bc we want to r/o mass effect before doing LP

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25
Q

CM in babies with meingitis?

A

bulging fontanelles

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26
Q

what is it mean by ASEPTIC meningits?

A

microbe causing meningitis doesnt culture on bac media… so viral, fungal, etc

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27
Q

College student living in close proximity with other students.. we want to think?

A

bac meningitis

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28
Q

what must we make sure the PT does not have prior to doing a LP?

A

INCR ICP
**check for papilloedema
also, get a CT if unsure if there is brain swelling

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29
Q

which two diseases cause high protein in CSF?

A

bac meningitis (also fungal)
and
GBS

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30
Q

how to differntiate GBS and bac meningitis CSF results?

A

GBS—- will have NORMAL glucose
BM—decr glucose!!

(both have incr protein)

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31
Q

Aseptic meningits… assume dx when?

A

any meningitis with neg bac cultures

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32
Q

MCC of aseptic/viral men

A

Enterovirus

  • coxsackievirus
  • echovirus
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33
Q

CM for viral men?

A

*classic s/s but can be milder

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34
Q

PE for virla men

A

same as bac
+Brudzinski
+Kernig
+meningeal signs

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35
Q

how to differentiate b/w viral men and encephalitis?

A

VIRAL MEN: has NOOO focal deficits (hemiparesis, sensory, CN palsies) and NO AMS
ENCEPH: has focal deficits and AMS!!!!!

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36
Q

DX for viral men

A

*diagnosis of exlucsion AFTER r/o bacterial *
—-VIA LP!
CSF: will be normal, WBC mainly lymphocytes, and protein normal

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37
Q

TX for viral men

A
  • supportive mainly—antipyretics, IV fluids, analgesics

* most cases are self limiting

38
Q

Do you need droplet precaution in viral men

A

NO!

39
Q

infection or inflammation of brain parancyhmia or brain itself

A

Encephalitis

40
Q

etiology for encephalitis

A

-infectious agents
-metabolic
-mitochrondiral dysfunction
brain tumor
incr ICP
prolong exposure toxin
trauma
poor nutrition
lack of oxygen to brain

41
Q

hallmark of encephalopathy ?

A

AMS

42
Q

MCC viral encephalopathy?

A

HSV-1

43
Q

Leukocyte aggregation in the perivascular space
or
Perivascular “cuffing”
+
lymphocytic infiltration and macrophage proliferation involving gray matter regions

A

viral encephalitis

44
Q

CM of viral enceph

A 
AMS 
Seizures 
HA
neck stiffness 
photosensitivty 
fever 
chills
N/V
45
Q

PE findings for viral enceph

A

focal neuro deficits–hemiparesis, CN palsies, sensory deficits

meningeal signs:
-neck stiffness on passive flexion
-+Brudzinski (often not present)
+Kernig (often not present)

46
Q

What is IMP to do with a PT who has focal neuro deficits prior to LP? and WHY

A

HEAD CT because we want to make sure there is NO tumor

then after -CT… move onto LP

47
Q

CSF findings with viral enceph

other DX tools for dx

A 
Lymphocytes (like aseptic men) 
pressure is normal-slightly increased 
-glucose normal 
-protein is normal-slighthy incr 
RBC can be present (good way to differentiate b/w meningitis too)

***MRI–temporal involvement is characteristics of HSV

48
Q

TX for herpes enceph

A

IV Acyclovir
*empirically started if PT has no obvious causes for encephalitis

+

supportive measures

49
Q

Prodrome to viral enceph?

A

flu-like s/s for few days:

  • mild HA
  • sore throat
  • red appetite
  • myalgias
  • progress to AMS, drowsiness and coma
50
Q

cerebral s/s from hepa enceph caused by ?

A

ammonia toxicity—since liver is damaged–body cannot properly rid of ammonia

51
Q

CM for hepat enceph

A
  • somnolence
  • agitation
  • nystagmus
  • Asterixis
  • seizures
52
Q

how to test for Asterixis

A

Ask PT to put hands out infront of them….. and hands will show tremor

53
Q

Asterixis define

A

flapping tremor of outstretched, dorsiflexed hands or feet

-result from impaired postural control

54
Q

DX for hepatic enceph

A

blood tests: show incr amonia levels, prolonged PT & PTT–b/c liver is not creating the clotting factors you need so PT is at risk for bleeding

CSF: shows elevated glutamine** (AA)

55
Q

TX for hepatic enceph

A

Coagulopathy tx–fresh frozen plasma or Vit K

Lactulose: decreased pH and incr ammonia absop

Rifaximin–redu ammonia forming bacteria in colon

*severe: liver transplant

56
Q

What is the outcome related to in hepatic enceph?

A

related to LIVER function and not really neuro function

57
Q

MC manifestation from West Nile encephalitis

what can also develop?

A

RARE!!!! because mot ppl who get bitten by infected mostiquo will show no s.s

Meningoencephalitis

Acute paralytic poliiomyelitis can also dev
-acute focal or generalized ASYMMETRIC weakness or by a rapidly ascending quadriplegia

58
Q

TX for west nile virus encephalitis

A

Supportive

59
Q

Acute, focal or generalized asymmetric weakness or rapid ascending quadriplegia present?

A

Think acute paralytic poliomyelitis

60
Q

Paralytic shellfish poisoning–what is the toxin

A

Saxitoxin–blocks NA channels–blocks APs—in motor and sensory nerve and muscle

61
Q

CM of paralytic shellfish poisoning

A

rapidly progressive acute peripheral neruopathy
sensory s/s
ASCENDING paralysis

**can lead to resp paralysis—-death

62
Q

how long does it take from ingesting of saxitoxin to s/s

A

30 mins

63
Q

Rapidly progressing acute periphereal neuropathy with sensory s/s
paralysis is in ascending fashion

A

Paralytic shellfish poisoning

64
Q

TX for shellfish poisoning?

A

No antitoxin

-but with proper supportive care…PT can recover

65
Q

Arsenic poisoning—classic CM

A

rapidly evolving sensorimotor polyneuropathy
SYMMETRIC
often with GI distrubances + crampy ABD pain
RASH ON PALMS ON HAND **

sensory s/s are painful
*motor impairment is more in toes and legs vs arms

66
Q

DX for arsenic pois

A

measure arsenic content of HAIR —pubic hair works best bc less contaminated with external substances

urine to—-only ACUTE phase tho

67
Q

TX for arsenic pois

A

No tx

*neuro recovery dep on sevreity of poisoning

68
Q

organophosphate pois——can be from what items

A

pesticides
insecticides
active ingredient in nerve gas

69
Q

cholinergic crisis… think of??

A

organophosphate pois

70
Q

What is blocked during organophos pois

A

ACHE inhibitoin—- so ACHE cannot be b/d into ACH

71
Q

what is usually first s/s of organophos pois? then followed by? next???

A

crampy muscle pain —followed by distal numbness and paresthesias—-then followed by leg weakness–decr in tendon reflexes–

72
Q

TX of organophosphate pois

A

decon skin with BLEACH or SOAP/H2O

Admin ATROPINE 2-6mg every 5mins
Pralidoximine 1G every hour up to 3 hours
*IV OR IM FOR BOTH

TX for neruopathies: none…might go away over time. central deficits can be permanent

73
Q

Lead poisoning–common or not

-affects CNS or PNS

A

common

Affects both CNS and PNS

74
Q

in kids, what is the major neurologic feature of lead poisoning?

A

Acute encephalopathy

75
Q

what nerve is typically affected with lead pois

*causes what kind/ pattern/ of disturbances?

A

RADIAL

*causes asymmetric progressive motor disturbances

76
Q

CM lead pois

A 
anemia 
constipation 
colicky abdominal pain (colicky=pains comes/goes)
gum discoloration 
neuropathy
77
Q

tx for lead poisoning?

A

none

78
Q

Botulism toxin can cause? and how?

A

neuromuscular paralysis by preventing release of ACH at NMJ

79
Q

typical CM for botulism toxicity

A 
diplopia 
facial weakness 
dysphagia 
nasal speech 
diff breathing when diapragm aff

weakness
flaccid paralysis
resp arrest

80
Q

MC cause of botulism tox

A

home canning

81
Q

other causes of botuism tox

A
  • vacuum and smoked oacked foods
  • honey—-infants
  • iv drug users
  • wounds
82
Q

when does weakness s/s begin after exposure to botulism toxin?

A

12-72 hours after ingestion of toxin

6-8 hrs in infants

83
Q

weakness in what body part s/s for botulism occurs when in disease progression?

A

LAST in the limbs

84
Q

classic pupilary CM for botulism tox

A

fix
dilated
unreactive
*blurry vision

85
Q

prodromal s/s for botulism tox

A

GI symptoms
N/V
ABD pain
diarrhea

86
Q

what s/s occur after the GI prodromal s/s for botulism tox?

A

diplopia, dry mouth, dilated and fixed pupils, descending and decreased muscle strength (flaccid paralysis) and decr DTR

87
Q

infant presnts: lethargic, feeding difficulty, hypotonia and weak cry

A

floppy baby syndrome due to botulism toxicity

88
Q

if you get C botulism through wound: what are s/s

A

weakness
fever
leukocytosis

89
Q

Dx for botulism

A

clinical

90
Q

how to CONFIRM dx of botulism?

A

stool wound or serum assay

91
Q

Managemtn for Botullism:

  1. foodborne
  2. wound
A
  1. if >1yr old–>antitoxin is first line
    if <1 yr old—>human derived botulism immune globulin
  2. Antitoxin and ABX… PCN first lone

Clin Med (52 decks)

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