Neurological Flashcards
You evaluate an 83 year old man in the ED for confusion. He is accompanied by his daughter who says this isn’t normal for him and yesterday he was complaining of ear pain. You also noticed the patient’s neck is really stiff and present with a positive Kernig’s sign. You perform a lumbar puncture and diagnostic findings are made. What do you see in his CSF?
CSF 18 cm H2O, glucose 3.5mmol/L5, WBC cells in CSF, gram stain did not identify anything
Increased CSF pressure, reduced glucose level, High cell count, gram stain identified gram-positive diplococci
normal CSF pressure, normal glucose level, mononuclear cells in CSF, gram stain did not identify anything
mild increased CSF pressure, mild decreased glucose level, mononuclear cells in CSF, gram stain did not identify anything
Increased CSF pressure, reduced glucose level, High cell count, gram stain identified gram-positive diplococci
bacterial meningitis takes up glucose
A 23-year-old man arrives at ED with a severe headache, fever and lethargy. He is not confused and has no neurological signs. On examination he has a positive Kernig sign and nuchal rigidity. A lumbar puncture was performed and revealed normal CSF protein, normal glucose and some lymphocytosis. Based on the clinical history and CSF findings this is most consistent with which of the following?
Viral meningitis
Without culture and gram stain results, all of the above options are equally likely
Viral encephalitis
Bacterial meningitis
Viral meningitis (lymphocytes and normal glucose)
You are a junior house officer working late in the ED when a 20 year old male student is brought in with a fever, stiff neck and headache. You suspect meningitis and set up to perform a lumbar puncture. .Question 1: While waiting for the LP to be done, and for lab results to confirm the diagnosis and causative organism, you wish to give empiric therapy. What is the best choice? Question 2: Now that the lab has sent the gram stain result shown above (it is pink diplococci), would you like to switch antibiotic? What to?
Start on vancomycin, then switch to ceftriaxone.
Start on ceftriaxone, then switch to penicillin.
Start on cephtriaxone plus amoxicillin, then switch to just amoxicillin or penicillin.
Start on ceftriaxone, and don’t switch.
Start on penicillin, and don’t switch.
Start on ceftriaxone, and don’t switch.
(Emperic therapy is always ceftriaxone. (+ Amoxicillin if they are old or pregnant). Can then switch to a penicillin, but ONLY if you know it is susceptible which you don’t. You don’t switch on the basis of a gram stain.
piNk = Negative = N. meningiditis)
A 23 year old university student presents to ED in the afternoon following a 3 day leadership camp. She complains of headache, chills, and feeling weak and achy since waking up this morning. She also reports difficulty moving her head, and complains of the bright lights in ED. Her temperature is 38.1 and on examination you notice a non-blanching rash. Which organism is NOT likely to be the cause of her presentation?
Neiserria meningiditis
Listeria
Staph aureus
Strep pneumococcus
Staphylococcus aureus
In the emergency department, you are called to see a 31 year old woman who has been urgently sent by her GP to Wellington hospital. She is 28 weeks pregnant. The woman is complaining of a severe headache, nausea and vomiting, neck stiffnessand that the light hurts her eyes.You order a lumbar puncture and find a gram-positive bacilli. Whatpathogen are you suspicious of in this woman?
Group B strep
Neisseria meningitidis
Streptococcus pneumoniae
Listeria monocytogenes
Listeria monocytogenes
(She is preggo + this is a gram positive bacilli)
Charlie is an 18 year old female who presents to ED with fever, neck stiffness and headache. She is treated and is found to have meningococcal meningitis. Which of her following risk factors is NOT commonly associated with a Neisseria meningitidis infection?
Select one:
Charlie has recently found out that she is pregnant
Charlie is 18 years old
Charlie’s partner currently has a respiratory infection which Charlie thought she may have caught
Charlie lives in a student hall
Charlie has recently found out that she is pregnant
(this increases Listeria risk but not the others)
A patient presents to the emergency department with a worsening headache, fever of 38.3 and a stiff neck. Blood cultures are taken and a lumbar puncture is taken for analysis of CSF. The doctor starts empiric antibiotics. A gram stain of the CSF shows gram negative cocci in pairs, suggestive of N. meningitidis. Which of the following is false regarding antibiotic selection in meningitis?
Select one:
penicillin is a good choice if Streptococcus pneumonia (pneumococcus) is present
empiric antibiotic treatment should not be started until after blood cultures are taken
empiric antibiotic treatment does not always need to cover Listeria monocytogenes
ceftriaxone is a good first line choice for empiric treatment
Penicillin is a good choice if Streptococcus pneumonia (pneumococcus) is present (nah its not always effective)
A 11 year old male called Thomas presents to the Emergency Department after a 2 hour history of feeling unwell and hot with a headache. On further questioning it is revealed that he also has a stiff neck and his mother mentions a rash that has also recently appeared. He has no other medical conditions and is normally a healthy child.GIven the constellation of symptoms you decide to a lumbar puncture on Thomas. The results are as follows;
WCC: 4500/mm3
Primary cell type: Neutrophils
CSF glucose: 1.0CSF
Protein g/L: 4
What organism is mostly the cause of this presentation?
Select one:
Streptococcus agglactiae (Group B Strep)
Neisseria meningitidis
Staphylococcus aureus
Mycobacterium tuberculosis
Mumps virus
Neisseria meningitidis
A 36 year old man from Papua New Guinea whom immigrated to NZ two years ago, is sent to ED by the after hours clinic. He presents with fever, a terrible headache, photophobia, and a stiff neck, coming on over 7 days. As the house surgeon in ED you send him off for a lumbar puncture to determine a possible meningitis. You find out during taking a history that he has HIV. What is the most likely pathogen causing his meningism?
Select one:
H. influenzae
Listeria monocytogenes
M. tuberculosis
N. meningitidis
M. tuberculosis (TB common in PNG and he has HIV)
You are the house surgeon on the ward reviewing a male patient with suspected bacterial meningitis. He lives in a student hostel and has a recent history of painful swallowing (odynophagia). You have just performed a lumbar puncture and collected CSF. You want to start antibiotic therapy while awaiting results. Which of the following is most appropriate?
Select one:
Ceftriaxone
Await microbial culture and sensitivity before prescribing antibiotics
Amoxycillin
Vancomycin
Penicillin
Ceftriaxone
A 32 year old patient presents to ED with a 3 day history of headache, fever and neck stiffness. On examination the patient is febrile and tachycardic. Meningitis is suspected and a lumbar puncture was done and comes back with the following results:
WBC 256 cells/mm3
Primary cell type - mononuclear
CSF glucose 1.7 mmol/L
CSF protein 2.2 g/L
Based on these results what is the most likely cause of patients meningitis?
Select one:
Strep pneumoniae
Herpes Simplex Virus
Mycobacterium tuberclosis
Neisseria meningitidis
Mycobacterium tuberclosis
(mononuclear rules out bacterial, and protein is too high for viral)
A 40 year old pregnant lady became acutely unwell with nausea and vomiting, fever, headaches, muscle pains, neck stiffness, sensitivity to light. You performed a lumbar puncture, and before you send it to the lab you see that it is very cloudy.While you wait for the CSF results, what empiric antibiotic treatment should you commence?
Select one:
Amoxycillin and Ceftriaxone
Vancomycin and Ceftriaxone
Ceftriaxone
Penecillin
Amoxycillin and Ceftriaxone (have to cover for Listeria coz she preggo)
You are an paediatrics registrar on your night shift when you get an urgent call from ED regarding a 23-day-old baby boy. His parents had brought him in as he had been irritable the whole day, but had spiked a fever in the last hour and become breathless. He also had multiple episodes of vomiting. You take a complete history, do a full exam and decide to do a lumbar puncture to rule out meningitis.You notice that the CSF is cloudy - you send off the sample to the lab and promptly begin the baby on empiric antibiotics. Out of the following choices, what is the most likely organism that may be causing meningitis?
Select one:
Neisseria meningitidis
Group B Streptococci
Listeria monocytogenes
Streptococcus pneumoniae
Enterovirus
Group B streptococci (he is a neonate, this is a common bacteria by da vagina)
An 8 year old girl presents with her first seizure. Her family migrated from Peru 3 years ago. She has normal neurological exam. Her CT brain shows multiple calcified cysticerci.
Select one:
All of the above
Epilepsy
Taenia Solium infection
Toxic cerebral injury
Space occupying lesion
Taenia Solium infection
