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Yr 5 - Neuro > Revision > Flashcards

Revision Flashcards

1
Q

What are the 5 most common viral causes of meningitis?

A

1) Enteroviruses e.g. coxsackie

2) HSV

3) VZV

4) CMV

5) Mumps

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2
Q

Describe different aspects of CSF in viral meningitis:

a) appearance

b) glucose

c) protein

d) white cell count

A

a) clear
b) normal or mildly raised
c) normal or mildly raised
d) raised, lymphocytes

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3
Q

Describe different aspects of CSF in bacterial meningitis:

a) appearance

b) glucose

c) protein

d) white cell count

A

a) cloudy
b) low
c) raised
d) raised, neutrophils

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4
Q

Describe different aspects of CSF in TB meningitis:

a) appearance

b) glucose

c) protein

A

a) cloudy, fibrin web
b) low
c) ++ raised

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5
Q

Mx of viral meningitis

A

Typically viral meningitis is self-limiting, with symptoms improving over the course of 7 - 14 days.

Can give aciclovir in HSV meningitis

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6
Q

What are the 5 main causes of bacterial meningitis?

A

1) Neisseria meningitidis

2) Strep. pneumoniae

3) H. influenzae

4) GBS (neonates)

5) Listeria monocytogenes (neonates)

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7
Q

What is the most common cause of bacterial meningitis?

A

Neisseria meningitidis (meningococcus)

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8
Q

What 2 special tests can look for meningeal irritation?

A

1) Kernig’s

2) Brudzinski’s

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9
Q

Where is the needle inserted in an LP?

A

L3/4 or L4/5

Spinal cord ends at L1/2

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10
Q

Where does spinal cord end?

A

L1/2

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11
Q

Management of children in 1ary care with suspected meningitis AND a non-blanching rash?

A

Urgent dose of IM or IV benzylpenicillin whilst waiting transfer to hospital (shouldn’t delay transfer).

If true penicillin allergy, transfer should be the priority rather than other antibiotics.

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12
Q

If meningococcal meningitis is suspected, what investigation should be done?

A

Meningococcal PCR

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13
Q

There should be a low threshold for treating suspected meningitis, particularly in babies and younger children. Always follow the local guidelines.

What are the typical antibiotics used in babies:
a) under 3 months
b) over 3 months

A

a) IV cefotaxime + amoxicillin

b) IV ceftriaxone

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14
Q

When & why are steroids indicated in meningitis?

A

Indicated in bacterial meningitis

To reduce risk of hearing loss

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15
Q

Who are steroids avoided in in meningitis?

A

Babies <3 months old

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16
Q

What steroids are given in bacterial meningitis?

A

Dexamethasone

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17
Q

Which types of meningitis are notifiable diseases to the UK Health Security Agency?

A

Bacterial

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18
Q

What is the usual post-exposure prophylaxis against meningococcal infection?

A

Single dose of ciprofloxacin

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19
Q

What is the most common complication of meningitis?

A

Sensorineural hearing loss

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20
Q

Patients with meningococcal meningitis are at risk of Waterhouse-Friderichsen syndrome.

What is this?

A

Failure of adrenals 2ary to adrenal haemorrhage

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21
Q

What is the most common cause of encephalitis in neonates?

A

HSV-2 (from genital herpes contracted during birth)

22
Q

What GCS is a contraindication for an LP?

A

<9

23
Q

What is anti-NMDA receptor encephalitis?

A

A paraneoplastic syndrome.

24
Q

What is detected in up to 1/2 of female adult patients with anti-NMDA receptor encephalitis?

A

Ovarian teratoma

25
Q

Mx of anti-NMDA encephalitis?

A

IV steroids

26
Q

What testing is indicated in all patients with encephalitis?

A

HIV testing

27
Q

Mx of CMV encephalitis?

A

ganciclovir

28
Q

What is usually performed to ensure successful treatment prior to stopping antivirals in encephalitis?

A

Repeat LP

29
Q

When should patient’s with Bell’s palsy be referred urgently to ENT?

A

If no improvement in symptoms after 3 weeks

30
Q

What is pituitary apoplexy?

A

Sudden enlargement of a pituitary tumour (usually non-functioning macroadenoma) 2ary to haemorrhage or infarction.

31
Q

Precipitating factors for pituitary apoplexy? (4)

A

1) HTN
2) pregnancy
3) trauma
4) anticoagulation

32
Q

Clinical features of pituitary apoplexy?

A

1) sudden onset headache (similar to SAH)

2) vomiting

3) neck stiffness

4) visual field defects: classically bitemporal superior quadrantic defect

5) features of pituitary insufficiency
- hypotension/hyponatraemia 2ary to hypoadrenalism

6) extraocular nerve palsies

33
Q

What investigation is diagnostic of pituitary apoplexy?

A

MRI

34
Q

Mx of pituitary apoplexy?

A

1) urgent steroid replacement due to loss of ACTH

2) careful fluid balance

3) surgery

35
Q

Is IV or oral ciprofloxacin used as prophylaxis for contacts of patients with meningococcal meningitis?

A

Oral

36
Q

What triad is seen in shaken baby syndrome?

A

1) retinal haemorrhages

2) subdural haematoma

3) encephalopathy

37
Q

Is a history of rash with penicillin a contraindication to using benzylpenicillin or ceftriaxone in meningococcal sepsis?

A

No

38
Q
A
39
Q

What features of trigeminal neuralgia suggest a serious underlying cause?

A
  • Sensory changes
  • Deafness or other ear problems
  • History of skin or oral lesions that could spread perineurally
  • Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally
  • Optic neuritis
  • A family history of multiple sclerosis
  • Age of onset before 40 years

URGENT referral for specialist assessment

40
Q

Gold standrd for diagnosis of venous sinus thrombosis?

A

MRI venography

41
Q

Is HIV a notifiable disease?

A

No

42
Q

What is Ramsay Hunt syndrome?

A

AKA herpes zoster oticus

Caused by reactivation of the VZV in the geniculate ganglion of CN VII.

43
Q

What is often the 1st feature of Ramsay Hunt syndrome?

A

Auricular pain

44
Q

Features of Ramsay Hunt syndrome?

A
  • auricular pain
  • facial nerve palsy
  • vesicular rash around the ear
  • other features include vertigo and tinnitus
45
Q

Mx of Ramsay Hunt syndrome?

A

Oral aciclovir & steroids

46
Q

Give 2 key neurocomplications of HIV?

A

Focal neuro lesions:

1) Toxoplasmosis (most common)

2) Primary CNS lymphoma

47
Q

CT results in HIV associated toxoplasmosis?

A

Usually single or multiple ring enhancing lesions, mass effect may be seen

48
Q

CT results in HIV associated primary CNS lymphoma?

A

single or multiple homogenous enhancing lesions

49
Q

What is cryptococcus neoformans?

A

An encapsulated yeast and an obligate aerobe that can live in both plants and animals.

Infection with this organism is termed cryptococcosis.

50
Q

What can cryptococcus infection in immunocompromised cause?

A

Fungal meningitis and encephalitis can occur

A key group of patients are HIV +ve

51
Q
A

Yr 5 - Neuro (13 decks)

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