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Neuro Diseases / Disorders > Week 2 - Neuro Diseases / Disorders > Flashcards

Week 2 - Neuro Diseases / Disorders Flashcards

1
Q

tension-type headache

A

<40, more women, most common headache, episodic or chronic, 30 min - 7 days, bilateral headband pattern, may wake with it, phonophobia or photophobia, muscle tightness in scalp and neck, Tx stress reduction and tricyclic antidepressants (amitriptyline) and selective serotonin reuptake inhibitors (fluoxetine), acute Tx NSAIDs, tylenol, relaxation

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2
Q

cluster headache

A

20-30, more males, less common, episodic clusters, severe, unilateral, orbital, 15-180 min, lacrimation, congestion, sweating, eyelid edema, Tx verapamil, melatonin, prednisone; acute Tx oxygen, triptan injection; caused by dilation of vessels in dura (internal carotid artery in cavernous sinus)

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3
Q

migraine

A

<40, more adult females, more male children, intermittent, unilateral, crescendoing, lasts hours to days, possible preceding aura, Tx amitripyline, divalproex, propranolol, timolol; acute Tx triptans, DHE, perchlorperazine, metoclopramide, apap, ibu, naproxen, dexamethasone

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4
Q

subdural hematoma

A

hours to several weeks after head trauma, anticoagulant use

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5
Q

epidural hematoma

A

within hours of trauma, lucid period, associated with skull fractures

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6
Q

viral syndrome

A

flu-like, possible non-specific rash, contact with sick people with similar symptoms

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7
Q

glaucoma

A

severe, sudden onset, eye pain, vision loss, blurred vision, halos

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8
Q

meningitis

A

fever, stiff neck, photophobia, altered mental status

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9
Q

encephalitis

A

fever, stiff neck, photophobia, altered mental status

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10
Q

temporal arteritis

A

new onset of headaches, >50, high ESR, scalp tenderness

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11
Q

subarachnoid hemorrhage

A

sudden, sever headache, hypertension, smoker, alcohol, non-white, thunderclap headache

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12
Q

intracranial mass

A

gradual, focal neurologic deficits or symptoms

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13
Q

ruptured aneurysm

A

headache onset with exercise or sex, thunderclap headache - type of subarachnoid hemorrhage

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14
Q

environmental exposure

A

CO, new building, others at home or work with same symptoms

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15
Q

symptoms of cluster headache

A

pupil constriction, ptosis, lacrimation, diaphoresis, sharp frontotemporal pain

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16
Q

infection defense mechanisms

A

scalp / skull, meninges (dura, arachnoid, pia), blood-brain barrier

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17
Q

microbial invasion of brain

A

contiguous spread from previous infection, hematogenous spread, trauma or congenital lesion, viral infection

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18
Q

meningitis

A

infection in subarachnoid space

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19
Q

encephalitis

A

infection in brain parenchyma

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20
Q

abscess

A

focal infection in brain parenchyma

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21
Q

myelitis

A

spinal cord infection

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22
Q

shared symptoms of CNS infection

A

fever, headache, altered mental state; infectious - meningitis / encephalitis / abscess; noninfectious - subarachnoid hemorrhage, inflammatory disease (lupus), neoplasia, antimicrobial drugs

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23
Q

CNS infection acute Tx

A

H & P, blood culture –> empiric treatment, imaging (MRI/CT), lumbar puncture, ID organism, antibiotic susceptibility testing, switch to definitive Tx or supportive Tx (viral)

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24
Q

meningitis

A

headache, fever, altered mental status; plus nuchal rigidity, photophobia, rash, upper resp. symptoms; some with 3 symp.; most with 2 symp

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25
Q

aseptic meningitis syndrome

A

often viral, midler, less neck stiffness, has fever / headache / photophobia, more common in infants, CSF –> lymphocytes, monocytes, increased protein, normal glucose, PCR confirmation, Tx supportive therapy with recovery in two weeks

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26
Q

causes of viral meningitis

A

picornovirses (enteroviruses), poliovirus, coxsackievirus, echovirus; + sense s.s. RNA viruses

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27
Q

+ sense

A

can be immediately translated

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28
Q
  • sense
A

must make a copy (transcription) before translating

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29
Q

picornavirus (enterovirus)

A

coxsackie, ECHOvirus, polio; 90% summer, oral - fecal or respiratory transmission, s.s., + sense, RNA, naked (no envelope), isohedral

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30
Q

septic meningits

A

bacterial, fever, stiff neck, irritability, neurologic dysfunction, CSF - PMNs, increased protein, decreased glucose, acute onset and progression, Tx empirically after samples taken

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31
Q

acute, purulent meningitis

A

H. influenza type b, N. meningiditis, and Strep. pneumonia - can follow viral infection, colonize mucosae of nasopharynx, invade and multiply in blood, cross blood-brain barrier by transcellular route, release cytokines in CSF, increased BBB permeability, diapedesis of leukocytes / edema / ICP –> neuronal injury

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32
Q

neonatal bacterial meningitis

A

Group B Strep. (received from birth, give mother penecillin before), Listeria monocytogenes, E. coli, maternal antibodies protect against H. influenza type B and Neisseria meningitids

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33
Q

over 65 bacterial meningitis

A

Listeria monocytogenes, Strep. pneumonia

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34
Q

late adolescent bacterial meningitis

A

Neisseria meningitids, college dorms

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35
Q

Neisseria meningitidis virulence factors

A

gram -, capsule, IgA protease, pili, endotoxin, outer membrane proteins

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36
Q

Haemophilus influenzae virulence factors

A

gram -, capsule, IgA protease, pili, endotoxin, outer membrane proteins

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37
Q

Streptococcus pneumoniae virulence factors

A

gram +, capsule, IgA protease, no - pili / endotoxin / outer membrane proteins

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38
Q

lipopolysaccharide

A

endotoxin, shed from Gram - bacteria, activates macrophages to release NO (hypotension) and IL-1 (fever), activates intravascular coagulation leading to purpuric skin rash

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39
Q

LOS - like lipopolysaccharide

A

endotoxin of Neisseria meningitides, mimic brain sphingolipids, recognized as self

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40
Q

pili

A

virulence factor, attachment to epithelial cells –> colonization of nasopharynx

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41
Q

IgA protease

A

cleaves IgA, found in mucosa, helps colonization of mucosa

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42
Q

capsule

A

virulence factor, acidic polysaccharides, protects from phagocytosis by PMN granulocytes

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43
Q

lumbar puncture

A

collect 10mL of CSF, focal lesion (abscess) suspected do not perform - may cause brain herniation

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44
Q

MRI

A

not useful for acute meningitis

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45
Q

CSF bacterial meningitis

A

high pressure, really high WBC - 80% PMN, really high protein, low glucose, gram stain

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46
Q

CSF viral meningitis

A

high WBC - 50% lymphocytes and 20% PMNs, high protein, normal glucose

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47
Q

CSF fungal meningitis

A

high pressure, high WBC - 50% lymphocytes, high protein, normal glucose

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48
Q

CSF tuberculous meningitis

A

high WBC - 80% lymphocytes, high protein, low glucose, gram stain

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49
Q

management of bacterial meningitis

A

empiric tx after lumbar puncture, bactericidal 10x min inhibitory concentration, BBB - give steroid so more drug gets through, antibiotic susceptibility testing

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50
Q

septic meningitis empiric Tx

A

ceftriaxone and vancomycin; if penicillin / cephalosporin allergy –> meropenem / aztreonam and vancomycin; add ampicillin if listeria suspected

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51
Q

septic meningitis empiric Tx

A

ceftriaxone and vancomycin; if penicillin / cephalosporin allergy –> meropenem / aztreonam and vancomycin; add ampicillin if listeria suspected

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52
Q

listeria suspected in septic meningitis

A

young, old, immunocompromised - add ampicillin

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53
Q

listeria suspected in septic meningitis

A

young, old, immunocompromised - add ampicillin

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54
Q

prophylactic Tx for septic meningitis

A

household contact, close exposures

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55
Q

prophylactic Tx for septic meningitis

A

household contact, close exposures

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56
Q

H. influenzae septic meningitis

A

Tx rifampin

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57
Q

H. influenzae septic meningitis

A

Tx rifampin

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58
Q

N. meningitidis septic meningitis

A

Tx ceftriaxone

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59
Q

N. meningitidis septic meningitis

A

Tx ceftriaxone

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60
Q

antibacterial actions of ceftriaxone

A

reaction involving transpeptidation

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61
Q

antibacterial actions of ceftriaxone

A

reaction involving transpeptidation

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62
Q

antibacterial actions of vancomycin

A

binds to transpeptidases, MRSA, given IV

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63
Q

antibacterial actions of vancomycin

A

binds to transpeptidases, MRSA, given IV

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64
Q

Neisseria meningiditis

A

meningococcal meningitis, gram -, diplococcus, pili, IgA protease, capsule, endotoxin, late winter / early spring, dorms, respiratory droplets, LOS endotoxin –> hemorrhagic rash, Tx ceftriaxone

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65
Q

resistance to rifampin

A

mutation of genes for DNA-dependent RNA polymerase

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66
Q

Streptococcus pneumonia

A

gram -, diplococci, lancet shape, pneumococcal pneumonia, respiratory droplets, meningitis secondary to sinus or ear infection, >2 mnths old, Tx penicillin or ceftriaxone add dexamethasone to reduce hearing loss, vaccine, capsular swelling

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67
Q

Hemophilus influenza type b

A

gram -, coccoid rod, unvac infacts and children, pili, membrane proteins, IgA protease, endotoxin, hearing loss, Hib vaccine, chocolate agar with V and X, Tx ceftriaxone and proph rifampin

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68
Q

group B streptococcal (GBS) - Streptococcus agalactiae

A

gram +, diplcocci, noraml flora, to infant during birth, sight / hearing loss, more African Americans, pregnant women screened and given penicillin G proph to prevent in first week, hemolysis of RBC by phospholipase

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69
Q

Listeria monocytogenes

A

gram +, rod, intracellular, neonatal meningitis via mother, no nuchal rigidity, milk and deli meat, phospholipase and listeriolysin O = escape from vacuole, actin tails = pseudopod spread, Tx ampicillin and gentamicin

70
Q

action of ampicillin

A

weakens membrane

71
Q

action of gentamicin

A

ribosomal inhibitor

72
Q

Escherichia coli K1 strain

A

gram -, rod, enteric, transcellular across BBB, LPS prevents fusion with lysosome, beta-lactamase strains ceftriaxone and carbapenem

73
Q

Klebsiella pneumoniae

A

gram -, normal flora, enteric, lactose fermenters, healthcare acquired, Tx ceftriaxone, resistant strain with carbapenemase

74
Q

chronic meningitis

A

weeks, mycobacterium tuberculosis and spirochetes and fungi, base of brain (not dorsum), HIV/AIDS, Tx isoniazid, rifampin, ethambutol, pyrazinamide

75
Q

action of isoniazid

A

inhibits mycolic acid in mycobacterial cell wall, acetylated in liver faster in Asians and Native Americans

76
Q

action if rifampin

A

inhibits DNA-dependent RNA polymerase, induces formation of drug metabolizing enzyme P450

77
Q

action of ethambutol

A

inhibits cell wall synthesis by binding arabinosyl transferase in mycobacterium

78
Q

protozoa caused meningitis

A

Naegleria flwleri and Acanthamoeba, swimming in warm infected water, into nose –> olfactory necrosis, altered smell, Tx cephtriasone and metronitisol

79
Q

encephalitis

A

fever, headache, altered mental status, motor / sensory deficits, seizures, speech problems, lethargy, coma, empiric Tx acyclovir until HSV ruled out, previous infection, travel, tick bites

80
Q

viral encephalitis

A

enterovirus, arbovirus, herpes virus, rabies

81
Q

nonviral encephalitis

A

rickettsia, mycoplasma, ADEM

82
Q

encephalopathy

A

diffuse, toxin, metabolic dysfunction, steady mental status decline, unlike encephalitis

83
Q

encephalitis Dx

A

CSF - lymphocytes predominant, normal glucose, elevated proteins, negative culture, focal lesions on MRI, serum PCR and antibodies, EEG abnormal

84
Q

viral causes of encephalitis

A

HSV, mumps, varicella, rabies, HIV, polio, rubella, measles

85
Q

+ strand, RNA, isohedral viruses

A

picorniviridae (enterovirus), togaviridae (rubella), flaviviridae (WNV)

86
Q
  • strand, RNA, helical viruses
A

rhabdoviridae (rabies), paramyxoviridae (measles, mumps)

87
Q

segmented, - strand, RNA, helical virus

A

Bunyaviridae (LaCrosse strain of California virus)

88
Q

DNA viruses isohedral

A

adenoviridae (adenovirus), herpesviridae (HHV)

89
Q

herpes virus (HSV1, HSV2, VZV, CMV)

A

linear DNA, icosahedral, enveloped, human to human

90
Q

HSV1

A

acute sporadic encephalitis, respiratory secretions, reactivated in trigeminal ganlia, bilateral temporal lobe on MRI, necrotizing, hemorrhagic, RBC in CSF, IV acyclovir

91
Q

HSV2

A

neonatal encephalitis via mother during birth, STD, can cause encephalitis in adults, IV acyclovir

92
Q

fusion of viral envelop (nucleocapsid) with plasma membrane

A

paramyxovirus, retrovirus, herpesvirus

93
Q

fusion of viral envelop with endocytic membrane

A

togavirus, rhabdovirus, coronavirus, orthomuxovirus

94
Q

immediate early genes (lytic cycle)

A

produce viral RNAs needed for early gene expression

95
Q

early genes (lytic cycle)

A

thymidine kinase, ribonucleotide reductase, DNA polymerase –> DNA replication

96
Q

late genes (lytic cycle)

A

capsid protein, envelope glycoproteins, tegumental proteins (exocytosis, creates viruses)

97
Q

tegumental protein VP16

A

recruits host cell transcription machinery

98
Q

Oct1

A

key for early gene expression, RNA Pol II to viral promoters

99
Q

HSV1 latency in trigeminal ganglion

A

axon terminal of sensory neuron, capsids retrograde to cell body, enter nucleus, reactivated when VP16 and HCF-1 enter nucleus = transcription, new virion anteretrograde back to axon terminal

100
Q

action of acyclovir and ganciclovir for HSV1

A

inhibits viral DNA polymerase, terminates chain by replacing sugar on guanine, only active against dividing virus, suppresses bone marrow, resistance via loss of thymidine kinase

101
Q

action of foscarnet for HSV1

A

pyrophosphate analog, blocks chain elongation by DNA polymerase

102
Q

HHV-3 varcella zoster virus

A

rare immunocompromised encephalitis, lytic in epithelial cells, latent in trigeminal and dorsal root ganglia, reactivation, vaccine, Tx acyclovir

103
Q

Zoster pain

A

peripheral pain –> rash –> acute pain –> rash healed (30 days) –> chronic pain (post-herpetic neuralgia)

104
Q

cytomegalovirus (HHV5)

A

tropic to polymorphonuclear leukocytes, slight elevation in CSF protein, HIV/AIDS, organ transplant, congenital, paraventricular subependymal cells –> hemorrhagic necrotizing ventriculoencephalitis, Tx ganciclovir (organ transplant) add foscarnet (neuroinvasion)

105
Q

arboviruses

A

transmitted by arthropods

106
Q

flavivirus / togavirus

A

s.s., +, RNA, icosahebral, enveloped

107
Q

West Nile Virus

A

crows, jays, mosquito bite / breast feeding / blood transfusion, >60, mid-late summer, CSF normal glucose and protein, lymphocytic leukoctosis, IgM

108
Q

Powassan encephalitis

A

tick flavivirus, WNV related, ticks with lyme in <15 minutes of bite, May-Oct

109
Q

bunyaviridae (LaCrosse / California encephalitis)

A

<16, circular segmented genome, helical capsid, chipmunks/squirrels, mosquitos to humans

110
Q

rabies (encephalomyelitis)

A

saliva / aerosals from dogs / foxes / raccoons / bats, binds nicotinic ACh receptors, retrograde into CNS, replicates in grey matter, to saliva glands, bite irritation, sore throat, headache, fever, muscle spasms, convulsions, paralysis, Negri bodies with ribonucleoproteins in Purkinje cells of cerebellum, active and passive vaccines, rhabodoviridae, bullet shaped capsid, -, RNA

111
Q

progressive multifocal leukoencephalopathy (PML)

A

John Cunningham (JC) polyomavirus, d.s., circular, no envelope, infect oligodendrocytes, demyelination, inhaled to tonsils, latent in kidneys and bone marrow, reactivated in blood, neuroinvasion

112
Q

Rickettsia rickettsii

A

rocky mountain spotted fever, gram -, intracellular (need CoA and NAD+), pleomorphic, bacteria, headache, fever, petechia rash, endothelial cells, Tx doxycycline

113
Q

acute disseminated encephalomyelitis

A

inflammatory demyelination following infection or vaccination

114
Q

brain abscess

A

fever, headache, seizure, focal infection of parenchyma, acute - oropharyngeal / streptococci, chronic - mycobacterium tuberculosis / cryptococcus neoformans, poor teeth, ear infection, trauma, immunosuppressed, surgery, embolism, CT or MRI, Tx ceftriaxone and metronidazole (parasites) and surgery

115
Q

suspected ICP

A

get MRI first, then CSF sample, otherwise could cause herniation

116
Q

Toxoplasma gondii

A

protozoan, trachyzoite, immunocompromised, pregnant women, reactivation of latent infection, fever, headache, focal deficits due to intracranial calcification, schizophrenia?, uncooked meat and cat feces, Tx pyrimethamine (blocks dihydrofolate reductase) and sulfadiazine (blocks pteridine synthetase)

117
Q

myelitis

A

herpes, motor and sensory loss, polio / coxsackie / WNV attack ventral horn motor cells = paralysis, chronic Tropical Spastic Paraparesis caused by human T-lymphotropic retrovirus (s.s. RNA + linear diploid icosahedral), long latency in lymphocytes

118
Q

poliomyelitis (enterovirus)

A

headache, sore throat, vomiting, paralysis, brain invasion = encephalomyelitis, Tx pain killers, moist heat, PT, vaccine

119
Q

post-polio syndrome

A

muscle weakness, 30 years after disease, fecal-oral to throat to intestines to bloostream to CNS, degeneration of lower motor neurons in anterior spinal cord, Tx pain killers, moist heat, PT

120
Q

immunocompromised

A

bacterial meningitis (listeria, klebsiella), toxoplasmosis, fungal meningoencephalitis (candida, cryptococcus), encephalitis (CMV, HHV6, JC virus), AIDS subacute encephalitis with dementia

121
Q

perinatal infections

A

meningitis (strep group B, E. coli, listeria), toxoplasmosis, syphillis, varicella-zoster, parvovirus, rubella, cytomegalovirus, herpes

122
Q

inflammation

A

acute vs chronic

123
Q

acute inflammation

A

happens fast, lasts few days, neutrophil response, vessels dilate and leak so neutrophils (segmented nuclei) can get out and make pus, looks busy - black dots

124
Q

chronic inflammation

A

> few days, lymphocytes (mononuclear cells), macrophages, plasma cells, uniform round nuclei, seen with viral meningitis

125
Q

bacterial meningitis

A

neutrophils make pus, engorged cerebral vessels

126
Q

abcess

A

after acute inflammation, circumscribed collection of pus, can persist beyond few days, neutrophils, looks busy - segmented nuclei, necrotic tissue, compressed brain tissue with engorged vessels

127
Q

gliosis

A

astrocyte reaction to injury, scar, large pink processes

128
Q

microglial nodule

A

microglial proliferation around dying tissue

129
Q

hydrocephalus

A

block in CSF circulation, noncommunicating = block in ventricular system, communicating = block in CSF resorbption (sinus), can get due to meningitis, ex: as it healed it blocked arachnoid granulations causing communicating hyrocephalus and entire ventricular system is enlarged

130
Q

case - encephalitis (Rickettsia)

A

confused, lethargy, two weeks, unsteady gait, falls, high resp, high pulse, fever, mild nuchal rigidity, non-blanching macular rash knees to ankles (gram - endotoxin), CSF - slightly low glucose, high proteins, somewhat high WBC (neutrophils - PMNs = bacterial), not on gram stain - intracellular organism, serum platelet count low, season and location

131
Q

encephalitis

A

brain inflammation, seizures, stupor, coma, headache, fever, not as sick as meningitis, commonly viral or Rickettsial

132
Q

rocky mountain spotted fever

A

gram -, coccobacillus, intracellular (endothelial), tick-borne, death or serious sequelae, May - Aug, cases increases, deaths decreasing, small mammal in cycle, 2-14 days after bite, fever, rash (2-5 days after fever), headache - possible nausea, vomiting, abdominal pain, conjunctivitis, labs - low platelets, low serum sodium, high liver function, skin biopsy of vasculitis, Tx doxycycline (caution on kids and pregnant - ribosome inhibitor)

133
Q

anaplasmosis

A

tick-borne, fever and rash, no headache

134
Q

case - Neisseria meningitides meningitis

A

headache, 19, top of head, blurry vision, vomited, nausea, dull / pressure pain, dorm, lethargic, neck pain, photophobia, petechiae rash on arms and trunk, fever, high HR, CBC - high WBC (80% granulocytes / PMNs / neutrophils = bacterial) and platelets low, CSF - color abnormal, culture abnormal, glucose low, gram neg stain with diplococci, high proteins, high RBC, high WBC (mostly granulocytes = bacterial)

135
Q

normal CSF glucose

A

greater then 1/2 serum glucose

136
Q

CSF sample contraindicated by CT findings of ICP

A

examples - cerebral infarction (sharp white point on CT), hydrocephalus (enlarged ventricles), cerebral abscess (clearly demarkated circle), diffuse brain edema (gyri not clear - no dark / light contract on brain surface)

137
Q

<1 month

A

group B strep meningitis

138
Q

1-23 months

A

streptococcus pneumoniae

139
Q

2-18 years

A

neisseria meningitidis

140
Q

19-59 years

A

streptococcus pneumoniae

141
Q

> 60 years

A

streptococcus pneumoniae and listeria meningitidis

142
Q

case - bacterial meningitis Neisseria meningitidis

A

hematogenous, naspharyngeal -> blood -> crosses BBB to subarachnoid space, possible extension of nearby infection, fever, headache, stiff neck, vomiting, sleepy, seizures (but not confused - encephalitis), CT then lumbar puncture CSF, Tx IV fluids + immediate antibiotics (age 2-50 vancomycin + ceftriaxone, age > 50 ampicillin + vancomycin + ceftriaxone), prophylaxis for close contacts, immunization age 11-12

143
Q

Neisseria meningitidis

A

gram -, aerobic, encapsulated, colonize nasopharynx, crowded conditions - dorms, 40% of pop asymptomatic carries

144
Q

bacterial meningitis process

A

bacteraemia -> endothelial damage -> bacteri in CSF -> inflammatory cytokines -> increased BBB permeability + WBC infiltration + cerebral vasculitis -> edema + ischaemia -> ICP -> neuronal injury

145
Q

bacterial meningitis gross findings

A

pus (neutrophils in CSF), engorged veins, basal - H. influenza / TB / cryptococcus, cortical or basal - S. pneumoniae, basal is pus in cistera magna, dense over blood vessels, “organized” pus = late stage and likely hydrocephalus

146
Q

bacterial meningitis microscopic findings

A

neutrophils (busy - lumpy nuclei) in subarachnoid space, gram stain bacteria, phlebitis (neutrophils in wall of vessels), cerebritis (neutrophils in surface parenchyma), pink stringy fibrin organization of exudate -> healing and possible communicating hydrocephalus

147
Q

TB meningitis gross findings

A

basal gelatinous exudate in cisterns that encases cranial nerves and forms organized adhesions, tuberculomas (collection of mycobacterium and granuloma), more chronic presentation,

148
Q

TB meningitis microscopic findings

A

lymphcytes (mononuclear cells), caseating granulomas (central necrosis and pallisading histiocytes), obliterative endarteritis, positive acid fast stain

149
Q

pathology of viral meningitis

A

gross - swelling, microscopic - no findings, mildly lymphocytic meninges (mononuclear cells, small round dark nucleus)

150
Q

fungal meningitis outbreak

A

contaminated epidural injections with methyl prednisolone for back pain, no preservatives, clean room problems, large batches, bad sterilization, main causative agent Exserohilum rostratum (dead leaves, grass), steriods reduced immune system, filaments penetrate dura, warm for yeast form, injection site abscess or septic arthritis too, Tx voriconazole for 3 months or liposomal amphotericin B

151
Q

Dx fungal meningitis

A

lumbar puncture CSF - low glucose, high proteins, high lymphoctyes (mononuclear), visualize with KOH, stain, culture - low/high temp or high glucose agar, sequence 28S rDNA, not contagious, spores inhaled from environment

152
Q

fungi

A

heterotroph, saprophytic, eukaryotic

153
Q

yeast

A

Candida, Cryptococcus, single cell, warm environment

154
Q

mold

A

Aspergillus, Fusarium, Scedosporium, Zygomycete, mutlicellular, form hyphae, cold environment

155
Q

dimorphic fungi

A

Histoplasma, Blastomyces, Coccidioides, Paracoccidioides, converts between mold (cold) and yeast (heat)

156
Q

Tx fungal meningitis

A

usually self-limiting, antifungals are very toxic, drugs work on cell membrane or cell wall

157
Q

systemic mycoses

A

dimorphic, endemic, inhaled spores, bat dropping -> pneumonia, meningitis, Tx mostly resolve on own, liposomal amphotericin 1 month, itraconazole 3-12 months, add amphotericin B if meningitis; caused by Histoplasma, Blastomyces, Coccidioides, Paracoccidioides

158
Q

opportunistic mycoses

A

environment or human flora, infect immunocompromised

159
Q

Cryptococcus neoformans

A

opportunistic fungi, encapsulated yeast - inhibits phagocytosis, meningitis and pneumonia in immunicompromised, india ink, soap bubbles in brain, Tx amphotericin B + Flucytosine + Fluconazole (following)

160
Q

Candidiasis

A

opportunistic fungi, yeast, communicable, diaper rash, thrush, vaginal, systemic (catheter, skin breaks), seeds after antibiotic Tx, immunocompromised, Tx clotrimazole (azoles) or amphotericin / echinocandins

161
Q

Aspergillus fumigatus, Zygomycosis mucor

A

opportunistic mold, soil, pulmonary, sinusistis, otitis externa, CNS abscess, immunocompromised, tissue biopsy - 45 degree angles = Aspergillus, no angles = Zygomycosis, Tx voriconazole or amphotericin / echinocandins

162
Q

superficial mycoses

A

dematophyte, skin lesion, ringworm, athlete’s foot, Tx terbinafine or -azole

163
Q

subcutaneous mycoses

A

through skin, subcutaneous or lymphatic spread, Sporothrix, Tx itraconazole 6 months

164
Q

Horner Syndrome

A

interruption of sympathetic trunk on ipsilateral side at cervical sympathetic trunk or sympathetic fibers in brain stem / spinal cord, ptosis (drooping of eyelid - superior tarsal muscle), miosis (pupil constriction), anhidrosis (absence of sweat), flushed face (red/vasodilation)

165
Q

eye can’t adduct

A

medial rectus deficit, CN III oculomotor

166
Q

eye can’t look down

A

superior oblique deficit, CN IV trochlear nerve

167
Q

eye can’t abduct

A

lateral rectus deficit, CN VI abducens

168
Q

eye can’t look up

A

inferior oblique or superior rectus deficit, CN III oculomotor

169
Q

Bell’s Palsy

A

acute peripheral nerve palsy, CN VII, taste to ant ipsilateral tongue, general touch / pain sensory around ipsilateral ear, motor to facial expression ipsilateral, stapedius muscle in ear (dampens sound), dryness in ipsilateral eye (parasympathetic to lacrimal gland)

170
Q

case - HSV1 encephalitis

A

19, memory and behavior changes, coma, death, necrotizing hemorrhagic inflammation, perivascular infilatrate, Cowdry A inculsions

Neuro Diseases / Disorders (3 decks)

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