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PCM III Final > Neuro CIS > Flashcards

Neuro CIS Flashcards

1
Q

A high fever with tachycardia can cause a ______ in a child secondary to increased cardiac output

A

Flow murmur

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2
Q

In young children, urine for culture should always be obtained via _____

A

Catheterization

[so RBC in urine is likely from trauma]

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3
Q

What does it mean to have an elevated WBC with left shift?

A

Indicates the presence of infection

Left shift occurs when immature neutrophils (bands) are pushed out of the marrow to fight something

The I/T (immature/total neutrophils) ratio can be helpful in determining presence of infection; if greater than 0.2, it is likely that infection is present

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4
Q

Etiologic bacteria that cause meningitis from birth-2 months old

A

Group B strep (Strep.agalactiae)

E.coli

L.monocytogenes (tx with gentamycin)

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5
Q

Etiologic bacteria that cause meningitis in age 2 months-12 years

A

S.pneumoniae (gram+ diplococci)

N.meningitidis (gram- diplococci)

H.influenzae (gram- coccobacilli) — less cases since vaccination

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6
Q

Etiologic bacteria that cause meningitis in adolescents and young adults

A

N.meningiditis

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7
Q

Etiologic bacteria that cause meningitis in age>60

A

S.pneumoniae

L.monocytogenes (tx with ampicillin)

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8
Q

The ____ and ____ vaccines have decreased the incidence of meningitis in children in all age groups except those less than 2 months of age

A

HiB; S.pneumo

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9
Q

CSF findings with bacterial meningitis

[opening pressure, WBC, PMN, glucose, protein, gram stain, cytology]

A

Opening pressure >300 mmHg (nml <170)

WBC >1000/mm3 (nml <5 monos)

PMN >80% increased

Glucose decreased

Protein increased

Gram stain POSITIVE (+0)

Cytology negative

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10
Q

CSF findings with viral meningitis

[opening pressure, WBC, PMN, glucose, protein, gram stain, cytology]

A

Opening pressure <300 mmHg (nml <170)

WBC <1000/mm3 (nml <5 monos)

PMN 1-50% increased

Glucose normal

Protein normal or slight increase

Gram stain negative

Cytology negative

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11
Q

Neoplastic CSF findings

[opening pressure, WBC, PMN, glucose, protein, gram stain, cytology]

A

Opening pressure 200 mmHg (nml <170)

WBC <500/mm3 (nml <5 monos)

Glucose decreased

Protein increased

Gram stain negative

Cytology POSITIVE

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12
Q

CSF findings with fungal etiology

[opening pressure, WBC, PMN, glucose, protein, gram stain, cytology]

A

Opening pressure 300 mmHg (nml <170)

WBC <500/mm3 (nml <5 monos)

PMN 1-50% increased

Glucose decreased

Protein increased

Gram stain negative

Cytology POSITIVE

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13
Q

What can cause CSF protein to be artificially elevated?

A

Presence of large number of RBCs, as seen in intracranial hemorrhage and traumatic taps

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14
Q

While there are no absolute contraindications to an LP, when should careful consideration be taken?

A

When there is strong suspicion of increased intracranial pressure, coagulation abnormalities, or suspicion of a spinal epidural abscess

[consider a CT prior to LP in patients with significantly altered mentation, focal neurologic signs, papilledema, hx of a seizure within previous week, or impaired cellular immunity]

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15
Q

Typical signs of meningitis

A 
HA
Fever
N/v
Nuchal rigidity
Photophobia
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16
Q

How do you test kernig sign

A

Flex pts leg at both hip and knee and then straighten knee

Positive = extension of leg at knee when hip is flexed to 90 elicits PAIN

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17
Q

How do you test for brudzinskis sign

A

As you flex neck, watch hips and knees in reaction to your maneuver

Positive = flexion of neck elicits flexion at hips

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18
Q

When should fontanelles be checked?

A

In patients <2 y/o (anterior fontanelle is last to close around age 2)

[In a 3 yr old child, fontanelles will be closed and sutures are fused; the “typical” signs of ICP that coincide with meningitis will be present]

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19
Q

in suspected meningitis, Abx should be started as soon as labs have been drawn, with the option to tailor the medications later. What abx should empirically be given?

A

Vancomycin + Ceftriaxone

Add ampicillin if age 50+ and concerned for Listeria

Add acyclovir if suspicious of HSV encephalitis

Can add dexamethasone

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20
Q

Why do some docs choose to use Dexamethasone prior to abx for meningitis?

A

There is evidence that shows that administration of steroids PRIOR to abx can decrease hearing loss and neurological sequelae — depends on preference of physician if this is prescribed

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21
Q

SIADH is a disorder of impaired water excretion caused by inability to suppress the secretion of ADH; if water intake exceeds the reduced urine output, the ensuing water retention leads to development of ______

A

Hyponatremia

22
Q

In most adults, a fever is:

Oral temp above _____

Rectal or ear temp above _____

A

100.4 (38 C)

101 (38.3)

23
Q

A child has a fever when rectal temp is _____ or higher

A

100.4 (38C)

24
Q

General causes of fever

A

Infection — Most common

Medicines (abx, opioids, antihistamines, etc)

Severe trauma or injury (MI, stroke, heatstroke, burns)

Other conditions: arthritis, hyperthyroid, DVT, cancers like leukemia and lung cancer

25
Q

Which of the following is the most accurate way to measure temperature?

A. Rectal
B. Oral
C. Armpit
D. Bladder
E. They are all the same
A

D. Bladder — used in critically ill patients via foley catheter with probe

Typically most accurate way is rectal temp — closest to core temp.

A rectal or ear temp will be slightly higher than oral reading; armpit temp with be slightly lower than oral reading

26
Q

OMM considerations for meningitis

A

Contraindicated in acute setting

Once pt is stable and on abx, consider:
Lymphatics (rib raising, ST to C-spine, Venous sinus drainage)
Gentle techniques on C-spine
BLT to lumbar spine (careful of LP area!)

27
Q

5 essential components to neuro exam

A
  1. General assessment (mental status)
  2. Cranial nerves
  3. Motor (strength, gait, coordination, balance)
  4. Sensory (dermatomes, pain, temp, position, vibration, Romberg)
  5. Reflexes (DTRs, cutaneous reflexes, pathologic reflexes)
28
Q

Modes of evaluating mental status

A

Level of alertness

Appropriateness of response

Orientation to person, time, place

Congruency of mood

29
Q

Locations of CN in brain

A

Telencephalon: I

Diencephalon: II

Midbrain: III-IV

Pons: V

Pontomedullary junction: VI-VIII

Medulla: IX-XII

30
Q

What score on snellen chart is legally blind?

A

20/200

31
Q

Pupillary light reaction checks which CNs?

A

Sensory CN II

Constriction CN III

32
Q

Trigeminal motor function can be assessed by palpating temporal and masseter mm and asking pt to clench their teeth while you note the strength of contraction. Ask pt to move jaw side to side, testing lateral pterygoids

Unilateral weakness with this indicates a _____ lesion in CNS

Bilateral weakness with this indicates ______ _____ disease d/t bilateral cortical innervation

A

Pontine

Cerebral hemispheric

33
Q

CNS patterns of stroke — where is the lesion:

Facial and body sensory loss on same side

A

Contralateral cortical or thalamic lesion

34
Q

CNS patterns of stroke — where is the lesion:

Ipsilateral face but contralateral body sensory loss

A

Brainstem

35
Q

Condition affecting the facial n. —-> upper and lower face affected, loss of taste, hyperacusis, increased or decreased tearing

A

Bell’s palsy

36
Q

A central lesion to facial nerve affects mainly the ____ part of the face

A

Lower

37
Q

Facial features that indicate weakness caused by CN VII lesion

A

Widened palpebral fissure

Nasolabial fold

38
Q

Methods for testing CN VIII

A

Whisper test

Weber’s test — diminished tone in affected ear indicates sensorineural loss; louder tone in affected ear indicates conductive deafness

Rinne test — if tone is not heard once removed from mastoid process, it is conduction deafness

39
Q

Nerve segments associated with UE strength testing: elbow flexion/extension, wrist flexion/extension, hand grip, finger abduction, opposition of thumb

A

Elbow flexion (C5, 6); extension (C6,7,8)

Wrist flexion/extension (C6-7)

Hand grip (C7-8, T1)

Finger abduction and opposition of thumb (C8, T1)

40
Q

Nerve segments associated with LE strength testing: hip flexion, extension, adduction, and abduction

A

Hip flexion — L2-4 (psoas and iliacus)

Extension — S1–glut max

Adduction (L2-4)

Abduction (L4-5, S1)

41
Q

Nerve segments associated with LE strength testing: knee flexion and extension

A

Knee flexion — L4-5, S1-2 — hamstrings

Extension — L2-4 — quads

42
Q

Nerve segments associated with LE strength testing: ankle plantar and dorsiflexion

A

Ankle plantar flexion — S1-gastroc

Dorsiflexion — L4-5 tibialis anterior

43
Q

Methods of gait testing

A

Walk down hall and turn back — look for posture, balance, swinging arms, normal balance, smoothness, instability = ataxia

Tandem walking may reveal ataxia

Walk on toes then heels — tests plantar vs. dorsiflexion of ankles, as well as balance

44
Q

An inability to walk on one’s ____ may indicate CST damage

A

Heels

45
Q

Cerebellar function tests

A

Rapid alternating movements

Finger-to-nose

Finger-to-finger

Heel to shin

Pronator drift

Abnormal tests = dysdiadokinesias

46
Q

Test used for proprioception

A

Move fingers and toes with pts eyes closed, have them track movement

47
Q

Dermatomes associated with:

Shoulder top
Radial aspect of forearm
Little finger
Nipple line
Umbilicus
Great toe
Posterolateral calf/little toe
A

Shoulder top = C4

Radial aspect of forearm = C6

Little finger = C8

Nipple = T4

Umbilicus = T10

Great toe = L5

Posterolateral calf/little toe = S1

48
Q

Nerves tested with biceps, triceps, brachioradialis, patellar, and achilles

A

Biceps (C5,C6)

Triceps (C6,C7)

Brachioradialis (C5,C6)

Patellar (L2,L3,L4)

Achilles (S1)

49
Q

In general:

Hyperactive reflexes = _____ lesion

Hypoactive reflexes = _____ lesion

A

CNS

PNS

50
Q

Cutaneous simulation reflexes

A

Abdominal — T10-T12: see contraction of abs w/ deviation of umbilicus toward stim

Cremasteric reflex — Afferent L1, efferent L2

Plantar response — L5,S1

Anal reflex —S2-S4

51
Q

Describe plantar response with babinski sign

A

Normal response to plantar surface stroke should be plantar — dorsiflexion of big toe and fanning of toes is + and suggests UMNn dysfunction

PCM III Final (9 decks)

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