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Flashcards in Neuro CIS Deck (51)
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1

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

Flow murmur

2

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

Catheterization


[so RBC in urine is likely from trauma]

3

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

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

4

Etiologic bacteria that cause meningitis from birth-2 months old

Group B strep (Strep.agalactiae)

E.coli

L.monocytogenes (tx with gentamycin)

5

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

S.pneumoniae (gram+ diplococci)

N.meningitidis (gram- diplococci)

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

6

Etiologic bacteria that cause meningitis in adolescents and young adults

N.meningiditis

7

Etiologic bacteria that cause meningitis in age>60

S.pneumoniae

L.monocytogenes (tx with ampicillin)

8

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

HiB; S.pneumo

9

CSF findings with bacterial meningitis

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

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

10

CSF findings with viral meningitis

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

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

11

Neoplastic CSF findings

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

Opening pressure 200 mmHg (nml <170)

WBC <500/mm3 (nml <5 monos)

Glucose decreased

Protein increased

Gram stain negative

Cytology POSITIVE

12

CSF findings with fungal etiology

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

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

13

What can cause CSF protein to be artificially elevated?

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

14

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

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]

15

Typical signs of meningitis

HA
Fever
N/v
Nuchal rigidity
Photophobia

16

How do you test kernig sign

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

17

How do you test for brudzinskis sign

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

Positive = flexion of neck elicits flexion at hips

18

When should fontanelles be checked?

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]

19

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?

Vancomycin + Ceftriaxone

Add ampicillin if age 50+ and concerned for Listeria

Add acyclovir if suspicious of HSV encephalitis

Can add dexamethasone

20

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

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

21

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 ______

Hyponatremia

22

In most adults, a fever is:

Oral temp above _____

Rectal or ear temp above _____

100.4 (38 C)

101 (38.3)

23

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

100.4 (38C)

24

General causes of fever

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

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

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

OMM considerations for meningitis

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

5 essential components to neuro exam

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

Modes of evaluating mental status

Level of alertness

Appropriateness of response

Orientation to person, time, place

Congruency of mood

29

Locations of CN in brain

Telencephalon: I

Diencephalon: II

Midbrain: III-IV

Pons: V

Pontomedullary junction: VI-VIII

Medulla: IX-XII

30

What score on snellen chart is legally blind?

20/200