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Flashcards in Neuro High Yield HO Deck (34)
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1

neuro pediatric patients require special considerations when taking their history. name some examples

establish developmental baseline
ask how pregnancy/delivery/nursing went
any sick child that prefers to be left alone and doesnt want to be moved (meningitis)
high fever with tachycardia can cause flow murmor in a child secondary to increased CO
urine for culture should always be obtained via catheterization

2

components of a cbc

WBC count
RBC count
hemoglobin
hematocrit
MCV
MCHC
RBC distrib width
platelet

3

components of the diff part of a CBC with diff

neutrophils
lymphocytes
monocytes
eosinophils
basophils
absolute neutrophil
absolute lymphocyte
absolute monocyte
absolute eosinophil
neutrophil
comment

4

what causes a left shift?

elevated white count with a left shift indicates an infection
a left shift occurs when neutrophils are pushed out of the marrow to fight something
I/T ratio == immature/total neutrophils - a value .2 indicates an infection

5

birth - 2mo of age most common pathogens for meningitis

group b strep (streptococcus agalactiae)
e coli
l monocytogenes

6

2mo - 12y of age most common pathogens for meningitis

s pneumoniae ( gram + diplococci)
n meningitides (gram - diplococci)
h influenza (gram - coccobacil.li --> on the decline since vaccinations)

7

adolescents - young adults of age most common pathogen for meningitis

n meningitidis

8

patients over 60 of age most common pathogens for meningitis

s pneumoniae
l monocytogenes

9

high opening pressure
high white count
80% PMN
glucose less than 40
>200 mg/dl protein
positive gram stain
negative cytology

what type of meningitis is indicated by these CSF findings

bacterial

10

moderate opening pressure
high white count
1-50% PMN
>40 mg/dl glucose
<200 mg/dl protein
negative gram stain
negative cytology
what type of meningitis is indicated by these CSF findings

viral

11

200 mmhg opening pressure (slightly elevated)
500 wbc
1-50% PMN
glucose <40 mng/dl
protein >200 mg/dl
negative gram stain
positive cytology
what type of meningitis is indicated by these CSF findings

neoplastic

12

300 mmhg opening pressure
<500 wbcs
1-50% PMN
glucose <40mg/dl
>200 mg/dl protein
negative gram stain
positive cytology
what type of meningitis is indicated by these CSF findings

fungal

13

reasons why CSF protein can be artificially elevated

rbcs d/t
intracranial hemorrhage
traumatic taps

14

what are the absolute contraindications to a LP

trick question
there are none

15

although there are no absolute contraindications to performing an LP, when should special precaution be taken

strong suspicion of increased ICP
coagulation abnormalities
suspicion of spinal epidural abscess

16

when should you consider performing getting a CT before performing an LP

significantly altered mentation
focal neurologic signs
papilledema
hx of a seizure within previous week
impaired cellular immunity

17

classic signs of meningitis

HA
fever
nuchal rigidity
photophobia (variable)

18

how to perform a kernig sign test

flex pt leg at both hip and knee and then straighten (extend) the knee
+ test = pain on extension

19

how to perform a brudzinski sign test

flex the neck, watch hips and knees for flexion
+ test = flexion at hips and knees

20

pe exams that are positive for meningitis

kernig
brudzinksi
nuchal rigidity

21

at what age will the infantile presentation of increased ICP change to the adult presentation?

at 3 yo the fontanelles are closed and sutures are fused
tyipcal ICP signs will be present

22

if you suspect meningitis in an ill patient, should you wait for LP cultures before starting antibiotics?

no, treat empirically after drawing blood
draw the LP after, glucose, csf cell count, protein will be valid still

23

empiric tx for meningitis

vancomycin and ceftriaxone

24

what antibiotic should you add to the empiric tx of vancomycin and ceftriaxone in elderly patients when you are concerned for listeria?

ampicillin

25

what antibiotic should you add to the empiric tsx of vancomycin and ceftriaxone in patients suspicious of HSV encephalitis

acyclovir

26

glucocorticoids are debated in their use for meningitis, what glucocorticoid is typically used?

dexamethasone

27

disorder of impaired water excretion causeds by inability to suppress secretion of what hormone

ADH

28

siadh leads to

water retention - hyponatremia

29

definitions of oral fever and rectal/ear fever

oral fever - temp abobve 100.4F (38C)
rectal/ear - temp above 101 (38.3 C)

30

in children, fever threshold for ear/rectal begins at

100.4