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Flashcards in Neurology, Infectious Deck (128)
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0

Folic acid supplementation for pre-pregnant women

0.4 mg/day

If with prior history of NTD, 4mg/day

1

Setting sun sign

Downward deviation of the eyes due to impingement of the dilated supeapineal recess on the tectum

Seen in hydrocephalus

2

Obstructive hydrocephalus - where is the pathology?

Obstruction within the ventricular system

Problem with the aqueduct or a lesion in the 4th ventricle (aqueductal stenosis)

3

CSF flow

Choroid villi - lateral ventricle - foramen of Monroe - 3rd ventricle - Aqueduct of Sylvius - into subarachnoid space - lateral - Foramen of Luschka - medial - Foramen of Magendie - arachnoid villi

4

Hydrocephalus with foreshortened occiput

Chiari Malformation

5

Hydrocephalus with prominent occiput

Dandy-Walker malformation

6

Major cause of complication of shunts for hydrocephalus

S. aureus

7

Epilepsy definition

2 or more unprovoked seizure occur at an interval greater than 24 hours apart

8

DOC for absence seizure

Ethosuximide

9

Duration of absence seizures

Rarely persist longer than 30 secs

10

Seizure with aura, rhythmic stiffening and relaxation of extremities with loss of sphincter control and LOC

Generalized tonic clonic seizures

11

Age group that present with infantile spasms

4-8 months

12

Hypsarrhythmia on EEG

High voltage bilaterally asynchronous, slow wave activity

Seen in Infantile spasms

13

DOC for infantile spasms

Vigabatrin

14

Most common seizure disorder in childhood

Febrile seizure

15

Peak age of children with benign febrile seizures

14-18 months old

Rare before 9 months and after 5 years

16

Simple vs Complex febrile seizure

Simple
Duration: less than 15 minutes
Once in 24 hrs
Generalized tonic-clonic

Complex
More than 15 minutes
More than once in 24 hrs
Focal seizure activity

17

Status epileptics definition

One seizure lasting 30 minutes
OR
Multiple seizures during 30 minutes without regaining consciousness

18

Only drug proven for migraine prophylaxis

Propanolol 10-20 TID for > 7 yrs old

19

In tuberous sclerosis, where are the tubers typically located

Subependymal region

20

Chromosome involved in Von Hippel Lindau

Chromosome 3 - VHL = 3 letters

21

Chromosome in Von Recklinghausen disease

Chromosome 17 = 17 letters!

22

Hamartomas within the iris

Lisch nodules

23

Most distinctive feature of NF 2

Bilateral acoustic neuromas

24

Mode of transmission of meningitis infection

Hematogenous dissemination from a distant site of infecrion

25

At what age can you start eliciting Brudzinski and Kernig signs?

2 and aboce

26

Kernig sign

Hip flexion 90 degrees with subsequent pain with extension of the leg

27

Brudzinski sign

Involuntary flexion of the knee and hips after passive flexion of the neck while supine

28

Contraindications to LP

Evidence of increased ICP
Severe cardiopulmonary compromise
Infection of the overlying skin

29

MCC of viral meningitis

Echovirus (Coxsackie)

30

Important imaging test to request for in MG

Chest CT scan - visualize presence of a thymoma

31

Diagnostic test for MG?

Edrophonium chloride IV - Tensilon test

Short acting cholinesterase inhibitor

Ptosis, ophthalmoplegia improves within seconds

32

Treatment for MG

Neostigmine 0.04 mg/kg IM q4-6 hrs

Or 0.4 mg/kg PO q4-6 hrs

33

Nerve involved in Bell's palsy

Facial nerve

Weakness of facial muscles

34

Bacteria most associated with GBS

Campylobacter jejuni - undercooked chicken

35

Muscle weakness in GBS

Symmetric ascending weakness or paralysis

36

Commando crawl

Seen in spastic diplegia type of cerebral palsy - bilateral spasticity of legs

37

Location of most brain tumors between 2-12 yrs old

Posterior fossa/ infrarentorial

38

Most common location of medulloblastoma

Cerebellum

39

Homer Wright rosettes

Medulloblastoma

40

Most common infrarentorial tumor

Cerebellar Astrocytoma
Best prognosis

41

Origin of craniopharyngioma

Rathke's pouch

42

Treatment that involves implantation of radiation seeds

Brachytherapy

43

Spore forming gram positive rods

Bacillus
Clostridium species

44

Toxin that causes whooping cough in Diptheria

Tracheal toxin

45

Bull neck appearance

Diptheria

46

Differentiate Diptheria from Strep throat

Diptheria
- relative lack of fever
- non-exudative throat
- with gray brown adherent pseudomembrane

47

Treatment for Diptheria

Penicillin
Erythromycin - eliminates nasopharyngeal carriage
Antitoxin

48

Culture medium for organism causing Diphtheria

Tellurite plate

(Tell a corny joke)

49

At what phase of illness is the whooping cough present

Paroxysmal phase

50

When is a patient with Diphtheria most infectious

During the catarrhal phase

51

Culture medium for organism causing pertussis

Bordet Gengou agar plate

Swab from posterior nasopharynx for 15-30 seconds

52

Complications of pertussis

HSOAP

Hemorrhage - subconj, intracranial
Seizures
Otitis media
Atelectasis, apnea, activation of latent TB
Pneumonia

53

Treatment for pertussis

Erythromycin 40-50mg/kg/day q6 x 14 days

54

Prophylaxis for pertussis

Erythromycin for 14 days given promptly to all household contacts and other close contacts

55

Most common strains of neisseria meningitidis

A, B, C, Y, W135

56

Vaccine for n. meningitidis available against what strains

Group A, B, C, Y, W135

57

Most severe form of n. meningitidis infection

Waterhouse Friderichsen syndrome

Diffuse bilateral adrenal hemorrhage

58

Most common s/s of meningococcemia

Fever
Petechiae, Purpura (initially morbilliform becoming petechial then purpuric within hours)

59

DOC for meningococcemia

Penicillin G - DOC
Ceftriaxone 100mg/kg/day or Cefotaxime 200mg/kg/day

60

Who are considered exposed to patients with meningococcemia

Contacts during the 7 days before onset of illness

Medical personnel with intimate exposure (intubation, suctioning)

61

Prophylaxis for meningococcemia

Children: Rifampicin 10mg/kg PO q12 for a total of 4 doses
OR
< 12 yo: Ceftriaxone 125mg single dose IM

> 18 yo: Ciprofloxacin 500mg PO single dose

62

Salmonella mode of transmission

Fecal-oral

63

Rose spots

Maculopapular rashes on the lower chest, abdomen

Seen in typhoid fever, 2nd week (day 7-10 of illness)

64

Treatment for Typhoid fever

Chloramphenicol 50-75 mg/kg/day for 14-21 days
OR
Amoxicillin 75-100 mg/kg/day for 14 days

If with drug resistance
FQ 15mg/kg/day for 5-7 days

If severe
Ampicillin 100mg/kg/day for 14 days
Ceftriaxone 60-75 mg/kg/day for 10-14 days

65

Chronic carriers of salmonella infection have the organism in what organ? Treatment?

Gallbladder
Tx: Ampicillin

66

Culture medium of Shigella

Xylose-Lysine Deoxycholate agar
SS agar
MacConkey agar

67

Tx for shigella

Cefixime
Ceftriaxone
Azithromycin

Also give Zinc 20ng/day for 14 days

68

Toddlers' and travelers diarrhea

ETEC

69

E. coli bacteria that will give bloody stool

EIEC, EHEC

70

Tx for ETEC

Co-trimoxazole

71

Vibrio cholera serogroups

01 and 0139

72

Rice water consistency and fishy odor without abdominal pain

Cholera

73

Culture medium for cholera

Cary-Blair transport medium plated onto Thiosulfate Citrate Bile Sucrose (TCBS) media

74

Tx for cholera

Tetracycline 50mg/kg/day PO qid for 3 days
OR
Doxy 5mg/kg/day PO single dose
Co-tri 8-10 mg/kg/day bid PO

75

Risus sardonicus

Sardonic smile due to intractable spasm of facial and buccal muscles

Seen in tetanus

76

Pathogenesis of tetanus

Tetanospasmin binds to NM junction
Prevents the release of GABA and glycine (inhibitory NTs) leading to sustained contraction

77

Opisthotonus

Muscle spasm where only the back of the head and the heels touch the ground

78

When does neonatal tetanus present

Within 3-12 days of birth

79

Mode of transmission of congenital syphillis

Transplacental transfer

80

Reaction seen in 15-20% of patients with syphillis treated with penicillin

Jarish-Herxheimer reaction

With treatment, killed treponema release a pyrogen that causes an acute systemic febrile reaction with exacerbation of lesions

81

Leptospirosis - what type of hypersensitivity reaction

Type 3

82

Screening test for leptospirosis

Microscopic slide-agglutination test

83

Tx for leptospirosis

Penicillin
Tetracycline

84

Measles - what type of virus

Paramyxovirus

85

Mode of transmission of measles

Droplet

86

Period of communicability of measles

4 days before and 4 days after

87

Characteristics of rash of measles

From hairline downward
With branny desquamation

88

MC complication of measles

Otitis media

89

Post exposure prophylaxis of measles

Measles Ig within 6 days of exposure

90

Mode of transmission of rubella

Droplet or transplacentally

91

Period of communicability of measles

7 days before and 7 days after

92

Most characteristic sign of measles

Retroauricular, posterior cervical and post occipital lymphadenopathy

93

Enanthem of measles? Of rubella?

Measles - Koplik
Rubella - Forscheimer spots

94

Swollen glands push the ear lobe upward and outward and the angle of the mandible is no longer visible

Mumps

95

Most frequent complication of mumps

Meningoencephalitis

96

What causes roseola

HHV 6 and 7

97

Nagayama spots

Ulcers in the uvulopalatal junction, seen in Roseola

98

If with chicken pox, until when is the patient infectious?

Until all the lesions have crusted

99

Important presentation of congenital varicella

Interruption of limb development - short and malformed limbs covered with cicatrix

100

Lifetime risk for herpes zoster

10-15% with 75% of cases occurring after 45 yrs old

101

When best to give acyclovir in herpes infection

Within 24 hours

102

Post exposure prophylaxis for varicella

Active vaccine within 3-5 days of exposure
Anti-VZV Ig for immunocompromised, within 96 hours
Includes newborns who were exposed to moms with varicella 5 days before or 2 days after birth

103

Virus that causes HFMD?

Coxsackie A16

104

What causes herpangina

Coxsackie A

105

What causes erythema infectiosum

Parvovirus B19

106

Parts of the brain affected by HSV

Temporal lobe, frontal love, limbic system

107

Test of choice in examining HSV encephalitis

PCR to detest HSV DNA

108

Type of paralysis seen in poliomyelitis

Flaccid paralysis

109

IPV vs OPV - which is live? Attenuated?

OPV - Sabin - Live
IPV - Salk - Killed

110

Paul Bunnel antibodies

Seen in EBV - heterophil antibody

111

Most feared complication of Infectious mononucleosis

Splenic rupture

112

Gianotti-Crosti syndrome

Associated with infectious mononucleosis - EBV

113

Most common congenital infection

CMV

114

Strikingly enlarges epithelial or mesenchymal cells with large intranuclear inclusions

CMV

115

Tx for CMV

Ganciclovir

116

Influenza virus - from what family?

Orthomyxoviridae

117

Influenza is confirmed serologically by ?

Hemagglutination inhibition

118

Prophylaxis and tx for influenza type A outbreaks

Amantadine and Rimantadine

119

Neuraminidase inhibitor used against influenza

Oseltamivir

120

MOA of Osteltamivir

Neuraminidase inhibitor

121

Worst dengue serotype

Type 2

122

When to request for dengue NS1?

Days 1-4

123

When is serology the dx of choice for dengue?

Day 5 to day 10

124

Most severe disease in rabies involves what part of the brain

Pons and floor of the 4th ventricle

125

If bleeding is induced after a dog bite on the arm, under what category does it fall?

Category II

Category I - licking, nibbling on intact skin
Category II - superficial abrasions without bleeding or induced bleeding
Category III - lacerations, transdermal bites, puncture with bleeding, all wounds on head and neck with or without bleeding

126

Schedule for rabies vaccine post-exposure prophylaxis

Days 0,3,7,14,28 or 30

127

Additional treatment for category III bites

Co-Amoxiclav 40mg/kg/day for 7 days