Neurology, Infectious Flashcards
0
Q
Setting sun sign
A
Downward deviation of the eyes due to impingement of the dilated supeapineal recess on the tectum
Seen in hydrocephalus
1
Q
Folic acid supplementation for pre-pregnant women
A
0.4 mg/day
If with prior history of NTD, 4mg/day
2
Q
Obstructive hydrocephalus - where is the pathology?
A
Obstruction within the ventricular system
Problem with the aqueduct or a lesion in the 4th ventricle (aqueductal stenosis)
3
Q
CSF flow
A
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
Q
Hydrocephalus with foreshortened occiput
A
Chiari Malformation
5
Q
Hydrocephalus with prominent occiput
A
Dandy-Walker malformation
6
Q
Major cause of complication of shunts for hydrocephalus
A
S. aureus
7
Q
Epilepsy definition
A
2 or more unprovoked seizure occur at an interval greater than 24 hours apart
8
Q
DOC for absence seizure
A
Ethosuximide
9
Q
Duration of absence seizures
A
Rarely persist longer than 30 secs
10
Q
Seizure with aura, rhythmic stiffening and relaxation of extremities with loss of sphincter control and LOC
A
Generalized tonic clonic seizures
11
Q
Age group that present with infantile spasms
A
4-8 months
12
Q
Hypsarrhythmia on EEG
A
High voltage bilaterally asynchronous, slow wave activity
Seen in Infantile spasms
13
Q
DOC for infantile spasms
A
Vigabatrin
14
Q
Most common seizure disorder in childhood
A
Febrile seizure
15
Q
Peak age of children with benign febrile seizures
A
14-18 months old
Rare before 9 months and after 5 years
16
Q
Simple vs Complex febrile seizure
A
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
Q
Status epileptics definition
A
One seizure lasting 30 minutes
OR
Multiple seizures during 30 minutes without regaining consciousness
18
Q
Only drug proven for migraine prophylaxis
A
Propanolol 10-20 TID for > 7 yrs old
19
Q
In tuberous sclerosis, where are the tubers typically located
A
Subependymal region
20
Q
Chromosome involved in Von Hippel Lindau
A
Chromosome 3 - VHL = 3 letters
21
Q
Chromosome in Von Recklinghausen disease
A
Chromosome 17 = 17 letters!
22
Q
Hamartomas within the iris
A
Lisch nodules
23
Q
Most distinctive feature of NF 2
A
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
