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26 Cards in this Set
- Front
- Back
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PT > 60 yrs presents w/ aphasia, prior Hx of CNS dz, decreased LOC, seizure & you suspect mass lesion. Do need to do a CT to rule out ________ |
brain herniation |
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Pt presents w/ acute onset fever, HA, stiff neck, N/V, + kernigs or Brudzinski. What do you suspect? What do you do next? |
meningitis do next--> LP w/ CSF exam |
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Mc pathogens for Neonates (< 1 month) tx? |
Strep agalactiae (GBS)* E. coli* Listeria monocytogenes* -tx for 21 days Tx: Ampicillin* + cefotaxime |
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Mc pathogens for Children & Adults tx? |
Strep pneumoniae -tx for 10-14 days Neisseria meningitidis*-tx for 4-7 days after afebrile H. influenza (3rd mc in children) -tx for 7-10 days Tx: Vancomycin + Cefotaxime or Ceftriaxone |
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Mc pathogens for Elderly? Tx? |
Strep pneumoniae -tx for 10-14 days Listeria monocytogenes* -tx for 21 days Tx: Vancomycin + Ceftriaxone or Cefotaxime + Ampicillin |
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Mc nosocomial (trauma or surgery) pathogens? Tx? |
staph aureus gram (-) rods (E. coli, Klebsiella, Pseudomonas, Acinetobacter, Enterobacter) -tx for 21 days Tx: Vancomycin + Cefepime* or Ceftazidime |
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what can be given w/ antimicrobials in Bacterial meningitis to decrease poor neurological outcome? |
Dexamethasone (steroids) *w/ first dose & w/ S. pneumoniae |
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_________ may cause blood stream infection (septic bacteremia) +/- meningitis = meningococcemia + petechia/ ecchymotic lesions *peak in February & March *Dorms & military barracks common Prevention? |
Neisseria meningitis prevention: vaccine |
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What should be give as prophylaxis for meningococcal meningitis to at risk exposed individual ? |
Rifampin adult- 600 mg bid for 2 days child- 10 mg/kg bid for 2 days |
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What vaccinations are available for bacterial meningitis? |
HiB (H. influenze type B)- most ppl get at 2 months, 4 months, 12-15 months Pneumococcal- given to geriatrics, immunocompromised, pts predisposed to pneumonia (asthma, smokers) should get 5 yr boosters Meningococcal- given at 11-12, booster at 16 |
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Aseptic meningitis pts present w a neg CSF culture & possible pressure change. How is aseptic meningitis tx? ((-) culture) |
Supportive care IV Acyclovir - HSV, CMV, Varicella Antiretrovirals - HIV |
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Pt presents w/ fever, HA, behavioral abnormalities, memory loss, seizure. Hx reveals URI sxs prodrome. CSF has elevated lymphocytes. MRI reveals temporal & frontal lobe changes (hyperintensity). Dx? Tx? |
Dx: PCR (+) for HSV DNA --> HSV Encephalitis Tx: IV acyclovir |
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Encephalitis presentation: |
Altered LOC Motor abnormalities (weakness w/ myoclonus) Seizures Temperature control HA photophobia Stiff neck Fever malaise, myalgia Resp & GI sx |
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Encephalitis tx: |
Analgesia (HA) Cooling blanket (hyperthermia) Supportive care Seizure tx/prophylaxis Isolation |
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Pt comes in w erythema migrans (bullseye lesion(s)) & flu-like sx +/- meningeal signs. PE reveals Facial nerve (Bell's) Palsy & asymmetric large joint arthritis. ECG reveals AV block. Dx? |
Lyme Disease Ixodes Tick w/ Borrelia burgdorferi spirochete Dx w/ ELISA & confirmed w/ Western Blot* |
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Lyme Disease: treatment |
Tick bite prophylaxis- Doxycycline (w/i 72 hrs) Early Tx- Amoxicillin or Doxycycline 10-21 days Bell's palsy alone- Oral Doxycycline or Amoxicillin Neuro involvement- IV Ceftriaxone 10-28 days Late Tx- Amoxicillin or Doxycycline 1-2 months |
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Meningitis (1st yr)--> CV thrombosis or infarct (Meningovascular) (5-10 yrs)--> Tabes dorsalis (20-30 yrs)--> General paresis (10-20 yrs)--> Dementia |
Neurosyphilis: Treponema pallidum |
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Pt comes in after being bitten by a stray dog a month ago w/ high fever, encephalitis, muscle hyperactivity, hydrophobia, weakness of bitten limb. dx? Tx? |
dx: Rabies tx: Clean bite, Rabies Ig's & Rabies Vaccine |
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AIDs pt presents w/ progressive dementia, visual impairment, seizures, hemiplegia. MRI reveals multiple lesions in white matter. Dx? Tx? |
Progressive Multifocal Leukoencephalopathy (JC virus) Dx: CSF--> PCR + JC DNA Tx: HAART therapy |
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Pt presents w/ fever, HA, disturbed consciousness, hemiparesis, N/V, nuchal rigidity, dysarthria, seizures, sepsis/ septic shock, & visual disturbances. Dx? Tx? |
dx: MRI---> Brain abscess Surgical aspiration--> gram stain, culture Tx: removal of abscess (need aspiration, surgical), dexamethasone, abx |
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Brain abscess focal mass effect depends on the area involved, Contralateral homonymous superior quadrantic visual field defect Aphasia what area? |
Temporal lobe |
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Motor deficit what area? |
Supratentorial |
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Ipsilateral limb ataxia nystagmus what area? |
Cerebellar |
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Pt presents w/ HA, fever, neurologic deficit, & stiff neck following a unilateral paranasal sinus infection. Dx? tx? |
Dx: MRI--> Subdural empyema Tx: surgical drainage + Abx |
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Pt presents w. unilateral periorbital edema, HA, photophobia, proptosis following paranasal sinus infection. Dx? Tx? |
Dx: MRI, MR venogram--> Cavernous Sinus Thrombosis (mc Staph aureus) Tx: Abx + paranasal sinus drainage + heparin |
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Pt presents w/ rapidly progressive dementia, myoclonus, cognitive decline: abnormal EEG, elevated CSF protein (14-3-3 marker) Genetic studies reveal Methionine at codon 139. Dx? tx? |
Dx: MRI--> Prion Disease Tx: supportive |
