Neuro 6.04 - Meningitis

Front 1

What structural feature is most important for the physical aspects of the BBB?

Back 1

The continuous tight junctions between endothelial cells form the morphological correlate of the BBB.
The endothelial cells in systemic tissues have discontinuous tight junctions.

Front 2

Why is L-Dopa used for treatment of Parkinson Disease instead of Dopamine?

Back 2

Dopamine cannot cross the BBB, L-Dopa has a transporter (and is converted to dopamine in brain parenchyma)

Front 3

At what temperature does cardiac fibrillation occur?
A. 40-44
B. 34-36 C
C. 30-34 C
D. 27-29 C

Back 3

• Normal range: 36-38 C
• Fever or exercise: 38-40 C
• Heat stroke: 40-44
• Mild hypothermia: 34-36 C
• Severe hypothermia: 30-34 C
• Cardiac fibrillation: 27-29 C

Front 4

The classic triad of bacterial meningitis consists of

Back 4

Fever
Headache
Neck stiffness

Front 5

How is acute meningitis diagnosed?

Back 5

CSF examination of blood culture

Front 6

What are the 3 common bacterial pathogens of acute meningitis?

Back 6

Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Neisseria meningitidis

Front 7

What would you expect to find in the CSF of a patient with acute bacterial meningitis?

Back 7

- Numerous neutrophils
- Low glucose
- High protein

Front 8

What are the 4 common pathogens of acute viral meningitis?

Back 8

– Echo
- Coxsackie
- Mumps
- Measles

Front 9

What would you expect to find in the CSF of a patient with acute viral meningitis?

Back 9

- Lymphocytes
- Normal glucose
- protein ± raised

Front 10

What organisms commonly cause chronic meningitis?

Back 10

– Tuberculosis
– Cryptococcus

Front 11

What type of encephalitis is carried and spread by fruit bats in Australia?

Back 11

Lyssavirus

Front 12

What is the empirical therapy for bacterial meningitis?

Back 12

– ceftriaxone/(cefotaxime) (3rd generation cefalosporin)
+ penicillin/(ampicillin) (beta lactam) (not required 3 months - 15 years. ie. Listeria rare unless neonate, immune suppressed, pregnancy, alcoholism, >60yo)
– increasingly, vancomycin if ? pen-R pneumo

Penicillin or cephalosporin ceased once organism identified and susceptibility available.

Front 13

What treatment can be added to antibiotics to reduce inflammatory damage in bacterial meningitis?

Back 13

Corticosteroids (dexamthasone) given prior to or simultaneously with antibiotics decreases damage from host inflammation response, esp in children

Front 14

What is the treatment of TB?

Back 14

4 drugs for 9-12 months
• Isoniazid
• Rifampicin
• Pyrazinamide
• Ethambutol
(+/- Fluoroquinolones + Corticosteroids)

Front 15

The most common cause of aseptic meningitis is...

Back 15

Enteroviruses (80%)

Front 16

What would you expect to find in the CSF of a patient with aseptic (enterovirus) meningitis?

Back 16

A moderate white blood cell count (50 - 500 cells) and the absence of bacterial pathogens

Enteroviruses may be isolated from CSF by cell culture in 50-60% of cases. Molecular diagnostic assays, such as the polymerase chain reaction, can identify the presence of enteroviruses in the CSF in >90% of cases

Front 17

Back 17

A. Olfactory
B. Optic
C. Oculomotor
D. Trochlear
E. Trigeminal
F. Abducens
G. Facial
H. Vestibulocochlear
I. Glossopharyngeal
J. Vagus
K. Accessory
L. Hypoglossal

Front 18

Lesion to WHICH nerve or nucleus results in ipsilateral ophthalmoplegia (paralysis or weakness of one or more of the muscles that control eye movement): It also results in
(i) mydriasis: loss of parasympathetic generating diluted pupil.
(ii) accommodation of lens is lost; causes blurred vision for near objects
(iii) eye turns down and out (unopposed actions of superior oblique [down,in] and lateral rectus (abduct])
(iv) ptosis (eyelid droop) (loss of LPS); usually more marked than Horner Syndrome

Back 18

CN III - Ocularmotor

Front 19

What are two unusual features of the trochlear nerve?

Back 19

(i) it is the only crossed cranial nerve;
(ii) it is the only one that exits dorsally from the brainstem.

Front 20

With a lesion to WHICH nerve, the eye displays:
(i) extortion (outward rotation), albeit slight, of superior aspect of eye,
(ii) weak depression of eye, particularly when eye adducted.
Diplopia, particularly noticeable when the patient is walking down stairs.

Back 20

Trochlear nerve (CN IV)

Front 21

A lesion to WHICH nerve causes:
opened jaw deviates to ipsilateral side due to unopposed lateral pterygoid of contralateral side;
some wasting in masseter muscle (major muscle of mastication).

Back 21

V3 Mandibular

Front 22

A lesion to WHICH nucleus or nerve results in:
(i) Bell’s palsy (paralysis of ipsilateral facial muscles)
(ii) loss of lacrimation (dry eye), some loss of taste, salivation impaired.
(iii) hyperacusis: sound is abnormally loud (loss of stapedius which acts to dampen excessive vibrations of the tympanic membrane)

Back 22

Facial nerve (VII)

Front 23

Damage to WHICH nerve can produce deafness, loss of balance as well as dizziness, nausea and nystagmus?

Back 23

Vestibulocochlear (VIII)

Front 24

WHICH lesions result in a loss of the gag reflex and dysphagia, loss of taste and can result in reflex bradycardia and syncope? Neuralgia can also result in pain affecting oropharynx and/or tonsils.

Back 24

Glossopharyngeal nerve (IX)

Front 25

A lesion to WHICH nerve commonly results in
i) Palate weakness (dyspalatia): sagging of faucial arch and uvula deviation to contralateral side of lesion
ii) Pharyngeal weakness (dysphagia): if bilateral a marked dysphagia ensues
iii) Laryngeal weakness (dysphonia): may cause hoarseness and vocal weakness

Back 25

Vagus nerve (X)

Front 26

Damage to WHICH nerve can result in weakness of head rotation away from the damaged side and causes drooping of the shoulder?

Back 26

Accessory nerve (XI)

Front 27

A lesion to WHICH nerve results in atrophy of ipsilateral muscles of tongue: When protruded, the tongue deviates to side of lesion due to unopposed actions of the intact genioglossus muscle of the other side

Back 27

Hypoglossal (XII)

Front 28

What is the characteristic triad associated with raised intracranial pressure?

Back 28

Headache, vomiting and papilloedema

Front 29

What should never be done in the presence of papilloedema or focal neurological signs until you have ruled out focal mass lesion?

Back 29

Lumbar puncture