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50 Cards in this Set
- Front
- Back
What are the layers of the CNS in the Head Area ? |
1) Skull [Outside] 2) Dura Mater Layer 3) Sub-Dural Space 4) Arachnoid Layer 5) Sub-Arachnoid Space 6) Dia Mater 7) Brain [Inside] |
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Which of the layers of the CNS contains CSF? |
Sub Arachinoid Space |
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What is Meningitis? |
Inflammation of the membranes of the brain and spinal cord, specifically changes in the CSF between the pia and arachinoid membranes of the meninges |
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What are the examples of CNS infections? (7) |
1) Meningitis 2) Encephalitis 3) Meningoencephalitis 4) Brain Abscess 5) Subdural Empyema 6) Epidural Abscess 7) Ventriculo Peritoneal Shunt Infections |
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What is the function of CSF ? |
CSF provides nutrients to the CNS and Protection |
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What are the normal components of CSF? |
Water, Glucose, Some Proteins, Ions (Sodium, Potassium) and pH of 7.34 |
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"Despite the use of antibioitcs, the mortality rate from meningitis has remained constant at 5-25%" True or False? |
TRUE |
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"20% of patients with meningitis have persistent neurological disabilities" True or False? |
False, it is actually 50% |
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What is the incidence of meningitis in children <15 years old? |
75% |
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What is the incidence of meningitis in children <1 years old? |
35% |
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What are some of the causes of Aseptic Meningitis? |
Fungal, Viral, Rickettsiae, Spirochetes and Protozoa sources of infection |
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What are some of the causes of Septic Meningitis? |
Bacterial sources of infections |
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What are some of the causes of Non-Infectious Meningitis? |
NSAIDs and Invasive Procedures |
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"Viral Meningitis is more severe than Bacterial Meningitis" True or False? |
FALSE |
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"Most viral meningitis patients get better on their own within 7-10 days without treatment" True or False? |
TRUE, although infants younger than 1 month and people with weakened immune system are more likely to have a severe illness |
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What typically causes meningitis infections in Neonates? |
Usually infected by bacteria found in the birth canal |
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What are the risk factors of Meningitis in Neonates?(4) |
1) Early Rupture of Membranes 2) Low Birth Weight 3) Immature Immune System 4) Immature blood brain barrier |
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What are the risk factors of Meningitis in Children?(3) |
1) Immature Immune System 2) Daycare Centres 3) Upper Respiratory Tract Infections |
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What are the risk factors of Meningitis in Young Adults?(3) |
1) Spleenectomy 2) Travel 3) Complement Deficency |
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What are the risk factors of Meningitis in Adults or Immunocompromised?(1) |
A decreased immune system |
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What are the risk factors of Meningitis in Open Head Trauma?(4) |
1) Common with car accidents 2) Barrier Breakdowns 3) Contamination from Surgery/ Injuries 4) Foreign Indwelling Devices |
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What are the risk factors of Meningitis in Close Head Trauma?(1) |
More internal injury then open head trauma |
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What are the common organisms causing Meningitis in Neonates? |
Group B Streptococci, Listeria monocytogenes, E.Coli and other gram negative bacilli |
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What are the common organisms causing Meningitis in Children? |
Streptococcus pneumoniae, Neisseria meningitidis {H.influenza} |
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What are the common organisms causing Meningitis in Young Adults? |
Streptococcus pneumoniae, Neisseria meningitidis {H.influenza} |
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What are the common organisms causing Meningitis in Adults or Immunocompromised? |
Streptococcus pneumoniae, Listeria monocytogenes, Gram Negative bacilli, Neisseria meningitidis |
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What are the common organisms causing Meningitis in Open Head Trauma? |
Staphylocci aureus, Staphylocci epidermidis, Gram Negative Bacilli |
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What are the common organisms causing Meningitis in Close Head Trauma? |
Streptococcus pneumoniae, H. influanzae, Streptococcus pyogenes |
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What are the three major routes of Meningitis Infection? |
1) Hematogenous: following systemic bacteremia (e.g.endocarditis) 2) Contigous: When colonization by potential pathogens is followed by mucosal invasion of the nasopharynx 3) Direct Inoculation: Direct extension of bacteria across a skull fracture with subsequent leaking into the CSF |
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Which is the most common route of Meningitis infection? |
Hematogenous |
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What are the common signs and symptoms of Meningitis? |
1) Fever 2) Headache/Lethargy/Restlessness 3) Swollen Eyes 4) Tachycardia 5) Hemorrhagic Rash (common with Neisseria) or Petechiae (common with Listeria) 6) Altered mental status 7) Stiff Neck 8) Photophobia 9) Seizures |
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What are the most common signs of Meningits? |
Fever, Headache, Stiff Neck, Altered Mental Status |
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When would platelets be reduced in a Meningitis patient? |
If the patient is in septic shock or in the face of meningococcal bacteremia |
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What is the normal CSF appearance? |
Yellow and Liquidy |
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What is the appearance of CSF in Meningitis patients? |
Darker, Cloudy Color with a higher protein count |
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What are the common lab results of CSF in Meningitis patients? |
1) Turbid Dark Color 2) Glucose <2.2 mmol 3) Elevated protein levels >50g/L 4) Lactic Acid >1.8 mmol/L 5) CSF/Blood Glucose <0.33-0.5 6) Elevated WBC 7) pH will be lower than 7.34 |
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"It is easer for antibiotics to pass through the Blood Brain Barrier rather than the Blood CSF Barrier" True or False? |
FALSE |
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What are the characterisitcs of drugs that penetrate into the CNS well? |
Small, Lipophilic and with low protein binding |
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"If the organisms are found to be sensitive to Cephalosporins then we would discontinue Vancomycin from the empiric therapy" True or False? |
TRUE |
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What is the recommended Empiric therapy for Meningitis in Neonates? |
1) Ampicillin + Cefotaxime 2) Ampicillin + Gentamycin {14-21 days} |
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What is the recommended Empiric therapy for Meningitis in Children-Young Adults? |
1) Cefotaxime + Vancoymicn 2) Ceftriaxone + Vancomycin 3) Meropenem + Vancomycin {10 days} |
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What is the recommended Empiric therapy for Meningitis in Adults or Immunocompromised? |
1) Cefotaxime (+ Ampicilin + Vancomycin) 2) Ceftriaxone( + Ampicillin + Vancomycin) 3) Meropenem (+ Ampicllin + Vancomycin) 4) Vancomyicn + TMP/SMX [if severe beta lactam allergy] {S.pneumo: 10-14days, N.meningitids: 5-7days, Listeria: 21days} |
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What is the recommended Empiric therapy for Meningitis in Open Head Trauma? |
1) Meropenem (+Vancomycin) 2) Ceftazidime (+Vancomycin) 3) Cefepime (+Vancomycin) {10-14 days} |
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What is the recommended Empiric therapy for Meningitis in CSF shunt Infection? |
1) Cefotaxime (+Vancomycin ±Rifampin) 2) Ceftriaxone (+Vancomycin ±Rifampin) {14 days after shunt removal} |
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What is the recommended Empiric therapy for Meningitis in Closed Head Trauma? |
1) Cefotaxime (+Vancomycin) 2) Ceftriaxone (+Vancomycin) {10-14 days} |
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When would you perform a CSF shunt? |
Performed on patients who have congenital malformations which result in a large production of CSF and resulting in an abnormally large brain area |
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What organisms can be prevented by Chemoprophylaxis? |
Neiserria meningococcal and Haemophilus influenza |
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What are the general guidelines for Chemoprophylaxis? |
Neisseria: 1) Rifampin 600mg PO BID x 4doses 2) Ciprofloxacin 500mg PO x1dose Hemophilus: 1) Rifampin 600mg PO Daily x4days |
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When would you use Dexamethasone in Meningitis? |
To decrease mortalitity and hearing loss in adult patients with s.penumonia meningitis as well in children >6 weeks of age |
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"Dexamethasone can be given after the first dose of antibioitcs in Meningitis?" True or False? |
FALSE, should be given 20 mins before 1st dose or with the first dose |