Emergency Medicine

Front 1

inflammation of the brain parenchyma, presents as diffuse and focal neurophysiological deficits

Back 1

Encephalitis

Front 2

Etiologies of encephalitis
- 2 MC
-exculsive- neonates

Back 2

- Arboviruses
- Herpes simplex I, II

Front 3

General viral prodrome- encephalitis

Back 3

fever, headache, nausea, vommtiing, lethargy, myalgias- several days long

Front 4

Classic Presentation of Encephalitis

Back 4

AMS, stiff neck, photophobia, seizures, flaccid

Front 5

Physical findings- encephalitis

Back 5

AMS, Movement disorders, ataxia, dysphagia, unilateral sensorimotor dysfunction

Front 6

Diagnostic evaluations- encephalitis

Back 6

CBC w/ diff- normal, UA- normal, Serum electolytes (SIADH-25%), BMP, CSF- i,ncreased mononuclear cells, normal gulcose, elevated protein, oligoclonal bands observed

Front 7

CT before or after LP- encephalitis

Back 7

before

Front 8

How to tx
HSV encephalitis

Back 8

- acyclovir
- w/ or without antibotics/steriods

Front 9

Should you collect samples and blood cultures before or after therapy?

Back 9

before

Front 10

Emergency Managment of Encephalitis?

Back 10

manage fever and pain
give fluids- for hypotension
early diuresis- lasix, manitol
dexamethasone
hyperventilation

Front 11

AN inflammation of the archnoid , the pia matter, CSF, eventually extending throughout the CNS.

Back 11

Meningitis

Front 12

Populations more exposed to meningitis?

Back 12

infants, young children, > 60 yrs

Front 13

Common Bacteria-neonates for meningitis

Back 13

s. agalactaiae
E. Coli
L. Monocytogenes

Front 14

Common bacteria in older children, teenagers, adults < 50- -menningitis

Back 14

N. Meningitis, S. Pneumoniae, H. Influenzae

Front 15

Common bacteria in> 50- menningitis

Back 15

- L. Monocytogenes, N. Meningitis, S. Pneumoniae

Front 16

What is the most common syndrome affecting the CNS?

Back 16

Aseptic meningitis syndrome

Front 17

The classic presentation of meningitis?

Back 17

fever, headache, neck stiffness, photophobia, nausea, vomiting

Front 18

Meningitis Triad

Back 18

fever, nuchal rigidity, AMS

Front 19

Physical Exam Findings- meningitis

Back 19

Kernig's, Brudinski's signs
headache, fever, nuchal rigidity AMS

Front 20

petechial, purpuric, ecchymotic rash w/ meningeal findings?

Back 20

Meningococcal infection

Front 21

Diagnostic evaluations- meningitis

Back 21

CBC w/ diff ( left shift- bacterial), blood cultures, CSF: chemistry, opening pressure, cell count, gram stain and culture

Front 22

Imaging for meningitis

Back 22

CT- before LP

Front 23

CSF results : bacterial meningitis

Back 23

: opening pressure 200-300, WBC 100-5000> 80% PMNs, glucose< 40, Protein >100, + culture

Front 24

CSF results: viral meningitis

Back 24

opening pressure- 90-200, WBC- 10-300 lymphs, Glucose- normal/reduced, Protein- slighlty elvated, neg- culture

Front 25

Medical Management - meningitis

Back 25

Initial tx as bacterial if cannot be r/o
In older children & adults- cefotaxime or ceftriaxone, vancomycin
in adults > 50 years ampilcillin is added to vanco and 3rd gen cephalosporins
dexamethasone in children before 3rd gen cephalosporin

Front 26

How long should meningitis infection of L. monocytogenes be treated for?

Back 26

21 days

Front 27

prompt prophylaxis is warranted for contacts of a meningococcal patient? T or F

Back 27

True

Front 28

a nuerological deficit that lasting more then 24 hours that is caused by reduced blood flow in an artery supplying part of the brain- leads to infarction

Back 28

Stroke

Front 29

2 types of strokes

Back 29

hemorrhagic
ischemic

Front 30

ischemic strokes counts for % of strokes

Back 30

85%

Front 31

Most common disorder that leads to stroke

Back 31

Athersclerosis

Front 32

Athersclerosis can cause stroke in three different ways:

Back 32

*mural thrombosis- obstructs artery
*ulceration or rupture of the the plaque- leads to clot
*hemorrhage into a plaque obstructs artery

Front 33

Risk factors for Stroke:

Back 33

hypertension, smoking, heart disease, hypercholesterolemia, disease associated increased viscosity of the blood, OCPs

Front 34

What is the most important risk factor for a stroke?

Back 34

HTN

Front 35

If stroke symptoms reslove within 1-2 hours patient had a ?

Back 35

TIA

Front 36

Sings and symptoms of stroke

Back 36

drooping of facial muscles- can wrinkle forehead, paresis, visual loss, diplopia, dysarthria, aphasia, decreased level of consiousness

Front 37

Stroke of what artery produces: contralateral hemiparesis, contralateral hyperhesia, ipsilateral hemianopsia, gaze preferenace toward lesion, weakness of upper extremities > lower exremities

Back 37

MCA

Front 38

What artery stroke causes: producing primary reflexes, AMS, imparied judgement, contralateral weakness, contralateral cortical sensory deficits, apraxia, urinary incontinence

Back 38

ACA

Front 39

what artery stroke causes: homonymous hemianopsia, cortical blindness, visual agnosia, AMS, impaired mental status

Back 39

PCA

Front 40

Infarct of what artery causes: nystagmus, vertigo, diplopia, visul fields deficits, dysphagia, dysarthria, syncope, ataxia

Back 40

Vertebrobasilar artery

Front 41

Hallmark of posterior circulation loss?

Back 41

ipsilateral cranial nerve deficit and contralateral motor deficits

Front 42

Diagnostic evaluations of stroke?

Back 42

CBC, ESR- giant cell arteritis, blood gulcose, prothrombin time and partial thrombin time, EKG

Front 43

Imaging for stroke

Back 43

CT scan- standard initial imaging study, MRI- most sensitive

Front 44

What is the gold standard imaging study for a cerebral stroke?

Back 44

cerebral angiography

Front 45

Emergent management for a Cerebral Stroke?

Back 45

Thrombolytic therapy- only safe and effective way for acute managment of stroke: t-pa- start within 3 hours- if hypertensive (185/110) give labetol m(BB) before starting t-PA

Front 46

a prolonged seizure that last > 30 min

Back 46

Status Epilepticus

Front 47

physical exam findings- status epilepticus

Back 47

complusive: generalized/focal seizure activity
non-convulsive: confusion, delirium, bizzare behavior, memory loss catatonia
changes in respiration, temp, bp

Front 48

Emergency management - status epilepticus?

Back 48

ABCs, IV, ECG, Thiamine, D50- unless glucose known, Lorazepam, Diazepam, phenytoin, phenobarb, propofol

Front 49

Diagnostic evaluations- status eplilepticus

Back 49

antiepileptic drug levels, CBC, CMP, CT, ECG, LP, UA tox

Front 50

when are the peak incidences of epilepsy?

Back 50

childhood and elderly

Front 51

Partial seizure -def

Back 51

involve localized region or collection of cells in a specific area that display a bursting behavior

Front 52

Generalized seizures

Back 52

diffuse clinical and EEg changes that involve many areas of the brain

Front 53

do simple partial seizures have altered consciousness?

Back 53

no

Front 54

When is a partial seizure become complex?

Back 54

when consciousness is altered

Front 55

Generalized clonic-tonic seizure- physical findings

Back 55

patient becomes stiff, clonic, rhythmic jerking of all four extremities, diaphoretic, urinary incontinence, cyanosis