Term
| Most common adult cause of meningitis in terms of mortality? |
|
Definition
meningococcus (10%)
pneumococcus (25%) |
|
|
Term
| most common neurological sequalae of meningitis? |
|
Definition
|
|
Term
| which organism commonly causes meningitis in the immunosuppressed? |
|
Definition
|
|
Term
| between ages 6 and 60 years which 2 are the common organisms to causes meningitis? |
|
Definition
Neisseria meningitidis
Strep pnemoniae
in over 60's you get these 2 plus Listeria. Listeria is common in infecting those who are immunosuppressed. |
|
|
Term
| in 0-3m babies which are the 3 most common causative organisms of meningitis? |
|
Definition
GBS (most common in neonates)
ecoli
listeria |
|
|
Term
| in 3m - 6year old children which 3 organisms commonly cause meningitis? |
|
Definition
Nesseria
Strep pnemonia
Haemophillus influenza. (more common in those <4 years) |
|
|
Term
| which type of meningitis (viral or bacterial) is most common? |
|
Definition
|
|
Term
| which quadravalent meningitis vaccine is given to all 17-18 year olds? |
|
Definition
|
|
Term
| common risk factors for meningitis |
|
Definition
those with csf shunts or dural defects (staph)
those getting spinal anaesthesia (psuedomonas spa)
bacterial endocarditis
alcoholism and cirrhosis
DM
malignancy (listeria)
splenectomy
crowding
IVDU |
|
|
Term
| which HSV subtype is associated with long term complications after meningitis in neonates? |
|
Definition
HSV -2
cerebral palsy
general learning disability
seizures
microcephaly
visual impairement |
|
|
Term
| what is aseptic meningitis and give causes for it |
|
Definition
it is when CSF has cells but it is gram stain negative and no bacteria can be cultured on standard media. causes include:
partially treated bacterial meningitis
viral infection: mumps, echo, HSV
fungal infection
parasites
atypical: TB, lyme
Kawasaki disease
mollaret's meningitis - recurrent, aseptic, chronic, benign meningitis |
|
|
Term
| give some causes of non infective meningitis |
|
Definition
malignant cells (luekimia)
chemical meningitis (intra theca drugs)
drugs (NSAIDs, trimethoprim)
sarcoidosis
SLE
Bechets |
|
|
Term
|
Definition
| pain and resistance on passive knee extension with hips fully flexed |
|
|
Term
| what is brudzinkski's sign? |
|
Definition
| the hips flex on bending the head forward |
|
|
Term
| List the early and late signs that may be present in meningococcal disease |
|
Definition
Early signs with median onset 7-12 hours: nonspecific features such as leg pain, cold hands and feet and abnormal skin colour.
Later signs such as haemorrhagic rash, meningism and impaired consciousness appear later after 13-22 hours. |
|
|
Term
| what is the classic triad of meningitis? |
|
Definition
Fever
Neck stiffness
change in mental status |
|
|
Term
| when is LP performed in ?meningitis |
|
Definition
Immediately providing there are no signs of raised ICP
samples sent for gram stain, zielh-neelso stain (TB), cytology, virology, glucose, protein, culture, PCR and india ink for cryptococci. |
|
|
Term
| name the supportive management in meningitis |
|
Definition
Fluids
antipyretics
antiemetics |
|
|
Term
|
Definition
Aciclovir for herpetic infections
Gancyclovir for CMV
ganciclovir has significant renal toxicity and needs close monitoring. |
|
|
Term
| if you suspect meningococcal septicaemia and the pt has a non bleaching rash what should you administer pre hospital to the pt? |
|
Definition
| IM/IV Benpen 1.2 g or 600mg for children (check dose) |
|
|
Term
| apart from Abx what do NICE recommend children over 3 months be given if they have suspected or confirmed bacterial meningitis? |
|
Definition
Dexamethasone
Corticosteroids given to patients of all ages with bacterial meningitis have been shown to reduce hearing loss and neurological sequelae |
|
|
Term
which Abx can you use in blind therapy in meningitis for those 3months or >
what about those < 3months? |
|
Definition
Ceftriaxone
those less than 3 months use cefotaxime +amoxicillin or ampicillin |
|
|
Term
| in meningitis why should ceftrixaone not be used in premature babies? |
|
Definition
it may exacerbate hyperbillirubinemia
For the same reason it should also not be give to babies with jaundice, hypo albumin or acidosis. |
|
|
Term
| How to rx meningitis caused by meningococci? |
|
Definition
IV Ceftriaxone 7 days
prevention of secondary cases usually with Rifampicin or ciprofluoxacin |
|
|
Term
| how to treat meningitis caused by pneumococci |
|
Definition
| Vancomycin and 3rd gen cephalopsorin (cefotaxime or ceftriaxone) |
|
|
Term
| what would you give to rx meningitis caused by Hemophilus influenza type B? |
|
Definition
| IV ceftriaxone for 10 days |
|
|
Term
| how would you treat meningitis caused by GBS (usually in babies) when does meningitis usually occur by GBS? |
|
Definition
Cefotaxime 14 days
meningitis usually occurs between the ages of 7-90 days |
|
|
Term
| how would you rx meningitis caused by Listeriosis in children under the age of 3 months? |
|
Definition
| IV amoxicillin or ampicillin for 21 days + gentamicin for at least the 1st 7 days. |
|
|
Term
| complications of meningitis (acute) |
|
Definition
Shock and DIC
cerebral oedema and raised ICP
septic arthritis
pericardial effusion
hemolytic anemia (h. influenzae)
subdural effusions
SIADH
seizures |
|
|
Term
| delayed complications of meningitis |
|
Definition
decreased hearing or deafness
multiple seizures
focal paralysis
intellectual deficits
blindness
waterhouse-frederichsen syndrome
peripheral gangrene |
|
|
Term
|
Definition
| A systemic reaction of the body (SIRS) to a bacterial infection of the urogenital organs. There is a risk of life threatening symptoms including shock. |
|
|
Term
| Causes of urosepsis (primary infections) |
|
Definition
pyelonephritis
renal abscess
infected hydronephrosis
bacterial prostatitis
epididymitis |
|
|
Term
| name some responsible organisms implicated in urosepsis |
|
Definition
Ecoli
Klebsiella
Enterobacter
Serratia
Proteus
Pseudomonas
Enterococcus |
|
|
Term
signs and symptoms of urosepsis
which sign indicates poor prognosis? |
|
Definition
flank pain
abdominal tenderness
scrotal pain
fever, chills, hyperventilation, tachycardia, hypotension
HYPOTHERMIA indicates poor prognosis
further symptoms
impairment of consciousness, oliguria, confusion |
|
|
Term
the following CSF analysis is suggestive of?...
Appearance: cloudy
Glucose: Low <1/2 that of plasma
Protein: High >1g/L
WCC:10-5000 polymorphs/mm^3 |
|
Definition
|
|
Term
| Describe the CSF composition in viral meningitis |
|
Definition
Colour : clear/cloudy
Protein: Normal/ raised
Glucose: 60-80% of plasma glucose
WCC: 15-1000 lymphocytes/mm^3 |
|
|
Term
The CSF analysis shows the following
appearance: slight cloudy, fibrin web
glucose: low
protein: high
WCC: 10-1000 mainly lymphocytes
what is the likely causative organism? |
|
Definition
|
|
Term
| describe what is toxic shock syndrome |
|
Definition
| it is a systemic reaction to staphylococcal exotoxins. |
|
|
Term
| list the diagnostic criteria for toxic shock syndrome |
|
Definition
fever: temperature >38.9
hypotension SBP <90mmHg
diffuse erythematous rash
desquamation of rash especially on palms and soles
involvement of 3 or > organ systems |
|
|
Term
| in fever of unknown origin, what clues will change the direction of the diagnostic plan? |
|
Definition
| New physical clues during work up such as appearance of a rash, skin lesion or lymph node. |
|
|
Term
| in which disease would you see a tertian and quartan pattern of fever? |
|
Definition
|
|
Term
| in unknown fever recent residence in or travel to an area endemic for tropical disease can increase likelihood of which diseases? |
|
Definition
TB
malaria
hepatitis
typhoid fever
parasitic infections
rocky mountain fever
lyme disease |
|
|
Term
| Ddx of night sweats in unknown fever? |
|
Definition
TB
AI
Hematological malignancies
weight loss may be useful in the evaluation of patients with malignancy, TB, HIV infection, or endocrine disorders. |
|
|
Term
| in fever of unknown origin, the presence of a new heart murmur would point you towards which diagnosis? |
|
Definition
|
|
Term
| Relative bradycardia is aka pulse-temperature dissociation. if this is present in fever of unknown origin which disease would you steer towards? |
|
Definition
|
|
Term
| name the lab test you would order for a pt with fever of unknown origin |
|
Definition
FBC with differential
U and E
LFTs
ESR
urine and blood culture
skin culture for TB
chest radiography
MRI indicated in initial work up for suspected cases of osteomylitis |
|
|
Term
| if initial lab tests fail to reach a cause of fever of unknown origin (FUO) what test is recommended next line? |
|
Definition
CT of abdomen and pelvis with oral and IV contrast
serological studies to rule out collagen vascular disease like RA, SLE, PMR.
if diagnosis still elusive then further tests including nuclear medicine, liver and bone marrow biopsies, endoscopy, venous doppler imaging and MRI may be indicated. |
|
|
Term
| when would you use nuclear imaging in FUO? |
|
Definition
| when working up suspected infectious or malignant causes where CT has failed to ID a cause. |
|
|
Term
| if you suspected sarcoidosis or IBD in FUO what test is useful? |
|
Definition
|
|
Term
| if you suspect a venous thrombosis as the source of fever in FUO what test would be useful? |
|
Definition
|
|
Term
| which novel method seems promising as a diagnostic tool for FUO? |
|
Definition
Fluorodeoxyglucose-PET (FDG-PET)
it should be considered among the first diagnostic tools for patients with FUO in whom conventional diagnostics have been unsuccessful. |
|
|
Term
| For most cases of FUO rx is withheld until a diagnosis can be made. in certain circumstances a therapeutic trial of Abx or corticosteroids might be given. Name 3 scenarios in which these might be. |
|
Definition
?GCA
patient is neutropenic
pt is immunocompromised |
|
|
Term
| For most cases of FUO rx is withheld until a diagnosis can be made. in certain circumstances a therapeutic trial of Abx or corticosteroids might be given. Name 3 scenarios in which these might be. |
|
Definition
?GCA
patient is neutropenic
pt is immunocompromised |
|
|
Term
| sometimes in FUO a diagnostic trial of NSAIDs are given to see if the fever is relieved. which fevers are likely to respond to a trial of NSAIDs? |
|
Definition
| fevers that are secondary to malignancy or AI disorders rather than fevers that are associated with infection. |
|
|
Term
| define an immunocompromised host |
|
Definition
a person that does not have the ability to respond normally to an infection due to impaired or weakened immune system.
this can be due to DM, malnutrition, infection and drugs |
|
|
Term
| in terms of giving live vaccines to pts who will become immunosupressed, when is the best time to give them? |
|
Definition
| at least 4 weeks before immune suppression and avoid within 2 weeks of immunosupression |
|
|
Term
| B cell immunosupression increases risk to which types of infection? |
|
Definition
sinopulmonary
respiratory tract
infections from non enveloped viruses e.g. B19 and and rotavirus |
|
|
Term
| what does T cell immunosuppression increase risk of infection from? |
|
Definition
Candida
mycobacterium
herpes simplex
p jirovecii |
|
|
Term
| which organisms causes Q fever? |
|
Definition
Coxiella burnetti
this is a gram negative obligate intracellular parasite |
|
|
Term
| a pt presents with fever. They work in close proximity to sheep, cows and goats and it is birthing time. what is the most likely diagnosis? |
|
Definition
|
|
Term
|
Definition
doxycycline 100mg bd 14 days
for children <8 years give co-trimoxazole |
|
|
Term
| what could be the most likely cause of fever in a post op pt.? |
|
Definition
|
|
Term
| what type of analgesia does the WHO initially recommend? |
|
Definition
peripherally acting drugs like NSAIDs or ibuprofen.
if pain persists introduce weak opiates like codeine or dextropropoxyphene.
the final step of the ladder it to give centrally acting drugs like morphine. |
|
|
Term
| how does the WHO and anaesthesiologist pain ladder differ? |
|
Definition
| The WHO ladder starts with peripherally acting drugs and builds up to centrally acting drugs whereas the anaesthesiologist ladder starts with strong drugs in combo with local blocks and gradually reduces down to peripherally acting analgesia. |
|
|
Term
| give one disadvantage of epidural anaesthesia and name another type of block that could be used instead. |
|
Definition
| they affect the motor aspect so pt is confined to bed. if you use a transverses abdominal plane block, the pt's motor fx is not affected. |
|
|
Term
| what is the rx for neuropathic pain? |
|
Definition
1st line: amitriptyline or pregabalin
2nd line: amitriptiline AND pregabalin
3rd line: refer to pain specialist and give tramadol in the interim.
if DM: give duloxetine. |
|
|
Term
| define neuropathic pain and give examples |
|
Definition
pain that arises due to damage damage or disruption of the nervous system.
examples: diabetic neuropathy, post herpetic neuralgia, trigeminal neuralgia, prolapsed intervertebral disc. |
|
|
Term
| In which type of pain might you use strong opioids. give examples |
|
Definition
| severe pain from deep or visceral structures. e.g. morphine and pethidine |
|
|
Term
| Discuss properties of morphine including SE |
|
Definition
it has a short half life, poor bioavailibility
metabolised in liver.
clearance reduced in liver disease, elderly and debilitated.
SE: nausea, vomiting, constipation, respiratory depression
tolerance may occur with repeated doses. |
|
|
Term
| discuss properties of pethidine as well as side effects |
|
Definition
synthetic opioid. structurally different from morphine and has 10% of the potency.
short t 1/2, similar bioavailibity and clearance to morphine.
short duration of action and may need to be given hourly
it has a toxic metabolite cleared by the kidney. this accumulates in renal failure and may lead to convulsions or muscle twitching. |
|
|
Term
| what is the most serious side effect that can occur with pethidine and renal failure? |
|
Definition
| muscle twitching and convulsions. this also occurs with prolonged used so extreme caution is advised if pethidine is used over a prolonged period or in patients with renal failure. |
|
|
Term
| after how long can you say you have chronic pain? |
|
Definition
|
|
Term
| if you have deep/visceral pain then you should give?? |
|
Definition
|
|
Term
| what adjuvant therapies can be used to control pain? |
|
Definition
| antidepressants such as amitriptiline and anticonvulsants such as carbamazepine |
|
|
Term
| how is somatic pain descryibed as? |
|
Definition
|
|
Term
| how is visceral pain described as? |
|
Definition
| pressure like, deep, squeezing, dull, diffuse |
|
|
Term
| describe neuropathic pain |
|
Definition
| burning, shooting, tingling, stinging, pins and needles type pain |
|
|
Term
| A delta fibres in nociception... list some characteristics. |
|
Definition
they are myelinated
allow action potential to travel fast towards CNS
perceived as sharp pain.
can travel at 20 metres/sec towards CNS |
|
|
Term
| C fibres. name some characteristics of them |
|
Definition
They are unmyelinated and slower than A delta.
they conduct at 2metres/sec whereas a delta fibres can conduct at 20 metres/second. |
|
|
Term
| describe what wind-up is and which fibres does it involve? |
|
Definition
| if there is massive or prolonged input into a c fibre, there is progressive build up in the spinal cord dorsal horn. It is similar to tetanus and if it occurs then there may be increased sensitivity to pain. |
|
|
Term
| in which laminae do A delta fibres synapse in? |
|
Definition
|
|
Term
| which segment do C fibres synapse in? |
|
Definition
|
|
Term
| which segment do A-beta fibres synapse in? |
|
Definition
|
|
Term
name 3 scales in rating pain for adults
name a pain chart that is suitable to use with children |
|
Definition
VAS
verbal rating scale
numerical rating scale
a pain chart that is suitable to use with children is the 'faces' scale. |
|
|
Term
| name 4 types of scales that can be used to measure pain from patients both adults and children |
|
Definition
[image]
VAS
verbal rating
numerical rating
FACES scale |
|
|
Term
| what could pts use with chronic lower back pain? what other considerations and risks must be taken into account? |
|
Definition
NSAIDs can be used for lower chronic back pain pts e.g. ibuprofen.
cardiovascular and GI risk needs to be taken into account when prescribing these medications |
|
|
Term
| what medications can you give to pts with chronic hip and knee OA |
|
Definition
| paracetamol in combination with NSAIDs and non pharmacological treatment. |
|
|
Term
| in pts with chronic MSK pain who cannot tolerate PO NSAIDs what could you give? |
|
Definition
| Topical NSAIDs e.g. Diclofenac |
|
|
Term
| when can topical capsaiscin patches be in used... In what type of pain. are they 1st line? |
|
Definition
| consider them in rx of pts with neuropathic pain if 1st line pharmacological therapies have been ineffective or not tolerated. |
|
|
Term
Strong opioids should be considered as an option for pain relief for patients with chronic low back pain or osteoarthritis,. When should this be continued?
what else is required? |
|
Definition
| Only continued if there is ongoing pain relief. Regular review is required. |
|
|
Term
| what medication is recommended for fibromyaligia? |
|
Definition
| Pregabalin. this should be titrated up to at least 300mg daily |
|
|
Term
1st line for neuropathic pain?
2nd line?
diabetic neuropathy 1st line? |
|
Definition
gabapentin
pregabalin if gabapentin not working or not tolerated
duloxetine for diabetic neuropathy |
|
|
Term
| Tricyclic antidepressants should not be used for the management of pain in patients with chronic low back pain. They can be used as an adjunct in neuropathic pain. Which one is commonly used? |
|
Definition
| Amitriptyline (25 - 125 mg/day) should be considered for the treatment of patients with fibromyalgia and neuropathic pain (excluding HIv-related neuropathic pain). |
|
|
Term
| what dose duloxetine for diabetic neuropathy? |
|
Definition
|
|
Term
| name two non pharmacological therapies available for chronic pain pts |
|
Definition
progressive relaxation
EMG biofeedback
pain team refferal for pain education |
|
|
Term
| how does operant behaviour fit into chronic pain management? |
|
Definition
| basically clinicians need to be aware that their own behaviour and the clinical environment can impact on reinforcement of unhelpful responses. |
|
|
Term
| name a type of non pharmacological therapy that can be considered in pts with chronic pain |
|
Definition
|
|
Term
| in chronic pain pts how many you improve adherence to exercise ? |
|
Definition
supervised exercise sessions
individualised exercises in group settings
addition of supplementary material
provision of a combined group and exercise programme |
|
|
Term
| name some manual therapy options available for pts with chronic pain |
|
Definition
|
|
Term
| name some complementary therapies available for chronic pain pts |
|
Definition
acupuncture
herbal remedies; willow bark, ginger, indian frankincense, devils claw. |
|
|
Term
| pain arising from visceral sources is also known as what type of pain? |
|
Definition
|
|
Term
| if a pt is in significant pain, in what time period should they be treated in? |
|
Definition
| 30 minutes. they should be reassessed after an appropriate interval. |
|
|
Term
| how is acute pain managed in children |
|
Definition
they have individualised rx plans based on principals of multimodal analgesia.
it should include both pharmacological and non pharmacological rx and be safe, appropriate to their developmental age and clinical condition. |
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