MMD Exam II

Inflammation that can develop around the meninges

Inflammation taht can develop around the meninges and the brain parenchyma

Meningitis caused by a viral or fungal or noninfectious eitiology

Bacterial meningitis pathogen that is more common in elderly

What are the most common bacterial that cause acute bacterial meningitis?

What are some risk factors for developing bacterial meningtitis?

Pts with asplenia are more suseptible to what type of organism

What is the "classic" triad of meningitis symptoms?

AMS in a pt with meningitis suggests what about the disease?

Pt presents with HA that is accompanied by NV and photophobia. What two diagnoses are top on your differential? How does it change if the pt has Fever and nuchal ridgity?

In a pt with meningitis, seizures are pathopneumonic for what?

Which meningitis causing bacteria is associated with a petechial rash?

What two PE tests can you use to test for nuchal ridgidity?

Anisocoria is a deficit of cranial nerve __ found in some cases of ___

18 y.o. pt presents with HA, diffuse HA and photophobia. He is an exchange student who recently came to the U.S. and is living in a frat house with 10 other guys. You note moderate fever, no nuchal ridgidity and anisocoria on exam however no other findings. What does your pt have?

You believe your pt may have bacterial meningitis IN ORDER! what exams/treatments will you initiate next?

What are 3 signs you would see on PE that suggest elevated ICP?

In a meningitis patient what does their lactate level tell you?

Name the conditions where you would do a CT before an LP in a case of meningitis (7)

CSF finding of WBCs 100-5,000, decreased glucose and increased protein is suggestive of ___ meningitis

CSF finding of WBCs 10-500, lymphocytic, glucose normal and protein elevated is suggestive of ___ meningitis

CSF findings of WBCs 0-500, lymphocytic, glucose normal or decreased, and protein elevated is suggestive of __ or __ meningtitis

What two conditions will elevate RBCs in the CSF?

After you give IV abx to a pt with acute bacterial meningtitis you have a _-_ hour time window to get an LP because...

Is LP opening pressure increased, decreased or the same in pts with meningitis?

What two sites do you perform and LP at ?

What are 4 findings on head CT that would contraindicate LP??

What would you add to an empiric antibiotic regimine for a pt who also had elevated ICP?

What can you use to lower ICP in kids

ABM in pts who are age 16-50 the 3 most common organisms are

For pts with ABM who are over age 50 the most common organiams are

For Immunocompromised pts the most common pathogens of ABM are

For pts with recent neurosurgery the most common ABM pathogens are...

The Tx for ABM pts age 16-50 is...

Tx for ABM pts age 50+ is ..

Tx for ABM pts with immunocompromise is...

Tx for an ABM in a pt with Hx of recent neurosurgery or brain trauma is...

What is the most common cause of viral meningitis?

How is enterovirus spread?

What time of the year are most viral meningitis cases?

What are some medications that can cause aseptic meningitis?

What are some systemic disease that can lead to aseptic meningitis?

What is your treatment plan for a pt whom you supect has viral meningitis?

inflammation of the parenchyma of the brain resulting from direct viral invasion or a hypersensitivity reaction to a virus or another foreign protein several weeks after exposure

Inflammation of the brain and nerve roots

Describe the mechanism of secondary encephalitis

The most common anteceedent illness for secondary encephalitis is

What is the most common viral cause of encephalitis?

What is the most severe herpetic cause of encephalitis?

What are the herpetic viruses that cause encephalitis? (4)

What are the enteroviruses that can cause encephalitis?

group of viruses transmitted by bloodsucking vector usually and insect. The group includes, La Crosse, St. Louis, Easter Equine, Japanese, West nile and western equine

Toxoplasmosis can cause encephalitis in what two pt groups?

Cysticerosi is spread by...

Toxoplasmosis is transmitted by

The only tick borne encephalopathy is...

"Ice pick headache"

"Throbbing" or "pulsating" headache

"worst headache of my life"

What are some warning signs that a headache may need neuroimaging?

What are 4 causes of subacute headache

A ___ headache occurs over a period of months to years and is more likely a benign cause

Name some of the pain sensitive structures in the head

76 y.o. F presents with headach x4 wks. She states that she notices the headache most with her morning cup of tea. She states it usually has an aura type component and that she has never had headaches except occasional "little ones" her whole life. She is presenting to you today because she says the headache got alot worse this morning while she was having a BM. Her PMH is significant for HTN, Malignant melanoma 2 yrs ago, and being prediabetic. What do you suspect is causing your pts headache? what is your next step?

What proceedure should you avoid on a pt who you suspect has a brain tumor?

What might you find on the PE of a pt with a brain tumor?

What is the other name for pseudomotor cerebri

Headache that is caused by idiopathic incresae in ICP that can compress cranial nerves making focal neurological deficits

45 y.o. F presents with diffuse generalized headache that is worse with straining. She states that the also has nausea and ringing/swooshing sound in her ears. She became concerned and came to see you because she noticed a facial droop and strange eye movements in the mirror this morning. Her PMH is unremarkable except for obesity and prediabetes. On PE you note CN 7 deficit and CN 3 deficit. You suspect her headache is....

CN deficit where the eye pulls outward to the side causing horizontal double vision which is worse on the affected side

Cranial nerve lesion that causes strange eye movements

CN lesion that causes total or partial weakness of the muscles of the facial expression on one or both sides of the face

Papilledema is a sign of what?

Sx of Idiopathic intracranial hypertension include...

What diagnostic tests should you perform for a pt whom you suspect has idiopathic intracranial hypertension?

What is the treatment for Idiopathic intracranial hypertension?

pt has pain along the nose cheek and eye. It is exacerbated by any type of touch or change in temperature. pt has a positive PMH of shingles. pt describes the pain as a pinprick sensation and has a decreased ability to blink on corneal reflex test. What do you suspect and how do you treat?

How long before post herpetic neuralgia symptoms subside?

What is the treatment for post herpetic neuralgia?

"tic douloruex" is more commonly called...

Who gets trigeminal neuralgia more men or women?

What is the pathogenesis/eitiology of trigeminal neuralgia?

Excruciationg "lancinating" pain over the lower 2/3 of the face... dx?

T or F the physical exam of a pt with Trigeminal neuralgia is normal except for pain
True False

What is the treatment/prognosis for Trigeminal neuralgia?

Who is more likely to get migrains men or women?

T or F migraines tend to run in families
True False

What are some migraine triggers?

What does the acronym POUND stand for?

Pt is a 30 y.o. F who presents with pulsitile, unilateral headache that has nausea and vomiting. She states that it happens once or twice a month and is usually around the beginning or end of her period. She cannot tolerate loud noises or light when she has the headache. She has no papilledema on exam and no focal neurological or visual defects, she denies and aura, or use of caffine or analgesics other than her morning cup of tea. What do you think she has?

Is imaging nessisary with typical migraine symptoms?

What is the treatment for migraines?

What are some contraindications to perscribing 5HT agonists for migraines

Why are 5 HT agonists superior to NSAIDs for the treatment of migraines?

How should you start 5HT therapy for a pt with migraines?

How do Ergot preparations work?

What are some contraindications to using Ergot preparations?

What are some SEs of Ergot preparations?

Name an anitemetic you might use to help treat a migraine

What can you use to prophylax a pt who has frequent recurrant migraines?

What are some contraindications for using a Beta blocker for Headache prophylaxis?

a 24 y.o. F PA student presents during her spring break with cc headache. She looks and feels very ill. She is completely healthy and her Hx is only remarkable for the fact that she does not sleep well because she studies all the time. She reports drinking 7-8 energy drinks a day to stay awake in class and study. Since she has been on break she has switched to a green tea 2-3 times a day. What kind of headache is this? what will you give her for the transition?

What two drugs are notorious for drug rebound headaches?

What can you treat a drug reboung headache with acutely?

A 27 y.o. M presents with headache that is unilateral and starts as a buring/aching sensation behind the right eye. He states it occasionally wakes him from sleep and that he notices that he can't help but cry but that is only from one side. He says they typically last about 30 mins. What is it?

Who gets cluster headaches more males or females?

What is the theoretical pathogenesis of a cluster headache?

28 y.o. M presents with unilateral HA that starts as a buring sensation over the nose and he reports that his nose runs on that side. He has about 5 of these per day and they each last around 15 mins. Notices his eye freqently gets red on the same side of the pain and he has trouble keeping that eyelid open.

What is the treatment for acute relief from a cluster headache?

What can you perscribe for prophylaxis of a cluster type headache?

HA that feels " like a tight band around my head"

Which type of headache begins before age 10y.o in some pts?

chronic headache of unapparent cause that lack features of migrain or cluster headaches

This headache type is thought to be caused by contraction of the neck and scalp msucles and is probably a secondary phenomena

What is the treatment for acute tension headache?

What is the prophylaxis for pts who have chronic tension HAs?

__ is caused by the spirochete borrelia burgdorfi

The vector for lyme is the __ tick

____ is when a tick attaches to the end of a blade of grass with their hind legs and grab animals with their other limbs

T or F ticks can jump onto a host from up to a foot away.
True False

The bullseye rash also known as _______ is pathopneumonic for Lyme

Some early symptoms of Lyme include...

An avid New England runner presents to you with fatigue malaise, localized lymphadenopathy in the right groin, with a slight fever and arthralgias. What should you look for on the skin of his right lower leg?

One of your pts presents with nuchal ridgitity and fever with mild headache. You are worried because they presented in July after a camping trip with a flu-like syndrome. You are confident that they have meningitis but are unsure what it is from so you do a lumbar puncture. The CSF shows moderate CSF pleocytosis and moderate protein elevation with normal glucose. You suspect a diagnosis of...

CSF from Lyme meningitis typically has what findings?

Lyme carditis typically manifests as

what are some Sx of Lyme carditis?

What are some eye manifestations of Lyme disease?

If you have hepatitis with Lyme disease you should look for what co-infection?

Musculoskeletal manifestions of Lyme include...

Positive C6 antibody

How do you test for lyme?

Lyme that occurs months to years after initial infection and includes neurologic and joint symptoms incluidng arthritis, and mild cognitive deficits is called ____ lyme

hookworm migration of larvae throught the lungs causing nausea vomiting pharyngeal irritation, cough, dyspnea and hoarsness

How do you treat Lyme in adults?

How do you treat Lyme in children?

How do you treat lyme in an amoxcillin allergic pt

How do you treat disseminated lyme with meningitis or cardiac involvement

when do you give post tick bite exposure prophylaxis?

Human granulocytic anaplasma is carried by the ___ tick

80y.o. Pt presents with fever, chills, headache, myalgias, and malaise. They state that they had an engorged tick on them but did not develop a bulls eye rash. You order labs and find, CBC is positive for Leukopenia, thrombocytopenia and they also have elevated liver enzymes. The peripheral smear shows a morula (mulberry like inclusion in the white cells) What does your patient have?

What two groups of people are at risk of death from anaplasma?

How does anaplasma kill?

Triad of Fever, thrombocytopenia, and leukopenia

"morula" (black berry nucleus in white cells from an infected vacuole)

What two lab tests can you do to confirm a clincal diagnosis of anaplasmosis?

What do you treat anaplasmosis with?

Babesia is transmitted by the __ tick

Erhlichia is tranmitted by the __ tick

Which tick borne disease can also be transmitted by blood transfusion?

Which tick borne disease is associated with a hemolytic anemia?

Who is at risk for severe disease with Babesia infection? (5 risk factors)

A father 76y.o. and son 34 y.o. come in to the clinic after a hiking trip they think that they may have encountered something on their hike that made them ill. The son has fever, chills, myalgias, malaise, nausea, andorexia, and some jaundice. The father has SOB, fever, chills, myalgias, malaise, nausea, anorexia, headache and jaundice as well as bruising and purpura. On peripheral smear they both have cirucular staining organisms that look similar to malaria. and the both have elevated liver enzymes, thrombocytopenia and hemolysis/anemia. What do they have (hint: it is the same disease) ? why is dad presenting differently? What is your biggest concern?

How do you treat severe Babesia infection?

How do you treat mild babesia infection

Tick borne illness caused by rickettsia reckettsii

The vector for rocky mountain spotted fever (RMSF) is

how long does a tick have to be attached in order to transimit RMSF?

What is the incubation period of RMSF?

Which tick borne disease has a pathopneumonic rash on the wrists ankles palms and soles?

A 26 y.o. Black male with history of G6PD deficency presents to his primary care with an engorged tick. The tick is sent for processing and he is told to come back if he has symptoms of Lyme. Pt returns to his PCM 7 days later with confusion, lethargy, cough, flu like sx and a strange rash that is hard to identify because of his dark skin the rash is on his wrists and legs. His lungs have rales on auscultation and he is lethargic with decreased mental function. His labs show elevated liver enzymes, anemia, elevated bun/creatinine, and thrombocytopenia. Where should the pt be referred to? what is his diagnosis?

What do you use to treat pregnant women with rocky mountain spotted fever?

Who is at high risk for developing fulminant rocky mountain spotted fever?

What do you give moderate or sever cases of RMSF?

What serology test can you do for RMSF?

What are some complications of RMSF?

Meningoencephalitis due to RMSF is associated with what findings on LP?

Untreated cases of RMSF usually die within ___ days of onset

_____ is the infectious agent of malaria that not only causes the majority of malarial infections, but is also the most virulent

What is the vector for Lyme?

explain the pathology of Malaria

What are risk factors for severe Malarial disease?

23 y.o. M pt presents with fatigue malaise, fever, chills, N,V, D and abdominal pain. He recently returned from a trip to India. what do you suspect?

What should you order on your peripheral smear if you suspect malaria?

Name a few drugs used to treat malaria

You just diagnosed a pt with malaria, what are some signs of serious disease that you want to be vigulant of?

What are the two human infecting hookworms?

How is hookworm aquired?

How does hookworm cause infection?

While you are on a clincal rotation in the carribean, a young woman on her honeymoon presents to you with a serpigenous rash on her foot along with GI upset and a cough. Her labs show anemia and eosinophila. What is the next diagnostic test you order? What is the disease?

What will lab studies of a pt with hookworm show?

What is the treatment for hookworm?

Who is at high risk of pinworm

What is the organism that causes pinworm?

T or F pinworm can be spread via a fomite
True False

Anal pruritis that is worse at night and may migrate to the peritoneum, nasal and vaginal openings

What test do you do to confirm pinworm diagnosis?

How do you treat Pinworm?

This AIDS associated disese occurs at a CD4 count less than 100 and is characterized by a focal ring or nodular enhancing mass or lesion with surrounding edema in teh brain on CT or MRI. It can consist of a single (usually but may be multiple) lesions in the basal ganglia, thalamus and corpus callosum, and less commonly the cerebellum, midbrain and pons

___ is the most common cause of an intracranial mass lesion in AIDs and is spread by handling kitty litter, undercooked or raw meat handling or eating, and gardening.

This AIDS associated intracranial lesion occurs at a CD4 less than 200, has Sx of fever, HA, focal neurological defects and seizures. It is characterized by MRI/CT findings which include: encephalitis
focal or multiple ring and or nodular enhanding lesins surroudned by variable degrees of edema
rings that primarily occur where gray and white matter meet
Lesions that tend to be located superficially or deeply the basal gangila or thalamus

AIDs related encephalopathy that begins with viral infection of the oligodendrocytes and leads to demyelination that affects the white matter and tends to be asymetric. It typically occurs in pts with a CD4 of less than 100

This pathogen is the most common OI in AIDs pts. Especially prevalent with CD 4 counts less than 200, It causes a pneumonia with fever, dry cough and progressive SOB, often clear lung sounds are heard on auscultation, but 6 min walk of life shows O2 desat, and CT reveals ground glass opacities.

Is chest X-ray and auscultation enough to rule out PCP in an AIDs pt?

These two labs are typically elevated in a pneumocystic jirovechi pneumonia

What is seen on Chest CT of a pt with PCP?

This acid fast bacilli is a common OI in AIDs pts with a CD4 count of less than 100. It causes disseminated infection to the bone marrow, liver, spleen, lymph nodes, and lungs. Typically pts have Fever, night sweats, abdominal pain, diarrhea and wt loss

A 26 y.o. M presents with fever, night sweats, abdominal pain, diarrhea, and wt loss. A complete pannel is done on him including blood cultures. The labs are significant for Anemia, alk phos elevation and LDH elevation. A few days later the blood cultures grow out MAC. What co-infection should be considered in this patient? What test should he have done?

Pt presents with dark brown plaque like lesions on the torso and limbs. Biopsy and stain of the lesions reveals a spindle shaped cell that stains positively for human herpes virus. Pt is a known AIDs pt and so his CD4 count is drawn and is less than 200 what are the lesions most likely to be.

This virus in AIDs pts can lead to Retinitis that leads to blindness, Esophatitis that leads to wt loss, colitis, and nurological symptoms that are similar to guillian barre syndrome with an ascending myelitis. It occurs in pts with a CD4 of less than 100

This disease causes a chronic life threatening cholera type diarrhea in AIDs pts with a CD4 less than 100. It causes wasting and chronic diarrhea that can lead to death. It is contracted from contaminated water or contact with animals or farms.

This AIDs pathogen likes to hang out in the lungs (reservoir) the optic nerve, CSF, brain, liver and prostate. It reactivates upon a CD4 count of less than 200 and causes meningoencephalitis that has Sx of progressive confusion, fever, somnolence, thrus, wasting. India ink prep will show an encapsulated bacteria

What are some early infections that may occur at a CD4 of less than 350 that may be indicators of HIV infection?

What is the primary way that women aquire HIV?

What region of the US has the highest number of AIDs cases?

Minorities are (overrepresented or underrepresented) in AIDs case statistics

What are some risk factors for transmission of AIDs?

What are 2 ways STDs improve HIV transmission?

What type of intercourse carries the highest transmission risk for HIV

What are the 3 primary modes of HIV transmission

What are some symptoms of primary AIDs infection?

What are some stage B HIV/AIDs associated illnesses?

What are some AIDs definding illnesses (Stage C)

A person recently infected with HIV who has acute seroconversion syndrome with an EBV or viral type symptoms is what stage of HIV infection?

A person who may be asymptomatic or have only generalized lymphadenopathy with recen HIV infection is at what stage of infection?

Formerly known as AIDs related complex this stage of HIV infection has signs of troublesome but common infections that appear more frequently

Stage __ also called ___ is an HIV infectoin plus either a CD4 count less than 200 reguardless of symptoms or an ___ defining condition at any CD4 count

The _____ test for HIV tests for antibodies to different surface antigens on the HIV virus. it requires seroconversion which is approximatly 2 wks post exposure. becomes positve 2 wks at the earliest and months at the latest and must be confirmed with western blot

This test for HIV becomes positive 5-20 days after infection onset and is ALWAYS positive at high levels when the patient has symptoms.

The ___ antigen test for HIV becomes positve earlier than the antibody test but can be negative in up to 10% of cases of primary HIV

If you suspect acute HIV infection what tests should you order?

What medication is used for HIV post exposure prophylaxis?

What two situations would you perscribe post exposure prophylaxis for HIV?

What are the 5 classes of Drugs used to treat HIV/AIDs?

Name an integrase inhibitor

What entry inhibitor can you only use for CCR5 viruses?

Name a Protease inhibitor

name a non-nuke (nnRTI)

Name a nRTI

What must you check before perscribing a HIV pt Abacavir?

Tenofovir should be perscribed with water and calcium why?

___ is an HIV drug that causes asymptomatic rise in unconjugated bilirubin so it won't hurt the patient but they will turn yellow

___ is the PI of choice in HIV tx

What are some of the SEs associated with Efavirenz for HIV?

Which non-nuke can induce non-nuke resistance in HIV strains?