1. Neuro Infections + sequalae
Quiz

2. What are the most common organisms implicated in bacterial meningitis in children?

3. a) N. meningitidis, H. influenzae b) S. pneumoniae, L. monocytogenes
What are the most common organisms implicated in bacterial meningitis in children?
a) N. meningitidis, H. influenzae
b) S. pneumoniae, L. monocytogenes
c) E. coli, group B streptococci
d) N. meningitidis, S. pneumoniae

4. What CSF findings would be most suggestive of bacterial meningitis?

5. What CSF findings would be most suggestive of bacterial meningitis?
Low turbidity, positive latex agglutination test, CSF/ serum glucose ratio = 0.5
PMN leukocytosis (400/mm3), CSF/ serum glucose ratio = 0.3, increased protein, negative culture
CSF opening pressure = 130mmH2O, CSF/ serum glucose ratio = 0.7, mononuclear leukocytosis (200/mm3)
CSF/ serum glucose ratio = 0.4, high protein, cells (PMN and mono) = 150/mm3

6. What are the 3 components of meningismus?

7. What are the 3 components of meningismus?
nuchal rigidity, meningeal irritation, headache
photophobia, nuchal rigidity, headache
headache, nuchal rigidity, fever
fever, photophobia, nuchal rigidity

8. Describe Kernig’s and Brudzinski’s signs.

9. Describe Kernig’s and Brudzinski’s signs.
Kernigs - leg is bent at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful (leading to resistance)
Brudzinski’s - appearance of involuntary lifting of the legs in meningeal irritation when lifting a patient's head off the examining couch, with the patient lying supine

10. Aciclovir’s mechanism of action is:

11. Aciclovir’s mechanism of action is:
Prodrug nucleoside analogue that inhibits viral DNA polymerase after phosphorylation, resulting in chain termination.
Inhibition of viral protease used to cleave nascent proteins for assembly of new virions.
Binding to viral neuraminidase, rendering the influenza virus unable to escape its host cell and infect others.
interference with a viral M2 ion channel which is required for the viral particle to become "uncoated" once taken inside a cell by endocytosis.

12. SPOT DIAGNOSIS! A 45 year old female from nimbin presents with loss of coordination (with high stepping gait), urinary incontinance, impaired pupil reaction to light, lower limb areflexia and lower back pain that shoots down her legs sometimes. There has been no recent illness or infections, but she says that 5 years ago she did have a ‘sore’ down there.

13. Guillain Barre Syndrome Myasthenia gravis Tabes dorsalis HIV/ AIDS
SPOT DIAGNOSIS! A 45 year old female from nimbin presents with loss of coordination (with high stepping gait), urinary incontinance, impaired pupil reaction to light, lower limb areflexia and lower back pain that shoots down her legs sometimes. There has been no recent illness or infections, but she says that 5 years ago she did have a ‘sore’ down there.
Guillain Barre Syndrome
Myasthenia gravis
Tabes dorsalis
HIV/ AIDS

14. VZV reactivation involving the facial and auditory nerves is known as:

15. VZV reactivation involving the facial and auditory nerves is known as:
Bell’s palsy
Ramsay Hunt Syndrome
Trigeminal neuralgia
Postherpetic neuralgia

16. What is the most helpful ‘clinical triad’ for diagnosis of GBS?

17. What is the most helpful ‘clinical triad’ for diagnosis of GBS?
Areflexia, lower back pain radiating to legs, fever
Ascending flaccid paralysis, areflexia, respiratory distress or autonomic dysfunction
Respiratory distress, positive Campylobacter jejuni serum Ig, areflexia
Cytoalbumin dissociation, areflexia, ascending flaccid paralysis

18. SPOT DIAGNOSIS! A new patient, a 40 year old man presents with left sided ptosis and diplopia. He also has dysphagia and his wife adds that he is slurring his speech (you just thought it was normal for him). All other examinations are normal.

19. Eaton-Lambert syndrome Multiple Sclerosis Stroke Myasthenia gravis
SPOT DIAGNOSIS! A new patient, a 40 year old man presents with left sided ptosis and diplopia. He also has dysphagia and his wife adds that he is slurring his speech (you just thought it was normal for him). All other examinations are normal.
Eaton-Lambert syndrome
Multiple Sclerosis
Stroke
Myasthenia gravis

20. Why does thymectomy help some patients with myasthenia gravis?

21. Why does thymectomy help some patients with myasthenia gravis?
Something about knocking out the activation of T-helper cells that activate B-cells to plasma cells which then throw out the Ig against the Ach receptor….?

22. What drugs are used to treat Myasthenia gravis? Why?

23. What drugs are used to treat Myasthenia gravis? Why?
Atropine
Penicillin
Pyridostigmine
Oxybutinin