Antibiotics & ID

Question 1

10s-100s Lymphocytes in CSF
Markedly elevated protein level
Negative stain and culture

Answer 1

Tuberculosis

Question 2

Fever
HA
N/V

Answer 2

Think CNS infections

- can lead to seizures

Question 3

Four major causes of Meningitis?

Answer 3

Strep pneumo
Neisseria meningitides
GBS
H-flu
Listeria

Recent neurosurgery?
- Staphylococcus

Question 4

Camper/hiker, rash moves from arms/legs to trunk

Might remember?

Answer 4

Rocky Mountain Spotted Fever (Rickettsia)

- tick remembered 60% of the time

Question 5

What test order if…

• papilledema
• seizures
• focal neuro abnormalities
• confusion

Answer 5

Head CT

• needs to be done before LP if worry for space occupying lesion
• concern for herniation

Question 6

Describe papilledema

Answer 6

Blurred, fuzz disc margin seen on fundoscopy due to increased ICP

Question 7

Best Initial Test for CNS infections?

Answer 7

LP

Question 8

When do a latex agglutination antigen test for CNS infection?

Answer 8

If abx already given

- then LAT is as good as culture which may be neg due to the abx

Question 9

Best initial treatment for bacterial meningitis?

Answer 9

Vancomycin
Ceftriaxone
Steroids - for strep pneumo

Do based on cell counts: 1000’s of neutrophils

Question 10

What add to cover listeria in CNS infection?

Answer 10

Ampicillin

Elderly, pregger, HIV, immunocompromised, alcoholic, neonate