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Brain_FCs_Infections Flashcards

1
Q

Strep pneumoniae meningitis commonly ass’d w/ what 3 things?

A
  • Pneumonia
  • Sinusitis
  • Otitis
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2
Q

Meningitis ass’d w/ overwhelming sepsis, purpura fulminans (gun metal grey lesions)

A

Neisseria meningitidis

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3
Q

Chemoprophylaxis in what types of meningitis? What drugs to use?

A
  • Neisseria meningitidis (Rifampin, ceftriaxone, or ciprofloxacin)
  • H. influenzae if succeptible child <4 yrs. (Rifampin)
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4
Q

Neonatal meningitis - most common cause

A

Group B Streptococcus

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5
Q

Meningitis in elderly w/ chronic disease (diabetes, cirrhosis, alcoholism, renal failure)

A

Group B Streptococcus

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6
Q

Type of vaccine for Haemophilus influenzae?

A

Protein Conjugated Hib vaccine

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7
Q

H. influenzae meningitis may be ass’d w/ what 2 things?

A

sinusitis or otitis

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8
Q

GI tract organism, not nasopharyngeal carriage

A

Listeria monocytogenes

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9
Q

Meningitis in newborns, immunodeficient, or elderly

A

Listeria monocytogenes (or Group B Streptococcus)

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10
Q

Meningitis ass’d w/ pregnancy loss

A

Listeria monocytogenes

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11
Q

When to think meningitis might be Staphylococcus aureus?

A

Post-Neurosurgery or Endocarditis

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12
Q

When to think meningitis might be Gram negative bacilli (Salmonella)?

A

Newborns & Post-Neurosurgery

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13
Q

Meningitis primary management/diagnosis

A
  1. Draw blood cultures & give antibiotics (1st dose)
  2. CT scan
  3. Lumbar Puncture
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14
Q

Empiric antibiotic therapy for acute bacterial meningitis when age >2mo.

A

Ceftriaxone + Vancomycin
(+ Dexamethasone)
If >50 yrs, add Ampicillin (Listeria)

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15
Q

Adult Tx along w/ antibiotics to reduce unfavorable outcomes?

A

Dexamethasone

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16
Q

Most common viral meningitis

A

Enterovirus

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17
Q

HSV Encephalitis treatment?

A

Acyclovir

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18
Q

Vaccine preventable form of meningitis that may follow parotitis

A

Mumps

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19
Q

Meningitis ass’d w/ Facial Palsy &/or Peripheral Neuropathy

A

Lyme disease (aseptic)

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20
Q

2 spirochetal ASEPTIC meningitis causes?

A

Treponema pallidum (Syphilis) & Borrelia burgdorferi (Lyme)

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21
Q

Granulomatous meningitis - 3 causes?

A

Mycobacterium tuberculosis, Cryptococcus neoformans, Coccidioidomycosis

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22
Q

Encephalitis CSF usually looks like ______ meningitis

A

aseptic

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23
Q

Major treatable cause of encephalitis?

A

HSV (HSV 1&raquo_space; HSV 2, except in newborns)

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24
Q

Encephalitis acquired from maternal genital lesion during birth –> HSV 1 or HSV 2?

A

HSV 2

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25
Q

Arbovirus that kills some bird hosts (crows)?

A

West Nile Virus (WNV)

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26
Q

Encephalitis w/ highest morbidity/mortality?

A

Eastern Equine Encephalitis (but it’s rare)

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27
Q

2 common presentations of rabies?

A
  • Most common - Hydrophobia (fear of swallowing water – painful pharyngeal spasms)
  • Flaccid paralysis
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28
Q

Viral encephalitis that is also cause of infectious mononucleosis

A

EBV

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29
Q

Viral encephalitis ass’d w/ VZV reactivation

A

Herpes zoster

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30
Q

Viral encephalitis following monkey bites

A

Herpes B virus

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31
Q

Focal encephalitis, particularly of temporal lobe

A

HSV

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32
Q

Demyelinating process (white matter lesions) in immunocompromised hosts - destroys connections

A

Progressive Multifocal Leukoencephalopathy (JC virus)

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33
Q

kuru “falling sickness” among New Guinea Highlanders

A

Subacute spongiform encephalopathies (caused by prions)
Other names:
- Creutzfeld-Jacob Disease (CJD)
- “Mad Cow Disease”

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34
Q

Startle reactions, ataxia, dementia, w/:
- Normal CSF
- Long incubation period
Diagnosis?

A

Mad cow disease (CJD, Subacute spongiform encephalopathy)

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35
Q

Back/radicular pain w/ fever & weakness, then paralysis

A

Spinal Epidural Abscess

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36
Q

Parameningeal brain abscess from hematogenous spread in person w/ alpha-hemolytic strep & R–>L shunt

A

Staph aureus

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37
Q

Parameningeal brain abscess from direct introduction (open head trauma or neurosurgery)?

A

Staphylococci, gram-negative bacteria

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38
Q

Acyclovir is active against ___ & ____, not ____

A

HSV & VZV, not CMV

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39
Q

Acyclovir requires?

A

Thymidine Kinase (TK) phosphorylation to make monophosphate

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40
Q

Symptom management for edema w/ increased ICP?

A

Corticosteroids (tighten BBB, but also decrease penetration of chemo agents)

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41
Q

Headache symptom management for brain tumors?

A

Corticosteroids

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42
Q

Primary spinal cord tumors –> 2 most common types?

A

Ependymoma or Astrocytoma

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43
Q

Primary spinal cord tumor Tx?

A

Resection
- XRT (sometimes)

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44
Q

Spinal meningiomas –> where in spinal cord?

A

Thoracic spine (most)

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45
Q

4 common symptoms of spinal meningioma

A

Paraparesis
- Radicular pain
- Hyperreflexia
- Sphincter dysfunction

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46
Q

Metastatic spinal tumors usually go to vertebral bodies how?

A

via bloodstream (then compress spine via epidural space)

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47
Q

Difference in pain from spinal tumor vs. disc disease

A

Spinal tumor - worse lying down
Disc disease- better lying down

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48
Q

Diagnosis? –> back pain & neuro deficit w/ history of cancer

A

Spinal cord compression (tumor)

49
Q

3 most common primary tumors to metastasize to spine?

A

Prostate, breast, lung

50
Q

Paraneoplastic syndrome –> most common type of cause?

A

Immunologic factors – Antibody or t-cell responses agains nervous system antigens expressed by tumor

51
Q

Paraneoplastic syndromes- most common in pts w/ what 2 types of tumors?

A

Small cell carcinoma of the lung
- Thymoma

52
Q

Type of headache specific to jaw claudication?

A

Ominous Tempora Arteritis

53
Q

Type of headache w/ drop attacks

A

Colloid cyst, 3rd ventricle

54
Q

Type of headache w/ intracranial HYPOtension

A

Orthostatic

55
Q

Type of headache: Acute, w/ Horner’s Syndrome

A

Carotid artery dissection

56
Q

Type of headache: Cough, w/ exertion

A

Arnold-Chiari syndrome

57
Q

Type of headache: periodic w/ autonomic features (3 types)

A

Cluster, Paroxysmal hemicrania, Trigeminal cephalgias

58
Q

Type of headache: orgasmic (3 types)

A

Pre-coital, Intra-coital, Post-coital

59
Q

Contraindications of Triptans (5HT agonists) in headache Tx?

A

Pregnancy
- Complicated migraine
- Hypertension or CAD/PVD
- Renal or Hepatic insufficiency

60
Q

4 drugs established as effective Prophylaxis for benign headaches?

A

Valproate & Topiramate
- Propranolol (long-acting)
- Frovatriptan

61
Q

Prophylaxis for benign headache & mood stabilization?

62
Q

Prophylaxis for benign headache & weight loss?

A

Topiramate

63
Q

Prophylaxis for benign headache & hypertension?

A

Propranolol

64
Q

Prophylaxis for menstrual-associated migraine?

A

Frovatriptan

65
Q

Prophylaxis for benign headache & insomnia?

A

Tricyclic, amitriptyline

66
Q

Prophylaxis for benign headache & anxiety?

A

SNRI, venlafaxine

67
Q

Type of headache in overweight girls w/ papilledema, elevated ICP, & visual problems (may lead to blindness)?

A

Ominous “Pseudotumor” cerebri

68
Q

Cause of primary CNS lymphoma in AIDS?

A

Epstein-Barr virus (genomes in transformed B cells)

69
Q

Example of 2 Grade IV tumors?

A

Glioblastoma, Medulloblastoma

70
Q

2 types of “sheath” tumors?

A

Meningioma & Schwannoma (others are Neuroepithelial)

71
Q

Pilocytic astrocytoma - circumscribed or infiltrative? Tx?

A

Circumscribed
Tx = Surgical resection

72
Q

Tumor w/ increased cellularity & pleomorphic cells, but NO mitoses, microvascular proliferation, or necrosis

A

Diffuse astrocytoma

73
Q

Tumor that stains w/ densely cellular small “blue cells”

A

Medulloblastoma

74
Q

Typical spread of medulloblastoma?

A

via CSF to bone or regional lymph nodes
- tumor in cerebellar vermis has spread via CSF to 4th ventricle

75
Q

Tumor w/ benign spindle cells on histology?

A

Schwannoma

76
Q

Tumor w/ perivascular organization of tumor cells?

A

Primary CNS lymphoma (EBV)

77
Q

Most common (3) primary sites of metastatic CNS tumors

A
  1. Lung
  2. Breast
  3. Other (skin, colon, kidney)
78
Q

Most common(3) locations of metastasis to the CNS?

A
  1. Brain parenchyma (cerebral hemisphere then cerebellum)
  2. Dura mater
  3. Leptomeninges
79
Q

Common location of epidural hemmorrhage?

A

Temporal-parietal region (where skull fractures cross path of & lacerate Middle Meningeal Artery)

80
Q

Clinical consequence of epidural hemorrhage

A
  • High pressure arterial bleeding (rapid expansion & mass effect on brain)
  • Rapid loss of consciousness (eventual herniation if not treated)
81
Q

Contusion vs. concussion (difference)?

A

Contusion: parenchymal injury caused by direct transmission of kinetic energy through skull to brain (soft tissue bruise)
Concussion: Clinical syndrome characterized by “immediate & transient alteration in brain function (including alteration of mental status & level of consciousness) resulting from mechanical force or trauma

82
Q

Location of most shear injuries?

A
  1. Frontal & temporal lobes
  2. Corpus Callosum
83
Q

2 types of shear injuries?

A

Sheared vessels –> Hemorrhage
Sheared axons –> Traumatic Axonal Injury

84
Q

4 common locations of Traumatic Axonal Injury?

A
  • Corpus callosum
  • Cerebral white matter
  • Internal Capsule
  • Rostral brainstem
85
Q

Staining method to identify axonal swellings in TAI?

A

Amyloid Precursor Protein (looks brown on Silver stain biopsy)

86
Q

Why does glioblastoma multiforme cause contrast enhancement on CT scan?

A

Abnormal vascular permeability

87
Q

Structure that produces CSF? Location?

A

Choroid plexus
- Walls of lateral ventricles
- Roof of 3rd & 4th ventricles

88
Q

Do capillary endothelial cells in Choroid Plexus have fenestrations?

A

Yes
(epithelium of CP provides BBB, whereas brain capillary endothelium provides BBB elsewhere)

89
Q

General location of most vasogenic edema?

A

Mainly white matter

90
Q

Composition of vasogenic edema?

A

Plasma filtrate & protein

91
Q

ECF volume in vasogenic edema?

92
Q

Active demyelination causes ____ edema

93
Q

Organizing hematomas cause ____ edema

94
Q

Abscesses cause ____ edema

95
Q

Pathogenesis of cytotoxic edema?

A

Cellular swelling due to impaired membrane ion pump systems

96
Q

General location of most cytotoxic edema?

A

Gray & white matter

97
Q

Composition of cytotoxic edema?

A

Intracellular H2O & Na+

98
Q

ECF volume in cytotoxic edema?

99
Q

Infarction of brain tissue causes ____ edema

100
Q

Acute hypoxic-ischemic encephalopathy causes _____ edema

101
Q

Loss of gray-white matter demarcation occurs in _____ edema

102
Q

2 histologic features of cytotoxic edema / acute cerebral infarct?

A
  • Red neurons
  • Vacuoles
103
Q

Pathogenesis of Interstitial (hydrostatic) edema

A

Increased brain fluid due to impaired CSF circulation or resorption

104
Q

General location of interstitial (hydrostatic) edema?

A

Periventricular white matter

105
Q

Composition of interstitial edema

A

Same as CSF

106
Q

ECF volume in interstitial edema

107
Q

Hydrocephalus causes _____ edema

A

interstitial

108
Q

Colloid cyst blocking outflow of CSF causes _____ edema

A

interstitial

109
Q

Primary & secondary events of Subfalcian herniation

A
  1. Sliding of cingulate gyrus beneath falx cerebri
  2. Compression of ACA – Infarction of medial frontal lobe
110
Q

Primary & secondary events (4) of Transtentorial herniation

A
  1. Displacement of medial temporal lobe through tentorial notch
  2. a. Stretching & compression of 3rd CN (ipsilateral CN paresis & pupillary dilatation)
    b. Compression of contralateral cerebral peduncle (Kernohan’s notch), causing ipsilateral hemiparesis (same side as primary lesion)
    c. Compression of PCA, causing infarction of medial temporal-occipital lobes
    d. Shearing of perforating vessels in upper brainstem–> Duret hemorrhages in midbrain & rostral pons & Coma (damage to RF)
111
Q

Primary & secondary events of Cerebellar tonsillar herniation

A
  1. Downward displacement of cerebellar tonsils through foramen magnum
  2. Compression of medulla –> dysfunction of respiratory & cardiovascular control centers –> cessation of respiration & death
112
Q

Gross pathology of global hypoxic ischemia due to increased ICP

A

Softening, edema, poor gray-white demarcation

113
Q

Biochemical pathology of TAI

A

Shear injury damages axonal membranes –> Influx of Ca++ & Na+ through membrane channels –> Axonal swelling –> Axonal cytoskeletal damage –> Impaired axonal transport –> Accumulation of axonal transport proteins

114
Q

How does choroid plexus form/secrete CSF?

A

Active transport of ions across its epithelium from blood to CSF

115
Q

How does Glioblastoma cause edema & what type of edema is it?

A
  • Angiogenesis forms abnormal blood vessels don’t have functional BBB
  • Vasogenic edema
116
Q

How does MS cause edema & what type of edema is it?

A
  • Cytokine mediated inflammation causes “leaky” vessels
  • Vasogenic edema
117
Q

Amyloid precursor protein on Silver staining means what?

A

Traumatic Axonal Injury

118
Q

Cause of Meningitis? –> Gram-negative (pink), pleomorphic coccobacilli (diplococci)

A

Haemophilus influenzae

119
Q

Meningitis ass’d w/ pregnancy loss

A

Listeria monocytogenes

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