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Kaplan ID > CNS > Flashcards

CNS Flashcards

1
Q

What are sx of meningitis?

A

Cns infection sx (fever, nausea, vomiting, seizures, headache) + stiff neck, meningismus, photophobia

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2
Q

Your patient presents with confusion plus cns sx

A

Encephalitis

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3
Q

Encephalitis presents with which sx?

A

Nausea, vomiting, headache, fever + confusion

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4
Q

Your patient presents with cns sx and focal neurological findings

A

Brain abscess

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5
Q

Meninges are separated in 3 layers

A

Pia, arachnoid, dura

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6
Q

Meningitis is an infection of

A

Arachnoid or pia

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7
Q

Most common cause of bacterial meningitis?

A

Strep pmeumo

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8
Q

Most common etiology of neonatal meningitis

A

Group B Strep

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9
Q

Most common etiologies of bacterial meningitis

A 
S. Pneumo
GBS
H.influenza
N.meningitis
Listeria, in immunocompromised (add ampicillin!)
Staph (if recent surg)
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10
Q

Meningitis can give you focal abnormalities in which percentage of pts?

A

30%

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11
Q

If there is confusion you should…

A

Do a CT and an LP

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12
Q

What are specificities of cryptococcal meningitis?

A

Slow, goes on several weeks

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13
Q

Pt with stiff neck, photophobia, AIDS with

A

Cryptococcus

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14
Q

Stiff neck, photophobia, joint pain, target like rash, camper, facial palsy, most likely dx is

A

Lyme

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15
Q

Cryptococcus meningitis presents most likely in a patient with?

A

AIDS CD4>100

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16
Q

Lyme meningitis presents more often in a patient with?

A

Rash, joint pain, facial palsy, camper, hiker, tick remembered in 20 %

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17
Q

Patient is a hiker, has a rash that moved from arms and legs to trunk and stiff neck and photophobia

A

Rocky mountain spotted fever (Rickettsia)

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18
Q

Patient that has stiff neck and photophobia and TB?

A

Tuberculosis

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19
Q

Stiff neck and photophobia but nothing else :/

A

Viral meningitis

20
Q

Stiff neck, photophobia, adolescent with petechial rash

A

Neisseria

21
Q

Best initial test in meningitis?

A

LP

22
Q

CSF evaluation in meningitis

A

Neutrophils: 1000s in bacterial, 10s-100s in crypto, lyme, rickettsia, TB and viral
Proteins: elevated in bacterial, crypto, lyme, rickettsia and specially TB, normal in viral
Glucose: decreased in all except viral
Gram stain and culture: positive in bact

23
Q

In meningitis when is head CT the best initial test?

A

Papilledema
Seizures
Focal neurological abnormalities
Confusion (you cant do an accurate neuro exam in a confused pt)

24
Q

If there is a contraindication to immediate LP, what is the best first step in management?

A

Antibiotics: ceftriaxone, vancomycin

Steroids

25
Q

When is bacterial agglutination test indicated?

A

Those who received antibiotics prior to LP, cause culture may be falsely negative
Careful, if negative not sufficient to exclude bacterial meningitis

26
Q

What is the most accurate test for TB?

A

Acid fast stain and culture on 3 high volume LPs
Centrifuge to concentrate organisms
TB has high CSF protein
Uncentrifuged sample of CSF is 10% sensitive

27
Q

What is the most accurate dx for lyme and rickettsia?

A

Specific serologic testing, ELISA, western blot, PCR

28
Q

What is the most accurate dx test for cryptococcus?

A

India ink is 60-70% sensitive

Crypto antigen is 95% sensitive and specific

29
Q

What is the best dx test for viral meningitis?

A

None, it is a dx of exclusion

30
Q

Best initial tx for bacterial meningitis?

You should base your tx answer on which test?

A

Ceftriaxone, vancomycin and steroids

Cell count

31
Q

Your patient has sx of meningitis, on PL has 1000s of neutrophils and is immunocompromised what tx should you start?

A

Ceftriaxone, vancomycin and steroids, add ampicillin because immunocompromised to cover listeria

32
Q

Listeria monocytogenes is resistant to?

Sensitive to?

A

Resistant to all forms of cephalosporins

Sensitive to penicillins : add ampicillin to tx

33
Q

Risks factors for listeria monocytogenes infection

A 
Elderly
Neonates
Steroid use
AIDS/HIV
immunocompromised (alcoholism)
Pregnant
Bone marrow transplant, leukemia, lymphoma etc.
34
Q

Patients with neisseria meningititis, who should benefit from prophylaxis?

A

Their close contacts: major respiratory fluid contacts, household contacts, kissing, sharing cigarettes or eating utensils.
Close contacts should be treated with rifampin or cipro

35
Q

Your patient has neisseria meningitis, when do you qualify as a “close contact”?

A

Intubated the patient
Performed suction
Have contact with resp secretions

36
Q

Man comes to ER with fever, severe headache, stiff neck and photophobia. He has weakness in his left arm and leg, what is the best next step in management?

A

Ceftriaxone, vancomycin and steroids BEFORE head CT

37
Q

What is the most common deficit of untreated bacterial meningitis?

A

VIII CN deficit or deafness

38
Q

What is the most common cause of encephalitis?

A

Herpes simplex

39
Q

What are specific sx of encephalitis?

A

Fever and confusion

40
Q

What is the best initial test to do if encephalitis is suspected (cns infection signs plus confusion)

A

Head CT

41
Q

What is the most accurate test of herpes encephalitis?

A

PCR of CSF

42
Q

What is e best initial therapy for herpes encephalitis?

A

Acyclovir IV

43
Q

In which situation would you use foscarnet?

A

In there is acyclovir resistant herpes encephalitis

44
Q

A woman with herpes encephalitis confirmed by PCR gets 4 days of acyclovir. Her creatinine level rises. What is the most appropriate next step in management?

A

Reduce the dose of acyclovir and hydrate, you cannot stop acyclovir even if she has renal insufficiency

45
Q

What is the problem (SE) with acyclovir?

A

Renal insufficiency,

Even worse with foscarnet

46
Q

Your patient presents with stiff neck, photophobia and meningismus, the most likely dx is

A

Meningitis

Kaplan ID (11 decks)

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