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Clinical Pathology > CNS > Flashcards

CNS Flashcards

1
Q

Summary of CNS infections

A

Meningitis
-Bacterial/ Viral/ TB/ Cryptococcus/ Neonatal

Encephalitis

Brain abscesses

VPS & EVD infections

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2
Q

Which CNS infection is called by Viral (HSV1), Bacteria or autoimmune?

A

Encephalitis

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3
Q

What are the 3 components of meningism?

A

Neck stiffness
Headache
Photophobia

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4
Q

Which CNS infection presents as meningism, acute fever, +/- rash and no focal neurology?

A

MENINGITIS

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5
Q

Which CNS infection presents as +/- meningism, acute fever, CHANGE IN MENTAL STATE, +/- focal neurology?

A

ENCEPHALITIS

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6
Q

What type of fever do you get with a brain abscess?

other symptoms?

A

Gradual fever

Headache
+/- neck stiffness/ focal neurology

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7
Q

Causes of brain abcesses?

A

Bacteria

parasites

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8
Q

Which CNS infections have altered conciousness?

A

ENCEPHALITIS

BRAIN ABSCESS

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9
Q

State the 4 causes of meningitis

A

Viral
Bacterial
TB
Cryptococcus

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10
Q

What test would you do to analysis a patient’s CSF?

A

Lumbar puncture

Patient in foetal position - L3-L4

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11
Q 
What type of infection does the following CSF analysis suggest:
Cell count > 200
WBC present
Low glucose
Increase protein
A

Bacterial infection

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12
Q

Bacterial meningitis can be caused by which 3 organisms?

A

N. Meningitidis
H. Influenzae
S. pneumoniae

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13
Q

How would you treat Bacterial meningitis?

A

Ceftriaxone
Cefotaxime
Penicillin

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14
Q

Would you give prophylaxis to the contacts of the bacterial meningitis patient?

A

YES

Rifampicin

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15
Q

Neonatal meningitis is caused by E.Coli, Listeria monocytogenes, Group B strep.
How were they exposed?

A

Preg

Birth canal

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16
Q

How would you treat neonatal meningitis?

A

Cefotaxime

Ampicillin + Gentamicin

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17
Q

Which type of meningitis is a MEDICAL EMERGENCY + NOFTIABLE?

A

VIRAL MENINGITIS

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18
Q

Viral meningitis is common in which age group?

A

Neonates

Children

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19
Q

State 5 common causes of viral meningitis.

A 
ENTEROVIRUS*
HSV - diff= Mollarets M..
VSV
Mumps 
HIV

“V” for Viral Meningitis

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20
Q

Kernig’s and Brudzinski’s sign would be found on examination of a patient with bacterial meningitis.
T/F?

A

F

+ve in patient with VIRAL meningitis

21
Q

Describe Kernig’s sign.

A

When hip & knee flexed –> pain/stiff in hamstrings, when EXTEND knee

22
Q

Describe Brudzinski’s sign.

A

Flexing neck causes hip & knee to flex

patient lying down

23
Q

What investigations would you do in a case of suspected viral meningitis?

A 
Blood tests - esp Clotting
LP
CT head
Throat/stool - enterovirus
Serology - Mumps, HSV, EBV, HIV
24
Q

Treatment for Viral meningitis?

A

Supportive

25
Q

What test do you need to do before performing a Lumbar puncture?

A

Clotting

26
Q

In order to compare the glucose CSF: blood, what should be taken simultaneously?

A

Blood glucose

27
Q

TB meningitis is gradual onset. (Bacteria slow to grow). What are the risk factors?

A

Same as TB
Immunocompromised
Alcoholics

28
Q

What cell type would you see in a LP confirming TB meningitis?

A

Lymphocytes

29
Q

Treatment of TB meningitis?

A

12 month standard TB treatment

30
Q

Cryptococcus meningitis is seen especially in whom?

A

HIV

31
Q

Cryptococcus meningitis has the same CSF findings as TB M. What is the treatment?

A

Fluconazole

Amphotericin

32
Q

List the complications of Meningitis

A 
Sepsis
Increased ICP
Deafness
Delayed development
Seizures
Stroke
Hydrocephalus
33
Q

Which CNS infection should you treat on clinical suspicion?

A

ENCEPHALITIS

34
Q

With suspected Meningitis/Encephalitis, What should you alwyas ask the patient?

A

TRAVEL HISTORY

35
Q

90% of Encephalitis is caused by…?

A

HSV1

36
Q

Presentation of Encephalitis?

A 
(Meningism)
Acute fever
CHANGE IN MENTAL STATE
\+/- focal neurology (weakeness, ataxia, dysphagia, CN palsy..)
Seizures
ALTERED CONCIOUSNESS
37
Q

Investigations of Encephalitis?

A 
FULL NEUROLOGICAL EXAM
Bloods
CT
MRI - typical changes
LP
EEG - abnormal tempora activity
38
Q

How do the LP results of Encephalitis compare to Viral Meningitis?

A

The same

39
Q

Treatment of Encephalitis?

A

IV Aciclovir (14-21 days)

Repeat LP

40
Q

Which autoimmune CNS demyelination condition presents the same and has same CSF fidnings as encephalitis?

A

ADEM

Acute disseminated Encephalomyopathy

41
Q

Are brain abscess monomicrobial or polymicrobial?

A

POLYMICROBIAL

42
Q

How do brain abscesses occur?

A

Direct spread (ear, sinus, teeth)

Blood- Endocarditis, Bronchiectasis

Trauma

Idiopathic

43
Q

Clinical presentation of brain abcesses?

A 
Headache
Neck stiffness
Gradual fever
Seizures
Nausea/Vomiting
Focal neurology
44
Q

State 2 complications of brain abscesses.

A

Increased ICP –> mass effect

Rupture –> Ventriculitis

45
Q

What is the main way of managing brain abscesses?

A

Drainage

46
Q

What is an example of a brain abscess

A

Subdural empyema

47
Q

Neurosurgical patients have a VP shunt/EVD shunt to treat hydrocephalus/monitor CSF respectively. How does infection occur?

A

Tubes become colonised

48
Q

How would you manage VP shunt/EVD infection to avoid ventriculitis?

A

Remove drain

IV antibiotics

Clinical Pathology (13 decks)

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