CNS infection

Question 1

What pathogens tend to cause viral meningitis?

Answer 1

Enteroviruses e.g. ECHO virus

Question 2

What viruses can cause encephalitis?

Answer 2

Herpes simplex

Varicella zoster

HIV

CMV

Measles

Travel e.g. west Nile virus

Question 3

What is the treatment for viral encephalitis?

Answer 3

IV aciclovir

Question 4

How does viral encephalitis present?

Answer 4

Insidous onset; sometimes sudden

Meningismus

Stupor, coma

Seizures, partial paralysis

Confusion, psychosis

Speech, memory symptoms

Question 5

What condition is cryptococcal meningitis associated with?

Answer 5

HIV

Question 6

What condition does testing a lumbar puncture sample with India Ink show positive?

Answer 6

Cryptococcal meningitis

Question 7

What might be seen on lumbar puncture results for cryptococcal meningitis? (Opening pressure, cell type, glucose, proteins)

Answer 7

Opening pressure increased

Lymphocyte predominant

Glucose decreased

Proteins increased

Question 8

What meningitis might the following lumbar puncture report indicate?

Opening pressure - normal

Lymphocyte predominant

Protein - normal

Glucose - normal

Answer 8

Viral meningitis

Question 9

What meningitis might the following lumbar puncture report indicate?

Opening pressure - increased

Neutrophil-predominant

Protein - increased

Glucose - decreased

Answer 9

Bacterial meningitis

Question 10

In which condition is elevated levels of 14-3-3 proteins elevated?

Answer 10

Creudtzfelt-Jakob disease

Question 11

What do the prions in Creudzfelt-Jakob disease do to cause neurological dysfunction?

Answer 11

Convert normal alpha-helical prion proteins into abnormal beta-sheet proteins

Question 12

What are the common causes of bacterial meningitis in neonates?

Answer 12

Listeria

Group B strep

E. Coli

Question 13

What are the common causes of bacterial meningitis in children?

Answer 13

H. influenza

Question 14

What is the most common cause of bacterial meningitis in ages 10-21?

Answer 14

Meningococcal

Question 15

What tends to be the most common cause of bacterial meningitis in those >21?

Answer 15

Pneumococcal>meningococcal

Question 16

What tends to be the most common cause of bacterial meningitis in the elderly?

Answer 16

Pneumococcal > listeria

Question 17

What infection is associated with fracture of the cribiform plate?

Answer 17

Pneumococcal meningitis

Question 18

Which bacteria are associated with infection of a CSF shunt causing meningitis?

Answer 18

S. epidermidis

S. aureus

aerobic GNR

Propionibacterium acnes

Question 19

What are some of the disabilities caused by meningitis?

Answer 19

Limb loss

Deafness

Blindness

Cerebral palsy

Quadriplegia

Severe mental impairment

Question 20

What are some of the causal bacteria in meningitis in the immunocompromised?

Answer 20

Listeria monocytogenes

Mycobacterium tuberculosis

Nocardia asteroides

Cryptococcus neoformans (AIDS)

Question 21

What is the causal bacteria of meningococcal meningitis?

Answer 21

Neisseria Meningitis

Question 22

Where is Neisseria Meningitis found?

Answer 22

In the throats of healthy carriers

Question 23

What causes the symptoms in Neisseria Meningitis infection?

Answer 23

Endotoxin

Question 24

What is the most common causal bacteria of meningitis in children under four?

Answer 24

H. influenzae type b

Question 25

What prevention of meningitis due to haemophilus influenzae can be taken?

Answer 25

A conjugated vaccine directed against the capsular polysaccharide antigen is available

Question 26

What is the causal bacteria of pneumococcal meningitis?

Answer 26

Streptococcus pneumoniae

Question 27

Which patients are most susceptible to pneumococcal meningitis?

Answer 27

Hospitalised patients Diabetics Alcoholics Young children Patients with CSF skull fractures

Question 28

What is the antibiotic of choice for listeria monocytogenes?

Answer 28

- IV Ampicillin/amoxicillin: - Ceftriaxone no value as intrinsically resistant

Question 29

Who is most likely to get infection from listeria monocytogenes?

Answer 29

Neonates Elderly Immunosuppressed especially malignancy

Question 30

How does tuberculous meningitis present?

Answer 30

Reactivation in the elderly Non specific ill health

Question 31

How should cryptococcal meningitis be treated?

Answer 31

IV amphotericin b/flucytosine Fluconazole

Question 32

What are the signs and symptoms of meningitis??

Answer 32

Headache Vomiting Pyrexia Neck stiffness Photophobia Lethargy Confusion Rash

Question 33

What is the emprical antibiotic therapy in meningitis?

Answer 33

IV ceftriaxone Add IV ampicillin/amoxicillin if listeria suspected

Question 34

What should also be given alongside antibiotics to treat suspected bacterial meningitis?

Answer 34

IV steroids

Question 35

What drug should be given alongside empirical treatment in age \>55 and why?

Answer 35

Ampicillin Listeria coverage

Question 36

What antibiotics should be given if pneumococcal penecillin resistance suspected?

Answer 36

Vancomycin + rifampicin

Question 37

What antibiotics should be given for meningitis with history of penecillin allergy?

Answer 37

Chloramphenicol and vancomycin

Question 38

What antibiotic should be given for listeria infection if penecillin allergy known?

Answer 38

Co-trimoxazole

Question 39

Which type of bacterial meningitis has administration of steroids with antibiotics been most successful in?

Answer 39

Pneumococcal

Question 40

When should steroids not be given to treat meningitis?

Answer 40

Post-surgical meningitis Severe immunocompromise Meningococcal or septic shock Hypersensitivity to steroids

Question 41

What antibiotics are used for contact prophylaxis for meningitis?

Answer 41

Rifampicin 4x or Ciprofloxacin (adults and children \>12)