CNS Infection Flashcards
Characteristic imaging triad of TB meningitis?
Hydrocephalus, Basal Enhancement and Infarcts
initial event in the neurosyphilitic infection which occurs in approx 25% of all cases of syphilis?
Meningitis
Most common form of neurosyphilis
Meningovascular syphilis
Tuberculomas may grow up to size of
range
2-12 mm
page 742
most frequent opportunistic fungal infection
Candidiasis
The following are true of Candidiasis, except:
a. antecedents include severe burns, use of TPN
b. with treatment of IV amphotericin B, the prognosis is good
c. Yeast can be seen on direct microscopy n half of the cases
d. no feature distinguishes candidiasis with other fungal infection
b. with treatment of IV amphotericin B, the prognosis is good
- even with treatment of IV amphotericin B, the prognosis is grave
page 753
Cerebral toxoplasmosis occurs in patients with HIV and CD4 counts below:
a. 400/ul
b. 200/ul
c. 100/ul
d. 50/ul
c. 100 /ul
page 755
Which of the following would be the first reaction to bacterial infection in the brain?
a. exudation of protein
b. migration of neutrophils into the pia and subarachnoid space
c. lymphocytes and histiocytes migrate into the area of infection
d. hyperemia of the meningeal venules and capillaries
d. hyperemia of the meningeal venules and capillaries
Signs and symptoms of headache, stiff neck, Kernig and Brudzinski signs would correlate with this pathological reaction:
a. pure pia-arachnoiditis
b. subpial encephalopathy
c. thrombosis of meningeal veins
d. inflammatory or vascular involvement of cranial nerves
a. pure pia-arachnoiditis
Table 31-1 page 721
Signs and symptoms of focal seizures, focal cerebral defects eg hemiparesis, aphasia would correlate with this pathological reaction:
a. pure pia-arachnoiditis
b. subpial encephalopathy
c. thrombosis of meningeal veins
d. inflammatory or vascular involvement of cranial nerves
c. thrombosis of meningeal veins
table 31-1
most sensitive and specific test for CSF rhinorrhea and otorrhea
B2 transferrin
household contacts of patients with meningococcal meningitis should be protected with antibiotic treatment. the following are recommended prophylactic treatment
,except:
a. rifampin 10 mg/kg q12 for 2 days in children
b. ciprofloxacin 500 mg once a day for 2 days
c. single dose of ciprofloxacin 500 mg
d. rifampin 600mg q12 hrs in adults for 2 days
except B
components of oslers triad
pneumococcal meningitis
pneumonia
endocarditis
which of the bacterial etiologies of encephalitis can cause GBS, cranial neuritis, acute myositis, aseptic meningitis, transverse myelitis, global encephalitis, seizures, cerebellitis? *
a. mycoplasma b, legionella c. bartonella d. anthrax e. listeria
a. mycoplasma
p 739
Which of the following bacterial etiologies of encephalitis can cause hemorrhagic and inflammatory CSF?
a. mycoplasma
b. legionella
c. bartonella
d. listeria
e. anthrax
e. anthrax
p 732
most common congenital heart defect associated with brain abscess
tetralogy of fallot
most frequent initial symptom of intracranial abscess?
a. seizure
b. focal neurologic deficit
c. headache
d. drowsiness
c. headache
p. 738
Most frequent initial symptom of intracranial abscess?
a. focal seizure
b. unilateral weakness
c. headache
d. drowsiness
e. confusion
c. headache
p. 738
which aspect of bacterial meningitis produces seizures
a. pia-arachnoiditis
b. subpial encephalopathy
c. hydrocephalus
d. inflammatory involvement of cranial nerve roots
b. subpial encephalopathy
table 31-1
Single most effective anti TB drug in treating tuberculous infections
a. Rifampin
b. Isoniazid
c. Pyrazinamide
d. Ethambutol
b. Isoniazid
Which anti TB medication is associated with optic neuropathy?
a. Rifampin
b. Isoniazid
c. Pyrazinamide
d. Ethambutol
d. Ethambutol
Which anti TB medication is associated with neuropathy and hepatitis?
a. Rifampin
b. Isoniazid
c. Pyrazinamide
d. Ethambutol
b. Isoniazid
Which is not a presentation of syphilis?*
a. tabes dorsalis
b. meningovascular meningitis
c. weils syndrome
d. dementia paralytica
e. spinal syphilis
c. Wiels syndrome
- extreme form of leptospirosis
inflammation and fibrosis of small arteries in meningovascular syphilis?
Heubner arteritis
Medication given to counteract the antifolate action of pyrimethamine in cerebral toxoplasmosis
Leucovorin
dose:15-20 mg daily
Infections of which of the following organisms does not cause seizures?*
a. entamoeba histolytica
b. schistosomiasis
c. toxoplasmosis
d. trichinella
e. taenia solium
d. trichinella
Most common finding on lumbar tap of cerebral malaria?*
a. increased protein
b. low glucose
c. elevated opening pressure
Treatment of CNS toxoplasmosis in HIV infected patients?*
Pyrimethamine + sulfadiazine
Least helpful diagnostic test in the treatment of cryptococcal meningitis?*
positive Saboraud agar culture
Characteristic CSF finding of Anthrax?*
hemorrhagic and inflammatory CSF
RBCs on CSF
Transmission of :
- epidemic typhus -
- Murine (endemic) Typhus -
- Scrub typhus/Tsutsugamushi fever -
- Rocky mountain spotted fever -
- epidemic typhus - lice
- Murine (endemic) Typhus - fleas from rats
- Scrub typhus/Tsutsugamushi fever - mites from infected rodents
- Rocky mountain spotted fever - ticks
The following viruses involves retrograde axoplasmic transport system, except?
a. rabies
b. poliovirus
c. HSV
d. VZV
b. poliovirus
Which of the following would be the most common viral identifiable cause of aseptic meningitis?
a. enteroviruses
b. HSV-2
c. mumps
d. varicella
e. HIV
a. enteroviruses
eg. echoviruses and coxsackie virus
page 764
Most common sporadic cause of viral encephalitis and has no seasonal or geographic predilection?
HSV
Typical eeg finding of HSV encephalitis
lateralized periodic high-voltage sharp waves in the temporal regions
and slow wave complexes at regular 2-3s intervals
Incubation period of rabies?
a. 7-14 days
b. 10-30 days
c. 20-60 days
d. 30-90 days
c. 20-60 days
Most common site involved in Herpes Zoster?
Thoracic T5-T10
followed by craniocervical regions
A characteristic cranial nerve syndrome consisting of facial palsy in combination with a herpetic eruption of the external auditory meatus, sometimes with tinnitus, vertigo and deafness
Ramsay Hunt Syndrome
of the focal opportunistic infectious complications of HIV, this is the most frequent
cerebral toxoplasmosis
p. 781
Progressive multifocal leukoencephalopathy occurs in patients with CD4+ counts of below:
50 cells/uL
Among NON-focal opportunistic infectious neurologic complications of AIDS, these 2 are the most common
CMV and cryptococcal infections
Shingles involving several contiguous dermatomes have known to occur in HIV with CD4 counts below
500
cerebral disease characterized by rapid or subacutely progressive and profound dementia associated with diffuse myoclonic jerks and cerebellar neurologic disturbances
Creutzfeldt Jacob disease
Most common variant of CJD (2 answers)
a. MM1
b. MV1
c. MM2
d. MV2
a and b
MM1 and MV1
MM > VV
type 1 > Type 2
page 791
CSF findings in CJD
a. normal
b. elevated protein
c. elevated leukocytes
d. presence of RBCs
a. normal
page 791
Which of the following is a recommended inactivating process for prion agent:
a. autoclaving at 132 degrees C at 15 lb/in2
b. immersion for 1 hour in 5 percent sodium hypochlorite (bleach)
c. boiling in water for 30 minute duration
d. A and B
e. B and C
f. all of the above
D. A and B are correct
boiling, treatment with formalin and alcohol and ultravoilet radiation are ineffective
p 793
causative organism of Progressive Multifocal Leukoencephalopathy
JC virus
Severe clinical worsening of PML that may occur during the initial treatment of HIV infection with antiretroviral drug
which is attributed to the emergence of acute inflammation surrounding the demyelinating lesions as a result of reconstitution of the immune system
Immune reconstitution inflammatory syndrome (IRIS)
