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CABS Neurology > CNS infections > Flashcards

CNS infections Flashcards

1
Q

who is bacterial meningitis most common in

A

Children under 2 months
-median age is 42

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2
Q

What are some predisposing factors of bacterial meningitis

A

Household browsing (dorms)
Occupation
Prior viral infection

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3
Q

What are the most common bacteria that cause bacterial meningitis

A

Neonates: Strep B
Newborns: S. Pneumoniae
Babies/children: N. Meningitidis
Older adults: L. Monocytogenes

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4
Q

Where does Nisseria meningitides generally enter the body

A

Nasopharynx

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5
Q

How does Strep pneumoniae generally enter the body

A

nasopharynx
skull fx
distant infection

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6
Q

What are some common sources that cause bacteremia and ultimately lead to bacterial meningitis

A

Otitis Media
Sinuses
Dental infection

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7
Q

What type of organism is Neisseria Meningitidis

A

Aerobic
gram negative
diplococcus

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8
Q

How does Neisseria meningitides generally present with

A

rash

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9
Q

What Vaccines can you get to prevent Meningitis

A

Meningococcal (2 rounds early in life)
MenB

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10
Q

What is the drug of choice against Neisseria meningitis

A

Ceftriaxone

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11
Q

What is a common symptoms with streptococcus pneumoniae meningitis

A

Neurologic sequelae

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12
Q

What vaccine is preventative for strep pneumoniae

A

PPSV23

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13
Q

What is the drug of choice to treat streptococcus pneumoniae diseases

A

Vanco and ceftriaxone

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14
Q

What does listeria monocytogenes cause once it enters the brain

A

ataxia
seizures
focal deficits
*seen early in disease

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15
Q

What bacteria is most likely to cause a brain abscess

A

Listeria monocytogenes

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16
Q

What is the drug of choice to treat listeria monocytogenes

A

ampicillin
*bactrim if allergic

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17
Q

What is the meningitis triad

A

Fever
stiff neck
petechiae/purpura

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18
Q

If a patient presented with confusion instead of lethargy, what would the concern be

A

encephalitis

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19
Q

How do you test a babies mental status

A

breast feeding

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20
Q

If someone becomes septic from H. influenza… what is their most likely cause of death

A

cardiac failure

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21
Q

If a patient gets meningitis from H influenza… what is their most likely cause of death

A

increased ICP

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22
Q

What is the drug of choice to treat H. Influenza

A

Cetriaxone

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23
Q

How fast does the clinical presentation of bacterial meningitis appear after the onset of symptoms

A

less than 24 hours

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24
Q

What are some signs babies can get from bacterial meningitis

A

Vacant staring
high pitched moan/cry
tense fontanelle
abnormal tone

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25
Q

What is positive Kernigs or Burdinski a sign of

A

meningitis

26
Q

What is an elevated anion gap indicative of

A

Increased PH and lactate

27
Q

What is a normal glucose range in an LP

A

45-85

28
Q

What will bacterial meningitis glucose level be

A

<40

29
Q

What will glucose level be with viral meningitis

A

normal

30
Q

What type of white blood cells are normally seen in an LP and what amount

A

<5
Monocytes

31
Q

What amount and what type of WBC are seen in bacterial meningitis

A

> 1000
Neutrophils

32
Q

What type of WBC and what amount is seen in an LP with Viral meningitis

A

100-1000
Lymphocytes

33
Q

What is normal opening pressure for an LP

A

70-180

34
Q

What is opening pressure in someone with bacterial meningitis

A

> 200

35
Q

What will the CSF look like with bacterial meningitis

A

Turbid/cloudy

36
Q

What are the biggest forms of treatment in the first hour in someone suspected to have bacterial meningitis

A

2 large bore IVs
Labs (CBC,CMP,PT/PTT)
Fluid resuscitation
Dexamethasone (for inflammation)

37
Q

When is dexamethasone given

A

prior to antibiotics

38
Q

What type of antibiotics are you giving someone with suspected meningitis

A

Broad spectrum until the organism is knows

39
Q

What is the classic antibiotic regimen with bacterial meningitis

A

ceftriaxone
vanco
ampicillin

40
Q

When is chemoprophylaxis used with meningitis

A

for anyone who has had >8hours of contact, close defined as less than 3 feet or swapping spit

41
Q

What are the most common causes of subacute chronic meningitis

A

TB
Lyme
Listeria
VZV
HIV
SLE
NSAIDs/IVIG

42
Q

What is viral meningitis (aseptic) caused by

A

enterovirus
-coxsackie
-echo

43
Q

Which form of meningitis is less likely to have seizures

A

viral
*also less sick than bacterial

44
Q

How do you treat viral meningitis

A

supportive care
*if VZV or HSV-> acyclovir

45
Q

What is the difference between encephalitis and meningitis

A

Encephalitis effects the brain
meningitis effects the meninges

46
Q

What is encephalitis

A

inflammation of the brain parenchyma

47
Q

What is the usual cause of encephalitis

A

Generally viral
-herpes

48
Q

Where does the swelling generally occur with encephalitis

A

cerebrum -> cerebellum -> brainstem

49
Q

What is pleocytosis

A

increase in cells

50
Q

How long does someone need to have AMS to meet major criteria of encephalitis

A

> 24 hours

51
Q

Where does HSV generally affect in the brain with encephalitis

A

temporal lobe

52
Q

What is the test of choice for encephalitis

A

MRI with contrast (CT may look normal)

53
Q

How will post infectious encephalitis appear on imaging

A

Mutlifocal lesions of the surpatentorial white mater

54
Q

How do you treat encephalitis

A

monitoring and supportive care

55
Q

How do you treat encephalitis

A

PREVENTION
*GET YOUR VACCINES

56
Q

Which gender is at higher risk of getting a brain abscess

A

Men

57
Q

How do brain abscesses occur

A

Generally a direct spread from other infection
-otitis media
-mastoiditis
-dental infection

58
Q

What is the classing presentation of a brain abscess

A

Headache
fever
focal neurological deficit

59
Q

Which patients are LPs NOT preformed in the workup of a brain abscess

A

Neuro deficit
focal symptoms
papilledema
risk of brainstem herniation

60
Q

What is the initial treatment of a brain abscess

A

Metronidazole (has anaerobic coverage)

61
Q

Where are brain abscesses most common

A

Frontal and temporal lobes

CABS Neurology (11 decks)

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