CNS infections

Question 1

What happens grossly with pyogenic meningitis?

Answer 1

a thick layer of suppurative exudate which covers the meninges over the surfave of the brain esp. in basal and convex surfaces

Question 2

What is seen micrsocopically in pyogenic meningitis?

Answer 2

neutrophils in the subarachnoid space

Question 3

When is viral meningitis commonly seen?

Answer 3

late summer/autumn

Question 4

What commonly causes viral meningitis?

Answer 4

enteroviruses eg ECHO

Question 5

What investigations are done with viral meningitis?

Answer 5

viral stool culture; throat swab and CSF PCR

Question 6

What is the treatment for viral meningitis?

Answer 6

supportive as self-limiting

Question 7

What are the clinical features of encephalitis?

Answer 7

insidious onset; sometimes sudden; meningismus; stupor, coma; seizures; confusion; psychosis; speech and memory symptoms

Question 8

What are the investigations for encephalitis?

Answer 8

LP; EEG and MRI

Question 9

What treatment should be started immediately with encephalitiy?

Answer 9

aciclovir

Question 10

What are the most common causes of bacterial meningitis in neonates?

Answer 10

listeria; group B strep; e.coli

Question 11

What are the most common causes of bacterial meningitis in children?

Answer 11

H.influenza

Question 12

What are the most common causes of bacterial meningitis in ages 10-21?

Answer 12

neisseria meningitidis

Question 13

What are the most common causes of bacterial meningitis over 21s?

Answer 13

strep. pneumo > neisseria meningitidis

Question 14

What are the most common causes of bacterial meningitis in over 65s?

Answer 14

strep. pneumo > listeria

Question 15

What bugs do patients wti hdecreased cell mediated immunity tend to get?

Answer 15

listeria monocytogenes

Question 16

What bugs do neurosurgery or head trauma pts get?

Answer 16

staph; gram negatvie bacilli; s.epidermidis

Question 17

What bug do patients with cribiform plate #s get?

Answer 17

strep. pnuemo

Question 18

What bugs do patients with a CSF shunt get?

Answer 18

s. epidermidis; s.aureus; aerobic GNR; propionibacterium acnes

Question 19

What CNs are particularly vulnerable in purulent meningitis?

Answer 19

III and VI

Question 20

What prevents meningitis becoming an abscess?

Answer 20

pia

Question 21

What antibiotic is given for listeria?

Answer 21

amoxicillin

Question 22

How does meningitis cause hydrocephalus?

Answer 22

flow of CSF blocked due to puss

Question 23

What are the routes of pathogenesis of bacterial meningitis?

Answer 23

nasopharyngeal colonisation; direct extension of bacteria; from remote foci of infection

Question 24

What causes symptoms of with neisseria meningitis?

Answer 24

endotoxin

Question 25

Who is most susceptible to s.pneumoniae meningitis?

Answer 25

hospitalised pts; patients with CSF skull #s; dibaetics/alcoholic and young children

Question 26

What CNS device is associated with S.pneumoniae?

Answer 26

cochlear implants

Question 27

What type of bacteria is listerai monocytogenes?

Answer 27

gram positive bacilli

Question 28

Who gets TB meningitis?

Answer 28

elderly

Question 29

Who gets cryptococcal meningitis?

Answer 29

HIV CD4<100

Question 30

What is the treatment for cryptococcal meningitis?

Answer 30

IV amphotericin

Question 31

What is given empirically for suspected meningitis?

Answer 31

cefotaxime or ceftriaxone and dexamethosone

Question 32

What are the signs of bacterial meningitis?

Answer 32

fever; stiff neck and alteration in conscousness; heache; vomiting; photophobia; rash

Question 33

What is seen typically on LP with bacterial meningitis?

Answer 33

neutrophilic pleocytosis and low CSF glucose

Question 34

What are causes of non-infectious meningitis?

Answer 34

chemical meningitis-contrast; behcet syndrome and drug-induced

Question 35

What is aseptic meningitis?

Answer 35

meningitis that has has low number of WBC; minimally elevated protein and a normal glucose on LP

Question 36

Who should have a CT before an LP?

Answer 36

immunocompromised; hx of CNS disease; new onset seizures; papilloedema; altered consciousness; focal neurologic deficits

Question 37

What are warning signs with meningitis?

Answer 37

makred depressive conscious level; focal neurology; seizures; shock; bradycardia and HT; papilloedema

Question 38

What is given for penicillin allergy empirically?

Answer 38

chloramphenicol with vancomycin

Question 39

What is given penicillin allergy for listeria?

Answer 39

co-trimaxazole

Question 40

What is given prophylactically for those been in contact with meningitis patient?

Answer 40

ciprofloxacin

Question 41

How many groups of meningococcus are ther?

Answer 41

12

Question 42

What capsular groups of meningococcus are more common in the UK?

Answer 42

B,C, W and Y

Question 43

When is listeria cover required?

Answer 43

>60 years; immunocompromised (inc DM and alcohol)

Question 44

What bug should be considered in a pt with encephalitis and contact with fresh water?

Answer 44

leptospirosis

Question 45

Give an example of an aerobic GNR?

Answer 45

Pseudomonas

Question 46

What is given for penicillin resistant pneumococci?

Answer 46

vancomycin or rifampicin

Question 47

what drugs can cause aseptic meningitis?

Answer 47

co-trimoxazole; IVIG; NSAIDs

Question 48

What indicates a fluctuating conscious level?

Answer 48

>2 fall in GCS