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Emergency Medicine > CNS Infections > Flashcards

CNS Infections Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What test is more sensitive for meningitis/CNS infx on PE than brudzinski/kernig?

A

Jolt Accentuation Test

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2
Q

Procedure for Jolt Accentuation Test

A

rotate 2 times/sec

(+) if HA exacerbation

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3
Q

Meningococcal/petechiael rash indicates which pathogen for meningitis?

A

N. meningitides

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4
Q

IDSA Criteria for CT before LP…

1+ of what 6 RFs?

A
  • immunocompromise
  • Hx CNS dz
  • new onset seizure
  • papilledema
  • ALOC
  • Focal Neuro Deficit
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5
Q

G+ diplococci in meningitis…

A

pneumococcal

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6
Q

G- diplococci in meningitis

A

meningococcal

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7
Q

G- coccobacilli in meningitis

A

H. flu

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8
Q

G+ rods & coccobacilli in meningitis

A

L. monocytogenes

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9
Q

Which pathogen?

Hx sinusitis, AOM, mastoiditis

Facial fx/cochlear implant

A

S. pneumo

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10
Q

Which pathogen?

post- head trauma/neurosurg

A

staph

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11
Q

Which 2 pathogens?

exposure during delivery

A

E. coli

GBS

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12
Q

Workup for meningitis

A

blood Cx x 2

CT

LP + CSF Analysis & Cx

CBC with diff
CMP
ESR + CRP
Serum Glucose
Coags
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13
Q

CSF Analysis…

WBCs: > 1000, Neutrophils

Glucose: < 40

CSF:Blood Glucose: < 0.4

Prot: Elevated

G stain: POS

A

Bacterial

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14
Q

CSF Analysis…

WBCs: < 250, lymphocytes

Glucose: WNL

CSF:Blood Glucose: WNL

Prot: Elevated

G stain: NEG

A

Viral

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15
Q

Dexamethasone helps w. what pathogen?

A

pneumococcal

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16
Q

Dexamethasone dose

A

0.15 mg/kg q 6 hrs x 4 days

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17
Q

Meningitis Tx algorithm if 1+ RF for ICP

A

Stat blood cx

dexamethasone + empiric abx

Head CT

+/- LP + Cx (CT Dependent)

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18
Q

Meningitis Tx algorithm if no ICP RFs

A

Stat blood cx

LP

dexamethasone + empiric Abx

CSF analysis/Cx

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19
Q

CSF Cx shows:

G+ Diplococci

What pathogen, what tx?

A

Strep Pneumo

Targeted Abx + Dexamethasone + Rifampin

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20
Q

CSF Cx Shows:

Not S. Pneumo

What Tx?

A

Targeted Abx

d/c dexamethasone, no rifampin

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21
Q

Empiric meningitis Tx for newborn …

L. monocytogenes coverage

A

Ampicillin + Cefotaxine/Gentamycin

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22
Q

Empiric meningitis Tx for 1mo - 50 yrs …

A

Vanco + Ceftriaxone/Cefotaxime + Dexamethasone

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23
Q

Empiric meningitis Tx for immunocompromised or > 50 yo…

L. monocytogenes coverage

A

Ampicillin + Vanco + Ceftriaxone/Cefotaxime + Dexamethasone

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24
Q

Empiric meningitis Tx for adults w/ PCN allergy

A

Vanco + Moxifloxacin + Bactrim

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25
Q

Empiric meningitis Tx for basilar skull Fx

A

Vancomycin + cefotaxime/gentamycin +Dexamethasone

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26
Q

Empiric meningitis Tx for penetrating trauma/neurosurg

A

Vanco + Ceftazidime/Cefepime/Meropenem + Dexamethasone

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27
Q

PEP for bacterial meningitis

A

Cipro 500mg PO x 1 dose

Rifampin 600mg q 12hrs x 2 days

28
Q

PEP for bacterial meningitis in pregnant clinician/family member

A

Ceftriaxone 250mg IM x 1

29
Q

What occurs prior to onset of meningitis sxs if HSV-2?

A

genital lesions 7 days prior

30
Q

What pathogen?

Meningitis + unvaccinated

A

mumps

31
Q

What pathogen?

Meningitis + vesicular genital lesions

A

Primary HSV-2

32
Q

What pathogen? (3)

Meningitis + maculopapular exanthem, mildly ill

A

enteroviral, primary HIV, Syphilis

33
Q

What pathogen?

Meningitis + OP Thrush + Cervical LAD

A

Primary HIV

34
Q

What pathogen?

Meningitis + Asymmetric flaccid paralysis

A

West Nile

35
Q

Aseptic meningitis CSF analysis = WNL except…

A

WBCs < 500 +/- lymphocytes

36
Q

MC cause of fatal encephalitis

A

HSV 1

37
Q

MC cause of viral encephalitis in US

A

west nile

38
Q

Encephalitis sxs + ulcers/vesicles

A

HSV-1

39
Q

Encephalitis sxs + parotitis

A

mumps

40
Q

Encephalitis sxs + flaccid paralysis + rash

A

west nile

41
Q

Encephalitis sxs + hydrophobia + hyperactivity + pharyngeal spasm

A

rabies

42
Q

Encephalitis sxs + tremors tongue/lips/eyelids

A

St. Louis virus

43
Q

RBCs in CSF indicates…

A

HSV-1

44
Q

CSF Analysis shows:

Elevated Protein

WBCs: < 250 + lymphocytes

A

viral encephalitis

45
Q

Study of choice in encephalitis

A

MRI (CT is faster tho)

46
Q

temporal lobe changes on MRI =

A

HSV

47
Q

Hydrocephalus on MRI =

A

bacterial/fungal/parasitic

48
Q

Abscess in temporal lobe… etiology?

A

AOM, mastoiditis

49
Q

Abscess in frontal lobe… etiology?

A

sinusitis

dental infx

50
Q

Hematogenous spread presents with…

A

multiple abscesses

51
Q

Severe unilateral HA not relieved w. OTC analgesics…

A

cerebral abscess

52
Q

Ring enhancing lesion on MRI

A

cerebral abscess

53
Q

Dx and Tx proceddure if no ICP sxs for brain abscess…

A

CT aspiration

54
Q

Multiple abscesses indicates…

A

fungal/parasitic

cysticercosis

55
Q

Abx for abscess if oral source…

A

metro + PenG

56
Q

abx for abscess if otogenic/sinus source

A

Metro + Ceftriaxone/Cefotaxime

57
Q

Intracranial epidural abscess MC a complication of…

A

neurosurg

58
Q

Pt. p/w:

fever, headache, lethargy, N/V

+/- signs of increased ICP

A

Intracranial epidural abscess (IEA)

59
Q

IEA Dx…

A

think of it + Contrast MRI

60
Q

IEA Tx if contiguous spread

A

Metro + ceftriaxone/cefotaxime

61
Q

IEA Tx if no contiguous spread

A

vanco + metro + ceftriaxone/cefotaxime/ceftazidime

62
Q

Pt. p/w:

Spinal pain
neuro deficits
weakness/paralysis

+/- fever

A

Spinal epidural abscess

63
Q

Dx for SEA

A

Think of it + Contrast MRI

contrast CT 2nd line

64
Q

Mgmt of SEA

A

blood cx x 2 + empiric abx

decompression + drainage

f/u MRI in 4 weeks

65
Q

Empiric Abx for SEA

A

Vanco + cephalosporin

Emergency Medicine (12 decks)

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