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MOHD Keystone exam 3 > CNS infections, HIV, tickborne illnesses > Flashcards

CNS infections, HIV, tickborne illnesses Flashcards

1
Q

most common CNS infection

A

meningitis

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2
Q

CNS infection involving parenchyma

A

encephalitis

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3
Q

very severe meningitis that may also involve parenchyma

A

meningoencephalitis

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4
Q

CNS infections (6)

A

meningitis, encephalitis, meningoencephalitis, brain abscess, subdural/epidural abscess, spinal canal abscess

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5
Q

acute neurologic disorders

A

focal: vascular (arterial or venous), traumatic

non-focal: meningitis (bacterial), toxic/metabolic

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6
Q

subacute neuro disorders (days)

A

focal: vascular (venous, brain abscess, spinal abscess, traumatic
non-focal: meningitis (bacterial or viral), encephalitis, autoimmune, toxic/metabolic

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7
Q

chronic (wks-months) neuro disorders

A

focal: brain abscess, tumor

non-focal: degenerative, toxic/metabolic

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8
Q

type of meningitis with most acute presentation

A

bacterial meningitis

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9
Q

time course for encephalitis

A

subacute (days)

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10
Q

meds that can cross the BBB in presence of inflammation

A
  • penicillins
  • 3rd/4th generation cephalosporins
  • vancomycin
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11
Q

BBB function and integrity can be affected by:

A
  • LPS

- multiple cytokines

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12
Q

3 major routes of infection:

A
  1. hematogenous
  2. contiguous
  3. ascending
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13
Q

majority of community-onset bacterial CNS infections

A

hematogenous

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14
Q

direct extension from neighboring anatomical sites

A

contiguous

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15
Q

typical route of infection for HSV or other virus

A

ascending

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16
Q

encapsulated organisms

A

Neisseria meningitidis, streptococcus pneumoniae, haemophilus influenzae, cryptococcus neoformans

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17
Q

Intracellular organisms

A

Listeria monocytogenes, enterovirus group, arbovirus group

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18
Q

organisms in systemic infections > CNS

A

staph aureus, HIV, Group B strep, mycobacterium tuberculosis

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19
Q

symptoms are caused by:

A
  • increased P in intracranial/spinal canal space
  • direct injury to nerve tissues
  • inflammation
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20
Q

systemic signs, neck stiffness, Kernig’s sign/Brudzinski’s sign are all signs of:

A

inflammation

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21
Q

focal neuro deficit, seizure are signs of:

A

direct injury to nerve tissues

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22
Q

headache/back pain, altered mental status, visual disturbance are signs of:

A

increased P in intracranial/spinal canal space

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23
Q

lifting leg is

A

Kernig’s sign

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24
Q

lifting head and following lifting of knees is

A

Brudzinski’s sign

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25
Q

Question to ask all of the time:

A

Am I missing Bacterial meningitis??!!

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26
Q

nuchal rigidity, Kernig/Brudzinski signs, jolt accentuation are signs for

A

meningeal irritation

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27
Q

bulging of anterior fontanelle in infant & papilledema signify

A

intracranial HTN

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28
Q

‘Do Not Miss’ physical exam findings for CNS infection

A

meningeal irritation, intracranial hypertension, focal neurologic sign

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29
Q

single most important diagnostic test for meningitis

A

lumbar puncture

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30
Q

routine CSF tests to order

A

opening pressure; cell count with diff; glucose; total protein; gram stain; bacterial cultre

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31
Q

extra CSF tests

A

AFB smear/culture; fungal smear/culture; cryptococcal antigen; cytology; PCR of specific organism (HSV, enterovirus, tb)

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32
Q

when to administer antibiotics for suspected bacterial meningitis?

A

after PE, basic labs, blood culture and possibly 1 LP attempt; (if cannot get LP on first try or if need CT before LP, begin antibiotics immediately)

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33
Q

last resort diagnostic procedure for suspected CNS infection

A

brain/meningeal biopsy

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34
Q

major bacterial pathogens of meningitis:

A

strep pneumoniae, neisseria meningitidis, H influenzae, listeria monocytogenes, GBS, e coli

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35
Q

major viral pathogens of meningitis

A

HSV, enterovirus, arvovirus

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36
Q

fungal and Tb meningitis

A

cryptococcus neoformans, mycobacterium tb

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37
Q

classic triad for meningitis disease recognition:

A

nuchal rigidity, fever, altered mental status (at least 2 >95% frequency); vomiting and headache are other sign/symptoms

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38
Q

neonatal meningitis signs/symptoms

A

septic; consider meningitis for any febrile illness in newborn; body temp alteration (typically hyothermia), seizure, bulging fontanelle, nuchal rigidity, poor feeding

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39
Q

WBC count: 3000, mainly neutrophils,

A

bacterial meningitis

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40
Q

WBC count: 800, mainly mononuclear cells, glucose 50, protein 100

A

viral meningitis

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41
Q

meningitis patient presenting in august has a high likelihood of being caused by:

A

enteroviral meningitis

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42
Q

newborn meningitis micro:

A

group B strep, e. coli, listeria

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43
Q

microbio most common for 2-50 y.o. meningitis

A

s. pneumoniae, n. meningitidis

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44
Q

aerobic GNR can cause meningitis in what population

A

immune suppressed, elderly, neurosurgery patients

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45
Q

administration of meds

A

IV (can’t get into CNS with lower levels)

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46
Q

adjunctive therapy

A

steroids (decrease inflammation reaction in CSF)

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47
Q

> 80% encephalitis is caused by

A

idiopathic

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48
Q

most common known pathogens of encephalitis

A

viral: HSV, VZV, HHV6/7, arboviruses

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49
Q

bacterial causes of encephalitis

A

N. meningitidis (meningoenceph); l. monocytogenes (pure enceph)

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50
Q

“treatable” encephatlitis

A

HSV encephalitis

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51
Q

gold standard for HSV encephalitis diagnosis

A

HSV PCR on CSF (very sensitive and specific)

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52
Q

HSV encephalitis management

A

high-dose acyclovir; start immediately for suspected encephalitis

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53
Q

imaging for brain abscesss

A

CT w contrast; MRI gadolinium-enhanced T1 or diffusion-weighted image

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54
Q

severe sepsis

A

sepsis + hypoperfusion, hypotension (SBP

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55
Q

septic shock

A

severe sepsis + 1 of following:

ongoing hypotension despite volume resuscitation; need for vasopressors to maintain BP

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56
Q

refractory septic shock

A

hypotension despite vasopressor use

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57
Q

anti-inflammatory mediators in sepsis ‘cytokine storm’

A

IL-10, cortisol

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58
Q

pro-inflammatory mediators in sepsis ‘cytokine storm’

A

TNF-alpha, IL-6, IL-1Beta, C5a

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59
Q

what are mechanisms behind organ failure in sepsis?

A
  1. hypoperfusion
  2. coagulopathy
  3. programmed cell death/apoptosis
  4. oxygen utilization/metabolism
60
Q

warm shock

A

early, increased CO can still compensate for decreased peripheral VR; bounding pulses; warm flushed skin; cap refill

61
Q

cold shock

A

later; CO cannot compensate for decreased peripheral VR; weak pulses, cold clammy skin; cap refill delayed; low ScvO2

62
Q

why patients with warm shock demonstrate perfusion of skin despite hypoperfusion to vital organs

A

redistributive shock

63
Q

elevated lactate is a sign of

A

anaerobic respiration, often result of hypoperfusion

64
Q

types of shock

A

cardiogenic, hypovolemic, redistributive (sepsis)

65
Q

coagulopathy at IV sites, elevated glucose, elevated lactate are examples of:

A

organ failure in sepsis

66
Q

Management of sepsis (2 interventions):

A
  1. Source control - treat infection appropriately and immediately (antibiotics, surgical therapy or complete drainage of pus)
  2. institute resuscitation to optimize tissue perfusion IMMEDIATELY; vasopressors if needed
67
Q

staph epidermidis signifies:

A

likely contaminant

68
Q

staph aureus likely signifies ____ bacteremia

A

continuous

69
Q

minimize false negatives when diagnosing bacteremia with blood cultures by:

A

obtaining cultures prior to starting antibiotics

70
Q

minimize false positives by:

A

proper technique/skin antiseptic prior to draw; avoid drawing cultures through intravascular cath (one set should be via direct venipuncture site); >1 bl culture set

71
Q

examples of continuous bacteremia (endovascular)

A
  1. endocarditis 2. infection of vascular graft
72
Q

bacteria that have surface proteins making adhere to host proteins

A

staph and strep

73
Q

bacteria not common in endocarditis due to lack of adherence abilities

A

e. coli; very common bacteremia but not endocarditis

74
Q

cause of 32% of IE

A

staph aureus

75
Q

main bacteria in IVDU IE

A

60-70% staph aureus; 15-20% strep and enterococci; likely multiple organisms

76
Q

splinter hemorrhages indicative of:

A

endocarditis

77
Q

Osler’s nodes

A

painful, late stage endocarditis

78
Q

Janeway lesions

A

painless, flat, endocarditis

79
Q

RNA + HIV test means

A

acute HIV infection; initiate care

80
Q

if RNA - HIV test,

A

initial serologic assay was false +

81
Q

HIV 1/2 immunoassay is positive, then do ___

A

HIV-1/HIV-2 differentiation immunoassay

82
Q

if differentiation immunoassay is HIV-1 and HIV-2 negative, then do ___

A

HIV RNA

83
Q

time from HIV infection to clinical AIDS without effective therapy:

A

9.8 years

84
Q

CD4 count of direct HIV symptoms (PCP/PJP)

A

> 500 cells/mm3

85
Q

toxo, histo, MAI, CMV CD4 count

A
86
Q

thrush, zoster CD4 count

A

200-500; infections associated with mild-moderate immune defects

87
Q

skin conditions in HIV infected patients are related to:

A

CD4 count (seborrheic dermatitis ~600, herpes zoster ~500; eosinophilic folliculitis

88
Q

common manifestations when CD4 > 500 cells/mm3

A

primary HIV infection (acute HIV, HIV mono); PGL; aseptic meningitis; HIV CNS disease; ITP; depression

89
Q

signs and symptoms seen when CD4 > 500 are due to:

A

HIV infection itself (not immunosuppression)

90
Q

when are HIV levels the highest?

A

acute IV infection

91
Q

T or F: HIV antibody wil be + in HIV mono

A

F: HIV antibody testing is usually negative in early HIV mono; may need RNA levels

92
Q

primary HIV infection

A

HIV-mono, acute HIV; presents 1-12 weeks post-exposure and lasts 1-8 weeks

93
Q

signs/symptoms of acute HIV infection:

A

non-specific, flu-like, mono symptoms, derm

94
Q

CD4 count of infections related to impaired immune surveillance, not life threatening, respond to therapy

A

200-500

95
Q

community acquired pneumonia, oral hairy leukoplakia, seborrheic dermatitis, oral/vaginal candidiasis, recurrent oral/genital HSV, shingles, NH lymphoma, sarcoma, TB

A

common manifestations of CD4 200-500

96
Q

oral hairy leukoplakia CD4 level

A

doesn’t come off; 200-500

97
Q

oral candidiasis (thrush)

A

comes off in chunks; 200-500 CD4 level

98
Q

pneumocystitis carinii pneumonia, cryptosporidium parvum

A

CD4 100-200

99
Q

CD4

A

toxoplasmosis, cryptococcus, CMV (

100
Q

CDC definition of AIDS

A

CD4

101
Q

cotton wool spot in retina, retinitis in HIV/AIDS patients, likely caused by ____

A

CMV/ Cd4 likely

102
Q

ketchup on scrambled eggs

A

CMV; (retina with hemorrhage along blood vessels and inflammation)

103
Q

severe IRIS therapy

A

stop ART and begin steroids; (Immune reconstitution inflammatory syndrome)

104
Q

IRIS is associated with:

A

low CD4, unrecognized OI, high microbial burden, starting HAART close to OI therapy; local and systemic inflammation may occur

105
Q

HIV infection clinical category A

A

mono-asymptommatic-PGL

106
Q

HIV infection clinical category B

A

symptommatic

107
Q

HIV infection clinical category C

A

AIDS indicators

108
Q

OI

A

PCP, toxoplasmosis, HPV, HSV, VZV, CMV; in most people, reactivate due to immunosuppression

109
Q

best predictor of rate of HIV clinical disease

A

HIV viral load; (better than CD4 count)

110
Q

predictor of CD4 decline

A

VL

111
Q

antiretroviral drug classes (4):

A

RT inhibitors (NRTI, NNRTI); protease inhibitor; integrase inhibitor; fusion and entry inhibitor

112
Q

disease from Borrelia burgdorferi

A

Lyme disease

113
Q

disease from Babesia microti

A

babesiosis

114
Q

disease from anaplasma phagocytophilum

A

granulocytic anaplasmosis

115
Q

disease from ehrlichia chaffeensis

A

monocytic ehrlichiosis

116
Q

disease from rickettsia rickettsii

A

rocky mountain spotted fever

117
Q

associated with deer ticks, rash erythema chronicum migrans (ECM), most common tickborne infection in US

A

Lyme Disease (spirochete Borrelia burgdorferi)

118
Q

tickborne disease prevalent on western coast and E/SE US + Wisconsin/minnesota

A

Lyme disease

119
Q

Lyme disease tick on West coast

A

Western blacklegged tick (ixodes pacificus)

120
Q

Geographic location for deer tick (ixodes scapularis)

A

east/se USA/wisconsin/minnesota

121
Q

Lyme disease vector

A

nymph

122
Q

Borrelia burgdorferi transmission (vector)

A

ixodes scapularis nympths = majority; ixodes pacificus

123
Q

primary reservoir for borrelia burgdorferi

A

small rodents

124
Q

3 sites of dissemination in secondary stage of lyme disease

A

1)dermatologic; 2) cardiac (AV conduction abn) 3)neurologic (Bell’s palsy, aseptic meningitis)

125
Q

migratory, regcurrent oligoarticular arthritis in knee or confusion and peripheral neuropathy indicate

A

tertiary stage of lyme disease

126
Q

oral drug for lyme disease

A

doxycycline; amoxicillin, cefuroxime

127
Q

IV drug for lyme disease

A

ceftriaxone

128
Q

ixodes scapularis is vector for:

A

lyme disease and babesiosis and ehrlichiosis

129
Q

protozoal parasite of RBC

A

babesiosis (babesis microti)

130
Q

Treatment for babesiosis

A

Azithromycin + atovaquone; or Quinine + clindamycin

131
Q

diagnosis of babesiosis

A

PCR or blood smear

132
Q

organism and vector that cause HGA

A

organism: ixodes tick
vector: anaplasma phagocytophilum

133
Q

have intracellular rickettsi-like organisms infecting WBC

A

anaplasmosis, ehrlichiosis

134
Q

organism and vector that cause HME

A

organism: ehrlichia chaffeensis (arkansas) (lone star tick): SE USA
vector: ambylomma americanum

135
Q

incidence of HGA is highest in what parts of USA

A

same as Lyme, babesiosis (western coast, e, s/e USA)

136
Q

incidence of HME is highest in what parts of USA:

A

SE

137
Q

leukopenia, increased bands, thrombocytopenia, increased LFTs, possibly morulae indicate:

A

ehrlichiosis, anaplasmosis

138
Q

indications for doxycycline:

A

lyme disease, ehrlichiosis, anaplasmosis, RMSF

139
Q

RMSF organism and vector:

A

organism: rickettsia rickettsii
vector: dermacentor variabilis-dog tick & dermacentor andersoni-wood tick

140
Q

RMSF populations:

A

kids

141
Q

pathogenesis of RMSF can lead to:

A

organ failure (endothelial dysfunction>extravasation>clotting factor activation; poor perfusion, edema, organ failure

142
Q

periorbital edema may indcate

A

RMSF (early)

143
Q

only tickborne illness where doxy is not indicated

A

babesiosis

144
Q

clinically diagnosed tickborne illness that does not require further testing

A

Lyme disease

145
Q

ixodes scapularis can transmit what organisms?

A

Borrelia burgdorferi, anaplasma phagocytophilum, babesia microti

146
Q

febrile + Bell’s palsy + tick bite

A

Lyme disease (disseminated, 2nd stage)

MOHD Keystone exam 3 (9 decks)

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