DSA 29 CNS Infections (McIntosh)

Question 1

what is Kernig’s sign?

Answer 1

flex the hip 90^o and try to straighten the leg. patient gets intense pain in the back of the hamstring

Question 2

what is Brudzinski’s sign?

Answer 2

flex the neck and the patient flexes the leg or both legs

Question 3

which HSV causes herpes encephalitis? which HSV causes garden variety aseptic meningitis?

Answer 3

HSV-1, HSV-2

Question 4

under what conditions do you perform brain imaging prior to lumbar puncture?

Answer 4

if patient has ANY of the following

1. ) altered mental status
2. ) focal neurologic deficit
3. ) trauma
4. ) immunocompromised
5. ) papilledema

Question 5

what is the difference in a CBC between bacterial meningitis and viral meningitis?

Answer 5

CBC is usually normal with a virus or maybe a mild luekocytosis

Question 6

what is the difference between the clinical presentation between viral meningitis and bacterial meningitis?

Answer 6

the patients generally appear much less ill with a viral meningitis; mental status is not as altered as it is in bacterial meningitis

Question 7

identify: cranial nerve abnormalities + headache + nuchal rigidity + fever

Answer 7

bacterial meningitis and viral encephalitis/meningoencephalitis

Question 8

ALL patients with suspected bacterial meningitis should have what done first diagnostically?

Answer 8

labs drawn which is show CBC; then draw culture and an LP if there are no contraindications; if there are contraindications you have to do a CT scan first

Question 9

what is the treatment for bacterial meningitis?

Answer 9

dexamethasone (steroid) + antimicrobial therapy (antibiotics + acyclovir)

Question 10

true or false: morbidity and mortality are high in patients with bacterial meningitis

Answer 10

true

Question 11

what if a member of a family is diagnosed with bacterial meningitis?

Answer 11

close contacts should receive prophylaxis such as an oral single dose cephalosporin or rifampin

Question 12

who should avoid rifampin?

Answer 12

pregnant females

Question 13

what is the difference between viral encephalitis/meningoencephalitis vs. just meningitis?

Answer 13

there are profound mental changes and more frequent seizures and focal neurlogical symptoms

Question 14

what imaging is preferred for viral encephalitis?

Answer 14

MRI

Question 15

what virus is positive on an MRI?

Answer 15

herpes simplex encephalitis

Question 16

what are the CSF findings in viral encephalitis?

Answer 16

increased red blood cells in a non-traumatic LP; other than that it is identical to viral meningitis

Question 17

presents with a subacute or chronic headache

Answer 17

fungal meningitis or tuberculous meningitis

Question 18

frequent history of immunocompromised status

Answer 18

fungal or TB

Question 19

brain imaging for subacute meningitis (TB or Fungal)

Answer 19

normal

Question 20

identify: most common presenting symptom is headache along with a frequent history of preceding sinus, dental, or ear infections, mastoiditis, pulmonary infections or recent dental or neurological procedures

Answer 20

brain abscess

Question 21

is fever present in a brain abscess?

Answer 21

present <50% of the time

Question 22

What is the best diagnostic test?

Answer 22

brain MRI scan

Question 23

What is the treatment for a brain abscess?

Answer 23

antibiotic therapy, surgical aspiration and drainage, anti-seizure medication

Question 24

What is the etiology of a spinal cord abscess?

Answer 24

most of the time it is due to an infection from a brain abscess with hematogenous psread to the spinal cord epidural area

Question 25

identify: spine pain is common presentation

Answer 25

spinal cord abscess

Question 26

polyradicular findings of a spinal cord abscess occurs where in relation to the spinal cord?

Answer 26

occurs below the spinal cord

Question 27

myelopathic findings if lesion encroaches where in a spinal cord abscess?

Answer 27

on the spinal cord directly

Question 28

what is Cushion’s triad? what does it indicate?

Answer 28

hypertension + bradycardia + respiratory irregularity. indicates increased ICP

Question 29

define fever in adults 18-40.

Answer 29

temp <98.9 in the AM or >99.9 in the PM

Question 30

what is required for diagnosis of bacterial meningitis?

Answer 30

>2 of the following: fever, neck stiffness, headache, altered mental status

Question 31

identify: this test is mandatory for the diagnosis of bacterial meningitis.

Answer 31

lumbar puncture

Question 32

list general signs of increased ICP.

Answer 32

headache: occipitonuchal, holocephalic, worse supine, at night

N/V, lethargy/coma, papilledema, lateral rectus palsy, blurred vision, Cushing’s triad

Question 33

how can you differentiate between meningitis and encephalitis based on clinical presentation?

Answer 33

both have headache and fever. meningitis will have meningismus. encephalitis will have mental status change, seizures, or focal signs.

Question 34

what is the common pattern of meningial involvement in bacterial meningitis?

Answer 34

outer surfaces of cerebral hemispheres (cerebral convexities)

Question 35

what part of the brain does tuberculosis like to infect?

Answer 35

the base of the brain