Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Emergency/surg > E3: CNS Infections > Flashcards

E3: CNS Infections Flashcards

1
Q

What is it called when there is an infection of the arachnoid mater and CSF in the subarachnoid space and cerebral ventricles?

A

Bacterial meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What pathogens are most likely responsible to bacterial meningitis from exposure during delivery?

A

E. coli or GBS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What pathogen is most likely responsible for bacterial meningitis cause by colonization from the nasopharynx (Sinusitis, otitis media, mastoiditis)?

A

S. Pneumo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What pathogen is mostly likely responsible for bacterial meningitis in young person living in crowded conditions (military, dorm)?

A

N. Meningitides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What kind of pathogen is mostly likely responsible for bacterial meningitis caused by a head trauma?

A

Staph

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What kind of pathogen is most likely responsible for bacterial meningitis that occurred after a neurosurgical procedure?

A

Staph, gram -

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the classic triad of meningitis?

A

Fever, nuchal rigidity, and AMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the jolt accentuation test?

A

A test for meningitis, when the patient rotates their head horizontally at a frequency of two times per second.
A positive test is the exacerbation of an existing headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is bacterial meningitis diagnosed?

A
  • Blood cultures x2 before abx
  • Possible CT
  • LP
  • CBC, CMP, ESR, CRP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the gold standard for diagnosing meningitis and what will the results be?

A
  • CSF analysis
  • Will show increased WBC, decreased glucose, increased protein, positive gram stain and culture, and increased opening pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When should you CT for Meningitis?

A
  • Immunocompromised
  • History of CNS disease
  • New onset seizure
  • papilledema
  • Abnormal level of consciousness
  • focal neuro deficit

** if there is increased ICP and mass lesion present, LP may result in cerebral herniation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

If gram stain shows gram positive diplococci, what should you suspect?

A

Pneumococcal infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

If gram stain shows gram negative diplococci, what should you suspect?

A

Meningococcal infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

If gram stain shows gram negative coccobacilli, what should you suspect?

A

H influenza

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If gram stain shows gram positive rods and coccobacilli, what should you suspect?

A

L monocytogenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What findings are predictive of adverse outcomes in meningitis?

A

Presence of leukopenia, AMS, seizures, and/or hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is bacterial meningitis treated?

A
  • Initate dexamethasone and empiric antibiotics immediately after blood cultures and LP
  • Dexamethasone must be give shortly before or at the same time as ABX, DO NOT GIVE AFTER
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why is dexamethsone recommended for bacterial meningitis?

A
  • Used to decrease rate of hearing loss and neurologic sequel are and decreased morbidity and mortality
  • significant benefit only in pneumococcal meningitis
  • only continue dex if gram stain or blood cultures are positive for strep pneumo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the recommended treatment for newborns with bacterial meningitis?

A

Ampicillin + cefotaxime OR gentamycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What pathogens are the most common etiologies of bacterial meningitis in newborns?

A

GBS, E. coli, and L. Monocytogenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the recommended treatment fo bacterial meningitis in 1 month-50 years old?

A

Vancomycin + ceftriaxone or Cefotaxime + dexamethsone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the recommended treatment of bacterial meningitis in patients >50 years old?

A

Ampicillin + Vancomycin + ceftriaxone or cefotaxime + dexamethasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the recommended treatment for bacterial meningitis in immunocompromised patients?

A

Ampicillin + vanc + cefepime or meropenem + dexamethsone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

If patients have a penicillin allergy, what is the recommended treatment for bacterial meningitis?

A

Vanc + moxifloxacin + bactrim

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the treatment of bacterial meningitis caused by a basilar skull fracture?
Vanco + cefotaxime or Gentamycin +dexamethasone
26
What is the treatment of bacterial meningitis caused by penetrating trauma or post neurosurgery?
Vanco + ceftazidime or cefepime or meropenem + dexamethasone
27
If on CSF gram stain, there is gram positive diplococci only, how should you treat?
Targeted antibiotic therapy, continue dexamethasone, and add rifampin
28
If CSF gram stain is negative and there is no bacteria seen, but other CSF findings are consistent with bacterial meningitis, how should you treat?
Continue empiric ABX therap and dexamethasone
29
What are the common complications associated with bacterial meningitis?
- septic shock - DIC - Acute respiratory distress syndrome - Possible long term neurologic complications
30
Which strains of meningitis are there vaccinations against?
S. Pneumo, N meningitides, and H flu
31
What is the post exposure prophylaxis for bacterial meningitis?
- Cipro 500mg po x1 - Rifampin 600mg q12 hours x 2 days - Ceftriaxone (if pregnant or family member) 250mg IM x1
32
What is aseptic meningitis?
When there is clinical evidence of meningeal inflammation, but bacterial cultures are negative -AKA viral meningitis
33
What is the most common viral cause of aseptic meningitis?
- Enterovirus (coxsackie, echovirus) | - HSV is also common
34
Other than infection, what are two other causes of aseptic meningitis?
- Malignancy (direct invasion of the meninges) | - Drug induced
35
On CSF analysis, there is WBC <500 and >50% lymphocytes, normal glucose, normal protein, and negative gram stain. What should you suspect?
Aseptic meningitis
36
What is the recommended treatment of aseptic meningitis?
- Self limiting so treatment is supportive - analgesics and antipyretic - anti-vitals only in severe cases or in immunocompromised individuals
37
What is the clinical presentation of encephalitis?
Abnormalities in brain function are common: AMS, seizures, motor or sensor deficits, personality changes, speech or movement disorders
38
What is encephalitis?
Viral infection of the CNS resulting in acute inflammation of the brain
39
What is acute disseminated encephalomyelitis?
When no virus is detected, neurons are spared, and there is perivascular inflammation and demyelination. -Typically occurs are initial infection is resolving
40
What are the common causes of Encephalitis?
- Arbovirus (west Nile virus and St. Louis virus) - Influenza - Lyme disease, Rocky Mountain spotted fever, syphilis - VZV, HIV mumps - HSV
41
What is the most common cause of fatal encephalitis?
HSV1
42
What is the most common cause of viral encephalitis in the US?
West Nile virus
43
Do you see photophobia and nuchal rigidity with encephalitis?
Rarely, but common with meningoencephalitis
44
How is encephalitis diagnosed?
- Blood cultures x2 - CBC with diff - LP:CSF PCR for HSV, enteroviruses, and EBC. - Cultures
45
What CSF finding is indicative fo HSV1 infection?
RBCs
46
What is the recommended imaging for encephalitis?
MRI with contrast **EEG will also be abnormal
47
What is the recommended treatment of encephalitis?
- Acyclovir 10mg /kg IV q8 hours - HSV is the most important to identify and treat - seizure prophylaxis and control - Diuretics if increased ICP
48
What is the most common etiology of cerebral abscess in immigrants from Mexico?
Parasites
49
What are the most common etiologies of cerebral abscess in immunocompromised/HIV/AIDS patients?
- Toxoplasma gondii - Listeria monocytogenes - Nocardia asteroides
50
What is the clinical presentation of cerebral abscess?
- unilateral headache - Not relieved by OTC medications - fever - nuchal rigidity - AMS - Vomiting (if increased ICP) - seizures - papilledema
51
How is a cerebral abscess diagnosed?
- Blood cultures x2 - CBC with diff - MRI w/ contrast is imaging of Choice (will show ring enhancing lesion)
52
When is LP contraindicated in cerebral abscess?
If there are focal symptoms (unilateral headache), unilateral CN deficits, hemiparesis or papilledema -Asymmetric cerebral edema results in brain stem herniation in up to 30% if LP done
53
What is the management of a cerebral abscess?
- CT guided aspiration or surgical excision - Abx empirically - Dexamethasone
54
What is the recommended treatment of cerebral abscess from an oral source?
Metronidazole and penicillin G
55
What is the recommended treatment of a cerebral abscess caused by an otogenic or sinus source?
Metronidazole +ceftriaxone or cefotaxime
56
What is an intracranial epidural abscess?
An abscess that forms between the dura and the skull
57
If a patient has a IEA and contiguous spread, how should you treat?
Metronidazole + ceftriaxone or cefotaxime
58
How should you treat an IEA without contiguous spread?
Vanco + Metronidazole + ceftriaxone or cefotaxime or ceftazidime)
59
What is the the most common cause of SEA?
S. Aureus
60
What is the classic triad of SEA?
Fever, spinal pain, and neurologic deficits
61
What is the clinical presentation of SEA?
- Classic triad of fever, spinal pain, and neuro deficits - back pain with nerve root pain, motor weakness, sensory changes - Paralysis that quickly becomes irreversible
62
What is the first line diagnostic test for SEA?
MRI with contrast with imaging of the entire spine to evaluate for skip lesions
63
What is the management of SEA?
- Blood cultures x2 - Vanco + cefotaxime or ceftriaxone or cefepime or ceftazidime - early surgical decompression and drainage

Emergency/surg (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions