EXAM #1: CNS INFECTIONS

Question 1

What is the first thing to ask yourself with a patient that has a suspected CNS infection?

Answer 1

Duration

Question 2

What is the second thing to ask yourself with a patient that has a suspected CNS infection?

Answer 2

Etiology

Question 3

What is the third thing to ask yourself with a patient that has a suspected CNS infection?

Answer 3

Work-up

Question 4

What is the fourth thing to ask yourself with a patient that has a suspected CNS infection?

Answer 4

Treatment

Question 5

What are the four main types of infections that affect the brain?

Answer 5

1) Acute meningitis
2) Chronic meningitis
3) Brain abscess
4) Ecephalitis

Question 6

What are the non-infectious etiologies of presentations similar to a CNS infection?

Answer 6

1) Neoplasia
2) Collagen Vascular Disorder
3) Medications

Question 7

What are the routine tests done on a lumbar puncture?

Answer 7

1) WBC w/diff
2) RBC
3) Glucose
4) Protein
5) Gram stain
6) Bacterial culture
7) Opening pressure

Question 8

What infectious etiology is associated with an elevated opening pressure?

Answer 8

Cryptococcal meningitis

Question 9

What is xanthochromia?

Answer 9

Yellow supernantant of CSF from RBC lysis

Question 10

What are the expected CSF findings in bacterial meningitis?

Answer 10

• 1000-5000 WBC
• 100-500 Protein
• Less than 40 glucose
• Neutrophils

Question 11

What CSF findings are associated with tuberculous meningitis?

Answer 11

• 50-300 WBC
• Mononuclear
• Less than 45 glucose
• 50-300 Protein

Question 12

What CSF findings are associated with viral meningitis?

Answer 12

• 50-1000 WBC
• Mononuclear
• Greater than 45 glucose
• Less than 200 protein

Question 13

What are the CSF findings associated with Cryptococcal meningitis?

Answer 13

• 20-500 WBC
• Mononuclear
• Less than 40 glucose
• Greater than 45 protein

Question 14

What imaging study is preferred for neuroimaging in the setting of CNS infection?

Answer 14

MRI

Question 15

When is imaging warranted?

Answer 15

1) Persistent or prolonged fever
2) Focal neuro findings
3) Increased ICP
4) New/ recurrent seizure
5) Persistent dysfunction
6) Persistently abnormal CSF parameters

*An enlarging head circumference in a neonate

Question 16

What are the characteristics of the antibiotic you want to give for acute bacterial meningitis?

Answer 16

1) Needs to CROSS the BBB

2) Must be BACTERIOCIDAL

Question 17

What are the two most common causes acute bacterial meningitis?

Answer 17

1) Streptococcus pneumonaie

2) Neisseria meningititdis

Question 18

What viruses are most viral meningitis?

Answer 18

1) Enterovirus

2) Herpes virus

Question 19

What three pathogens are associated with subacute/ chronic meningitis?

Answer 19

1) M. tuberculosis
2) T. pallidum
3) Borrelia burgdorferi

Question 20

What is the intracellular pathogen that can cause meningitis in the very young and old?

Answer 20

L. monocytogenes

Question 21

How do you start off treating a patient with acute bacterial meningitis?

Answer 21

1) IV Vancomycin

2) Ceftriaxone

Question 22

If a patient is very young or old and you’re considering L. monocytogenes, what drug should you add?

Answer 22

Ampicillin

Question 23

In a patient that has had neurosurgery, what pathogens should come to mind?

Answer 23

1) Coagulase negative S. species
2) Pseudomonas

*B/c this is part of the normal skin flora

Question 24

What drug covers coagulase negative Staph species?

Answer 24

Vancomycin

Question 25

What drug do you need to use to cover for Pseudomonas?

Answer 25

Ceftazidime (4th gen. cephalosporin, NOT 3rd)

Question 26

What pathogen responds well to steroids?

Answer 26

S. pneumoniae

Question 27

What is the vector for Lyme disease?

Answer 27

Ixodes tick

Question 28

What is the first line drug for Lyme Disease?

Answer 28

Doxycycline

*Alternative is amoxicillin

Question 29

What is the initial treatment for Cryptococcal meningitis?

Answer 29

1) Amphotericin B or fluconazole

2) Reduction ICP

Question 30

What duration of symptoms is associated with chronic meningitis?

Answer 30

4 weeks

Question 31

What is the most common cause of chronic meningitis?

Answer 31

Cryptococcus neoformans

Question 32

What is a potential neurologic complication of chronic meningitis?

Answer 32

Hydrocephalus