Exam 5 - CNS Infections Mikesell

Question 1

what are the normal CSF values for the following?
WBC
Differential
Protein
Glucose

Answer 1

WBC < 5
Differential -
Protein < 50
Glucose 30-70 (2/3 peripheral)

Question 2

bacterial meningitis: what are the CSF values for the following?
WBC
Differential
Protein
Glucose

Answer 2

WBC > 1000-5000
Differential: > 80% neutrophils
Protein > 150
Glucose < 50 (<0.4 CSF and blood)

Question 3

fungal meningitis: what are the CSF values for the following?
WBC
Differential
Protein
Glucose

Answer 3

WBC 10-500
Differential: > 50% lymphs
Protein 40-150
Glucose < 30-70

Question 4

viral encephalitis: what are the CSF values for the following?
WBC
Differential
Protein
Glucose

Answer 4

WBC 5-300
Differential: 50% lymphs
Protein 30-150
Glucose < 40-70

Question 5

which type of CNS infections includes protein values > 150 mg/dL?

a. bacterial
b. fungal
c. viral

Answer 5

a. bacterial

Question 6

tough outer membrane – directly adheres to skull and vertebral column

a. dura mater
b. arachnoid
c. subarachnoid space
d. pia mater

Answer 6

a. dura mater

Question 7

middle layer

a. dura mater
b. arachnoid
c. subarachnoid space
d. pia mater

Answer 7

b. arachnoid

Question 8

-CSF
-where infection occurs

a. dura mater
b. arachnoid
c. subarachnoid space
d. pia mater

Answer 8

c. subarachnoid space

Question 9

delicate innermost membrane that adheres to contours of the brain

a. dura mater
b. arachnoid
c. subarachnoid space
d. pia mater

Answer 9

d. pia mater

Question 10

Which of the following antibiotics does NOT achieve therapeutic concentrations in the CSF, even in the presence of inflamed meninges?

a. cefazolin
b. pen G
c. ceftriaxone
d. ertapenem
e. A and D

Answer 10

e. A and D

Question 11

Which of the following antibiotics does NOT achieve therapeutic concentrations in the CSF, even in the presence of inflamed meninges?

a. bactrim
b. vancomycin
c. azithromycin
d. fluconazole
e. doxycycline

Answer 11

c. azithromycin

(macrolides; doxy is the only tetracycline that does go into CNS)

Question 12

Which of the following is not a characteristic that effects CNS penetration?

a. excretion
b. molecular weight
c. protein binding
d. ionization

Answer 12

a. excretion

Question 13

most common way bacteria gain access into the CNS

Answer 13

hematogenous spread -> from the blood stream into subarachnoid space

Question 14

acute bacterial meningitis: critical 1st step of hematogenous spread

Answer 14

nasopharyngeal colonization

Question 15

bacterial meningitis: listeria is found in which of the following age groups? SELECT ALL THAT APPLY (2)

a. neonates (< 1 month)
b. infants (1-23 months)
c. children and adults (2-50 yrs)
d. older adults (50+)

Answer 15

a. neonates (< 1 month)
d. older adults (50+)

Question 16

Which of the following findings would be expected in the cerebrospinal fluid (CSF) analysis and culture of a patient with suspected acute bacterial meningitis?

a. Low glucose concentration (< 50 mg/dL)
b. Low protein concentration (< 50 mg/dL)
c. A predominance of monocytes in the white blood cell count differential
d. Negative Gram stain and culture
e. Low white blood cell count (< 5 cells/mm3)

Answer 16

a. Low glucose concentration (< 50 mg/dL)

(b. is > 150; c. is neutrophils; d. would have GP or GN; e. is > 1000-5000)

Question 17

bacterial meningitis empiric antibiotics: vanc + ceftriaxone only. SELECT ALL THAT APPLY (2)

a. neonates (< 1 month)
b. infants (1-23 months)
c. children and adults (2-50 yrs)
d. older adults (50+)

Answer 17

b. infants (1-23 months)
c. children and adults (2-50 yrs)

Question 18

bacterial meningitis empiric antibiotics:
vanc + ceftriaxone + ampicillin

a. neonates (< 1 month)
b. infants (1-23 months)
c. children and adults (2-50 yrs)
d. older adults (50+)

Answer 18

d. older adults (50+)

(also for immunocompromised pts)

Question 19

bacterial meningitis due to MSSA: what is the preferred tx?

a. Pen G; 10-14 days
b. Oxacillin; 14-21 days
c. Nafcillin; 14-21 days
d. Ceftriaxone; 7 days

Answer 19

c. Nafcillin; 14-21 days

Question 20

bacterial meningitis due to listeria: what is the preferred tx?

a. Ampicillin + Gentamicin; 21 days
b. Cefepime; 21 days
c. Penicillin or Ceftriaxone; 7 days
d. Vancomycin; 14-21 days

Answer 20

a. Ampicillin + Gentamicin; 21 days

Question 21

how long should tx be for S. pneumoniae bacterial meningitis?

a. 7 days
b. 10-14 days
c. 14-21 days
d. 21 days

Answer 21

b. 10-14 days

Question 22

B-lactamase negative haemophilus tx

a. ceftriaxone x 7 days
b. ampicillin x 7 days

Answer 22

b. ampicillin x 7 days

Question 23

B-lactamase positive haemophilus tx

a. ceftriaxone x 7 days
b. ampicillin x 7 days

Answer 23

a. ceftriaxone x 7 days

Question 24

A 58-year-old male is admitted for suspected bacterial meningitis (LP with low glucose, elevated bacteria and WBC). He also has a PMH of COPD, CAD, HTN, HLD. What would be the best empiric treatment option?

a. Ceftriaxone + vancomycin
b. Ceftriaxone + vancomycin + dexamethasone
c. Ampicillin + ceftriaxone
d. Ampicillin + ceftriaxone + vancomycin
e. Ampicillin + ceftriaxone + vancomycin + dexamethasone

Answer 24

e. Ampicillin + ceftriaxone + vancomycin + dexamethasone

Question 25

T or F: Dexamethasone has been shown to decrease mortality and unfavorable outcome in adults with bacterial meningitis due to any organism.

Answer 25

F (only in meningitis due to Streptococcus pneumoniae)

Question 26

A renal transplant pt is admitted with a 3 week hx of headache, photophobia and fever. The LP demonstrates 80 WBC with 90% lymphs, and his serum and CSF cryptococcal antigen titers are positive. Which therapy would be most appropriate? a. Liposomal ampho B 4 mg/kg IV daily b. Conventional ampho B 1 mg/kg IV daily over 4 hours + flucytosine PO c. Fluconazole 400mg IV QD d. Conventional ampho B 1 mg/kg IV daily over 24 hours + Flucytosine PO e. Caspofungin 50mg IV QD

Answer 26

d. Conventional ampho B 1 mg/kg IV daily over 24 hours + Flucytosine PO

Question 27

fungal meningitis maintenance phase duration for persons living with HIV (3 things)

Answer 27

at least 12 months AND CD4 > 200 AND suppression of viral load on ART

Question 28

viral encephalitis is most often characterized by fever, headache, and _____ _____ _____ (bolded on slide)

Answer 28

altered mental status

Question 29

T or F: All types of viral encephalitis should be treated with Acyclovir 10mg/kg IV every 8 hours

Answer 29

F (Most cases of viral encephalitis are benign and self-limiting. Only HSV and VZV encephalitis should be treated with high dose IV acyclovir)

Question 30

what drug is combined with ganciclovir in tx of CMV encephalitis for persons living with HIV? a. gentamicin b. foscarnet c. flucytosine d. dexamethasone

Answer 30

b. foscarnet

Question 31

which type of CNS infections includes WBC values > 1000-5000? a. bacterial b. fungal c. viral

Answer 31

a. bacterial