Infection - Infection in the CNS Flashcards
infection/ inflammation of the meninges
a.meningitis
b.encephalitis
c.meningoencephalitis
d.prion disease
meningitis
which of these meningitis infections is more common and self limiting
a.bacterial
b.viral
b.viral
most organisms causing meningitis invade the meninges across which barrier
a.blood brain
b.csf
b.csf
somewhat porous as endothelium of vessels is porous
inflammation of the white matter of the brain
a. meningitis
b.encephalitis
c.meningoencephalitis
b.encephalitis
most organisms causing encephalitis invade the brain across which barrier
a.blood brain
b.csf
a.blood brain
not fenestrated so harder to penetrate
viruses with tropism for nervous tissue
infection of peripheral nervous system ascends to CNS
eg herpes simplex, varicella zoster and rabies
which of these pathogens does NOT invade the peripheral nerves
a.rabies
b.varicella zoster
c.herpes simplex
d.e coli
d.e coli
a combination of meningeal and white matter inflammation/ infection
a. meningitis
b.encephalitis
c.meningoencephalitis
c.meningoencephalitis
in which of these conditions does the presence of a specific protein alter the configuration of proteins to cause white matter loss
a. meningitis
b.encephalitis
c.meningoencephalitis
d.prion disease
d.prion disease
what are the 3 main bacteria that case CNS infections
(NHS)
neisseria meningitis
haemophilus influenza
streptococcus pneumonae
what type of bacteria is neisseria meningitis
a.gram positive rod
b.gram positive coccus
c. gram negative rod
d, gram negative coccus
d, gram negative coccus
in pairs so diplococcus
what gram stain is haemophilus influenzae type B
a.a.gram positive rod
b.gram positive coccus
c. gram negative rod
d, gram negative coccus
e.gram negative cocco bacillus
e.gram negative cocco bacillus
which of these is a gram negative coccus
a.neisseria meningits
b.haemophilus influenzae
c. strep pneumonae
a.neisseria meningits
which of these is a gram negative cocco- bacillus
a.neisseria meningits
b.haemophilus influenzae
c. strep pneumonae
b.haemophilus influenzae
which of these is a gram positive coccus
a. neiseeria meningitis
b.haemophilus influenzae
c. strep pneumonia
c. strep pneumonia
occurs in pairs so diplococcus
what gram stain is strep pneumonae
a.a.gram positive rod
b.gram positive coccus
c. gram negative rod
d, gram negative coccus
e.gram negative cocco bacillus
b.gram positive coccus
in pairs so diplococcus
where can all of the 3 main CNS infection bacteria commence ?
a.GI tract
b.GU tract
c.upper respiratory tract
d.lower respiratory tract
c.upper respiratory tract
what does meningitis usually occur from
a.direct infection of brain
b.blood stream spread from upper Respiratory tract infection
b.blood stream spread from upper Respiratory tract infection
when are the 3 NHS meningitis organisms vaccinated against
a.primary school
b.secondary school
c.adulthood
d.as a baby
a.primary school
which organism is a gram positive rod
a.neisseria menigitis
b.haemophilus influenzae
c. strep pneumonae
d.listeria monocytogenes
d.listeria monocytogenes
what type of organism is listeria monocytogenes
a.a.gram positive rod
b.gram positive coccus
c. gram negative rod
d, gram negative coccus
e.gram negative cocco bacillus
a.a.gram positive rod
which organism is not a common cause of meningitis but is seen in the elderly, neonates and immunocompromised patients
a.neisseria menigitis
b.haemophilus influenzae
c. strep pneumonae
d.listeria monocytogenes
d.listeria monocytogenes
NHS organisms common
how is listeria monocytogenes spread
a. droplets
b.food borne
c.close communities
d.dirty water
b.food borne
who is commonly effected by TB meningitis
a.elderly
b.neonates
c.teenagers
d.young children
d.young children
which type of meningitis occurs shows as a military appearance on chest x ray
a.Nesseria menigitis
b.haemophilus influenzae
c.strep pneunoneae
d.TB
d.TB
disseminated TB
pregnant women are advised to avoid food borne sources eg unpasteurised soft cheeses of which pathogen
a.Nesseria menigitis
b.haemophilus influenzae
c.strep pneunoneae
d.TB
e.listeria monocytogenes
e.listeria monocytogenes
vaginal colonisation
other than the core list NHS of bacteria causing meningitis in neonates which bacteria should be considered.
GBS - group B strep
E coli
listeria monocytogenes
GEL
in early infection (within 7 days) of a neonate with GBS how is the infection acquired
a.during birth from mother
b.other children
c.hospital
a.during birth from mother
late infection of a baby with GBS is most likely from what
a.mother during birth
b. hospital acquired
c.other children at nursery
c.other children at nursery
a pregnant women is given prophylaxis at the time of delivery for which organism if it is found in the vagina/urine during pregnancy
a.GBS
b.e coli
c. Listeria monocytogenes
d.TB
a.GBS
type B strep
which organism is specifically associated with HIV/AIDS patients and patients recieveing chemotherapy
a.GBS
b.e coli
c. Listeria monocytogenes
d.TB
e.cryptococcus neoformans
e.cryptococcus neoformans
yeast like fungi
immunocompromised pre disposed for fungal infections
how is CNS infection with cyptococcus neoformans ( HIV/AIDS patients/ chemotherapy) diagnosed
a.gram stain
b.indian ink stain of blood
c.indian ink stain csf
c.indian ink stain csf
shows capsule
and antigen detection tests
what is a significant cause of CNS infection in those with impaired T cell immunity that is associated with cats and a mild fever with swollen lymph nodes
a.GBS
b.e coli
c. Listeria monocytogenes
d.toxoplasma gondii
e.cryptococcus neoformans
d.toxoplasma gondii
which of these is a protozoa
a.GBS
b.e coli
c. Listeria monocytogenes
d.toxoplasma gondii
e.cryptococcus neoformans
d.toxoplasma gondii
other than NHS what organisms are important to consider for CNS infection in immunocompromised patients
TLC
Toxoplasma gondii - protozoa associated with cats , mild fever and swollen lymph nodes , HIV with low CD4
listeria monocytogenes
cyptococcus neoformans- fungi, HIV and chemotherapy patients
confusion, seizures, altered conscious and abnormal behaviour are symptoms of what
a. meningitis
b. encephalitis
c.encephalomeningitis
b. encephalitis
which of these encephalitis organisms causes flaccid paralysis ascending from the peripheral nerves to the CNS and causes non severe encephalitis
a.mumps
b.polio
c.rabies
a.mumps
which of these encephalitis organisms causes long term disability
a.mumps
b.polio
c.rabies
b.polio
which of these encephalitis organisms causes fatality
a.mumps
b.polio
c.rabies
c.rabies
what is the most common cause of encephalitis in the UK
a.mumps
b.polio
c.rabies
d.herpes simplex
d.herpes simplex
headache, fever, irritability , neck stiffness and photophobia indicate what
a. meningitis
b. encephalitis
c.encephalomeningitis
a. meningitis
may also have prodromal sore throat
what is the characteristic sign of meningococcal septicaemia
a.headache
b.neck stiffness
c.photophobia
d.non blanching rash
e.blanching rash
d.non blanching rash
what is the first thing to do if meningitis is suspected
a.give antibiotucs
b.imaging
c.lumbar puncture
d.blood for culture
e.throat swabs
a.give antibiotucs
in normal adult csf there are….white cells
a.some
b.no
b.no
a high number of neutrophils and high protein count in the csf indicates what
a.bacterial infection
b.fungal infection
c. viral infection
d. protozoa infection
a.bacterial infection
`(cloudy appearance to csf)
high numbers of t lymphocytes and normal protein in the csf indicates what
a.bacterial infection
b.fungal infection
c. viral infection
d. protozoa infection
c. viral infection
clear appearance to csf
what is the first line drug for most cases of bacterial meningitis
a.ceftriaxone
b.amoxicillin
c.cefotaxime
d.chloramphenicol
a.ceftriaxone
what is added to ceftriaxone (elderly) or cefotaxime (neonates) to cover listeria in bacterial meningitis
a. flucloxacillin
b.erythromycin
c.gentamicin
d. amoxicillin
d. amoxicillin
what is the first line for bacterial meningitis in neonates
a.ceftriaxone
b.amoxicillin
c.cefotaxime
d.chloramphenicol
c.cefotaxime
what is added to cefotaxime and amoxicillin in neonates to cover gram negatives
a. flucloxacillin
b.erythromycin
c.gentamicin
d. amoxicillin
c.gentamicin
what is given for bacterial meningitis if the patient has a life threatening penicillin allergy
a.ceftriaxone
b.amoxicillin
c.cefotaxime
d.chloramphenicol
d.chloramphenicol
close contacts of those with meningococcal meningitis should be offered prophylaxis with which drug
a.ceftriaxone
b.amoxicillin
c.cefotaxime
d.chloramphenicol
e.ciprofloxacin
e.ciprofloxacin
infective encephalitis is most often cause by
a.bacteria
b.viruses
b.viruses
herpes simplex leading to viral encephalitis is most often due to reactivation of latent virus in the trigeminal ganglia that ascends typically causing infection in which lobes
a. temporal
b.occipital
c. parietal
d.temporal
a. temporal
what is the key to diagnosing encephalitis
a.gram stain
b. csf pcr
c.imaging
d.throat swabs
c.imaging
CT MRI
can show raised intra cranial pressure which contraindicates a lumbar puncture as it can cause brainstem to be pulled down through foramen magnum (coning)
vesicular rashes in encephalitis indicate what cause
a.herpes simplex
b.mumps
c.measles
d.eneterovirus meningoencephalitis
a.herpes simplex
non vesicular rash in encephalitis is suggestive of what cause
a.herpes simplex
b.mumps
c.measles
d.eneterovirus meningoencephalitis
d.eneterovirus meningoencephalitis
how is encephalitis disgnosed
scanning PCR from throat, swabs of rash vesicles, blood , lumbar puncture
what is used to reduce swelling in encephalitis
a.steroids
b.antibiotics
c.NSAIDs
d.diuretics
a.steroids
which antiviral is given as the first step of treatment for encephalitis
a.ceftriaxone
b.amoxicillin
c.cefotaxime
d.chloramphenicol
e.aciclovir
e.aciclovir
how is acyclovir given for herpes simples encephalitis
a,oral
b.ointment
c.IV
c.IV
which of these drugs competes with deoxyguanosine to be incorporated into the viral
DNA stopping viral DNA synthesis
a.ceftriaxone
b.amoxicillin
c.cefotaxime
d.chloramphenicol
e.aciclovir
e.aciclovir
which of these is often a primary infection with HSV
a.herpetic gingivostomatitis
b.herpes labialis - cold sores
a.herpetic gingivostomatitis
in cases of keratoconjunctivitis (HSV eye infection) what should be done
a.antibiotic eye drops
b.oral antibiotics
c.urgent specialist referral
d.specialist referral
c.urgent specialist referral
what is used topically to treat herpes labialis
a.ceftriaxone
b.amoxicillin
c.cefotaxime
d.chloramphenicol
e.aciclovir
e.aciclovir
what is the secondary infection of varicella known as
shingles
varicella = chickenpox
what is used for shingles when the patient is immunocompromised; the pain
of the infection is severe; the facial dermatomes are involved (branches of the
trigeminal nerve which supply sensory supply to the face.)
a.ceftriaxone
b.amoxicillin
c.cefotaxime
d.chloramphenicol
e.aciclovir
e.aciclovir
what is used IV for treatment of cmv infection
a.ceftriaxone
b.amoxicillin
c.ganciclovir
d.chloramphenicol
e.aciclovir
c.ganciclovir
what is used topically for the treatment of herpes keratitis
a.ceftriaxone
b.amoxicillin
c.ganciclovir
d.chloramphenicol
e.aciclovir
c.ganciclovir
what is the main side effect of ganciclovir
a.vomiting
b.GI upset
c.agranulocytosis
d. bone marrow suppression
d. bone marrow suppression
what is used for prophylaxis of cmv
a.ceftriaxone
b.valaciclovir
c.ganciclovir
d.chloramphenicol
e.aciclovir
b.valaciclovir given orally
who is at specific risk of cmv infection
