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Y3 NEUROLOGY > Infections > Flashcards

Infections Flashcards

1
Q

CNS infections are medical emergencies. True/False? Why?

A

True
Untreated infection can lead to brain herniation and death, and cord compression with paralysis
Brain and spinal cord do not regenerate once injured

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2
Q

List the main differential diagnoses for CNS infections causing fever and/or altered mental state

A

Meningitis (inflammation of the meninges)
Encephalitis (inflammation of brain)
Meningoencephalitis (inflammation of brain and meninges)
Encephalomyelitis (inflammation of brain and spinal cord)
Severe sepsis syndrome
Abscess

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3
Q

When is the typical onset of viral meningitis?

A

Late summer/autumn

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4
Q

Which viruses are typically responsible for viral meningitis?

A

Enteroviruses most common e.g. ECHO, coxsacchie

HSV and other microbes also

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5
Q

List investigations/diagnostic tools for viral meningitis

A

Viral stool culture
Throat swab
Lumbar puncture for CSF
PCR

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6
Q

Outline treatment for viral meningitis

A

Supportive - paracetamol, fluids, rest, dark room

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7
Q

Which part of the brain does viral encephalitis affect?

A

Infection of brain parenchyma

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8
Q

List the main causes of viral encephalitis

A 
Herpes simplex
Varicella zoster
CMV, HIV, measles
Travel-viruses
Rabies
Non-infectious (autoimmune)
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9
Q

Which viruses are the only treatable causes of viral encephalitis?

A

HSV

Varicella zoster

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10
Q

List clinical features of viral encephalitis

A

Insidious onset
Meningismus (rigidity, photophobia, headache)
Altered consciousness (comatose, seizures, paralysis)
Confusion, psychosis
Speech and memory deficit

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11
Q

List investigations for viral encephalitis

A

Lumbar puncture
Electroencephalography (EEG)
MRI

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12
Q

What is the main treatment for viral encephalitis?

A

IV aciclovir

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13
Q

List the main causes of bacterial meningitis in neonates

A

Listeria monocytogenes
Group B Strep. (pneumococcus)
E. coli

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14
Q

Which antibiotic combats Listeria monocytogenes?

A

Ampicillin/amoxicillin

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15
Q

Which organism is the main causes of bacterial meningitis in children?

A

H. influenzae (type b)

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16
Q

Which organism is the main cause of bacterial meningitis in 10-21 year olds?

A

Neisseria meningitides from the throats of healthy carriers

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17
Q

List the main causes of bacterial meningitis in adults

A

Strep. pneumoniae

Neisseria meningitides

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18
Q

A fracture of the cribriform plate increases the risk of which bacterial meningitis?

A

Pneumococcal (Strep. pneumoniae)

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19
Q

List the main causes of bacterial meningitis in the immunocompromised

A 
Strep. pneumonia
Neisseria meningitides
Staph aureus
Listeria
Aerobic Gram -ves
Mycobacterium
Cryptococcus neoformans
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20
Q

List clinical features of bacterial meningitis

A 
Meningismus  (rigidity, photophobia, headache)
Nausea/ Vomiting
Pyrexia
Stiffness/ pain (particularly in neck)
Confusion (GCS <14)
Rash
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21
Q

Signs of bacterial meningitis are often absent in the very young, very old and immunocompromised. True/False?

A

True

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22
Q

List investigations for bacterial meningitis

A

Blood cultures
Throat swab (meningococci)
Lumbar puncture for CSF

23
Q

What CSF findings would you expect in bacterial meningitis?

A 
High WBC (>2000)
High neutrophils (>1180)
High protein (>220)
Low glucose (<34) in blood
24
Q

A low ratio of blood sugar : CSF sugar is indicative of bacterial meningitis. True/False?

25
Q

What is aseptic meningitis? What are the findings of CSF analysis?

A

Non-pyogenic bacterial meningitis (includes viral meningitis): high WBC count, high lymphocytes, normal glucose, elevated protein

26
Q

List indications for hospital admission for bacterial meningitis

A

Altered consciousness
Petechial rash
Febrile, headache

27
Q

Which antibiotic is given for suspected meningitis 1st line? If the patient is over 60 yo add? If worried about resistance add?

A

Ceftoxamine/ ceftriaxone
Amoxicillin
Vancomycin + rifampicin

28
Q

A CT scan should delay treatment in bacterial meningitis. True/False?

A

False

An urgent CT scan should be requested but does not delay treatment

29
Q

Why are steroids given to all patients suspected of bacterial meningitis? What steroid is given?

A

Dampen down cerebral swelling caused by antibiotic treatment

Dexamethasone

30
Q

If a patient is penicillin-allergic, what antibiotics given for bacterial meningitis? If the patient is over 60 yo add?

A

Chloramphenicol

Co-trimoxazole

31
Q

What is the appearance of acute pyogenic meningitis in the brain?

A

Thick layer of suppurative exudate covers meninges over surface of brain
Neutrophils in sub-arachnoid space

32
Q

Which medication combats Haemophillus Influenza?

A

Dexamethasone

33
Q

What are some complications of bacterial meningitis?

A 
Limb loss
Deafness
Blindness
Cerebral palsy
Quadriplegia
Mental impairment
Hydrocephalus
34
Q

What is the pathenogenesis of meningitis - how can the bacteria reach the brain?

A

Nasopharyngeal colonization
Direct extension of bacteria
From remote foci of infection (endocarditis, pneumonia, UTI)

35
Q

Outline the treatment for tuberculosis meningitis

A

Isoniazid + rifampicin —> + pyrazinamide + ethambutol

36
Q

Cryptococcal meningitis is a bacterial/viral/fungal infection

37
Q

Cryptococcal meningitis is classically found in which immunocompromised group?

A

HIV sufferers (CD4 <100)

38
Q

Outline the treatment for cryptococcal meningitis

A

IV amphotericin B/ flucytosine

Fluconazole

39
Q

What are the warning signs to look out for in CNS infection?

A 
Marked reduced consciousness (GCS <12) or fluctuating conscious level (fall >2)
Focal neurology
Seizure
Shock
Bradycardia and hypertension
Papilloedema
40
Q

What preventative strategies are used in CNS infection?

A

Report to public health

Give vaccines where appropriate - neisseria, HIb, strep pneumoniae

41
Q

When should a lumbar puncture not be performed before a CT?

A

Reduced consciousness
Seizures
Rapidly progressive rash (suspicious of VIC)

42
Q

Which organism is associated with gram negative diplococci?

A

Neisseria meningitis

43
Q

Which organism is associated with gram positive diplococci?

A

Strep pneumoniae

44
Q

Which antibiotic should be given as prophylaxis to people who have been in close contact with infectious meningitis?

A

Ciprofloxacin`

45
Q

What is the difference between petechia and purpura?

A

Petechia < 0.5cm

Purpura >0.5cm

46
Q

What is a complication of prescribing ceftriaxone?

A

C. diff infection

47
Q

How does a brain abscess appear on imaging?

A

Ring-enhancing lesion

48
Q

Outline the treatment for brain abcess

A

Ceftriaxone

Metronidazole

49
Q

Which organisms are mostly likely to trigger the formation of a brain abscess?

A

Streptococcoi
Bacteriodes (anaerobes)
G- bacilli (coliforms)

50
Q

Which organism is associated with gram positive flagellated rods? Who is at risk of infection?

A

Listeria

Neonates, pregnant woman, elderly

51
Q

Which organism is associated with gram negative coccobacillus?

A

Haemophillus influenzae

52
Q

HSV encephalitis has a preference towards affecting which lobes of the brain?

A

Temporal lobes

53
Q

What are the findings of CSF analysis in tuberculosis meningitis?

A 
Opaque (if left to settle it forms a fibrin web)
Elevated opening pressure
Lymphocytes present
High protein
Low glucose

Y3 NEUROLOGY (22 decks)

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