Infections

Question 1

CNS infections are medical emergencies. True/False?

Answer 1

True

Brain and spinal cord do not regenerate once injured

Question 2

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

Answer 2

Meningitis
Encephalitis
Meningoencephalitis
Encephalomyelitis
Severe sepsis syndrome
Abscess

Question 3

When is the typical onset of viral meningitis?

Answer 3

Late summer/autumn

Question 4

Which viruses are typically responsible for viral meningitis?

Answer 4

Enteroviruses most common e.g. ECHO

HSV and other microbes also

Question 5

List investigations/diagnostic tools for viral meningitis

Answer 5

Viral stool culture
Throat swab
Lumbar puncture for CSF PCR

Question 6

Outline treatment for viral meningitis

Answer 6

Supportive - paracetamol, fluids, rest, dark room

Question 7

Which part of the brain does viral encephalitis affect?

Answer 7

Infection of brain parenchyma

Question 8

List the main causes of viral encephalitis

Answer 8

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

Question 9

Which viruses are the only treatable causes of viral encephalitis?

Answer 9

HSV

Varicella zoster

Question 10

List clinical features of viral encephalitis

Answer 10

Meningismus (rigidity, photophobia, headache)
Comatose
Seizures
Paralysis
Confusion, psychosis
Speech and memory deficit

Question 11

List investigations for viral encephalitis

Answer 11

Lumbar puncture
Electroencephalography (EEG)
MRI

Question 12

What is the main treatment for viral encephalitis?

Answer 12

IV aciclovir

Question 13

List the main causes of bacterial meningitis in neonates

Answer 13

Listeria monocytogenes
Group B Strep.
E. coli

Question 14

Which antibiotic combats Listeria monocytogenes?

Answer 14

Ampicillin/amoxicillin

Question 15

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

Answer 15

H. influenzae

Question 16

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

Answer 16

Neisseria meningitides from the throats of healthy carriers

Question 17

List the main causes of bacterial meningitis in adults

Answer 17

Strep. pneumoniae

Neisseria meningitides

Question 18

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

Answer 18

Pneumococcal (Strep. pneumoniae)

Question 19

List the main causes of bacterial meningitis in the immunocompromised

Answer 19

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

Question 20

List clinical features of bacterial meningitis

Answer 20

Meningismus
Vomiting
Pyrexia
Stiffness
Confusion
Rash

Question 21

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

Answer 21

True

Question 22

List investigations for bacterial meningitis

Answer 22

Blood cultures
Throat swab (meningococci)
Lumbar puncture for CSF

Question 23

CSF must be interpreted in 5 tubes - list them and their contents

Answer 23

1: haematology- cell count, differential
2: microbiology- gram stain, cultures
3: biochemistry- glucose, protein
4: haematology- cell count, differential
5: PCR if necessary

Question 24

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

Answer 24

True

Question 25

What is aseptic meningitis?

Answer 25

Non-pyogenic bacterial meningitis: low WBC count, normal glucose, small elevated protein

Question 26

List indications for hospital admission for bacterial meningitis

Answer 26

Altered consciousness Petechial rash Febrile, headache

Question 27

Which antibiotics are given for bacterial meningitis pre-hospital?

Answer 27

Penicillin | Ceftriaxone

Question 28

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

Answer 28

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

Question 29

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

Answer 29

Dampen down cerebral swelling caused by antibiotic treatment

Question 30

If a patient is penicillin-allergic, what antibiotic is given for bacterial meningitis?

Answer 30

Chloramphenicol