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ABPP > Infections & HIV > Flashcards

Infections & HIV Flashcards

1
Q

Meningitis is usually caused by

A

Spread of an infectious agent via bloodstream from an infective focus elsewhere in the body

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2
Q

Clinical manifestations of meningitis

A

Rapid onset over several days; generalized HA, fever, vomiting, lethargy, stiff neck, confusion

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3
Q

Neurologic complications of meningitis

A

Seizures, focal cerebral signs, acute cerebral edema, CN dysfx (3, 4, 6, 7), hearing loss, HP, dysphagia, hemianopsia

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4
Q

Brain abscess can be caused by

A

Infection spread from middle ear or sinus
In assoc. w/ congenital heart disease
Spread of infection from distant site
Direct intro of bacteria following PHI

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5
Q

Cardinal symptom of brain abscess

A

Relentless & progressive HA, usually followed by focal neurological signs

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6
Q

Pott’s disease

A

TB in spinal column

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7
Q

Early symptoms of neurosyphilis

A

Fatigue, irritability, personality changes, forgetfulness, tremor

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8
Q

Symptoms of late stage neurosyphilis

A

Impaired memory & judgment, confusion, disorientation, seizures, dysarthria, myoclonus, poor motor control

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9
Q

General paresis

A

Accumulation of neurosyphilis lesions causes dementia, behavioral changes, delusions of grandeur, psychosis, & diffuse UMN-type weakness

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10
Q

Tabes dorsalis

A

In neurosyphilis, there is involvement of the spinal cord dorsal roots resulting in degeneration of dorsal columns

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11
Q

Lyme disease

A

Neuro manifestations after a delay of several weeks; untreated cases eventually show WM abnormalities; may involve memory impairment & difficulty with complex cognitive fx, irritability, depressed mood

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12
Q

Tetanus

A

Affects the motor unit of the PNS

Tonic contractions eventually appear secondary to continuous activity of multiple muscle groups

Also see nuchal rigidity, lockjaw, risus sardonicus, dysphagia

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13
Q

Herpes simplex affects which area of the brain most?

A

Limbic cortex/temporal lobe

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14
Q

Presentation of CNS involvement of herpes simplex

A

Bizarre psychotic behavior, confusion, lethargy, HA, fever, meningeal signs, seizures, focal signs

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15
Q

Subacute sclerosing panencephalitis is caused by

A

persistent infection of genetically mutated forms of the measles virus that escape immune clearance; latent period of 6-8 yrs

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16
Q

Initial symptoms of subacute sclerosing panencephalitis

A

mild mental deterioration followed by myoclonic jerks, seizures, vision loss

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17
Q

Advanced state of subacute sclerosing panencephalitis

A

muscle spasms/rigidity, progressive deterioration to comatose & then persistent vegetative state

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18
Q

Progressive multifocal leukoencephalopathy

A

Demyelination of CNS due to destruction of oligodendrocytes by the JC polyoma virus (JCV)

Mostly seen in immunocompromised individuals

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19
Q

How does toxoplasmosis present on neuroimaging?

A

Ring-enhancing lesions

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20
Q

Common presenting features of toxoplasmosis

A

seizures, HA, fever, lymphocytic predominant meningitis, focal signs; general subacute encephalopathy & language impairment

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21
Q

Varicella-zoster

A

Herpes virus that causes chickenpox, becomes latent in CN & dorsal-root ganglia, & frequently reactivates decades later to produce shingles & postherpetic neuralgia

22
Q

Varicella-zoster affects which cranial nerves?

A

5, 7, 3

23
Q

Neurological complications of rabies

A

Delirium, seizures, nuchal rigidity, paralysis, excitabilty

24
Q

Cysticercosis

A

Caused by ingestion of eggs of pork tapeworm, forms multiple cysts in muscles, eyes, & CNS

Seizures, HA, nausea, vomiting, lymphocytic meningitis, focal deficits

25
Q

Kuru

A

Chronic, rapidly progressing, fatal nervous system disease caused by prions & characterized by prominent ataxia, dysarthria, tremulousness, dementia in late stages

Shows severe cerebellar loss, spongiform changes, & prion-amyloid plaques

26
Q

Guillain-Barre syndrome

A

Post-infectious disease of peripheral myelin assoc. w/ paresthesias in the distal extremities & leg weakness

27
Q

How does sarcoidosis affect the CNS?

A

takes form of a granulomatous infiltration of the meninges & underlying parenchyma, most frequent at base of brain

Lesions - focal collections of epithelioid cells surrounded by rim of lymphocytes

28
Q

Retrovirus

A

Stores genetic info as RNA, releases RNA & an enzyme, making DNA using the viral RNA as a pattern; viral DNA is incorporated into host cell DNA

29
Q

CDC classification of HIV/AIDS

A

Category A: pts who have remained medically asymptomatic or have had only a transient illness
Category B: pts w/ more serious HIV-related conditions
Category C: pts who have more serious AIDS-defining illnesses

AIDS is diagnosed in those w/ CD4<200 and/or a category C complication

30
Q

What is the most common cause of CNS mass lesions in AIDS patients?

A

Toxoplasmosis

31
Q

Common opportunistic infections in HIV/AIDS patients

A

Yeast infections, crytococcal meningitis, mycobacterium avium complex, cryptosporidium, PML, cytomegalovirus encephalitis, Kaposi’s sarcoma, lymphomas, toxoplasmosis

32
Q

What percentage of AIDS patients may develop some form of CNS disease?

A

50-66%

33
Q

HIV-related mild neurocognitive disorder/minor cognitive motor disorder

A
  • Difficulty in concentrating, unusual fatigability, subjectively slowed down, mild memory
  • May be seen as anxiety, depression, or hypochondriasis
  • Difficulties w/ info processing speed, divided attention, sustained effortful processing, deficiencies in learning & recalling new info
  • Verbal skills less affected
34
Q

Diagnostic criteria for HIV-Associated dementia (HAD)

A
  • Acquired impairment in 2 domains of cognitive fx, w/ focus in learning, slowed info processing, distractibility/inattention
  • Verified by neurological, NP, or clinical eval
  • Marked interference w/ daily fx
  • Present for 1 mo or more
  • No alteration in consciousness
  • Ruling out other causative etiology
35
Q

AIDS dementia complex staging scheme (Sidtis & Price)

A
  • Stage 0 (normal)
  • Stage 0.5 (equivocal/subclinical): no impairment of work or ADL performance
  • Stage 1 (mild): able to perform all but more demanding asepcts of work or ADLs, can walk w/o assistance
  • Stage 2 (moderate): cannot work or maintain more demanding aspects of daily life, can perform basic self-care
  • Stage 3 (severe): major intellectual incapacity or motor disability
  • Stage 4 (end stage): nearly vegetative
36
Q

What are some psychosocial factors that should be considered with HIV/AIDS patients?

A

Stigmatism, may affect immediate social support, adjustment d/o, anxiety d/o, mood disorders, psychosis, substance use disorders (may/may not be pre-existing)

37
Q

Asceptic meningitis

A

Nonbacterial meningitis, can be inflammatory, idiopathic, or viral infection

38
Q

Cryptococcal meningitis

A

Meningitis caused by cryptococcus (yeast) infection; often result of opportunistic infection

Often presents with headache, CN involvement, & CSF obstruction

39
Q

Mollaret meningitis

A

Recurrent asceptic meningitis of unclear origin

40
Q

Mental status changes are more often associated with bacterial or viral meningitis?

A

Bacterial

41
Q

Meningismus

A

Meningeal irritation often caused by meningitis or SAH, carcinomatous meningitis, or chemical sensitivity

42
Q

6 common signs of meningismus

A

HA, lethargy, photo & phonophobia, fever, nuchal rigidity

43
Q

Common symptoms of brain abscess

A

HA, lethargy, fever, nuchal rigidity, nausea, vomiting, seizures, focal signs

44
Q

Where do epidural abcesses most often occur?

A

Spinal canal

45
Q

Neurological symptoms of Lyme disease

A

Often delayed by weeks; meningeal signs, emotional changes, impaired memory & cognition

46
Q

What is the most common cause of viral encephalitis?

A

HIV-1

47
Q

Cerebritis

A

Focal bacterial invasion of the brain parenchyma with no associated capsule or pus

48
Q

Granuloma

A

Focal, more or less encapsulated, chronic inflammatory lesion (e.g., sarcoidosis, syphilis, TB, fungi, larvae of intestinal parasites)

49
Q

Progressive multifocal leukoencephalopathy

A

Demyelinating viral infection of the brain

50
Q

Kaposi’s sarcoma

A

Tumor that appears as painless, red to purple, raised patches on skin

51
Q

Lymphomas

A

Tumors of the immune system which may 1st appear in brain or other internal organs; pts typically present with slowly progressive neuro deterioration & may die within 3 months

52
Q

The most common neurologic manifestation of HIV is

A

Emotional lability & delirium associated with HIV-associated dementia

ABPP (34 decks)

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