Infections of the central nervous system

Question 1

Widespread rash, can be caused by toxins or drugs, microorganisms, or can result from autoimmune disease. Non-blanching

Answer 1

Exanthum

Question 2

Most common community acquired bacterial meningitis bugs in adults

Answer 2

S. pneumo, N. meningitidis, H. flu

Question 3

Most common community acquired bacterial meningitis bug in newborns

Answer 3

group B strep

Question 4

Most common bugs responsible for nosocomial bacterial meningitis

Answer 4

e. coli, k. pneumoniae, p. auruginosa

Question 5

Triad of meningitis

Answer 5

high fever, nuchal rigidity, change in mental status (lethargy)

Question 6

Typical LP findings for this disease include: Elevated opening pressure, Leukocytosis, increased protein, decreased glucose

Answer 6

meningitis

Question 7

Gram stain that suggests S. pneumo

Answer 7

gram-positive diplococci

Question 8

gram stain that suggest N. meningitidis

Answer 8

gram-negative diplococci

Question 9

Gram stain that suggests H. flu

Answer 9

Small pleomorphic gram-negative coccobacilli

Question 10

Empiric tx for community acquired meningitis aimed at s. pneumo and meningococcal

Answer 10

Cefotaxime IV (Claforan) or ceftriaxone IV (Rochephin) + vancomycin

Question 11

Empiric tx for nosocomial acquired meningitis

Answer 11

Ceftazidime + vancomycin

Question 12

Pharm tx that reduces mortality and neurologic disability in pts w/ Glasgow Coma Scale (GCS) scores of 8-11 and pneumococcal diagnosis

Answer 12

IV dexamethasone before or w/start of abx

Question 13

Childhood vaccines for the prevention of meningitis

Answer 13

HIB vaccine starting at 2 months and Pneumococcal conjugate vaccine (PCV13) for children under 2 yrs

Question 14

Most common cause of aseptic meningitis

Answer 14

enterovirus

Question 15

Type of meningeal inflammation w/ neg bacterial cultures,

Answer 15

aseptic meningitis

Question 16

Difference between bacterial and aseptic meningitis

Answer 16

Aseptic meningitis is a self-limited course that resolves without specific therapy

Question 17

Sx include: Fever, HA, stiff neck and photophobia

Answer 17

aseptic meningitis

Question 18

Tx for aseptic meningitis

Answer 18

If CSF with LP is fairly clear, you can observe pt without antibiotics. If uncertain, start on antibiotics and wait 24-48 hrs for culture results

Question 19

Most important distinguishing feature between encephalitis and meningitis?

Answer 19

Meningitis-cerebral fxn remains intact. Encephalitis- more severe mental status changes

Question 20

Sx include: altered mental status, seizures, focal neuro deficits, exaggerated DTRs, behavior or personality changes

Answer 20

encephalitis

Question 21

Most likely etiolgoy of encephalitis

Answer 21

Viral- west nile**

Question 22

Disease with CSF findings that may include: increased WBCs with differential showing mostly lymphocytes, Elevated protein, but < 150 mg/dL, Normal glucose

Answer 22

viral encephalitis

Question 23

Sx include: fever, stiff neck, sore throat, N/V. Eventually signs of UMN lesion (increased DTRs, spastic paralysis)

Answer 23

west nile virus

Question 24

CSF: Protein and opening pressure increased and there will be lymphocytic leukocytosis

Answer 24

west nile virus

Question 25

Most significant risk factor for developing severe neuro dz with West Nile Virus

Answer 25

advanced age

Question 26

Tx for West nile

Answer 26

supportive and ribavirin

Question 27

Sx include: fever, HA, blanching maculopapular rash on palms/soles that spreads centrally

Answer 27

rocky mtn spotted fever

Question 28

CSF: inc lymphocytes/PMN’s, inc protein; neg gram stain

Answer 28

rocky mtn spotted fever

Question 29

Etiology of rocky mtn spotted fever

Answer 29

rickettsia rickettsii (gm neg bacteria)

Question 30

Tx of Rocky Mtn Spotted fever

Answer 30

Doxycycline 100 BID x 7 days

Question 31

Lab results for this disease include hyponatremia, low platelets, elevated LFTs

Answer 31

Rocky Mtn Spotted Fever

Question 32

Etiology of Lyme Disease

Answer 32

Borrelia burgdorferi (deer tick)

Question 33

Most common cause of tick-bourne disease

Answer 33

Borrelia burgdorferi

Question 34

Sx include: erythema migrans rash initially, EM lesions and/or neurologic and/or cardiac findings, intermittent or persistent arthritis later stages

Answer 34

lyme disease

Question 35

First line early tx for lyme disease

Answer 35

Doxycycline - 100 mg BID for 21 to 28 days

Question 36

Tx for late or severe lyme disease

Answer 36

Cefotaxime (Claforan) or Penicillin G

Question 37

Describe as pus-filled cavity ringed by granulation tissue & outer fibrous capsule surrounded by edematous brain tissue

Answer 37

brain abscess

Question 38

Classic triad of brain abscess

Answer 38

HA, fever, focal deficit

Question 39

Sx of frontal lobe abscess

Answer 39

hemiparesis

Question 40

Sx of temporal lobe abscess

Answer 40

homonymous superior quadrant visual field deficit or aphasia

Question 41

Sx of cerebellar abscess

Answer 41

limb incoordination or nystagmus

Question 42

Contraindicated for brain abscess

Answer 42

LP