infections of the CNS

Question 1

risk factors for bacterial meningitis

Answer 1

exposure in packed social areas - e.g. festivals, university barracks
baby picks up strep B vaginal commensal from mother at birth

Question 2

common bacteria that cause meningitis

Answer 2

Neisseria meningitidis
Streptococcus pneumoniae
Group B Streptococcus

Question 3

less common bacteria that cause meningitis

Answer 3

Haemophilus influenzae

Listeria monocytogenes

Question 4

bacteria that may cause meningitis in the immunocompromised

Answer 4

Cryptococcus

TB

Question 5

viruses that may cause meningitis

Answer 5

Herpes simplex virus
Varicella zoster virus
enteroviruses

Question 6

classic triad of symptoms for meningitis

Answer 6

headache and stiff neck
photophobia
fever

Question 7

signs of bacterial meningitis

Answer 7

purpuric rash
CSF cloudy with increased protein and decreased glucose
polymorph neutrophils in CSF

Question 8

signs of viral meningitis

Answer 8

CSF clear with high glucose, low protein, and mononuclear white cells

Question 9

risk factors for septicaemia

Answer 9

immunodeficiency 
major trauma
burns
neonates
elderly

Question 10

what percentage of cases of septicaemia start as an infection in the lungs?

Answer 10

50%

Question 11

who must you call if a patient has Neisseria meningitidis?

Answer 11

Public Health England

Question 12

signs of septicaemia

Answer 12

shock - cold hands and feet
evolving rash
metabolic acidosis
coagulation disorder

Question 13

diagnosis of septicaemia

Answer 13

blood cultures

Question 14

treatment of septicaemia

Answer 14

airway support
fluid resuscitation
IV abx - ceftriaxone (and also amoxicillin if over 60 or immunocompromised)

Question 15

pathology of encephalitis

Answer 15

acute inflammation of brain parenchyma

Question 16

risk factors for encephalitis

Answer 16

living in areas with vector - tick

travel

Question 17

common causes of encephalitis

Answer 17

HSV, VZV, enterovirus

non-infective - autoimmune, paraneoplastic

Question 18

symptoms of encephalitis

Answer 18

confusion
decrease consciousness
fever
headache
seizures
preceding flu-like illness
±meningism

Question 19

diagnosis of encephalitis

Answer 19

EEG characteristics: parodic shave and slow wave complexes
culture and PCR of CSF
MRI - inflamed areas of brain appear white

Question 20

treatment of encephalitis if HSV or VZV

Answer 20

acyclovir

Question 21

treatment of encephalitis

Answer 21

supportive

Question 22

risk factors for shingles

Answer 22

prior varicella zoster infection

Question 23

pathology of shingles

Answer 23

varicella zoster reactivation, dormant in dorsal root ganglion

appears to be contained within a dermatome

Question 24

symptoms of shingles

Answer 24

pain in dermatomal distribution
doesn't cross midline
rash 
paraesthesia
hyperasthesia

Question 25

diagnosis of shingles

Answer 25

dermatomal pattern of rash

blood test for VZV specific IgM antibody

Question 26

treatment of shingles

Answer 26

acute: oral acyclovir

post-herpetic neuralgia: amitriptyline