Infectious Disease

Question 1

What three vaccines have led to a decrease in incidence of meningitis?

Answer 1

Hemophilus Influenza B
Pneumococcus
Meningococcus

Question 2

Meningitis is an infection of the __________ space.

Answer 2

subarachnoid

Question 3

Infection of the subarachnoid space leads to __________.

Answer 3

cerebral edema

Question 4

The classic signs and symptoms of meningitis are ___________.

Answer 4

fever, headache, nuchal rigidity, and depressed consciousness (100% have at least 2 of these; 40% have three)

Question 5

What is the mortality of bacterial meningitis?

Answer 5

20%

Question 6

The first step in managing suspected meningitis is ___________.

Answer 6

starting antibiotics (preferably within 60 minutes)

Question 7

The definitive diagnostic procedure for diagnosing meningitis is __________.

Answer 7

lumbar puncture

Question 8

CSF signs of meningitis are ___________.

Answer 8

pleocytosis, neutrophils greater than 80%, glucose less than 40 mg/dL, high protein, and culture/Gram stain

Question 9

What is papilledema?

Answer 9

Bulging of the optic disk in the eye (a sign of increased ICP)

Question 10

What are the most common bacterial species that cause neonatal meningitis?

Answer 10

• Group B Streptococcus (50%)
• Escherichia coli (14%)
• Streptococcus pneumoniae
• Neisseria meningitidis

Question 11

What are the most common bacterial species that cause infant-toddler meningitis?

Answer 11

Strep pneumo
N meningitidis
Group B Strep

Question 12

What are the most common bacterial species that cause adult meningitis?

Answer 12

2-35:

• Neisseria meningitidis (50% - 60%)
• Streptococcus pneumoniae

Older than 35:
- Streptococcus pneumoniae

Question 13

Research indicates that, in addition to antibiotics, _________ should also be given with or before the first antibiotics.

Answer 13

Corticosteroids (to decrease inflammation-related injuries)

Question 14

Altered conscious happens in ________ bacterial meningitis.

Answer 14

advanced

Question 15

What patients have atypical presentations of meningitis?

Answer 15

Infants and the elderly

Question 16

What is the most common mechanism that bacteria enter the meninges?

Answer 16

Hematogenously (less common are through adjacent infections and penetrating trauma)

Question 17

When should you not do an LP immediately?

Answer 17

Focal neurologic deficit
Papilledema
Prior CNS issues
Seizures
Decreased level of consciousness
Immunocompromised

Question 18

What is the normal CSF protein for adults and children?

Answer 18

Less than 50 for adults and 150 for children

Question 19

True or false: those with brain abscesses present with high CSF WBC.

Answer 19

False (because the white blood cells stay in the abscess)

Question 20

What antibiotics should be given to neonates with suspected meningitis?

Answer 20

Ampicillin

Cefotaxime / aminoglycoside

Question 21

What antibiotics should be given to people in the 3 month to 50 year age group?

Answer 21

Ceftriaxone or cefotaxime

Vancomycin

Question 22

What antibiotic should be given to the elderly with suspected meningitis?

Answer 22

Ampicillin
Vancomycin
Ceftriaxone

Question 23

What antibiotics should be given to immunocompromised patients with suspected meningitis?

Answer 23

Ampicillin
Meropenem / cefepime
Vancomycin

Question 24

Which bacterial species require the longest treatment plans?

Answer 24

Gram-negative bacteria and listeria

Question 25

Which strain of bacterial meningitis has been shown to benefit the most from steroid treatment?

Answer 25

Strep pneumo

Question 26

The three most common viruses that cause meningitis are ______________.

Answer 26

HSV-2
WNV (seasonal fall/summer)
Enterovirus (seasonal fall/summer) (80%)

Question 27

What CSF finding can indicate arbovirus (besides PCR)?

Answer 27

elevated IgM

Question 28

What clinical feature distinguishes encephalitis?

Answer 28

Neurologic impairment

Question 29

What two viruses cause the most mortality from encephalitis?

Answer 29

HSV-2 and WNV

Question 30

If a patient has hyperglycemia and suspected meningitis, what formula should be used to calculate their CSF glucose?

Answer 30

CSF:serum should be greater than 0.4 (if it is less, suspect bacterial meningitis)

Question 31

Listeria is Gram ___________.

Answer 31

positive

Question 32

What big outcome has steroid treatment been shown to prevent in developed countries?

Answer 32

Hearing loss (CN VIII palsy)

Question 33

HSV-1 is more likely to cause ____________.

Answer 33

encephalitis

Question 34

What is a non-cerebral sign of enterovirus infection?

Answer 34

Pharyngitis with macular rash

Question 35

Having antibodies to NMDA can mimic ______________.

Answer 35

viral encephalitis (so test the CSF for the antibody; if positive, immunosuppression is the treatment)

Question 36

True or false: most HSV encephalitis is primary.

Answer 36

False –most results from reactivation

Question 37

What is the etymology of arbovirus?

Answer 37

ARthropod-BOrne virus

Question 38

Most people with WNV display what symptoms?

Answer 38

Trick question… None! 80% are asymptomatic

Question 39

What is the MRI pattern of WNV?

Answer 39

Early: normal
Late: deep-brain nuclei affected

Question 40

Toxoplasmosis can lead to __________ in the brain.

Answer 40

cysts

Question 41

Describe the findings associated with cryptococcal meningitis infection.

Answer 41

Few lymphocytes

Elevated protein