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🧠📖💯 > Infectious pt 1 > Flashcards

Infectious pt 1 Flashcards

1
Q

Confusion, stupor, coma, seizures. Cerebral infarctions.

A) Pure pia-arachnoiditis
B) Subpial encephalopathy
C) Thrombosis of meningeal veins
D) Ependymitis, choroidal plexitis

A

B) Subpial encephalopathy

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2
Q

Headache, stiff neck, Kernig and Brudzinski signs.

A) Pure pia-arachnoiditis
B) Subpial encephalopathy
C) Thrombosis of meningeal veins
D) Ependymitis, choroidal plexitis

A

A) Pure pia-arachnoiditis

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3
Q

Focal Seizures, focal cerebral defects. Most often after the first week

A) Pure pia-arachnoiditis
B) Subpial encephalopathy
C) Thrombosis of meningeal veins
D) Ependymitis, choroidal plexitis

A

C) Thrombosis of meningeal veins

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4
Q

NOT found in acute meningeal inflammation

A) Subpial encephalopathy
B) Pure pia-arachnoiditis
C) Thrombosis of meningeal veins
D) Subdural effusion
E) Ependymitis, choroidal plexitis
A

D) Subdural effusion (Subacute - chronic forms)

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5
Q

Most common causes of bacterial meningitis except:

A) S. pneumoniae
B) S. aureus
C) Group B Strep
D) L. monocytogenes

A

B. S. aureus

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6
Q

Pneumococcal meningitis can be preceded by an infection in the following areas EXCEPT:

A) Lungs
B) Ears
C) Sinuses
D) Heart valves
E) None of the above (all are possible areas)
A

E) None of the above

Pneumococcal meningitis can be preceded by an infection in the lungs, ears, sinuses, heart valves

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7
Q

Seizures are more common with w/c type of meningitis?

A. H. influenzae
B. Pneumococcal
C. Staphylococcal

A

A. H. Influenzae

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8
Q

CN abnormalities are more common with w/c type of meningitis?

A. H. influenzae
B. Pneumococcal
C. Staphylococcal

A

B. Pneumococcal

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9
Q

Most common causative agents for neonatal meningitis

A

E. coli and GBS

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10
Q

Clinical characteristics likely associated with an abnormal scan in pts with suspected meningitis EXCEPT:

a. Headache
b. Recent seizure
c. Gaze palsy
d. Confusion

A

a. Headache

Recent sz, coma/confusion, gaze palsy a/w abnormal scans in pts w/ suspected meningitis.

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11
Q

Which of the following bacterial etiologies of encephalitis can cause hemorrhagic and
inflammatory CSF?

a. Mycoplasma
b. Legionella
c. Bartonella
d. Listeria
e. Anthrax

A

e. Anthrax

Other etiologies of hemorrhagic CSF:

Viral - dengue, ebola, hantavirus

Amebic meningoenceph

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12
Q

Most specific & sensitive test for CSF otorrhea & rhinorrhea

A

B2-transferrin (tau)

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13
Q

Meningitis, mucosal ulceration, uveitis, orchitis

A

Behcet disease

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14
Q

Recurrent meningitis, iridocyclitis, poliosis, vitiligo

A

Vogt-Koyanagi-Harada Syndrome

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15
Q

Mollaret meningitis usually caused by what organism?

A

Herpes simplex

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16
Q

Empiric treatment for BM patients >50 yo

A

3rd G ceph + vancomycin + ampicillin

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17
Q

Empiric treatment for BM pts w/ head trauma/neurosurgery

A

Vancomycin + ceftazidime

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18
Q

Alternative antibiotic for pts allergic to penicillin & cephalosporins

A

Chloramphenicol

except for Listeria

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19
Q

Causative agent of nosocomial meningitis

A

Coagulase (+) S. aureus

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20
Q

Empiric treatment for BM pts w/ basilar skull fracture

A

3rd G ceph + vancomycin

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21
Q

Empiric treatment for BM pts who are immunocompromised

A

Vancomycin + ampicillin + ceftazidime

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22
Q

Empiric treatment for BM pts 0-4 weeks

A

Cefotaxime + ampicillin

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23
Q

Empiric treatment for BM pts 4-12 weeks

A

3rd G ceph + ampicillin + dexa

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24
Q

Empiric treatment for BM pts 3mos- 18 y

A

3rd G ceph + vancomycin + ampicillin

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25
Q

Patients with this causative agent will benefit from dexamethasone

A

Pneumococcus

  • dexa will reduce mortality, improve overall outcome
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26
Q

For meningococcal meningitis

a) Who should receive antibiotic prophylaxis?
b) Dose?

A

a) Household contacts

b) Ciprofloxacin x 1
Rifampin x 2 days

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27
Q

Which among the following has the highest mortality rate for meningitis?

a. Pneumococcal
b. H. influenzae
c. Meningococcal

A

a. Pneumococcal 15% - probably due to population affected

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28
Q

What is the Osler Triad?

A

Pneumococcal Meningitis
Pneumonia
Endocarditis

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29
Q

Which among the following has the highest frequency of neurologic sequelae

a. Pneumococcal
b. H. influenzae
c. Meningococcal

A

a. Pneumococcal

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30
Q

Treatment of m. pneumoniae?

A

Macrolides, tetracycline derivatives

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31
Q

Which can present with rhombencephalitis?

a. M. pneumoniae
b. L. monocytogenes
c. Meliodosis

A

b. L. monocytogenes

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32
Q

Which is not true about melioidosis?

a. Found in India and SEA
b. Presents w/ multiple abscesses
c. Diabetics are prone to this infection
d. Ashdown’s medium is used
e. Ceftriaxone is used to treat this

A

e. Ceftriaxone

Tx of melioidosis:

Ceftazidime x 14 days

TMP SMX +/- Doxycycline for eradication to prevent relapse

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33
Q

Which of the following is not true regarding Legionella?

a. Can present as transverse myelitis or diffuse encephalomyelitis
b. Treated with levofloxacin, moxifloxacin, or azithromycin
c. Serologic tests are vital to the diagnosis
d. Rifampin can be used as an alternative treatment
e. Can be seen via urine antigen

A

c. Serologic tests

these have little impact on decision-making

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34
Q

What is the a) etiologic agent and b) clinical presentation c) treatment of catscratch fever?

A

Agent:
bartonella henselae

Presentation:
Encephalopathy, seizures, optic neuritis
Axillary/cervical adenopathy after catscratch

HIV: focal vasculitis

Treatment:
Azithromycin, doxycycline

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35
Q

Related to ingestion of raw milk. Can present with Tuberculous-like osteomyelitis which can lead to spinal cord compression.

A

Brucellosis

Tx: doxycycline + strepto/genta/rifampin

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36
Q

Presents in middle-aged men with weight loss, GI symptoms, dementia (more common sx), oculomasticatory myorhythmia, supranuclear ophthalmoplegia

A

Whipple Disease
t. whipplei

Dx: (+) PAS in CSF

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37
Q

NOT true about subdural empyema

a. Malaise, fever, HA, vomiting are the first indications of intracranial spread
b. Occurs mainly in adults
c. Spreads from the frontal or ethmoid sinuses
d. Caused by staphylococcus in post cranial surgery pts
e. Caused by streptococci in pts w/ sinus origins

A

b. Occurs mainly in children

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38
Q

Organisms involved in intracranial septic thrombophlebitis?

A

Streptococci

Staphylococci

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39
Q

Which among the following is the most common source of brain abscess?

a. Direct extension
b. Metastatic
c. Osteomyelitis
d. None of the above

A

b. Metastatic

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40
Q

Most common congenital heart disease associated with Brain Abscess

A

Tetralogy of Fallot

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41
Q

Most common etiologic agent of brain abscess

A

Virulent streptococci

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42
Q

Etiologic agent of brain abscesses 2/2 lung or paranasal sinuses?

a. Staphylococcal
b. Anaerobic streptococci
c. Gram negative
d. Enteric anaerobes

A

b. anaerobic streptococci

Staph - trauma, endocarditis, IV drug users

Enteric - otitic infections

Gram neg - oral

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43
Q

What are the stages of brain abscess?

A

Early cerebritis (1–4 days)

Late cerebritis (4–10 days)

Early capsule formation (11–14 days)

Late capsule formation (>14 days).

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44
Q

What is the most frequent initial symptom of brain abscess?

A

Headache

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45
Q

Antibiotic coverage for cerebritis and early abscess formation

A

Vancomycin
2nd-3rd G ceph
Meropenem/Metronidazole

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46
Q

Antibiotic coverage for brain abscess of oral origin

A

Penicillin + Metronidazole or 3rd-4th gen ceph

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47
Q

TB meningitis etiologic agent for post NSx procedure pts

A

M. fortuitum

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48
Q

In terms of location / invasion, what makes TB meningitis unique vs typical bacterial meningitis?

A

TB men is not confined to the subarachnoid space.

It penetrates pia and ependyma.

Meningoencephalitis

49
Q

Most common clinical feature of TB meningitis

a. Headache
b. Stiff neck
c. Fever
d. Malaise

A

b. Stiff neck

50
Q

In the first 2 months, TB meningitis can be treated with HRZE or what combination?

A

HRZ + Moxifloxacin

51
Q

What do you add for MDR TB?

A

Ethionamide (ETA)

52
Q

What is the single most effective drug for TB?

a. Isoniazid
b. Rifampin
c. Pyrazinamide
d. Ethambutol

A

a. Isoniazid

53
Q

Identify TB drug associated with this ADR:

Gastric irritation

A

Ethionamide

54
Q

Identify TB drug associated with this ADR:

Optic neuropathy

A

Ethambutol and ETA

EMB above 20m/kg

55
Q

Identify TB drug associated with this ADR:

Rash, GI, hepatitis

A

Pyrazinamide

56
Q

Identify TB drug associated with this ADR:

Neuropathy, hepatitis

A

Isoniazid

57
Q

Anti TB drugs that can be given parenterally

A

Isoniazid

Rifampin

58
Q

Which TB drugs have the highest penetration of BBB?

A

Isoniazid

Pyrazinamide

59
Q

What is the initial event in neurosyphilis?

A

Meningitis

60
Q

Which among the following is “virtually diagnostic” of neurosyphilis?

a. CSF VDRL
b. Serum VDRL
c. Serum FTA-ABS
d. CSF FTA0ABS

A

a. CSF VDRL

- highest specificity in symptomatic NS

61
Q

“Most reliable” test for NS

A

T. pallidum immobilization test

expensive, difficult to perform, not widely available

62
Q

What is the most common form of neurosyphilis?

a. Asymptomatic
b. Meningeal
c. Meningovascular
d. Paretic
e. Tabetic

A

c. Meningovascular syphilis

63
Q

Most common time of occurrence of meningovascular syphilis?

A

6-7 years after the original infection

64
Q

Notable pathologic change in meningovascular syphilis?

A

Heubner arteritis

65
Q

Most commonly infarcted territories in Heubner arteritis?

A

Distal territories of small-medium caliber lenticulostriate branches

66
Q

When does paretic neurosyphilis occur?

A

15-20 years after original infection

67
Q

Microscopic changes in dementia paralytica are seen most pronounced in which structures of the brain?

A

Frontal and temporal lobes

68
Q

Most prominent feature in the late established phase of Tabes Dorsalis?

A

Ataxia

69
Q

What is Erb spastic paraplegia?

A

Syphilitic meningomyelitis

Gumma of spinal meninges and cord

70
Q

Spinal meningovascular syphilis can take the form of?

A

ASA syndrome

71
Q

What is the Jarisch-Herxheimer reaction?

A

Side effect of Penicillin that presents with mild temperature elevation and systemic leukocytosis after the first dose

72
Q

What is the initial manifestation of Lyme Disease?

A

Erythema chronicum migrans

73
Q

Most common neurologic manifestation of Lyme Disease?

A

Bilateral facial palsy

74
Q

What is Bannwarth Syndrome?

A

In pts w/ Lyme Disease

Painful cauda equina meningoradiculitis

75
Q

Alternative treatment for neurosyphilis in HIV patients

A

Doxycycline

76
Q

Treatment for the first stage (rash, CN palsies) of Lyme Disease

A

Doxycycline x 2 weeks

Alternatives:
amoxicillin, cefuroxime

77
Q

Treatment for advanced Lyme Disease (meninges, central/peripheral NS implicated)

A

Ceftriaxone x 4 weeks

Alternatives:
Tetracycline, Cefotaxime, Pen G

78
Q

Which of the following is NOT true of Leptospirosis?

a. Can present with hepatitis, aseptic meningitis, renal failure (extreme - Weil disease)
b. Prominent conjunctival suffusion and photophobia are typical
c. Can cause subarachnoid and intracerebral bleeding due to inflamed vessels
d. Treatment should be implemented once cluster of symptoms appear

A

NOT true
d.Treatment should be implemented once cluster of symptoms appear

ANS: Treatment effective only if implemented during initial febrile phase

79
Q

Alternative treatment for Neurosyphilis in patients with allergies

A

Ceftriaxone

80
Q

Most valuable initial screening for Lyme Disease?

A

ELISA

81
Q

Most common presentation of meningovascular lesions in Cryptococcal meningitis?

A

Pure motor hemiplegia

82
Q

What is the primary treatment regimen for Cryptococcal meningitis?

A

Amphotericin B x 6 weeks

Flucytosine

83
Q

Treatment regimen for HIV pts with cryptococcal meningitis?

A

Ampho + Fluco for 2 more weeks

Fluconazole x 1 year to prevent relapse

Can be d/c if CD4 > 100/mm3

84
Q

Most frequent opportunistic fungal infection?

A

Candidiasis

85
Q

Most common source of aspergillosis of the brain?

A

Chronic sinusitis (sphenoidal)

    • osteomyelitis of the skull base 2/2 otitis, mastoiditis
86
Q

Treatment of Mucormycosis?

A

Amphotericin / posaconazole

Rapid correction of hyperglycemia and acidosis

Debridement -> enucleation

87
Q

Treatment of Coccidiomycosis?

A

Ampho B

Ommaya reservoir

88
Q

Treatment of histoplasmosis, blastomycosis, actinomycosis?

A

Ampho B + fluconazole

Relapse: intrathecal ampho via reservoir

89
Q

Difference in transmission: Epidemic vs. Endemic vs. Scrub typhus?

A

Epidemic typhus: lice -> humans -> humans

Endemic typhus: rats -> fleas -> humans

Scrub (tsutsugamushi fever) typhus: rats -> mites

90
Q

Dermatologic sign of scrub typhus or tsutsugamushi fever?

A

Necrotic ulcer and eschar at the site of attachment

91
Q

Which among the following rickettsial diseases is NOT associated with an exanthem?

a. Typhus
b. Q fever
c. Rocky Mountain spotted fever
d. Tsutsugamushi fever

A

b. Q fever

- main symptom: low-grade meningitis

92
Q

Which of the following is NOT a source of Toxoplasmosis?

a. Cat feces
b. Raw beef
c. Spoiled chicken
d. Uncooked mutton

A

c. Chicken

Sources of toxo:
Cat feces
Raw beef
Uncooked mutton (handling of)

93
Q

Toxoplasmosis is expected to occur in CD4 counts of ____?

A

CD4 < 100/ul

94
Q

Treatment of Toxoplasmosis?

A

Sulfadiazine + Pyrimethamine

Alternatives:
TMP-SMX

95
Q

Duration of treatment for Toxoplasmosis?

a. In immunocompetent pts
b. In HIV pts

A

Immunocompetent: 6 weeks

HIV: Until CD4 200-250 x 6 mos or more

96
Q

Causative agent of Amebic Meningoencephalitis?

A

Naegleria fowleri

> > acanthamoeba, balamuthia

97
Q

Which is true of amebic meningoencephalitis?

a. Found in swimming pools
b. Gradual onset
c. Benign condition
d. One can see RBCs in CSF

A

D. RBCs in the CSF

98
Q

What are Durck nodes and in what disease can these be found?

A

Small foci of necrosis surrounded by glia, found in Cerebral Malaria (Adams)

99
Q

Which of the following are “common features” of cerebral malaria?

a. Headache
b. Seizures
c. Bruxism & hiccups
d. Coma

A

c. Bruxism and hiccups

100
Q

What is the treatment for cerebral malaria?

A

Quinine and artesunate

Others:
Mefloquine, artemether w/ lumefantrine, atovaquone

101
Q

What are the 2 types of Trypanosomiasis, their etiologic agents, and their countries of origin?

A

African Type / Sleeping Sickness
T. brucei, rhodesiense, gambiense via tsetse fly

Chagas - South America
T. cruzi via reduviid bug bitten animals

102
Q

What is the Winterbottom Sign and in what disease entity can this be found?

A

Posterior cervical adenopathy, feature of subsequent CNS infection

Found in African Type/Sleeping Sickness

103
Q

What is Kerandel hyperesthesia and in what disease entity can this be found?

A

Pronounced pain at sites of minor injury.

Found in African Type/Sleeping Sickness

104
Q

What is the disease progression in Trypanosomiasis?

A

Begins w/ chancre + lymphadenopathy

2nd year of infection: parasitemia -> diffuse meningoencephalitis

105
Q

Which of the following are unique in Chagas Disease?

a. Reversal of circadian sleep rhythm
b. Vacant facial expression
c. Ptosis, ophthalmoplegia
d. Esophageal and colonic motility disorders, cardiac disease

A

d. Esophageal and colonic motility disorders, cardiac disease

106
Q

What’s the treatment for Gambiense and Chagas?

A

Gambiense: Nifurtimox + Eflornithine

Chagas: Nifurtimox + Benznidazole

**For early stage african: Pentamidine, suramin
(less effective once w/ NS sx)

107
Q

Which of the following Nematodes causes seizures?

a. Trichinosis
b. Gnathostomiasis
c. Strongyloidiasis
d. Visceral larva migrans

A

c. Strongyloidiasis

108
Q

What parasite causes a solid “Chitinoma”?

A

Echinococcus: Hydatid Disease

Chitinoma: solid nodular brain lesion

109
Q

Which parasites can cause myelitis/myelopathy?

A

Strongyloides - myelitis

Schistosomiasis - myelopathy

110
Q

Which organ is often involved in Trichinosis?

A

Heart

myocarditis -> brain embolism

111
Q

This Cestode is the most common cause of acquired epilepsy in many developing countries

A

Neurocysticercosis

112
Q

Caused by taenia multiceps.
Definitive hosts are dogs in sheep-raising areas.
Presents w/ grape-like cysts in the posterior fossa

A

Cerebral Coenuriasis

113
Q

Common agents of Schisto?

A

S. japonicum (more common)
S. hematobium
S. mansoni

114
Q

Where can S. Japonicum and Mansoni be found?

A

S. Japonicum - hemispheres

S. Mansoni - spinal cord

115
Q

What are the initial symptoms of Schistosomiasis?

A

Swimmer’s itch
Large serpiginous urticarial rash on the trunk
Katayama fever (if w/ prior exposure)

116
Q

Identified endemic areas for Schistosomiasis in the Philippines

A

Mindoro Oriental and Sorsogon in Southern Luzon

North, East and Western Samar; Leyte; and Bohol in Eastern Visayas,

All the provinces of Mindanao with the exception of Misamis Oriental, Davao Oriental and Maguindanao.

117
Q

Treatment of Schistosomiasis

A

Praziquantel 20mg/kg TID

118
Q

Which food items are a/w Angiostrongylus infections?

A

Snails, prawns (freshwater)

Lettuce (unwashed)

119
Q

What are the main manifestations of Angiostrongylus infections?

A

Pain, paresthesias
Sensorimotor abnormalities
Confusional state

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