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
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
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
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)
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
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
7
Q
Seizures are more common with w/c type of meningitis?
A. H. influenzae
B. Pneumococcal
C. Staphylococcal
A
A. H. Influenzae
8
Q
CN abnormalities are more common with w/c type of meningitis?
A. H. influenzae
B. Pneumococcal
C. Staphylococcal
A
B. Pneumococcal
9
Q
Most common causative agents for neonatal meningitis
A
E. coli and GBS
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.
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
12
Q
Most specific & sensitive test for CSF otorrhea & rhinorrhea
A
B2-transferrin (tau)
13
Q
Meningitis, mucosal ulceration, uveitis, orchitis
A
Behcet disease
14
Q
Recurrent meningitis, iridocyclitis, poliosis, vitiligo
A
Vogt-Koyanagi-Harada Syndrome
15
Q
Mollaret meningitis usually caused by what organism?
A
Herpes simplex
16
Q
Empiric treatment for BM patients >50 yo
A
3rd G ceph + vancomycin + ampicillin
17
Q
Empiric treatment for BM pts w/ head trauma/neurosurgery
A
Vancomycin + ceftazidime
18
Q
Alternative antibiotic for pts allergic to penicillin & cephalosporins
A
Chloramphenicol
except for Listeria
19
Q
Causative agent of nosocomial meningitis
A
Coagulase (+) S. aureus
20
Q
Empiric treatment for BM pts w/ basilar skull fracture
A
3rd G ceph + vancomycin
21
Q
Empiric treatment for BM pts who are immunocompromised
A
Vancomycin + ampicillin + ceftazidime
22
Q
Empiric treatment for BM pts 0-4 weeks
A
Cefotaxime + ampicillin
23
Q
Empiric treatment for BM pts 4-12 weeks
A
3rd G ceph + ampicillin + dexa
24
Q
Empiric treatment for BM pts 3mos- 18 y
A
3rd G ceph + vancomycin + ampicillin
25
Patients with this causative agent will benefit from dexamethasone
Pneumococcus
- dexa will reduce mortality, improve overall outcome
26
For meningococcal meningitis
a) Who should receive antibiotic prophylaxis?
b) Dose?
a) Household contacts
b) Ciprofloxacin x 1
Rifampin x 2 days
27
Which among the following has the highest mortality rate for meningitis?
a. Pneumococcal
b. H. influenzae
c. Meningococcal
a. Pneumococcal 15% - probably due to population affected
28
What is the Osler Triad?
Pneumococcal Meningitis
Pneumonia
Endocarditis
29
Which among the following has the highest frequency of neurologic sequelae
a. Pneumococcal
b. H. influenzae
c. Meningococcal
a. Pneumococcal
30
Treatment of m. pneumoniae?
Macrolides, tetracycline derivatives
31
Which can present with rhombencephalitis?
a. M. pneumoniae
b. L. monocytogenes
c. Meliodosis
b. L. monocytogenes
32
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
e. Ceftriaxone
Tx of melioidosis:
Ceftazidime x 14 days
TMP SMX +/- Doxycycline for eradication to prevent relapse
33
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
c. Serologic tests
these have little impact on decision-making
34
What is the a) etiologic agent and b) clinical presentation c) treatment of catscratch fever?
Agent:
bartonella henselae
Presentation:
Encephalopathy, seizures, optic neuritis
Axillary/cervical adenopathy after catscratch
HIV: focal vasculitis
Treatment:
Azithromycin, doxycycline
35
Related to ingestion of raw milk. Can present with Tuberculous-like osteomyelitis which can lead to spinal cord compression.
Brucellosis
Tx: doxycycline + strepto/genta/rifampin
36
Presents in middle-aged men with weight loss, GI symptoms, dementia (more common sx), oculomasticatory myorhythmia, supranuclear ophthalmoplegia
Whipple Disease
t. whipplei
Dx: (+) PAS in CSF
37
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
b. Occurs mainly in children
38
Organisms involved in intracranial septic thrombophlebitis?
Streptococci
| Staphylococci
39
Which among the following is the most common source of brain abscess?
a. Direct extension
b. Metastatic
c. Osteomyelitis
d. None of the above
b. Metastatic
40
Most common congenital heart disease associated with Brain Abscess
Tetralogy of Fallot
41
Most common etiologic agent of brain abscess
Virulent streptococci
42
Etiologic agent of brain abscesses 2/2 lung or paranasal sinuses?
a. Staphylococcal
b. Anaerobic streptococci
c. Gram negative
d. Enteric anaerobes
b. anaerobic streptococci
Staph - trauma, endocarditis, IV drug users
Enteric - otitic infections
Gram neg - oral
43
What are the stages of brain abscess?
Early cerebritis (1–4 days)
Late cerebritis (4–10 days)
Early capsule formation (11–14 days)
Late capsule formation (>14 days).
44
What is the most frequent initial symptom of brain abscess?
Headache
45
Antibiotic coverage for cerebritis and early abscess formation
Vancomycin
2nd-3rd G ceph
Meropenem/Metronidazole
46
Antibiotic coverage for brain abscess of oral origin
Penicillin + Metronidazole or 3rd-4th gen ceph
47
TB meningitis etiologic agent for post NSx procedure pts
M. fortuitum
48
In terms of location / invasion, what makes TB meningitis unique vs typical bacterial meningitis?
TB men is not confined to the subarachnoid space.
It penetrates pia and ependyma.
Meningoencephalitis
49
Most common clinical feature of TB meningitis
a. Headache
b. Stiff neck
c. Fever
d. Malaise
b. Stiff neck
50
In the first 2 months, TB meningitis can be treated with HRZE or what combination?
HRZ + Moxifloxacin
51
What do you add for MDR TB?
Ethionamide (ETA)
52
What is the single most effective drug for TB?
a. Isoniazid
b. Rifampin
c. Pyrazinamide
d. Ethambutol
a. Isoniazid
53
Identify TB drug associated with this ADR:
Gastric irritation
Ethionamide
54
Identify TB drug associated with this ADR:
Optic neuropathy
Ethambutol and ETA
| EMB above 20m/kg
55
Identify TB drug associated with this ADR:
Rash, GI, hepatitis
Pyrazinamide
56
Identify TB drug associated with this ADR:
Neuropathy, hepatitis
Isoniazid
57
Anti TB drugs that can be given parenterally
Isoniazid
| Rifampin
58
Which TB drugs have the highest penetration of BBB?
Isoniazid
| Pyrazinamide
59
What is the initial event in neurosyphilis?
Meningitis
60
Which among the following is "virtually diagnostic" of neurosyphilis?
a. CSF VDRL
b. Serum VDRL
c. Serum FTA-ABS
d. CSF FTA0ABS
a. CSF VDRL
| - highest specificity in symptomatic NS
61
"Most reliable" test for NS
T. pallidum immobilization test
| expensive, difficult to perform, not widely available
62
What is the most common form of neurosyphilis?
a. Asymptomatic
b. Meningeal
c. Meningovascular
d. Paretic
e. Tabetic
c. Meningovascular syphilis
63
Most common time of occurrence of meningovascular syphilis?
6-7 years after the original infection
64
Notable pathologic change in meningovascular syphilis?
Heubner arteritis
65
Most commonly infarcted territories in Heubner arteritis?
Distal territories of small-medium caliber lenticulostriate branches
66
When does paretic neurosyphilis occur?
15-20 years after original infection
67
Microscopic changes in dementia paralytica are seen most pronounced in which structures of the brain?
Frontal and temporal lobes
68
Most prominent feature in the late established phase of Tabes Dorsalis?
Ataxia
69
What is Erb spastic paraplegia?
Syphilitic meningomyelitis
| Gumma of spinal meninges and cord
70
Spinal meningovascular syphilis can take the form of?
ASA syndrome
71
What is the Jarisch-Herxheimer reaction?
Side effect of Penicillin that presents with mild temperature elevation and systemic leukocytosis after the first dose
72
What is the initial manifestation of Lyme Disease?
Erythema chronicum migrans
73
Most common neurologic manifestation of Lyme Disease?
Bilateral facial palsy
74
What is Bannwarth Syndrome?
In pts w/ Lyme Disease
| Painful cauda equina meningoradiculitis
75
Alternative treatment for neurosyphilis in HIV patients
Doxycycline
76
Treatment for the first stage (rash, CN palsies) of Lyme Disease
Doxycycline x 2 weeks
Alternatives:
amoxicillin, cefuroxime
77
Treatment for advanced Lyme Disease (meninges, central/peripheral NS implicated)
Ceftriaxone x 4 weeks
Alternatives:
Tetracycline, Cefotaxime, Pen G
78
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
NOT true
d.Treatment should be implemented once cluster of symptoms appear
ANS: Treatment effective only if implemented during initial febrile phase
79
Alternative treatment for Neurosyphilis in patients with allergies
Ceftriaxone
80
Most valuable initial screening for Lyme Disease?
ELISA
81
Most common presentation of meningovascular lesions in Cryptococcal meningitis?
Pure motor hemiplegia
82
What is the primary treatment regimen for Cryptococcal meningitis?
Amphotericin B x 6 weeks
| Flucytosine
83
Treatment regimen for HIV pts with cryptococcal meningitis?
Ampho + Fluco for 2 more weeks
Fluconazole x 1 year to prevent relapse
Can be d/c if CD4 > 100/mm3
84
Most frequent opportunistic fungal infection?
Candidiasis
85
Most common source of aspergillosis of the brain?
Chronic sinusitis (sphenoidal)
- + osteomyelitis of the skull base 2/2 otitis, mastoiditis
86
Treatment of Mucormycosis?
Amphotericin / posaconazole
Rapid correction of hyperglycemia and acidosis
Debridement -> enucleation
87
Treatment of Coccidiomycosis?
Ampho B
Ommaya reservoir
88
Treatment of histoplasmosis, blastomycosis, actinomycosis?
Ampho B + fluconazole
Relapse: intrathecal ampho via reservoir
89
Difference in transmission: Epidemic vs. Endemic vs. Scrub typhus?
Epidemic typhus: lice -> humans -> humans
Endemic typhus: rats -> fleas -> humans
Scrub (tsutsugamushi fever) typhus: rats -> mites
90
Dermatologic sign of scrub typhus or tsutsugamushi fever?
Necrotic ulcer and eschar at the site of attachment
91
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
b. Q fever
| - main symptom: low-grade meningitis
92
Which of the following is NOT a source of Toxoplasmosis?
a. Cat feces
b. Raw beef
c. Spoiled chicken
d. Uncooked mutton
c. Chicken
Sources of toxo:
Cat feces
Raw beef
Uncooked mutton (handling of)
93
Toxoplasmosis is expected to occur in CD4 counts of ____?
CD4 < 100/ul
94
Treatment of Toxoplasmosis?
Sulfadiazine + Pyrimethamine
Alternatives:
TMP-SMX
95
Duration of treatment for Toxoplasmosis?
a. In immunocompetent pts
b. In HIV pts
Immunocompetent: 6 weeks
HIV: Until CD4 200-250 x 6 mos or more
96
Causative agent of Amebic Meningoencephalitis?
Naegleria fowleri
>> acanthamoeba, balamuthia
97
Which is true of amebic meningoencephalitis?
a. Found in swimming pools
b. Gradual onset
c. Benign condition
d. One can see RBCs in CSF
D. RBCs in the CSF
98
What are Durck nodes and in what disease can these be found?
Small foci of necrosis surrounded by glia, found in Cerebral Malaria (Adams)
99
Which of the following are "common features" of cerebral malaria?
a. Headache
b. Seizures
c. Bruxism & hiccups
d. Coma
c. Bruxism and hiccups
100
What is the treatment for cerebral malaria?
Quinine and artesunate
Others:
Mefloquine, artemether w/ lumefantrine, atovaquone
101
What are the 2 types of Trypanosomiasis, their etiologic agents, and their countries of origin?
African Type / Sleeping Sickness
T. brucei, rhodesiense, gambiense via tsetse fly
Chagas - South America
T. cruzi via reduviid bug bitten animals
102
What is the Winterbottom Sign and in what disease entity can this be found?
Posterior cervical adenopathy, feature of subsequent CNS infection
Found in African Type/Sleeping Sickness
103
What is Kerandel hyperesthesia and in what disease entity can this be found?
Pronounced pain at sites of minor injury.
Found in African Type/Sleeping Sickness
104
What is the disease progression in Trypanosomiasis?
Begins w/ chancre + lymphadenopathy
2nd year of infection: parasitemia -> diffuse meningoencephalitis
105
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
d. Esophageal and colonic motility disorders, cardiac disease
106
What's the treatment for Gambiense and Chagas?
Gambiense: Nifurtimox + Eflornithine
Chagas: Nifurtimox + Benznidazole
**For early stage african: Pentamidine, suramin
(less effective once w/ NS sx)
107
Which of the following Nematodes causes seizures?
a. Trichinosis
b. Gnathostomiasis
c. Strongyloidiasis
d. Visceral larva migrans
c. Strongyloidiasis
108
What parasite causes a solid "Chitinoma"?
Echinococcus: Hydatid Disease
| Chitinoma: solid nodular brain lesion
109
Which parasites can cause myelitis/myelopathy?
Strongyloides - myelitis
Schistosomiasis - myelopathy
110
Which organ is often involved in Trichinosis?
Heart
myocarditis -> brain embolism
111
This Cestode is the most common cause of acquired epilepsy in many developing countries
Neurocysticercosis
112
Caused by taenia multiceps.
Definitive hosts are dogs in sheep-raising areas.
Presents w/ grape-like cysts in the posterior fossa
Cerebral Coenuriasis
113
Common agents of Schisto?
S. japonicum (more common)
S. hematobium
S. mansoni
114
Where can S. Japonicum and Mansoni be found?
S. Japonicum - hemispheres
| S. Mansoni - spinal cord
115
What are the initial symptoms of Schistosomiasis?
Swimmer's itch
Large serpiginous urticarial rash on the trunk
Katayama fever (if w/ prior exposure)
116
Identified endemic areas for Schistosomiasis in the Philippines
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
Treatment of Schistosomiasis
Praziquantel 20mg/kg TID
118
Which food items are a/w Angiostrongylus infections?
Snails, prawns (freshwater)
| Lettuce (unwashed)
119
What are the main manifestations of Angiostrongylus infections?
Pain, paresthesias
Sensorimotor abnormalities
Confusional state
