Lecture 10 - CNS Infections

Question 1

classic triad of meningitis:

Answer 1

nuchal rigidity, fever, mental status change;

also headache

Question 2

meningitis is due to inflammation of _____

Answer 2

leptomeninges (pia, arachnoid)

Question 3

Kernig sign:

Brudzinski’s sign:

Answer 3

can’t fully extend knee when supine (K for kernig);

flexion of neck causes flexion of legs/thighs

Question 4

bacterial meningits/signs:
_____ = meningitis with seizures and focal neurological deficits early;
_____ ____ = meningitis plus petechiae and palpable purpura

Answer 4

listeria;

neisseria meningitidis

Question 5

encephalitis vs meningitis:
altered mental status is especially associated with ____;
headache and neck pain are more associated with _____

Answer 5

encephalitis;

meningitis

Question 6

CSF findings in meningitis:

increased PMNs, ____ protein and ____ glucose are associated with _____ meningitis

Answer 6

increased, decreased;

bacterial

Question 7

CSF findings:

fungal and also _____ = increased _____ (cells), _____ protein, _____ glucose

Answer 7

Tb;

lymphocytes, increased, decreased

Question 8

Viral CSF findings:
______ (cell type);
normal/increased protein;
_____ glucose

Answer 8

increased lymphocytes (pleimorphic/hemorrhagic);
normal

Question 9

most common cause of meningitis overall?

newborns = _____ , _____ , ______

Answer 9

s pneumo;

group B strep, E. coli, listeria

Question 10

classic cause of meningitits in college students = ______
in unvaccinated kid = _____;
in HIV = ______

Answer 10

N. Meningiditis;
H. Flu;
cryptococcus

Question 11

S. pneumo vaccine:

PCV13 is the ____ vaccine and should be given to ____. causes a ____ response

Answer 11

conjugated;
kids;
IgG

according to FA

Question 12

PPSV23 is a _______ vaccine. should be given to ____ and causes a ____ response (according to FA)

Answer 12

polysaccharide (unvaccinated);

adults, IgM

Question 13

what nesseria m. serogroup does not have a widely available vaccine and thus causes most of the meningitis?

Answer 13

type B

Question 14

N. meningiditis colonizes the ____ in 10% of the population. what immunodeficiency causes increased risk of infection?

Answer 14

nasopharynx;

complement deficiency

Question 15

N. meningiditis:

treat patient with _____ typically. treat close contacts with _____

Answer 15

ceftriaxone;

rifampin (or cipro, ceftriaxone)

Question 16

for bacterial meningitis, give _____ emperically. if listeria is suspected, add ______

Answer 16

ceftriaxone and vancomycin (for s pneumo);

ampicillin

Question 17

what should you do if you find group B strep in pregnant woman’s vaginal canal at 36 weeks?

Answer 17

give mom penicillin

Question 18

most common cause of viral meningitis:

____ especially _____

Answer 18

enterovirus, coxsackie

especially in summer and fall

Question 19

HSV encecphalitis:
which type?
usually affects the ______. causes mental status changes, seizures, and/or ______

Answer 19

HSV1;
temporal lobe;
aphasia

Question 20

cryptococcus:
what do you use to visualize?
heavily \_\_\_\_\_ yeast;
\_\_\_\_\_\_ on CT
treat with \_\_\_\_\_

Answer 20

india ink;
encapsulated;
soap bubble lesion;
ampho B + flucytosine

Question 21

Mucor/Rhizopus:
clasically seen in who?
enters brain through .______;
______ abcess

Answer 21

DKA patients;
cribiform plant;
rhinocerebral

Question 22

lyme disease
stage 2 causes what CNS symptom?
what about stage 3?
treatment?

Answer 22

bilateral bell’s palsy;
encephalitis;
ceftriaxone for encephalitis (or doxy)

Question 23

tertiary syphillis causes tabes dorsalis, which results from ______ of _____ columns –> impaired _____ and sensory ataxia

Answer 23

demyelination/degeneration, dorsal;

propioception

Question 24

tabes dorsalis is associated with ____ joints, _____ pupils, and positive _____ sign

Answer 24

chacot;
argyll-robinson;
rhomberg

Question 25

tertiary neurosyphillis also causes “____ ____” which results in personality and emotional changes. characterized by ____ atrophy

Answer 25

general paresis;

frontal lobe

Question 26

treatment of syphillis:

Answer 26

penicillin G

Question 27

prion disease:
conversion of prion protein to a _____ form (PrPsc). causes ____ encephalopathy. can be sporadic, familial, or transmitted by eating _____ or receiving _____ transplant

Answer 27

beta-pleated;
sponigform (ie vacuoules);
human parts;
corneal

Question 28

creutzyfeldt jacob:

characterized by _____ dementia, _____ _____ (physical exam finding). _____ cortex

Answer 28

rapidly progressive;
startle myoclonus;
spongiform

Question 29

familial fatal insomina:
inherited ____ disease;
characterized by severe _____ and exaggerated ____ response

Answer 29

prion;
insomnia, startle

dysautonomia, endocrine disturbances

Question 30

brain abscess:
2 more common pathogens =
multiple abscesses indicates cause from _____;

Answer 30

s. viridans, s. aurues;

bacteremia

Question 31

brain abscess:
otitis media and mastoiditis can lead to ____ lobe abscess.
sinusitis or dental infection can lead to ___ lobe involvement

Answer 31

temporal;

frontal