meningitis

Question 1

CNS syndromes- description matches: meningitis, encephalitis, or mass lesions:

Focal neurologic deficits

Answer 1

Mass lesions (focal infection in the brain tissue i.e. abscess)

Question 2

CNS syndromes- description matches: meningitis, encephalitis, or mass lesions:

Fever, headache, stiff neck

Answer 2

Meningitis (coverings of the brain)

Question 3

CNS syndromes- description matches: meningitis, encephalitis, or mass lesions:

Confusion, somnolence, seizures

Answer 3

Encephalitis (deeper, diffuse infection in the brain tissue)

Question 4

classical triad of meningitis

Answer 4

headache, fever and stiff neck

Question 5

CSF that is purulent: high WBC, mostly neutrophils and low glucose

Answer 5

bacterial cause

Question 6

CSF that is lymphocytic with low glucose: WBC elevated but less than purulent

Answer 6

TB, fungal, Spirochetes, listeria, sarcoidosis, CA

Question 7

CSF that is lymphocytic with normal glucose: WBC elevated but less than purulent and less thanlymphocytic with low glucose

Answer 7

viral

Question 8

type of meningitis risk:

neonate

Answer 8

Group B strep
E. coli
Listeria

Question 9

type of meningitis risk:

young adult

Answer 9

mening.>pneum

Question 10

type of meningitis risk:

older

Answer 10

pneum.> mening

listeria

Question 11

type of meningitis risk:

immunosuppressed

Answer 11

cryptococcus

listeria

Question 12

purulent meningitis:

“Lancet-shaped” gram-positive diplococci
Most common in older people
Vaccinate <2 yr. old children, the immunocompromised, and elderly >65

Answer 12

S. pneumoniae

Question 13

purulent: meningitis:

Kidney-shaped gram-neg 
diplo-cocci
Usually younger patients
May have a rash
College students in dorm

Answer 13

N. meningitidis

Question 14

if there is a high chance of a space occupying lesion what do you do?

Answer 14

CT head before LP if yes

Question 15

Empiric Treatment of Purulent Meningitis:

1. Neonate
2. Children and adults
3. Immunocompromised or older than 50

Answer 15

1. Neonate
   Ampicillin (strep B, Listeria) + cefotaxime (E coli)
2. Children and adults
   Ceftriaxone (CTX) + Vancomycin
   (Vancomycin for pen-resistant S. pneumo)
3. Immunocompromised or older than 50
   Ceftriaxone + vancomycin + ampicillin (for Listeria)

Question 16

steroids in bacterial meningitis

Answer 16

by giving dexamethasone with first doe of antibiotic or right before antibiotics there is better neurological outcomes (decreased chance of deafness)

Question 17

AIDS patient with meningitis, high opening pressure on lumbar puncture, encapsulated, budding yeast

Answer 17

think of Cyptococcal meningitis

Question 18

vancomycin CNS penetration?

Answer 18

poor penetration

Question 19

what penetrates better to the CNS? lipid soluble or lipid insoluble?

Answer 19

lipid soluble

Question 20

Sometimes with GI symptoms
Found in unpasturized dairy products and cold meats
Detected by culture
Suspect if really young (< 1 month), and the older (>50)
Suspect in the immunocompromised

Needs to be treated with ampicillin
Empirically give ampicillin to those <1 month of age and > 50 years of age and the immunosuppressed patient

Answer 20

listeria monocytogenes

Question 21

Summertime
Three distinct presentations: meningitis; encephalitis; poliomyelitis-like paralysis
Dx: Serum and CSF antibody tests

Answer 21

west nile virus

Question 22

drug induced meningitis: (3)

Answer 22

1. NSAIDs
2. Trimethoprim-sulfamethoxazole
3. IV immune globulin