Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neuro > Meningitis + HIV CNS Infections B&B > Flashcards

Meningitis + HIV CNS Infections B&B Flashcards

1
Q

what are the symptoms of meningitis? (4)

A
  1. fever
  2. headache
  3. photophobia
  4. nuchal rigidity (hurts to move back of neck)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

positive Kernig and Brudzinski signs both indicate what?

A

Kernig sign: thigh bent at hip 90*, subsequent knee extension is painful

Brudzinski sign: paying lying flat, lift head off table, legs involuntarily lift (to relieve discomfort)

both signs of meningitis (could also be subarachnoid hemorrhage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is a normal opening pressure on spinal tap?

A

250mm H2O - note patient must be laying on their side (falsely raised if sitting up)

pressure >250 may indicate bacterial/fungal/TB/viral infection or hydrocephalus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

which is more severe meningitis, bacterial or viral?

A

bacterial is more severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how do CSF findings differ for meningitis caused by:
a. bacterial
b. viral
c. fungal/TB

A

a. bacterial: HIGH PMNs, HIGH protein, low glucose

b. viral: HIGH lymphocytes, normal/high protein, normal glucose

c. fungal/TB: HIGH lymphocytes, HIGH protein, low glucose

[normal CSF has 0-5 lymphocytes, <45mg/dl protein, >45mg/dl glucose]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

A spinal tap is performed on a pt admitted for meningitis. CSF shows high lymphocytes, high protein, and low glucose. Is the source of their meningitis:
a. bacterial
b. viral
c. fungal/TB

A

c. fungal/TB

bacterial: HIGH PMNs, HIGH protein, low glucose
viral: HIGH lymphocytes, normal/high protein, normal glucose
fungal/TB: HIGH lymphocytes, HIGH protein, low glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the 4 antibiotics used to treat meningitis?

A
  1. ceftriaxone
  2. vancomycin
  3. ampicillin
  4. gentamycin

these are used because they all have good CSF penetration!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the most common causes of infectious meningitis in:
a. newborns (0-6mo) - 3
b. children (6mo-6yrs) - 4
c. young adults (6-60yrs) - 4
d. elderly (60+) - 3

A

a. newborns (0-6mo): Group B Strep (Agalactiae), E. coli, Listeria

b. children (6mo-6yrs): S. pneumo, N. meningitidis, H. Flu B, enteroviruses

c. young adults (6-60yrs): S. pneumo, N. meningitidis, enteroviruses, HSV

d. elderly (60+): S. pneumo, Gram (-) rods, Listeria

[notice bimodal distribution of Listeria - patients with weakened cell-mediated immunity]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what infectious agents (3) most often cause neonatal (0-6mo) meningitis, and what antibiotics are used to treat this?

A

newborns (0-6mo): Group B Strep (Agalactiae), E. coli, Listeria

rx: ampicillin + gentamycin

[note this is different than what everyone else gets!]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what antibiotics are used to treat meningitis in children (6mo-6yrs), young adults (6-60yo), and the elderly (60+)?

A

children and young adults: ceftriaxone + vancomycin

elderly: ceftriaxone + vancomycin + ampicillin

[note neonates get ampicillin + gentamycin]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the most common causes of meningitis in the elderly (3), and how is it treated?

A
  1. S. pneumo
  2. Gram (-) rods
  3. Listeria

rx: ceftriaxone + vancomycin + ampicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

which patients (3) have increased risk of meningitis from streptococcus pneumoniae?

A
  1. asplenic patients (need spleen for encapsulated organisms)
  2. sickle cell (functionally asplenic)
  3. alcoholics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how does bacteremia following meningitis from Neisseria meningitidis (meningococcemia) present? (3)

A
  1. sepsis: fever, chills, tachycardia
  2. purpuric rash
  3. DIC (disseminated intravascular coagulation)

may cause Waterhouse-Friderichsen syndrome! (adrenal hemorrhage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

close contacts of patients with meningitis due to Neisseria meningitidis receive prophylaxis of… (3)

A
  1. rifampin

(or, if people don’t like orange tears…)

  1. ceftriaxone
  2. ciprofloxacin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

which patients will present with meningitis due to H. influenza?

A

unvaccinated/unimmunized children, usually immigrants

Hib conjugate vaccine is given in infancy - HIB (H. influenza B) is now rare cause of meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

which antibiotic are mothers given during labor to prevent transmission of the most common cause of neonatal meningitis?

A

ampicillin to prevent transmission of Group B Strep (Agalactiae)

can be transmitted when baby passes through birth canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what does E. coli need to cause neonatal meningitis?

A

2nd most common cause of neonatal meningitis

requires K-1 capsular antigen to inhibit complement and evade host immunity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

which viruses most commonly cause meningitis? (3) how are they transmitted?

A

enteroviruses:

  1. coxsackievirus
  2. echovirus
  3. poliovirus

all single stranded RNA viruses transmitted via fecal-oral!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what neuro illnesses can HSV-1 vs HSV-2 cause?

A

HSV-1: encephalitis (LOVES to infect the temporal lobe!!) [+ oral/eye herpes]

HSV-2: meningitis [+ genital herpes] (+ encephalitis in neonates and immunocompromised)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

which antiviral drugs (3) can be used to treat herpes simplex virus (HSV-1 or HSV-2)?

A
  1. acyclovir
  2. valacyclovir
  3. famciclovir

or… “oh HSV my FAV”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what test is used to determine if a patient has meningitis due to TB?

A
  1. NAAT (nucleic acid amplification test): uses PCR techniques

can also do CSF tap which will show HIGH lymphocytes, HIGH protein, low glucose

22
Q

which symptoms (4) are common in patients with encephalitis (brain inflammation) but NOT meningitis? what is the most common cause of encephalitis?

A
  1. altered mental status
  2. motor/sensory deficits
  3. alerted behavior/personality changes
  4. speech/movement disorders

most common cause of encephalitis is HSV-1 (LOVES temporal lobe!!)

23
Q

patients infected with measles causing encephalitis may years later develop…

A

subacute sclerosing panencephalitis (SSPE): inflammation of the whole brain, very hard to treat, usually fatal

[note patients will be unvaccinated, probably not from US]

24
Q

patient coming to ED after swimming in fresh water lake presenting with fever, mental status changes, encephalitis =

A

Naegleria fowleri (protozoa): “brain-eating amoeba”

25
Q

what 4 CNS infections are associated with HIV?

A
  1. cryptococcus neoformans
  2. cytomegalovirus (CMV)
  3. toxoplasmosis
  4. JC virus (progressive multifocal leukoencephalopathy/ PML)
26
Q

HIV patient with CNS fungal infection, culture shows thick polysaccharide capsule, species is present in soil and pigeon droppings =

A

cryptococcus neoformans

27
Q

what CD4 count is needed for HIV patients to be at significant risk for cryptococcus neoformans CNS infection?

A

CD4 < 50 cells/mm3

can also occur in chemo and post-transplant patients

28
Q

how does cryptococcus neoformans CNS infection present in HIV patients?

A

indolent meningitis symptoms over weeks (fever, headache)

can cause increased ICP! - this causes risk of herniation with spinal tap, so MUST do CT or MRI beforehand to look for dilated ventricles (sign of increased ICP)… if dilated, more caution is taken with lumbar puncture

[presents in patients with CD4 < 50]

29
Q

how is cryptococcus neoformans meningitis treated in patients with HIV? (2 antibiotics, 1 procedure)

A

causes indolent meningitis symptoms over weeks, can increase ICP

  1. amphotericin B
  2. fluconazole
  3. repeated spinal taps to relieve high ICP
30
Q

how can infection with cryptococcus neoformans be diagnosed in patients with HIV/immunocompromised? (3)

A
  1. Sabouraud’s agar
  2. Latex agglutination test: mix CSF with latex beads, which agglutinate if cryptococcus is present
  3. soap bubble lesions on MRI
31
Q

soap bubble lesions in periventricular white matter on brain MRI =

A

CNS infection with cryptococcus neoformans (occurs in HIV with CD4 <50, post-transplant, immunocompromised)

32
Q

how does CMV infection present in patients with HIV? What CD4 count predisposes patients to this infection?

A

CD4 < 50 (very low!)

CMV infection presents as retinitis (retinal edema/ necrosis) —> floaters + decreased vision

looks like “pizza pie” on fundoscopy

33
Q

what CD4 count predisposes HIV patients to CNS infection with JC virus? how does this present?

A

CD4 < 200

reactivation of latent JC virus (DNA) causes demyelination —> progressive multifocal leukoencephalopathy (PML)

causes slow onset of altered mental status + focal neuro defects (motor, gait, etc)

34
Q

what are the most common locations of a brain abscess that results as a complication of the following:
a. sinusitis
b. otitis media
c. dental infection
d. hematogenous seeding

A

a. sinusitis —> frontal lobe, temporal lobe, or sella turcica

b. otitis media —> temporal lobe or cerebellum

c. dental infection —> frontal lobe

d. hematogenous seeding —> multiple locations

35
Q

what are the two most common pathogens that cause brain abscess due to hematogenous spread?

A

Streptococcus and staphylococcus

hematogenous spread will usually just have a single pathogen, while contiguous infection is usually mixed infection due to head and neck flora

36
Q

how should a brain abscess be diagnosed?

A

brain MRI is diagnostic procedure of choice, can also use head CT with contrast (hypodense center with peripheral ring enhancement, surrounded by edema)

Lumbar puncture is contraindicated!!! risk of herniation due to mass effect

Biopsy or aspiration needed for microbiologic diagnosis + blood cultures

37
Q

which patients most commonly present with spinal epidural abscesses?

A

usually secondary to hematogenous spread - IV drug users, infective endocarditis

Diabetes present up to 50% of patients

often occurs with vertebral osteomyelitis

38
Q

what are the stages of presentation of spinal epidural abscess?

A
  1. back pain and tenderness at the level of infection.
  2. Radicular pain and paresthesias.
  3. Impaired spinal cord function, motor paresis and sensory deficits.
  4. Complete paralysis.

Neurological manifestations can be reversible before complete paralysis

39
Q

What is the key clinical feature that differentiates encephalitis from meningitis?

A

Hallmark of encephalitis is abnormal brain function, while cerebral function is normal in patients with meningitis

40
Q

what is the diagnostic tool of choice for viral encephalitis and what will it show?

A

CSF - will show elevated protein with normal glucose, low cell count (<500)

If glucose is low, consider an alternative diagnosis

41
Q

What is the treatment for encephalitis caused by herpes simplex virus?

A

among most severe of viral brain infections, high mortality - primarily infects temporal lobe

Treat with high-dose acyclovir

42
Q

what does CSF show with arbovirus-mediated encephalitis?

A

arthropod-borne viruses, transmitted by insect vector (mostly mosquitos)

CSF initially shows neutrophils which rapidly converts to lymphocytes + elevated protein and normal glucose

43
Q

what is the main reservoir of West Nile Virus? How long is the incubation period?

A

main reservoir: birds

incubation period: 5-15 days

note, can also be transmitted via transplanted organs or blood transfusions

44
Q

what are 3 forms of severe disease that can be caused by West Nile Virus?

A
  1. meningitis
  2. encephalitis/ meningoencephalitis
  3. poliomyelitis-like flaccid paralysis
45
Q

what are the 2 ways in which human rabies may present?

A
  1. encephalitic rabies: nonspecific symptoms —> neuro symptoms; mainly involves brain stem and cerebellum
  2. paralytic rabies: initial presentation with flaccid paralysis resembles Guillian Barre; mainly involves medulla and spinal cord

in both cases, late stage involves basal ganglia and thalamus, and virus is detectable in salivary/lacrimal glands

46
Q

when and how does Tabes Dorsalis present?

A

tertiary form of neurosyphilis (Treponema pallidum); damage to sensory nerves in dorsal roots/columns of spinal cords ~20 years after primary infection

sensory ataxia, cranial neuropathies, absent reflexes, impaired position/vibration sense, Argyll-Robinson pupils (pupils constrict with accommodation but not light, do not dilate to painful stimuli)

47
Q

what is the cause of cysticercosis, and how does it present in the CNS?

A

ingestion of eggs of pork tapeworm Taenia solium via fecal-oral contamination from human carrier

during end-stage infection, larvae leave GI tract and spread via blood - symptoms occur/intensity when host immunity degenerates larvae and causes inflammation

CNS symptoms: seizures and headaches, encephalitis, brain edema can cause obstructive hydrocephalus

48
Q

HIV associated neurocognitive disorders (HANDs)

A

Spectrum of neurocognitive deficits in HIV infected individuals without alternative explanation

Ranges from mild or asymptomatic neurocognitive impairment to HIV associated dementia.

49
Q

2 treatments for cytomegalovirus (CMV) encephalitis

A
  1. ganciclovir
  2. foscarnet
50
Q

most common protozoal cause of brain abscess? describe its presentation

A

toxoplasma gondii: transmission via ingestion of tissue cysts in contaminated meat/food or oocysts in food/water contaminated from cat feces

most commonly presents with intracerebral mass lesions or encephalitis in immunocompromised hosts (HIV, transplant, malignancy) —> initially focal symptoms followed by non-focal neuro symptoms (esp. in basal ganglia and brainstem)

51
Q

most common cause of opportunistic meningitis in AIDS patients?

A

cryptococcus neoformans: yeast, stains with India Ink

indolent course, progressively debilitating and fever over 1-2 weeks

Neuro (50 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions