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Foundations 4 SG > Neuro Infections 2- MJ > Flashcards

Neuro Infections 2- MJ Flashcards

1
Q

Meningitis is an inflammatory dz of the __________

A

leptomeninges

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2
Q

What are the 5 etiologies of meningitis?

A
  1. Viruses
  2. Bacteria
  3. Fungi
  4. Medications
  5. Cancer
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3
Q

What are the 6 risk factors of meningitis?

A
  1. Extremes of age
  2. Birth hx/maternal infection
  3. Immunodeficiency/immunocompromised
  4. Vaccine status
  5. Exposure risk
  6. IV drug use
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4
Q

What is the clinical presentation of meningitis? (5)

A

1. HA

  1. Photophobia
  2. N/V

4. Neck stiffness

5. Fever

**If a pt has these sxs, it is bacterial meningitis until proven otherwise**

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5
Q

What is the most common etiology of viral meningitis?

A

Enteroviruses

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6
Q

The following is the clinical presentation of what condition?

  • Fever
  • HA
  • N/V
  • Neck stiffness
  • Photophobia
  • +/- URI sxs, rash or diarrhea
A

Viral meningitis

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7
Q

What are 2 associated historical clues that might make you think a patient has viral meningitis?

A
  • HSV- genital lesions
  • Mumps (this is the MC extra-salivary complication)
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8
Q

What is the course of viral meningitis?

A

usually self-limited

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9
Q

How do you diagnose viral meningitis?

A

H&P + CSF analysis

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10
Q

What does CSF analysis show for a patient with viral meningitis?

  • Tubidity and color?
  • Opening pressure?
  • WBC count?
  • Differential cells?
  • RBC count
  • Protein?
  • Glucose?
A
  • Tubidity and color- Clear or cloudy, colorless
  • Opening pressure- normal to increased
  • WBC count- increased
  • Differential cells- Lymphocytes
  • RBC count- 0
  • Protein- increased
  • Glucose- normal
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11
Q

CSF analysis of viral meningitis looks similar to what other condition?

A
  • looks similar to CSF analysis of viral encephalitis
  • LP doesnt help distinguish between the two
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12
Q

What is the pathophysiology of bacterial meningitis in adults vs. neonates?

A
  • Adults: hematogenous spread, extension from nearby infection, penetrating injury
  • Neonates: pathogens acquired from the birth canal, through the placenta, or from surroundings

After, there is rapid replication of the bacteria, which triggers the inflammatory cascade

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13
Q

What is the MC etiology of bacterial meningitis in neonates (<28d)?

A

Group B strep

(this will be a question)

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14
Q

What is the MC etiology of bacterial meningitis in babies/children?

A

Strep pneumonia

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15
Q

What is the MC etiology of bacterial meningitis in teens, young adults?

A

Neisseria meningitides

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16
Q

What is the MC etiology of bacterial meningitis in Adults?

A

Strep pneumonia

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17
Q

T/F, bacterial meningitis symptoms are usually rapid in onset

A

True

(can be slow (1-several days) but it is rare to go >24 hrs w/o seeking tx)

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18
Q

The following is the clinical presentation of what condition?

  • Rapid onset (hours)
  • Fever
  • Meningismus
  • Altered mental status
  • Severe headache
  • Nausea, vomiting
  • Photophobia
  • Back pain
A

Bacterial meningitis

(the bolded sxs are what differs from viral meningitis)

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19
Q

The following is the clinical presentation of what condition in neonates/infants?

  • Irritability
  • Poor feeding
  • Vomiting
  • Lethargy
  • High-pitched cry
  • “floppy”
  • Rash (petechiae if N. meningitides)
  • +/- seizures
A

Bacterial meningitis

20
Q

The following are possible physical exam findings for what condition?

Vitals:

  • signs of septic shock
  • Fever
  • decreased SaO2
  • Widened pulse pressure (seen w/ increased ICP)

Skin:

  • Viral exanthem, petechiae, purpura
A

Bacterial Meningitis

21
Q

What 2 special neuro exams would you perform on a pt w/ bacterial meningitis?

A
  • Kernig sign- inability or reluctance to allow full extwnsion of the knee when hip is flexed
  • Brudzinski sign- Spontaneous flexion of hips during attempted passive flexion of neck
22
Q

What is the Diagnosis and management of bacterial meningitis? (8 steps)

A
  1. IV access
  2. Blood culture x 2
  3. Administer antibiotics (ASAP- LP/CT should NOT delay abx)
  4. CBC with diff
  5. CMP
  6. Coags
  7. +/- CT
  8. LP with CSF analysis
24
Q

What does CSF analysis show for a patient with bacterial meningitis?

  • Tubidity and color?
  • Opening pressure?
  • WBC count?
  • Differential cells?
  • RBC count
  • Protein?
  • Glucose?
A
  • Tubidity and color- Turbid, yellow
  • Opening pressure- Elevated
  • WBC count- VERY elevated
  • Differential cells- Neutrophils
  • RBC count- 0
  • Protein- VERY elevated
  • Glucose- Decreased (“bacteria eat up the glucose”)
25
What is the **empiric treatment** for bacterial meningitis for a person **\<50y/o** and has **no allergies**?
**Ceftriaxone or cefotaxime** + **Vancomycin**
26
What is the **empiric treatmen**t for bacterial meningitis for a person **\>50y/o** and has **no allergies**?
**Ceftriaxone or cefotaxime** + **Vancomycin** + **Ampicillin** (only if \> 50y/o)
27
What is the **empiric treatment** for bacterial meningitis for a person who is **\<50 y/o** and has a **severe beta lactam allerg**y?
**Vancomycin** + **Moxifloxacin**
28
What is the **empiric treatmen**t for bacterial meningitis for a person who is **_\>50 y/o_** and has a **severe beta lactam allergy**?
**Vancomycin** + **Moxifloxacin** + **TMP- SMX** (only if \>50y/o)
29
What **antibiotics** would you give to a patient with **bacterial meningitis** caused by **Strep pneumo**?
**Vancomycin** + **3rd generation cephalosporin**
30
What **antibiotics** would you give to a patient with **bacterial meningitis** caused by **Neisseria meningitidis**?
**3rd gen cephalosporin**
31
What **antibiotics** would you give to a patient with **bacterial meningitis** caused by **Listeria**?
Ampicillin or Penicillin G
32
What **antibiotics** would you give to a patient with **bacterial meningitis** caused by **Haemophilus influenza?**
3rd gen cephalosporin
33
What is the steps for treating bacterial meningitis? (4)
* antibiotics * Fluid management * Monitor and manage ICP (elevate bed, hyperventilate, +/- glucocorticoids/dexamethasone) * Induced hypothermia
34
**The following are possible neuro complications for what condition?** * Impaired mental status * Increased ICP and cerebral edema * Seizures * Focal neurologic deficits * Sensorineural hearing loss * Intellectual impairment
Bacterial meningitis
35
T/F: bacterial meningitis is a **medical emergency**?
TRUE | (untreated- mortality approaches 100%)
36
* When should you give chemoprophylaxis to close contacts of a person with bacterial meningitis? * What is a common med given for prophylaxis?
* Prolonged contact w/ the person (\>8hrs) * Direct exposure to oral secretions 7d prior to onset until 24 hrs after initiation of abx therapy Common med given= Ciprofloxacin
37
How is Bacterial Meningitis prevented in neonates?
All pregnant women are tested for Group B Strep at 35-37wks gestation and if they are positive then they get abx during labor (if they aren't tested then they get prophylactic abx during labor)
38
What 4 vaccinations are available for prevention of bacterial meningitis? Which 2 are specifically for high risk pts?
* Quadrivalent meningococcal conjugate vaccines protecting against **serogroups A, C, W, and Y** * **_\*Menactra:_** approved for 9mo- 55yrs * **\*​_Menveo:_** approved for 2mo - 55 yrs * **High risk** pts recommended to get: Meningococcal vaccines against **serogroup B** * **_Trumenba:_** approved for 10-25yrs * **_Bexsero_**: approved for 10-25 yrs
39
Due to difficulty differentiating between viral encephalitis and bacterial meningitis, it is common to treat these patients with what pharmacologic treamtents?
empiric abx + Acyclovir
40
Is fungal meningitis common or rare?
Rare | (consider in HIV and cancer)
41
T/F: fungal meningitis is spread person to person
FALSE Fungal meningitis is **NOT** spread person-to-person
42
What are the 4 causative agents of fungal meningitis?
1. Cryptococcus 2. Histoplasma 3. Blastomyces 4. Coccidioides ("COPs BLAST CRYPTic HISTOry about fungus")
43
**The following is the definition of which condition?** * Clinical and lab evidence of meningeal inflammation **_without signs of (bacterial) infection_**
Aseptic meningitis
44
What are the 5 etiologies of aseptic meningitis?
1. Malignancy 2. Medications 3. SLE 4. Head injury 5. Brain surgery ("My Mother Said Have Brains")
45
What 5 medications can cause aseptic meningitis?
* **Trimethoprim-sulfamethoxazole** * **Ibuprofen** (and other NSAIDS) * **IVIG** * Certain **chemo** agents * Certain **immunosuppressive** drugs (Azathioprine, Infliximab)
46
**The following patients are considered "high risk" and should receive which vaccination in order to try to prevent meningitis?** * Pt \>10y/o w/ persistent complement component deficiency * functional or anatomical asplenia * microbiologists routinely working with N. meningitidis * Person at risk due to serogroup B meningococcal outbreak
•Meningococcal vaccines **against serogroup B** * _Trumenba:_ approved for 10-25 years, 2-dose and 3-dose series * _Bexsero:_ approved for 10-25 years, 2-dose series

Foundations 4 SG (19 decks)

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