Neuro Infections

Question 1

When during the year is the typical onset of viral meningitis?

Answer 1

Late summer/autumn

Question 2

Which viruses are typically responsible for viral meningitis?

Answer 2

Enteroviruses most common e.g. ECHO

HSV and other microbes also

Question 3

List investigations/diagnostic tools for viral meningitis

Answer 3

Viral stool culture
Throat swab
Lumbar puncture for CSF PCR

Question 4

Outline treatment for viral meningitis

Answer 4

Supportive - paracetamol, fluids, rest, dark room

Question 5

What is the main cause of viral encephalitis?

Answer 5

Herpes simplex

Question 6

List investigations for viral encephalitis

Answer 6

Lumbar puncture
Electroencephalography (EEG)
MRI
CSF PCR

Question 7

What is the main treatment for viral encephalitis?

Answer 7

IV aciclovir

Question 8

Which organism is the main causes of bacterial meningitis in children?

Answer 8

H. influenzae

Question 9

Which organism is the main cause of bacterial meningitis in 10-21 year olds?

Answer 9

Neisseria meningitides

Question 10

List the main cause of bacterial meningitis in adults (>21)

Answer 10

Strep. pneumoniae

Question 11

A fracture of the cribriform plate increases the risk of which bacterial meningitis?

Answer 11

Pneumococcal (Strep. pneumoniae)

Question 12

Signs of bacterial meningitis are often absent in the very young, very old and immunocompromised. True/False?

Answer 12

True

Question 13

List investigations for bacterial meningitis

Answer 13

Blood cultures
Throat swab (meningococci)
Lumbar puncture for CSF

Question 14

A low ratio of blood sugar : CSF sugar is indicative of bacterial meningitis. True/False?

Answer 14

True

Question 15

What is aseptic meningitis?

Answer 15

Aseptic meningitis means you suspect there is a bug but you can’t find it – low WBC, minimally elevated protein and normal glucose

Question 16

A CT scan should delay treatment in bacterial meningitis. True/False?

Answer 16

False

An urgent CT scan should be requested but does not delay treatment

Question 17

Strep pneumoniae looks like what under a microscope?

Answer 17

Gram positive diplococcus

Question 18

Neisseria meningitidis looks like what under a microscope?

Answer 18

Gram negative intracellular

Question 19

What causes meningitis in >60 years or immunocompromised or neonates?

Answer 19

Listeria (gram +ve bacillus)

Question 20

What is Kernig’s sign in meningitis?

Answer 20

Painful knee extension while lying supine (inability to straighten the leg when the hip is flexed to 90 degrees)

Question 21

> 2000 white cells in the lumbar puncture indicates what type of meningitis?

Answer 21

Bacterial

Question 22

Cases of meningitis have to be reported to who?

Answer 22

Public health

Question 23

What is the immediate treatment for meningitis?

Answer 23

Ceftriaxone IV (chloramphenicol for penicillin allergy) + dexamethasone IV

Question 24

Elevated lymphocytes in a lumbar puncture indicated what type of encephalitis?

Answer 24

Viral

Question 25

A single brain abscess can be caused by direct implantation OR secondary to what 2 conditions?

Answer 25

Chronic otitis media/mastoiditis

Question 26

Multiple brain abscesses can be caused by what?

Answer 26

IV drug abuse, lung abscesses, congenital heart disease etc