OME - ID Brain inflammation

Question 1

DDx fever and HA?

Answer 1

• *Look for photo / phonophobia +/- NV
  1. Meningitis
  2. Encephalitis
  3. Abscess

Question 2

Most common type meningitis?

Answer 2

Bacterial

Question 3

Types Meningitis?

Answer 3

1. TB
2. Lyme
3. RMSF
4. Cryptococcal

Question 4

What to look for to point towards abscess?

Answer 4

1. Focal neurologic deficit

Question 5

What points to encephalitis?

Answer 5

1. AMS (encephalopathy)

Question 6

Viral encephalitis causes?

Answer 6

1. West nile
2. Equine
3. HSV
   * *Do not alter rx, only have to report to CDC

Question 7

Rx encephalitis?

Answer 7

Supportive

Question 8

Only viral encephalitis with Rx?

Answer 8

HSV - acyclovir

Question 9

What to do before LP?

Answer 9

Look for signs elevated ICP (contraindications):
"FAILS"
Focal deficit (mass)
AMS
Immunosuppressed
Lesion over spine
Seizure

Question 10

What happens if do LP with ICP?

Answer 10

Brain herniates through foramen magnum

Question 11

Who is immunocompromised?

Answer 11

1. Elderly
2. Neonate
3. Chemo
4. Monoclonal Ig

Question 12

What to do if LP unsafe?

Answer 12

1. Non con CT - looking for mass

Question 13

If LP is unsafe to do you give ABX?

Answer 13

Yes, LP then CT

Question 14

IF LP safe, order of treatment?

Answer 14

1. LP

2. CT

Question 15

Signs bacterial LP?

Answer 15

1. > 1000 poly WBCs

Question 16

Empirical Rx all bacterial meningitis?

Answer 16

1. Ceftriaxone
2. Vancomycin
3. Steroids
   * Add amp if immunosuppressed

Question 17

What points towards Lyme?

Answer 17

1. Travel to connecticut
2. Targetoid lesion
3. Arthralgias
4. Arrhythmias
5. Ig
   * Do not need to see tic

Question 18

What points towards crypto?

Answer 18

1. Aids
2. Antigen
3. Elevated Opening pressure

Question 19

What points towards RMSF?

Answer 19

1. Rash moving from arms to trunk
2. Tick bites
3. Camping
4. Ig on CSF

Question 20

What points to TB?

Answer 20

1. Nights sweats
2. Weight loss
3. Hemoptysis
4. Homeless / prison / endemic areas

Question 21

What points to Syphillis?

Answer 21

1. Chancer

2. Erythema multiforme (bullseyes lesionS)

Question 22

Rx cryptococcal?

Answer 22

Amphoterecin

Question 23

Rx RMSF / Lime

Answer 23

1. Ceftriaxone

Question 24

Rx TB?

Answer 24

"RIPE"
Rifampin
Isoniazid
Pyramid Azole
Ethambutol

Question 25

Step if HIV+, AIDS, And Toxo Ig +?

Answer 25

1. Treat toxo:
   a. Pyrimethamine
   b. Sulfadiazine
2. Rescan 6 weeks later

Question 26

Next step mass and not Aids?

Answer 26

1. Brain biopsy

Question 27

Rx Brain abscess?

Answer 27

1. Drain

2. Abx

Question 28

What to think if hemorrhagic tab or “temporal lobe” and encephalitis?

Answer 28

HSV

Question 29

How to diagnose HSV?

Answer 29

HSV PCR