SANS Infection Flashcards
Seorang pria berusia 23 tahun mempunyai riwayat lama fraktur fasial dengan nyeri kepala progresif lebih dari 4 hari, demam ringan dan kebingungan/kacau. Hasil pemeriksaan neurologis dinyatakan non-fokal. Hasil CT kepala terlampir. Diagnosis yang paling TEPAT adalah :
A. Perdarahan subarachnoid/subdural
B. Hematoma subdural kronik
C. Kista Arachnoid
D. Empiema subdural
D. Empiema subdural
The contrast CT shows a thin rim of enhacement of the arachnoid/pia and a fluid collection that does not have the appearance of subarachnoid blood. The answer is subdural empyema, which may represent a neurosurgical emergency and should be drained urgently. Often the infection is a direct extension from the sinus, i.e., frontal or mastoid ares. Patients may deteriorate rapidly. There is a significant risk of developing epilepsy (> 30%), and mortality is 10-20%. As in this case, subdural empyema may be complicated by the occurence of hydrocephalus, suggested here by the enlarged temporal horns. Chronic subdural hematomas are low density on CT and can have membranes that show enhancement, although not at the arachnoid/pia. Arachnoid cysts usually appear in the middle or posterior fossa and are rarely symptomatic other than progressive headches over a more subacute time course.
Seorang pria 70 tahun dengan riwayat “atrial valve replacement” dengan fatigue, demam dan nyeri kepala. Secara neurologis dinyatakan baik. Hasil pemeriksaan laboratorium menunjukkan peningkatan laju endap darah dan C-reactive protein. Pasien kemudian menjalani gadolinium-enhanced MRI (A) dan angiogram serebral (B), yang menunjukkan lesi yang dicari. Apakah terapi awal yang paling tepat untuk pasien tersebut?
A. Observasi ketat dan kortikosteroid intravena
B. Endovascular repair pada lesi
C. Surgical repair pada lesi
D. Observasi ketat dan antibiotik intravena
E. Hanya dilakukan observasi
D. Observasi ketat dan antibiotik intravena
The most appropriate treatment for this presumed mycotic aneurysm is close observation and administration of intravenous antibiotics. The MRI and cerebral angiogram shown depict a mycotic aneurysm of the distal left middle cerebral artery. The clinical scenario depicted is highly suggestive of a patient with subacute bacterial endocarditis (SBE). Approximately 10% of patients with SBE will develop a mycotic aneurysm. The most common location overall is the thoracic aorta, with the most common intracranial site being the distal MCA. They are often multiple. Additionally, the patient’s history of headache may indicate rupture of his mycotic aneurysm. The current recommendation for the initial treatment of an intracranial mycotic aneurysm is close neurological observation and the initiation of appropriate intravenous antibiotics. Most intracranial mycotic aneurysms will resolve without surgical or endovascular occlusion following prolonged treatment with appropriate antibiotics. Mycotic aneurysms are often very friable and fragile, making surgical treatment more difficult compared to other intracranial aneurysms. While the peri-operative risk of endovascular repair (i.e. coiling) may be lower than for surgical clipping, the distal location of the aneurysm makes endovascular access difficult.
Antibiotik Profilaksis intravena untuk prosedur pembedahan paling baik diberikan saat :
A. Dalam pembedahan selama 24 jam
B. Dalam insisi selama 1 jam
C. Dalam 6 jam sebelum insisi
D. Dalam 1 jam sebelum insisi
D. Dalam 1 jam sebelum insisi
The National Surgical Infection Prevention Project recommends that antibiotics be administered one hour prior to skin incision. For cases longer than 6 hours, an intraoperative dose of antibiotic should be given. Data is not available for supporting the use of antibiotics in all types of surgery, but has been generalized for most surgical procedures. Of significance is that there is no evidence that continuing antibiotics for greater than 3-4 doses provides any benefit and may increase risk of superinfection.
Hasil analisis CSF berikut paling tepat mengarah pada diagnosis? (Opening pressure: 40 cmH20 Appearance: Turbid White Cells (per mm3): 1500 Differential: 95% PMNs 5% Lymphs Protein: 110 mg/dL Glucose: 15 mg/dL)
A. Meningitis bakterialis
B. CSF Normal
C. Meningitis fungal
D. Meningitis TB
E. Meningitis viral
A. Meningitis bakterialis
Typical CSF findings in these conditions are listed below: *Normal CSF* Opening pressure: 7-18, Appearance: clear colorless, Cells (per mm3): <5, protein: 15-45, glucose: 50. *Acute Bacterial Meningitis* Opening pressure: frequently elevated, Appearance: turbid, Cells (per mm3): 10-20000 mostly PMNs, protein: 100-1000, glucose: <20. *Tuberculous Meningitis* Opening pressure: frequently elevated, Appearance: opalescent, Cells (per mm3): 60-700 mostly lymphocytes and monos, protein: 100-1000, glucose: <20. *Aseptic/Viral Meningitis* Opening pressure: normal, Appearance: clear, Cells (per mm3): 40-100 mostly lymphocytes and monos, protein: 40-100, glucose: 50. *Fungal Meninitis* Opening pressure: frequently elevated, Appearance: opalescent, Cells (per mm3): 30-300 mostly monos, protein: 100-700, glucose: <30.
Manakah dibawah ini yang merupakan organisme penyebab abses otak pada pasien dengan imunokompeten yang sehat tanpa ada riwayat operasi sebelumnya?
A. S. pneumoniae
B. H.influenzae
C. S. aureus
D. S. milleri
E. N. meningitidis
D. S. milleri
S Milleri is the most common cause of cerebral abscess, although they are frequently polymicrobial.
S. aureus is the most common cause of spinal abscesses.
S. pneumoniae, N. meningitides, and H. influenzae are common causes of meningitis in the pediatric population. The former two are also common in adult meningitis.
