Skull, Spine, and Postsurgical Infections

Question 1

The most common organism involved in VP or VA shunt infection is Staphylococcus epidermidis. Following statements regarding shunt infection is true except?
● A. Over 50% of Staphylococcus infections occur within 2 weeks post shunt
● B. Children with shunt infection have an increased mortality rate
● C. Risk of seizure post shunt infection increases in children
● D. In MMC patient, waiting for shunt insertion until the child is 2 weeks old significantly lowers the infection rate
● E. In MMC patient, ventriculitis after shunting have no effect on IQ of the patient

Answer 1

E. In MMC patient, ventriculitis after shunting have no effect on IQ of the patient

Question 2

An 8-month-old child presented in neurosurgical emergency with fever, nausea, vomiting, and lethargy 10 days after placement of ventricular shunt. The patient had CSF analysis which showed WBC count to be > 20,000, protein elevated, glucose
normal, and CSF culture negative. The patient is not shunt dependent with Candida spp. infection. What is most appropriate treatment in this patient?
● A. Completely remove the contaminated shunt
● B. Completely remove the shunt, place EVD, and start antifungal therapy
● C. Completely remove the shunt and start antifungal therapy
● D. No need to remove the shunt and start antifungal therapy
● E. Place a fresh shunt immediately and continue antifungal therapy

Answer 2

B. Completely remove the shunt, place EVD, and start antifungal therapy

Question 3

In most instances of shunt infection, the shunt is either externalized or completely removed with placement of EVD. Treatment of shunt infection with antibiotics without shunt removal is acceptable in all of the following patients except?
● A. In terminally ill patient
● B. In patient with poor anesthetic risk
● C. In patients with slit ventricles
● D. In patients with septicemia
● E. None of the above

Answer 3

D. In patients with septicemia

Question 4

After removal of shunt hardware in case of shunt infection with shunt dependency, placement of EVD can serve which of the following functions?
● A. Easy monitoring of CSF flow
● B. Control of ICP
● C. Repeated sampling of CSF for signs of resolution of infection
● D. Administration of intrathecal antibiotics
● E. All of the above

Answer 4

E. All of the above

Question 5

A patient with EVD placed develops signs and symptoms of CSF infection. On CSF analysis, WBC count is more than 1,000/μL, CSF to blood glucose ratio is < 0.2 but negative Gram stain and culture. What is this called?
● A. Contamination
● B. Ventriculostomy colonization
● C. Possible ventriculostomy-related infection
● D. Probable ventriculostomy-related infection
● E. Definitive meningitis

Answer 5

C. Possible ventriculostomy-related infection

Question 6

Intraventricular or intrathecal administration of antibiotics may be required if systemic treatment is ineffective or for resistant organism. Following are the antimicrobials that can be used intrathecally except?
● A. Vancomycin
● B. Aminoglycosides like gentamicin, amikacin, tobramycin
● C. Cefepime
● D. Daptomycin
● E. Colistimethate sodium

Answer 6

C. Cefepime

Question 7

A patient presented with severe backache which is exacerbated by any movement, fever, and point tenderness 3 weeks after laminectomy and diskectomy. On MRI of lumbosacral spine with contrast, there is contrast enhancement in vertebral
bone marrow, disk space, and posterior annulus fibrosus. What is the most likely diagnosis in this case?
● A. Epidural abscess
● B. Recurrent/residual disk herniation
● C. Vertebral bone marrow infection
● D. Postoperative diskitis
● E. Postoperative arachnoiditis

Answer 7

D. Postoperative diskitis

Question 8

What is a Pott puffy tumor?
● A. Vertebral osteomyelitis with edema and swelling
● B. Spine infection with spread into spinal canal
● C. Skull infection without edema and swelling
● D. Skull infection with surrounding edema and swelling
● E. Skull infection with smoke-like pattern on X-ray around the tumor

Answer 8

D. Skull infection with surrounding edema and swelling

Question 9

A patient with history of IV drug abuse presented with severe backache at midthoracic region which started spontaneously. He has point tenderness on examination and elevated ESR and CRP levels. On MRI, there is hypointense epidural mass on T1 and hyperintense epidural mass on T2 which enhances
with contrast. Diagnosis of epidural abscess is confirmed with needle-guided aspiration. What is the most common pathogen in this case?
● A. Streptococcus epidermidis
● B. Staphylococcus aureus
● C. Pseudomonas aeruginosa
● D. E. coli
● E. Brucellosis

Answer 9

B. Staphylococcus aureus

Question 10

A patient with diabetes mellitus presents with chronic backache in neurosurgical OPD. MRI findings showed T1 low signal in vertebral bodies and intervertebral disk while increased intensity in vertebral bodies and intervertebral disk on T2. CT-
guided needle biopsy confirmed Pott’s disease or tuberculous vertebral osteomyelitis. What is the most commonly involved structure in this scenario?
● A. Posterior elements of vertebrae
● B. Intervertebral disk
● C. Vertebral body
● D. Both vertebral body and intervertebral disk
● E. Vertebral body and pedicles

Answer 10

C. Vertebral body