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Neurology > 133 Meningitis > Flashcards

133 Meningitis Flashcards

1
Q

when brain is directly injured by a bacterial or viral infection

A

encephalitis

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2
Q

focal infections involving brain tissue

A

cerebritis or abscess depending on the presence or absence of capsule

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3
Q

pathognomonic sign of meningeal irritation

A

nuchal rigidity

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4
Q

elicited with the patient in the supine position and when the thigh is flexed on the abdomen with the knee flexed patient extends knee to relieve pain from meningeal irritation

A

Kernig

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5
Q

elicited when lying supine, passive flexion of the neck results in spontaneous flexion of the hips and knees

A

Brudzinkis

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6
Q

True or false. Kernigs and Brudzinkis may be absent or reduced in very young or elderly patients, immunocompromised individuals or patients with severely depressed mental status

A

True.

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7
Q

Headache, fever with or without nuchal rigidity. With altered mental status. Consideration?

A

Meningoencephalitis, ADEM, encephalopathy, or mass lesion

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8
Q

headache, fever with or without nuchal rigidity. Without altered mental status. Consideration?

A

Meningitis.

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9
Q

Headache, fever with or without nuchal rigidity. With altered mental status. What to do

A

obtain blood culture, start empirical antimicrobial therapy

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10
Q

headache, fever with or without nuchal rigidity. Without altered mental status. What next?

A

check for focal neurologic deficit, papilledema, history of trauma, cancer or sinusitis.

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11
Q

Negative for focal neurologic deficit, papilledema, history of trauma, cancer or sinusitis. What to do next?

A

immediate blood culture and lumbar puncture

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12
Q

Positive for focal neurologic deficit, papilledema, history of trauma, cancer or sinusitis. What to do next?

A

obtain blood culture, start empirical antimicrobial therapy. Do Head CT or MRI

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13
Q

Lumbar puncture. Pleocytosis with PMNs elevated protein, decreased glucose Gram stain postive. Meaning

A

bacterial process

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14
Q

Lumbar puncture. Pleocytosis with PMNs, normal or increased protein, normal or decreased glucose, gram stain negative. What to do

A

Do Tier 1 of tests. Test for Viral, fungal, bacterial VDL, PCR, myobacterial work ups

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15
Q

Lumbar puncture. Tier 1 tests negative. What to do

A

Run Tier 2 tests for EBV, myoplasma, Influenza, Adenovirus, Histoplasma

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16
Q

Lumbar puncture. Tier 2 tests. Negative. What to do

A

Run Tier 3 test based on epidemiology

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17
Q

most common suppurative NS infection

A

bacterial meningitis

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18
Q

organism most often responsible for community acquired bacterial meningitis

A

strep pneumonia, neisseria meningitidis, Group B strep, Listeria monocytogenes, haemophilus influenza

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19
Q

most common cause of meningitis in adults age more than 20 years old

A

S. pneumoniae

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20
Q

what strains as invovled in the quadrivalent meningococcal glycoconjugate vaccine

A

serogroups A, C, W-135 and Y

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21
Q

an increasing important cause of meningitis in neonates, pregnant women, individuals more than 60 years of age and immunocompromised inviduals of all ages acquired from several ready to eat food

A

listeria monocytogenes

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22
Q

important causes of meningitis that occurs following invasive neurosurgical procedures particularly shunting procedures for hydrocephalus

A

S. Aureus and coagulase negative staphylococci

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23
Q

True or false. Complications of bacterial meningitis result from the immune response to the invading pathogen rather than from bacterial induced tissue injury

A

True.

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24
Q

True or false. Cerebral herniation usually results from effects of cerebral edema

A

True.

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25
Q

classic clinical triad of meningitis

A

fever, headache, and nuchal rigidity

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26
Q

Cushing reflex

A

bradycardia, hypertension, and irregular respirations

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27
Q

most disastrous complication of increased ICP

A

raised ICP

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28
Q

clues of rash of meningcoccemia

A

diffuse erythematous maculopapular rash resembling viral exanthem that rapidly become petechial over the trunk and lower extremities

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29
Q

Antibiotics. Hospital acquired meningitis, posttraumatic, postneurosurgery meningitis, neutropenic, with impaired cell mediated immunity

A

Ampicillin + ceftazidime or meropenem + vancomycin

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30
Q

meningitic dose of vancomycin

A

45-60 m/kg/day q6-12hrs

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31
Q

expected complication of bacterial meningitis and major cause of obtundation and coma in this disease

A

raised ICP

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32
Q

meningitic dose of ceftriaxone

A

4 grams/day

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33
Q

meningitic dose of cefipime

A

6 g/.day q8hrs

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34
Q

meningitic dose of ceftazidime

A

6 g/day q8hrs

35
Q

meningitic dose of cefotaxime

A

12 g/day q4hrs

36
Q

meningitic dose of meropenem

A

6 g/day q8hrs

37
Q

meningitic dose of gentamicin

A

7.5 mg/kg/day q8hrs

38
Q

meningitic dose of metronidazole

A

1500-2000 mg/day, q6hrs

39
Q

rapid diagnostic test for detection of gram negative endotoxin in CSF

A

Limulus amebocyte lysate assay

40
Q

typical CSF profile with viral CNS infection

A

lymphocytic pleocytosis with normal glucose concentration

41
Q

MRI abnormality seen in HSV encephalitis

A

T2 weighted, fluid attenuated inversion recovery (FLAIR) and diffusion weighted MRI images, high signal intensity lesions are seen in orbitofrontal, anterior, and medial temporal lobes in majority of patients within 48 hours of symptom onset

42
Q

What is the characteristic rash of rickettsial disease

A

rash develop within 96 h of the onset of symptoms; petechial rash to purpuric rash that begins in the wrist and ankles that spreads distally and proximally

43
Q

CNS disorder that mimic bacterial meningitis

A

SAH

44
Q

most common etiologic organism of community acquired bacterial meningitis

A

S. pneumoniae and N. meningitidis

45
Q

empiric antibiotic therapy for acute bacterial meningitis

A

dexamethasone, third or fourth generation cephalosporin and vancomycin

46
Q

broad spectrum fourth generation cephalosporin with greater activity against enterobacter and pseudomonas aeruginosa

A

cefipime

47
Q

when is metronidazole added to therapy

A

in patient with sinusitis, otitis, mastoiditis

48
Q

remains the antibiotic of choice for meningococcal meningitis caused by susceptible strains

A

Penicillin G

49
Q

chemoprophylaxis for index case and all close contacts of meningococcal meningitis

A

Rifampicin 600 mg q12hrs x 2 days

50
Q

alternative chemopropylaxis for meningococcal meningitis in adults

A

Azithromycin 500 mg one dose or ceftriaxone 250 mg IM single dose

51
Q

in pneumococcal meningitis, what is the antibiotic of choice if MIC is more than 1

A

vancomycin

52
Q

when is pneumococcal meningitis susceptible to penicillin

A

MIC is less than 0.06 ug/ml

53
Q

when is pneumococcal meningitis resistant to penicillin

A

MIC is more than 0.12 ug/ml

54
Q

when is pneumococcal meningitis sensitive to cephalosporins

A

MIC is less than 0.5 ug/ml

55
Q

when is pneumococcal meningitis immediate or resistant to cephalosporins

A

MIC of 1 ug/ml means intermediate; MIC more than 2 ug/ml means resistant

56
Q

can be added to vancomycin for synergistic effect

A

rifampicin

57
Q

duration of therapy for patient with pneumococcal meningitis

A

2 week course of intravenous antimicrobial is recommended

58
Q

does meningitis cause by s, pneumonaie need a repeat lumbar puncture and when

A

yes repeat lumbar puncture performed 24-36 hours after initiation of antimicrobial therapy to document sterilization of CSF; failure to sterilize means antibiotic resistance

59
Q

what to do if intravenous vancomycin unable to sterilize CSF

A

give intraventricular vancomycin

60
Q

how is meningitis due to L monocytogenes managed

A

ampicillin for 3 weeks; gentamicin 2 mg/kg loading dose then 7.5 mg/kg/ day every 8 hours adjusted on creatinine clearance

61
Q

alternative to ampicillin in allergic patient with listeria meningitis

A

TMP SMX 10-20 mg/KBW/ 50-100 mg/ KBW given every 6 hours

62
Q

in stapyhylocally meningitis, what is the antibiotic if MSSA

A

nafcillin

63
Q

drug of choice if MRSA meningitis

A

vancomycin

64
Q

with streptococcal meningitis, when is repeat lumbar puncture done and what to do next

A

repeat LP after 48 hrs of antibiotics; if still not sterilized additional intraventricular or intrathecal vancomycin 20 mg once a day is added

65
Q

antibiotics for gram negative bacillary meningitis

A

cefotaxime, ceftraixone, ceftazidime

66
Q

antibiotics for gram negative bacillary meningitis with P aeruginosa and how long

A

ceftrazidime, cefepime, meropenem for 3 weeks

67
Q

why is dexamethasone added in meningitis regimen

A

dexaamethasone exert its beneficial effect by inhibiting the synthesis of IL-1B and TNF alpha at the level of mRNA decreasing the CSF outflow resistance and stabilizing the blood brain barrier

68
Q

what is the timing of giving dexamethasone

A

Given 20 minutes before antibiotic therapy as it inhibits macrophages before these cells are activated by endotoxin

69
Q

True or false. Dexamethasone may decrease the penetration of vancomycin into CSF and delay sterilization of CSF in s.pneumoniae meningitis

A

True.

70
Q

important causative agents in acute viral meningitis

A

enterovirus, HSV, HIV and arbovirus

71
Q

predominant cell in viral meningitis CSF

A

lymphocytes

72
Q

causative agent if CSF is PMN pleocytosis with low glucose in immunocompromised hostsS

A

CMV

73
Q

differential diagnosis if CSF is lymphocytic pleocytosis with a low glucose

A

fungal or tuberculous meningitis

74
Q

single most important method for diagnosing CNS

A

amplification of viral specific DNA or RNA from CSF using PCR amplification

75
Q

most common cause of viral meningitis

A

enterovirus

76
Q

diagnostic procedure of for enteroviral meningitis

A

reverse transcriptase PCR

77
Q

in WNV epidemics, this serve as sentinel infections for subsequent human disease

A

avian deaths

78
Q

responsible for 90% of cases of HSV encephalitis

A

HSV-1

79
Q

Can be suspected in the presence of chicken pox or shingles

A

VZV meningitis

80
Q

True or false. Mumps remains a potential source of infection in non immunized individuals and population

A

True.

81
Q

Considered when aseptic meningitis occurs in late fall or winder in individuals with exposure to house mice as house pets or laboratory rodents

A

CMV infection

82
Q

True or false. Almost all cases of viral meningitis the treatment is primarily symptomatic and includes use of analgesics, antipyretics, and antiemetics

A

True.

83
Q

in cases of meningitis due to HSV-1, EBV AND VZV, what can be given

A

Acyclovir 15-30 mg/kg/day in three divided doses can be followed by a oral drug such as acyclovir 800 mg five times a day, or famciclovir 500 mg TID, valacyclovir 1000 mg TID for a total course of 7- 14 days

84
Q

true or false. In adults prognosis for full recovery from viral meningitis is excellent

A

True.

Neurology (14 decks)

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