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Infectious > Meningitis and Encephalitis > Flashcards

Meningitis and Encephalitis Flashcards

1
Q

Pathogonomic sign of meningeal irritation Harrison pp 883

A

Nuchal rigidity

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2
Q

Thigh is flexed against the abdomen with knee is also flexed, attempt to passively extend the knee and elicit pain when meningeal irritation is present.
Harrison pp 883

A

Kernig sign

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3
Q

Passive flexion of the neck. Result in spontaneous flexion of the hips and knee. Harrison pp 883

A

Brudzinski’s sign

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4
Q

What type of patient should undergo CT scan/MRI prior to lumbar puncture (LP)? Harrison pp 884

A 
Head trauma 
Immunocompromised (Malignant lesions or CNS)
Focal neurologic findings
Papilledema 
Depressed level of consciousness
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5
Q

What does not occur in viral meningitis? Harrison pp 884

A

Decreased level of consciousness
Seizures
Focal neurologic deficit

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6
Q

If MRI showed focal or generalized gray matter abnormalities or normal and no mass lesions, it is more of what disease? Harrison pp 884

A

Encephalitis

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7
Q

If MRI/CT showed, no mass lesion but noted white matter abnormalities? Harrison pp 884

A

Acute Dissiminated Encephalomyelitis

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8
Q

Most often responsible for community acquired bacterial meningitis? Harrison pp 885

A

Streptococcus pneumoniae
Neisseria meningitis
Group B streptococci

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9
Q

Causative organism of recurring epidemics of meningitis. Harrison pp 885

A

N. Meningitis

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10
Q

Risk factor associated with S. pneumoniae meningitis. Harrison pp 885

A

Most important: pneumococcal pneumoniae

  1. Acute or chronic pnuemococcal sinusitis or otitis media
  2. Alcoholism
  3. Diabetes
  4. Splenectomy
  5. Hypogammaglobulinemia
  6. Complement deficiency
  7. Head trauma w/ basilar skull fracture
  8. CSF Rhinorrhea
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11
Q

Risk factor for gram negative bacilli in meningitis Harrison pp 885

A

Chronic and debilatating disease such as diabetes, cirrhosis, alcoholism and chronic UTI

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12
Q

Commonly affected by L. monocytogenes Harrison pp 885

A

< 1month of age
pregnant woman
immunocompromised
> 60 years of age

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13
Q

These are important causes of meniningitis that occurs following invasive neurosurgical procedures like shunting procedures for hydrocephalus or as a complication secondary use of subcutaneous ommaya reservoir. Harrison pp 885

A

S. aureus

Coagulase negative staphylococci

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14
Q

Reasons why bacteria are able to multiply rapidly w/in CSF. Harrison pp 886

A
  1. absence of effective host immunodefense
  2. small amount of complement proteins
  3. fluid nature of CSF
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15
Q

What are the clinical triad of meningitis? Harrison pp 887

A
  1. Fever
  2. Headache
  3. Nuchal Rigidity
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16
Q

It occurs as part of the initial presentation of bacterial meningitis or during the course of the illness in 20-40% of patients. Harrison pp 887

A

Seizures

17
Q

What are the signs of increased ICP? Harrison pp 887

A
  1. decreased level of consciousness
  2. papilledema
  3. Dilated poorly reactive pupils
  4. 6th nerve palsies
  5. Decerebrate posturing
  6. Cushing reflex
18
Q

Cushing reflex

Harrison pp 887

A

Bradycardia
Hypertension
Irregular respiration

19
Q

Define the rash of meningococcemia. Harrison pp 887

A

Begins as a diffuse erythematous maculopapular rash resembling viral exanthem. Then rapidly becomes petechial that found at the trunk and lower extremities , mucous membranes and conjunctiva.

20
Q

Classic CSF abnormalities in bacterial meningitis. Harrison pp 887

A
  1. leukocytosis (>100 cells/ul in 90%)
  2. decrease glucose concentration (40mg/dl)
  3. CSF/serum glucose ratio <0.5 in 60%
  4. Increase protein concentration of >45mg/dl
  5. Increased opening pressure > 180mmH20
  6. CSF bacterial cultures are positive >80%
  7. CSF gram’s stain demonstrate > 60%
21
Q

Antibiotic use for hospital acquired meningitis post traumatic or post surgery meningitis, neutropenic patients, or patient with impaired cell-mediated immunity. Harrison pp 887

A

Ampicillin + Ceftazidime or Meropenem + Vancomycin

22
Q

Antibiotic use > 55 years old and adult of any age with alcoholism or other debilatating illness. Harrison pp 887

A

Ampicillin + cefotaxim, ceftriaxone or cefepime + vancomycin

23
Q

It is rapid diagnostic test for the detection of gram-negative endotoxin CSF. Harrison pp 888

A

Limulus amebocyte

Lysate assay

24
Q

What is the antibiotic of choice of meningococcal meningitis? Harrison pp 888

A

Pen G

25
Q

What is the beneficial effect of dexamethasone? Harrison pp 888

A

Inhibiting synthesis of IL-1B and TNF alpha at the level of MRNA
Decreasing CSF outflow resistance
Stabilizing the blood brain barrier

26
Q

Increasing the risk of death from bacterial meningitis. Harrison pp 890

A
  1. Decrease level of consciousness
  2. Onset of seizures w/in 24 hrs of admission
  3. Signs of increased intracranial pressure
  4. Young age (infancy) and age of >50 years old
  5. Comorbid condition
  6. Delayed initiation of treatment

Infectious (7 decks)

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