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Neurology - Physiology > INFECTIOUS DISEASE > Flashcards

INFECTIOUS DISEASE Flashcards

1
Q

Type of arteritis in TB NSP

Neutrophils and lymphocytes migrate from the adventitia
to the subintimal region, often forming a conspicuous
layer. Later there is subintimal fibrosis.

A

Heubner arteritis

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2
Q

Cortical thrombophlebitis
of the larger veins does not usually develop before the
end of the ______ of the bacterial infection.

A

second week

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3
Q

The much more frequent
occurrence of thrombosis in veins than in arteries
is probably accounted for by the ______and the
_______ in the former

A

thinner walls

slower current of blood flow

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4
Q

approximately
______of infants with meningitis younger than 18
months of age develop subdural effusions.

A

40 percent

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5
Q

These cytokines are believed to

stimulate and modulate the local immune response

A

TNF, cytokines

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6
Q

In a survey of community-acquired bacterial meningitis, hydrocephalus
occurred in only________ percent, but it was associated with
poor outcome

A

5

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7
Q

account for approximately 75 percent of sporadic cases of bact men

A

H. influenzae, N. meningitidis, and S. pneumoniae

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8
Q

________which
are usually a consequence of lumbar puncture, spinal
anesthesia, or shunting procedures to relieve hydrocephalus

A

Pseudomonas and

the Enterobacteriaceae, such as Klebsiella, Proteus,

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9
Q

____occurs most often in children and adolescents but is also
encountered throughout much of adult life, with a sharp
decline in incidence after the age of 50 years.

A

Meningococcal meningitis

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10
Q

_______predominates in the very young and in older

adults.

A

Pneumococcal

meningitis

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11
Q

The most common meningeal pathogens are all normal
inhabitants of the______ in a significant part of
the population and depend on _________ for survival in the tissues of the
infected host

A

nasopharynx

antiphagocytic capsular
or surface antigens

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12
Q

The isolation of anaerobic streptococci,
__________________
from the CSF should suggest the possibility of a brain
abscess with an associated meningitis

A

Bacteroides, Actinomyces, or a mixture of microorganisms

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13
Q

rash may

be observed with ________

A

echovirus serotype 9, enteroviruses,

S. aureus infections

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14
Q

Meningitis in the presence
furunculosis or following a neurosurgical procedure
directs attention to the possibility of a ___________

A

coagulase-positive

staphylococcal infection.

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15
Q

Ventricular shunts or drains

inserted for the relief of hydrocephalus

A

with coagulase-negative staphylococci

and Proprionobacerium acnes and diphteroids.

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16
Q

Focal cerebral signs in the early stages of the disease,

although seldom prominent, are most frequent in ________

A

pneumococcal and H. influenzae meningitides

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17
Q

Cranial nerve abnormalities are particularly frequent ________

A

with pneumococcal meningitis

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18
Q

Cell counts of more than

50,000 I mm3 raise the possibility of a ______

A

brain abscess having

ruptured into a ventricle.

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19
Q

Substantial hemorrhage or substantial numbers of

red cells in the CSF seen in

A

anthrax meningitis (see Lanska) as well
as certain rare viral infections (Hantavirus, dengue fever,
Ebola virus

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20
Q

Cultures of the spinal fluid, which prove to be positive in ______ percent of cases of bacterial meningitis

A

70 to 90

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21
Q

_______ is present in most cases of posttraumatic
meningitis, but it may be transient and difficult
to find

A

CSF rhinorrhea

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22
Q

The most specific and sensitive test for C􀄃F
otorrhea and rhinorrhea is the finding of
(tau), not found in fluids other than CSF.

A

b2 transferrin

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23
Q

Currently, ______ of H. influenzae
isolates produce the beta-lactamase enzyme, but almost
all remain sensitive to third-generation cephalosporins
(e.g., cefotaxime, ceftizoxime, ceftriaxone).

A

30 percent

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24
Q

In children and adults, ______________ is
probably the best initial therapy for the three major types
of community-acquired meningitides.

A

hird-generation cephalosporins

such as ceftriaxone, combined with vancomycin

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25
Q

_______should be added to the regimen in cases of
suspected Listeria meningitis, particularly in an imrnunocompromised
patient

A

Ampicillin

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26
Q

N. meningitides, at least in the

United States, remains highly susceptible to _______

A

penicillin and ampicillin

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27
Q

In cases of meningitis
caused by coagulase-positive S. aureus, including those that occur after neurosurgery or major head injury,
administration of ______

A

vancomycin plus a third-generation cephalosporin (e.g., cefepime, ceftazadime, or meropenem)

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28
Q

Most cases of bacterial meningitis

should be treated for a period of ______

A

10 to 14 days

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29
Q

Prophylaxis for meningo

A

An alternative is a daily oral dose of rifampin-600 mg q12h in adults and 10 mg/kg q12h in children-for 2
days

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30
Q

The triad of pneumococcal meningitis, pneumonia, and endocarditis

A

OSLER

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31
Q

_____ percent of children with pneumococcal meningitis were left with
persistent sensorineural hearing loss;

for meningococcal and H. influenzae meningitis, the figures were 10.5 and 6
percent, respectively

A

31

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32
Q

Deafness in these infections is a result of _________ or, less often now, of the ototoxic
effects of aminoglycoside antibiotics

A

suppurative cochlear destruction

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33
Q

bacterial infections that are

complicated by a special type of encephalitis or meningoencephalitis.

A

Mycoplasma pneumoniae
infections, L. monocytogenes meningoencephalitis,
and Legionnaire disease.

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34
Q

WHAT ORGNASIM CAUSES THESE:

Guillain-Barre polyneuritis, cranial neuritis,
acute myositis, aseptic meningitis, transverse myelitis,
global encephalitis, seizures, cerebellitis, acute disseminated
(postinfectious) encephalomyelitis, and acute
hemorrhagic leukoencephalitis (Hurst disease)

A

Mycoplasma pneumoniae

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35
Q

Organism that may take the form of a brainstem encephalitis, or “rhombencephalitis

A

Listeria

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36
Q

Treatment of Listeria

A

The treatment is ampicillin (2 g intravenously
q4h) in combination with gentamicin (5 mg/kg
intravenously in 3 divided doses daily)

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37
Q

Treatment of Legionela

A

Treatment in adults has consisted of one

of levofloxacin, moxifloxacin, or azithromycin

38
Q

Without such massive antimicrobial therapy and surgery,

some patients will die in________ patients with subdural empyema

A

, usually within 7 to 14 days

39
Q

MC areas of septic thrombophlebitis

A

lateral
(transverse), cavernous, petrous, and, less frequently; the
longitudinal (sagittal) sinuse

40
Q

However, contiguous involvement of the
___________emanating from
it causes seizures and focal cerebral signs

A

superior sagittal sinus and cortical veins

41
Q

The posterior part of the cavernous sinus may
become infected via the_______
veins without the occurrence of orbital edema or ophthalmoplegia

A

superior and inferior petrosal

42
Q

In approximately _______ of cases of abscesses,

the source cannot be ascertained.

A

20 percent

43
Q

It is estimated that ______ of cases of congenital

heart disease are complicated by brain abscess

A

5 percent

44
Q

The _______ by far the most common anomaly implicated CHD associated with abscess

A

tetralogy of

Fallot is

45
Q

Type of pulmo telengiectasia associated with abscess

A

Osler-Rendu-Weber telangiectasia

46
Q

most common organisms causing bacterial cerebral

abscess are _______

A

virulent streptococci,

47
Q

enteric organisms in abscesses are almost always associated with ______

A

otitic infections;

48
Q

The term _________ is
loosely applied to this local suppurative encephalitis or
immature abscess.

A

cerebritis

49
Q

The abscess capsule tends to

be thinner on the______

A

side directed to the lateral ventricle

50
Q

Practically all abscesses

larger than_____ produce positive scans.

A

1 em

51
Q

The least satisfactory results are obtained if the
patient is comatose before treatment is started; more
than ______ percent of such patients in the past have died

A

50

52
Q

TB Meningitis sx

The early manifestations are usually low-grade
fever, malaise, headache______
lethargy, confusion, and stiff neck ____

A

(more than 50 percent of cases),

(75 percent of cases),

53
Q

In approximately _____ of patients with tuberculous
meningitis there is evidence of active tuberculosis
elsewhere

A

two-thirds

54
Q

Other causes of persistent

polymorphonuclear pleocytosis

A

Nocardia, Aspergillus, and Actinomyces

55
Q

Most children with tuberculous meningitis have ______

positive tuberculin skin tests

A

85%

56
Q

Sn of TB PCR

A

80%

57
Q

Anti-Kochs associated with highest penetration to CNS

A

INH and PZA

58
Q

CS reduced mortality from 41 percent

to _____ percent but had no effect on residual disability

A

32

59
Q

In patients who are treated late in the disease,
when coma has supervened, the mortality rate is nearly
________

A

50 percent.

60
Q

_______focal
collections of epithelioid cells surrounded by a rim of
lymphocytes; frequently there are giant cells, but caseation
is lacking.

A

Sarcoidosis

61
Q

Primary CNS sarcoidosis incidence

A

5-10%

62
Q

Describe the spinal cord pathology associated with sarcoidosis

A

longitudinally extensive myelopathy

63
Q

The history or presence of ________further

raises suspicion of this process.

A

erythema nodosum or iritis

64
Q

MRI of Sarcoid

A

Nodular or
streak-like perivenular enhancement may be found on
the contrast-enhanced MR

65
Q

skin test for sarcoid:

a granuloma in response to homogenate of spleen or lymph node from patients with known sarcoidosis.

A

Kveim-Siltzbach skin reaction

66
Q

treponeme usually invades the CNS within ________

months of inoculation with the organism

A

3 to 1 8

67
Q

if the CSF is negative
at the end of 5 years, the likelihood of developing
neurosyphilis falls to ____

A

1 percent.

68
Q

All forms of neurosyphilis begin as ______and

meningeal inflammation

A

meningitis

69
Q

the late (secondary) ones are_____

followed even later by tertiary syphilis,
____

A

vascular syphilis
(1 to 12 years),

general paresis, tabes dorsalis, optic atrophy,

70
Q

Hence the _______ represents a specific
antibody response to the treponeme and is recognized
as the presence of oligoclonal banding

A

gamma globulin

71
Q

With either spontaneous or therapeutic remission
of the disease, the ___disappear first; next the
total ______ returns to normal; then the ________
concentration is reduced

The positive serologic tests are
the last to revert to normal

A

cells

protein

gamma globulin

72
Q

more sn for diagnosis in sero-negative NSY

A

The fluorescent

treponema! antibody absorption (FTA-ABS)

73
Q

M e n i n g e a l Syp h i l i s typically does so within the first
______

With adequate treatment, the prognosis is ____

A

2 years.

good

74
Q

occurrence of meningovascular syphilis/secondary

is ______ years after the original infection

A

6 to 7

75
Q

Most of the

infarctions occur in the____

A

distal territories of medium- and
small-caliber lenticulostriate branches that arise from
the stems of the middle and anterior cerebral arteries.

76
Q

Pa retic N e u rosyp h i l i occurs ______usually separate the onset of general paresis
from the original infection

A

some 15 to

20 years

77
Q

The

changes are most pronounced in the ______ in NSY

A

frontal and temporal

lobes

78
Q

The pathologic changes consist
of perioptic meningitis, with subpial gliosis and fibrosis
replacing degenerated optic nerve fibers.

A

Syp h i l it i c O ptic At ro p h y

79
Q

Types of SC syph

A

syphilitic meningomyelitis

spinal meningovascular
syphilis,

80
Q

Spinal meningovascular syphilis

may occasionally take the form of an ______

A

anterior spinal

artery syndrome.

81
Q

Also rare is
_____________
which allegedly gives rise to radicular pain, amyotrophy
of the hands, and signs of long tract involvement in the
legs

A

syphilitic hypertrophic pachymeningitis or arachnoiditis,

82
Q

Pathology of Sy p h i l it i c N e rve Deafness a n d Vesti b u l o pathy

A

mainly endarteritis in

the cochlea and labyrinths

83
Q

The treatment of all o f these forms of neurosyphilis
consists of the administration of penicillin G, given intravenously
in a dosage of ________ units daily (3 to
4 million units q4h) for _____

A

18 to 24 million

10 to 14 days

84
Q

AIDS are particularly vulnerable to cryptococcal infection;
estimates are that_______ of AIDS patients
are subject to meningoencephalitis with the organism

A

6 to 12 percent

85
Q

In patients without AIDS, this consists
of intravenous administration of amphotericin B, given
in a dose of _______

A

0.7 to 1 . 0 mg /kg/ d.

86
Q

renal cx of ampho B

A

Renal tubular acidosis also frequently

complicates amphotericin B therapy.

87
Q

The addition of
_______to amphotericin B results
in fewer failures or relapses, more rapid sterilization of
the CSF, and less nephrotoxicity

A

flucytosine (100 mg /kg/ d)

88
Q

this regimen, which has a success rate
of __________ percent in immunocompetent patients, has
proven to be much less effective in patients with AIDS.

A

75 to 85

89
Q

fluconazole, an oral triazole antifungal

agent, for up to________or indefinitely to prevent relapse

A

1 year

90
Q

______does not present as
meningitis but hyphal invasion of cerebral vessels may
occur, with thrombosis, necrosis, and hemorrhage; i.e., it
is an infectious vasculitis.

A

Aspergillosis

91
Q

_______, and echinocandins in some cases, is

the recommended treatment for aspergillosis

A

Liposoma amphotericin in combination

with voriconazole

92
Q

Toxoplasma organisms is readily

recognized in _______

A

Wright- or Giemsa-stained preparations

Neurology - Physiology (44 decks)

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