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E-med exam 3 > CNS infections > Flashcards

CNS infections Flashcards

1
Q

Bacterial meningitis

A

infection of Arachnoid mater and CSF in the:

subarachnoid space
cerebral ventricles

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2
Q

Bacteria can access CNS via

A

Bloodstream

Contiguous- along tissue lines, makes its way to CSF

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3
Q

Inflammation damages BBB causing increased permeability

A

alters PROTEIN and GLUCOSE transport

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4
Q

Progressive cerebral edema with increased Intracranial PRESSURE leads to:

A

Decreased cerebral perfusion and Neurologic damage

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5
Q

Newborns with Meningitis

A

Group B strep

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6
Q

Meningitis from nasopharynx

A

Strep. Pneumo

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7
Q

Meningitis in Military, college (crowded conditions

A

Neisseria Meningitides

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8
Q

Meningitis after Head trauma

A

Staph species

causes Pneumococcal meningitis

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9
Q

Meningitis after Neuro procedure

A

Staph, and other gram (-)

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10
Q

Neisseria Meningitides causes

A

Meningococcal meningitis

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11
Q

Strep PNA causes

A

Pneumococcal meningitis

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12
Q

Listeria Monocytogenes

A

Immune system is weak

elderly, newborns

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13
Q

Coag negative staph

A

Foreign body, surgery, alll age gropus

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14
Q

Staph Aureus

A

Enters thru skin or bacteremia,

Endocarditis, surgery, FB, ventricular drain, ulcer

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15
Q

H. Influenzae

A

Unvaccinated children or adults who have lost immunity to H. Influenzae

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16
Q

Classic triad of Meningitis

A

Fever
Nuchal rigid
AMS

(and also have HA)

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17
Q

Petechial rash and Palpable purpura

what type of Meningitis?

A

Neisseria Meningitides

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18
Q

Neisseria Meningitides

A

progresses very rapidly

young otherwise healthy individuals

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19
Q

Kernig’s sign

A

inability or reluctance to allow full extension of knee when hip is already flexed

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20
Q

Brudzinski’s sign

A

pt flexes hips as response of provider doing PASSIVE FLEXION of pt’s neck

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21
Q

Kernig and Brudsinski

A

late finding
will see false positives!! so be aware of that

(if pt has cervical arthritis, may be +)

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22
Q

Jolt accentuation test

A

rotate head horizontally 2x/second, + is exacerbation of HA

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23
Q

Papilledema

A

sign of INCREASED INTRACRANIAL PRESSURE

a late finding, be concerned

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24
Q

Labs to oder w Meningitis

A

CBC w/diff, CMP, ESR, CRP
Serum glucose AND CSF glucose
Coag studies

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25
Q

CSF findings of Bacterial meningitis

A 
Inc WBC
Inc Protein
Inc opening pressure
DEC glucose
(+) gram stain/culture
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26
Q

CSF findings of Aseptic meningitis

A

WBC <500
Normal protein and glucose
(-) gram stain
Lymphocytes

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27
Q

CT before LP if pt has ANY of these risk factors:

A 
Immunocompromised
Hx of CNS dz
New onset seizure
Papilledema
AMS
Focal neuro deficit
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28
Q

Reasons that we sometimes CT before LP in those pts

A

Risk of Cerebral herniation during LP if they already have increased intracranial pressure

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29
Q

Gram (+) Diplococci

A

Pneumococcal

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30
Q

Gram (-) Diplococci

A

Meningococcal

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31
Q

Gram (-) Coccobacilli

A

H. influenzae

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32
Q

Gram (+) Rods and Coccobacilli

A

L. Monocytogenes

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33
Q

Predictors of adverse outcomes

A

Leukopenia
AMS
Seizures
Hypotension

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34
Q

What to give to pt with Meningitis immediately after blood cultures and LP

A

IV Dexamethasone and Empiric Abx

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35
Q

Dexamethasone

A

decreases hearing loss, neurologic equelae, and morbidity/mortality in pts with PNEUMOCOCCAL MENINGITIS

since this is most common, automatically give this til this type is r/o

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36
Q

Start Dexamethasone and then only continue if

A

Gram stain/culture is (+) for Strep PNA which causes –> PNEUMOCOCCAL meningitis

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37
Q

Consider adding what if steroid is continued?

A

Rifampin

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38
Q

Use Ampicillin in all groups where

A

Immunocompromised

newborn, >50, etc

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39
Q

Vancomycin is used for everyone except

A

newborns

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40
Q

Ampicillin covers for

A

L. Monocytogenes

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41
Q

3rd gen Cephalosporin used for

A

newborns to >50 YO

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42
Q

Dexamethasone is used for everyone except

A

newborns

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43
Q

What two meds are NOT used in newborns?

A

Dexamethasone and Vancomycin

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44
Q

Med spec for immunocompromised

A

4th gen Cephalosporin (better coverage)

Cefepime or Meropenem

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45
Q

3rd gen Cephalosporins

A

Ceftriaxone, Cefotaxime

46
Q

4th gen Cephalosporins

A

Cefepime, Meropenem

47
Q

If PCN allergy,

A

Vancomycin, Moxifloxacin, Bactrim

48
Q

Basilar skull fracture

contiguous spread

A

Vanco, Cefotaxine (3rd gen) or Gentamycin

+ Dexa

49
Q

Penetrating trauma/ post neuro surgery

STRONGER cephalosporin- 4th gen

A

Vanco, Ceftazadime or Cefepime or Merepenem (4th gen)

+ Dexa

50
Q

What to do first in Meningitis pt who needs CT

A

Blood cultures
Dexa + Abx
CT
CSF for labs

51
Q

What to do first in Meningitis pt who can undergo LP

A 
Blood cultures
LP
Dexa + Abx (3rd)
CSF for labs
Tailor tx based on results
52
Q

If you get results back and its NOT gram (+) diplococci indicating s.pna, then

A

Discontinue Dexa and Rifampin

Start targeted Abx

53
Q

If gram stain doesn’t show bacteria, but other CSF findings consistent with bacterial meningitis

A

STILL continue Dexa and Abx

54
Q

Vaccinations against

A

S. PNA
N. Meningitidies
H. Influenzae

55
Q

Post exposure proph is available for N. MENINGITIDES

A

Cipro
Rifampin
Ceftriaxone

56
Q

Aseptic meningitis

A

sometimes referred to as Viral, but not always viral

57
Q

Aseptic meningitis

A

Sx less severe
Tx: Supportive

typical pt has COMPLETE recovery w no lasting sequela

58
Q

Viral- most common cause

A

ENTEROVIRUS
summer, autumn

Coxsackie, Echovirus, HSV2

59
Q

up to 36% w genital lesions d/t HSV2 have

A

meningeal involvement

60
Q

Unvaccinated pt

A

Parotitis suggests mumps

61
Q

Severe genital lesiosn

A

HSV2

62
Q

Mildly ill pt with Diffuse, maculopapular rash

A

Enteroviral infection
Primary HIV
Syphilis

63
Q

Thrush and cervical LAD

A

Primary HIV

64
Q

Asymm flaccid paralysis

A

West Nile Virus

65
Q

Predominance of lymphocytes on CSF

A

Viral cause!!

66
Q

Only use Antiviral in severe case or immunocomp

A

Acyclovir

67
Q

Encephalitis

A

infection of brain PARENCHYMA

68
Q

Whats the diff b/w Meningitis and Encephalitis?

A

Encephalitis you will see more serious sx like:

AMS, Seizure, Motor/sensory def, personality change, speech/motor disorders bc the ACTUAL BRAIN TISSUE is infected

69
Q

Meningitis

A

preservation of Cerebral fx, rather sx like fever, HA, neck stiff

70
Q

Primary infection of Encephalitis

A

Direct viral invasion of CNS
Can be cultured from brain tissue bc infection is right in there

+ Neuronal involvement

71
Q

Immune mediated response to an infection person has had

ADEM

A

Post- infectious enceph
Acute Disseminated Encephalomyelitis (ADEM)

Neurons are spared!
Perivascular inflammation/demyelinate

72
Q

When does ADEM occur?

A

as Initial infection is resolving

73
Q

Encephalitis is caused by

A

VIRUSES, West Nile, Lyme dz, RMSF, etc

Most common cause of fatal enceph: HSV1

74
Q

Most common cause of Viral Enceph in US

A

West Nile Virus

mosquitoes!!

75
Q

Most common viruses in Meningitis

A

Coxsackie
HSV2
HIV
Measles/Mumps

76
Q

Most common viruses in Encephalitis

A

West Nile
HSV1
CMV
Influenza

77
Q

What sx are usually NOT seen with Enceph?

A

Photophobia

Nuchal rigid

78
Q

Flaccid paralysis

A

West Nile

79
Q

Hydrophobia
Hyperactive
Pharyngeal spasm

A

Rabies virus

80
Q

St Louis virus

A

tongue tremor, lips, eyelids

81
Q

RBC in CSF can be indicative of

A

HSV1 infection

82
Q

Encephalitis study of choice

A

MRI with contrast

can take 3-4 days for changes to show up

83
Q

Temporal lobe changes on MRI suggest

A

HSV

84
Q

Hydrocephalus on MRI may suggest

A

Bacterial, Fungal, or Parasitic etiology

85
Q

Last resort testing

A

Brain biopsy only if etiology is unknown

86
Q

Mgmt of ENCEPHALITIS

A

Acyclovir!!!

seizure proph
diuretic IF increased ICP
-Mannitol
-Furosemide

87
Q

With ENCEPHalitis, poor prognosis if pt

A

Has initial diffuse cerebral edema or SEIZURES

88
Q

Cerebral abscess d/t direct spread

A

recent URI
head/facial trauma
post op
dental infection

89
Q

If brain abscess is in TEMPORAL lobe or CEREBELLUM, a likely etiology is:

A

Otitis media

Mastoiditis

90
Q

If brain abscess is in FRONTAL LOBE, a likely etiology is:

A

Frontal/ethmoid Sinusitis

Dental

91
Q

Abscess d/t hematogenous spread

A 
multiple abscess
skin inf
pelvic inf
intraabdominal inf
bacterial endocardiits

may not find a cause

usually BACTERIAL SOURCE

92
Q

Immigrants from Mexico, brain abscess

A

d/t Parasites
CYSTERCOSIS
d/t Taenia solium (larval stage of pork tapeworm)

93
Q

Immunocomp brain abscess

A

Toxoplasmosos
L. Mono
Nocardia asteroides

94
Q

Fungal abscess

A

multiple absess, poor outcome

95
Q

Cerebral abscess sx

A

UNILATERAL HA

other: severe pain, not relieved OTC meds, fever, AMS, vomiting if increased ICP, neuro def, seizure, papilledema (late finding)

96
Q

Study of choice for brain abscess

A

MRI with contrast

Will show Ring enhancing lesion*

97
Q

late >2 wks findings of Brain abscess on MRI

A

Necrosis and liquefacation

Lesion surrounded by fibrotic capsule

98
Q

How to get culture for brain abscess

A

CT guided aspiration or Surgical excision

99
Q

When is LP CONTRA for brain abscess?

A 
Focal sx
Unilateral HA
Unilateral CN deficit
Hemiparesis
Papilledema
100
Q

Mgmt of Cerebral abscess

A 
Neurosurg- CT guided aspiration or Surgical excision
Abx empiric 
Dexamethasone if substantial mass effect
Alter abx as needed, continue 4-8 wks 
Track w MRI
101
Q

Oral source of Brain abscess tx

A

Metronidazole + Pen G

102
Q

Ear or Sinus source of Brain abscess tx

A

Metronidazole + Ceftriaxone or Cefotaxime (3rd gen)

103
Q

Intracranial epidural abscess

A

b/w brain and skull
often a complication of Neurosurgery

usually stay within head, don’t spread caudally

104
Q

If purulent drainage from nose or ear, be thinking about:

A

Intracranial Epidural Abscess

105
Q

Imaging for IEA

A

MRI with contrast

then CT guided aspiration or open drainage for cultures

106
Q

Contiguous spread of IEA

tx

A

Metro + 3rd gen Ceph

107
Q

All other causes of IEA

A

Metro + 3rd gen Ceph + VANCOMYCIN

more aggressive tx for post op, trauma cause

108
Q

Spinal Epidural Abscess (SEA)

A

major cause: Staph Aureus

109
Q

Classic triad for Spinal Epi Absc

A

Fever
Spinal pain
Neuro deficits

110
Q

Progresssion of sx for SEA

A

back pain
nerve root SHOOTING pain
motor weakness/sensory change
PARALYSIS- quickly becomes irreversible (24-36 hrs)

111
Q

Imaging for SEA

A

MRI w contrast ASAP (showing “skip lesions”)

CT w contrast 2nd line

112
Q

Tx for SEA

A

Empiric abx ASAP
Vanco + 3rd gen
for 4-8 wks

Early surgical decompression and drainage
F/u MRI in 4-6 wks

E-med exam 3 (5 decks)

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