Brain abscess

Question 1

A brain abscess is a collection of pus that occurs in the brain. What is the incidence of a brain abscess?

1 - 800 cases per 100,000
2 - 80 cases per 100,000
3 - 8 cases per 100,000
4 - 0.8 cases per 100,000

Answer 1

4 - 0.8 cases per 100,000

Question 2

A brain abscess is a collection of pus that occurs in the brain. What age does the incidence of a brain abscess typically peak at?

1 - >75
2 - 50-60
3 - 30-50
4 - 20-30

Answer 2

4 - 20-30

Question 3

Is a brain abscess, a collection of pus that occurs in the brain more common in men or women?

Answer 3

• men

2:1 ratio

Question 4

Which of the following patients are at greater risk of a brain abscess?

1 - older patients
2 - young babies
3 - HIV patients
4 - diabetic patients
5 - all of the above

Answer 4

5 - all of the above

All are immunosuppressed

Question 5

Bacterial infections is one of the most common causes of a brain abscesses. Infection in which of the following sites can cause a brain abscess?

1 - sinuses (sinusitis)
2 - ear infection
3 - dental infection
4 - blood born infections
5 - all of the above

Answer 5

5 - all of the above

Question 6

The location of the brain abscess ultimately affects the symptoms that the patients present with. However, all of the following EXCEPT which once can result due to a brain abscess?

1 - severe headaches
2 - reduced reflexes
3 - fever
4 - focal neurology
5 - increased ICP (papilledema)
6 - changes in mental status

Answer 6

2 - reduced reflexes

Can cause focal neurological symptoms, but not reduced reflexes

Question 7

Focal neurology can occur in patients with a brain abscess. Which 2 of the following are the most common presentations?

1 - oculomotor nerve palsy
2 - abducens nerve palsy
3 - loss of sensation
4 - vertigo

Answer 7

1 - oculomotor nerve palsy
2 - abducens nerve palsy

Typically this is secondary to increased ICP

Question 8

Which of the following can be caused by increased ICP?

1 - nausea
2 - papilledema
3 - seizures
4 - all of the above

Answer 8

4 - all of the above

Question 9

Fevers can be common in brain abscess. Are these swinging fevers like in abscesses elsewhere in the body?

Answer 9

• typically no

Can also be absent as well

Question 10

Which of the following is the least likely differential diagnosis for a brain abscess?

1 - meningitis
2 - encephalitis
3 - optic neuritis
4 - brain tumour

Answer 10

3 - optic neuritis

Question 11

Which imaging modality is the image of choice in suspected brain abscess?

1 - head MRI with contrast
2 - head CT
3 - head X-ray
4 - PET scan

Answer 11

2 - head CT

Ring enhancement often appears on contrast-enhanced CT, as the abscess wall thicken

Question 12

All of the following should be performed in a patient with suspected brain abscess, but which is least important?

1 - FBC (marked leukocytosis)
2 - ESR and CRP
3 - Renal function and electrolytes
4 - Blood cultures
5 - ECG
6 - Serological tests
7 - CSF sample

Answer 12

5 - ECG

Question 13

Which of the following can typically be performed in patients with suspected brain abscess?

1 - drainage via a burr hole
2 - antibiotic treatment
3 - dexamethasone
4 - all of the above

Answer 13

4 - all of the above

Dexamethasone = reduces ICP

Question 14

Which of the following is NOT a common complication of a brain abscess?

1 - ventriculitis due to rupture of abscess
2 - epilepsy (30-50% of patients)
3 - paraplegia
4 - visual field loss (hemiparesis)

Answer 14

3 - paraplegia