CH31: Bacterial, Fungal, Spirochetal, Parasitic Infections

Question 1

Most common spontaneous or community-acquired pathogenic organisms (p. 719)

Answer 1

S pneumoniae, N meningitidis, group B strep, Listeria monocytogenes, Staphylococcus

Question 2

Most common spontaneous or community-acquired pathogenic organisms in neonates (p. 719)

Answer 2

E. coli, group B strep

Question 3

Most common spontaneous or community-acquired pathogenic organisms in infants(p. 719)

Answer 3

H influenzae

Question 4

Released by macrophages believed to stimulate and modulate the local immune response affecting neurons (p. 721)

Answer 4

interleukin-1, TNF

Question 5

Most prominent finding in the later stages in meningitis (p. 721)

Answer 5

infiltration of the subependymal perivascular spaces

Question 6

Most significant factor in the pathogenesis of meningitis in infants and newborns (p. 723)

Answer 6

Maternal infection

Question 7

Pressure over approximately what value suggest the presence of brain swelling and potential for cerebellar herniation (p. 724)

Answer 7

350mmH20

Question 8

Cell counts of more than what value raise the possibility of a brain abscess having ruptured into a ventricle? (p. 724)

Answer 8

50,000

Question 9

Cutoff for protein and glucose in bacmen?

Answer 9

higher than 45mg.dL protein, 40mg/dL glucose of 40% of blood glucose concentration

Question 10

A clinical prediction rule was made to classify children at very low risk for bacmen if the have the following (p. 725)

Answer 10

negative CSF gram stain
CSF absolute neutrophil count under 1,000 cells/ mL
CSF protein under 80mg/dL
peripheral absolute neutrophil count under 10,000 cells/ mL
no history of seizure

Question 11

blood cultures positive up to how many percent of patients w H influenza, meningococcal and pneumococcal meningitis? (p. 725)

Answer 11

40-60%

Question 12

Most specific and sensitive test for CSF otorrhea and rhinorhea (p. 726)

Answer 12

b2- transferrin

Question 13

Recurrent meningitis, iridocyclitis, depigmentation of hair and skin (p. 726)

Answer 13

Vogt- Koyanagi- Harada

Question 14

Best initial therapy for the three major types of community acquired meningitis (p. 727)

Answer 14

Ceftriaxone + Vancomycin

Question 15

Corticosteroids decrease this in patients with H influenza meningitis (p. 728)

Answer 15

sensorineural hearing loss

Question 16

How to give steroids is bacmen (p. 728)

Answer 16

Dexamethasone 10mg IV now theN Q6 FOR 2 DAYS

Question 17

Prophylaxis for meningococcal exposure (p. 728)

Answer 17

Single dose of Ciprofloxacin or daily oral dose of rifampin 600mg q12 in adults, 10mgq12 in children for 2 days

Question 18

Osler triad carrying high fatality rate (p. 729)

Answer 18

pneumococcal meningitis, pneumonita, endocarditis

Question 19

Etiologic agent of Melioidosis (p.731)

Answer 19

Burkholderia pseudomallei

Question 20

Treatment for melioidosis (p. 631)

Answer 20

Ceftazidime for 10 to 14 dyas then Cotrimoxazole

Question 21

Unilateral axillary or cervical adenopathy occuring after a seemingly innocuous scratch (p. 732)

Answer 21

Catscratch fever

Question 22

Treatment for catscratch fever (p. 732)

Answer 22

Azithromycin or doxycycline

Question 23

Treatment for Anthrax (p. 732)

Answer 23

Ciprofloxacin with clindamycin, rifampin or meropenem

Question 24

Ingestion of raw milk (p. 732)

Answer 24

Brucellosis

Question 25

Most common areas of subdural empyema (p. 733)

Answer 25

Frontal or ethmoid

Question 26

Most common areas of brain abscess (p. 736)

Answer 26

frontal and sphenoid

Question 27

Percent of congenital heart disease complicated by brain abscess; percent of brain abscess associated with congenital heart disase (p. 737)

Answer 27

5%, 60%

Question 28

Most common cardiac anomaly associated with brain abscess (p. 737)

Answer 28

Tetralogy of Fallot

Question 29

CT scan finding of brain abscess (p. 738)

Answer 29

capsule of abscess is not uniform; medial paracentricular aspect is thinner

Question 30

Mycobacterium associated with neurosurgical procedures and cranial trauma (p. 740)

Answer 30

Mycobcaterium fortuitum

Question 31

Used to document previous or current TB infection (p. 741)

Answer 31

interferon-gamma-release assay

Question 32

Alternative treatment for TB (p. 743)

Answer 32

INH, PZA, high dose RMP, Moxifloxacin

Question 33

Single most effective drug for TB (p. 743)

Answer 33

INH

Question 34

Except for which drug , all anti-Kochs can be given via stomach tube (p. 743)

Answer 34

INH

Question 35

Meningitis occurs in how many percent of all cases of syphilis (p. 744)

Answer 35

25%

Question 36

If CNS not involved in 2 years, 5 years, how many percent chance of developing neurosyphillis? (p. 744)

Answer 36

5% then 1%

Question 37

Early clinical syndromes of syphilis (p. 744)

Answer 37

aseptic meningitis, meningovascular syphilis

Question 38

Late or secondary syphilis (p. 744)

Answer 38

vascular syphilis

Question 39

Tertiary syphilis ( p. 744)

Answer 39

general paresis, tabes dorsalis, optic atrophy, subacute myelitis

Question 40

CSF findings in syphillis (p. 745)

Answer 40

pleocyctosis 100cells/ mm3, elevation of gamma globulin, elevation of TP 40 to 200mg/dL, positive serologic tests

Question 41

Most reliable but expensive to perform diagnostic modality for syphillis (p. 745)

Answer 41

T pallidum immobilization

Question 42

Most common form of neurosyphilis (p. 745)

Answer 42

Meningovascular syphilis

Question 43

Most common area of infarction for MV syphilis (p. 745)

Answer 43

distal territories of medium and small caliber LS branches that arise from the stems of the MCA and ACA

Question 44

Paretic neurosyphilis syndrome-- prominent focal signs, unilateral frontal or temporal lobe disease (p. 746)

Answer 44

Lissauer cerebral sclerosis

Question 45

Most prominent feature of Tabtic neurosyphilis (p. 747)

Answer 45

Ataxia

Question 46

Treatment of syphilis (p. 745)

Answer 46

PenG IV 18 to 24M units daily for 10 to 14 days [4M q4]

Question 47

painful lymphocytic meningoradiculotis in Borreliosis (p. 749)

Answer 47

Bannwarth syndrome

Question 48

Treatment for Cyrptococcal meningitis (p. 752)

Answer 48

Amphothericin B 0.7 to 1.0 mg/kg/day or 3-4 mg/kg/day liposomal amphthericin. Add Flucytosine 100mg/kg/day

Question 49

Associated with chronic sinusitis with osteomyelitis at the base of the skull (p. 753)

Answer 49

Aspergillosis

Question 50

Treatment for Aspergillosis (p. 753)

Answer 50

Itraconazole

Question 51

Most common rickettsial disease (p. 754)

Answer 51

Rocky Mountain spotted fever

Question 52

Important diagnostic sign in scrub typhus (p. 754)

Answer 52

necrotic ulcer and eschar at the site of attachment of infected mite

Question 53

Treatment for rickettsial disease (p. 754)

Answer 53

Doxycycline or chloraphenicol

Question 54

Treatment for Toxoplasmosis ( p.755)

Answer 54

Sulfadiazine and Pyrimethamine. Add Leucovorin (15 to 20mg daily)

Question 55

Trypanosomiasis: characteristic feature of posterior cervical adenopathy of subsequent CNS infection (p. 756)

Answer 55

Winterbottom sign

Question 56

Trypanosomiasis: sign pronounced pain at sites of minor injury (p. 756)

Answer 56

Kerandel hyperesthesia

Question 57

Multiple calcified lesions in the thigh, leg and shoulder (p. 758)

Answer 57

Cystecircosis

Question 58

Schistosomiasis: cerebral hemisphere (p. 759)

Answer 58

S. japonicum

Question 59

Schistosomiasis: spine (p. 759)

Answer 59

S. mansoni

Question 60

S. mansoni location in the spine (p. 760)

Answer 60

conus medullaris