CNS infection

Question 1

Listeria- bug? age? signs?

Answer 1

Gram positive Rod, >55yo, seizure or FND

Question 2

Pneumococcus bug? treatment?

Answer 2

gram positive doplococci, Vanc plus 3rd gen ceph

Question 3

Meningococcus bug? tx?

Answer 3

Gram negative diplococci, 3rd gen ceph

Question 4

why and when steroids for meningitis? dose?

Answer 4

stabilized BBB, given before abx/10q6 for 4 days

Question 5

at risk for pseudomonas meningitis?

Answer 5

skull fx, penetrating trauma, NSG, shunt

Question 6

Neisseria meningitis prophylaxis?

Answer 6

roomate, next to infected for 8 hours, intimate partner

Question 7

TB meningitis CSF glucose? cells?

Answer 7

very low/pleocytosis with mononuclear cells

Question 8

WNV presentation, RF?, tx?

Answer 8

flaccid paralysis, immunocompromised, nothing

Question 9

Brain Abscess bugs?

Answer 9

toxo, nocardia, listeria, aspergillus

Question 10

immigrant with brain abscess?

Answer 10

neurocystericosis

Question 11

brain abscess treatment?

Answer 11

Vanc cephalosporin anaeorobic coverage

Question 12

when to give steroids with brain abscess?

Answer 12

mass effect , inc ICP

Question 13

size threshold of brain abscess to treat medically?

Answer 13

<2.5 cm

Question 14

Viral meningitis diagnosis?

Answer 14

CSF PCR but if repeat negative consider biopsy

Question 15

TB meningitis CSf?

Answer 15

lymphocyte predominance, very low glucose

Question 16

listeria CSf?

Answer 16

elevated WBC modestly and mostly lymphocytes, glucose is normal to decreased. Cultures positive within 3 days

Question 17

viral meningitis with blood in CSf?

Answer 17

HSV

Question 18

encephalitis with MRI showing b/l BG and thalamic hyperintensities

Answer 18

WNV

Question 19

dosing of HSV meningitis?

Answer 19

acyclovir 10mg/kg/day

Question 20

dexamethasone in bacterial meningitis dosing and timing?

Answer 20

before first abx, .15mg/kg every 6 hours for 4 days

Question 21

HSV encephalitis CSF?

Answer 21

lymphtocytic pleocytosis, normal glucose, slightly elevated protein, RBC characteristic

Question 22

MRI finding of HSV encephalitis?

Answer 22

hemorrhagic lesion of the temporal lobe

Question 23

bugs that will cause post neurosurgical meningitis?

Answer 23

staph, pseudomonas, propionobacterium

Question 24

characteristic speccific to propionobacterium growth?

Answer 24

indolent growth, can take up to 10 days to be positive on culture

Question 25

bugs causing menignitis with a CSF leak?

Answer 25

S pneumo and H flu

Question 26

listeria can be found in what?

Answer 26

soft cheeses and smoked meats

Question 27

most common bugs of infected VP shunt?

Answer 27

initially skin flora like staph, later on more like strep and pseudomonas

Question 28

when to use intraventricular abx for ventriculomeningitis?

Answer 28

refractory

Question 29

when do the most of venticulomeningitis happen?

Answer 29

within 10 days after EVD placement

Question 30

goal MIC for cephalosporin to be effective against pneumococcal meningitis? if does not reach that then use what?

Answer 30

MIC

Question 31

what can you give if van does not sterilize CSF in pneumococcal meningitis?

Answer 31

intraventicular abx and can add rifampin

Question 32

positive latex agglutination test in meningitis?

Answer 32

very specific for neisseria or strep

Question 33

empiric meningitis coverage in severely immunocompromised?

Answer 33

vanc rocephin amp, ampho B, flucytosine

Question 34

tuberculosis meningitis CSF?

Answer 34

high lymphs, very low glucose, high protein

Question 35

meningitis that can present with seizures and focal neurologic deficits?

Answer 35

listeria

Question 36

gram negative rods meningitis?

Answer 36

H flu

Question 37

gram positive rods meningitis?

Answer 37

listeria

Question 38

who to cover for pseudomonal meningitis?

Answer 38

shunt, penetrating trauma, NSG