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IBI Test 2 > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

tumbling motility at room temp (37)

A

Listeria

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2
Q

grows at 4 degrees C

A

listeria

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3
Q

high risk patients for listeria

A

neonates
pregnant women (20 fold increase)

patients with defective or cell mediated immunity

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4
Q

refrigeration is not sufficient to kill

A

listeria

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5
Q

how is early onset listeria acquired in neonates?

A

transplacentally

**80 mortality

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6
Q

disseminated abscesses and granulomas in multiple organs

A

granulomatosis infanticeptica

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7
Q

how is late onset listeria acquired?

A

at birth or soon after

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8
Q

late onset listeria presents 2-3 weeks after birth with

A

meningoencephalitis septicemia

**70% mortality

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9
Q

in immunocompromised adults, listeria can present as

A

meningitis
bacteremia

**50% mortality in immunocompromised

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10
Q

facultative intracellular, replicates in macrophages

A

listeria

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11
Q

listeria’s internalins help mediate

A

forced phagocytosis

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12
Q

listeriolysin

A

pore forming hemolysin
activated by acidic pH

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13
Q

how is listeria motile?

A

actin polymerization (ActA protein)

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14
Q

listerias phospholipases do what?

A

destabilize vacuolar membrane

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15
Q

not sensitive for CSF

A

listeria

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16
Q

umbrella like growth in mobility agar

A

listeria

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17
Q

how has listeria acquired antibiotic resistance

A

conjugated plasmids from enterococci

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18
Q

DOC listeria

A

ampicillin or TMP-SMX

**IV for meningitis

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19
Q

listeria prevention

A

avoid eating at risk foods

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20
Q

is GBS encapsulated

A

yes

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21
Q

colonizes GI and GU tracts

A

GBS

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22
Q

pregnant women are at high risk of transmission of GBS, what is done to screen these patients?

A

culture at 35-37 weeks

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23
Q

GBS is part of normal vaginal flora in

A

25% of women

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24
Q

in non-pregnant adults, GBS can cause

A

endocarditis

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25
Q

in neonates, GBS can cause

A

pneumonia
meningitis
sepsis

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26
Q

risk factors for neonatal GBS infection

A

maternal colonization
PROM

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27
Q

diagnostic factor for GBS

A

CAMP factor

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28
Q

DOC for GBS meningitis/bacteremia in adults

A

pen G

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29
Q

DOC for GBS endocarditis

A

Pen G and gent

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30
Q

DOC for GBS infections in neonates

A

ampicillin + gent

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31
Q

prevention of GBS

A

prenatal screen cultures

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32
Q

two major causes of neonatal meningitis

A

E coli
GBS

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33
Q

portal of entry for E coli in neonates

A

nasopharynx and GI tracts

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34
Q

Hib is covered by what vaccine

A

2nd gen PRP conjugate

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35
Q

what age is the Hib vaccine given?

A

2-15 months

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36
Q

non-encapulated strains of Hib cause

A

otitis media, sinusitis, geriatric pneumonia

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37
Q

DOC invasive H. flu

A

cephalosporin

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38
Q

common cause of community acquired meningitis

A

N. meningitidis

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39
Q

what capsule serogroups of N. meningitidis are relevant to the US

A

B, C, Y

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40
Q

is N. meningitidis considered normal flora

A

no

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41
Q

transmitted through exchange of respiratory and throat secretions

A

N. meningitidis

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42
Q

diagnostic triad: N. meningitidis

A

nuchal rigidity
sudden high fever
altered mental status

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43
Q

3-7 days after exposure
starts with severe headache

A

N. meningitidis

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44
Q

20% of N. meningitidis cases develop

A

meningococcemia

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45
Q

progression of meningococcemia

A

petechial lesions –> hemorrhagic bullae –> gangrene

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46
Q

DOC N. meningitidis

A

ceftriaxone, cefotaxime

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47
Q

N. meningitidis prophylaxis

A

rifampin
ceftriaxone

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48
Q

diagnosis N. meningitidis

A

lumbar puncture and gram/stain culture of CSF

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49
Q

what age group is the Hib-MenCY vaccine for
[N. meningitidis]

A

6-18 months

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50
Q

what age group is the MenACWY vaccine for
[N. meningitidis]

A

2-55 years
quadrivalent

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51
Q

infection of the leptomeninges-including arachnoid mater and the CSF in both the subarachnoid space and cerebral ventricles

A

meningitis

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52
Q

infection of brain parenchyma; AMS >24 hrs, focal neuro deficit, seizure, CSF pleocytosis, abnormal imaging

A

encephalitis

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53
Q

cross over between infection of the arachnoid CSF and brain parenchyma with combine clinical features

A

meningoencephalitis

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54
Q

rare inflammatory demyelinating disease of the CNS though to be an autoimmune process triggered by an environmental stimulus in susceptible individuals

A

acute disseminated encephalomyelitis

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55
Q

HA
stiff neck
retained cerebral function

A

meningitis

56
Q

no stiff neck
AMS

A

encephalitis

57
Q

no fever
normal CSF
MRI unremarkable

A

encephalopathy

58
Q

ADEM occurs

A

post infection/vaccination

59
Q

MRI focal hyperinstensity in gray matter

A

viral encephalitis

60
Q

MRI focal hyperintensity in white matter

A

ADEM

61
Q

most common fatal sporadi viral encephalitis worldwide

A

HSV

62
Q

treatment HSV/VZV meningitis

A

IV acyclovir

63
Q

temporal lobe changes

A

HSV meningitis

64
Q

Diagnosis HSV meningitis

A

HSV PCR of CSF

65
Q

diagnosis VZV meningitis

A

CSF VZV PCR

maybe IgM

66
Q

leading recognizable cause of aseptic meningitis accounting for 85-95% of all cases

A

enterovirus

67
Q

summer/fall seasonality

A

enterovirus

68
Q

fecal oral spread, houseflies, wastewater [virus]

A

enterovirus

69
Q

diagnosis EV meningitis

A

CSF EV PCR

70
Q

treatment EV meningitis

A

supportive care

71
Q

treatment CMV meningitis

A

ganciclovir, foscarnet

72
Q

is EBV meningitis common?

A

no, exceedingly rare

**don’t go looking for it

73
Q

in AIDS and POTs, consider EBV causing _______ in the CNS

A

B cell lymphoma

74
Q

seasonality July-September

A

West Nile

75
Q

transmitted from Culex mosquito

A

West Nile

76
Q

fever
rash
flaccid paralysis

A

West Nile

77
Q

diagnosis WNV meningits

A

IgM in CSF

78
Q

treatment WNV meningitis

A

supportive

79
Q

encapulated yeast

A

cryptococcal meningoencephalitis

80
Q

risk for cryptococcal meningoencephalitis increases in HIV patients when

A

CD4 is below 100

81
Q

treatment cryptococcal meningoencephalitis

A

ampho B + flucytosine

82
Q

diagnosis cryptococcal meningoencephalitis

A

CSF cryptococcal antigen

83
Q

main protozoan causing primary amebic meningoencephalitis

A

N. fowleri

84
Q

primarily children/young adults freshwater swimming

A

N. fowleri

85
Q

July-Sept seasonality

A

N. fowleri

86
Q

timing to onset is 5-8 days but could be as short as 24 hrs

A

N. fowleri

87
Q

bifrontal or fitemporal headaches unresponsive to analgesics w/high fevers

A

N. fowleri

88
Q

alteration in taste/smell

A

N. fowleri

89
Q

treatment: N. fowleri

A

miltefosine

but most people die

90
Q

illness script: encephalitis

A

fever, confusion, no meningismus, fluctuating level of consciousness

91
Q

illness script: acute meningitis

A

acute onset headache with fever and meningismus

92
Q

what two signs can be used to indicate meningismus?

A

Kernig’s
Brudzinkski’s

93
Q

why would you get a head CT prior to lumbar puncture?

A

immunocompromised
altered consciousness
new seizure
known CNS disease
papilledema
focal neuro defect

94
Q

neutrophils predominate CSF, think….

A

bacterial

95
Q

monocytes predominate CSF, think….

A

TB, crypto

96
Q

lymphocytes predominate CSF, think….

A

viral

97
Q

eosinophils predominate CSF, think…..

A

parasite

98
Q

WBC 1000-5000 in CSF

A

bacterial

99
Q

WBC 50-300

A

TB

100
Q

WBC 50-500

A

cryptococcal

101
Q

WBC 50-1000

A

viral

102
Q

WBC 150-200

A

parasite

103
Q

glucose normal

A

viral, parasite

104
Q

glucose >45

A

bacteria

105
Q

glucose <40

A

bacterial

106
Q

glucose <45

A

TB

107
Q

clear CSF

A

viral

108
Q

protein 100-500

A

bacterial

109
Q

protein 50-300

A

TB

110
Q

protein >45

A

cryptococcal

111
Q

protein <200

A

viral

112
Q

protein >45

A

parasitic

113
Q

high risk for S. pneumo meningitis

A

non vaccinated
asplenic

114
Q

treatment S. pneumo meningitis

A

ceftriaxone

115
Q

high risk of N. meningitidis

A

complement deficiency

116
Q

treatment N. meningitidis meningits

A

ceftriaxone

117
Q

high risk of listeria meningitis

A

low cell-mediated immunity
extremes of age

118
Q

treatment listeria meningitis

A

ampicillin

119
Q

high risk of H. flu meningitis

A

asplenic

120
Q

treatment H. flu meningitis

A

ceftriaxone

121
Q

empiric antimicrobial therapy for bacterial meningitis

A

ceftriaxone and vanc

**add amp if concern for listeria

122
Q

if S. pneumo is suspected, what should be added to chemotherapy

A

dexamethasone

**discontinue if cultures come back negative for S. pneumo

123
Q

illness script brain abscess

A

subacute onset headache with fever and focal neurodefecit

124
Q

brain abscesses are caused by what pathogens

A

bacterial (frequently anaerobes)
protozoan
fungal

125
Q

brain abscess associated with cranial trauma, post neurosurgery, endocarditis

A

S. aureus

126
Q

Toxoplasmosis can cause brain abscesses after

A

reactivation a long time after initial exposure in AIDS patients

127
Q

gram positive diplococci

A

S. pneumo

128
Q

gram positive rod

A

listeria

129
Q

gram negative rod/coccobacilli

A

H. flu

130
Q

gram negative cocci

A

N. meningitidis

131
Q

otitis media + CNS infection

A

S. pneumo

132
Q

pregnant + CNS infection

A

listeria

133
Q

asplenia + CNS

A

encapsulated

134
Q

encephalitis with orchitis or parotitis

A

mumps

135
Q

subacute meningoencephalitis in HIV+

A

cryptococcus

136
Q

asymmetric flaccid paralysis

A

west nile

137
Q

MRI temporal lobe enhancement

A

HSV-1 encephalitis

IBI Test 2 (14 decks)

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