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Flashcards in CNS Infections Deck (71):
1

4 Signs of increased ICP

-papilledema
-Abducens (6) palsy
-bulging fontanelle
-cushings reflex

2

List the cushings reflex triad

-HTN
-bradycardia
-irregular respiration

3

Are Kernigs and Brudinskis sensitive or specific for meningitis?

-both are very specific but not sensitive (5%, 95%)

4

Which clinical meningitis sign is most sensitive?

-nuchal rigidity
(but still not very sensitive, 30%)

5

CNS infection- pertinent labs

-CBC
-Complete Chemistry
-PT/PTT
-HCG
-blood + urine cultures

6

When is it appropriate to scan prior to LP?

-localizing signs
-AMS
-seizures
-signs of increased ICP

7

What are the uses of the four tubes drawn during LP?

1- glucose and protein
2- cell count
3- gram stain, routine culture
4- viral studieqs, VDRL

8

What should never be tested from tube 1 in LP?

-culture and gram stain, skin flora in tube one

9

How quickly is CSF normally replenished?

-half mL per minute
normal volume = 140 mL

10

Normal CNS glucose levels

2/3 serum glucose, 1/3 or less very sensitive for bacterial meningitis

11

How can protein levels be evaluated in traumatic tap?

-protein up 1 for every 700 RBCs

12

How many mononuclear WBCs are typically in CSF?

0-5

13

Proper position for LP opening pressure determination?

-lateral decubitus, not prone

14

What type of meningitis has normal opening pressure?

-fungal CAN be normal or low, other types at least slightly elevated

15

What type of meningitis has normal glucose?

-viral, all others have low glucose, esp bacterial

16

What type of meningitis has normal protein?

-viral, all others have high protein, esp bacterial

17

What type of meningitis involves RBCs in CSF?

-Bacterial

18

List the normal number of WBCs in CSF for each meningitis etiology:

-bacterial: over 200
-viral: 50-200
-fungal: 30-50
-TB: 20-30

19

Cell type predominant in CSF for bacterial, viral, fungal and TB meningitis

-mono except in bacterial = PMNs

20

Viral meningitis:
frequent bugs

-adeno
-entero
-arbo

21

Viral meningitis:
-typical months
-typical length

-summer
-week

22

Frequent bacterial meningitis bug across all age groups

-strep pneumo

23

Top 2 bugs in neonatal meningitis + empirical treatment

-1 GBS
-2 Listeria
-amp & gent

24

Top 2 bugs in 1-23 month olds + empirical treatment

1- strep pneumo
2- n men
ceftriaxone + vanc

25

Top 2 bugs in 2-18 year olds + empirical treatment

1- n men
2- strep pneumo
(GBS, Listeria also possible)

ceftriax + vanc + amp

26

19-59 top 2 meningitis bugs + treatment

-strep
-n men
ceftriax + vanc

27

Top 2 bugs in elderly meningitis + empiric treatment

-Strep pneumo
-Listeria
-ceftriax, vanc, amp

28

Treatment for GBS meningitis (2)

-amp
or
-pen G

29

Treatment for neisseria meningitis (2)

-amp
or
-ceftriaxone

**may add dexamethasone

30

Strep pneumo meningitis treatment

-ceftriax + vanc if penicillin resistant

31

Listeria treatment in meningitis

amp and gent

32

Treatment for gram - meningitis

-ceftriaxone or cefotaxime

33

Px for n meningitis

-rifampin 2 weeks or ceftriax one dose IM

34

Long term effects of bacterial meningitis

-hearing loss
-learning disability
-epilepsy
-hydrocephalus

35

Mortality rate encephalitis

10%

36

Common encephalitis origins

HSV1
arboviruses (west nile, eastern equine)
enterovirus (polio)

37

Nonviral causes of encehpalitis in the immunocompromised

-toxoplasmosis
-aspergillosis

38

When bacterial infections involve the brain they are called ____

cerebritis vs abscess depending on whether capsule exists

39

At what CD4 count is AIDs patient at risk of encephalitis?

200

40

Risks for encephalitis aside from immunosupression

-travel
-bats, mosquito exposure
(in endemic areas)

41

Encehpalitis workup: how do labs differ from meningitis workup?

-send CSF for cytology to evaluate for cancer cells

42

Basic lab added to encephalitis workup

UA

43

Imaging most sensitive for diagnosing viral encephalitis

-T2 MRI.

44

Treatment for HSV, VZV, EBV encehpalitis

IV acyclovir

45

Treatment for CMV encephalitis

ganciclovir, foscarnet

46

Treatment for lacrosse california encehpalitis

Ribaviron

47

Viral encephalitis with highest number of neuro sequelae

eastern equine (80%)

48

Otitis/mastoiditis:
how commonly do they cause abscess?
Where do they most commonly form abscess in brain?

cause of 33% abscesses
MC temporal/cerebeller

49

Common otitis/mastoiditis organisms?

-strep
-bacteroides
-pseudomonas

50

Sinusitis:
-what bugs are implicated
-where might they form cerebral abscess?

-staph aureus
-haemophilus

51

How commonly are brain abscesses a result of hematogenous spread?

25%

52

MC symptom of brain abscess?

-#1 headache
60% focal deficits, 35% seizure

53

Typical antibiotics for abscess?

cephalosporin
metronidazole

54

Neurosurg abscess drugs

ceftaz and vanc to cover staph and pseudomonas

55

When should steroids be given for abscess?

only if there is significant edema

56

MC cause subdural empyema

extension of sinus infection or meningitis

57

Treatment for subdural empyema

-burr hole + drainage
-cefotaxime + metronidazole

58

Cause of epidural empyema

#1 sx/skull fracture
-also mastoiditis, sinusitis, otitis

59

Treatment epidural empyema

-drainage
-vanc
-metronidazole

60

#1 cause meningitis in AIDs patients

cryptococcus

61

C. neoformans animal assc

pigeon soil --> inhaled --> blood --> meninges

62

Stain for cryptococcus

india ink

63

Treatment for cryptococcus

amphotericin
fluconazole

64

At what CD4 count is toxoplasmosis a concern in HIV patients?

200

65

Toxo:
How is diagnosis made?

MRI

66

How is toxoplasmosis treated?

sulfadiazine
pyrimethamine + leucovorin

67

What is toxo px for AIDs patients

TMP SMX daily until CD4 is greater than 200

68

What part of the brain is most susceptible to toxo?

basal ganglia

69

Bug assc with neurocysticercosis

T solium

70

Dx neurocysticercosis

MRI/CT

71

Treatment for neurocysticercosis

-seizure treatment (no px until after 1st seizure)
-steroids
-albendazole