CNS Infections

Question 1

Most likely diagnosis:

• stiff neck
• photophobia
• meningismus

Answer 1

Meningitis

Question 2

Most likely diagnosis:

• fever
• headache
• confusion

Answer 2

Encephalitis

Question 3

MCC meningitis in elderly, neonates, and IC pts?

Answer 3

Listeria

Question 4

Cause of meningitis after recent neurosurgery?

Answer 4

Staphylococcus

Question 5

Cause of meningitis in AIDS pt w/ CD4

Answer 5

Cryptococcus

Question 6

Cause of meningitis in camper with rash shaped like a target, joint pain, and facial palsy?

Answer 6

Lyme disease

Question 7

Cause of meningitis in camper, rash moving from risks to trunk

Answer 7

RMSF

Question 8

Cause of meningitis in pulmonary TB pt?

Answer 8

TB

Question 9

Cause of meningitis in pt with no specific presentation?

Answer 9

viral

Question 10

Cause of meningitis in adolescent w/ petechial rash?

Answer 10

Neisseria

Question 11

Best initial test/most accurate test for meningitis?

Answer 11

LP

Question 12

Characteristics of CSF of pt with bacterial meningitis?

Answer 12

HIGH neutrophils/cell count
ELEVATED protein level
DECREASED glucose level
Sometimes positive stain and culture

Question 13

Characteristics of CSF of pt with viral meningitis?

Answer 13

LOW cell count
NORMAL protein level
NORMAL glucose level
Negative stain and culture

Question 14

Characteristics of CSF of pt with Cryptococcus, Lyme, or Rickettsia meningitis?

Answer 14

LOW cell count
possibly elevated protein level
possibly decreased glucose level
Negative stain and culture

Question 15

Characteristics of CSF of pt with TB meningitis?

Answer 15

LOW cell count
MARKEDLY ELEVATED protein level
Possibly decreased glucose level
Negative stain and culture

Question 16

What is a specific characteristic in CSF of TB meningitis?

Answer 16

Markedly elevated protein level in CSF

Question 17

If pt has focal findings, seizures, papilledema, or confusion with diagnosis of meningitis, what is the first initial test?

Answer 17

Head CT

Question 18

If Listeria is possible cause of meningitis, what is added to treatment regimen?

Answer 18

Ampicillin

Question 19

All close contacts of a patient treated for N. meningitis meningitis are treated with what abx?

Answer 19

rifampin, cipro, or ceftriaxone

Question 20

MC neuro deficit of untreated meningitis

Answer 20

8th CN deficit or deafness

Question 21

MCC of encephalitis

Answer 21

HSV

Question 22

Most accurate test for HSV encephalitis

Answer 22

PCR of CSF

Question 23

1st line Tx for HSV encephalitis

Answer 23

acyclovir

Question 24

1st line Tx for Acyclovir-resistant encephalitis?

Answer 24

Foscarnet

Question 25

What is a major side effect of acyclovir?

Answer 25

renal toxicity

Question 26

What is the most accurate diagnostic test for TB meningitis?

Answer 26

acid-fast stain and culture on 3 high-volume lumbar punctures

Question 27

What is the most accurate diagnostic test for Lyme and Rickettsia meningitis?

Answer 27

specific serology testing, ELISA, Western blot, and PCR

Question 28

What is the most accurate diagnostic test for Cryptococcus meningitis?

Answer 28

``` India ink (60-70% sensitivity) Cryptococcal Ag (>95% sensitive and specific) ```

Question 29

What is the most accurate diagnostic test for viral meningitis?

Answer 29

diagnosis of exclusion