CNS infections

Question 1

what does pyogenic meningitis show

Answer 1

a thick layer of suppurative exudate which covers the leptomeninges over the surface of the brain

Question 2

where do you see the exudate in pyogenic meningitis

Answer 2

in basal and convexity surface

Question 3

what do you see microscopically in pyogenic meningitis

Answer 3

neutrophils in the subarachnoid space

Question 4

what is acute encephalitis

Answer 4

an infection of the brain parenchyma

Question 5

what time of year is viral meningitis most common

Answer 5

late summer/autumn

Question 6

what viruses can cause viral meningitis

Answer 6

enteroviruses eg ECHO virus

Question 7

how is viral meningitis diagnosed

Answer 7

viral stool culture, throat swab, CSF PCR

Question 8

what are the clinical features of encephalitis

Answer 8

insidious onset-sometimes sudden 
meningismus 
stupor, coma 
seizures, partial paralysis 
confusion, psychosis 
speech, memory symptoms

Question 9

what drug would you give for suspected encephalitis

Answer 9

acyclovir

Question 10

what type of organisms tend to cause neonatal community acquired bacterial meningitis

Answer 10

listeria, group B streptococci, E COLI

Question 11

organisms in children bacterial meningitis

Answer 11

h. influenza

Question 12

organisms in over 21

Answer 12

strep pneumonia > Neisseria meningitides

Question 13

10-21 bacterial meningitis

Answer 13

Neisseria meningitis

Question 14

over 65

Answer 14

step pneumonia > listeria

Question 15

what are the risk factors for bacterial meningitis

Answer 15

decreased cell mediated immunity-listeria monocytogenes
neurosurgery-staphylococcus, gram negative bacilli
fracture of the cribriform plate-step pneumonia

Question 16

what is the pathogenesis of bacterial meningitis

Answer 16

1. nasopharyngeal colonization
2. direct extension of bacteria-sinusitis, mastoiditis, or brain abscess
3. from remote foci of infection-endocarditis, pneumonia, UTI

Question 17

which organism causes meningococcal meningitis

Answer 17

Neisseria meningitis

Question 18

where is n. meningitis found

Answer 18

in the throats of healthy carriers

Question 19

what causes the symptoms of n. meningitis

Answer 19

endotoxin (bacteria may be found in leukocytes in CSF)

Question 20

in which cell is the n. meningitis bacteria found

Answer 20

leukocytes

Question 21

n.meningitiis occurs in which demographic

Answer 21

young children

Question 22

how are military vaccinated against n. meningitis

Answer 22

purifies capsular polysaccharide

Question 23

where is h. influenza found

Answer 23

in the throat microbiota

Question 24

what does h. influenza require for growth

Answer 24

blood factors

Question 25

what type of vaccine is available for h. influenza

Answer 25

conjugated vaccine directed against the capsular polysaccharide antigen

Question 26

who are most susceptible to s. pneumoniae meningitis

Answer 26

hospitalised patients, patients with CSF skull fractures, diabetics, alcoholics and young children

Question 27

where is s. pneumonia found

Answer 27

in the nasopharynx

Question 28

what vaccine is for s, pneumonia

Answer 28

new conjugate vaccine for pneumococcal pneumonia also provides protection against pneumococcal meningitis in children

Question 29

what type of bacteria are listeria monocytogenes

Answer 29

gram positive bacilli

Question 30

what is listeria resistant to

Answer 30

ceftriaxone

Question 31

what is the antibiotic of choice for listeria

Answer 31

IV ampicillin/amoxicillin

Question 32

how is tuberculous meningitis diagnosed

Answer 32

reactivation in the elderly high index of suspicion for diagnosis previous TB on CXR poor yield from CSF

Question 33

what type of organism produced cryptococcal meningitis

Answer 33

fungal infection

Question 34

what does cryptococcal meningitis look like on CSF

Answer 34

aseptic picture

Question 35

what type of infection does cryptococcal meninigitis produce

Answer 35

disseminated infection

Question 36

how do you treat cryptococcal meningitis

Answer 36

IV amphotericin B/flucytosine/fluconazole

Question 37

what are the most common symptoms of meningitis

Answer 37

fever, neck stiffness, changes in mental state, headache

Question 38

what do you need to be cautious of in lumbar puncture

Answer 38

if pt has ICP

Question 39

what are the main cells found in viral meningitis

Answer 39

lymphocytes

Question 40

what are the main cells in bacterial meningitis

Answer 40

polymorphs

Question 41

CSF is 99% predictive of bacterial meningitis if

Answer 41

``` WBC>2000 Neutrophils >1180 Protein >220 Glucose <34 Glucose (csf/serum) <0.23 ```