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ID Flashcards

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1
Q

Risk factors for mucormycosis

A
  • Diabetes/DKA
  • Malignancy
  • High dose steroids
  • Organ transplantation
  • Immunosupression
  • Iron chelation therapy (with Deferoxamine)
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2
Q

HIV aseptic meningitis

A

Alertness and cognition reserved
Will have fever, headache and symptoms of meningeal irritation

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3
Q

West Nile encephalitis

A
  • Tremors
  • Parkinsonian signs
  • Asymmetric flaccid paralysis
  • Areflexia
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4
Q

Quickest and most sensitive test for Cryptococcus

A

Cryptococcal antigen detection
(India ink smear is not very sensitive)

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5
Q

Treatment for Cryptococcus

A

Initial treatment: Flucytosine + amphotericin for 2-3 weeks
Chronic maintenance therapy: Fluconazole (to prevent recurrences)

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6
Q

Side effects of amphotericin

A
  • Renal failure
  • Hypokalemia
  • Hypomagnesemia
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7
Q

Side effects of Flucytosine

A

Hematologic abnormalities

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8
Q

Treatment for Toxoplasmosis

A

Sulfadiazine plus pyrimethamine. Since they affect folate metabolism: supplement with folinic acid
If allergic to sulfa: clindamycin

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9
Q

Prophylaxis for Toxoplasmosis

A

For: CD4 <100/μL with positive IgG antibodies to toxoplasma
Trimethoprim-sulfamethoxazole

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10
Q

CNS lymphoma diagnosis

A
  • Positive CSF PCR for EBV
  • Flow cytometry: monoclonal B lymphocytes.
  • MRI showing one or more lesions usually in the periventricular and deep regions of the brain, may have contrast enhancement, surrounding edema, and produce mass effect.
  • Definitive diagnosis is done with brain biopsy.
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11
Q

PML symptoms

A
  • Focal neurologic manifestations
  • Visual field deficits and visual agnosias (parieto-occipital involvement)
  • Language disorders and ataxia may occur
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12
Q

Neuropath findings in PML

A

Myelin loss, giant astrocytes, and altered oligodendrocytes, with enlarged nuclei and viral inclusions –> “spaghetti and meatballs”

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13
Q

Bacterial meningitis bacteria in neonates

A
  • Escherichia coli and other enteric gram-negative bacilli
  • Listeria monocytogenes
  • Group B streptococci
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14
Q

Bacterial meningitis bacteria in 1-23 months

A
  • Streptococcus pneumoniae
  • Neisseria meningitidis
  • Streptococcus agalactiae = Group B strep
  • Haemophilus influenzae
  • Escherichia coli
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15
Q

Bacterial meningitis bacteria for 2 to 50 years

A
  • Streptococcus pneumoniae
  • Neisseria meningitidis
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16
Q

Bacterial meningitis bacteria for older patients >50 yo

A
  • Listeria monocytogenes
  • Aerobic gram-negative bacilli
  • Streptococcus pneumoniae
  • Neisseria meningitidis
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17
Q

Bacterial meningitis in neurosurgical patients

A
  • Aerobic gram-negative bacilli (including Pseudomonas aeruginosa)
  • Staphylococcus aureus
  • Staphylococcus coagulase negative (such as epidermidis)
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18
Q

Bacterial meningitis in the setting of CNS instrumentation

A
  • Aerobic gram-negative bacilli (including Pseudomonas aeruginosa)
  • Staphylococcus aureus
  • Staphylococcus coagulase negative (such as epidermidis)
    -Propionibacterium acnes
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19
Q

Where does TB affect the spine

A

T-spine
Specifically the anterior region of the vertebral body

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20
Q

Stage 1 of Lyme disease

A

Within 4 weeks of the tick bite: Erythema migrans

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21
Q

Stage 2 of Lyme disease

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A

Days to weeks after the rash:
* Systemic manifestations: fever, chills, migratory MSK pain, arthralgias, fatigue
* Cardiac symptoms: conduction block
* Lymphocytic meningitis
* Neuropathies: cranial and peripheral

22
Q

Stage 3 of Lyme disease

Study These Flashcards
A

Months after secondary stage: Oligoarthritis, encephalomyelitis, encephalopathy, dementia, axonal polyneuropathy

23
Q

Tt of Lyme disease

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A

If no cardiac involvement and CSF is normal: oral doxycycline.
If CNS involvement: IV CTX or IV Penicillin G for 2-4 weeks

24
Q

HIV associated dementia: MRI findings

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A

Subcortical regions, cerebral cortical is spared

25
West Nile diagnosis
CSF IgM antibodies
26
MRI findings with if brain involvement of Cryptococcus
- Hydrocephalus - Gelatinous pseudocysts - Infarcts - Cryptococcomas (ring enhancing, located in cerebellum, basal ganglia, thalamus, associated with mass effect)
27
MRI findings PML
Multiple white matter nonenhancing lesions that coalesce and predominate in the parieto-occipital regions
28
Leprosy variants
Tuberculoid and lepromatous
29
Leprosy: Tuberculoid variant
- Affects patients with good cellular immunity - Skin lesions are better localized - Asymmetric peripheral neuropathies with thickened nerves (most commonly ulnar nerve); may resemble mononeuritis multiplex.
30
Leprosy: Lepromatous variant
- Affects patients with impaired cell- mediated immunity - Maculopapular rash - Nodules - Poorly demarcated skin lesions - Sensory loss predominantly in the coolest regions of the body (pinna of the ear, tip of the nose, dorsal surfaces of the hands, forearms and feet, and dorsolateral surface of the legs)
31
Leprosy therapy
Rifampin, dapsone, clofazimine
32
TB meningitis: path
Caseating granulomas
33
TB meningitis treatment
Combination of TB agents: rifampin, pyrazinamide, ethambutol, streptomycin, isoniazid - Starts with a combination of 4 meds for 2 months, then combination of 2 meds for a few months
34
Syphilis stages
Stage 1: chancre Stage 2: constitutional symptoms, lymphadenopathy, rash (palms and soles), syphilitic meningitis, cranial neuropathies Stage 3: cardiovascular complications, neurologic complications, gummatous complications
35
Neurosyphilis
- Pure meningeal syphilis - Meningovascular syphilis (due to endarteritis obliterans and vasculitis) --> strokes - Tabes dorsales (leads to Charcot joints) - Parenchymatous neurosyphilis (dementia, neuropsych manifestations, speech changes, pupillary abnormalities -Argyll Robertson)
36
Whipple disease: symptoms
- GI symptoms: abdominal pain, diarrhea - Neuro symptoms: oculomasticatory myorhythmia, supranuclear ophthalmoplegia, ataxia, dementia - Cutaneous: hypopigmentation - Adrenal insufficiency
37
Whipple disease: diagnosis
Gastrointestinal biopsy demonstrating periodic acid Schiff-positive macrophage inclusions
38
Whipple disease: treatment
IV CTX x2 weeks, followed by a prolonged course of trimethoprim-sulfamethoxazole
39
CJD MRI
- Cortical ribboning and head of caudate - Hockey stick sign: anterior putamen and caudate head hyperintensity
40
Primary CNS lymphoma association with EBV
- If immunocompromised: Almost all of these cases are associated with EBV, and CSF EBV PCR is helpful in the diagnosis - If immunocompetent: not commonly associated with EBV
41
Neurosyphilis treatment
Penicillin G 4 million units every 4 hours for 14 days
42
Fatal familial insomnia
- Progressive intractable insomnia - Sympathetic hyperactivity: tachycardia, hyperthermia, hypertension, hyperhidrosis - Tremor, ataxia, myoclonus, hyperreflexia, cognitive impairment
43
What differentiates brain abscess from metastatic or brain tumor?
Restricted diffusion on DWI (not seen in mets or brain tumors)
44
VZV neuro manifestations
- Herpes zoster: mid-thoracic region ++ - Zoster sine herpete: sensory symptoms w/o the rash. - Herpes zoster ophthalmicus: reactivation of the virus in the ophthalmic division of CNV --> sensory symptoms + rash in the distribution of this nerve. Cornea and conjunctiva can be involved --> keratitis --> blindness. - Ramsay–Hunt syndrome: facial palsy + herpetic rash in the external auditory meatus, 2/2 geniculate ganglion involvement. - Necrotizing retinitis --> visual loss. - VZV vasculopathy: Small and large intracranial vessels --> ischemic strokes, TIAs, aneurysmal dilatations with SAH and ICH - Myelitis
45
VZV vasculopathy: Diagnosis
CSF anti-VZV IgG >> PCR
46
VZV vasculopathy: Treatment
IV Acyclovir 10-15 mg/kg TID for at least 2 weeks
47
Neuropath of Rabies
Cytoplasmic eosinophilic inclusions known as Negri bodies, in Purkinje cells and pyramidal cells of the hippocampus
48
Symptoms that occur in children with HIV more than adults
- Microcephaly - Failure to thrive - Lymphocytic interstitial PNA - Bone marrow failure - Hepatosplenomegaly - Chronic diarrhea - Basal ganglia calcifications
48
49
Symptoms that occur in children with HIV more than adults
- Microcephaly - Failure to thrive - Lymphocytic interstitial PNA - Bone marrow failure - Hepatosplenomegaly - Chronic diarrhea - Basal ganglia calcifications
50
Risk of mother with HIV transmitting it to her child
15-45% if not treated <5% if treated If positive: 20% will have a rapidly progressive course with death in infancy

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