Infectious Disease

Question 1

What is the Class Triad of clinical features of bacterial meningitis?

Answer 1

Fever, headache, and neck stiffness

Question 2

What is the median age of bacterial meningitis?

Answer 2

42 years

Question 3

From where does bacteria enter subarachnoid space most commonly?

Answer 3

Bloodstream

Question 4

What is the most common organism that causes bacterial meningitis in patients under 2 months of age?

Answer 4

Group B Strep

Question 5

What is the most common organism that causes bacterial meningitis in patients between 2 and 23 months of age?

Answer 5

Pneumococcus (50%)

Question 6

What is the most common organism that causes bacterial meningitis in patients between 23 months and 34 years of age?

Answer 6

Meningococcus (40%) and Pneumococcus (40%)

Question 7

What is the most common organism that causes bacterial meningitis in patients over 35 years of age?

Answer 7

Pneumococcus (50-70%)

Question 8

What is a normal WBC count for adults in the CSF?

Question 9

What is a normal WBC count for newborns in the CSF?

Question 10

What is a normal protein count for adults in the CSF?

Answer 10

18-50 (avg 35) mg/dL

Question 11

What is a normal protein count for newborns in the CSF?

Question 12

What is a normal glucose value for adults in the CSF?

Answer 12

2/3 of serum glucose (50-60)

Question 13

What is a normal glucose value for newborns in the CSF?

Answer 13

2/3 of serum glucose (variable)

Question 14

What is a typical WBC count in the CSF with bacterial meningitis?

Answer 14

100-10,000

Question 15

What is a typical WBC count in the CSF with viral meningitis?

Answer 15

10-2,000

Question 16

What is a typical WBC count in the CSF when encephalitis is present?

Answer 16

10-2,000

Question 17

What is the main WBC cell type in the CSF with bacterial meningitis?

Answer 17

PMN (80-90%)

Question 18

What is the main WBC cell type in the CSF with viral meningitis?

Answer 18

Mononuclear (lymphocyte)

Question 19

What is the main WBC cell type in the CSF when encephalitis is present?

Answer 19

Mononuclear (lymphocyte)

Question 20

What is the main WBC cell type in the CSF when a brain abscess is present?

Answer 20

Mononuclear (lymphocyte)

Question 21

Is CSF glucose high low or normal with bacterial meningitis?

Answer 21

Low

Question 22

Is CSF glucose high low or normal with viral meningitis?

Answer 22

Normal

Question 23

Is CSF protein high low or normal with bacterial meningitis?

Answer 23

High

Question 24

Is CSF protein high low or normal with viral meningitis?

Answer 24

Normal or slightly elevated

Question 25

What is the initial empiric therapy to treat bacterial meningitis in neonates and infants?

Answer 25

Ampicillin and cefotaxime

Question 26

What is the initial empiric therapy to treat bacterial meningitis in children and adults 3 months-50 years?

Answer 26

Ceftriaxone or cefotaxime, and vancomycin

Question 27

What is the initial empiric therapy to treat bacterial meningitis in adults over 50 years?

Answer 27

Ceftriaxone or cefotaxime, and vancomycin, AND ampicillin

Question 28

What is the initial empiric therapy to treat bacterial meningitis in hospital acquired, recent head trauma/neurosurgery, immunocompromised, and alcoholics?

Answer 28

Vancomycin and meropenem +/- ampicillin

Question 29

Which antibiotic is added when treating bacterial meningitis caused by Listeria?

Answer 29

Ampicillin

Question 30

When are steroids added to the treatment of bacterial meningitis?

Answer 30

Before or at the start of antibiotic treatment (only with pneumococcal meningitis)

Question 31

What are the common viruses that cause viral meningitis?

Answer 31

Enteroviruses, HSV-2, and arboviruses (WNV)

Question 32

What is the most important diagnostic tool for viral meningitis?

Answer 32

PCR amplification of viral genome

Question 33

What is the most common virus that causes viral encephalitis in the summer or early fall?

Answer 33

Arboviruses (WNV)

Question 34

What is the most common virus that causes viral encephalitis in the fall and winter?

Answer 34

LCMV

Question 35

What is the most common virus that causes viral encephalitis in the winter and spring?

Answer 35

Mumps

Question 36

What is a common virus that causes viral encephalitis in any season?

Answer 36

Herpes simplex

Question 37

What are 4 diagnostic tests used in the diagnosis of viral encephalitis?

Answer 37

PCR amplification, CSF pleocytosis, EEG, and CT/MRI

Question 38

What medication is used to treat viral encephalitis caused by HSV or VZV?

Answer 38

Acyclovir