Lecture 5- CNS infections

Question 1

bacterial meningitis from NP

Answer 1

S. pneumo

Question 2

bacterial meningitis assoc. w/ military/college

Answer 2

N. meningitidis

Question 3

bacterial meningitis assoc. w/ head trauma

Answer 3

staph

Question 4

bacterial meningitis assoc. w/ neuro procedures (2)

Answer 4

staph

gram-

Question 5

bacterial meningitis assoc. w/ newborn - 1 mo. (3)

Answer 5

GBS
Listeria
E. coli

Question 6

bacterial meningitis assoc. w/ 1-3 mo. (6)

Answer 6

GBS
listeria
E. coli
S. pneumo
H. flu
N. meningitidis

Question 7

bacterial meningitis assoc. w/ 3 mo.-55 years (3)

Answer 7

S. pneumo
H. flu
N. meningitidis

Question 8

bacterial meningitidis > 55 years (4)

Answer 8

S. pneumo
H. flu
Listeria
G-

Question 9

bacterial meningitis triad

Answer 9

Fever
nuchal rigidity
AMS

Question 10

CSF lab findings bacterial meningitis (4)

Answer 10

> 1000 WBC
glucose less than 40
CSF:glucose less than 0.4
protein 100-500

Question 11

indications for CT in bacterial meningitis (6)

Answer 11

immuncompromised
hx CNS disease
new onset seizure
papilledema
abn LOC
focal neuro deficit

Question 12

newborn empiric abx for bacterial meningitis

Answer 12

Ampicillin + Ceftoxamie (or gentamycin)

Question 13

1 mo. - 50 years empiric abx for bacterial meningitis

Answer 13

Ceftriaxone + vancomycin

dexamethasone

Question 14

> 50 y/o empiric abx for bacterial meningitis

Answer 14

Ceftriaxone + ampicillin + vanco

dexamethasone

Question 15

immunosuppressed empiric abx for bacterial meningitis

Answer 15

Cefepime/Meropenem + ampicillin + vanco

dexamethasone

Question 16

empiric abx for bacterial meningitis for the PCN allergic

Answer 16

vanco + moxifloxacin + bactrim

Question 17

dexamethasone effect on bacterial meningitis (2)

Answer 17

decr. rate of hearing loss

decr. neuro sequelae

Question 18

most common cause of aseptic meningitis

Answer 18

enterovirus

Question 19

drug rxn causing aseptic meningitis (2)

Answer 19

NSAIDs

antibiotics

Question 20

aseptic meningitis labs (5)

Answer 20

WBC less than 500
> 50% lymphocytes
Normal glucose
normal or mildly elevated protein
negative gram/culture

Question 21

gold standard for aseptic meningitis

Answer 21

viral cultures

Question 22

aseptic meningitis treatment

Answer 22

symptomatic- analgesics, antipyretics

Question 23

hallmark of encephalitis

Answer 23

abn brain function

Question 24

bacterial assoc. w/ delivery (2)

Answer 24

E. coli

GBS

Question 25

viral invasion of the CNS w/ neuronal involvement

Answer 25

primary encephalitis

Question 26

immune-modulated, neuron-sparing inflammation of the CNS

Answer 26

postinfectious encephalitis

Question 27

HA, AMS, seizures, hemiparesis, CN palsies, incr. DTRs, ulcers/vesicles

Answer 27

encephalitis

Question 28

most common cause of encephalitis & where do you see it?

Answer 28

HSV-1 temporal lobe

Question 29

encephalitis labs/imaging findings? (3)

Answer 29

CT/MRI: possible abnormalities of the temporal lobes EEG: abn CSF: consistent w/ aseptic meningitis (negative culture)

Question 30

encephalitis tx (2)

Answer 30

Acyclovir 10 mg/kg IV q8h seizure prophylaxis

Question 31

direct spread sources of cerebral abscess (many)

Answer 31

otitis media, mastoiditis, meningitis, head trauma, sinusitis, dental infection, s/p neuro procedure

Question 32

unilateral HA, fever, nuchal rigidity, vomiting, AMS, focal neuro deficits, seizures

Answer 32

cerebral abscess

Question 33

MRI finding for cerebral abscess

Answer 33

ring-enhancing lesion

Question 34

early cerebral abscess (1-2 weeks) (4)

Answer 34

lesion poorly demarcated localized edema acute inflammation no tissue necrosis

Question 35

late cerebral abscess (> 2 weeks) (2)

Answer 35

necrosis & liquefaction | lesion surrounded by fibrotic capsule

Question 36

tx cerebral abscess (2)

Answer 36

CT-guided aspiration or surgical excision | abx for 4-8 weeks based on source

Question 37

abx for cerebral abscess, oral/otogenic/sinus source?

Answer 37

Metronidazole + Pen G (oral source) or Ceftriaxone (otogenic or sinus source)

Question 38

abx for cerebral abscess, hematogenous source

Answer 38

vanco + metronidazole

Question 39

abx for cerebral abscess postop neurosurg pts

Answer 39

vanco + ceftazidime/cefepime/meropenem

Question 40

abx for cerebral abscess, penetrating trauma source

Answer 40

vanco + ceftriaxone/cefotaxime

Question 41

abx for cerebral abscess, unknown source?

Answer 41

vanco + ceftriaxone/cefotaxime + metronidazole