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LGS Flashcards

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1
Q

What is encephalitis?

A

Acute inflammation within the brain

Most common cause is viral infections.

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2
Q

What are the signs and symptoms of encephalitis?

A

Headache, Acute Fever, AMS, Confusion, Seizures, Motor Weakness

Complications include coma and death.

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3
Q

What is meningitis?

A

Inflammation of the meninges

Classic triad includes sudden fever, neck stiffness, and AMS.

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4
Q

What is the classic triad of meningitis?

A

Sudden Fever, Neck Stiffness, AMS

Additional symptoms include headache, nausea, vomiting, muscle soreness, photophobia, and seizures.

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5
Q

What is myelitis?

A

Inflammation of the spinal cord.

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6
Q

In cases of altered mental status, what conditions should be considered?

A

Encephalitis or meningoencephalitis, usually arising from viral infections.

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7
Q

What are the causative organisms of encephalitis?

A
  • Arboviruses
  • HSV-1
  • HHVs
  • Measles
  • Etc.
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8
Q

What are the causative organisms of meningitis?

A
  • S Pneumo
  • GBS
  • N Meningitidis
  • H Influenzae
  • Listeria
  • E Coli
  • Etc.

Capsules help bacteria cross BBB

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9
Q

What are risk factors for developing meningitis?

A
  • High population living areas
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10
Q

What are risk factors for developing encephalitis?

A
  • Exposure to viruses such as HSV and Measles
  • Unvaccinated individuals
  • Mosquitos
  • Immunodeficiency
  • Pregnancy
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11
Q

When is a lumbar puncture indicated?

A

If there is a possibility of meningitis

Empiric antibiotics should be given immediately.

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12
Q

What is the recommended antibiotic treatment for a patient over 50 with suspected meningitis?

A
  • Third Gen. Cephalosporin
    + Ampicillin
    + Vancomycin

Ampicillin covers Listeria, Vanc covers gram (+)

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13
Q

When should dexamethasone be administered?

A

Before or at the same time as initiating antibiotics

It helps decrease ICP, cerebral edema, and neuronal injury.

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14
Q

What are the indications for a CT before a lumbar puncture?

A
  • Focal neurologic deficit
  • AMS or deteriorating level of consciousness
  • New onset seizure
  • Papilledema
  • Immunocompromised state
  • Hx of focal CNS lesion
  • Age > 60
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15
Q

What characterizes N. Meningitidis?

A
  • Gram Neg. Diplococci
  • Chemoprophylaxis recommended
  • Rapid progression
  • Grown on Thayer-Martin Media
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16
Q

What types of vaccines are available for N. Meningitidis?

A
  • Serogroup B Meningococcal Vaccine
  • Conjugate Vaccine for Serotypes A, C, W, and Y
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17
Q

What is supportive therapy for encephalitis and meningitis?

A
  • Airway protection
  • Seizure control
  • Analgesics
  • Antipyretics
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18
Q

What is Naegleria Flowleri associated with?

A

Primary amoebic meningoencephalitis

Opportunistic in HIV and immunocompromised patients.

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19
Q

What is Acanthamoeba associated with?

A

Keratitis and granulomatous amoebic encephalitis

Contaminated contact lens solutions.

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20
Q

What are prevention strategies for encephalitis and bacterial meningitis?

A
  • Practice good hygiene
  • Vaccinations
  • Avoid sharing utensils
  • Protect against mosquitoes and ticks
  • Eliminate standing water
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21
Q

What is the treatment for GAE and PAM?

A
  • Amphotericin B
  • Azoles
  • Antibiotics
  • Miltefosine
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22
Q

What is the GCS of a patient with significant altered mental status?

A

A GCS of 7 or lower indicates coma.

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23
Q

What distinguishes meningitis from encephalitis?

A

Encephalitis presents with a significantly altered mental status.

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24
Q

What is the structure of California Encephalitis Virus?

A

Segmented, 3 circular segments, (-)ssRNA

Spread by Aedes mosquitoes.

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25
Should dexamethasone be given to neonates with meningitis?
No, there is no proven benefit in neonates. ## Footnote Dexamethasone is not recommended for neonates due to lack of evidence supporting its effectiveness.
26
Is there a benefit to giving dexamethasone to infants and children?
Yes, there is a benefit in cases of H Influenzae. ## Footnote Dexamethasone can be beneficial in treating infections caused by H Influenzae in infants and children.
27
What is the main serogroup targeted by the Serogroup B Meningococcal Vaccine?
Serotype B ## Footnote Serotype B is the predominant cause of meningococcal disease in adolescents and young adults.
28
What key protein does the Serogroup B Meningococcal Vaccine contain?
Factor H Binding Protein ## Footnote This protein is crucial for the vaccine's mechanism of action.
29
What is the role of Factor H in the context of the immune response?
Degradation of C3 ## Footnote Factor H helps regulate the complement system, preventing excessive immune response.
30
How does Factor H protect cells from being tagged for phagocytosis?
By preventing C3b tagging ## Footnote C3b is a protein that marks cells for destruction by phagocytes.
31
What pathway does C3B activate?
Alternate Complement Pathway ## Footnote This pathway is a part of the immune system that enhances the ability to clear pathogens.
32
If Factor H is bound, what happens to its protective role?
It cannot protect the cells but can protect the bacteria ## Footnote This highlights the dual role of Factor H in immune evasion.
33
What family do the Eastern Equine Encephalitis and Western Equine Encephalitis viruses belong to?
Togaviridae
34
What are the dead-end hosts for the Eastern and Western Equine Encephalitis viruses?
Horses and Humans
35
Which organisms serve as live reservoirs for the Eastern and Western Equine Encephalitis viruses?
Swamp Dwelling Birds
36
What types of mosquitoes are associated with the Western Equine Encephalitis virus?
Aedes and Culex
37
What type of vaccine is available for both Eastern and Western Equine Encephalitis viruses?
Inactivated/Killed Vaccine
38
What is the primary reservoir for the Venezuelan Equine Encephalitis virus?
Rodents
39
Where is the Venezuelan Equine Encephalitis virus primarily located?
South America
40
How is Venezuelan Equine Encephalitis virus controlled?
Live Vaccination of Animals
41
What family does the California Encephalitis virus belong to?
Bunyaviridae
42
What is the structure of the California LaCrosse Virus?
Segmented -- 3 Circular Segments; (-)ssRNA
43
What type of mosquito is responsible for spreading the California Encephalitis virus?
Aedes
44
What is the reservoir for the California Encephalitis virus?
Small Mammals-- Chipmunks, Squirrels, or Forest Rodents
45
Is there a vaccine available for the California Encephalitis virus?
No Vaccines-- Mosquito Control
46
What family does the St. Louis Encephalitis virus belong to?
Flaviviridae
47
What is the primary reservoir for the St. Louis Encephalitis virus?
Wild Birds-- Sparrows, Crows, Pigeons, Blue Jays
48
Is there a vaccine available for the St. Louis Encephalitis virus?
No Vaccines-- Mosquito Control
49
What type of vaccine is used for the Japanese Encephalitis virus in endemic areas?
Inactivated/Killed
50
What type of Japanese Encephalitis vaccine is used by the Chinese Military?
Live Attenuated Version ONLY
51
Who is commonly affected by the Japanese Encephalitis virus?
People in Endemic Regions, Military, etc.
52
What imaging modalities should be considered if a brain tumor is suspected?
Non-Contrast CT or MRI ## Footnote MRI is superior for visualizing different brain tissues, but CT is often performed first due to cost.
53
What are the risks associated with CT and MRI imaging?
CT - Ionizing Radiation; MRI - Pacemaker, Shrapnel, etc. ## Footnote These risks must be considered when selecting imaging modalities.
54
What is the advantage of PET-CT in brain tumor follow-up?
Easier to differentiate scar from recurrent tumor ## Footnote This is important for accurate assessment of treatment response.
55
What is the primary imaging modality used for initial brain tumor diagnosis?
CT due to its lower cost ## Footnote MRI is preferred if there is a good clinical history.
56
What diagnosis is indicated by a large tumor causing compression of ventricles and midline shift?
Meningioma ## Footnote This is characterized by mass effect.
57
What is the significance of intra-axial versus extra-axial tumors?
Intra-Axial - Arising from tissue inside the brain; Extra-Axial - From tissues outside the brain ## Footnote This distinction influences treatment and prognosis.
58
What imaging findings are associated with hydrocephalus?
Enlarged ventricles; mass effect causing occlusion of ventricles ## Footnote Hydrocephalus can occur due to various tumors.
59
What is the WHO grade of a medulloblastoma?
Grade 4 ## Footnote Medulloblastomas are classified as high-grade malignancies.
60
What histological features are characteristic of medulloblastomas?
Pseudo-Rosettes and small round blue cells ## Footnote These features are indicative of embryonal tumors.
61
What is the prognosis for pilocytic astrocytoma?
Benign tumor; often does not recur ## Footnote Surgical removal is typically curative.
62
What molecular mutation is commonly associated with pilocytic astrocytomas?
KIAA1549-BRAF Mutation ## Footnote This mutation is part of the MAPK pathway alterations.
63
What distinguishes glioblastoma multiforme from anaplastic astrocytoma?
Presence of necrosis and a pseudo-palisading pattern ## Footnote Necrosis is a hallmark of grade 4 tumors.
64
What are the two broad categories of glioblastoma based on their development?
Primary (De Novo) and Secondary ## Footnote Secondary glioblastomas arise from low-grade gliomas and generally have a better prognosis.
65
What is the significance of IDH mutations in glioblastoma?
IDH mutations indicate a favorable prognosis ## Footnote Mutant types are often associated with secondary glioblastomas.
66
What is the typical demographic for ependymomas?
Younger patients, commonly found in the 4th ventricle ## Footnote In older patients, they are more likely to occur in the spine.
67
What histological feature is often observed in ependymomas?
Pseudo-Rosettes ## Footnote This feature helps in identifying the tumor type.
68
What imaging characteristics suggest a meningioma?
Dural tails and extra-axial mass ## Footnote Meningiomas are often associated with these features.
69
What are psammoma bodies?
Calcified structures often found in meningiomas ## Footnote They are indicative of certain tumor types.
70
What is the clinical presentation of glioblastoma multiforme?
Headaches, seizures, and mental status changes ## Footnote Symptoms can vary based on tumor location.
71
What is the histological appearance of oligodendrogliomas?
Bland round nuclei with perinuclear clearing ## Footnote Often described as having a 'fried egg' appearance.
72
What genetic alterations are characteristic of anaplastic oligodendrogliomas?
Deletion of Chromosome 1p and 19q ## Footnote These alterations are associated with better prognosis.
73
What is a common indication of a meningioma in imaging?
Dural Tails and Extra-Axial Mass ## Footnote Dural tails are characteristic findings associated with meningiomas on MRI.
74
What type of bodies may be present in meningiomas?
Psammoma Bodies ## Footnote Psammoma bodies are calcified structures often found in certain tumors, including meningiomas.
75
List the three broad categories of meningioma cytology.
* Mesothelial Variant * Epithelioid Variant * Transitional Variant ## Footnote These categories reflect different cellular appearances and characteristics of meningiomas.
76
What is the sarcomatoid variant of meningioma characterized by?
Cells that are Long and Skinny Spindles ## Footnote The sarcomatoid variant can exhibit spindle-shaped cells, which may resemble sarcomas.
77
How do meningiomas generally grow and behave?
Slow Growing, Behave Well ## Footnote Meningiomas are typically slow-growing tumors that have a favorable prognosis.
78
What is the WHO Grade classification for most meningiomas?
Most are WHO Grade 1 ## Footnote WHO Grade 1 tumors are considered benign and have the best prognosis.
79
What is the impact of mutations in meningiomas?
Tend to allow them to recur, but still slow grade ## Footnote While mutations can lead to recurrence, meningiomas generally remain slow-growing.
80
What is the prognosis for meningiomas if they are resectable?
Good as long as location is amenable to resection ## Footnote The ability to surgically remove the tumor significantly improves the prognosis.
81
Describe the gross features of meningiomas.
Attached to the Meninges and pushing inward ## Footnote Meningiomas typically arise from the meninges and can compress adjacent brain tissue.
82
What imaging technique is used to visualize the coronal dissection of the brain with meningioma?
Coronal Dissection of the Brain ## Footnote This imaging technique helps visualize the anatomical relationship between the tumor and surrounding structures.

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