LO3 CNS IFXNs

Question 1

Classic triad of meningitis

Answer 1

1. Fever
2. headache
3. Neck stiffness

(altered mental status)

(viral meningitis is more mild than bacterial)

Question 2

Bacterial MENINGITIS is a disease of the ________

Viral Encephalitis is an infection of ______

Answer 2

subarachnoid space

Brain tissue

Question 3

How does bacterial meningitis result in cytotoxic edema?

Answer 3

Bacterial cell wall --> 
stim proinflamm cytokines -->
Increase BBB perm -->
Recruits PMNs -->
Increase cytotoxic edema

Question 4

Most common bacteria in indiv

Answer 4

Strep. agalactiae (GBS)

Gram - rods

Listeria monocytogenes

(tx: ampicillin + cefotaxime)

Question 5

Most common bacteria in indiv 2-23 mos

Answer 5

Strep pneumoniae

N. Meningitides

S. agalactiae (GBS)

(agalactiae most common in

Question 6

Most common bacteria in indiv 23 mos-34 years

Answer 6

N. meningitidis (40%)

Strep. pneumoniae (40%)

Question 7

Most common bacteria in indiv >35

Answer 7

Strep pneumoniae

N. Meningitides

(S. pneumoniae is also most common in 2-23 mos)

Question 8

Most common bacteria in indiv >65

Answer 8

S. pneumoniae

Listeria

(Tx: ceftriaxone or cefotaxime AND vanco AND amp)

Question 9

Bacterial meningitis shows which cell type?

Answer 9

PMNs 
(all the rest are mononuclear
- Viral men
- Chronic men
- Encephalitis
- Brain abcess)

Question 10

Chronic Meningitis cultures

Answer 10

TB
Fungi
Cryptococci

Question 11

Tx for Neonatal/Infant Bacterial meningitis:

Answer 11

Ampicillin AND Cefotaxime

Question 12

Tx for Children & Adult (3mos-50yrs) Bacterial meningitis:

Answer 12

Ceftriaxone or Cefotaxime

AND
Vancomycin

Question 13

Tx for indiv >50 who have Bacterial meningitis:

Answer 13

Ceftriaxone or Cefotaxime

AND
Vancomycin
AND
Ampicillin

(note that the Amp is added to treat listeria)

Question 14

Tx for indiv with nosocomial, Recent head trauma/neurosurgery, immunocompromised, alcoholics with bacterial meningitis

Answer 14

Vancomycin AND meropenem (for pseudomomas and G - rods)

+/- Ampicillin

Question 15

Most common organisms for viral meningitis

Answer 15

Enterovirus
HSV-2
Arbovirus (WNV)

Question 16

Which serology is diagnostic of arbovirus (WNV)?

Answer 16

CSF IgM

(but PCR amp of viral material from CSF is most important diagnostic

Question 17

Clinical features of Viral encephalitis

Answer 17

Headache
Fever
Altered consciousness - (no neck pain)

Seizures and neurological s/sx common

Question 18

Cause of encephalitis?

Answer 18

up to 60% idiopathic

Question 19

Which type of viral encephalitis is prevalent in the winter/spring?

Answer 19

Mumps

(WNV is summer/early fall

Herpes is whenever)