Nervous System Infection

Question 1

What are the common symptoms of acute bacterial meningitis?

Answer 1

Fever, headache, photophobia, neck stiffness (meningism), altered consciousness, increased sensitivity to light and sound.

Question 2

What physical exam findings suggest meningitis?

Answer 2

Positive neck stiffness (meningism), no papilledema (if no increased intracranial pressure), no focal neurological deficit.

Question 3

What are the classic CSF findings in bacterial meningitis?

Answer 3

• High WBC count (neutrophil predominant) → turbid CSF
• High protein (suggestive of pus)
• Low sugar (bacteria consume glucose; compare with serum glucose)
• Gram stain: Streptococcus pneumoniae (Gram-positive cocci in chains, lancet-shaped)

Question 4

What are common Gram-negative and Gram-positive pathogens in bacterial meningitis?

Answer 4

• Gram-negative: Haemophilus influenzae, Neisseria meningitidis
• Gram-positive: Streptococcus pneumoniae (elderly), Streptococcus agalactiae (Group B, in children)

Question 5

Why is a lumbar puncture sometimes contraindicated in bacterial meningitis?

Answer 5

Increased intracranial pressure may lead to brain herniation.

Question 6

What is the significance of low CSF glucose in bacterial meningitis?

Answer 6

Indicates bacterial metabolism of glucose; CSF glucose <50% of serum glucose suggests bacterial infection.

Question 7

What is the chief complaint in the chronic meningitis case?

Answer 7

AIDS, fever & headache for 2 weeks

The patient was recently diagnosed with AIDS.

Question 8

What were the findings in the CSF analysis for the chronic meningitis case?

Answer 8

High WBC, high protein, low sugar

Macrophage predominant WBC.

Question 9

What organism was identified in the CSF culture?

Answer 9

Cryptococcus neoformans

Takes 1-2 days for culture results.

Question 10

What test is used to detect cryptococcal antigen in the CSF?

Answer 10

CSF cryptococcal antigen test

Question 11

What is the significance of the mucicarmine stain?

Answer 11

Stains capsular antigen

Question 12

What complication can arise from cryptococcal infection?

Answer 12

Cryptococcoma - hydrocephalus

Question 13

What is a common pulmonary infection associated with cryptococcal meningitis?

Answer 13

Pulmonary infection

Question 14

What type of meningitis occurs at the base of the brain?

Answer 14

TB meningitis

Question 15

What is the chief complaint in the encephalitis case?

Answer 15

DM & HT, fever & headache for 3 days

Symptoms were acute.

Question 16

What behavioral symptoms were observed in the encephalitis case?

Answer 16

Behavioral changes & hallucinations

Question 17

What was the mental status change in the encephalitis case?

Answer 17

Declined mental status

Question 18

Fill in the blank: The CSF analysis showed high _______ predominant WBC.

Answer 18

macrophage

Question 19

True or False: Cryptococcus neoformans is a yeast with a larger capsule.

Answer 19

True

Question 20

What special bacteria can be found in CSF analysis for chronic meningitis?

Answer 20

Mycobacterium tuberculosis

Question 21

What parasite is associated with increased eosinophils in CSF?

Answer 21

Angiostrongylus cantonensis

Question 22

What is the purpose of the CrAg lateral flow assay?

Answer 22

To detect cryptococcal antigen

Question 23

What antifungal treatment is likely considered for cryptococcal meningitis?

Answer 23

Antifungal therapy

Question 24

What are the vesicle lesions observed in the physical exam?

Answer 24

Lower lip lesions

Vesicle lesions can indicate a viral infection, particularly herpes simplex virus (HSV).

Question 25

What were the findings in the cerebrospinal fluid analysis?

Answer 25

Higher RBC (1000 cells/mm3), slightly high protein, normal sugar levels ## Footnote These findings may suggest viral or traumatic causes of meningitis.

Question 26

What is the treatment for HSV identified in the cerebrospinal fluid?

Answer 26

Acyclovir IV for 21 days ## Footnote Acyclovir is an antiviral medication used to treat infections caused by certain types of viruses.

Question 27

What is the etiology of the viral infection mentioned?

Answer 27

Type 1: oralis, includes genital infections ## Footnote HSV-1 is commonly associated with oral herpes but can also cause genital infections.

Question 28

What clinical presentations are associated with the viral infection?

Answer 28

Altered level of consciousness, behavioral change, neurological deficits, hemiparesis, cranial nerve palsies, seizures ## Footnote These symptoms indicate central nervous system involvement.

Question 29

What were the symptoms of the young patient with a brain abscess?

Answer 29

Fever, severe headache, weakness in the arm ## Footnote These symptoms suggest a central nervous system infection or abscess.

Question 30

What imaging study was performed for the brain abscess?

Answer 30

CT brain with contrast ## Footnote CT scans help visualize brain lesions and assess for abscesses.

Question 31

What type of bacteria was identified in the Gram stain of the brain abscess?

Answer 31

Gram-negative coccobacilli ## Footnote Examples include Haemophilus influenzae, which can cause severe infections.

Question 32

What is a significant risk factor for developing infections like mucormycosis?

Answer 32

Immunocompromised status ## Footnote Conditions such as severe diabetes mellitus and hematological disorders increase susceptibility.

Question 33

What is the treatment for infections associated with the cavernous sinus?

Answer 33

Drainage ## Footnote Surgical intervention may be necessary to relieve pressure and remove infected material.

Question 34

What is a medical emergency related to eye and ENT infections?

Answer 34

Orbital cellulitis ## Footnote This condition can lead to vision loss and requires prompt treatment.

Question 35

What is the common percentage associated with ear infections?

Answer 35

37% ## Footnote This statistic reflects the prevalence of ear infections in certain populations.

Question 36

What is keratitis?

Answer 36

Inflammation/infection of lens ## Footnote Often very painful condition.

Question 37

What are the common etiologies of keratitis?

Answer 37

* Gram negative bacteria (e.g. pseudomonas) * Virus (e.g. HSV) * Fungal * Parasite/protozoa (e.g. acanthamoeba) ## Footnote These pathogens can lead to serious eye infections.

Question 38

What is endophthalmitis?

Answer 38

Inflammation/infection of vitreous chamber ## Footnote A serious condition that can follow keratitis.

Question 39

What are the causes of endophthalmitis?

Answer 39

* Outside in: * Cellulitis → endophthalmitis * Bacteremia ## Footnote These pathways indicate how infections can spread.

Question 40

What does rhinitis refer to?

Answer 40

Inflammation/infection of nose tissue ## Footnote Antibiotics are not usually needed for this condition.

Question 41

What is sinusitis?

Answer 41

Inflammation/infection of the sinuses ## Footnote Commonly associated with upper respiratory infections.

Question 42

What are common causes of ear infections?

Answer 42

* Streptococcus pneumoniae * Haemophilus influenzae ## Footnote These bacteria are frequently involved in otitis media.

Question 43

Fill in the blank: Keratitis can be caused by _______.

Answer 43

[Gram negative bacteria, virus, fungal, parasite/protozoa]

Question 44

True or False: Antibiotics are necessary for treating rhinitis.

Answer 44

False ## Footnote Rhinitis typically resolves without the need for antibiotics.

Question 45

What percentage of keratitis cases are attributed to a specific cause mentioned?

Answer 45

37% ## Footnote This statistic highlights the prevalence of the condition.

Question 46

What is a common protozoan cause of keratitis?

Answer 46

Acanthamoeba ## Footnote This organism is particularly associated with contact lens wearers.