Nervous system´s infections

Question 1

The most common cause of bacterial meningitis and sepsis in neonates aged ≤ 72 hours

Answer 1

Group B Streptococci

Question 2

Main cause of meningitis in newborns

Answer 2

1- Group B Streptococci

2- E. coli
3- Lysteria monocytogenes

Question 3

Main cause of meningitis in children 1 month - 2 years

Answer 3

1- Streptococcus pneumoniae

2- Neisseria meningitidis
3- Group B Streptococci
4- Haemophilus influenzae B (if not immunized)

Question 4

Main cause of meningitis 2-50 years

Answer 4

Streptococcus pneumoniae (except 11-17 Neisseria meningitidis)

Question 5

Main cause of meningitis at over 50 years of age

Answer 5

1- Streptococcus pneumoniae

2- E. coli
3- Listeria monocytogenes
4- Haemophilus influenzae b
5- N

Question 6

Inflammatory disease of the meninges

Answer 6

Meningitis

Question 7

Inflamation of the cerebral parenchyma

Answer 7

Encephalitis

Question 8

Encapsulated concentration of pus inside of the brain. Tends to be pluribacterial.

Answer 8

Brain abcess

Question 9

Most common bacterial causes of meningitis in HIV

Answer 9

Mycobacterium tuberculosis
Listeria monocytogenes

Question 10

Most common viral causes of meningitis in HIV

Answer 10

CMV
VZV
HSV-2
EBV
HSV-6
JCV (leukoencephalopathy)

Question 11

Most common fungal causes of meningitis in HIV

Answer 11

Cryptococcus

Question 12

Bacterial pathogens most related to brain abcess post-sinusitis

Answer 12

Streptococcus viridans
Streptococcus milleri
Staphylococcus aureus

Question 13

Most common parasitical cause of meningitis in HIV

Answer 13

Toxoplasma gondii

Question 14

Clinical triad of meningitis

Answer 14

Fever
Headache
Neck stifness (rigidez nuca)

(Bacterial meningitis symptoms, in only 50% of cases)

Question 15

Most common agent of meningitis post a basilar skull fracture

Answer 15

S. pneumoniae

Question 16

Most common agent of meningitis post a penetrating trauma

Answer 16

Staphylococcus aureus

Question 17

Clinical signs of meningitis IN NEONATES

Answer 17

Lethargy
Muscle hypotonia
Vomiting
Hypo/hyperthermia
¡¡¡Fontanelle bulging!!!

Question 18

Clinical triad of acute encephalitis

Answer 18

• Focal neurological deficiencies (related to medial temporal lobe)
• Seizures
• Altered mental status

Question 19

Prodromal symptoms of encephalitis

Answer 19

Fever
Headache
Nausea/vomiting

Question 20

Most common pathways on infection meningitis

Answer 20

1- Previous colonization of the nasopharynx or uppar airways before entering the CNS through:
* hematogenous dissemination
* contiguous tissue spread

2- Direct infection due to head trauma or surgery

Question 21

Incubation period bacterial meningitis

Answer 21

3-7 days

Question 22

Treatment for bacterial meningitis for children under 1 month

Answer 22

Ampicilin + an aminoglicoside (gentamicine) +/ 3° gen cephalosporin (cefotaxime / ceftazidime)

NOT ceftriaxone (contraindicated for high risk of billiary sludging uner

Question 23

Treatment for bacterial meningitis in children over 1 month to adults under 50 years

Answer 23

Vancomycin + 3° gen cephalosporin (ceftriaxone/ cefotaxime)

Question 24

Treatment for bacterial meningitis in adults over 50 years

Answer 24

Vancomycin + ampicilin + 3° gen cephalosporin (ceftriaxone/ cefotaxime)

Question 25

Treatment for bacterial meningitis in immunocompromised patients

Answer 25

Vancomycin + ampicilin + cefepime / meropenem ## Footnote * cefepime (4° gen cef) * meropenem (carbapenem)

Question 26

tx viral meningitis (enterovirus)

Answer 26

Supportively (symptoms)

Question 27

Tx viral meningitis (VZV / HSV-1 / HSV-2)

Answer 27

Acyclovir

Question 28

Tx viral meningitis CMV

Answer 28

Ganciclovir / Valganciclovir

Question 29

If meningitis due to S. pneumoniae or H. influenzae is suspected or proven, include ------------ to tx

Answer 29

Corticosteroids (dexamethasone)

Question 30

If meningitis due to L. monocytogenes is suspected or proven, include -------- to tx

Answer 30

Ampicilin

Question 31

Syndrome commonly associated with meningococcal meningitis

Answer 31

Waterhouse-Friderichsen syndrome (adenal insufficiency caused by an adenal hemorrage) | With a petechial rash, fever, hypotension, shock, IV coagulation ## Footnote * Coagulopathy ----- Icutus ----- Necrosis * Coagulopathy ----- Embolus ----- Hemorrage

Question 32

Bacteria most commonly related to brain abcesses

Answer 32

**Streptococcus milleri** Viridans streptococci (sinusitis) Streptococcus aureus

Question 33

Most common cause of bacterial meningitis in a basilar cranial fracture

Answer 33

S. pneumoniae

Question 34

Most common cause of bacterial meningitis from a external cranial fracture

Answer 34

Streptococcus aureus

Question 35

Infiltration of neutrophils and cerebral edema in the first 3-5 days of infection

Answer 35

Early cerebritis

Question 36

Necrosis, liquefaction, and infiltration of macrophages that eventually results in the formation of a fibrotic capsule around the lesion and happens after 2-3 weeks of infection

Answer 36

Late cerebritis

Question 37

Multiple brain abcesses is related to a ---------- spread

Answer 37

Hematogenous

Question 38

Single brain abcesses are related to a ---------- spread.

Answer 38

Contiguous