• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/66

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

66 Cards in this Set

  • Front
  • Back
what is meningitis?
inflammation of the meninges
what is encephalitis
inflammation of the brain matter
where does CSF and blood vessels flow
in btw arachnoid and pia matter
where do most CNS infections orginate?
upper respiratory tract
what is the most common pathogen associated with CNS infections
Strep Pneumo
what are the possible ways that inctious material can enter to the CNS
sinusitis, Upper respirtatiory tract infection, from the blood, invasive injury.
what are some way that infectious entities enter the CNS from the blood following primary bacteremia
paracellular transport after disruption of tight junctions of BBB

transport within phagocytic cells such as monocytes

transcellurlar transport within endothelial cell vacuoles.
When should you do LP on neonate
unwell
fever,septic
lethargic/irritable
apnea
neurological signs
rash

at least 3 above
when should you do LP on 1-18months
fever
lethargic/irritable
seizures
bulging fontanelle
rash
when should you do LP anyone over 18 mos
fever
photophobia
headache
seizure
nausea/vomiting
stiff neck
petichial rash
what is the differential for CSF pleocytosis
infection: bacterial, viral, tuberculosis, fungal, protozoa

intracranial lesion near the subarachnoid space: malignancy, abscess, demyelination, infarct, hemorrhage, vasculitis.

recent seizure

radiation therapy

injection of drug into the intrathecal space.
what is important to remember when ordering tests on CSF
you need at least 6ml to perform every test needed on CSF. if you have less that 6 ml you must get cell count and chemistry and then all other tests must be prioritized.
what is the expected difference in cell/ul between viral and bacterial meningitis?
bacterial will have 500-10,000 cells and viral will have 10-500. basically greater than 500-700 you are going to be much more likely to assume bacterial infection
what is the expected neutorphil findings in bacterial and viral menignitis on LP
close to or greater than 90% neuts for bacteria

early viral can be higher than 50 but late is usually less than 20%
what is the expected glucose findings difference btw bacterial and viral meningitis in LP
bacterial should be less than 40mgs

viral will probably be 45-85
what is the CSF/serum glucose found in LP difference btw bacterial and viral
bacterial less than 0.6

viral more than 0.6
what is the exptected protien amount difference in LP for bacterial and viral mengitis
bacterial greater than 150

viral less than 100
what is a hot specimen of CSF
opaque due to high white count indicates bacterial menigitis
what is the normal cell count of CSF and what is usually the type of cell found?
1-5

mainly monocytes
what is the main cell type found on LP in viral menigitis
lymphocytes
what are the two types of meningitis?
septic and aseptic
what is the primary cause of septic meningitis?
bacterial
what is the primary cause of aseptics meningitis
viruses, fungi, mycobacterium tuberculosis
when would protein be elevated in aseptic meningitis
with M. tuberculosis infection.
what are the two leading causes of bacterial menigitis
step pneumo

neiseria meningitidis
what are some neurological sequelae for bacterial meningitis
hearing loss
focal neurological deficits
cognitive impairment
what is a common cause of neonate menigitis recieved from the mother
Group B streptococcus from a colonized mother passing to child during birth.
what laboratory test that was once used to diagnose bacterial meningitis is now considered bad
latex agglutination
what are the predominate bacterail agents of meningitis
streptococcus pneumoniae(1st)
haemophilus influenza (pediatric not vaccinated )
neiseria meningitidis(2nd)
listeria monocytogenes(pregnant females teens to 30s)
staphylococcus aureaus
gram neg organisms
where does pneumococcal meningitis orginate
mucosal colonization of nasopharynx
what population is most at risk for pneumococcal meningitis
child in crowded area(day care)

if adult usually from crowded area
what are the common cases that see coagulase negative staphylococci
in patients with CNS shunts or have recently undergone neurological procedures.

coagulase-neg staphylococci is a skin organism
what are most commong seen bugs in head trauma meningitis
coagulase-neg staphylococci

staphylococcus aureus

pseudomona aruginosa
what are some features of acute viral meningitis that differentiate it from bacterial
less severe
shorter in duration
less than 1000 usually less than 500 white count in CSF
predominating lymphocytes
normal glucose
opening pressure is normal or only slightly elevated
what should you be thinking if there is lowered glucose in an otherwise assumed viral meningitis
mumps
lymphocytic choriomeningitis
what is the gold standard of diagnosis of acute viral meningitis
PCR can be done in 2 hours

culture-takes 24 hours

serology- only good for classifying or screening not diagnostic
what are the etiological agents of viral meningitis
enterovirus(coxsackie, echovirus)
herpes simplex virus type 1, 2
mumps
varicella-zoster
lymphocytic choriomeningitis
HIV
what are the two major causes of viral meningitis
enterovirus
HSV
what is the seasonal predominance of enteroviral meningitis
late summer or fall
what are the differences in type 1 and type 2 herpes simplex meningitis
type 1 is above the diaphram, less severe
more common


type 2 below the diaphram, more severe
what are some diagnositic test that can be run to see if a person has tuberculosis meningitis
CBC
electrolytes
PPD
sputum acid fast smear/culture
chest radiograph
urinalysis

none above are usually useful

PCR is main use but to use it u must involve infectious disease specialists
what is the CSF profile of tuberculosis meningitis
elevated opening pressure
cell count 50-500 usually around 223
lymphocytics predominates late neuts early
small protein elevation
decreased glucose(slight)
what are the requirements for workup with CSF for tuberculosis meningitis
2mls
greater than 10wbc
elevated proteins greater than 80mg/dl
devoid of blood
what may eosinophilia in CSF is what differential
parasitic infection
malignancy
MS
subarachnoid hemorrhage
obstructive hydrocephalus with shunt
granulomatous meningitis
idiopathic eosinophilic meningitis
mycobacterium tuberculossi
treponema pallidum(neurosyphilis)
mycoplasma pneumoniae
fungal
rocky mountain spotted fever
subacute sclerosiing panencephalitis
lymphocytic choriomeningitis virus
what should you think about with granulomatous meningitis
fungal or TB
what are the three forms of fungal meningitis
chronic
vasculitis
parenchymal invasion
what is the causes of chronic fugnal meningitis
cytococcus neoformans(yeast)-most common cause of meningitis in HIV

coccidoides immitis- west coast southwest
what are the main causes of vasculitis fungal meningitis
mucor-diabetes* this can kill in 24h

aspergillus- everyone is exposed to this but only immunocomprimised will get infection by it
what are the main causes of parenchymal invasion fungal meningitis
candida

cryptococcus neoformans(HIV)
what are the main causes of encephalitis
mainly viral
1.HSV
2. Arthropod borne
-west nile
-east/western equine
- st. louis
- laCross
what is the main cause of parasitic CNS infection
toxoplasma gondii
how does toxoplasmosis manifest typically in the CNS
encephalitis

usually in immunocompromised
what is a characteristic finding that would make you think first about toxoplasmosis?
ring enhancing legions
what are some exposures that lead to toxoplasmosis
cat litter

can be exposed at any time even before getting AIDs because after getting AIDS latent infection can become active
what are all the common parasitic CNS infections
toxoplamsa gondii

cerebral malaria

cysticercosis

naegleeria fowleri
what causes cerbral malaria?
plasmodium falciparum
what the primary source of cysticercosis?
taenia solium in pork
how does cysticercosis manifest
cyst like lesions everywhere including the brain
what does naegleeria fowleri cause?
meningoencephalitis

also causes eye infections
where is naegleeria fowleri acquired?
swimming in warm fresh water during the summer
what should you think about cause wise with brain abscess
anerobic bacteria
what are the three most common ways that brain abscesses recieve their infectious agent
paranasal sinus

trauma

hematogenous spread
where are common primary sites for abscesses that may hematogenously spread to the brain
endocarditis or lung abscess can throw small blood clots that contain the infectious agents called septic emboli

emboli lodge in capillaries in the brain causing localized hemorrhage
what bugs are most common in immunocompentent patients with brain abscesses
staphylococcus aureus

viridans streptococci
actinomyces
anerobes
what do you expect to cause brain abscesses in immunocomprimised patients
aspergillus mucor rhizopus
what do you expect to cause brain abscess in trauma patients
S. aureus. gram neg.