Hdm Test 4: Viral Cns Infections

Front 1

Possible indicator for viral meningitis v. bacterial meningitis

Back 1

viral meningitis can have nasal congestion + runny nose

Front 2

What often presents with N. meningitidis?

Back 2

rash or embolic phenomena

Front 3

Considerations when pt presents with fever and HA as it relates to possible meningitis

Back 3

meningitis or encephalitis

Front 4

Common meningitis viral causing agent

Back 4

HSV

Front 5

Possible acute causes of meningitis

Back 5

enterovirus, strep pneumo, N. meningitidis

Front 6

Possible chronic causes of meningitis

Back 6

mycobacteria, fungal, sarcoid, malignancy

Front 7

Recurrent courses of meningitis

Back 7

strep pneumo, HSV2

Front 8

2 common transmission risks for meningitis health care workers

Back 8

N. meningitidis, M. tb

Front 9

altered consciousness with no evidence of inflammation in the CNS on imaging of CSF analysis

Back 9

encephalopathy

Front 10

Altered consciousness with no other cause identified and evidence of CNS inflammation on imaging or CSF analysis. Defined as virologically confirmed if pathogen ID'd by culture or PCR

Back 10

encephalitis

Front 11

Only meningism (HA w/ neck stiffness and/or photophobia) w/o evidence of altered consciousness and no evidence of inflammation on imaging or CSF analysis

Back 11

Meningism

Front 12

Common fungal infection from southwest US

Back 12

Coccidiodes

Front 13

Meningism with CSF white cell count >1000/ml or between 100-1000/ml w/ predominance of polymorphonuclear cells and a CSF:plasma glucose ratio <0.5

Back 13

Purulent meningitis

Front 14

Meningism in a conscious patient, with normal CSF: glucose ratio (>0.5) and either a CSF white cel count of 5-20 or 20-1000/ml with lymphocyte predominance. Can be viral or M. tb etiology

Back 14

aspetic meningitis

Front 15

common cause of meningitis if pt is in prison/homeless?

Back 15

TB

Front 16

common cause of meningitis if pt is is Miss River/Ohio River Valley

Back 16

Histoplasma

Front 17

common cause of meningitis if pt is in Arizona, NM

Back 17

Coccidioides immitis

Front 18

common cause of meningitis if pt is in Shelter Island, NY

Back 18

Borrelia burgdorferi

Front 19

common cause of meningitis if pt is swimming in summer warm ponds in NC

Back 19

acute amebic meningoencephalitis

Front 20

common cause of meningitis if pt is immunodeficient

Back 20

Chronic enterovirus meningitis

Front 21

common cause of meningitis if pt is taking NSAIDs

Back 21

Drug induced acute meningitis

Front 22

common cause of meningitis if pt is HIV+

Back 22

HIV/CMV meningoencephalitis, toxoplasma, cryptococcal meningitis

Front 23

common cause of meningitis if pt is + hx of splenectomy

Back 23

encapsulated org (N. meningitidis)

Front 24

General routes of access to CNS

Back 24

mucosal infection of Respiratory + GI tract
Infection of local lymph nodes
Viremia
Seeding of CNS

Front 25

6 considerations of meningitis DDx

Back 25

non-infectious
viral
bacterial
fungal
mycobacterial
parasites

Front 26

Evidence of meningitis with neg standard bacterial culture

Back 26

aseptic meningitis

Front 27

Most common cause of aseptic meningitis

Back 27

Enteroviruses (most common in the summer)

Front 28

Who gets the most severe disease from enteroviruses?

Back 28

Neonates <2 weeks

Front 29

Clues to enteroviral disease (7)

Back 29

Time of year (late summer/early autumn)
exanthem
myopericarditis
conjunctivitis
Hand-foot-and-mouth disease
Herpangina
Pleuodynia

Front 30

enterovirus risk factors

Back 30

fecal oral (swimming in sewage contaminated water)
seasons
infants/young children (no prev immunity)
Congenital or acquired immune deficiency
-agammaglobulinemia, rituximab

Front 31

Most common encephalitis viral pathogens in US

Back 31

enterovirus, HSV, influenza A, HIV, West Nile

Front 32

Classic brain presentation of HSV encephalitis

Back 32

temporal (usually focal), associated with speech
often presents with Abnormal CSF

Front 33

Incubation period of West Nile Virus

Back 33

2-14 days

Front 34

<1% of West Nile virus causes neuroinvasive diease. What are 4 symptoms of this?

Back 34

-aseptic meningitis
-meningoencephalitis
-acute flaccid paralysis
-rarely movement disorders, cranial neuropathy

Front 35

patient population with CMV encephalitis

Back 35

HIV and transplant pts

Front 36

What virus causes subacute sclerosis panencephalitis (SSPE)?

Back 36

measles

Front 37

Symptoms of SSPE

Back 37

personality changes
periodic axial myoclonic jerks with recurrent falls
eventually generalized rigidity with unresponsiveness

Front 38

What can occur with varicella zoster virus?

Back 38

encephalitis (often poor outcomes)

Front 39

What population can have problems with JC virus?

Back 39

immunocompromised (AIDS, Transplant)

Front 40

What is the pathophys of JC polyoma virus?

Back 40

Dead cells, not swelling

In PML, JC replicated in oligodendrocytes of brain, demyelinating neurons.

Front 41

Typical symptoms of progressive multifocal leukoencephalopathy

Back 41

focal motor and sensory deficits
gait abnormalities
speech and language disturbances
cognitive disorders
HA
visual impairment

Front 42

Gold standard of JC virus diagnosis

Back 42

brain biopsy

Front 43

Tx for JC virus/PML

Back 43

relax immunosuppressive therapy
aggressive anti-HIV therapy
untreated...kills in a few months

Front 44

Spongiform encephalopathy often comes from what?

Back 44

Prion-contaminated ingestion

Front 45

What protein prion is infectious and can aggregate?

Back 45

Scrapie-associated prion protein (can aggregate with B-sheets)