Meningitis

Front 1

define a medical emergency and list 4

Back 1

an infection that gives rise to a life threatening condition with a short potential for reversibility
1. meningitis
2. endocarditis
3. epiglottitis
4. osteomyelitis

Front 2

septic meningitis

Back 2

is bacterial in nature
has purulent exudate
requires antibiotic therapy

Front 3

aspetic meningitis

Back 3

meningitides are not purulent
may or may not require antibiotic/antimicrobial therapy

Front 4

most common overall causes of meninigitis

Back 4

1. Strep pneumoniae
2. N. meningitidis

Front 5

meningitis is a disease primarily affecting what age group

Back 5

adults
mean age is 25 y/o

Front 6

2 ways to acquire meningitis

Back 6

1. metastatic seeding from blood
2. direct invasion

Front 7

most common location of origin of meningitis in > 2 month olds

Back 7

oropharynx and lungs

Front 8

most common location of origin of meningitis in < 2 month olds

Back 8

intestinal tract and mother's birth canal

Front 9

define nuchal rigidity

Back 9

resistance to passive movement of the neck

Front 10

what is kernig's sign

Back 10

resistance to passive extension of the knee due to meningitis

Front 11

what is brudzinski's sign

Back 11

when passive neck flexion causes flexion at the knees and hips

Front 12

what is meningismus

Back 12

the signs and symptoms of meningitis but without infection of the meninges (no inflammatory cells in the CSF)

Front 13

what it the #1 cause of acquired mental retardation

Back 13

meningitis

Front 14

what kind of antibiotics must we use when treating meningitis

Back 14

cidal

Front 15

5 problems associated with CNS infections

Back 15

1. phagocytes cannot engulf encapsulated bacteria
2. phagocytes in the CNS have decreased opsonic & cidal activity
3. decreased complement activity in CSF
4. decreased concentration of Ig in CSF
5. an active exit pump for and different diffusion properties of antibiotics

Front 16

Phosphorylcholine

Back 16

if expressed in high amounts it can allow an organism to be transcytosed into CSF by epithelial cells in th BBB

Front 17

How does N. meningitidis cross BBB

Back 17

uses a type IV pilus which allows for microcolonies to form on epithelial cells in BBB. These microcolonies usurp the proteins needed to form tight junctions thus destroying the tight junctions

Front 18

Top overall causes of meningitis

Back 18

#1 = Strep pneumoniae
#2 = N. meningtidis

Front 19

top causes of meningitis in neonates

Back 19

#1 Group B strep
#2 E. coli
# 3 Listeria

Front 20

top causes of meningitis in children 2 to 23 months

Back 20

#1 strep pneumoniae
#2 N. meningitidis

Front 21

what are the 2 most common groups where N. meningitidis is seen

Back 21

military and college aged

Front 22

Prevnar

Back 22

for children < 2 y/o
protects against strep. pneumoniae diseases (including bacteremia & ottitis media)
conjugated vaccine

Front 23

Pneumovax

Back 23

for children > 2 y/o
also given to >65 y/o and anyone at high risk for meningitis
last for 10 years

Front 24

Menomume

Back 24

protects against N. meningitidis
non-conjugated vaccine
not effective in children < 2 y/o
last 3-5 years

Front 25

Menactra

Back 25

conjugated vaccine
preferred vaccine for ages 11-55 y/o

Front 26

Hib vaccine

Back 26

protects against H. influenzae
conjugated vaccine

Front 27

Normal CSF values

Back 27

clear appearance
0 PMNs
glucose = 50-80 mg/dL
protein = 15-40 mg/dL

Front 28

CSF values due to bacterial meningitis

Back 28

turbid appearance
high PMNs
low glucose
high protein
microbes present

Front 29

CSF values due to viral meningitis

Back 29

clear appearance
low PMNs (mononuclear cells)
normal glucose
high protein

Front 30

CSF values due to fungal meningitis

Back 30

clear or turbid appearance
low PMNs (mononuclear cells)
slightly low glucose
high protein
microbe usually visible

Front 31

what is the main difference between adult and child CSF values

Back 31

in adults 1 PMN is abnormal
in a child > 30 PMNs is abnormal

Front 32

procalcitonin

Back 32

high levels of procalcitonin in the CSF of children is indicative of bacterial over viral meningitis

Front 33

#1 cause of viral meningitis

Back 33

enteroviruses

Front 34

Xpert EV test

Back 34

amplifies viral genetic material in CSF in 2 - 2 1/2 hours
only identifies enteroviruses

Front 35

Mycobacteria meningitis

Back 35

gradual onset (~3 months) as opposed to acute
funduscopic exam shows retinal tubercles

Front 36

# 1 cause of fungal meningitis

Back 36

cryptococcal
95% of cases are in HIV + patients

Front 37

#1 cause of amoebic meningitis

Back 37

Naegleria folwerii

Front 38

Patient has mucopurulent menigoencephalitis and claims they were recently swimming in a fresh water pond near a power plant. What is the cause of his/her meningitis and prognosis?

Back 38

Naegleria folwerii
100% mortality rate

Front 39

Which antimicrobials enter the CSF in high concentrations?

Back 39

chloramphenicol, isoniazid, cycloserine, TMP-SMX, ceftriaxone/cefotaxime

Front 40

what is the major contraindication to performing a lumbar puncture?

Back 40

increased CSF pressure

Front 41

Why are there conjugated vaccines?

Back 41

some antigens do not cause a good immune response so they are attached to other antigens that do cause a good immune response thus conferring good immunity to the original antigen

Front 42

what is the major cytokine that causes neuronal cell apoptosis?

Back 42

TNF alpha

Front 43

what is peroxynitritie and what does it do?

Back 43

it is a reactive nitrogen species
it causes mitochondrial death in neurons