Nath Cns Infections Micro

Front 1

Classic triad of meningitis

Back 1

Fever, headache, nuchal rigidity

Front 2

The most common cause of meningitis is ___, which are associated with ____ meningitis syndrome

Back 2

Viruses, aseptic

Front 3

Life-threatening meningitis is caused primarily by a small group of ____

Back 3

bacterial pathogens

Front 4

_____ is the common evasive mechanism among meningeal pathogens

Back 4

Encapsulation

Front 5

What is a frequently seen feature of bacterial meningitis versus viral

Back 5

altered mental status

Front 6

When do you NOT do a lumbar puncture to assess meningitis?

Back 6

focal mass lesions (risk brain herniation)

Front 7

LP results for bacterial meningitis

Back 7

WBC >1000/uL Protein >100mg/dL glucose LOW <40mg/dL

Front 8

____ and certain fungi can produce meningeal enhancement that can be seen on MRI studies

Back 8

Mycobacterium

Front 9

_____ organism in menginitis can by dx with India Ink stain

Back 9

Cryptococcus

Front 10

____ characterized by fever, headache,and early alteration of mental status

Back 10

Encephalitis

Front 11

_____ are the most common cause of viral encephalitis and occur primarily in late ___

Back 11

Enteroviruses, summer to fall

Front 12

Which encephalitis is seen year long

Back 12

Herpes virus

Front 13

Which encephalitis has hydrophobia

Back 13

Rabies virus

Front 14

____ encephalitis is associated with temporal lobe disease, particularly hemorrhagic lesions

Back 14

HSV

Front 15

20 y/o male, January 12hour history of high fever, chills, HA. Confused and mad,purpuric skin lesions.
BP 71/54 with neck stiffness

Back 15

Neisseria meningitidis (meningococcal meningitis)

Front 16

Gram negative and found in pairs (diplococci) coffee bean shape, LOS endotoxin, oxidase positive

Back 16

Neisseria meningitidis (meningococcal meningitis)

Front 17

Acid is produced from fermentation of glucose and maltose, but NOT lactose

Back 17

Neisseria meningitidis (meningococcal meningitis)

Front 18

____ leading cause of bacterial meningitis in kids and teens

Back 18

Neisseria meningitidis (meningococcal meningitis)

Front 19

A congenital deficiency of terminal _____ predisposes individuals to meningococcemia

Back 19

complement components C5-C9

Front 20

Meningococcal pili allow colonization of nasopharynx, and ___ enhances colonization of upper repiratory tract

Back 20

IgA protease

Front 21

What in N. meningitidis is antiphagocytic

Back 21

polysaccharide capsule

Front 22

What causes the purpuric rash in N. meningitidis?

Back 22

LOS-associated endotoxin into the blood stream leads to thromnocytopenia, DIC

Front 23

possible permanent sequelae of meninggococcal meningitis

Back 23

mental retardation, deafness, and hemiparesis

Front 24

Acute adrenal gland failure in children younger 12 due to bleeding by meningococcal is associated with _____

Back 24

Waterhouse-Friderichsen syndrome

Front 25

DOC for Neisseria meningitidis

Back 25

Penicillin G

Front 26

Polyvalent vaccine against capsular polysaccharide groups _, _, _, and ___ is available for children older than 2 years for N. meningitidis

Back 26

A, C , Y, and W135

Front 27

3 week old baby boy, 24hour history fever, poor feeding, irritability, and a seizure. Baby born preterm with very low birth weight normal vaginal delivery. BP 90/42 with nuchal rigidity

Back 27

Streptococcus agalactiae (group B) type III

Front 28

____ gram positive, cocci in chains, exhibits group B carbohydate antigen. Encapsulated. B-hemolysis. Catalase negative and bacitracin resistant.

Back 28

Streptococcus agalactiae (group B) type III

Front 29

_____ leading bacteria cause of disease and death among newborns

Back 29

GBS infection

Front 30

Pathogenesis of GBS is dictated by ____ with GBS strain with enhanced virulence

Back 30

maternal colonization

Front 31

The ____ of GBS is the major virulence factor, which interferes with ingestion by phagocytes.

Back 31

type III capsular polysaccharides

Front 32

DOC for Streptococcus agalactine

Back 32

Penicillin G

Front 33

64 y/o women, 5 day fever, HA, confusion. Diarrhea 2 day, history of RA with tx prednisone. No nuchal rigidity or focal defects. Meningeal enhancement on MRI

Back 33

Listeria monocytogenes (Listeria meningitis)

Front 34

____ gram positive, small (nonspore-forming) rod with rounded ends. Facultatively anaerobic. Narrow zone of B-hemolysis. "Tumbling motility" somatic "O" and flagellar "H" antigen

Back 34

Listeria monocytogenes (Listeria meningitis)

Front 35

_____ causes food borne illness in adults and meningitis in newborns, found in soil and animal reservoirs, processed meats and cheese.

Back 35

Listeria monocytogenes (Listeria meningitis)

Front 36

Major risk groups for L. monocytogenes

Back 36

pregnant, fetuses, neonates, IMMUNOCOMPROMISE

Front 37

What does L. monocytogenes have that permits escape from phagosomes

Back 37

listeriolysin O (B-hemolysin) and phospholipases

Front 38

L. monocytogenes cell to cell spread occurs via pseudopods that extend into adjacent host cells, cellular ___

Back 38

actin "tails"

Front 39

DOC for Listeria monocytogenes

Back 39

Ampicillin with aminoglycoside

Front 40

August, 29 people ages 9-15 rapid onset of fever, HA, stiff neck, photophobia, some diarrhea before HA. Negative Kernig sign. Normal BP

Back 40

Echovirus type 9 (enteroviral meningitis)

Front 41

___ belongs to enteroviruses (Picornaviridae), small either-resistant, nonenveloped virus. RNA single stranded and (+) sense

Back 41

Echovirus type 9

Front 42

___ virus are acid stable and have low density

Back 42

Enteroviruses

Front 43

___ virus are acid labile, multiply better at 33C and have higher density than do enteroviruses

Back 43

Rhinoviruses

Front 44

What months have the highest incidence of Enteroviral illness

Back 44

summer and fall

Front 45

Transmission of enteroviruses usually is ___, through either the ___ or ___ routes

Back 45

person-to-person; fecal-oral or oral-oral

Front 46

Where do enteroviruses multiplication take place in the body

Back 46

oropharynx and small intestine

Front 47

Which meningitis doesn’t requires hospitalization?

Back 47

aseptic meningitis

Front 48

Tx for viral meningitis

Back 48

symptomatic, maintain respiration and hydration

Front 49

July, 61 y/o homeless man. Fever, malaise, worsening HA for 3 days. Nausea, vomiting, and diarrhea. Confused. Hard to control mosquito population. Tremors of the face and extremities.

Back 49

St. Louis encephalitis virus

Front 50

____ are leading cause of viral encephalitis

Back 50

Arthropod-borne (arbo-) viruses

Front 51

____ are spherical or pleomorphic enveloped viruses. Triple-segmented, circular, single-stranded, negative-sense RNA

Back 51

Bunyaviridae

Front 52

___ and ___ are enveloped virons (45-60nm), single strand RNA with positive polarity

Back 52

Togaviridae and Flavivirdae

Front 53

Which viron causes St. Louis virus encephalitis, yellow fever, and dengue

Back 53

Flaviviruses

Front 54

Which virus types are associated with trashfilled drainage system and artificial containers, mosquitoes and birds and rodents

Back 54

Arboviruses

Front 55

____ is the vector for St. Louis virus in rural WESTERN and CENTRAL United States

Back 55

Culex TARSALIS

Front 56

___ is the vector for St. Louis virus in URBAN Central and EASTERN United States

Back 56

Culex PIPIENS

Front 57

Where do Arboviruses replicate?

Back 57

endothelial cells

Front 58

What in Arboviruses trigger a complement activation process, leading to DIC

Back 58

virus-antibody complexes

Front 59

Complications of St. Louis viral encephalitis include ___, __ and ___

Back 59

cranial nerve palsies, hemiparesis, and convulsions (20% cause of death in elderly)

Front 60

Which Flavivirus has antigenic clinical syndrome of Febrile illness, rash, hemorrhagic shock syndrome

Back 60

Dengue

Front 61

Which Flavivirus has antigenic clinical syndrome of Hemorrhagic fever, hepatitis (jaundice)

Back 61

Yellow Fever

Front 62

56 y/o man notes change in personality over several days, more irritable and confused. Fevers and HA with decreased Daily activities. At ED now with left-sided weakness and seizure. MRI shows hemorrhagic necrosis of right temporal lobe

Back 62

Herpes simplex virus (HSV) type 1 (herpes simplex encephalitis [HES])

Front 63

Icosahedral nucleocapsid, linear ds-DNA genome, lipoprotein envelope. Multinucleated giant cells.

Back 63

All herpesviruses

Front 64

___ after primary infection is characteristic feature of all herpesviruses, including HSV-1

Back 64

LATENCY

Front 65

____ and ___ are most frequent clinical manifestation of first-episode HSV-1

Back 65

Oral lesion (gingivostomatitis) and pharyngitis (kids and teens)

Front 66

____ most frequent clinical manifestation of HSV-1 in young adults

Back 66

herpes labialis

Front 67

how does HSV-1 damage the brain parenchyma

Back 67

direct damage (necrosis)

Front 68

How does HSV-1 contribute to perivascular inflammation, resulting in hemorrhage usually in the right temporal lobe

Back 68

Virus-specific T-cell response

Front 69

TX for HSV-1

Back 69

Acyclovir for 21 days

Front 70

45y/o homosexual man at ED for fever, HA, nausea, vomiting, and mental status change that is progressive over 2 weeks. Has HIV 2 years and NOT on tx. Nuchal rigidity with positive Kernig sign

Back 70

Cryptocccus neoformans (cryptococcal meningitis)

Front 71

___ is a yeast-like fungus (not dimorphic) with oval, budding yeast cell (4-6um). Think gelatinous capsule. India Ink shows budding cells, surrounded by refractile, sharply demarcated capsule.

Back 71

Cryptocccus neoformans (cryptococcal meningitis)

Front 72

Grows on Sabouraud-dextrose agar

Back 72

Cryptocccus neoformans (cryptococcal meningitis)

Front 73

A latex agglutination test shows polysaccharide antigen in CSF and serum

Back 73

Cryptocccus neoformans (cryptococcal meningitis)

Front 74

found in soil and PIGEON droppings

Back 74

Cryptocccus neoformans (cryptococcal meningitis)

Front 75

C. neoformans causes a deep mycosis in AIDS patients with ____

Back 75

CD4 count <100

Front 76

Cryptococci cross the BBB and accumulate in the perivascular areas of _____

Back 76

cortical gray matter

Front 77

Where do C. neoformans replicate?

Back 77

brain parenchyma resulting in macroscopically visible gelatinous pathology

Front 78

tx for ACUTE C.neoformans meningitis

Back 78

Amphotericin B with Flucytosine (5-FC)

Front 79

Tx for maintence therapy of C. neoformans

Back 79

Fluconazole

Front 80

30 y/o women at ED for 2-week history of HA, nausea and vomiting, seizures past 2 days. Has HIV with poor compliance. Mild right side weakness. MRI shows ring-enhancing lesions in left parietal lobe and right frontal lobe

Back 80

Toxoplasma gondii (Toxoplasma encephalitis)

Front 81

Proliferative form is banana-shaped tachyzoites. Resting form is slow-growing bradyzoites found in muscle and brain

Back 81

Toxoplasma gondii (Toxoplasma encephalitis)

Front 82

Why is there no Toxoplasmosis on some isolated Pacific Islands

Back 82

NO CATS!!!

Front 83

How do humans get Toxoplasmosis?

Back 83

1. Eat pseudocysts in undercooked meat
2. ingestion of contaminated cat feces containing OOCYST

Front 84

Why is Toxoplasmosis a "Torch" of pregnancy?

Back 84

Transplacental crossing of parasite causes congenital infections

Front 85

In AIDS patients ___ is the most common cause of intacerebral mass lesions

Back 85

Toxoplasma gondii (Toxoplasma encephalitis)

Front 86

In patients with AIDS, what is the CD4 count for bradyzoites to reactivate and transform into tachyzoites

Back 86

less than 200

Front 87

How do you DX Toxoplasmosis

Back 87

High level of IgG for T. gondii (>1:256)

Front 88

DOC for Toxoplasmosis

Back 88

Sulfadiazine and primethamine

Front 89

Seronegative pregnant women with Toxoplasmosis may present with __ and ___

Back 89

mononucleosis or flu-like symptoms

Front 90

Infants born with toxoplasmosis are typically ___ but then develop ___, ___ , ___

Back 90

asymptomatic; chorioretinitis, epilepsy, and psychomotor

Front 91

How do you check if a newborn has Toxoplasmosis infection

Back 91

cord blood for IgM

Front 92

28 y/o man at ED for HA, two generalized seizure w/o history of seizure. Immigrant of Mexico. CBC did had 12% eosinophils. CT shows intracranial calcified cyst and a scolex in right occipital lobe

Back 92

Taenia Solium (neurocysticerosis) tapeworm

Front 93

How do humans acquire Taenia solium?

Back 93

eating uncooked meat with larvae

Front 94

Where in the world has the highest prevalence of Cysticercosis?

Back 94

Africa, Latin America, SE Asia, and Eastern Europe

Front 95

What causes seizures in Neurocysticercosis?

Back 95

mass effect of larval cyst on the brain parenchyma

Front 96

Scolex on MRI scan

Back 96

Neurocysticerocosis

Front 97

how do you confirm DX of cycstiercosis

Back 97

IgG for T. solium

Front 98

Possible TX for Taenia solium (neurocysticecosis)

Back 98

Praziquantel or albedazole

Front 99

How does Taenia Solium cause hydrocephalus?

Back 99

Intraventricular cysts

Front 100

31 y/o white man ED for Fever and visual hallucinations. 4day history of malaise and back pain while working on roadside clean up. Complains of muscle plain, vomiting, abdominal cramps tx with acetaminophen. Hyperesthesia over entire right side body. increasing agitated. developed hydrophobia. Hypersalivation and wide body fluctuations of temperature and BP

Back 100

Rabies virus

Front 101

bullet-shaped nucleocapsid surrounded by lipoprotein. Envelope glycoproteins in knob-like structure. ssRNA with negative polarity

Back 101

Rabies virus

Front 102

Can you get rabies from organ transplant

Back 102

YES

Front 103

Incubation period of rabies

Back 103

3-8 weeks(big wound can make it 9 days)

Front 104

Viral glycoproteins bind to ___, contributing to neurovirulence of rabies virus

Back 104

Ach receptor

Front 105

Where do rabies virus replicate?

Back 105

Exclusively in gray matter

Front 106

Characteristic pathologic finding for rabies

Back 106

intracytoplasmic inclusions call NEGRI BODIES

Front 107

how does rabies cause encephalitis

Back 107

cytotoxic Tcells kill virus infected neurons

Front 108

How to TX rabies bite?

Back 108

3step. 1clean soap water 2. passive immunization 3. active immunization with antirabies HDCV

Front 109

9 day newborn at ED for inability to nurse due to difficulty opening jaw. Foul smelling discharge from umbilical cord. Trismus, opisthotonus and hyper-responsiveness to external stimuli. Yellow-green discharge from umbilical cord. WBC up

Back 109

C. Tentani (Tetanus)

Front 110

Gram positive anaerobic rod. Forms terminal spores. Potent exotoxin.

Back 110

C. Tentani (Tetanus)

Front 111

How do you get Tetanus?

Back 111

injury or trauma with contamination with soil full of spores.

Front 112

____ is a Zn-dependent endopeptidase, cleaves synaptobrevin, a vesicl associated membrane protein critical to the "docking and fusion" apparatus of neuroexoctosis

Back 112

Tetanospasmin

Front 113

How does Tetanospasmin leave the LMN uninhibited leading to muscle rigidity

Back 113

blocks release of glycine and GABA in descending inhibitory neurons

Front 114

trismus

Back 114

lockjaw

Front 115

risus sardonicus

Back 115

sardonic smile

Front 116

TX for Tetanus

Back 116

maintain airway and intubate, BZ for spasms and rigidity. B-Blocker for sympathetics hyperactivity. Passive immunization with IgG + Active immunization. Metronidazole

Front 117

DOC for Tetanus

Back 117

Metronidazole

Front 118

normal prevention of Tetanus

Back 118

Full series vaccine (adult Td, child DPT) booster 10 years