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50 Cards in this Set

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  • Back

What are the layers of the CNS in the Head Area ?

1) Skull [Outside]


2) Dura Mater Layer


3) Sub-Dural Space


4) Arachnoid Layer


5) Sub-Arachnoid Space


6) Dia Mater


7) Brain [Inside]

Which of the layers of the CNS contains CSF?

Sub Arachinoid Space

What is Meningitis?

Inflammation of the membranes of the brain and spinal cord, specifically changes in the CSF between the pia and arachinoid membranes of the meninges

What are the examples of CNS infections? (7)

1) Meningitis


2) Encephalitis


3) Meningoencephalitis


4) Brain Abscess


5) Subdural Empyema


6) Epidural Abscess


7) Ventriculo Peritoneal Shunt Infections

What is the function of CSF ?

CSF provides nutrients to the CNS and Protection

What are the normal components of CSF?

Water, Glucose, Some Proteins, Ions (Sodium, Potassium) and pH of 7.34

"Despite the use of antibioitcs, the mortality rate from meningitis has remained constant at 5-25%" True or False?

TRUE

"20% of patients with meningitis have persistent neurological disabilities" True or False?

False, it is actually 50%

What is the incidence of meningitis in children <15 years old?

75%

What is the incidence of meningitis in children <1 years old?

35%

What are some of the causes of Aseptic Meningitis?

Fungal, Viral, Rickettsiae, Spirochetes and Protozoa sources of infection

What are some of the causes of Septic Meningitis?

Bacterial sources of infections

What are some of the causes of Non-Infectious Meningitis?

NSAIDs and Invasive Procedures

"Viral Meningitis is more severe than Bacterial Meningitis" True or False?

FALSE

"Most viral meningitis patients get better on their own within 7-10 days without treatment" True or False?

TRUE, although infants younger than 1 month and people with weakened immune system are more likely to have a severe illness

What typically causes meningitis infections in Neonates?

Usually infected by bacteria found in the birth canal

What are the risk factors of Meningitis in Neonates?(4)

1) Early Rupture of Membranes


2) Low Birth Weight


3) Immature Immune System


4) Immature blood brain barrier

What are the risk factors of Meningitis in Children?(3)

1) Immature Immune System


2) Daycare Centres


3) Upper Respiratory Tract Infections

What are the risk factors of Meningitis in Young Adults?(3)

1) Spleenectomy


2) Travel


3) Complement Deficency

What are the risk factors of Meningitis in Adults or Immunocompromised?(1)

A decreased immune system

What are the risk factors of Meningitis in Open Head Trauma?(4)

1) Common with car accidents


2) Barrier Breakdowns


3) Contamination from Surgery/ Injuries


4) Foreign Indwelling Devices

What are the risk factors of Meningitis in Close Head Trauma?(1)

More internal injury then open head trauma

What are the common organisms causing Meningitis in Neonates?

Group B Streptococci,


Listeria monocytogenes,


E.Coli and other gram negative bacilli

What are the common organisms causing Meningitis in Children?

Streptococcus pneumoniae,


Neisseria meningitidis


{H.influenza}

What are the common organisms causing Meningitis in Young Adults?

Streptococcus pneumoniae,


Neisseria meningitidis


{H.influenza}

What are the common organisms causing Meningitis in Adults or Immunocompromised?

Streptococcus pneumoniae,


Listeria monocytogenes,


Gram Negative bacilli,


Neisseria meningitidis

What are the common organisms causing Meningitis in Open Head Trauma?

Staphylocci aureus,


Staphylocci epidermidis,


Gram Negative Bacilli

What are the common organisms causing Meningitis in Close Head Trauma?

Streptococcus pneumoniae,


H. influanzae,


Streptococcus pyogenes

What are the three major routes of Meningitis Infection?

1) Hematogenous: following systemic bacteremia (e.g.endocarditis)


2) Contigous: When colonization by potential pathogens is followed by mucosal invasion of the nasopharynx


3) Direct Inoculation: Direct extension of bacteria across a skull fracture with subsequent leaking into the CSF

Which is the most common route of Meningitis infection?

Hematogenous

What are the common signs and symptoms of Meningitis?

1) Fever


2) Headache/Lethargy/Restlessness


3) Swollen Eyes


4) Tachycardia


5) Hemorrhagic Rash (common with Neisseria) or Petechiae (common with Listeria)


6) Altered mental status


7) Stiff Neck


8) Photophobia


9) Seizures

What are the most common signs of Meningits?

Fever, Headache, Stiff Neck, Altered Mental Status

When would platelets be reduced in a Meningitis patient?

If the patient is in septic shock or in the face of meningococcal bacteremia

What is the normal CSF appearance?

Yellow and Liquidy

What is the appearance of CSF in Meningitis patients?

Darker, Cloudy Color with a higher protein count

What are the common lab results of CSF in Meningitis patients?

1) Turbid Dark Color


2) Glucose <2.2 mmol


3) Elevated protein levels >50g/L


4) Lactic Acid >1.8 mmol/L


5) CSF/Blood Glucose <0.33-0.5


6) Elevated WBC


7) pH will be lower than 7.34

"It is easer for antibiotics to pass through the Blood Brain Barrier rather than the Blood CSF Barrier" True or False?

FALSE

What are the characterisitcs of drugs that penetrate into the CNS well?

Small, Lipophilic and with low protein binding

"If the organisms are found to be sensitive to Cephalosporins then we would discontinue Vancomycin from the empiric therapy" True or False?

TRUE

What is the recommended Empiric therapy for Meningitis in Neonates?

1) Ampicillin + Cefotaxime


2) Ampicillin + Gentamycin


{14-21 days}

What is the recommended Empiric therapy for Meningitis in Children-Young Adults?

1) Cefotaxime + Vancoymicn


2) Ceftriaxone + Vancomycin


3) Meropenem + Vancomycin


{10 days}

What is the recommended Empiric therapy for Meningitis in Adults or Immunocompromised?

1) Cefotaxime (+ Ampicilin + Vancomycin)


2) Ceftriaxone( + Ampicillin + Vancomycin)


3) Meropenem (+ Ampicllin + Vancomycin)


4) Vancomyicn + TMP/SMX [if severe beta lactam allergy]


{S.pneumo: 10-14days,


N.meningitids: 5-7days,


Listeria: 21days}

What is the recommended Empiric therapy for Meningitis in Open Head Trauma?

1) Meropenem (+Vancomycin)


2) Ceftazidime (+Vancomycin)


3) Cefepime (+Vancomycin)


{10-14 days}

What is the recommended Empiric therapy for Meningitis in CSF shunt Infection?

1) Cefotaxime (+Vancomycin ±Rifampin)


2) Ceftriaxone (+Vancomycin ±Rifampin)


{14 days after shunt removal}

What is the recommended Empiric therapy for Meningitis in Closed Head Trauma?

1) Cefotaxime (+Vancomycin)


2) Ceftriaxone (+Vancomycin)


{10-14 days}

When would you perform a CSF shunt?

Performed on patients who have congenital malformations which result in a large production of CSF and resulting in an abnormally large brain area

What organisms can be prevented by Chemoprophylaxis?

Neiserria meningococcal and Haemophilus influenza

What are the general guidelines for Chemoprophylaxis?

Neisseria:


1) Rifampin 600mg PO BID x 4doses


2) Ciprofloxacin 500mg PO x1dose


Hemophilus:


1) Rifampin 600mg PO Daily x4days

When would you use Dexamethasone in Meningitis?

To decrease mortalitity and hearing loss in adult patients with s.penumonia meningitis as well in children >6 weeks of age

"Dexamethasone can be given after the first dose of antibioitcs in Meningitis?" True or False?

FALSE, should be given 20 mins before 1st dose or with the first dose