Meningitis

Front 1

Collection of pus between the dura mater & overlying bone in either the cranial or spinal epidural space

Back 1

epidural abscess

Front 2

Collection of pus in the space between the dura & arachnoid

Back 2

subdural empyema

Front 3

Infection of the spinal cord

Back 3

myelitis

Front 4

What kind of meningitis does cryptococcus cause?

Back 4

chronic

Front 5

Most acute cases of meningitis are caused by _________

Back 5

bacteria

Front 6

Stiff neck refers to __________ flexion ONLY

Back 6

forward

Front 7

Brudzinski Sign

Back 7

Flexing neck leads to flexion of hips and knees (involuntary)

Front 8

Kernig sign

Back 8

Flex knee & hip to 90°, then extend knee results pain in hamstrings

Front 9

T/F If acute bacterial meningitis is suspected, obtain CSF & blood cultures before neuroimaging

Back 9

T

Front 10

When would you image before spinal tap?

Back 10

Pts with neurologic findings or papilledema (usually have something other than bacterial meningitis)

Front 11

optic disc swelling that is caused by increased intracranial pressure.

Back 11

papillodema

Front 12

When should LP NOT be performed?

Back 12

With brain abscess, subdural empyema, subdural hematoma or cerebral hemorrhage, LP may be catastrophic

Front 13

How will GLUCOSE change in the following meningitises:

A) Bacterial
B) Viral
C) fungal
D) abscess (not meningitis)

Back 13

A) LOWER
B) No change
C) Lower
D) no change

Front 14

How will %PMNs change in the following meningitises:

A) Bacterial
B) Viral
C) fungal
D) abscess (not meningitis)

Back 14

A) greatly increase
B) increase a little
C) increase a little
D) increase a little

Front 15

How will PROTEIN change in the following meningitises:

A) Bacterial
B) Viral
C) fungal
D) abscess (not meningitis)

Back 15

A) ++++ increase
B) + increase
C) ++ increase
D) + increase

Front 16

Most common cause of viral meningitis (80-85% of patients)

Back 16

Enteroviruses (Echo, Coxsackie)

Front 17

When is enterovirus meningitis most common?

Back 17

Summer, fall

Front 18

St. Louis Encephalitis virus, Eastern Equine Encephalitis virus, Western Equine Encephalitis and West Nile all have what in common?

Back 18

Arboviruses (transmitted by arthropod vector) that can cause meningitis

Front 19

Meningitis-causing virus Transmitted via contact with hamsters, rat, mice or their excreta

Back 19

Lymphocytic choriomeningitis virus

Front 20

T/F Meningitis occurs in 20-30% of persons with first episode of genital herpes

Back 20

T

Front 21

T/F Meningitis may be part of the acute retroviral syndrome

Back 21

T

Front 22

•Produces eosinophilic meningitis

Back 22

Helminthic meningitis: Angiostrongylus cantonensis

Front 23

Angiostrongylus cantonensis: causes what

Back 23

Helminthic meningitis

Front 24

Helminthic meningitis: how spread?

Back 24

via ingestion of snails containing a roundworm that normally infects rats

Front 25

Most common cause of fungal meningitis

Back 25

crytococcus neoformans

Front 26

Risk factors for crytococcus neoformans

Back 26

Immunosuppression (HIV, transplant, chemo)

Front 27

How to dx crytococcus neoformans?

Back 27

Encapsulated budding yeast on India ink or gram stain
–India ink stain largely replaced by the cryptococcal antigen

It's a nondimorphic, narrow neck budding. transmitted via inhalation of bird droppings or soil. Goes from lungs --> brain

Front 28

India ink stain, former mainstay of crytococcus neoformans dx, largely replaced by_____

Back 28

the cryptococcal antigen

Front 29

Most common causes of bacterial meningitis in ages 19-50

Back 29

1) S. pneumoniae

2 and 3) H. influenzae, N. meningitis

4) Group B strep

Front 30

Most common causes of bacterial meningitis in ages <1 mo

Back 30

1) Group B Strep

2) Listeria

3) S pneumoniae

Front 31

Most common causes of bacterial meningitis in ages 1 - 23 months

Back 31

1) S. pneumoniae

2)N. meningitidis

3) Group B strep

4) H influenza

Front 32

Most common causes of bacterial meningitis in ages 2-18 years

Back 32

1) N. meningitidis

2) S. pneumoniae

3) Others are very minor

Front 33

Most common causes of bacterial meningitis in ages 60+ years

Back 33

1) S. pneumoniae

2) Listeria

Other are minor

Front 34

If fever, neck stiffness, & altered mental status are ALL absent, then what?

Back 34

The dx of bacterial meningitis is virtually nonexistent

Front 35

Kernig & Brudzinski signs have low sensitivity but high specificity. What does this mean?

Back 35

positive result from the test means a high probability of the presence of disease; absence of the result does not mean no disease

Front 36

T/F Culture is almost always + in bacterial meningitis

Back 36

F. Culture (+) in 70-85%

BUT <50% (+) in those partially treated

Front 37

T/F Most strains of H influenzae causing meningitis are encapsulated

Back 37

T

Front 38

Risk factors for H influenzae meningitis

Back 38

* Another infection

* Diabetes

* Alcoholism

* No spleen (risk for all encapsulated bacterial diseases)

* Head trauma with CSF leak

Front 39

Neisseria meningitidis most common in what age groups?

Back 39

Children, young adults

Front 40

Neisseria meningitidis risk factors

Back 40

–Hypogammaglobulinemia
–late complement deficiency (C5-C9)
–crowding (college students in dorms, jails, day care centers)
–active & passive smoking
–alcohol use (binge drinking)
–bar patronage

Front 41

Small, pleomorphic, gram (-) coccobacillus causing meningitis

Back 41

H influenza

Front 42

Gram (-), biscuit shaped diplococcus causing meningitis

Back 42

Neisseria meningitidis

Front 43

Most common cause of bacterial meningitis in adults

Back 43

S pneumoniae

Front 44

Accounts for ½ of cases of bacterial meningitis in the US

Back 44

S pneumoniae

Front 45

Gram +, lancet-shaped, diplococcus encapsulated causing meningitis

Back 45

S pneumoniae

Front 46

T/f Give penicillin for pneumococcal meningitis

Back 46

F.

Front 47

–Gram + rod
–Resemble corynebacteria on gram stain
-MOTILE
-Causing meningitis

Back 47

Listeria

Front 48

What kind of meningitis does Listeria cause?

Back 48

subacute

Front 49

–Gram + coccus
–beta-hemolytic
–Catalase negative
–CAMP test +
-causing meningitis

Back 49

Group B Strep

Front 50

Risk factors for Gram Negative Rod meningitis

Back 50

Risk factors:
–Head trauma
–Neurosurgery
–Elderly

Front 51

What kind of meningitis does Mycobacterium tuberculosis cause?

Back 51

chronic.

Causes basilar meningitis, therefore often associated with cranial nerve palsies

Front 52

For acute bacterial meningitis, when should abx be started?

Back 52

Antibiotics should be started within 30 minutes of presentation. These are TRUE emergencies

Front 53

What should abx cover for acute bacterial meningitis?

Back 53

Therapy should usually cover S. pneumoniae, H. influenzae, N. meningitidis, + L. monocytogenes (Listeria if pregnant)

Front 54

If there is significant immunosuppression, h/o CSF leak, recent neurosurgery, head trauma, potential line sepsis, therapy should also cover ______

Back 54

gram(-) rods & S. aureus

Front 55

gram(-) rods & S. aureus cause meningitis when?

Back 55

immunosuppression, h/o CSF leak, recent neurosurgery, head trauma, potential line sepsis