Brain Abscess and Differential Diagnosis Quiz

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What is the most common causative organism in malignant otitis externa?

Streptococcus

Staphylococcus

Escherichia coli

Pseudomonas (correct)

What is the recommended first-line intravenous antibiotic treatment for malignant otitis externa?

Amoxicillin and clavulanic acid

Vancomycin and gentamicin

Azithromycin and ciprofloxacin

Ceftazidime and piperacillin-tazobactam (correct)

What is the most common predisposing factor for otitis externa infection?

Underlying diabetes mellitus

Exposure to loud noises

Exposure to water (correct)

Trauma to the ear canal

Which of the following is NOT a typical clinical presentation of otitis externa?

Sore throat Signup and view all the answers

What is the recommended empiric topical treatment for uncomplicated otitis externa?

Neomycin/bacitracin combination Signup and view all the answers

Which of the following is the most accurate test for diagnosing brain abscess?

Biopsy Signup and view all the answers

According to the passage, which of the following statements about brain abscess is true?

It is polymicrobial in nature, involving both Gram-positive and Gram-negative bacteria. Signup and view all the answers

Which of the following is the recommended empiric treatment for brain abscess?

Vancomycin + metronidazole + ceftriaxone Signup and view all the answers

According to the passage, which of the following statements about otitis media is incorrect?

Tympanocentesis is routinely performed to obtain a sample for culture and sensitivity. Signup and view all the answers

Which of the following is a contraindication for performing a lumbar puncture (LP) in the context of brain abscess?

Possible herniation Signup and view all the answers

What additional measures should be taken for the 19-year-old male patient experiencing seizures, severe headache, confusion, fever, stiff neck, and petechial rash?

All of the above Signup and view all the answers

If the 19-year-old male patient's girlfriend is pregnant, how should the management of the case be modified?

Avoid certain antibiotics that may be harmful to the fetus Signup and view all the answers

In the case of the 54-year-old man with HIV, diagnosed 20 years ago, presenting with fever, stiff neck, and photophobia, what is the best next step in management after empiric treatment with vancomycin, ceftriaxone, and steroids is started?

Perform a lumbar puncture to obtain cerebrospinal fluid for analysis Signup and view all the answers

What is the significance of the patient's irregular respiratory rate in the first case?

It indicates the patient is experiencing respiratory distress and requires immediate intervention Signup and view all the answers

In the second case, what is the most likely underlying cause of the 54-year-old man's presentation with fever, stiff neck, and photophobia?

Bacterial meningitis Signup and view all the answers

Based on the patient's presentation and the CSF results, which of the following is the most likely diagnosis?

Viral meningitis Signup and view all the answers

What is the rationale for starting empiric treatment with vancomycin and ceftriaxone in this case?

To cover for bacterial meningitis caused by Streptococcus pneumoniae and Neisseria meningitidis Signup and view all the answers

Why is the addition of steroids to the empiric treatment regimen important in this case?

To decrease the inflammatory response and associated brain edema Signup and view all the answers

Why is the best next step in management to switch to acyclovir?

The CSF results, along with the patient's presentation, are most consistent with a viral etiology, likely herpes simplex virus, requiring a switch to acyclovir Signup and view all the answers

What is the significance of the patient's CD4 count of 770 cells/cc in this case?

The high CD4 count suggests the patient is not immunocompromised and is less susceptible to opportunistic infections Signup and view all the answers

Based on the clinical presentation, what is the most likely diagnosis?

Meningitis Signup and view all the answers

Which of the following is the most appropriate next step in management?

Perform a lumbar puncture Signup and view all the answers

Which of the following findings is most concerning for a potentially life-threatening complication of meningitis?

Irregular respiratory rate Signup and view all the answers

If the patient is diagnosed with bacterial meningitis, which type of isolation precautions should be implemented?

Droplet precautions Signup and view all the answers

Which of the following findings is least suggestive of meningitis in this case?

Seizures Signup and view all the answers