CNS Infections Quiz
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Questions and Answers

What is the primary mechanism by which pathogens breach the blood-brain barrier and cause CNS infections?

  • Direct penetration through the blood vessels
  • Induction of apoptosis in endothelial cells
  • Release of pro-inflammatory cytokines and disruption of tight junctions (correct)
  • Activation of immune cells and subsequent transmigration

    • Which of the following is a characteristic feature of CNS infections in terms of epidemiology?

  • Seasonal variation in incidence
  • Higher mortality rate in developing countries (correct)
  • Higher incidence in immunocompetent individuals
  • Predominance of viral etiology

    • A 35-year-old patient presents with fever, headache, and confusion. What is the most sensitive diagnostic test for CNS infections in this patient?

  • CT scan of the brain
  • Electroencephalogram (EEG)
  • Lumbar puncture with CSF analysis (correct)
  • Blood cultures and serology

    • A patient with a CNS infection exhibits signs of seizures, altered mental status, and focal neurological deficits. What is the most likely etiology of this clinical presentation?

    <p>Brain abscess</p> Signup and view all the answers

    What is the primary goal of management in CNS infections?

    <p>Eliminating the underlying pathogen</p> Signup and view all the answers

    What is the most common symptom of meningitis in newborns and infants?

    <p>Irritability</p> Signup and view all the answers

    What type of meningitis is caused by fungi such as Cryptococcus and Aspergillus?

    <p>Fungal meningitis</p> Signup and view all the answers

    What is the recommended vaccination schedule for the Meningococcal conjugate vaccine?

    <p>11-12 years old, with a booster dose at 16 years old</p> Signup and view all the answers

    What is the primary purpose of a lumbar puncture in the diagnosis of meningitis?

    <p>To collect cerebrospinal fluid to analyze for signs of infection</p> Signup and view all the answers

    What is the primary treatment for bacterial meningitis?

    <p>Antibiotics</p> Signup and view all the answers

    What type of meningitis is caused by viruses such as enteroviruses, herpesviruses, and West Nile virus?

    <p>Viral meningitis</p> Signup and view all the answers

    What is the recommended vaccination schedule for the Pneumococcal conjugate vaccine?

    <p>2, 4, 6, and 12-15 months old, with a booster dose at 5 years old</p> Signup and view all the answers

    What is the primary goal of imaging tests in the diagnosis of meningitis?

    <p>To rule out other conditions</p> Signup and view all the answers

    What type of meningitis is typically less severe than bacterial meningitis?

    <p>Viral meningitis</p> Signup and view all the answers

    What is the primary treatment for fungal meningitis?

    <p>Antifungal medications</p> Signup and view all the answers

    Which of the following symptoms specifically indicates increased intracranial pressure and irritation of the meninges?

    <p>Nuchal rigidity</p> Signup and view all the answers

    A 40-year-old patient presents with altered mental status. Which other symptom would most likely support a diagnosis involving CNS infection?

    <p>Rapid onset of fever</p> Signup and view all the answers

    Which symptom is least likely to be directly associated with a CNS infection?

    <p>Malaise</p> Signup and view all the answers

    In the context of CNS infections in adults, what does 'altered mental status' typically refer to?

    <p>Confusion or disorientation</p> Signup and view all the answers

    Which of the following pairs of symptoms is most indicative of a CNS infection in adults?

    <p>Rapid onset of fever and nuchal rigidity</p> Signup and view all the answers

    Which symptom is common to both age groups?

    <p>Headache</p> Signup and view all the answers

    Which of the following is a symptom that specifically affects infants and is difficult to detect?

    <p>Seizures</p> Signup and view all the answers

    Which symptom is uniquely listed under the 'over age 2' category?

    <p>Confusion</p> Signup and view all the answers

    What symptom might indicate a rapidly spreading rash in children over age 2?

    <p>Petechiae</p> Signup and view all the answers

    What is a common symptom in infants that involves a lack of responsiveness or movement?

    <p>Inactivity</p> Signup and view all the answers

    What characterizes the appearance of cerebrospinal fluid in pyogenic bacterial meningitis?

    <p>Purulent/cloudy</p> Signup and view all the answers

    Which type of meningitis is associated with a very low glucose level in the CSF?

    <p>Pyogenic Bacterial Meningitis</p> Signup and view all the answers

    What is the typical protein level in the cerebrospinal fluid for normal CSF?

    <p>15-40mg</p> Signup and view all the answers

    Which type of meningitis shows a clear or slightly turbid appearance and high protein levels in the CSF?

    <p>Tuberculosis meningitis</p> Signup and view all the answers

    Which type of meningitis typically results in raised lymphocytes in the cerebrospinal fluid?

    <p>Tuberculosis meningitis</p> Signup and view all the answers

    Which cerebrospinal fluid finding is most indicative of bacterial meningitis?

    <p>Elevated protein concentration</p> Signup and view all the answers

    What type of white cell predominates in the cerebrospinal fluid of a patient with bacterial meningitis?

    <p>Neutrophils</p> Signup and view all the answers

    Which pattern of glucose concentration in cerebrospinal fluid is typically observed in bacterial meningitis?

    <p>Decreased glucose concentration</p> Signup and view all the answers

    Which diagnostic technique is commonly positive in bacterial meningitis?

    <p>Positive gram stain and culture</p> Signup and view all the answers

    Which cerebral spinal fluid findings would NOT be expected in bacterial meningitis?

    <p>Decreased protein concentration</p> Signup and view all the answers

    Which of the following Glasgow Coma Scale scores is an indication against performing a lumbar puncture?

    <p>Less than 9</p> Signup and view all the answers

    What is a sign of raised intracranial pressure that contraindicates lumbar puncture?

    <p>Papilledema</p> Signup and view all the answers

    Which of the following is NOT considered a focal neurological sign that contraindicates lumbar puncture?

    <p>Abnormal posture</p> Signup and view all the answers

    Bradycardia and hypertension together are indicative of what condition that contraindicates lumbar puncture?

    <p>Raised intracranial pressure</p> Signup and view all the answers

    Which of the following eye signs would contraindicate a lumbar puncture?

    <p>Poorly responsive pupils</p> Signup and view all the answers

    What does a verbal score of 3 on the Glasgow Coma Scale indicate?

    <p>Utters inappropriate words</p> Signup and view all the answers

    Which motor score on the Glasgow Coma Scale corresponds to 'Obeys commands'?

    <p>6</p> Signup and view all the answers

    What eye response score does 'Opens eyes spontaneously' receive on the Glasgow Coma Scale?

    <p>4</p> Signup and view all the answers

    What does a motor response score of 2 indicate on the Glasgow Coma Scale?

    <p>Extension to painful stimuli (decerebrate response)</p> Signup and view all the answers

    Which verbal score would be given to a patient who is 'Oriented, converses normally'?

    <p>5</p> Signup and view all the answers

    Which eye response is given a score of 2 on the Glasgow Coma Scale?

    <p>Opens eyes in response to painful stimuli</p> Signup and view all the answers

    Study Notes

    Symptoms of Meningitis

    • Fever, headache, stiff neck, nausea and vomiting, sensitivity to light, and confusion or disorientation are common symptoms
    • Severe symptoms include seizures, difficulty speaking or walking, weakness or numbness in the face or extremities, and rash or skin lesions
    • Newborns and infants may show irritability, refusal to eat, high-pitched crying, bulging soft spot on the head, and stiffness or floppiness

    Types of Meningitis

    • Bacterial meningitis is caused by bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, and is the most severe and potentially life-threatening type
    • Viral meningitis is caused by viruses such as enteroviruses, herpesviruses, and West Nile virus, and is typically less severe than bacterial meningitis
    • Fungal meningitis is caused by fungi such as Cryptococcus and Aspergillus, and typically occurs in people with weakened immune systems
    • Parasitic meningitis is caused by parasites such as Naegleria fowleri, and aseptic meningitis is caused by non-infectious agents such as medications or cancer

    Vaccination

    • Available vaccines include Meningococcal conjugate vaccine (MenACWY), Meningococcal B vaccine (MenB), and Pneumococcal conjugate vaccine (PCV)
    • Recommended vaccination schedules include Meningococcal conjugate vaccine at 11-12 years old with a booster dose at 16 years old, Meningococcal B vaccine at 16-23 years old with a series of 2-3 doses, and Pneumococcal conjugate vaccine at 2, 4, 6, and 12-15 months old with a booster dose at 5 years old

    Diagnosis

    • Physical examination involves assessing vital signs, neurological function, and overall health
    • Imaging tests such as CT or MRI scans are used to rule out other conditions
    • Lumbar puncture is used to collect cerebrospinal fluid to analyze for signs of infection
    • Laboratory tests include blood cultures to identify the causative organism, and PCR or other molecular tests to detect viral or fungal infections

    Treatment Options

    • Bacterial meningitis is treated with antibiotics such as ceftriaxone or vancomycin, and supportive care such as fluid replacement, oxygen therapy, and pain management
    • Viral meningitis is treated with supportive care such as fluid replacement, pain management, and anti-nausea medications, and antiviral medications in some cases
    • Fungal meningitis is treated with antifungal medications such as amphotericin B, and supportive care such as fluid replacement, oxygen therapy, and pain management

    Symptoms of Meningitis

    • Common symptoms: fever, headache, stiff neck, nausea and vomiting, sensitivity to light, and confusion or disorientation
    • Severe symptoms: seizures, difficulty speaking or walking, weakness or numbness in the face or extremities, and rash or skin lesions
    • Newborns and infants: irritability, refusal to eat, high-pitched crying, bulging soft spot on the head, and stiffness or floppiness

    Types of Meningitis

    • Bacterial meningitis: caused by bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis; most severe and potentially life-threatening
    • Viral meningitis: caused by viruses such as enteroviruses, herpesviruses, and West Nile virus; typically less severe than bacterial meningitis
    • Fungal meningitis: caused by fungi such as Cryptococcus and Aspergillus; typically occurs in people with weakened immune systems
    • Other types: parasitic meningitis, aseptic meningitis

    Vaccination

    • Available vaccines: Meningococcal conjugate vaccine (MenACWY), Meningococcal B vaccine (MenB), Pneumococcal conjugate vaccine (PCV)
    • Recommended vaccination schedules:
      • Meningococcal conjugate vaccine: 11-12 years old, with a booster dose at 16 years old
      • Meningococcal B vaccine: 16-23 years old, with a series of 2-3 doses
      • Pneumococcal conjugate vaccine: 2, 4, 6, and 12-15 months old, with a booster dose at 5 years old

    Diagnosis

    • Physical examination: assessing vital signs, neurological function, and overall health
    • Imaging tests: CT or MRI scans to rule out other conditions
    • Lumbar puncture: collecting cerebrospinal fluid to analyze for signs of infection
    • Laboratory tests: blood cultures to identify the causative organism, PCR or other molecular tests to detect viral or fungal infections

    Treatment Options

    • Bacterial meningitis: antibiotics to treat the underlying infection, supportive care (fluid replacement, oxygen therapy, pain management)
    • Viral meningitis: supportive care (fluid replacement, pain management, anti-nausea medications), antiviral medications in some cases
    • Fungal meningitis: antifungal medications to treat the underlying infection, supportive care (fluid replacement, oxygen therapy, pain management)

    Meningitis Signs and Symptoms

    In Infants Under 2 Years

    • Fever is a common symptom
    • Headache may be present, although difficult to detect in infants
    • Stiff neck is a characteristic sign
    • Inactivity and lethargy may be observed
    • Vomiting and poor feeding habits are indicative of meningitis
    • Seizures may occur, which can be hard to detect in infants

    In Children Over 2 Years

    • High fever is a significant symptom
    • Headache is a common complaint
    • Stiff neck is a hallmark sign of meningitis
    • Nausea and vomiting are frequent symptoms
    • Sensitivity to light is a characteristic feature
    • Confusion and sleepiness may be present
    • Rapidly spreading petechiae is a significant symptom
    • Seizures can occur in children over 2 years old

    Cerebrospinal Fluid Analysis

    Normal CSF

    • Appearance is normal
    • White Blood Cells (WBCs) count is below 5x 106/l
    • Protein concentration is between 15-40mg
    • Glucose level is between 45-72mg

    Pyogenic Bacterial Meningitis

    • CSF appearance is purulent/cloudy
    • WBCs count is usually high, with many pus cells
    • Protein concentration is high
    • Glucose level is very low

    Viral Meningitis

    • CSF appearance is clear or slightly turbid
    • WBCs count is raised with lymphocytes
    • Protein concentration is normal or usually increased
    • Glucose level is not specified (normal)

    Tuberculosis Meningitis

    • CSF appearance is clear or slightly turbid
    • WBCs count is raised with lymphocytes
    • Protein concentration is high
    • Glucose level is reduced

    Symptoms of Meningitis

    • Common symptoms:
      • Fever
      • Headache
      • Stiff neck
      • Nausea and vomiting
      • Sensitivity to light
      • Confusion or disorientation
    • Severe symptoms:
      • Seizures
      • Difficulty speaking or walking
      • Weakness or numbness in the face or extremities
      • Rash or skin lesions
    • Newborns and infants:
      • Irritability
      • Refusal to eat
      • High-pitched crying
      • Bulging soft spot on the head
      • Stiffness or floppiness

    Types of Meningitis

    • Bacterial meningitis:
      • Caused by bacteria like Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis
      • Most severe and potentially life-threatening type
    • Viral meningitis:
      • Caused by viruses like enteroviruses, herpesviruses, and West Nile virus
      • Typically less severe than bacterial meningitis
    • Fungal meningitis:
      • Caused by fungi like Cryptococcus and Aspergillus
      • Typically occurs in people with weakened immune systems
    • Other types:
      • Parasitic meningitis (caused by parasites like Naegleria fowleri)
      • Aseptic meningitis (caused by non-infectious agents like medications or cancer)

    Vaccination

    • Available vaccines:
      • Meningococcal conjugate vaccine (MenACWY)
      • Meningococcal B vaccine (MenB)
      • Pneumococcal conjugate vaccine (PCV)
    • Recommended vaccination schedules:
      • Meningococcal conjugate vaccine: 11-12 years old, with a booster dose at 16 years old
      • Meningococcal B vaccine: 16-23 years old, with a series of 2-3 doses
      • Pneumococcal conjugate vaccine: 2, 4, 6, and 12-15 months old, with a booster dose at 5 years old

    Diagnosis

    • Physical examination:
      • Assessing vital signs, neurological function, and overall health
    • Imaging tests:
      • CT or MRI scans to rule out other conditions
    • Lumbar puncture:
      • Collecting cerebrospinal fluid to analyze for signs of infection
    • Laboratory tests:
      • Blood cultures to identify the causative organism
      • PCR or other molecular tests to detect viral or fungal infections

    Cerebrospinal Fluid Analysis

    • Normal CSF:
      • Appearance: clear
      • Cells (WBCs): below 5x10^6/l
      • Protein: 15-40mg
      • Glucose: 45-72mg
    • Pyogenic bacterial meningitis:
      • Appearance: purulent/cloudy
      • Cells (WBCs): many pus cells
      • Protein: high
      • Glucose: very low
    • Viral meningitis:
      • Appearance: clear/slightly turbid
      • Cells (WBCs): raised lymphocytes
      • Protein: normal/usually increased
      • Glucose: normal
    • Tuberculosis meningitis:
      • Appearance: clear/slightly turbid
      • Cells (WBCs): raised lymphocytes
      • Protein: high
      • Glucose: reduced

    Treatment Options

    • Bacterial meningitis:
      • Antibiotics to treat the underlying infection
      • Supportive care (fluid replacement, oxygen therapy, and pain management)
    • Viral meningitis:
      • Supportive care (fluid replacement, pain management, and anti-nausea medications)
      • Antiviral medications in some cases
    • Fungal meningitis:
      • Antifungal medications to treat the underlying infection
      • Supportive care (fluid replacement, oxygen therapy, and pain management)

    Contraindications to Lumbar Puncture

    • Raised intracranial pressure is suspected if:
      • Glasgow Coma Scale score is less than 9, indicating reduced or fluctuating level of consciousness
      • Relative bradycardia and hypertension are present
    • Other signs that contraindicate lumbar puncture include:
      • Focal neurological signs
      • Abnormal posture or posturing
      • Unequal, dilated, or poorly responsive pupils
      • Papilledema
      • Abnormal 'doll's eye' movements

    Glasgow Coma Scale

    • The Glasgow Coma Scale is a tool used to assess the level of consciousness in a person following a brain injury or other neurological condition.
    • The scale ranges from 3 to 15, with 3 indicating the lowest level of responsiveness and 15 indicating normal responsiveness.

    Eye Response

    • A score of 1: does not open eyes.
    • A score of 2: opens eyes in response to painful stimuli.
    • A score of 3: opens eyes in response to voice.
    • A score of 4: opens eyes spontaneously.
    • A score of 5: no abnormality in eye response.

    Verbal Response

    • A score of 1: makes no sounds.
    • A score of 2: incomprehensible sounds.
    • A score of 3: utters inappropriate words.
    • A score of 4: confused, disoriented.
    • A score of 5: oriented, converses normally.

    Motor Response

    • A score of 1: makes no movements.
    • A score of 2: extension to painful stimuli (decerebrate response).
    • A score of 3: abnormal flexion to painful stimulus (decorticate response).
    • A score of 4: flexion/Withdrawal to painful stimulus.
    • A score of 5: localizes painful stimuli.
    • A score of 6: obeys commands.

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    CNS Infections PDF

    Description

    Assess your knowledge of Central Nervous System infections, including their causes, diagnosis, clinical presentation, and treatment. Topics covered include aetiology, pathophysiology, epidemiology, and management.

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