Bacterial meningitis

Question 1

Bacterial meningitis history

Answer 1

fever
malaise
headache
photophobia
neck stiffness
nausea/vomiting

Question 2

Bacterial meningitis PE

Answer 2

nuchal rigidity
Kernig sign
Brudzinski sign
“jolt sign”

Question 3

Kernig sign

Answer 3

A positive test is the elicitation of pain or resistance with passive extension of the patient’s knees past 135 degrees

Question 4

Brudzinski sign

Answer 4

Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed

Question 5

Bacterial meningitis diagnosis

Answer 5

LP

CT Head first if signs of increased intracranial pressure, AMS, or focal deficit

Blood cultures before Abx

Question 6

Bacterial meningitis CSF findings

Answer 6

Opening pressure 200-500

Cell type PMNs

Glucose low

Protein High

Question 7

Viral meningitis CSF findings

Answer 7

Opening pressure < 250

Cell type Lymphocytes

Glucose normal

Protein normal

Question 8

TB meningitis CSF findings

Answer 8

Opening pressure 180-300

Cell type Lymphocytes

Glucose low to normal

Protein normal to high

Question 9

Bacterial meningitis treatment

Answer 9

Empiric Abx immediately after blood cultures

Even short delay increases mortality

Do not delay Abx if LP cannot be done

Dexamethasone before Abx if Strep pneumoniae is suspected

Add penicillin for Listeria in patients > 50 years or immunocompromised

Question 10

Bacterial meningitis common causes in neonates

Answer 10

neonates 0-4 weeks: Group B strep, E coli, Listeria

Question 11

Bacterial meningitis common causes in infants

Answer 11

infants 1-23 months

Streptococcus pneumoniae, Neisseria meningitidis
H influenza

Question 12

Bacterial meningitis common causes 2-50 years

Answer 12

Strep pneumoniae
N meningitidis

Question 13

Bacterial meningitis common causes > 50 years

Answer 13

Sprep pneumoniae
N meningitidis
Listeria monocytogenes