Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Meningitis > Bacterial Meningitis > Flashcards

Bacterial Meningitis Flashcards

(102 cards)

Start Studying
1
Q

Neurological Sequelae can develop even after proper treatment of meningitis. List these:

A

1) Seizures
2) Hearing Loss
3) Learning Disabilities
4) Hydrocephalus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most common bacteria causing meningitis is:

A

Strep. pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

List the layers of the skull:

A

Dura mater, arachnoid, subarachnoid space, pia mater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The three pathways bacteria can spread to cause meningitis:

A

1) Hematogenous spread (bacteremia, fungemia, parasites invade blood stream)
2) Neuronal pathway spread (never endings in face may transfer bacteria) (olfactory & peripheral nerves)
3) Extension from contiguous and direct inoculation (sinusitis, otitis media, trauma, intracranial manipulation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is meningitis?

A

an inflammation of the meninges affecting the subarachnoid space or spinal fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is encephalitis?

A

inflammation of the brain tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Acute classification of meningitis occurs within

A

hours to several days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Worst classification of meningitis is…

A

Acute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Chronic Meningitis occurs within

A

weeks to months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Chronic meningitis signs and symptoms in the CSF remain abnormal for how long?

A

at least 4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Septic meningitis is due to…

A

bacteria in blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Septic meningitis can cause what?

A

Altered mental status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Aseptic meningitis occurs due to

A

drugs/ chemical irritants, viral infections, spirochetal infections (syphillis & lyme disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What drugs can cause aseptic meningitis?

A

1) Bactrim
2) IV Ig
3) NSAIDS (Ibuprofen, Naproxen)
4) Allopurinol (gout)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the most likely pathogens associated with bacterial meningitis?

A

1) Streptococcus pneumoniae
2) Neisseria meningitis
3) H. influenza (SERO B TYPE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Aside from the three most common bacteria, acute bact. meningitis can be caused by what other bacterias?

A

1) listeria monocytogenes
2) staph
3) gram negative bacilli
4) anaerobes
5) mycobacterial infxns
6) spirochetal infxns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Acute meningitis is characterized by…

A

an acute onset of meningeal symptoms and CSF pleocytosis (changes in CNS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Chronic meningitis is characterized by…

A

signs and symptoms of meningeal irritation and CSF pleocytosis for greater than 4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Meningitis Risk Factors:

A

1) AGE (50)
2) Cranial or congenital deformities
3) Head trauma
4) Diabetes, hypoparathyroidism, CF, sickle cell, alcoholism, cirrhosis, IVDA, IE
5) Immunosuppression- (HIV- encapsulated Strep. pneumo) (mailgnancy- increased risk for listeria) (HIV- salmonella)
6) Crowded living conditions
7) Recent exposure to others
8) Cigarette exposure and history of ear implanatation
9) Travel- ie, meningitis belt in sub-saharan Africa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

S/S are different with certain patient populations such as:

A

1) adults
2) infants
3) elderly
4) immunosuppresed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Classic Triad clinical presentation:

A

1) Headache & altered Mental Status
2) Neck stiffness
3) Fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Clinical presentation for Adults:

A

1) Headache, fever, chills
2) Meningismus
3) Altered consciousness
4) seizures
5) N/V
6) Rash
7) photophobia
8) myalgia
9) sweating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Clinical presentation for Children:

A

1) irritability
2) temperature instability
3) lethargy, grunting, high pitched cry
4) feeding intolerance
5) N/V/D
6) seizures
7) rash
8) apnea
9) BULGING FONTANELLE (when skull isn’t fused and pressure causes swollen forehead)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Clinical presentation in Elderly:

A

1) Confusion
2) Mental status changes
3) Lethargic
4) Possible afebrile
5) Concurrent infections
- pneumonia
- sinusitis
- bronchitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Most elderly present with what bacteria causing meningitis?
S. pneumoniae, BUT some may also acquire gram negative pathogens
26
Clinical pres of Neutropenic patients:
1) impaired immune function 2) impaired inflammation response 3) non- specific symptoms
27
Three signs of meningitis inflammation:
1) Kernig's sign 2) Brudzinski's sign 3) Jolt accentuation of headache
28
How do you perform the Kernig sign test?
Flex patients legs at the hip and knee, then straighten knee & report resistance or pain
29
How do you perform the Brudzinski sign test?
Patient supine, flex head and neck towards chest- watch for resistance and pain, and flexion of hips and knees
30
Jolt accentuation of headache test:
move head from right to left- document pain
31
What is KEY in meningitis diagnosis?
Early Identification
32
Diagnosis is based on what?
1) Patient history & assessment- identify causative agents 2) CT scan of head and MRI of brain 3) Clinical presentation 4) CSF results from CSF analysis & lumbar puncture 5) Blood cultures (CBC, serum electrolytes, serum glucose, BUN, CrCL, liver profile (renal fxn )) IN ADDITION: 6) Blood, nasopharynx, resp, urine and skin cultures 7) Serum Procalcitonin (marker for inflammation) 8) Special clinical conisderations - Acid Fast Bacilli (test for TB) - Venereal disease research lab (VDRL) - Fungal culture
33
How is CSF produced?
85% in the 3rd & 4th lateral ventricle of the choroid plexus
34
How much CSF is produced per day in children?
40-60 mL/ day
35
How much CSF is produced per day in adults?
500 mL/day
36
How does CSF flow?
Unilaterally- skull to spinal chord and down
37
You can give antibiotics to patients empirically for meningitis because:
ABX do not change the CSF for 24-48 hours so they won't affect the initial cultures drawn
38
What test do you perform for collection of CSF?
Lumbar puncture (needle inserted between the 3rd and 4th lumbar vertebrae)
39
LP is C/I in patients with evidence of:
1) focal neurological exam 2) intracerebral pressure 3) thrombocytopenia 4) bleeding diathesis
40
When meningitis is suspected, what do you do first?
1) obtain two sets of blood cultures 2) immediately begin empiric ABX therapy 3) perform CT scan
41
Analysis of CSF:
1) appearance 2) expected cell composition 3) absence of bacteria 4) normal chem of fluid 5) normal pressure <200 mm HgO
42
Normal WBC & bacterial WBC in CSF
Normal: <5 Bact: 1,000- 5,000
43
Normal & Bacterial Differential in CSF
Normal: >90% (monocytes) Bact: > 80 PMN
44
Normal & bacterial pH in CSF
Normal: 7.3 Bact: 7.1
45
Lactic acid in CSF
Normal: 35 mg/dL
46
Protein in CSF
Normal: <50 Bact: 100-500
47
Glucose in CSF
Normal: 30-70 Bact: <40
48
How many hours until mortality occurs in meningitis?
24-48 hours
49
Supportive care treatments are:
1) Fluids 2) Electrolytes 3) Antipyretics 4) Analgesics 5) Anti-epileptics
50
When you treat Men empirically, what should you do?
1) Continue ABX for 72 hours or when diagnosis of ABM is ruled out 2) Consider adjunctive corticosteroids (dexamethasone) when applicable
51
When pathogen is identified, how do you treat definitively?
Therapy based on specific pathogen and continue for appropriate duration.
52
Obstacles to consider when initially treating are?
1) Neurological morbidity even after proper treatment 2) Concerns for delay in LP or C/I 3) HIgh mortality if not treated 24-48 hours
53
When should you give the first dose of ABX?
ASAP - NEVER withhold if suspected
54
Changes in CSF after empiric ABX apparent after how many hours?
12-24 hours
55
What principles should you consider when recommending an ABX regimen?
1) Penetration into the CNS - adequate drug concentration in CNS (exceed MBC > 10 fold) - bactericidal and dependent on time in the CNS high doses and IV ONLY 2) Dependent on inflammation process - Low MW - Low protein binding - Non-ionized at pH site - High-lipid SOLUBLE
56
Certain ABX's do better when there IS what in the brain?
inflammation in the brain, due to blases
57
MBC stands for what?
Minimum bacterioCIDAL concentration
58
Can you treat ABM orally?
HELL NO. IV ONLY!
59
What is DAT?
Direct Antimicrobial Therapy
60
When do you use DAT?
If MRSA is in the brain, Vancomycin cannot penetrate properly, so you need to insert a shunt in the brain or spine to administer Vanco locally. (Not preferred due to unilateral flow of CSF)
61
What ABX penetrate CSF with or without inflammation?
1) Sulfonamides 2) Trimethoprim 3) Chloramphenicol 4) Metronidazole 5) Rifampin 6) Pyrazinamide 7) Ethionamide 8) Cycloserine
62
What ABX penetrate CSF WITH inflammation?
1) Acyclovir 2) Nafcillin 3) BL/ BLI 4) FQ 5) Ceftriaxone 6) Imipenem 7) Meropenem 8) Daptomycin 9) Aztreonam 10) Linezolid 11) Synercid 12) Colistin 13) Vancomycin
63
What ABX are poorly entered into the CSF, but can be used empirically for hemo infxns?
1) Aminoglyc's 2) 1st & 2nd gen Ceph's except cefuroxime 3) Cefoperazone 4) Clindamycin 5) Erythromycin 6) Amphotericin B 7) Ketoconazole 8) Itraconazole
64
N. meningitis symptoms:
Asymptomatic carrier state, petechiae or purpuric lesions, rash that worsens after anti-inflamm agents used
65
Colonization of N. meningitis occuring in the ______________ can lead to _______________
nasopharynx, bacteremia
66
N. meningitis usually occurs when?
winter and spring months
67
What serotypes are identified with N. meningitis?
A, B, C, Y, and W-135
68
H. influenzae usually occurs in what population?
infants and children who are not vaccinated
69
What complication are common in early H. influenzae meningitis?
Neurological complications are common in early disease
70
What serotype is H. influenzae?
serotype B- vaccine is in the works
71
S. pneumo is common in what age group?
All ages
72
Predisposed pneumo infections leading to S. pneumoniae meningitis?
pneumonia, sinusitis, otitis media, cochlear implants
73
What occurs more frequently in S. pneumoniae meningitis?
Neurological compilations occur more frequently
74
Listeria monocytogenes meningitis is more common in what populations?
1) alcoholics 2) immunodeficient patients 3) neonates 4) elderly
75
Listeria meningitis normally occurs when?
summer and fall months
76
Listeria meningitis colonization occurs where?
GI Tract
77
How is listeria normally contracted?
Via food by immunocompromised patients- contaminated coleslaw, raw veggies, milk and cheese
78
Strep. agalactiae is common in what population?
neonates & pregnant women
79
A gram stain was obtained in a patient with a suspected acute case of bacterial meningitis, the results showed gram negative diplococci. What bacteria is responsible for the acute infection?
N. meningitis
80
A gram stain was obtained in a patient with a suspected acute case of bacterial meningitis, the results showed gram negative diplococci. What can we determine from this information?
Lumbar penetration, gram stain
81
Sensitivity of a gram stain % variation:
60-90%
82
Specificity of a gram stain is approximately what %?
100%
83
A patient <1 month most likely has what meningitis pathogens?
E.Coli, Strep agalactiae, Listeria, Enterococcus sp, Salmonell sp, Klebsiella
84
How would you treat a <1 month empirically?
Ampicillin PLUS Ceftriaxone or Cefotaxime (use if ceftriaxone resistance) or an aminoglycoside
85
1 month- 4 years of age common pathogens?
E. Coli, Strep agalactiae, Listeria, N. Meningitis, H. influenzae,S. pneumoniae
86
Empiric treatment for 1 month- 4 years?
Cefotaxime or Ceftriaxone PLUS Vancomycin
87
5-29 yo common pathogens?
N. meningitis, H. influenzae, S. pneumo
88
5-29 empiric treatment?
Cefotaxime or Ceftriaxone PLUS Vancomycin
89
30-60 yo common pathogens?
S. pneumo, N. meningitis
90
30-60 yo empiric treatment?
Cefotaxime or Ceftriaxone PLUS Vancomycin
91
> 60 yo common pathogens?
S. pneumo, listeria, n. meningitis, Gram Neg. bacilli
92
> 60 yo empiric treatment?
Ampicillin PLUS Cefotaxime or Ceftriaxone or an aminoglycoside PLUS Vancomycin
93
CSF Shunt common bacteria?
S. epidermis, S. aureus, Gram Neg bacilli
94
CSF Shunt empiric treatment?
Vanco + Cefepime or Ceftazidime or Meropenem
95
Adjunctive therapy for men?
Empirical corticosteroid therapy
96
Why use corticosteroid therapy in men patients?
Inhibits TNF and IL-1 | to decrease inflammation, edema, & intracranial pressure
97
Corticosteroids may do what to current ABX?
decrease penetration
98
When should you use corticosteroids in patients with men?
In children with H. influenzae meningitis | In adults with S. pneumo meningitis
99
When should you administer corticosteroids?
MUST admin 10-20 BEFORE or at the SAME time as ABX to prevent neuro complications
100
Administer corticosteroid in adults when:
suspected pneumo meningitis, increased intracranial pressure, high concentrations of bacteria in CSF, Change in mental status (Glasgow Coma Scale < II
101
When should you NOT admin dexamethasone?
When patient has already received ABX therapy!
102
Prophylaxis for patients with close contact of N. meningitis or H. influenzae?
Rifampin

Meningitis (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions