Bacterial Meningitis/Tension Headache

Question 1

MOA of sodium valproate

Answer 1

Prevents repetitive neuronal discharge by blocking voltage‑ and use-dependent sodium channels. Other actions include enhancement of GABA, inhibition of glutamate and blockade of T-type calcium channels.

Question 2

Sodium valproate indications

Answer 2

Primary generalised epilepsy, bipolar disorder, migraine preventsion (when other treatments have failed).

Question 3

Sodium valproate contraindications

Answer 3

Hypersensitivity, pancreatic dysfunction, porphyria

Question 4

Adverse effects of sodium valproate

Answer 4

Increased appetite, dose-related tremor, thinning or loss of scalp hair

Question 5

Adverse effects of sodium valproate

Answer 5

Increased appetite, dose-related tremor, thinning or loss of scalp hair

Question 6

What are the most commonly-implicated pathogens in bacterial meningitis?

Answer 6

Neisseria meningitidis and Streptococcus pneumoniae

Question 7

Risk factors for bacterial meningitis include:

Answer 7

Otitis media, sinusitis, cerebrospinal fluid leak after head trauma, sepsis, immunocompromised state, crowded living conditions, close contact with an infected person

Question 8

The pathognomonic triad of meningitis includes:

Answer 8

Fever, headache and neck stiffness

Question 9

Associated symptoms of meningitis include:

Answer 9

Altered mental status, photophobia, nausea/vomiting, malaise, seizures, cranial nerve palsies

Question 10

Signs of meningeal irritation on physical examination include:

Answer 10

Neck stiffness, Kernig’s sign, Brudzinski’s sign

Question 11

The gold-standard diagnostic test for bacterial meningitis is:

Answer 11

Lumbar puncture and cerebrospinal fluid analysis

Question 12

Cerebrospinal fluid findings in bacterial meningitis include:

Answer 12

• Cloudy, purulent fluid
• Elevated cell count with significant pleocytosis
• Granulocytosis
• Significantly increased opening pressure
• Significantly increased lactate
• Increased protein content
• Decreased glucose
• Positive Gram stain and culture

Question 13

Indications for imaging before lumbar puncture in suspected meningitis include:

Answer 13

Focal neurological deficits
Altered mental status
Immunocompromised/raised ICP
Lesions
Seizures

Question 14

Empiric antibiotic treatment for bacterial meningitis in patient’s aged <50 yo includes:

Answer 14

Vancomycin PLUS ampicillin PLUS ceftriaxone

Question 15

Adjuvant treatment for S. Pneumoniae or H. Influenzae meningitis includes:

Answer 15

Dexamethasone

Question 16

The most common neurologic complication of bacterial meningitis is:

Answer 16

Sensorineural hearing loss