CNS

Question 1

2 most common causes of meningitis?

Answer 1

Strep pneumonia and neisseria meningitidis

strep pneuomnia is most common

Question 2

Describe neisseria meningitidis?

Answer 2

Gram negative cocci in pairs

Question 3

What causes the classic non blanching rash of meningitis?

Answer 3

Neisseria meningitidis infection that gets in the blood

Question 4

Neisseria meningitidis is also referred to as?

Answer 4

meningococcus

Question 5

Describe strep pneumonia?

Answer 5

Alpha haemolytic gram positive cocci in chains

Question 6

Describe listeria moncytogenes?

Answer 6

gram positive bacilli

Question 7

Who does listeria monocytogenes tend to cause meningitis in?

Answer 7

neonates, elderly, immunosuppressed, particularly those with malignancy

Question 8

Describe some signs and symptoms of meningitis?

Answer 8

headache
neck stiffness
fever
photophobia
vomiting 
intense malaise
petechial rash in meningococcal infection

Question 9

Treatment of meningitis?

Answer 9

• ceftriaxone IV 2g bd (if penicillin allergic give chloramphenicol instead) + dexamethasone just before or started with antibiotics
• if listeria is suspected (it should be suspected in those 60 or over or immunocompromised which includes alcoholics and diabetics) should give amoxicillin IV
• if recent travel (within 6 months) to a country on list of high rates of penicillin resistance then add vancomycin too

Question 10

Who should listeria be suspected then and therefore be treated with amoxicillin as well as ceftriaxone?

Answer 10

those 60 or over

those immunocompromised which includes diabetics and alcoholics

Question 11

Does ceftriaxone cover listeria?

Answer 11

NO

so if suspected must give amoxicillin

Question 12

Describe 4 tests for suspected meningitis?

Answer 12

Blood cultures
Throat swab for culture
CSF sample (although cant do LP / must be careful if high ICP)
Might do PCR

Question 13

This describes the typical CSF findings for?

10^1-10^3 cell count predominantly lymphocytes
Gram staining neg
Normal or slightly high protein
Normal glucose

Answer 13

Viral meningitis

Question 14

This describes the typical CSF findings for?

10^1-10^4 cell count predominantly neutrophils
Positive gram staining
High protein count
Less than 70% of blood glucose

Answer 14

bacterial meningitis

Question 15

This describes the typical CSF findings for?

10^1-10^3 cell count predominantly lymphocytes
Positive or negative gram staining
High or very high protein
Less than 60% blood glucose

Answer 15

tuberculosis meningitis

Question 16

What are the public health reporting requirements in terms of meningitis?

Answer 16

Must report every suspected case of bacterial meningitis

May do tracing and give prophylactic treatment to contacts