Exam 4 Meningitis

Question 1

Bacterial Meningitis is?

Answer 1

Neuro emergency

Inflamm of arachnoid mater and CSF in subarachnoidspace and cerebral ventricles

Question 2

Bacterial Meningitis etiology:

Neonates thru delivery?

Nasopharynx?

Crowds?

Head trauma?

Neurosurg?

Answer 2

Neonate = E coli, Strep B

Nasopharynx = S pneumo from sinusitis/otitis media/mastoiditis

Crowds = Neisseria (military/college)

Head trauma = Staph

Neurosurg = Staph, G-

Question 3

Bacterial Meningitis pathophys?

Answer 3

Inflamm damages BBB -> 
↑ permeability ->
∆s protein/glucose transport ->
↑ edema/ICP and ↓ perfusion ->
Neuro damage

Question 4

Bacterial Meningitis presentation?

Answer 4

Progressively (few days)
Acutely w/ sxs of sepsis (over hrs)

Fever/Nuchal Rigidity/∆d Mental Status
HA/Photophobia
Anorexia
N/V
Weakness
CN palsies
Seizures

Neonates -> poor eating, irritability

Question 5

Meningococcemia presentation?

Answer 5

Petechiae and purpura

Question 6

Bacterial Meningitis labs? (6)

Answer 6

Lumbar puncture
CBC w/ diff
BMP
ESR
CRP
Blood Cx x2 before ABX

Question 7

Bacterial Meningitis imaging?

When should it be done?

Answer 7

CT

Before lumb puncture if 1+ of:
Immunocomp
Hx of CNS dz
New onset of seizures
Papilledema
Abn LOC
Focal neuro deficits

Question 8

Bacterial Meningitis CSF findings? (4)

Answer 8

↑ WBC w/ neutro dominance
↑ protein
↓ glucose
↑ opening pressure

Question 9

Bacterial Meningitis meds:

Newborn?

1 mo - 50 yo?

> 50yo?

Immunocomp?

Answer 9

Empiric IV ABX + steroids immediately after LP

Newborn = Ampicillin + Cefotax

1 mo - 50 yo = Ceftri + Vanco + Dexameth

> 50yo = Ceftri + Vanco + Amp + Dexameth

Immunocomp = Cefepime + Vanco + Amp + Dexameth

Question 10

Purpose of Dexamethasone?

Answer 10

↓ hearing loss and neuro damage

↓ morbidity/mortality

Question 11

How long for steroids?

Answer 11

4 days u/l S. pneumo, then longer

Question 12

Meningitis vaccines?

Answer 12

S. pneumo
Neisseria
H flu

Question 13

Aseptic Meningitis is?

Answer 13

Non-baterial

Clinical and lab evidence of meningitis with negative bacteria cultures

Question 14

Aseptic Meningitis viral etiology?

Non-viral?

Answer 14

Enterovirus (Most C): Coxsackie, Echovirus
HSV, Zoster, EBV, mumps, West Nile, CMV

Mycobacteria
Cryptococcus (fungi)
T pallidum, B burgd (spirochete)
Direct invasion by CA
Meds (NSAID, ABX)

Question 15

Aseptic Meningitis presentation?

Answer 15

Similar

Question 16

Aseptic Meningitis diagnostics?

Answer 16

Same labs

CT

Question 17

Aseptic Meningitis CSF findings?

Answer 17

↓WBC 50% lympho
Glucose = N
Protein = N or mild ↑
Gram stain = neg
Viral Cx = dx standard

Question 18

Aseptic Meningitis tx?

Answer 18

Symptomatic only

Empiric ABX until bacteria r/o