ID - Meningitis

Question 0

Consider neisseria meningitis if what PE finding?

Answer 0

Signs of meningitis with purpuric skin rash

Question 1

Patient suspected meningitis: diagnostic test to confirm?

Answer 1

Lumbar puncture

Question 2

Papilledema? Funduscopic examination would reveal?

Answer 2

Swelling of the optic nerve caused by increased the cranial pressure

See hazy optic disc margin

Question 3

Most common causes of meningitis?

Answer 3

1. Strep pneumonia
2. Neisseria meningitis
3. Group B strep (Streptococcus agalactiae).
4. Listeria
5. H influenza

Question 4

Suspect group B strep Meningitis in?

Answer 4

#Neonates 
# older than 50 with diabetes or liver disease

Question 5

Suspect Listeria meningitis in?

Answer 5

Pregnant women, neonates, elderly, AIDS patients, alcoholics

Question 6

How do bacteria usually get to meninges?

Answer 6

Seed the oropharynx, then move hematogenously

Question 7

Causes of meningitis after neurologic procedures?

Answer 7

Staph aureus and staff epidermidis

Question 8

Complications of inflammation due to meningitis?

Answer 8

Seizures, increased intracranial pressure, stroke

Question 9

Nuchal rigidity?

Answer 9

When passive or active flexion of the neck results in inability to touch the chin to chest

Question 10

Kernig vs Brudzibski sign?

Answer 10

Flex hip and knee and then passively extend. Positive if you elicits pain

Versus

Patient flexes knees and hips when their neck is passively flexed

Question 11

Pt with severe headache with symptoms of gastroenteritis. Cause of meningitis?

Answer 11

Enterovurus

Question 12

Causes meningitis in HIV patients?

Answer 12

Cryptococcus, TB

Question 13

If patient has focal neurologic findings consider?

Answer 13

Intracranial empyema or brain/epidural abscess

Question 14

Signs of subarachnoid hemorrhage?

Answer 14

1. Photophobia
2. Gossly bloody CSFs
3. Xanthochromic chromic supernatant

Question 15

CSF findings in bacterial meningitis: Opening pressure, WBC count/type, glucose, protein, RBC count, stain?

Answer 15

High, elevated and neutrophilic, <40, elevated, none, Gram

Question 16

CSF findings viral meningitis: Opening pressure, WBC count/type, glucose, protein, RBC count, stain?

Answer 16

Normal, elevated/lymphocytic, normal, normal, none, culture/PCR

Question 17

CSF findings in herpes simplex meningitis: Opening pressure, WBC count/type, glucose, protein, RBC count, stain?

Answer 17

Normal/high, elevated/lymphocytic, normal, normal/high, high, PCR

Question 18

CSF findings in tuberculosis meningitis: Opening pressure, WBC count/type, glucose, protein, RBC count, stain?

Answer 18

Normal/high, elevated/monocytes, very low, very high, none, PCR/AFB

Question 19

Bacteria and treatment of meningitis in neonates?

Answer 19

1. E. coli/group B strep
2. Listeria

Ampicillin plus cefotaxime

Question 20

Bacteria and treatment of meningitis in 1 month to 2 years old?

Answer 20

1. Strep pneumonia
2. Nisseria meningitis
3. H. flu

Cefotaxime/ceftriaxone plus vancomycin

Question 21

Bacteria and treatment of meningitis in 2 to 18-year-olds?

Answer 21

1. Nisseria meningitis
2. Strep pneumonia
3. H influenza

vancomycin plus ceftriaxone

Question 22

Bacteria and treatment of meningitis in 19 to 60 age group?

Answer 22

1. Strep pneumonia
2. Nisseria meningitis
3. H influenza

vancomycin plus ceftriaxone

Question 23

Bacteria and treatment of meningitis in 60 and older age group?

Answer 23

1. Strip pneumonia
2. Listeria
   3.

Ampicillin plus vancomycin plus ceftriaxone

Question 24

If suspect a patient of having meningitis, next steps?

Answer 24

Do LP

If radiological studies must be done before LP, send blood cultures and begin administering antibiotics while awaiting radiologic results

Question 25

If antibiotics are started, she an LP still be done?

Answer 25

Yes, LP still should be done if performed within two hours of antibiotic administration

Question 26

If patient is suspected of having HSV meningitis, radiological test of choice?

Answer 26

MRI

Question 27

MRI findings in HSV meningitis? Tuberculosis meningitis?

Answer 27

Enhancement of temporal lobes

Enhancement of basal region

Question 28

EEG findings in HSV meningitis?

Answer 28

2 to 3 second intervals of periodic sharp and slow wave complexes originating within temporal lobes

Question 29

Empiric treatment of meningitis?

Answer 29

Ceftriaxone plus vancomycin

Add ampicillin suspect the studio

Add acyclovir if suspect HSV

Question 30

Studies suggest giving glucocorticoids to decrease CNS inflammation if?

Answer 30

Patient is a child with H influenza or strep pneumonia meningitis

Question 31

Close contact prophylaxis for meningococcal meningitis?

Answer 31

Rifampin twice daily for two days or single-dose of ciprofloxacin

Question 32

Patient presents with nerve palsy, CSF findings (low glucose, high protein, low WBC count). Positive PPD but negative bacteria cultures at 48 hours. How to confirm diagnosis?

Answer 32

Repeat LP – if glucose falls at 48 hours, highly suggestive of TB

Question 33

Treatment for patient with Listeria meningitis?

Answer 33

Ampicillin

Question 34

When to get a CT before LP if suspect meningitis?

Answer 34

#papilledema
#seizures
#focal neurological deficits
#confusion

Question 35

If suspected meningitis pt cannot get immediate LP, next step?

Answer 35

Start antibiotics BEFORE LP

Question 36

Most common deficit in untreated bacterial meningitis?

Answer 36

Deafness