Lecture 25 - Fever and Headache

Question 1

Meningitis definition?

Answer 1

increase in WBC (inflammation) in CSF of the subarachnoid space

Question 2

Causes?

Answer 2

virus (benign), bacterial (n. meningitidis, s. pneumoniae, m. tuberculosis), other microbes, trauma, drugs, cancer

Question 3

Symptoms?

Answer 3

headache, photophobia, neck stiffness, drowsiness, systemic inflammation (rash, fever, septic shock)

Question 4

Bacterial pathophysiology?

Answer 4

nasopharyngeal infection, enter suarachnoid dpace and propogate

Question 5

Diagnosis?

Answer 5

signs and symptoms appear too late, take samples of CSF, blood culture and throat swab

Question 6

Kernig’s sign?

Answer 6

pull legs up while supine, sore head and neck before hamstrings implies meningitis

Question 7

CSF results - bacterial?

Answer 7

decreased glucose, increased protein and WBC, neutrophils, +/- gram stain, ++/- culture

Question 8

CSF results - viral?

Answer 8

normal glucose, normal or increased protein, increased WBC, lymphocyte presence, - gram stain and culture

Question 9

If CSF stain is negative and no characteristic rash?

Answer 9

find aetiology to exlude meningitis; CSF PCR to detect virus, meningicoccus and pneumococcus, Blood PCR for meningicoccus, and throat swab for carriage of both

Question 10

Meningitis secret weapon?

Answer 10

avoids complement through down regulation through protein H, pili cleaving complement factors, polysaccharide capsule, and blebs of lipopolysaccharide (breaks down neutrophils into DNA causing occlusion)

Question 11

Management of Bacterial meningitis?

Answer 11

give IV antibiotics (penicillin) immediately, blood cultures, hospitalise, pain relief, fluids

Question 12

Management of viral meningitis?

Answer 12

reassurance, analgesia, home recovery

Question 13

Generations of cephalosporins?

Answer 13

1. cefazolin, 2. cefuroxime, 3. ceftriaxone (best for bacterial meningitis) and ceftazidime

Question 14

Treatment for MRSA?

Answer 14

ceftaroline (5th gen)