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GENERAL MEDICINE > Meningitis > Flashcards

Meningitis Flashcards

1
Q

Name the causes of bacterial meningitis in neonates

A
  1. Negative Bacilli ( E. coli )
  2. Group B streptococcal (S. agalactia)
  3. listeria monocytogenes
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2
Q

Yes what is the main cause of bacteria meningitis in neonates

A

Negative Bacilli (E. coli)


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3
Q

What is the most common cause of bacterial meningitis in children

A

H. Influenza

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4
Q

What is the most common cause of bacterial meningitis in adults

A

S. pneumonia and N. meningitides 

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5
Q

Which type of bacterial infection may cause deafness associated with meningitis

A

H influenza

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6
Q

What is meningococcaemia

A

It is a condition that can be present with or without meningitis. It is when the meningococci enter the bloodstream. Presents with petechial rash. It can lead to hypertension and multi organ failure

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7
Q

How do you differentiate petechial rash due to meningococcaemia from other rashes

A

meningococcaemia lesions do not go away or disappear when pressure is applied

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8
Q

Which type of bacteria associated with meningitis is associated with middle ear infection

A

S. Agalactiae (group B strep)

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9
Q

What are the sign And symptoms of acute bacterial meningitis

A
  1. Headache, vomiting, fever
  2. photophobia and Phenophobia 
  3. Neck rigidity
  4. Altered level of consciousness such as confusion, delirium, lethargy and coma 
  5. Rash
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10
Q

 What are the two physical test to test for meningitis

A
  1. Kerning sign
  2. Brudzinski sign
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11
Q

 how do you test for kernings sign

A

Lay the patient in supine position, flex the hip joint and then slowly extend the knee joint. if back pain is present or the patient moves to fetal position the sign is positive

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12
Q

How do you test for Brodzinski sign

A

place your fingers on the occiput of the patient. Slowly raise their head until their chin touches their chest. If spontaneous knee and hip flexion occurs the sign is positive

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13
Q

What are the features of meningococcal septicaemia

A
  1. Meningitis
  2. rash
  3. shock
  4. DIC
  5. Renal failure
  6. peripheral gangrene
  7. arthritis
  8. pericarditis
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14
Q

What are the features of meningitis in neonates

A

Restlessness, high-pitched cry, refusal to feed and irritability

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15
Q

What are the complications of bacterial meningitis

A
  1. Septicaemia
  2. DIC
  3. shock
  4. raised intracranial pressure
  5. septic arthritis
  6. syndrome of inappropriate ADH secretion
  7. infarction of adrenal gland/waterhouse Fredrickson syndrome
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16
Q

What are the D/DS of meningitis

A
  1. Brain abscess
  2. viral meningitis
  3. TB meningitis
  4. other types of meningitis
  5. encephalitis
  6. meningism
  7. brain tumour
  8. cerebral malaria
  9. subarachnoid haemorrhage
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17
Q

What is meningism 

A

Meningeal irritation in the presence of normal CSF

18
Q

What are the causes of meningism

A
  1. Typhoid fever
  2. atypical pneumonia
  3. Shigellosis
  4. Acute exanthema
  5. Pyelonephritis
  6. Cervical lymphadenopathy
19
Q

What is the appearance of CSF during meningitis

A

 cloudy or turbid appearance

20
Q

What are the findings of CSF bacterial meningitis

A
  1. Increase number of white blood cells mostly polymorphs
  2. glucose is decreased
  3. protein is elevated
  4. Gram stain usually positive
21
Q

Why should lumber puncture not be done in a patient where there is increased intracranial pressure

A

There is a risk of brain herniation and death

22
Q

What are the investigations for meningitis

A
  1. Lumber puncture
  2. CSF culture
  3. CSF PCR
  4. blood CBC
  5. Coagulation screen and fibrin degradation product analysis
  6. SeruM Urea, creatinine and electrolytes
  7. X-ray chest
  8. CT scan of brain
23
Q

What is the management meningitis

A
  1. Bedrest
  2. IV fluids
  3. airway patency
  4. anti-microbial therapy
24
Q

What is the specific therapy for meningococcus meningitis

A

Benzyl penicillin

25
Q

What is the specific therapy for S pneumonia meningitis

A

Ceftriaxone plus vancomycin/rifampicin

26
Q

What is the specific therapy for H influenza meningitis

A

ceftriaxone

27
Q

What is the specific therapy for listeria monocytogenes meningitis

A

Ampicillin plus gentamicin

28
Q

What is the specific therapy for gram-negative bacilli Meningitis

A

ceftriaxone / cefotaxime

29
Q

Why are steroids given during therapy for meningitis

A

To prevent severe deafness

30
Q

If rash is present what medication should be used

A

Benzyl penicillin

31
Q

If a patient is allergic to beta lactam drugs what alternative medicine should be used

A

Chloramphenicol plus Vancomycin

32
Q

Which drug can be used to reduce intracranial pressure

A

Mannitol

33
Q

Which drugs can be used for seizure activity during meningitis

A

Diazepam/phenytoin/barbiturate

34
Q

What drugs are used as prophylaxis for meningococcal infection

A

Oral rifampicin 5 mg / KG for children and 10 mg/ KG for adults once for two days

OR

ciprofloxacin 500 MG single dose in adults as an alternative

35
Q

What are the sign and symptoms of tuberculosis meningitis

A
  1. Headache
  2. vomiting
  3. low-grade fever
  4. depression, confusion, behavioural changes
  5. meningism
  6. Oculomotor palsies
  7. papilloedema
  8. Focal hemisphere signs
36
Q

What is the characteristic finding of CSF in tuberculosis meningitis

A

when CSF is allowed to stand there is formation of a fine clot bracket (cobweb appearance)

37
Q

What are the investigations used for tuberculosis meningitis

A
  1. CSF culture
  2. CSF Gross examination
  3. CSF microscopic measurements
  4. acid fast Bacilli culture
  5. CT scan
  6. chest x-ray
38
Q

What are the complications of tuberculosis meningitis

A
  1. Hydrocephalus
  2. Mental retardation
  3. cranial nerve palsies
  4. hemiplegia
  5. blindness
  6. epilepsy
39
Q

Why are steroids given in tuberculosis meningitis

A

To decrease the incidence of obstructive hydrocephalus

40
Q

How do you treat tuberculosis meningitis

A

RIPE ( Rifampicin, isoniazid, Pyrazinamide, ethambutol) TB drugs plus pyridoxine.
Pyrazinamide is only used for two months. The rest for 12 months. 

41
Q

What is the glucose level of CSF in viral meningitis

A

Glucose is normal but may be low in herpes Simplex meningitis

42
Q

What is the treatment for viral meningitis

A

No specific treatment but bedrest, analgesics, and maintenance of water electrolyte balance important

GENERAL MEDICINE (9 decks)

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