Meningitis

Question 1

symptoms?

signs?

• kernig’s sign?
• ## brudzinski’s sign?

Answer 1

Fever,
Rash (non-blanching), Headache,
Neck stiffness,
photophobia

Kernig’s sign (pain + resistance on passive knee extension with hip fully flexed)

Question 2

o Meningism: ?

Answer 2

neck stiffness, photophobia

Question 3

Patients in pre-hospital setting (GP) with suspected meningitis should get what while waiting for transfeR?

Answer 3

IV benzylpenicillin

Question 4

Want to work out if it is bacterial (serious, septic) or viral (aseptic).

if its bacterial how would they present?

if it is viral how would they present?

Answer 4

bacterial: septicaemic (shock, tachycardic, fever, cold ahnds + feet, CRT >2
viral: meningism without shock

Question 5

what do you always do before an LP and why?

Answer 5

CT - rule out evidence of raised ICP and focal neuro deficits.

Question 6

if viral meningitis is confirmed - what do you give?

also what do you stop?

Answer 6

acyclovir

Abx and dexamethasone therapy as viral meningitis is self limiting

Question 7

what is the run through of management of meningitis?

Answer 7

ABC
Blood cultures (work out if viral or bacterial) 
IV Abx 
Dexamethasone 
CT before LP 

if viral - stop Abx and dexamethasone

if bacterial - continue Abx

Question 8

what Abx do you give to the following groups of patients?

• empirical therapy aged 3months to 50 yrs
• empirical therapy <3months and >50 yrs
• meningococcal ?
• pneumococcal?
• caused by H.influenza?
• caused by listeria?

Answer 8

• IV cefotaxime
• IV cefotaxime and amoxicillin
• IV cefotaxime or benzylpenicillin
• IV cefotaxime
• IV cefotaxime
• IV amoxicillin + gentamycin

essentially all get treeated with cefotaxime unless caused by listeria

or add amoxicillin to cefotaxime if young or old

Question 9

how do you distinguish bacterial from viral on LP?

• colour
• CSF protein?
• glucose?
• stain?

Answer 9

colour: cloudy in bacterial, clear in viral

CSF protein is raised in bacterial (viral normal)

Glucose is low in bacterial (viral normal)

stain is positive in bacterial

Question 10

where do you normally insert a LP needle?

Answer 10

Inserting a needle L3-L4 or L4-L5 to drain CSF

Question 11

LP is diagnostic test for which two conditions?

Answer 11

meningitis

CT -ve subarachnoid haemorrhage