meningitis

Question 1

what does neutrophils in the SAS suggest?

Answer 1

pyogenic meningitis

Question 2

what is acute pyogenic meningitis ?

Answer 2

bacterial

Question 3

what is aseptic meningitis ?

Answer 3

viral meningitis

Question 4

what is acute encephalitis?

Answer 4

infection of the brain parenchyma

Question 5

treatment of bacterial community acquired meningitis?

Answer 5

DECE - IV dexamethasone and ceftriaxone

Question 6

if penicillin allergic, what is the treatment?

Answer 6

DECH - dexamethasone and chloramphenicol

Question 7

what do you add as listeria cover?

Answer 7

IV ampicilin or amoxicillin (a is start of list)

Question 8

who gets infected by listeria?

Answer 8

the very young and very old (start and end of list)

Question 9

when is viral meningitis more common ?

Answer 9

late summer to autumn

Question 10

which type of viruses would cause meningitis

Answer 10

enteroviruses (eg echovirus)

Question 11

diagnosis od viral meningitis?

Answer 11

stool culture, throat swab, CSF PCR

Question 12

treatment of viral meningitis?

Answer 12

supportive as self limiting

Question 13

causitive orgs bacterial by age

Answer 13

explaining hot neck stiffness 
infant - e coli 
child - HI 
young adult - Nesseria 
old - strep pneumoniae

Question 14

what prevents meningitis becoming an access?

Answer 14

pia

Question 15

what can cause infection in immunocompromised patient s?

Answer 15

listeria monocytogenes

iMono

Question 16

what causes meningococcal ?

Answer 16

n meningiditis

Question 17

what are the symptoms in meningococcal meningitis due to?

Answer 17

endotoxin

Question 18

most common cause of meningitis in children under 4 years old?

Answer 18

H Influenza

Question 19

what antibiotic is used for listeria and which has no value ?

Answer 19

amoxicilin used, ceftriaxone has no value

Question 20

previous TB on x ray, poor yield from CSF?

Answer 20

tuberculous meningitis

Question 21

how do you treat tuberculous meningitis ?

Answer 21

rifampicin and Isoniazid (then add pyrazinimide and ethambutol)

Question 22

3 clinical signs of bacterial meningitis ?

Answer 22

fever, stiff neck, alteration in consciousness

Question 23

small, pleomorphic, gram negative rods?

Answer 23

HI

Question 24

what cells are usually seen in bacterial meningitis?

Answer 24

predominantly polymorphs

Question 25

CSF glucose in bacterial?

Answer 25

less than 70% of blood glucose

Question 26

CSF glucose in viral ?

Answer 26

normal

Question 27

cells in CSF in viral meningitis?

Answer 27

lymphocytes

Question 28

protein in viral/bacterial/tuberculous?

Answer 28

normal or slightly high in viral high in bacterial high or very high in tuberculous

Question 29

why do you get high protein in bacterial ?

Answer 29

bacterial meningitis leads to a more permeable blood brain barrier, due to increased inflammation. Protein leaks into the SAS from the blood, so you get markedly increased CSF protein levels

Question 30

what do you give if over 55 to cover listeria?

Answer 30

amox

Question 31

lumbar puncture, should it always be done?

Answer 31

yes, unless clear contraindication exists

Question 32

if penicillin allergy, which antibiotic would you give in place of ceftriaxone?

Answer 32

DECH - chloramphenicol

Question 33

Rapidly developing rash suggests

Answer 33

meningococcal disease

Question 34

when would you do a CT scan of the head ?

Answer 34

immunocompromised, history of CNS disease, new onset seizure, papilloedema, focal neurological deficit

Question 35

prophylaxis for contacts?

Answer 35

``` 600mg rifampicin orally 12 hourly for four doses or ciprofloxacin or ceftriaxone (not recommended in children) ```