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Infection > Meningitis > Flashcards

Meningitis Flashcards

1
Q

What is meningitis

A

Infection and inflammation of the meninges

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2
Q

What is meningism

A

Headache
Photophobia
Vomiting
Neck stiffness due to spasm on flexion

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3
Q

What can cause meningism

A

Meningitis
SAH
Migraine
Sinusitis / pneumonia / UTI

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4
Q

What are RF for meningitis

A

Skull trauma
Alcohol
DM
FH

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5
Q

How do you diagnose meningitis

A

Blood culture before Ax
LP for definite diagnosis
Bloods - U+E, LFT, FBC

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6
Q

What suggest poor prognosis

A

Severe sepsis + DIC

May have decreased WCC

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7
Q

What is DIC

A

Low platelet
Abnormal clotting
Increased fibrin

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8
Q

What do you do with LP

A 
Gram stain = bacterial 
PCR = viral 
Differential cell count 
Antigen detection 
AAFB on ZN for TB
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9
Q

What does LP look in bacterial

A 
High opening pressure 
Increased cells 
Neutrophils predominant 
Glucose reduced
Protein increased
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10
Q

What does LP look in viral

A 
High opening pressure 
Increased cells
Lymphocytes predominant 
Glucose normall 
Protein increased
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11
Q

What does LP look in TB

A

Increased cells
Mixed cell type
Glucose reduced
Protein increased

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12
Q

What causes meningococcal meningitis

A

Neisseria meningitides

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13
Q

What are the symptoms of meningococcus

A

Meningism
Systemic upset
Skin rash - petechial
Clouding of consciousness

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14
Q

What are the symptoms of meningococcal septicaemia

A 
Rapid deterioration in consciousness 
Purpuric rash 
Fever 
Septic shock 
Renal failure 
Acidosis 
DIC 
50% die in 24 hours
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15
Q

What is CSF like in meningococcal septicaemia

A

Sterile with no increase in WCC

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16
Q

What is Waterhouse-Fredrickson Syndrome

A

Bilateral adrenal haemorrhage
Hypotensive
Low N and high K

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17
Q

What is the Rx for meningococcus

A

Early Ax
All close contacts rifampicin or ciprofloxacin prophylaxis
Vaccination for A+C

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18
Q

What are the symptoms of Chronic Meningococcemia

A 
Rash 
Joint pain
Malaise 
Fever 
Due to serum complement deficiency
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19
Q

What causes pneumococcal meningitis

A

Pneumococci

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20
Q

What are the symptoms of pneumococcus

A

Meningism
More likely to have altered consciousness
Focal neuro signs
Petechiae is uncommon

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21
Q

What are the RF for pneumococcus

A 
Age 
Pneumonia
Sinusitis
Head trauma 
Endocarditis
Alcoholism 
Splenectomy
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22
Q

What is the Rx for pneumococcus

A

Benzypen
Ceftriaxone if resistant
Steroid to prevent complications
Pneumococcal vaccine

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23
Q

Who gets pneumococcal vaccine

A 
>65
DM
Splenectomy
Chronic disease
HIV
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24
Q

What are the complications of pneumococcus

A 
Death
Loss of hearing 
Cranial nerve palsies 
Hemiparesis 
Hydrocephalus 
Seizures
25
What does H influenza B present like ? (gram -ve bacilli)
``` Mild respiratory tract illness Rapid deterioration Meningism uncommon Fever Lethargy ```
26
What is the Rx for H influenza B meningitis
Ceftriaxone Dexamethasone Rifampicin for prophylaxis Hib vaccine
27
What does listeria monocytogenes present like ?
Febrile flu in pregnant Abortion Neonatal sepsis Meningits
28
How is listeria monocytogenes Dx
blood culture
29
How do you treat listeria?
IV ampicillin to cover
30
How does Leptospirosis and Lyme present ?
``` Septicaemia Meningism can occur fever rigors myalgia vomiting conjunctival effusion rash hepato-renal damage ```
31
How does TB meningitis present?
``` Meningism Low grade fever Lethargy HEadache Change in mentation Extra-meningeal TB ```
32
Why does TB meningitis occur?
Rupture of sub-ependymal tubercle into subarachnoid space | Can be post primary in children
33
How do you diagnose TB meningitis
``` AAFB on ZN stain of CSF Culture more sensitive Repeat LP as often -ve CXR / CT PCR of mycobacterial DNA ``` ALWAYS CONSIDER IF GLUCOSE REDUCED and no organism cultured
34
What are the viral causes of menigitis
``` Entero - coxsackie / echovirus HSV 2 VZV EBV HIV Mumps Polio ```
35
What are the symptom of viral meningitis
``` Non-specific illness Rapid headache Meningism Usually alert Encephalitis - lethargy, confusion, seizures, focal neuro Rash sometimes present ```
36
Dx of viral
PCR of CSF Throat swab HIV Dx
37
Rx of viral
Usually resolves in 72 hours Acyclovir in HSV MMR vaccine
38
What are the complications of mumps
Deaf Orchitis Testicular atrophy
39
What are the fungal causes of menigitis
Cryptococcus neoformans
40
What are the RF for fungal meningitis
HIV DM Lymphoma
41
What are the symptoms of fungal
``` Fever headache nausea lethargy confusion abdominal pain meningism less common ```
42
How do you diagnose fungal meningitis
India ink of CSF | Gram stain for candida
43
How do you treat fungal
Parenteral amphotericin Flucytosin / fluconazole Long term prophylaxis with fluconazole in HIV
44
What are common causes of neonatal meningitis
``` Group B strep E.coli Listeria monocytogenes H influenza B Enterovirus Parechovirus ```
45
What are the RF for neonatal meningitis
``` Low birth weight Prolonged rupture of membrane Pre mature Prolonged birth Maternal DM Intrapartum fever ```
46
How do you diagnose neonatal sepsis
CSF + blood culture Culture of mothers blood and genital tract EDTA of blood in viral
47
Treatment of neonatal sepsis
Parenteral amphicillin (cover group B and listeria) Gentamicin (cover -ve bacilli) IVIG for entero / parechovirus
48
How do you prevent neonatal sepsis
Amoxicillin / co-amoxiclav to high risk mother isolate IVIG to contacts
49
What are the complications of neonatal sepsis
Neurological and developmental sequeleae
50
What are the contraindications to LP
``` Unstable SKin infection Unstable bleeding disorder Increased ICP Chiari malformations ```
51
What are the complications of LP
``` Spinal headache Nerve root trauma CYsts Infection Disc herniation ```
52
What is a spinal headache
Bilateral Improves when supine Common in female with low BMI
53
How do you treat spinal headache
Hydrate Caffeine Epidural blood patch
54
What are the symptoms of nerve root trauma
Feel electric shock / back pain Altered mental status Cranial nerve abnormalities CUshings - Brady, increased BP, irregular breathing
55
How do you treat nerve root trauma
``` Remove needle Raised head to increased venous return Mannitol Intubate Corticosteroids Nerve conduction studies ```
56
Causative organism of meningitis aged 3 months - 60 y/o
Strep pneumoniae
57
Causative organism of meningitis < 3 months and > 60 y/o
Listeria monocytogenes
58
Initial empirical Tx of meningitis aged 3 months - 50 y/o
IV ceftoxamine
59
Initial empirical treatment of meningitis <3 months
IV ceftoxamine and amoxicillin

Infection (16 decks)

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