Meningitis and Encephalitis

Question 1

Inflammation of the brain itself

Answer 1

Encephalitis

Question 2

What bacteriological etiologies can cause Encephalitis / Meningitis

Answer 2

Streptococcus Pneumonia, Group B Streptococcus, N Meningitids, H influenza, Listeria monocytogenes

Question 3

What type of meningitis inoculation involves bacteria colonizing in the nasopharynx and entering the bloodstream. Upon making their way to the subarachnoid space, the bacteria cross the blood brain barrier, causing direct inflammatory and immune mediated reaction

Answer 3

Hematogenous seeding

Question 4

What route of meningitis inoculation involves organisms entering CSF via neighboring anatomic structures (Otitis media, sinusitis) or foriegn objects (Medical devices, penetrating trauma)

Answer 4

Direct contiguous spread

Question 5

Risk factors that increase the clinical suspicion of meningitis

Answer 5

• Close contact exposure
• Incomplete vaccinations
• Immunosuppression
• > 65 v/o & < 5 y/o
• Alcohol use disorder

Question 6

what is the complication in differentiating between fungal, bacterial, and viral meningitis

Answer 6

It is difficult

CSF Analysis may not be conclusive and cultures do not immediately yield an answer

Question 7

What special tests are used to assess signs of meningitis

Answer 7

Brudzinski

Kernig

Question 8

What are the characteristic skin findings of a patient with Meningococcal meningitis

Answer 8

Petechiae and purpura

Question 9

What is the classic meningeal tetrad

Answer 9

Fever, nuchal rigidity, altered mental status, and severe headache

Question 10

what lab is always recommended to distinguish between bacterial and aseptic meningitis

Answer 10

Lumbar puncture

Clinical signs/symptoms are unreliable

Question 11

Antibiotic treatment for meningitis

Answer 11

Ceftriaxone 2 g IV q 7 hours x 7 days

Pen-G 4 million units IV q4h x 7 days

Question 12

What is given to patients with meningitis to reduce rate of hearing loss, neurologic complications, and decreased mortality rate

Answer 12

Dexamethasone 4 gm IV

Question 13

What are signs of intracranial pressure

Answer 13

Altered mental status change, neurological deficits, non-reactive pupils, and bradycardia

Question 14

What is done when there are signs of intracranial pressure

Answer 14

Elevating the head of the bed 30 degrees, inducing mild hyperventilation in the intubated patient, osmotic diuretics

Question 15

What can be done to aid in the prevention of maningitis

Answer 15

Chemoprophylaxis for close contact of patients diagnosed with N meningitides and H. influenzae

Question 16

Chemoprophylaxis regimen for meningitis

Answer 16

Ceftiaxone 250 mg IM

Ciprofloxacin 500 mg PO

Question 17

What is the disposition of a patient with meningitis depending on the etiology

Answer 17

MEDEVAC REGARDLESS OF THE ETIOLOGY

Question 18

What pathogens are responsible for the mortality rates of meningitis

Answer 18

• Streptococcus pneumonia (17.9%)
• Neisseria Meningitidis (10.1%)
• Group B Streptococcus (11.1%)
• H. Influenzae (7%)
• Listeria Monocytogenes (18.1%)

Question 19

CSF Findings for Bacterial Meningitis

Answer 19

Turbid
WBC >1000-2000
Protein > 200
Glucose <40

Question 20

CSF Findings with Viral meningitis

Answer 20

Clear
WBC < 300 Lymphocytic
Protein < 200
Glucose Normal

Question 21

CSF Findings with Fungal meningitis

Answer 21

Clear
WBC <500
Protein > 200
Glucose Normal-Low

Question 22

What imaging is done prior to performing a lumbar punch on a patient with meningitis

Answer 22

CT

Question 23

What tests are performed to assess meningeal irritation

Answer 23

Brudzinski

Kernig