Meningitis + Multiple Sclerosis

Question 1

Features of meningitis

Answer 1

Headache
Neck stiffness
Photophobia
N/V
Non blanching purpuric rash

Kernig’s sign
Brudzinski’s sign

Question 2

Kernig’s sign

Answer 2

Flex hip with knees at 90 degrees
Straightening legs causes neck pain

Question 3

Brudzinski’s sign

Answer 3

Bending neck - pt flexes hips and knees

Question 4

Abx for meningitis

Answer 4

Community - Benzylpenicillin
< 50 - ceftriaxone
> 50 - ceftriaxone + ampicillin

Question 5

Mx of meningitis if viral causes supected

Answer 5

Aciclovir

Question 6

LP or not LP? that is the question

Answer 6

If septic - No LP

If meningitic - LP if no CIs

Question 7

Prophylaxis for household contacts to pts with meningitis

Answer 7

Rifampicin

Question 8

Continuing mx of meningitis

Answer 8

Ceftriaxone 2g BD IV:

• Meningococcus 7 days
• Pneumococcus 14 days

Question 9

Bacterial causative organisms of meningitis

Answer 9

Meningococcus
Pneumococcus
Listeria
Haemophilus
TB

Question 10

Viral causative agents of meningitis

Answer 10

Enteroviruses
HSV2

Question 11

Contraindications to an LP

Answer 11

Thrombocytopenia
Delayed abx
Raised ICP
Unstable pt
Coagulation disorder
Infection at LP site
Focal neurology

Question 12

CSF findings in bacterial meningitis
Appearence
Cells
Count
Glucose
Protein

Answer 12

Turbid
White cells
100-1000
Decreased
> 1.5

Question 13

CSF findings in viral meningitis
Appearence
Cells
Count
Glucose
Protein

Answer 13

Clear
Lymphocytic/mononuclear
50-1000
Normal
< 1

Question 14

CSF findings in TB meningitis
Appearence
Cells
Count
Glucose
Protein

Answer 14

Fibrin web
Lymphocytic/mononuclear
10-1000
Decreased
1-5

Question 15

MS definition

Answer 15

Multiple demyelination plaques disseminated in time and space

Chronic inflammation of CNS

Question 16

Epidemiology of MS

Answer 16

F>M

30 yrs

Question 17

Causes of MS

Answer 17

HLA-DRB1 gene
Environmental
Viral

Question 18

Pathophysiology of MS

Answer 18

CD4 mediated destruction of oligodendrocytes –> demyelination

Question 19

Classification of MS

Answer 19

Relapsing remitting 80%
Secondary progressive
Primary progressive
Progressive relapsing

Question 20

Presentation of MS

Answer 20

Tingling
Optic neuritis
Ataxia
Spastic paraparesis (weak legs)

Question 21

Presentation of optic neuritis

Answer 21

Decreased central vision

Question 22

Funky signs of MS

Answer 22

Lhermitte’s
Uhthoff’s
Internuclear ophthalmoplegia

Question 23

Lhermitte’s phenomenon

Answer 23

Neck flection causes electric shocks in limbs

Question 24

Uhthoff’s phenomenon

Answer 24

Sx worse with heat (e.g. shower)

Question 25

Internuclear ophthalmoplegia

Answer 25

Weak adduction –> nystagmus in other eye

Question 26

Investigations for MS

Answer 26

MRI- gadolinium enhanced (activity)

LP

Anti-MBP antibody

NMO-IgG antibody

Evoked potentials

Question 27

LP findings in MS

Answer 27

IgG oligoclonal bands

Question 28

NMO-IgG antibody

Answer 28

Neuromyelitis optica -IgG antibody

Question 29

Evoked potentials findings in MS

Answer 29

Delayed auditory / visual potentials

Question 30

Diagnosis of MS

Answer 30

Use McDonald Criteria

Question 31

Differentials of MS

Answer 31

CNS sarcoidosis
SLE
Neuromyelitis optica

Question 32

Acute Rx of MS

Answer 32

methylprednisolone

Question 33

Preventing relapse of MS

Answer 33

DMARDS
Biologics

Symptomatic control

Question 34

DMARDs used for MS

Answer 34

IFN-B

Glatiramer

Question 35

Biologics used for MS

Answer 35

Natalizumab

Alemtuzumab

Question 36

Poor prognostic factors for MS

Answer 36

Older
Male
Motor signs at onset
Many relapses early on
Many MRI lesions
Axonal loss