Meningoencephalitis

Question 1

What vaccine should you inquire about in a child with fever and headache

Answer 1

Pneumococcal
Meningococcal
Hemophillus
Influnza

Question 2

What are the signs in the of active meningitis

Answer 2

• 6th nerve palsy
• cushing triad
• brudznski and kernig
• neck stiffness

Question 3

Petchieal rash occur in which type of meningitis

Answer 3

Nisseria meningitidis

Meningococcemia

Question 4

Why is the meningitis present with lethargy and intact level of consciousness

Answer 4

Because it doesn’t affect the parenchyma.

Question 5

What are the symptoms seen in encephalitis not in meningitis?

Answer 5

• hallucinations
• photophobia
• change in personality & agression

Question 6

What is the most common bacterial meningitis in children >3m - 14 yeaes

Answer 6

Strep pneumonia.

> Nisseria > hemophillus

Question 7

How does strep pneumonia usually present under the microscope?

Answer 7

Gram positive diplococci

Question 8

How does nisseria usually present under the microscope?

Answer 8

Gram negative diplococci

Question 9

Why do we have to do brain CT before LP?

Answer 9

To avoid herniation if there’s incresae IOP

• hydrocephalus
• midline shift
• space occupying leison

Question 10

Where to insert needle in lumbar puncture?

Answer 10

L3-L4 or L4-L5

Question 11

What is the normal WBC in the CSF analysis

Answer 11

5-7. 20 in newborn.

Question 12

What is the normal protein in CSF

Answer 12

In the 60s

Question 13

What is the normal glucose in CSF in LP?

Answer 13

50% of serum

Question 14

When to start antibiotics for the patient with meningitis?

Answer 14

Immediately because it’s life saving

Question 15

What antibiotics should you give and for how long for meningitis in child aged >3m

Answer 15

strep pneumonia 14 days - nisseria 7 to 10 - h. Influnza 7 days

By 3rd generation cephalosporin + vancomycin.

Question 16

What is the role of adjunctive dexamethasone therapy in meningitis

Answer 16

Showed benefits in early treatment

Reduce hearing loss

Question 17

What are the late complications of meningitis

Answer 17

• decrease hearing loss (most common)
• paralysis or seizure
• intellectual difict
• ataxia
• hydrocephlaus
• ..

Question 18

Are health care workers at high risk for meningitis?

Answer 18

Not, unless there’s direct mucosal contact

Question 19

What is chemoprophylaxis if one is exposed to meningitis?

Answer 19

Rifampin or cefatrixone

Only in nisseria and hemophillus

Question 20

What is the golden hour between the antibiotic and CT

Answer 20

2 hours

Question 21

What is the most dangerous encephalitis organism?

Answer 21

Herpes simplex

Question 22

What is the most common organism to cause encephalitis

Answer 22

Enterovirus (non-polio)

Question 23

Physical signs of encephalaitis

Answer 23

• neurological: hemiparesis, involuntry movement, sizures etc..
• rash and fever.

Question 24

What are the acute phase reactants that are positive in encephalitis?

Answer 24

Procalcitonin negative - CRP is positive

Question 25

Herpes simplex cause enhancement of which lobe of the brain?

Answer 25

Temporal region

Question 26

When to expect herpes encephalitis by the CSF?

Answer 26

When there’s RBC

Question 27

How to confirm diagnosis of herpes simplx encephalitis?

Answer 27

• Paroxysmal lateral epiliptofrm discharge from the temporal region
• enhancement on MRI
• Blood in CSF
• viral PCR is positive.

Question 28

How to treat herpes simplex encephalitis

Answer 28

Acyclovir for 21 days