Neuro

Question 1

Difference between Meningococcal Meningitis and meningococcal Septicemia

Answer 1

Meningococcal meningitis - Bacteria is infecting the meninges and the cerebrospinal fluid around the brain and spinal cord Meningococcal septicemia- Meningococcus bacterial infection in the bloodstream and is the cause of the classic “non-blanching rash”, indicating infection has DIC and subcutaneous haemorrhages.

Question 2

Commonest cause of meningitis in: 1. Neonatal- 3 months 2. 1 month- 6 yrs 3. >6 yrs 4. >60yrs 5. Immunosupressed

Answer 2

1. Neonatal- 3 months - GBS
2. 1 month- 6 yrs- Neisseria Meningitiditis, Haem Infl
3. >6 yrs- Nesseria meningitidis
4. >60yrs- Strep Pneumoniae
5. Immunosuppressed- Listeria Monocytogenes

Question 3

Common cause of viral meningitis?

Answer 3

Herpes simplex virus (HSV) Enterovirus Varicella zoster virus (VZV)

Question 4

Indications for a lumbar puncture in children?

Answer 4

Under 1 month presenting with fever

1 to 3 months with fever and are unwell

Under 1 year with unexplained fever and other features of serious illness

Question 5

Contraindications of lumbar puncture (Signs of raised ICP)?

Answer 5

• Focal neurological signs
• Papilledema
• Significant bulging of the fontanelle
• Disseminated intravascular coagulation
• Signs of cerebral herniation
• Patients with meningococcal septicaemia - Instead do blood cultures and PCR .

Question 6

Describe Bacterial CSF?

Answer 6

• Cloudy
• >1.5g/l protein (HIGH)
• <0.5 glucose (V LOW)
• >1000 WCC + neutorphils

Question 7

Describe Viral CSF?

Answer 7

• Clear
• normal protein
• 0.6-0.8 glucose
• >1000 WCC + lymphocytes

Question 8

How do you treat meningococcal meningitis in the community in:

· < 1 year

· 1-9 years

· > 10 years and adults

Answer 8

IM benzylpenicillin

• < 1 year – 300mg
• 1-9 years – 600mg
• > 10 years and adults – 1200mg

Question 9

Antibiotic Treatment of a 3 month old vs a >3 month old for meningitis?

Answer 9

• < 3 months: IV cefotaxime + IV amoxicillin (or ampicillin)
• > 3 months: Just IV cefotaxime (or ceftriaxone)

Question 10

Treatment of meningitis in >50 yrs?

Answer 10

IV amoxicillin (or ampicillin) + IV cefotaxime (or ceftriaxone)

Question 11

Treatign listeria meningitis?

Answer 11

IV amoxicillin (or ampicillin) + gentamicin

Question 12

Who shoudl recieve dexamethasone for meningitis?

Answer 12

bacterial cause found on CSF

Question 13

Who should we avoid giving steroids for meningitis?

Answer 13

advise to withhold if:

• <3 months old
• Septic shock
• Meningococcal septicaemia
• Immunocompromised
• Meningitis following surgery

Question 14

What do you treat contacts of meningitis with?

Answer 14

Public health notification and antibiotic prophylaxis of contacts who have been on contact within 7 days

• Ciprofloxacin is now preferred over rifampicin

Question 15

Specific antibodies present in Myesthenia Gravis?

Answer 15

85-90% have AChR ab (Acetylcholine receptor antibodies)

40% have Anti MuSK ab (IgG antibodies against the muscle‐specific kinase)