PBL 2

Question 1

what is meningitis?

Answer 1

the inflammation of the leptomeninges which is caused by microbes

Question 2

what are the leptomeninges?

Answer 2

arachnoid and pia mater

Question 3

describe the main differences between bacterial and viral meningitis?

Answer 3

bacterial meningitis is much more serious but viral meningitis is much more common

Question 4

how can menigitis be spread?

Answer 4

sneezing, coughing, kissing

Question 5

describe the pathophysiology of meningitis?

Answer 5

a pathogen enters the meninges directly or through the blood through the blood brain barrier at vulnerable regions. the pathogen multiplies in the CSF causing inflammation which makes the blood brain barrier more permeable, leading to an influx of WBC and plasma constituents which increases the volume of CSF= oedema = cerebral vasculitis = inter cranial pressure increases = damaged brain tissue

Question 6

what is haemotogenous spread?

Answer 6

when a pathogen enters the blood stream and moves into the CSF using vulnerable spots on the blood-brain barrier

Question 7

how could infectious agents enter the meninges directly?

Answer 7

anatomical defects, up the nose or through overlying skin

Question 8

what is cerebral vasculitis?

Answer 8

when blood vessel walls in the brain and spine are inflamed

Question 9

what are the symptoms of meningitis?

Answer 9

fever, cold hands and feet, nausea, vomiting, headache, non-blanching rash, nuchal rigidity, photophobia, photophobia, confusion, breathing rate increased, muscle and joint pain, drowsiness, unresponsiveness, altered mental state, seizures

Question 10

what would the lumbar puncture sample of someone with meningitis look like?

Answer 10

clear/cloudy or purulent
it would have the presence of bacteria, increased proteins, increased polymorphonuclear cells, decreased glucose concentration
raised CSF opening pressure

Question 11

what are the 2 signs of meningitis you can find in examination?

Answer 11

kernels sign

brudzinskis sign

Question 12

what is kernigs sign?

Answer 12

when a patient lies flat on their back and their leg is raised with the knee flexed 90 degrees and the leg is supported and slowly straightened at the knee. if this causes back pain and can’t be extended beyond 135 degrees then this sign is positive

Question 13

what is brudzinskis sign?

Answer 13

when a person lies flat on their back and has their neck supported and flexed. if they automatically flex their knees or hips then this sign is positive

Question 14

what are some causes of meningitis?

Answer 14

infections bu bacteria, virus, fungi, parasites
TB
autoimmune diseases
adverse reactions to intrathecal medication

Question 15

who is most at risk for meningitis?

Answer 15

babies and young children
teenagers and young adults
elderly people
immunosupressed
those living in a community setting
pregnant
those skipping recommended vaccinations

Question 16

which vaccinations should you have to aim to prevent meningitis?

Answer 16

meningitis B vaccine, 6-in-1 vaccine, pneumococcal vaccine, MMR vaccine, Hib/MenC vaccine, meningitis ACWY vaccine

Question 17

how is bacterial meningitis treated?

Answer 17

in hospital with IV antibiotics, IV fluids, oxygen, steroid medication (to prevent swelling around brain)

Question 18

how is viral meningitis treated?

Answer 18

it tends to get better on its own within 7-10 days and can be treated at home with rest, painkillers and antiemetics

Question 19

how can you prevent the spread of meningitis?

Answer 19

prophylactic antibiotics to avoid outbreaks

Question 20

what are some complications of bacterial meningitis?

Answer 20

sepsis, hearing loss, Visio loss, memory and concentration issues, epilepsy, coordination, movement and balance problems, loss of limbs, bone and joint problems, learning difficulties, behavioural problems, kidney problems

Question 21

how many cases of meningitis are fatal?

Answer 21

1/10

Question 22

is there a predictable pattern to inheritance of the penicillin allergy?

Answer 22

no - about 10% of patients have this allergy but most actually lose this allergy over time

Question 23

describe the difference in structure between gram positive and gram negative bacteria?

Answer 23

gram positive has a thicker peptidoglycan layer but no outer lipopolysaccharide and protein membrane like gram negative bacteria

Question 24

why are gram negative bacteria more resistant to antibodies than gram positive?

Answer 24

because of their impermeable lipopolysaccharide cell wall

Question 25

what colour do the following go when stained with crystal violet dye?

a) gram positive bacteria
b) gram negative bacteria

Answer 25

a) retains purple colour

b) pink

Question 26

what type of antibiotics are cephalosporins?

Answer 26

beta lactam antibiotics

Question 27

what’s the difference between first, second and third generation cephalosporins?

Answer 27

first generation - coverage against gram positive and most gram negative bacteria
second generation- coverage against gram negative bacteria and slightly effective against gram positive bacteria
third generation- best coverage against gram negative bacteria

Question 28

how do cephalosporins work?

Answer 28

they disrupt the synthesis of the peptidoglycan layer forming the bacterial cell wall

Question 29

what are some side effects of cephalosporins?

Answer 29

stomach upset, nausea, vomiting, diarrhea, yeast infections, dizziness

Question 30

why might cephalosporins be taken with clavulanic acid?

Answer 30

as bacteria can produce beta lactase which can cause resistance. clavulanic acid had a high affinity for beta-lactamase enzyme so it can block its activity, allowing cephalosporins to work