Meningitis/Encephalitis

Question 1

What is the most common viral etiology of meningitis

Answer 1

enterovirus

Question 2

risk factors that should increase clinical suspicion of meningitis

Answer 2

close contact exposures
incomplete vaccinations
immunosuppresion
>65 y/o and <5 y/o
alcohol use disoorder

Question 3

What are the two routes of inoculation typical of meningitis

Answer 3

hematogenous seeding
direct contigous spread

Question 4

what is the classic meningeal tetrad of meningitis

Answer 4

fever, nuchal rigidity, altered mental status and severe headache (you do not need all four for diagnosis)

Question 5

preferred imaging modality for meningitis

Answer 5

CT. ideally done prior to lumbar puncture and CSF collection.

Question 6

treatment of meningitis

Answer 6

airway, o2, IV fluids, fever control.

Ceftriaxone 2g IV q12 hrs.
Pen-G 4 million units

STEROIDS: dexamethasone 4mg IV associated with reduced neurological deficits.

Question 7

what are your actions if your meningitis patient exhibits sign of ICP?

Answer 7

elevate bed to 30 degrees, induce mild hyperventilation in the intubated patient, osmotic diuretics. (CALL MO)

Question 8

Chemoprophylaxis for personnel exposed to meningitis

Answer 8

Ceftriaxone 250 mg IM once
Ciprofloxacin 500mg PO one time

Question 9

Disposition of meningitis

Answer 9

MEDEVAC