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Revision Cards > Week 221 - Meningitis > Flashcards

Week 221 - Meningitis Flashcards

1
Q

Week 221 - Meningitis: What are the risk factors for developing meningitis?

A
  • Age 60
  • DM
  • Renal or adrenal insufficiency
  • Immunosupression
  • Sickle cell disease
  • Alcoholism and cirrhosis
  • Recent exposure to meningitis
  • Contiguous infection
  • Dural defect
  • IV drug abuse
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2
Q

Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in neonates (<1month)?

A
  • E.Coli
  • Pneumococcal meningitis
  • Listeria monocytogenes
  • Nisseria meningitides
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3
Q

Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in children older than 2 months?

A
  • Pneumococcocal
  • N. Menigitides
  • H. Influenza
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4
Q

Week 221 - Meningitis: What are the two main mechanisms by which bacteria enter the subarachnoid space?

A
  • Haematogenous spread from respiratory tract.

* Direct spread from a contiguous infection (sinusitis, mastoiditis) or from an injury.

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5
Q

Week 221 - Meningitis: What are the symptoms of meningism?

A
  • Photophobia
  • Headache
  • Stiff neck
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6
Q

Week 221 - Meningitis: You may not see meningism in babies, what are the symptoms that you may see that would suggest meningitis?

A
  • Hyper/hypothermia
  • change in sleeping or eating habits.
  • irritability or lethargy.
  • high pitched cry
  • bulging fontenelle
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7
Q

Week 221 - Meningitis: What is Kernig’s sign?

A

Patient is in supine position, hip and knee is flexed to 90º, patient feels pain when leg is extended.

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8
Q

Week 221 - Meningitis: What is Brudzinski sign?

A

When supine, passively flex neck, this causes the lower extremities (hips and knees) to flex.

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9
Q

Week 221 - Meningitis: The non-blanching petechial rash is a sign of what?

A

Sepsis.

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10
Q

Week 221 - Meningitis: What are the signs of encephalitis?

A

Fever, headache and decreased neurological function.

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11
Q

Week 221 - Meningitis: Which investigations should be performed for suspected meningitis?

A
  • FBC, Coagulation studies, serum glucose.
  • ABG
  • Throat swab
  • H1N1
  • PCR
  • Lumbar puncture (if not contraindicated)
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12
Q

Week 221 - Meningitis: A CT is indicated before a lumbar puncture in which patients?

A

> 60 y.o., immunocompromised, known CNS lesions, seizure within 1 week of presentation, suspicion of elevated ICP (Papilloedema, high BP but low HR).

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13
Q

Week 221 - Meningitis: What are the absolute contraindications for a lumbar puncture?

A
  • Infected skin at site.
  • Raised ICP
  • Shock
  • Focal neurological signs
  • Unequal pressures between supratentorial and infratentorial compartments (from CT)
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14
Q

Week 221 - Meningitis: What would you expect the lumbar puncture result to be in viral meningitis?

A
  • Opening pressure - Normal or High
  • Colour - Clear
  • Cells/mm - 5-1000
  • Predominant cell - Lymphocytes
  • CSF:plasma glucose - Normal
  • Protein - Normal
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15
Q

Week 221 - Meningitis: What would you expect the lumbar puncture result to be in bacterial meningitis?

A
  • Opening pressure - High
  • Colour - Cloudy
  • Cells/mm - 100-50000
  • Predominant cell - Neutrophil
  • CSF:plasma glucose - Low
  • Protein - Elevated
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16
Q

Week 221 - Meningitis: What would you expect the lumbar puncture result to be in tuberculous meningitis?

A
  • Opening pressure - High
  • Colour - Cloudy/yellow
  • Cells/mm - 25-500
  • Predominant cell - Lymphocyte
  • CSF:plasma glucose - Low/very low
  • Protein - elevated
17
Q

Week 221 - Meningitis: What would you expect the lumbar puncture result to be in fungal meningitis?

A
  • Opening pressure - High/Very high
  • Colour - Clear/cloudy
  • Cells/mm - 0-1000
  • Predominant cell - Lymphocyte
  • CSF:Plasma glucose - Normal/low
  • Protein - Normal
18
Q

Week 221 - Meningitis: Which antibiotic should be used in neonates for listeria and Group b strep?

A
  • Listeria - Ampicillin and Aminoglycoside/Cefotaxime

* Group B strep - Benzylpenicillin and cefotaxime

19
Q

Week 221 - Meningitis: Which class of antibiotics is used to treat meningitis (not neonates)?

A

Cephalosporin

20
Q

Week 221 - Meningitis: Which antibiotic is used for the prophylaxis of meningitis?

A

Ciprofloxacin

21
Q

Week 221 - Meningitis: Which organisms that cause meningitis are routinely vaccinated against?

A
  • H influenze
  • Menningococcal C
  • Strep Pneumoniae
  • MMR
22
Q

Week 221 - Meningitis: What are the complications of meningitis?

A
  • Focal neurological sequelae
  • Hemiparesis, Facial palsy
  • Visual field defects, hearing loss, blindness,
  • Syndrome of inappropriate ADH secretion.
  • Cranial nerve palsies
23
Q

Week 221 - Meningitis: What are the measures in place to prevent transmission across the blood brain barrier?

A
  • Capillaries have tight junctions that do not exist in normal circulation.
  • There is also a thick basement membrane.
  • There is active transport for certain metabolites whilst small molecules like 02,CO2 and hormones are able to diffuse across.
24
Q

Week 221 - Meningitis: What are the names of the cells that line the choroid plexus and ventricles?

A

Ependymal cells.

25
Q

Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in neonates?

A
  • E. Coli
  • Streptococci
  • Listeria
26
Q

Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in children?

A
  • H. influenza
  • Pneumococcal
  • Meningococcal
27
Q

Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in young adults?

A
  • Pneumococcal

* Meningococcal

28
Q

Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in older adults?

A
  • Pneumococcal
  • Listeria
  • Gram -ve organisms
29
Q

Week 221 - Meningitis: Lyme disease is caused by which organism? What are the symptoms?

A

Borelia Burgdorferi

• Rash, arthritis, aseptic meningitis, focal nerve palsy, mild encephalopathy.

30
Q

Week 221 - Meningitis: What are the features of viral meningitis?

A
  • Acute onset of meningism, fever, irritability.
  • Usually self-limiting with complete recovery.
  • Often have systemic features.
31
Q

Week 221 - Meningitis: Which organisms cause viral meningitis?

A

Echo, coxsackie, mumps, HIV.

32
Q

Week 221 - Meningitis: Which organisms cause viral encephalitis?

A
  • Herpes simplex 1
  • Herpes simplex 2
  • CMV
  • Herpes zoster
  • Arboviruses
  • HIV
  • Rubella/Toxoplasmosis
33
Q

Week 221 - Meningitis: What are the features of viral encephalitis caused by Herpes simplex type 1?

A
  • Mostly children and young adults.
  • Affects temporal and inferior frontal lobes.
  • Oedema, necrosis, haemorrhage, specific viral inclusion bodies.
  • 40-70% mortality if left untreated.
34
Q

Week 221 - Meningitis: How much fluid should be given to a child experiencing shock due to meningitis?

A

• 20ml/kg (25% of circulating volume)

35
Q

Week 221 - Meningitis: What family of viruses most commonly causes viral meningitis?

A

Enteroviruses (echo, coxsachie, polio)

36
Q

Week 221 - Meningitis: Which bacteria is the most common cause of bacterial meningitis in the UK?

A

Neisseria meningitides - (Meningococcal)

37
Q

Week 221 - Meningitis: What are the two sites where the blood brain barrier is most commonly crossed? What conditions commonly occur when pathogens cross at these sites?

A
  • Brain microvascular endothelial cells - Causes encephalitis or brain abscess.
  • Choroid plexus - Causes meningitis.
38
Q

Week 221 - Meningitis: Why is the choroid plexus a weak spot for the crossing of the blood-brain barrier?

A

Endothelium is fenestrated, tight junctions are weaker and epithelium has fast rate of endocytosis.

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