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Flashcards in ID - Meningitis Deck (37):
0

Patient suspected meningitis: diagnostic test to confirm?

Lumbar puncture

1

Consider neisseria meningitis if what PE finding?

Signs of meningitis with purpuric skin rash

2

Papilledema? Funduscopic examination would reveal?

Swelling of the optic nerve caused by increased the cranial pressure

See hazy optic disc margin

3

Most common causes of meningitis?

1. Strep pneumonia
2. Neisseria meningitis
3. Group B strep (Streptococcus agalactiae).
4. Listeria
5. H influenza

4

Suspect group B strep Meningitis in?

#Neonates
# older than 50 with diabetes or liver disease

5

Suspect Listeria meningitis in?

Pregnant women, neonates, elderly, AIDS patients, alcoholics

6

How do bacteria usually get to meninges?

Seed the oropharynx, then move hematogenously

7

Causes of meningitis after neurologic procedures?

Staph aureus and staff epidermidis

8

Complications of inflammation due to meningitis?

Seizures, increased intracranial pressure, stroke

9

Nuchal rigidity?

When passive or active flexion of the neck results in inability to touch the chin to chest

10

Kernig vs Brudzibski sign?

Flex hip and knee and then passively extend. Positive if you elicits pain

Versus

Patient flexes knees and hips when their neck is passively flexed

11

Pt with severe headache with symptoms of gastroenteritis. Cause of meningitis?

Enterovurus


12

Causes meningitis in HIV patients?

Cryptococcus, TB

13

If patient has focal neurologic findings consider?

Intracranial empyema or brain/epidural abscess

14

Signs of subarachnoid hemorrhage?

1. Photophobia
2. Gossly bloody CSFs
3. Xanthochromic chromic supernatant

15

CSF findings in bacterial meningitis: Opening pressure, WBC count/type, glucose, protein, RBC count, stain?

High, elevated and neutrophilic, <40, elevated, none, Gram

16

CSF findings viral meningitis: Opening pressure, WBC count/type, glucose, protein, RBC count, stain?

Normal, elevated/lymphocytic, normal, normal, none, culture/PCR

17

CSF findings in herpes simplex meningitis: Opening pressure, WBC count/type, glucose, protein, RBC count, stain?

Normal/high, elevated/lymphocytic, normal, normal/high, high, PCR

18

CSF findings in tuberculosis meningitis: Opening pressure, WBC count/type, glucose, protein, RBC count, stain?

Normal/high, elevated/monocytes, very low, very high, none, PCR/AFB

19

Bacteria and treatment of meningitis in neonates?

1. E. coli/group B strep
2. Listeria

Ampicillin plus cefotaxime

20

Bacteria and treatment of meningitis in 1 month to 2 years old?

1. Strep pneumonia
2. Nisseria meningitis
3. H. flu

Cefotaxime/ceftriaxone plus vancomycin

21

Bacteria and treatment of meningitis in 2 to 18-year-olds?

1. Nisseria meningitis
2. Strep pneumonia
3. H influenza

vancomycin plus ceftriaxone

22

Bacteria and treatment of meningitis in 19 to 60 age group?

1. Strep pneumonia
2. Nisseria meningitis
3. H influenza

vancomycin plus ceftriaxone

23

Bacteria and treatment of meningitis in 60 and older age group?

1. Strip pneumonia
2. Listeria
3.

Ampicillin plus vancomycin plus ceftriaxone

24

If suspect a patient of having meningitis, next steps?

Do LP

If radiological studies must be done before LP, send blood cultures and begin administering antibiotics while awaiting radiologic results

25

If antibiotics are started, she an LP still be done?

Yes, LP still should be done if performed within two hours of antibiotic administration

26

If patient is suspected of having HSV meningitis, radiological test of choice?

MRI

27

MRI findings in HSV meningitis? Tuberculosis meningitis?

Enhancement of temporal lobes

Enhancement of basal region

28

EEG findings in HSV meningitis?

2 to 3 second intervals of periodic sharp and slow wave complexes originating within temporal lobes

29

Empiric treatment of meningitis?

Ceftriaxone plus vancomycin

Add ampicillin suspect the studio

Add acyclovir if suspect HSV

30

Studies suggest giving glucocorticoids to decrease CNS inflammation if?

Patient is a child with H influenza or strep pneumonia meningitis

31

Close contact prophylaxis for meningococcal meningitis?

Rifampin twice daily for two days or single-dose of ciprofloxacin

32

Patient presents with nerve palsy, CSF findings (low glucose, high protein, low WBC count). Positive PPD but negative bacteria cultures at 48 hours. How to confirm diagnosis?

Repeat LP – if glucose falls at 48 hours, highly suggestive of TB

33

Treatment for patient with Listeria meningitis?

Ampicillin

34

When to get a CT before LP if suspect meningitis?

#papilledema
#seizures
#focal neurological deficits
#confusion

35

If suspected meningitis pt cannot get immediate LP, next step?

Start antibiotics BEFORE LP

36

Most common deficit in untreated bacterial meningitis?

Deafness

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