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Flashcards in ID - Meningitis Deck (37)
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0
Q

Consider neisseria meningitis if what PE finding?

A

Signs of meningitis with purpuric skin rash

1
Q

Patient suspected meningitis: diagnostic test to confirm?

A

Lumbar puncture

2
Q

Papilledema? Funduscopic examination would reveal?

A

Swelling of the optic nerve caused by increased the cranial pressure

See hazy optic disc margin

3
Q

Most common causes of meningitis?

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

Suspect group B strep Meningitis in?

A
#Neonates 
# older than 50 with diabetes or liver disease
5
Q

Suspect Listeria meningitis in?

A

Pregnant women, neonates, elderly, AIDS patients, alcoholics

6
Q

How do bacteria usually get to meninges?

A

Seed the oropharynx, then move hematogenously

7
Q

Causes of meningitis after neurologic procedures?

A

Staph aureus and staff epidermidis

8
Q

Complications of inflammation due to meningitis?

A

Seizures, increased intracranial pressure, stroke

9
Q

Nuchal rigidity?

A

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

10
Q

Kernig vs Brudzibski sign?

A

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
Q

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

A

Enterovurus

12
Q

Causes meningitis in HIV patients?

A

Cryptococcus, TB

13
Q

If patient has focal neurologic findings consider?

A

Intracranial empyema or brain/epidural abscess

14
Q

Signs of subarachnoid hemorrhage?

A
  1. Photophobia
  2. Gossly bloody CSFs
  3. Xanthochromic chromic supernatant
15
Q

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

A

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

16
Q

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

A

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

17
Q

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

A

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

18
Q

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

A

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

19
Q

Bacteria and treatment of meningitis in neonates?

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

Ampicillin plus cefotaxime

20
Q

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

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

Cefotaxime/ceftriaxone plus vancomycin

21
Q

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

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

vancomycin plus ceftriaxone

22
Q

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

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

vancomycin plus ceftriaxone

23
Q

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

A
  1. Strip pneumonia
  2. Listeria
    3.

Ampicillin plus vancomycin plus ceftriaxone

24
Q

If suspect a patient of having meningitis, next steps?

A

Do LP

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

25
Q

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

A

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

26
Q

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

A

MRI

27
Q

MRI findings in HSV meningitis? Tuberculosis meningitis?

A

Enhancement of temporal lobes

Enhancement of basal region

28
Q

EEG findings in HSV meningitis?

A

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

29
Q

Empiric treatment of meningitis?

A

Ceftriaxone plus vancomycin

Add ampicillin suspect the studio

Add acyclovir if suspect HSV

30
Q

Studies suggest giving glucocorticoids to decrease CNS inflammation if?

A

Patient is a child with H influenza or strep pneumonia meningitis

31
Q

Close contact prophylaxis for meningococcal meningitis?

A

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

32
Q

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?

A

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

33
Q

Treatment for patient with Listeria meningitis?

A

Ampicillin

34
Q

When to get a CT before LP if suspect meningitis?

A
#papilledema
#seizures
#focal neurological deficits
#confusion
35
Q

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

A

Start antibiotics BEFORE LP

36
Q

Most common deficit in untreated bacterial meningitis?

A

Deafness

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