Meningitis

Question 1

Symptoms of Meningitis

Answer 1

fever,
neck stiffness,
photophobia,
altered mental status

Question 2

Signs of Meningitis

Answer 2

+ve Kerning sign,
+ve Brudzinski sign

Question 3

Precaution of Meningitis

Answer 3

• Droplet (discontinue isolation after 24 hours of antibiotic)

Question 4

Diagnosis of Meningitis

Answer 4

lumbar puncture

CT head to be done before if there is signs of increased
intracranial pressure such as papilledema, focal neurologic deficit, altered mental status, new onset seizure, previous CNS lesion or immunocompromised patient to avoid risk of
herniation

Question 5

Most common organism to cause meningitis

Answer 5

Streptococcus pneumonie

Think of listeria monocytogenus in extreme age, pregnant, immunocompromised and diabetic

affection of temporal area on imaging is a hint to diagnose HSV (herpes simplex virus)

Question 6

Dont memorize this just know
lists of diseases you will be asked about in CSF analysis

Answer 6

-bacterial meningitis
-viral meningitis
-Tuberculus meningits
-Cryptococcal meningits
-Subarachnoid hemorrhage
-Multiple sclerosis

Question 7

CSF analysis we mainly looking for?

Answer 7

-Glucose
-Predominant cell type
-RBCs for SAH
-Oligoclonal band for MS

Question 8

CSF analysis in bacterial meningitis

Answer 8

glucose = Low
Protein = Normal or increased
Predominant cell = Neutrophil

Question 9

CSF analysis in viral meningitis

Answer 9

glucose = Normal
Protein = Normal
Predominant cell = Lymphocyte

Question 10

CSF analysis in TB meningitis

Answer 10

glucose = Low
Protein = Normal or increased
Predominant cell = Lymphocyte

Question 11

CSF analysis in Cryptococcus meningitis (fungal infection in immunocompromised HIV)

Answer 11

glucose = Low
Protein = Normal or increased
Predominant cell = Lymphocyte

HIV PATIENT

Question 12

CSF analysis Xantochromia RBCs and increased ICP

Answer 12

Subarachnoid hemorrhage

Question 13

CSF analysis Oligoclonal band found in

Answer 13

Multiple sclerosis

Question 14

Management of meningitis Bacterial

Answer 14

IV Ceftriaxone + IV Vancomycin + IV Dexamethasone
+ IV Ampicillin only in extreme age (to cover listeria)

Question 15

post neurosurgical or hospital acquired meningitis

Answer 15

IV Vancomycin + IV Ceftazidime
or Cefepime or Meropenem (for pseudomonas aeruginosa)

Question 16

Management of meningitis Viral:

Answer 16

supportive (IV antibiotic is initiated until bacterial cause is excluded

Question 17

Management of Viral encephalitis

Answer 17

IV acyclovir

Question 18

Prophylaxis to contacted people

Answer 18

Single dose Ciprofloxacin or 2 doses of Rifampicin

Ciprofloxacin is contraindicated in age < 18 NOT FOR PREGNANCY
Ceftriaxone may be used as a prophylaxis also BEST IN PREGANCY

Question 19

-Lat complication of meningitis in general is
- with papilledema ?

Answer 19

Hearing loss
vision loss

Question 20

22-year-old female patient presented with meningeal irritation signs, CSF
showed: high WBCs, mainly lymphocyte, mildly elevated protein, normal level
of glucose, your most likely diagnosis?

Answer 20

Viral meningitis

Question 21

Man from India has fever, neck stiffness and photophobia, with high protein,
high lymphocytes and low glucose in CSF, what is this kind of meningitis?

Answer 21

Tuberculous meningitis

Question 22

Pediatric patient presented with meningeal irritations signs and neck stiffness,
they did CT scan which showed: low attenuation of the tempoparietal area,
what is the most likely diagnosis?

Answer 22

HSV meningitis

Question 23

Patient with neck stiffness and fever, CF analysis showed high protein, Low
glucose, high WBCs 70% polymorphs, what is the cause?

Answer 23

Bacterial meningitis

Question 24

In bacterial meningitis case, what do you expect to see on CSF analysis?

Answer 24

Low glucose, High protein, Neutrophil predominance

Question 25

Case of meningitis, CF analysis showed picture of tuberculous meningitis with
high protein and low glucose, what will be the predominant type of cell?

Answer 25

• Lymphocyte

Question 26

What are the type of precaution in both meningitis and pneumonia?

Answer 26

Droplets

Question 27

How many hours after beginning antibiotics for meningitis the patient should
be isolated before discontinuing isolation?

Answer 27

24 hours

Question 28

51-year-old patient with fever, neck stiffness and photophobia, on examination:
positive kerning sign, CF gram stain showed gram +ve cocci in chains, what is
the causative agent?

Answer 28

staph a= cluster
strept p= chain

so its Streptococcus pneumoniae

Question 29

A case of meningitis and CSF showed +ve Coccobacillus, what is the organism?

Answer 29

Listeria Monocytogenous
Ceftriaxone, Vancomycin, Ampicillin and Dexamethasone

Question 30

34-year-old male developed meningitis after swimming in a river, what is the
most likely organism?

Answer 30

Naegleria fowleri

Question 31

22-year-old patient with typical symptoms of meningitis, culture showed gram
+ve cocci in chains, what is the appropriate treatment?

Answer 31

staph a= cluster
strept p= chain its this so:
Ceftriaxone, Vancomycin and Dexamethasone

Question 32

Case od meningitis CF culture showed methicillin resistant staph aureus, which
type of antibiotics you should use?

Answer 32

Vancomycin

Question 33

A young male presented with altered sensorium (Encephalitis), Fever and nuchal rigidity,
CSF analysis showed high protein, high WBCs but normal glucose (viral), what is
the management?

Answer 33

Acyclovir

Question 34

Adult patient has contact with patient confirmed to has meningitis, which antibiotic
as a prophylaxis you should give?

Answer 34

Ciprofloxacin

Question 35

Meningitis in child with picture showed petechia, what you should give to his
young brother as a prophylaxis?

Answer 35

Rifampin

Question 36

Patient with meningitis, his sibling is allergic to the primary treatment given for
prophylaxis, what to give him as a prophylaxis?

Answer 36

-Ceftriaxone

Question 37

Late complication of meningitis?

Answer 37

Deafness