MENINGITIS

Question 1

Is an inflammation of the fluid and membranes (meninges) surrounding brain and spinal cord.

Answer 1

Meningitis

Question 2

The inflammatory response to infection in meningitis causes

Answer 2

Increased ICP

Question 3

3 Meninges of the brain and spinal cord

Answer 3

Dura, arachnoid, pia

Question 4

Normal CSF pressure

Answer 4

0-15 mmHg

Question 5

Normal CSF glucose

Answer 5

50-80 mg/dl (Decreased during increased ICP)

Question 6

Normal CSF protein

Answer 6

20-50 mg/dl (Increased during increased ICP)

Question 7

Normal specific gravity

Answer 7

1.007

Question 8

Causative organisms of Meningitis

Answer 8

Streptococcus pneumoniae
Haemophilus influenzae
Neisseria meningitidis

Question 9

Classification of meningitis

Answer 9

Bacterial

Question 10

Mode of transmission of meningitis

Answer 10

• Droplet
• Direct contact

Question 11

Incubation period of meningitis

Answer 11

2-10 days

Question 12

Average incubation period of meningitis

Answer 12

6-7 days

Question 13

Diagnostic test

Answer 13

Lumbar tap

Question 14

definitive diagnosis of meningitis: to collect cerebrospinal fluid (CSF)

Answer 14

• Lumbar tap
• spinal tap
• lumbar puncture
• Thecal puncture
• Rachiocentesis

Question 15

Position during lumbar tap

Answer 15

• Knee-chest
• fetal pos.
• side-lying pos
• sitting or leaning forward

Question 16

Number of test tubes and ml for lumbar tap

Answer 16

3 test tubes; 2-3 ml

Question 17

Position after lumbar tap

Answer 17

Flat on bed for 6-8 hours

Question 18

Test for spinal blockage or subarachnoid obstruction of the subarachnoid space, done before lumbar tap

Answer 18

Queckenstedt’s test

also known as lumbar manometric test performed
by compressing the jugular veins for 10 seconds on each side of the neck during the lumbar puncture

Question 19

Pathognomonic sigs of meningitis

Answer 19

1. Nuchal rigidity
2. Kernig’s sign
3. Brudzinski’s sign

Question 20

Other s/sx for meningitis

Answer 20

1. Opisthotonus
2. Decortication
3. Decerebration

Question 21

Signs of increased ICP
CADDHNPS

Answer 21

• Cushing’s triad
• Anisocoria
• Diplopia
• Doll’s eyes sign
• High temperature and chills
• Nausea and vomiting
• photophobia
• seizures

Question 22

CUSHING’S TRIAD

Answer 22

Hypertension, bradycardia, bradypnea

Question 23

Anisocoria

Answer 23

Unequal pupils
CN III- Oculomotor

Question 24

Diplopia

Answer 24

Double vision
CN VI- Abducens
Longest cranial nerve (prone to compression)

Question 25

Doll’s eye sign

Answer 25

Disconjugate eye (cover eye with cloth)

Question 26

Management of increased ICP: Position

Answer 26

Semi- fowler (drain CSF fluid)

Question 27

Management of increased ICP: HOB Elevation

Answer 27

30-45 degree (>90 degree= brain herniation lead to swelling and bleeding)

Question 28

Management of increased ICP: Safety

Answer 28

——

Question 29

Management of increased ICP: Limit fluid intake

Answer 29

Decrease CSF

Question 30

Management of increased ICP: REST

Answer 30

Any strenuous act can stimulate seizure and convulsion

Question 31

Management of increased ICP: Avoid factors that increase ICP

Answer 31

AVOID: bending, stooping, valsalva maneuver, blowing of nose, sneezing, laxative, enema

Question 32

Pharmacologic mgt for meningitis

Answer 32

1. OSMOTIC DIURETIC 2. CORTICOSTEROIDS 3. ANTICONVULSANTS 4. ANTACIDS

Question 33

Osmotic diuretic mgt for meningitis

Answer 33

Mannitol (decrease cerebral edema) ## Footnote WOF: hypotension and dizziness

Question 34

Corticosteroids/Glucocorticoids mgt for meningitis

Answer 34

Dexamethasone/ Decadron ## Footnote Crosses blood brain barrier

Question 35

Anticonvulsants mgt for meningitis

Answer 35

Phenobarbital: Phenytoin/Dilantin ## Footnote Causes: GI upset, nystagmus, ataxia, red urine

Question 36

Antacids mgt for meningitis

Answer 36

H2 receptor blockers

Question 37

Collaborative Management Bed rest for meningitis

Answer 37

dark room (prevent seizure) and cool cloth over eyes (photosensitivity)

Question 38

Collaborative Management Antibiotics IV for meningitis

Answer 38

Pen. G./ Ceftriaxone/ Ampicillin

Question 39

Collaborative Management For severe headache for meningitis

Answer 39

Codeine (Opioid Analgesic) ## Footnote SE: drowsiness and constipation

Question 40

Collaborative Management Temp above 38 degree C

Answer 40

Antipyretics

Question 41

Collaborative Management for meningitis to prevent seizures

Answer 41

Phenytoin/Dilantin

Question 42

Common SE of Phenytoin/Dilantin

Answer 42

Gingival hyperplasia

Question 43

PHENYTOIN THERAPY IF GIVEN P.O. , ADMINISTER _______ MEALS

Answer 43

With ## Footnote to prevent GI upset

Question 44

IF PHENYTOIN IS GIVEN PER IV, PREPARE ______NSS.WHY?

Answer 44

10 ml NSS; crystalizes in the vein (5ml NSS —> MEDS —> 5 ml NSS

Question 45

SE OF PHENYTOIN/DILANTIN (GNARGB)

Answer 45

G - GI upset A- ataxia N- nystagmus RU- red urine Gingival hyperplasia BMD- bone marrow depression (plastic anemia)

Question 46

PATHOGENESIS

Answer 46

1. Nasopharyngeal colonization of the bacteria (causative agents: S,H,N) 2. Invasion in the bloodstream (bacteremia) 3. Bacteria will invade the meninges 4. Bacterial multiplication in the subarachnoid and ventricular space 5. Cytokines & chemokines 6. Neutrophil invasion 7. Blood brain barrier breakdown & increase of CSF outflow resistance 8. Edema 9. Increase ICP- signs of increased ICP