Meningitis

Question 1

a collection of cells surrounding a group of capillaries in each ventricle that produces the CSF

Answer 1

choroid plexus

Question 2

which 2 structures are infected and inflamed in meningitis?

Answer 2

meninges
subarachnoid space

Question 3

what organism in most common in a patient between 18-50 years old?

Answer 3

strep pneumo.

Question 4

what organism would we suspect in a patient between 18-50 yo who lives in a crowded area?

Answer 4

neisseria meningitis

Question 5

what organism could be the cause of meningitis in a patient over 50 who was infected by a co-morbid infection?

Answer 5

strep pneumo.

Question 6

what organism could be the cause of meningitis in a patient over 50 who lives in a crowded area?

Answer 6

Neisseria

Question 7

what organism is a concern in a patient who is over 50 yo and has had suspicious food?

Answer 7

listeria mono.

Question 8

what 3 organisms would we expect in a patient who is post-surgical or post-trauma?

Answer 8

gram negative
strep pneumo
staph aureus

Question 9

what 3 organisms would we expect in a patient who is immunocompromised, HIV, has alcoholism, or uses steroids?

Answer 9

gram negative
strep pneumo
listeria mono.

Question 10

what are the 3 etiologies of chronic meningitis?

Answer 10

mycobacterium TB
atypical bacteria
fungi

Question 11

in a viral meningitis, what do we worry about?

Answer 11

HSV

Question 12

what is the classic triad of symptoms in meningitis?

Answer 12

fever
headache
neck stiffness

Question 13

what are 3 parts of the physical exam that would point to meningitis?

Answer 13

Kernig sign
Brudzinski sign
AMS

Question 14

a patient presents within 2 days of symptom onset and has the classic presentation of fever, headache, and neck stiffness. what is the type of meningitis?

Answer 14

bacterial (acute)

Question 15

a patient presents months after onset with focal neurological signs, strokes, seizures, and cranial nerve deficits. what is the type of meningitis?

Answer 15

chronic

Question 16

a patient presents days-1week after onset with headache and fever. what is the type of meningitis?

Answer 16

viral

Question 17

what 4 diagnostics should we order for meningitis?

Answer 17

Head CT
LP + CSF culture
blood culture
CBC

Question 18

what should we order if we are concerned about contaminated injection as a source of infection?

Answer 18

MRI with contrast of injection site

Question 19

CSF findings show increased neutrophils, low glucose, high protein, and markedly elevated opening pressure. what is the type of meningitis?

Answer 19

bacterial meningitis

Question 20

CSF findings show increased lymphocytes, low glucose, high protein, and moderately elevated opening pressure. what is the type of meningitis? (2)

Answer 20

mycobacterial or fungal

Question 21

CSF findings show increased lymphocytes, normal glucose, high protein, and normal-elevated opening pressure. what is the type of meningitis?

Answer 21

spirochetal meningitis

Question 22

CSF findings show increased lymphocytes, normal-low glucose, high protein, and slightly elevated opening pressure. what is the type of meningitis?

Answer 22

viral meningitis

Question 23

what should be done before obtaining blood or CSF?

Answer 23

IV empiric therapy

Question 24

what is the treatment for a 2-50 yo patient with bacterial meningitis? (2)

Answer 24

vancomycin
+
cefotaxime OR ceftriaxone

Question 25

what is the treatment for a patient over 50 yo with bacterial meningitis? (3)

Answer 25

vancomycin + ampicillin + cefotaxime OR ceftriaxone

Question 26

what is the treatment for a immunocompromised patient with bacterial meningitis? (3)

Answer 26

vancomycin + ampicillin + cefepime

Question 27

what is the treatment for a post-surgical/post-trauma patient with bacterial meningitis? (2)

Answer 27

vancomycin + cefepime

Question 28

what treatment should be given at the same time as the first dose of antibiotics, for bacterial meningitis if bacteria is unknown or strep pneumo is confirmed?

Answer 28

IV dexamethasone

Question 29

what are 3 considerations for transitioning to outpatient therapy?

Answer 29

inpatient therapy > 6 days no fever for at least 24-48 hours no significant neuro dysfunction

Question 30

what is the treatment for viral meningitis?

Answer 30

supportive care

Question 31

what is the treatment for fungal meningitis?

Answer 31

IV amphotericin B x 11-21 days

Question 32

what is the treatment for syphilis meningitis? (2)

Answer 32

IV aqueous penicillin x 10-14 days THEN IM benzathine pen G 1/week x 3 weeks

Question 33

what is the treatment for lyme disease meningitis? (2)

Answer 33

IV ceftriaxone x 2-4 weeks +/- dexamethasone

Question 34

what is the treatment for TB meningitis?

Answer 34

IM/PO Isoniazid x 6-18 months

Question 35

what is the complication of DIC associated with?

Answer 35

meningococcal meningitis

Question 36

what can cause hearing loss in a patient with meningitis?

Answer 36

inflammation of cochlear aqueduct (CN VIII)