Meningitis

Question 1

What is the dura mater?

Answer 1

Tough outer membrane - directly adheres to skull and vertebral column

Question 2

What is the arachnoid?

Answer 2

Middle layer

Question 3

What is the subarachnoid space?

Answer 3

Cerebrospinal fluid where infection occurs

Question 4

What is the pia mater?

Answer 4

Delicate innermost membrane that adheres to contours of the brain

Question 5

Normal WBC level in CSF

Answer 5

Less than 5

Question 6

Normal protein level in CSF

Answer 6

Less than 50

Question 7

Normal glucose level in CSF

Answer 7

30-70

Question 8

Antibiotic characteristics that influence CSF/CNS penetration

Answer 8

-Lipid solubility
-Ionization
-Protein binding
-Molecular weight
-Degree of meningeal inflammation

Question 9

Which drugs achieve therapeutic CSF concentration with or without meningeal inflammation?

Answer 9

-Acyclovir
-Bactrim
-Voriconazole
-Fluconazole
-Ganciclovir
-Linezolid
-Metronidazole
-FQs

Question 10

Which drugs achieve therapeutic CSF concentration with meningeal inflammation?

Answer 10

-Penicillins
-Third and fourth gen cephalosporins
-Aztreonam
-Colistin
-Vancomycin
-Meropenem (not ertapenem)

Question 11

Which drugs do not achieve therapeutic CSF concentration with or without meningeal inflammation?

Answer 11

-Macrolides
-Aminoglycosides
-Beta-lactamase inhibitors
-First and second gen cephalosporins
-Clindamycin
-Tetracyclines (except doxycycline)
-Echinocandins

Question 12

Common pathogens to cause meningitis in neonates

Answer 12

-Listeria
-Streptococcus pneumoniae
-Streptococcus agalactiae
-Neisseria meningiditis
-HSV if mother has it

Question 13

Common pathogens to cause meningitis in infants

Answer 13

-Strep pnemoniae
-Strep agalactiae
-Neisseria meningiditis
-H. influenzae

Question 14

Common pathogens to cause meningitis in children and adults

Answer 14

-Strep pneumoniae
-Neisseria meningiditis

Question 15

Common pathogens to cause meningitis in elderly

Answer 15

-Listeria
-Strep pneumoniae
-Neisseria meningiditis

Question 16

Clinical signs and symptoms of meningitis

Answer 16

-Headache
-Backache
-Nuchal rigidity
-Photophobia
-Fever
-Poor feeding habits in children

Question 17

CSF WBC count in patients with bacterial meningitis

Answer 17

More than 1000-5000

Question 18

CSF differential in patients with bacterial meningitis

Answer 18

More than 80% neutrophils

Question 19

CSF protein count in patients with bacterial meningitis

Answer 19

More than 150

Question 20

CSF glucose count in patients with bacterial meningitis

Answer 20

Less than 50

Question 21

What are the recommended empiric antibiotics for neonates?

Answer 21

-Ampicillin + ceftriaxone/cefepime
-Ampicillin + aminoglycoside

Question 22

What are the recommended empiric antibiotics for infants?

Answer 22

Vancomycin + ceftriaxone

Question 23

What are the recommended empiric antibiotics for children and adults?

Answer 23

Vancomycin + ceftriaxone

Question 24

What are the recommended empiric antibiotics for the elderly?

Answer 24

Vancomycin + ceftriaxone + ampicillin

Question 25

Streptococcus gram stain

Answer 25

Gram-positive diplococci

Question 26

Treatment for streptococcus infection that is sensitive to penicillin

Answer 26

-Penicillin G -Ampicillin

Question 27

Treatment for streptococcus infection that is resistant to penicillin

Answer 27

Ceftriaxone

Question 28

Treatment for streptococcus infection that is resistant to cephalosporins

Answer 28

Vancomycin

Question 29

Treatment duration for streptococcus infection

Answer 29

10-14 days

Question 30

When are steroids used for treatment of meningitis?

Answer 30

-Useful in adults with pneumococcal meningitis -Administer before or with first dose of antibiotics -Duration for 2-4 days

Question 31

Staph aureus gram stain

Answer 31

Gram positive cocci in clusters

Question 32

Treatment for MSSA

Answer 32

Nafcillin

Question 33

Treatment for MRSA

Answer 33

Vancomycin

Question 34

Treatment duration for staph aureus

Answer 34

14-21 days

Question 35

Listeria gram stain

Answer 35

Gram positive rod, non-spore forming

Question 36

Listeria treatment

Answer 36

Ampicillin +/- gentamicin for 21 days

Question 37

Neisseria gram stain

Answer 37

Gram-negative intra-cellular diplococci

Question 38

Neisseria treatment

Answer 38

-Penicillin -Ceftriaxone

Question 39

Neisseria treatment duration

Answer 39

7 days

Question 40

Haemophilus influenzae gram stain

Answer 40

Gram negative coccobacillus

Question 41

Treatment for beta-lactamase negative H. influenzae

Answer 41

Ampicillin

Question 42

Treatment for beta-lactamase positive H. influenzae

Answer 42

Ceftriaxone

Question 43

H. influenzae treatment duration

Answer 43

7 days

Question 44

Gram-negative treatment

Answer 44

-Ceftriaxone -Cefepime

Question 45

Gram-negative treatment duration

Answer 45

21 days