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Flashcards in Week 221 - Meningitis Deck (38):
1

Week 221 - Meningitis: What are the risk factors for developing meningitis?

• Age 60
• DM
• Renal or adrenal insufficiency
• Immunosupression
• Sickle cell disease
• Alcoholism and cirrhosis
• Recent exposure to meningitis
• Contiguous infection
• Dural defect
• IV drug abuse

2

Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in neonates (<1month)?

• E.Coli
• Pneumococcal meningitis
• Listeria monocytogenes
• Nisseria meningitides

3

Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in children older than 2 months?

• Pneumococcocal
• N. Menigitides
• H. Influenza

4

Week 221 - Meningitis: What are the two main mechanisms by which bacteria enter the subarachnoid space?

• Haematogenous spread from respiratory tract.
• Direct spread from a contiguous infection (sinusitis, mastoiditis) or from an injury.

5

Week 221 - Meningitis: What are the symptoms of meningism?

• Photophobia
• Headache
• Stiff neck

6

Week 221 - Meningitis: You may not see meningism in babies, what are the symptoms that you may see that would suggest meningitis?

• Hyper/hypothermia
• change in sleeping or eating habits.
• irritability or lethargy.
• high pitched cry
• bulging fontenelle

7

Week 221 - Meningitis: What is Kernig's sign?

Patient is in supine position, hip and knee is flexed to 90º, patient feels pain when leg is extended.

8

Week 221 - Meningitis: What is Brudzinski sign?

When supine, passively flex neck, this causes the lower extremities (hips and knees) to flex.

9

Week 221 - Meningitis: The non-blanching petechial rash is a sign of what?

Sepsis.

10

Week 221 - Meningitis: What are the signs of encephalitis?

Fever, headache and decreased neurological function.

11

Week 221 - Meningitis: Which investigations should be performed for suspected meningitis?

• FBC, Coagulation studies, serum glucose.
• ABG
• Throat swab
• H1N1
• PCR
• Lumbar puncture (if not contraindicated)

12

Week 221 - Meningitis: A CT is indicated before a lumbar puncture in which patients?

>60 y.o., immunocompromised, known CNS lesions, seizure within 1 week of presentation, suspicion of elevated ICP (Papilloedema, high BP but low HR).

13

Week 221 - Meningitis: What are the absolute contraindications for a lumbar puncture?

• Infected skin at site.
• Raised ICP
• Shock
• Focal neurological signs
• Unequal pressures between supratentorial and infratentorial compartments (from CT)

14

Week 221 - Meningitis: What would you expect the lumbar puncture result to be in viral meningitis?

• Opening pressure - Normal or High
• Colour - Clear
• Cells/mm - 5-1000
• Predominant cell - Lymphocytes
• CSF:plasma glucose - Normal
• Protein - Normal

15

Week 221 - Meningitis: What would you expect the lumbar puncture result to be in bacterial meningitis?

• Opening pressure - High
• Colour - Cloudy
• Cells/mm - 100-50000
• Predominant cell - Neutrophil
• CSF:plasma glucose - Low
• Protein - Elevated

16

Week 221 - Meningitis: What would you expect the lumbar puncture result to be in tuberculous meningitis?

• Opening pressure - High
• Colour - Cloudy/yellow
• Cells/mm - 25-500
• Predominant cell - Lymphocyte
• CSF:plasma glucose - Low/very low
• Protein - elevated

17

Week 221 - Meningitis: What would you expect the lumbar puncture result to be in fungal meningitis?

• Opening pressure - High/Very high
• Colour - Clear/cloudy
• Cells/mm - 0-1000
• Predominant cell - Lymphocyte
• CSF:Plasma glucose - Normal/low
• Protein - Normal

18

Week 221 - Meningitis: Which antibiotic should be used in neonates for listeria and Group b strep?

• Listeria - Ampicillin and Aminoglycoside/Cefotaxime
• Group B strep - Benzylpenicillin and cefotaxime

19

Week 221 - Meningitis: Which class of antibiotics is used to treat meningitis (not neonates)?

Cephalosporin

20

Week 221 - Meningitis: Which antibiotic is used for the prophylaxis of meningitis?

Ciprofloxacin

21

Week 221 - Meningitis: Which organisms that cause meningitis are routinely vaccinated against?

• H influenze
• Menningococcal C
• Strep Pneumoniae
• MMR

22

Week 221 - Meningitis: What are the complications of meningitis?

• Focal neurological sequelae
• Hemiparesis, Facial palsy
• Visual field defects, hearing loss, blindness,
• Syndrome of inappropriate ADH secretion.
• Cranial nerve palsies

23

Week 221 - Meningitis: What are the measures in place to prevent transmission across the blood brain barrier?

• Capillaries have tight junctions that do not exist in normal circulation.
• There is also a thick basement membrane.
• There is active transport for certain metabolites whilst small molecules like 02,CO2 and hormones are able to diffuse across.

24

Week 221 - Meningitis: What are the names of the cells that line the choroid plexus and ventricles?

Ependymal cells.

25

Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in neonates?

• E. Coli
• Streptococci
• Listeria

26

Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in children?

• H. influenza
• Pneumococcal
• Meningococcal

27

Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in young adults?

• Pneumococcal
• Meningococcal

28

Week 221 - Meningitis: Which are the most common organisms that cause bacterial meningitis in older adults?

• Pneumococcal
• Listeria
• Gram -ve organisms

29

Week 221 - Meningitis: Lyme disease is caused by which organism? What are the symptoms?

Borelia Burgdorferi
• Rash, arthritis, aseptic meningitis, focal nerve palsy, mild encephalopathy.

30

Week 221 - Meningitis: What are the features of viral meningitis?

• Acute onset of meningism, fever, irritability.
• Usually self-limiting with complete recovery.
• Often have systemic features.

31

Week 221 - Meningitis: Which organisms cause viral meningitis?

Echo, coxsackie, mumps, HIV.

32

Week 221 - Meningitis: Which organisms cause viral encephalitis?

• Herpes simplex 1
• Herpes simplex 2
• CMV
• Herpes zoster
• Arboviruses
• HIV
• Rubella/Toxoplasmosis

33

Week 221 - Meningitis: What are the features of viral encephalitis caused by Herpes simplex type 1?

• Mostly children and young adults.
• Affects temporal and inferior frontal lobes.
• Oedema, necrosis, haemorrhage, specific viral inclusion bodies.
• 40-70% mortality if left untreated.

34

Week 221 - Meningitis: How much fluid should be given to a child experiencing shock due to meningitis?

• 20ml/kg (25% of circulating volume)

35

Week 221 - Meningitis: What family of viruses most commonly causes viral meningitis?

Enteroviruses (echo, coxsachie, polio)

36

Week 221 - Meningitis: Which bacteria is the most common cause of bacterial meningitis in the UK?

Neisseria meningitides - (Meningococcal)

37

Week 221 - Meningitis: What are the two sites where the blood brain barrier is most commonly crossed? What conditions commonly occur when pathogens cross at these sites?

• Brain microvascular endothelial cells - Causes encephalitis or brain abscess.
• Choroid plexus - Causes meningitis.

38

Week 221 - Meningitis: Why is the choroid plexus a weak spot for the crossing of the blood-brain barrier?

Endothelium is fenestrated, tight junctions are weaker and epithelium has fast rate of endocytosis.