magzfellowship's version from 2015-10-15 21:16

Section 1

Question Answer
what's the most common cause?BACTERIAL: Streptococcus pneumoniae, Neisseria meningitides, Group B streptococcus, Haemophilus influenzae, Listeria monocytogenes; VIRAL: mumps, coxsackie, echovirus, herpes, EBV, enterovirus, CMV, HIV; FUNGI & PARACITES: cryptococcus, toxoplasma, cysticercosis; drugs - NSAID, bactrim, AZT; sarcoid, SLE , Wegener's
what are the Risk factors?CSF shunts or dural defects · Spinal procedures · OM/sinus/orbital infections · Splenectomy / asplenia / sickle-cell disease · bacterial endocarditis, DM, alcoholism, cirrhosis, IVDU, renal insufficiency, adrenal insufficiency, malignancy (↑Listeria), hypoparathyroidism, thalassaemia major, CF · GBS pos mother for neonate · Crowding
signs and symptoms?Fever, Neck stiffness, Headache, Altered mental state, Seizures, Focal neuro signs - cranial nerve palsies
assess for meningeal irritation?Resistance to passive neck flexion; BRUDZINSKI SIGN - flexion of hips and knees in response to passive neck flexion; KERNIG SIGN - contraction of hamstrings in response to knee extension while hip is flexed

Section 2

Question Answer
In neonates (birth-2/12, what are the causes?Group B streptococcus, Listeria monocytogenes, E. Coli & other G-ve organisms
CT SCAN BEFORE LP?>60, immunocompromised, Mx, CNS Dx-stroke, seizure, focal neurological deficit, altered LOC, papilloedema
how to diagnose on LPbacterial: cell >500 polymorphs; Gram stain + (80%); glucose decreased; protein high; culture +; bacterial Ag +80% // PARTIALLY TREATED: cell polymorphs & lymphocytes; Gram stain + (20%); glucose decreased/N; protein high/N; culture -; bacterial Ag +70% // VIRAL: cell lymphocytes; Gram stain -; glucose N; protein N // TB: cell lymphocytes; Gram stain -; glucose decreased; protein high

Section 3

Question Answer
empiric treatment for meningitis (adults & <2 months)dexamethasone 10 mg IV QID x4/7, starting before or with the first Abs + ceftriaxone 4 g IV day/ ceftriaxone 2 g IV BD/ cefotaxime 2 g IV QID
treatment for Listeria monocytogenes (immunocompromised patients, <50 years, alcoholic, pregnant or debilitatedbenzylpenicillin 2.4 g IV QID
treatment for Gram-positive diplococci (Streptococcus pneumoniae)vancomycin IV 1.5mg BD, depending on renal function

Section 4

Question Answer
chemoprophylaxisciprofloxacin 500 mg po stat/ ceftriaxone 250 mg IM stat/ rifampicin 600 mg po BD x 2/7. Rifampicin - C/I pregnancy and severe liver disease
chemoprophylaxis for Haemophilus influenzae type b (Hib)rifampicin 600 mg po daily x4/7. ceftriaxone 1 g IM/ IV, daily x2/7
who gets chemoprophylaxis exposed to confirmed meningococcus within the preceding 7 days
what are the complicationsseizures (30%), SIADH (30%); cerebral herniation, infarct, oedema; cerebral venous thrombosis; hydrocephalus; shock 10%; DIC; empyema - 30% haemophilus, 20% pneumococcus
what's the mortality?untreated 90%; treated 10% meningococcus & haemophilus; 30% pneumococcus
how many have long term effects?30%
Risk factors for adverse outcome<12mths, Hb <11, CSF WCC<1000, septicaemia; Haemophilus - coma, hypothermia, seizures, shock; meningococal - petechiae <12hrs, normal/ low WCC & ESR
what vaccines are availableroutine - HiB, meningococcal; pneumococcal - >2 without spleen, nephrotic, recurrent meningitis post-head trauma