Podcast
Questions and Answers
What is a significant finding in the CSF of individuals with tuberculous meningitis compared to those with other types of meningitis?
What is a significant finding in the CSF of individuals with tuberculous meningitis compared to those with other types of meningitis?
- No change in adenosine deaminase (ADA) activity
- Decreased adenosine deaminase (ADA) activity
- Increased adenosine deaminase (ADA) activity (correct)
- Fluctuating adenosine deaminase (ADA) activity
Which of the following factors can confound the reported sensitivity and specificity of ADA activity in diagnosing tuberculous meningitis?
Which of the following factors can confound the reported sensitivity and specificity of ADA activity in diagnosing tuberculous meningitis?
- Type of CSF collection method used
- Age of the patient at diagnosis
- Gender of the patient
- Comorbidities, especially HIV (correct)
What adjunctive treatment is commonly given for tuberculous meningitis?
What adjunctive treatment is commonly given for tuberculous meningitis?
- Glucocorticoids such as dexamethasone (correct)
- Antiretroviral therapy
- Antifungal medication
- Broad-spectrum antibiotics
Which imaging findings are associated with tuberculous meningitis?
Which imaging findings are associated with tuberculous meningitis?
What clinical signs may suggest meningoencephalitis in a child with tuberculous meningitis?
What clinical signs may suggest meningoencephalitis in a child with tuberculous meningitis?
What is the physiological intracranial pressure (ICP) for adults in the supine position?
What is the physiological intracranial pressure (ICP) for adults in the supine position?
Which symptom is more commonly associated with viral meningitis?
Which symptom is more commonly associated with viral meningitis?
Which of the following symptoms can indicate elevated ICP?
Which of the following symptoms can indicate elevated ICP?
What is a classic sign of meningeal irritation?
What is a classic sign of meningeal irritation?
What does a sustained ICP of ≥ 20 mm Hg typically indicate?
What does a sustained ICP of ≥ 20 mm Hg typically indicate?
Which type of therapy is commonly used for managing refractory intracranial hypertension?
Which type of therapy is commonly used for managing refractory intracranial hypertension?
Which of the following is a hallmark feature of meningoencephalitis?
Which of the following is a hallmark feature of meningoencephalitis?
What is a common non-surgical management strategy for elevated ICP?
What is a common non-surgical management strategy for elevated ICP?
Which condition is less likely to present with the classic triad of meningitis features in neonates?
Which condition is less likely to present with the classic triad of meningitis features in neonates?
Which of the following conditions can lead to elevated ICP?
Which of the following conditions can lead to elevated ICP?
What systemic sign is commonly associated with acute inflammation in meningitis?
What systemic sign is commonly associated with acute inflammation in meningitis?
What is ICP monitoring essential for?
What is ICP monitoring essential for?
What characteristic rash is suggestive of meningococcemia?
What characteristic rash is suggestive of meningococcemia?
What symptom indicates increased intracranial pressure in meningitis patients?
What symptom indicates increased intracranial pressure in meningitis patients?
In cases of elevated ICP, which medical therapy would NOT typically be used?
In cases of elevated ICP, which medical therapy would NOT typically be used?
Which feature is more commonly observed in adults with meningococcemia?
Which feature is more commonly observed in adults with meningococcemia?
What is the primary indication for administering corticosteroids in bacterial meningitis?
What is the primary indication for administering corticosteroids in bacterial meningitis?
What is the recommended agent for the treatment of suspected or proven meningitis due to S.pneumoniae or H.influenzae?
What is the recommended agent for the treatment of suspected or proven meningitis due to S.pneumoniae or H.influenzae?
What should be done if a pathogen other than S.pneumoniae or H.influenzae is identified after the administration of dexamethasone?
What should be done if a pathogen other than S.pneumoniae or H.influenzae is identified after the administration of dexamethasone?
Which is the incubation period for Tuberculous meningitis caused by Mycobacterium tuberculosis?
Which is the incubation period for Tuberculous meningitis caused by Mycobacterium tuberculosis?
Which clinical feature is most commonly associated with basal meningitis due to Tuberculous meningitis?
Which clinical feature is most commonly associated with basal meningitis due to Tuberculous meningitis?
What is considered the gold standard for diagnosing Tuberculous meningitis?
What is considered the gold standard for diagnosing Tuberculous meningitis?
What is a potential side effect of corticosteroid treatment in meningitis?
What is a potential side effect of corticosteroid treatment in meningitis?
When should antibiotics be administered concerning corticosteroid treatment in meningitis?
When should antibiotics be administered concerning corticosteroid treatment in meningitis?
What is the prognosis for untreated bacterial meningitis?
What is the prognosis for untreated bacterial meningitis?
Which of the following is true regarding viral meningitis?
Which of the following is true regarding viral meningitis?
What is a significant risk associated with fungal meningitis?
What is a significant risk associated with fungal meningitis?
What is the primary method of preventing meningitis caused by infections that spread to the CNS?
What is the primary method of preventing meningitis caused by infections that spread to the CNS?
What is recommended for close contacts of an index patient with bacterial meningitis?
What is recommended for close contacts of an index patient with bacterial meningitis?
Which of the following treatments should be avoided for pregnant patients exposed to bacterial meningitis?
Which of the following treatments should be avoided for pregnant patients exposed to bacterial meningitis?
What factor significantly influences the prognosis of treated bacterial meningitis?
What factor significantly influences the prognosis of treated bacterial meningitis?
Which of the following is recommended as a postexposure regimen for bacterial meningitis?
Which of the following is recommended as a postexposure regimen for bacterial meningitis?
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Study Notes
Hemodynamic Support and Management
- Provide hemodynamic support through the administration of fluids or vasopressors.
- Identify and reverse coagulopathies to stabilize patient condition.
- Evaluate and treat elevated intracranial pressure (ICP).
Intracranial Pressure (ICP)
- ICP is the pressure within the cranium, influenced by positioning and physiological factors like cardiac contractions.
- Normal ICP in supine adults is ≤ 15 mm Hg; an ICP of ≥ 20 mm Hg indicates pathological intracranial hypertension.
- Elevated ICP can decrease cerebral perfusion pressure and lead to brain herniation.
- Nonspecific symptoms of elevated ICP include impaired consciousness, headache, and vomiting.
- Specific indications of ICP elevation include findings from brain imaging (e.g., midline shift) and physical exam (e.g., papilledema).
Management of Elevated ICP
- Expedient surgical intervention for drainable or resectable lesions is essential.
- Conservative measures include positioning, sedation, and the use of antipyretics.
- Employ medical therapies such as hyperosmolar agents (mannitol or hypertonic saline) and glucocorticoids.
- Refractory intracranial hypertension may require CSF drainage, hyperventilation, or decompressive craniectomy.
Meningitis: Causes and Symptoms
- Meningococcemia symptoms include myalgia, petechial or purpuric rash, and possibly Waterhouse-Friderichsen syndrome.
- Viral meningitis often presents with flu-like symptoms, low-grade fever, malaise, myalgia, and upper respiratory symptoms.
- Less than half of adults exhibit all classic meningitis triad symptoms; neonates typically show nonspecific signs.
Clinical Features
- Signs of meningeal irritation: neck stiffness, Kernig sign, and Brudzinski sign.
- Systemic signs of inflammation may include fever, hypotension, and tachycardia.
- Symptoms indicative of increased ICP include cranial nerve palsies and papilledema.
Diagnosing Meningitis Types
- Classic triad of meningitis may also present in subarachnoid hemorrhage with a sudden onset.
- Physical examination can reveal signs of underlying infections (e.g., acute otitis media or specific rashes).
Meningoencephalitis Features
- Meningoenecphalitis involves inflammation of both the meninges and brain parenchyma.
Treatment for Meningitis
- Antibiotic regimens include cefepime for Pseudomonas aeruginosa, doxycycline for R. rickettsii, and acyclovir for herpes viruses.
- Dexamethasone is indicated in proven bacterial meningitis (S. pneumoniae, H. influenzae) to reduce inflammation; it should not delay antibiotic therapy.
- Tuberculous meningitis connected to Mycobacterium tuberculosis appears after a 2-8 week incubation with subacute presentation.
Tuberculous Meningitis: Clinical Features
- Typical meningitis symptoms with focal neurological deficits and prolonged clinical course.
- CSF analysis reveals acid-fast bacilli, and adenosine deaminase activity is significantly elevated.
Prognosis and Complications
- Untreated bacterial meningitis is often fatal; prognosis in treated cases depends on various patient factors.
- Viral meningitis usually resolves spontaneously, but complications like hearing loss are rare.
- Fungal meningitis has a higher mortality rate and neurological complications; adherence to treatment is crucial.
Prevention Strategies
- Primary prevention involves treating infections that could spread to the CNS and vaccination against meningococcal disease.
- Postexposure chemoprophylaxis should be administered swiftly to close contacts to limit transmission, with specific regimens identified for various pathogens.
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