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28 Cards in this Set
- Front
- Back
1. Typical triad of meningitis sx?
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1. Fever
2. HA 3. Stiff neck |
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2. Brudzinski sign?
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a. A physical finding consistent w/meningitis.
b. While the pt is supine, the neck is passively flexed resulting in involuntary knee and hip flexion. |
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3. Kernig sign?
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a. A physical finding consistent w/meningitis.
b. While the pt is supine, the legs are flexed at the hip and knee at 90° resulting in pain w/leg extension |
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4. Most common causes of Neonatal meningitis?
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1. E. coli
2. Group B strep (strep agalactiae) b. Listeria and other organisms (Citrobacter, streph sp, group D strep, and candida) are less common. |
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5. What infants are at increased risk for meningitis?
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a. Low birth weight and preterm infants
b. Those born to mothers w/chorioamnionitis c. After a prolonged rupture of amniotic membrane d. Traumatic delivery. |
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6. How does most neonatal bacterial meningitis occur?
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a. Via Haematogenous spread.
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7. Clinical symptoms of neonatal meningitis?
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a. Nonspecific and not the typical triad.
b. Instead, may have: 1. Thermal instability (often hypothermia) 2. Poor feeding 3. Emesis 4. Seizures 5. Irritability 6. Apnea c. May have Bulging fontanelles!!!! d. May either be hypo or hypertonic. |
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8. 2 main causes of bacterial meningitis in older children?
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1. S. pneumoniae
2. N. Meningitidis b. Vaccination has essentially eliminated Haemophilus influenza type B. |
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9. In what season does pneumococcal meningitis most commonly occur?
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a. In winter.
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10. What children are at highest risk for pneumoccal meningitis?
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a. Poorly functioning or absent spleen (it is encapsulated).
b. Children w/sickle cell have an infection incidence 300x greater |
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11. Other risk factors for pneumococcal meningitis?
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a. Sinusitis
b. Otitis Media c. Pneumonia d. Head trauma w/CSF leak |
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12. In what % of normal individuals does Neisseria meningitidis colonize the URT?
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a. 15%.
b. Carriage rates up to 30% are seen during invasive disease outbreaks. c. Disease appears to be caused by “new” infection rather than by long-term carriage |
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13. Most common disease causing serotypes of N. meningitidis?
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a. B and C.
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14. Classic symptoms of meningitis seen in older children and adults?
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a. Mental status change
b. N/V c. Lethargy d. Restlessness e. Ataxia f. Back pain g. Kernig and Brudzinski signs h. Cranial nerve palsies. |
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15. What do ¼ to 1/3 of pts w/meningitis experience during the course of their disease?
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a. Seizure.
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16. Rash in Meningitis caused by N. meningitidis?
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a. Petechial or purpuric rash (purpura fulminans)
b. It is associated w/septicemia. |
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17. Note: Pts w/septicemia due to N meningitidis often are gravely ill and may or may not have associated meningitis.
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17. Note: Pts w/septicemia due to N meningitidis often are gravely ill and may or may not have associated meningitis.
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18. Test of choice for suspected meningitis?
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a. LP
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19. Contraindications to LP?
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a. Skin infection over the planned puncture site!!
b. Evidence of or clinical concern for increased ICP c. Critically ill pts who may not tolerate the procedure. |
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20. What is measured in CSF analysis?
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1. Gram stain and culture
2. White and red blood cell counts 3. Protein and glucose b. Bacterial antigen screens can be performed in pts already receiving abx before the LP; these antigens may persist for several days, even when the culture is negative. |
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21. Typical bacterial meningitis findings with LP?
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a. Elevated opening pressure
b. Several hundred to thousands of WBCs w/PMN predominance. c. ↑ protein d. ↓ glucose. |
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22. What should guide the decision make process for tx of bacterial meningitis?
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a. CSF gram stain.
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23. Tx of meningitis in neonate?
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a. Ampicillin + (3rd gen ceph or aminoglycoside)
b. To cover infections caused by GBS, L. monocytogenes, and E. coli. |
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24. Tx of suspected pneumococcal meningitis?
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a. 3rd gen ceph + Vanco.
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25. What are most N. meningitidis strains susceptible to?
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a. PCN or cephs
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26. Acute meningitis complications?
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a. Seizures
b. Cranial nerve palsies c. Cerebral infarction d. Cerebral or cerebellar herniation e. Venous sinus thrombosis f. Subdural effusions. g. SIADH w/hyponatremia and central diabetes insipidus |
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27. Most common long-term sequela of acute meningitis infection?
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a. Hearing loss (up to 30% of pts w/pneumococcus)
b. Pts w/bacterial meningitis usually have a hearing eval at the conclusion of abx tx. |
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28. Note: retropharyngeal abscess can also cause a stiff neck. Look for sore throat, dysphagia and fullness in oropharynx. Prob have normal mental status. Can also have nuchal rigidity.
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28. Note: retropharyngeal abscess can also cause a stiff neck. Look for sore throat, dysphagia and fullness in oropharynx. Prob have normal mental status. Can also have nuchal rigidity.
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