8/30/2006 Meningitis

Front 1

Acute, community acquired bacterial meningitis (18-50)

Back 1

vanco 1g IV q12hr AND ceftriaxone 2g IV q12hr AND dexamethasone 10mg IV q6hr x 4days 15-20min before abx

(pneumococcal, meningococcal)

Front 2

Acute, community acquired bacterial meningitis (>50)

Back 2

amp 2g IV q4hr AND vanco 1g IV q12hr AND ceftriaxone 2g IV q12hr AND dexamethasone 10mg IV q6hr x 4days 15-20min before abx


(pneumococcal, listeria, GNB)

Front 3

Acute, commnity acquired bacterial meningitis (pen/ceph allergy)

Back 3

chloramphenicol 1g IV q6hr AND vancomycin +/- rifampin 300mg IV q12hr AND dexamethasone 10mg IV q6hr x 4days 15-20min before abx

Front 4

TB meningitis (adults)

Back 4

isoniazid 300mg QD (+pyridoxine 50mg QD) AND rifampin 600mg QD AND pyrazinamide 15-30mg/kg/d AND ethambutol 15-25mg/kg/day x 9-12 months

(may d/c pyr and etham after 2 months if susceptible)

dexa recommended especially w/ decreased level of consciousness

Front 5

Brain abscess (predisposing condition unknown)

Back 5

ceftriaxone 2g IV q12hr AND metronidazole 500mg IV q6hr

Front 6

listeria monocytogenes

Back 6

ampicillin AND gentamicin

Alt: bactrim

Front 7

enterobacteriaceae (E.coli,etc)

Back 7

cefotaxime

Front 8

haem influ

Back 8

cefotaxime

Front 9

pseudomonas aeru

Back 9

ceftazidime AND tobramycin

Front 10

Prophylaxis considerations

Back 10

meningococcal: rifampin 600mg q12hr x 2days

haem.influ: rifampin 600mg daily x 4days

Front 11

Non-viral encephalitis (toxoplasmosis)

Back 11

Pyrimethamine 100-200mg po once (loading dose), then 50-100mg PO qd + sulfadiazine 4-8 g PO qd OR clindamycin 900mg IV q6hr + folinic acid 10mg PO qd x minimum 6 weeks

Front 12

Bacterial etiology of meningitis

Back 12

1)strep. pneumo
2)n.meningitidis
3)listeria
4)h.influenzae

Front 13

The critical first step in acquisition of acute bacterial meningitis is?

Back 13

nasopharyngeal colonization of the host

Front 14

S/sx of meningitis

Back 14

headache, nuchal rigidity, fever, stiffness of neck/back, brudzinski's sign, kernig's sign

Front 15

What is brudzinski's sign?

Back 15

neck sign: flexion of the neck by the examiner produces hip and knee flexion

leg sign: flexion of leg causes same flexion of contralateral leg then the reciprocal contralateral sign where leg extends spontaneously

Front 16

What is kernig's sign?

Back 16

examiner flexes hip 90 degrees to trunk and attempts to extend the knees causing "contracture" or extensor spasm at the knee 135 degrees (patient is unable to extend the leg at the knee due to hamstring stiffness)

Front 17

Newborn-1 month empiric therapy

Back 17

ampicillin AND ceftriaxone OR AG

(gram - enterics, group B strep, listeria)

Front 18

1 month-4 years

Back 18

ceftriaxone AND vanco

(haem influ, n. meni, s. pneumo)

Front 19

5-29 years

Back 19

ceftriaxone AND vanco

(n. meni, s. pneum, h. influ)

Front 20

30-60 years

Back 20

ceftriaxone AND vanco

(s.pneum, n.meni)

Front 21

>60 years

Back 21

ampicillin AND ceftriaxone OR AG AND vanco

(s.pneum, gram - enterics, listeria)

Front 22

What distinguishes meningococcal meningitis from other bacterial causes?

Back 22

Unique immune reaction: pt develops characteristic immunologic reaction of fever, arthritis, and pericarditis about 10-14 days after onset of dz and despite successful treatment.

no additional antibiotic therapy required, benefit from NSAIDs and supportive care

Front 23

Primary clue that the underlying pathogen is n. meni?

Back 23

presence of petchiae

Front 24

a)Neurologic complications such as coma and seizure
b)bacteremia

s.pneumo or n.meni

Back 24

a)s. pneumo
b)n. meni

Front 25

pneumococcal vaccine

Back 25

Prevnar approved for use in ages 2 months - 9 years

Front 26

risk factors for listeria

Back 26

neonates, immunocompromised, alcoholics, elderly

Front 27

Incidence of listeria peaks when?

Back 27

summer and early fall

Front 28

Benefits of dexamethasone

Back 28

lower incidence of neurologic sequalae

Front 29

Diagnostic sign unique to tuberculosis meningitis?

Back 29

paralysis of the VI cranial nerve, which initially is unilateral and then progresses to bilateral

Front 30

Cryptococcus neoformans meningitis treatmnet

Back 30

amphotericin B 0.5-1mg/kg/day AND flucytosine 100mg/kg/day

Front 31

Side effects of flucytosine

Back 31

bone marrow suppression and GI distress

Front 32

AIDS-associated cryptococcal meningtitis treatment

Back 32

Amphoterecin B w/wo flucytosine OR fluconazole alone

maintenance therapy w/ fluconazole or itraconazole for life of patient

Front 33

Drug of choice for herpes simplex encephalitis

Back 33

acyclovir 10mg/kg IV q8hr x 2-3wks

Front 34

Alternative treatment for acyclovir-resistant herpes simplex virus

Back 34

foscarnet 40mg/kg infused over 1 hr q8-12hr x 2-3wks

Front 35

Major toxicity of foscarnet

Back 35

renal impairment

Front 36

Monitoring for foscarnet

Back 36

seizures related to plasma electrolyte level alterations; imperitive to ensure adequate hydration

Front 37

Duration of antibiotic treatment for meningitis

Back 37

7-21 days depending on organism