Meningitis

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1. All of the following are a cause of CNS infections EXCEPT 7. Define meningitis: Inflammation of the protective membranes
covering the brain and spinal cord.
A. Bacteria
- Pia mater, arachnoid mater, dura mater
B. Viruses 8. Dexamethasone dosing?: .15 mg/kg IV QID x 4 days
9. The microorganism specific to meningitis cases in neonate is
C. Fungi
A. Streptococcus pneumoniae
D. Parasites
B. Group B Streptococcus
E. All are causes of CNS infections: E. All are causes of CNS
infection
C. Haemophilus Influenzae

We will be focusing on "bacteria"

D. All the above: B. Group B streptococcus
2. Appropriate initial (empiric) therapy for Listeria
monocytogenes meningitis (pending antibiotic Group B strep is found within the mother and can be given to
susceptibility data) includes baby during delivery
10. Monitoring parameters for cefotaxime?: Diarrhea (C.diff)
A. Ampicillin plus gentamicin
11. Monitoring parameters for ceftriaxone?: Avoid IV calcium,
pancreatitis, diarrhea C.diff, gallbladder stones
B. Vancomycin alone
12. Monitoring parameters for dexamethasone?: Increased BP,
C. Vancomycin plus cefotaxime increased glucose, GI upset, GI bleeds, palpitations, insomnia,
tremors, increased appetite, edema, mood changes, acne
D. Cefotaxime alone: A. Ampicillin plus gentamicin 13. The most important laboratory tests needed to diagnose
bacterial meningitis are
Ampicillin covers for listeria
Gentamicin covers for e.coli A. Gram stain and aerobic culture
3. By definition, encephalitis is an infection of the
B. CBC with differential
A. Pia mater
C. Enzyme immunoassay (EIA) and polymerase chain
B. Brain tissue reaction (PCR)

C. Sub-arachnoid space D. MRI or head CT scan

D. Dura mater: B. Brain tissue E. PCR testing: A. Gram stain and aerobic culture

- Encephalitis is infection of the brain tissue - Most important because the gram stain can help determine
- Meningitis is infection of the protective layers of the brain which bug we are targeting in our treatment and can help
4. Cefotaxime dosing?: 1000 mg IV q6 hr (50 mg/kg/dose) determine if we are dealing with bacterial meningitis in the first
place
5. Ceftriaxone dosing?: 1000 mg IV q12 hr
14. Multidrug resistant Streptococcus pneumoniae may force
6. Close contacts of meningitis patients should receive
clinicians to resort to agents such as
prophylaxis in cases of

A. Aztreonam
A. Haemophilus influenzae

B. Erythromycin
B. Listeria monocytogenes

C. Tigecycline
C. Staphylococcus aureus

D. Linezolid: D. Linezolid
D. Streptococcus pneumoniae: A. Haemophilus influenza
15. Neonate ampicillin dosing: 200-400 mg/kg/day (50-100
Transferred by coughing and sneezing mg/kg/dose) IV q6 hr
16. Neonate cefotaxime dosing: 50 mg/kg/dose IV q6 hr 27. What are the 4th generation cephalosporins we should focus
17. Neonate gentamicin dosing: 5 mg/kg/dose IV q24 hr on?: 1. cefepime
18. Penicillin resistance has been seen in 28. What are the different types of meningitis?: - Bacterial (main
focus)
A. Streptococcus pneumoniae
- Viral (can be cleared with steroids)
B. Neisseria meningitides
- Other that we will not discuss: fungal, parasitic, amebic,
C. Haemophilus influenzae noninfectious
29. What bug are you more prone to during surgery or medical
D. All the above: D. All of the above procedures?: Will see Staph species (mainly)
19. The pneumococcal 13-valent conjugate vaccine (PCV13) is
recommended in which of the following populations: May see Strep. Pyogenes
30. What cause meningitis in babies/children?: - S. Pneumoniae
A. Adults ≥ 60 years of age
- N. Meningitidis
B. Healthy infants at 2 months of age
- H. Influenzae type B (HIB)
C. Individuals who are immunocompromised
- Group B Strep (less prevalent with age)
D. All of the above: C. Individuals that are 31. What causes meningitis in newborns: - Group B Strep (S.
immunocompromised Agalactiae) -- from mother during delivery (main)
20. Prophylactic Ceftriaxone dosing: 250 mg x 1 dose
21. Prophylactic Ciprofloxacin dosing: 500 mg x 1 dose - S. Pneumoniae
22. Prophylactic Rifampin dosing: 600 mg PO BID x2 days
- Listeria (very young or very old)
23. The use of dexamethasone in meningitis has been
questioned due to the - E. coli (from mother)
32. What causes meningitis in older adults?: - S. Pneumoniae
A. Corticosteroid's tendency to worsen inflammation

- N. Meningitidis
B. Possible decrease in drug penetration into the CNS

- H. Influenza type B (HIB)

C. Corticosteroid's effects on lipid profile

- Group B strep (S. Agalactiae)

D. Cost of corticosteroids: B. Possible decrease in drug
penetration into the CNS
- Listeria
24. What are common S/S of meningitis?: Headache, fever, neck
33. What causes meningitis in teens and young adults?: - N.
stiffness, altered mental status, seizures, abnormal CSF
Meningitidis
25. What are risk factors for developing meningitis?: Age --
newborns get it form their mother's (group B strep or E. coli) - S. Pneumoniae (cough and cold)
34. What drug should be given empirically if gram - bacilli are
Community setting -- college campuses
probable?: Gentamycin (amingoglycoside)
Certain medical conditions -- low immunosuppression or
Aminoglycosides can cause nephrotoxicity and ototoxicity
surgical procedures
35. What is found on the normal flora of the skin?:
Other: Staphylococcus epidermis
- working with meningitis causing pathogens
- travel (Africa or Mecca) Streptococcus pneumonia
26. What are the 3rd generation cephalosporins we should
E. coli + Enterococci in the gut
focus on?: 1. cetazidime
2. cefotaxime
3. ceftriaxone
36. What is used for diagnosis of meningitis?: Blood Cultures (tell if bacteria is G+ or G- best for rapid preemptive diagnosis)

Lumbar Puncture (determine if there is blood or unwanted items in the CSF)

MRI
CT
37. What labs do you want to monitor for rifampin?: Liver function, potential drug interactions, diarrhea (C.diff), increased glucose
38. What labs do you want to monitor for vancomycin?: Renal function (BUN, Cr, In/out), red man syndrome

To avoid red man syndrome - run over 1 hour or pre treat with Benadryl
39. What would you expect the CSF chemistry to look like in a case of bacterial meningitis

A. Presence of red blood cells

B. CSF protein level: 40 mg/dL (400 mg/L)

C. WBC >10/mm3 (> 10 × 106/L)all mononuclear

D. Decreased glucose (30% of serum glucose concentration)

E. All of the above are true: D. Decreased glucose (30% of serum glucose concentration)

Bacterial meningitis can be determined by looking at the CSF glucose levels.

- Bacteria feeds on the CSF glucose for nutrients
40. Which cephalosporins should be used in treatment of meningitis?: 3rd generation and 4th generation because they cross the BBB
well
41. Which diagnostic tool is preferred in newborns?: CAMP Test
42. Which drug turns bodily fluids orange?: Rifampin
43. Which of the following antibiotics are optimally dosed to ensure adequate CNS penetration in an adult with normal renal
function

A. Linezolid 600 mg IV every 8 hours

B. Meropenem 1 gram IV every 8 hours

C. Ceftriaxone 2 grams IV every 12 hours

D. Ampicillin 2 grams IV every 8 hours: C. Ceftriaxone 2 grams IV q12 hr