A 30-month-old female Native American child was brought to the emergency room by her parents with a fever of 39.7 C. She had come home with a "cold" from her day care center several days ago, but yesterday was extremely fussy, crying almost all the time she was awake, and screaming if she was picked up. Today she was very lethargic, and, in fact, her parents report that it was hard to rouse her at all. You note that she is responsive only to deep pain.
Question 1 - Single Best Answer
What is the first thing you must rule out in this child that is unresponsive to outside stimuli? Bugs Database
A) child abuse
B) ear infection
C) heart failure due to rheumatic fever
D) meningitis
E) brain tumor
You try to bend her neck forward and find that it is very difficult to do so.
Question 2 - Single Best Answer
This nuchal rigidity (stiff neck) is a sign of? Bugs Database
A) meningitis or possibly encephalitis
B) tetanus
C) injury to the spinal chord
D) increased intracranial pressure due to a brain tumor
E) myalgia due to the production of interferon in a viral infection
Question 3 - Single Best Answer
The physical explanation of the nuchal rigidity in meningitis is? Bugs Database
A) intracranial pressure caused by fluid accumulation directly causes the nuchal rigidity
B) the pain from the meningeal irritation causes the patient to resist bending the neck
C) the bacteria invade the region of the brain controlling the neck musculature
D) occlusion of blood vessels result in muscle spasms
E) reflex muscle contractions from the meningeal irritation
Question 4 - Single Best Answer
What must be done immediately in a case of suspected meningitis? Bugs Database
A) Gram stain of CSF
B) glucose and protein level of the CSF
C) culture of CSF
D) complete blood count
E) blood culture
There are many causes of meningitis. They are usually divided into bacterial causes and other causes. It is important to know if the meningitis is septic (bacterial) or aseptic (other causes) as the bacterial meningitides can be treated. Some of the "other" causes include viruses, fungi, amoebas, spirochetes, and mycobacteria. The Gram stain of the CSF in these cases would show no bacteria.
Question 5 - Single Best Answer
The three most common causes of bacterial meningitis are? Bugs Database
A) Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria gonorrhoeae
B) Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis
C) Streptococcus pyogenes, Haemophilus influenzae, and Neisseria meningitidis
D) Streptococcus pyogenes, Staphylococcus aureus, and Neisseria meningitidis
Question 6 - Single Best Answer
Which one of the three most common causes of meningitis would be LEAST likely in this age group (30 mo.)? Bugs Database
A) Streptococcus pneumoniae
B) Haemophilus influenzae
C) Neisseria meningitidis
D) Streptococcus pyogenes
E) Streptococcus agalactiae (Group B Strep)
The Gram stain of the CSF was positive for numerous white cells and some pleiomorphic Gram-negative coccobacilli.
Question 7 - Single Best Answer
This (Gram negative coccobacilli) identifies the cause of her meningitis as? Bugs Database
A) Streptococcus pneumonia
B) Haemophilus influenzae
C) Neisseria meningitidis
D) Streptococcus pyogenes
E) Bordetella pertussis
Question 8 - Single Best Answer
Which of the following CSF profiles would be typical of this case of Haemophilus influenzae meningitis? Bugs Database
A) normal glucose, normal protein, polys or lymphs
B) normal glucose, moderately elevated protein, lymphocytes
C) slightly low or low glucose, moderately elevated protein, lymphs
D) low glucose, high protein, polys
Question 9 - Single Best Answer
If no bacteria had been seen in the Gram stain, and the CSF had a high protein and a low glucose, how could the cause of the meningitis be rapidly diagnosed? Bugs Database
A) culture the CSF
B) blood culture
C) serology ( detection of antibodies to the causative agent in the blood)
D) latex agglutination for detection of antigen in the CSF
E) latex agglutination for detection of antigen in the urine
Question 10 - Single Best Answer
In what situation might the CSF Gram stain be negative but the child still have bacterial meningitis? Bugs Database
A) the child has been treated with antibiotics before the CSF is taken
B) the white cells in the CSF have phagocytosed all the bacteria
C) the high intracranial pressure has caused the bacteria to lyse
D) the bacteria have migrated out of the CSF and into the brain, causing the symptoms observed
E) the child has been immunized against the bacteria
Question 11 - Single Best Answer
If bacteria can be identified by the Gram stain, is there any reason to culture them? Bugs Database
A) yes
B) no
C) only if Streptococci are seen
Question 12 - Single Best Answer
How would you culture and identify H. influenzae? Bugs Database
A) blood agar - look for beta hemolysis
B) blood agar - look for gamma hemolysis
C) MacConkey's agar - look for pink color
D) chocolate agar - look for any growth
E) Thayer-Martin agar (chocolate agar plus antibiotics) - look for any growth
Question 13 - Single Best Answer
What is the major virulence factor for all of the three most common bacterial causes of meningitis? Bugs Database
A) toxin
B) intracellular growth
C) superantigen
D) capsule
E) endotoxin
Question 14 - Single Best Answer
How can meningitis with H. influenzae be prevented? Bugs Database
A) passive immunization with horse sera
B) immunization of the mother
C) immunization of the child with toxoid
D) immunization of the child with capsular antigen
E) antibiotic prophylaxis until age three
Question 15 - Single Best Answer
What is the most common sequela of H. influenzae meningitis? Bugs Database
A) blindness
B) mental retardation
C) hearing impairment
D) pneumonia
E) ataxia
Question 16 - Single Best Answer
Which one of the following is the most effective treatment for H. influenzae meningitis? Bugs Database
A) passive immunization
B) vaccination with the Hib vaccine
C) ampicillin plus chloramphenicol
D) dexamethasone
Question 17 - Single Best Answer
What special risk factor(s) did this child have for H. influenzae meningitis? Bugs Database
A) her sex
B) her sex and ethnic origin
C) her ethnic origin and day-care attendance
D) her ethnic origin only
E) day care attendance only
Question 18 - Single Best Answer
What is the prognosis for this child? Bugs Database
A) very good
B) moderately good
C) not very good
D) poor
E) very poor