Term
| Where is the subarachnoid space located? |
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Definition
In between the dura and the pia mater
**swelling of the meninges can cause brain to become necrotic |
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Term
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Definition
| Inflammation of the brain w/ EARLY mental status changes. Caused by a virus - CT and MRI rule out infection |
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Term
| What are the types of meningitis? |
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Definition
- Aseptic - no organism identified, but usually viral. Mild and self-limiting.
- Septic - a bacterial infection, usually caused by S. pneumoniae or N. meningitidis |
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Term
| What are risk factors for meningitis? |
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Definition
Age < 1 year
Alcoholic
High dose steroids
Spleen removal |
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Term
| What is the triad of meningitis symptoms? |
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Definition
- Fever
- Nuchal rigidity/stiff neck
- Altered mental status
**Children often have non-specific signs - low grade fever.
*** + Brudzinski's sign, Kernig's sign |
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Term
| How can a lumbar puncture diagnose meningitis? |
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Definition
- Normal - free of WBC
- Bacterial - highest WBC and protein |
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Term
| How do cultures impact treatment of meningitis? |
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Definition
| ALWAYS culture the CSF before treating empirically |
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Term
| How is meningitis treated? |
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Definition
- Hydration! + other supportive therapy
- Empiric treatment, then tx for 7-14 days
** +/- dexamethasone for S. pneumoniae or H. influenzae. |
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Term
| What promotes antibiotic penetration into the CSF? |
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Definition
- Low MW
- Maximized dose
- Do not choose an antibiotic with low CSF penetration |
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Term
| What are the most common treatments for bacterial meningitis? |
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Definition
- Ceftriaxone in adults, Cefotaxime in kids
- Pseudomonas - Cefepime/Ceftazidime
- Ampicillin in <1 month old |
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Term
| What are the most common causes of bacterial meningitis? |
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Definition
| - N. meningitidis/Meningococcus - most common. In winter or spring. Use High dose PCN if susceptible or Ceftriaxone. There is a vaccine! Rifampin for close contact - S. pneumoniae/Pneumococcus - common in adults - PCN, Ceftriaxone, or Vanc + Ceftriaxone. Vaccine! - H. influenzae - very rare after flu vaccine - Listeria - very young and old. use Ampicillin + gentamicin |
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Term
| What is the dose for ceftriaxone to treat meningitis? |
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Definition
ALWAYS 2 g q12h
**Push vancomycin peaks higher, to 40 or 45 |
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