Initial assessment of the acutely unwell- Meningitis

FRCEM EXAM QuestionsCategory: March 2017Initial assessment of the acutely unwell- Meningitis
FRCEM Intermediate Staff asked 2 years ago
25- year-old-lady is brought into AED by her housemates feeling generally unwell with myalgia and a headache which has been getting worse over the last 24 hours and nausea.
Her observations are temperature 38.6oC, HR 105 b/pm, BP110/75, RR 16/min. She is alert (GCS 15) but feels lethargic.
On examination, she has no focal neurological signs.
A. Give (4) clinical signs of meningitis? (1 mark)
B. What is the antibiotic of choice (dose & route)? What further drug should be considered? (1 mark)
C. Give (2) indications for CT scan? (1 mark)

1 Answers
FRCEM Intermediate Staff answered 2 years ago
A.
Severe headache (Thunderclap headache)
Stiff neck / Back rigidity.
Photophobia
Kernig’s sign (person unable to fully extend at the knee when hip is flexed)
Brudzinski’s sign (person’s knees and hips flex when neck is flexed)/*Impaired consciousness.
Focal neurological deficit (including cranial nerve involvement and abnormal pupils)
Seizures
Bulging fontanelle in children (but this patient is adult)

B.
Ceftriaxone 2g IV
Dexamethasone 16 mg. I. V

C.
Abnormal mental states
new onset seizures
immunocompromised
GCS < 10 focal neurological signs in keeping with a space occupying lesion.
Signs suggesting raised intracranial pressure.