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)
Severe headache (Thunderclap headache)
Stiff neck / Back rigidity.
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)
Bulging fontanelle in children (but this patient is adult)
Ceftriaxone 2g IV
Dexamethasone 16 mg. I. V
Abnormal mental states
new onset seizures
GCS < 10 focal neurological signs in keeping with a space occupying lesion.
Signs suggesting raised intracranial pressure.
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