Board Review Questions of the Week – Pediatric Meningitis

Adam WandermanPediatric Medicine Question of the Week, Personal Education, Question of the Week

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Free pediatric meningitis board review questions sample from Med-Challenger.

Med-Challenger offers meningitis review along with everything else for diagnosing and treating a variety of neurologic disorders with in-depth review questions with detailed explainations. More free neurologic disorder review questions can be accessed via this week’s Quick Quiz, and via free trial of the following specialty courses:

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This week’s case-based question:


A 9-year-old boy with no past medical history presents with 2 days of headache, vomiting, and fever as high as 104.1°F. When he starts complaining of a stiff neck, his mother takes him to the emergency department. Per his mother, there is no history of recent travel. He is in school, and reportedly several children in his class have been suffering from a gastrointestinal illness.

Lumbar puncture is performed, the results of which are as follows:

Fluid appearance: Clear
Pressure: 80 mm H2O (normal range: 50-80)
Leukocytes: 200/mL (normal range: < 5) with a lymphocyte predominance Protein: 100 mg/dL (normal range: 20-45) Glucose: 60 mg/dL (normal range: > 50)

What central nervous system disorder does this child most likely have?

Answer Options

viral meningitis
bacterial meningitis
tuberculous meningitis
fungal meningitis

And the answer is …


Correct Answer:

viral meningitis

Educational Objective:

Identify the etiology of meningitis based on findings on cerebrospinal fluid analysis.

Explanation:

Meningitis involves inflammation of the meninges. It may presents with nonspecific symptoms that include headache, nausea, vomiting, and an altered level of consciousness. Other common signs include fever, neck pain/rigidity, seizure disorder, and focal neurologic deficits.

Cerebrospinal fluid analysis may help distinguish the etiology of the meningitis. Acute bacterial meningitis often has elevated levels of opening pressure, leukocytes, and protein; by contrast, glucose levels are low. Viral meningitis has a normal or only slightly elevated opening pressure, elevated leukocytes (though often not > 1000/mL), elevated protein level (50-200 mg/dL), and normal glucose levels. With tuberculous and fungal meningitis, the opening pressure, leukocyte count, and protein level can be high, but the glucose level is usually low.

References:

Di Pentima C. “Viral meningitis: management, prognosis, and prevention in children.UpToDate (Accessed 4/24/2018)

Prober CG, et al. Central nervous system infections. In: Kliegman RM, et al, eds. Nelson Textbook of Pediatrics. 20th ed., 2015:2936-2948.

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