🤔 MEDIUM

This is a single MedGuide quiz about one differential. Prominently featured on the UKMLA, and in many an OSCE station, an acutely sick child fever presentation is bread-and-butter. Good luck! 

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child fever part two

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Question 1
Please read the SBAR to understand the patient case

What is the most common cause of bacterial meningitis in the neonate?
A
Group A streptococcus
B
Group B streptococcus
C
Group C streptococcus
D
Group D streptococcus
E
Group E streptococcus
Question 1 Explanation: 
Many trusts now automatically screen patients toward the end of the antenatal period for flora of GBS. This is because GBS is a key cause of bacterial meningitis in the neonate (alongside E.coli, staph aureus and listeria). The mortality rate of neonatal sepsis remains 50% according to some literature. Bundy LM, Noor A. Neonatal Meningitis. [Updated 2021 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK5322.
Question 2
The patient is prone (back-down), with the head passively flexed, until the chin touches the chest. Which manoeuver is this test describing?
A
Brudzinski
B
Kernig
C
Loomes-Vrdoljak
D
Murphy
E
Osler
Question 2 Explanation: 
Brudzinski’s sign, worth a google to see the images of the procedure, is an involuntary flexion of the hip and knee joints in response to passive forward flexion of the neck toward the thorax. Alongside Kernig’s sign, it is one of an examiner’s favourite screening tools for OSCEs. Murphy’s sign is used in the acute abdomen, Osler nodes are found in endocarditis on the hand. JLV is a co-founder of MedGuide and no sign named after him (yet!!).
Question 3
The test, undertaken above, is found to be positive. Which result below would suggest a positive outcome?
A
Pain in the head
B
Pain in the neck
C
Responsive foot flexion
D
Responsive hip flexion
E
Responsive truncal flexion
Question 4
Which of the following best describes the microbiology of the most common causative organism of meningococcal septicaemia in adults?
A
Encapsulated virus
B
Extant protozoan
C
Gram negative diplococcus
D
Gram positive diplococcus
E
Unencapsulated virus
Question 4 Explanation: 
The most common cause of meningococcal septicaemia in adults is neisseria meningitidis. This a circular diplococcus bacteria. Its worth noting that the meningococcal septicaemia state is when this organism is found in the blood, but meningococcal meningitis is when the bacteria is found in the cerebrospinal fluid to confirm meningitis occurring.
Question 5
In the community, a patient with a presentation of meningism should be given a stat dose of which medication intramuscularly?
A
Benzylpenicillin
B
Ceftriaxone
C
Metronidazole
D
Carbapenem
E
Amoxicillin
Question 5 Explanation: 
Meningism includes - fever, neck stiffness, non-blanching purpuric rash, photophobia and headache. If you add altered level of consciousness and acute onset, you have quite a good safety net of screening questions to identify meningitis in a history.
Question 6
Which of the below findings would be indicative of bacterial meningitis on cerebrospinal fluid tap? Select all which may apply.
A
Increased glucose level
B
Lymphocytic leukocytosis
C
Neutrophilic leukocytosis
D
Turbid fluid appearance
E
Xanthochromia
Question 6 Explanation: 
The parameters of a CSF analysis, and the surface anatomy of its acquisition, is bread and butter medical school knowledge. Make sure you know the appearance, glucose, blood, white cell and protein count for bacterial, viral, tuberculosis and fungal CSF infiltrates.
Question 7
Which of the below most accurately describes the layers transected to reach the cistern on a lumbar puncture?
A
Skin > supraspinous ligament > interspinous ligament > ligamentum flavum > epidural space > dura-arachnoid > subarachnoid space
B
Skin > interspinous ligament > supraspinous ligament > ligamentum flavum > epidural space > dura-arachnoid > subarachnoid space
C
Skin > interspinous ligament > ligamentum flavum > supraspinous ligament > epidural space > dura mater > subarachnoid space
D
Skin > interspinous ligament > ligamentum flavum > supraspinous ligament > epidural space > arachnoid mater > dura space > subarachnoid space
E
Skin > interspinous ligament > supraspinous ligament > epidural space > dura mater > arachnoid mater > subarachnoid space
Question 8
The patient is placed on intravenous ceftriaxone first-line. Given the patient’s demography, what is the appropriate dosing? You should use the paediatric BNF for your calculations in the UK.
The patient is a 7 year old female weighing 30kg.
A
2g once daily
B
2g twice daily
C
3g once daily
D
3g twice daily
E
4g once daily
Question 8 Explanation: 
Bacterial meningitis and bacterial endocarditis ceftriaxone IV dose - as per the paediatric BNF (August 2021) states - For Child 1 month–11 years (body-weight up to 50 kg) give 80–100 mg/kg once daily, 100 mg/kg once daily dose should be used for bacterial endocarditis; maximum 4 g per day. As such, with a 30kg weight, the 7 year old female receives (30*100) = 3000mg or 3g per day IV ceftriaxone.
Question 9
Due to the presence of bacterial infection suggested on lumbar puncture, another medication is ordered. Which of the below is the most appropriate adjunct to therapy?
A
Benzylpencillin
B
Carbapenem
C
Dexamethasone
D
Prone oxygen therapy
E
Vancomycin
Question 9 Explanation: 
Dexamethasone is given as adjunct therapy (and should never solely replace antimicrobial agents) due to its ability to decrease nervous system adverse effects of meningitis. It is known to be protective against development of cerebral palsy, hearing loss and other neurological deficits.
Question 10
What is the most common viral cause of meningitis in the paediatric population?
A
Cytomegalovirus
B
Herpes simplex virus
C
Mumps virus
D
Rubella virus
E
Varicella zoster virus
Question 11
Which of the CSF findings is most suggestive of viral meningitis?
A
Increased glucose level
B
Lymphocytic leukocytosis
C
Neutrophilic leukocytosis
D
Turbid fluid appearance
E
Xanthochromia
Question 11 Explanation: 
Remember, simplistically speaking, a neutrophilic leukocytosis is suggestive of a bacterial infection response. Conversely a lymphocytic leukocytosis is more suggestive of a viral response.
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