Spinal Tea
Opening pressure high, neutrophil-predominant pleocytosis in the thousands, glucose low, protein high — name this CSF category.
Bacterial meningitis
Standard empiric regimen for a healthy 30-year-old with suspected bacterial meningitis?
Ceftriaxone + Vancomycin (if resistance)
Close contacts of a patient with meningococcal meningitis need chemoprophylaxis — name two acceptable agents.
Rifampin, ciprofloxacin, or ceftriaxone (any two)
Door-to-antibiotics goal for suspected bacterial meningitis?
Within 60 minutes — ideally sooner
Lymphocyte-predominant CSF with LOW glucose and elevated protein — this pattern should push you past 'just viral.' Two organisms to consider?
TB meningitis or Listeria monocytogene
Patient is 65 — what do you ADD to ceftriaxone + vancomycin, and why?
Ampicillin, for Listeria monocytogenes coverage (add for age >50 or immunocompromised)
Droplet precautions for meningococcal meningitis can be discontinued how long after effective antibiotics start?
24 hours
You're waiting on a head CT before your LP. Should antibiotics wait for it too?
No — give empiric antibiotics (± steroids) immediately, then proceed to CT/LP
Lymphocytic pleocytosis with a NORMAL-to-mildly-low glucose and mildly elevated protein — classic for this broad category.
Viral (aseptic) meningitis
Empiric regimen for a neonate under 1 month — and which drug do you specifically avoid in this age group?
Ampicillin + Cefotaxime (± gentamicin); avoid ceftriaxone — bilirubin displacement risk in neonates
For Hib exposure, prophylaxis is recommended for household contacts when there's an unvaccinated or under-vaccinated child under what age in the household?
under 5 years age
Name two indications to get a CT before LP.
focal neurologic deficit, papilledema, new seizure, immunocompromised state
India ink stain positive, or CSF cryptococcal antigen positive, with lymphocytic pleocytosis and elevated opening pressure — which patient population should prompt this test?
Immunocompromised / HIV patients — cryptococcal meningitis
When should dexamethasone be given relative to the first antibiotic dose?
With or just before the first dose of antibiotics — not after
recommended Hib and pneumococcal vaccines at what intervals?
2,4,6 months and 12-15 months
LP is contraindicated (e.g., coagulopathy or mass effect) in a patient you strongly suspect has bacterial meningitis. What's your move?
Start empiric antibiotics and steroids immediately; defer the LP rather than delaying treatment
CSF protein markedly elevated, glucose low, but Gram stain is negative — in a patient who received oral antibiotics 2 days before the tap. What does this represent?
Partially (pre-)treated bacterial meningitis — cultures/Gram stain can be falsely negative
Adjunctive dexamethasone shows the clearest mortality/hearing-loss benefit with which pathogen?
strep pneumococcus
recommended routine meningococcal vaccines at what ages?
11 or 12 years, booster at 16 years of age
Should you delay antibiotics to draw blood cultures first?
No — draw blood cultures simultaneously with (or just before) giving antibiotics, but never delay treatment for them