Meningococcal Meningitis And Septicaemia
This quiz is based on the implementation of the current National Institute for Health and Clinical Excellence (NICE) UK Guideline for the management of bacterial meningitis and meningococcal septicaemia in children and young people in primary and secondary care.
- 1.Case fatality rates in bacterial meningitis in children and young people is:
- A.
1-2%
- B.
2-11%
- C.
15-20%
- D.
25-50%
- E.
Less than 1%
- 2.The highest case fatality rates in bacterial meningitis is in the:
- A.
Neonates
- B.
Infants and toddlers
- C.
2 to 5years
- D.
School age between 5 and 10 years
- E.
Adolescence and early adulthood
- 3.The two highest incidence of meningococcal disease occurs in what age groups are:
- A.
Children under 2 years
- B.
2 to 5years
- C.
School age between 5 and 10 years
- D.
Adolescence and early adulthood
- 4.The NICE (UK) guideline was published in:
- A.
Jan 2010
- B.
June 2010
- C.
Jan 2009
- D.
Dec 2009
- E.
Oct 2010
- 5.Commonest causes of bacterial meningitis in neonates include:
- A.
S agalactiae (group B streptococcus)
- B.
E coli
- C.
N meningitidis (meningococcus)
- D.
Strep pneumoniae
- E.
Listeria monocytogenes
- 6.Commonest causes of bacterial meningitis in older children and young people include:
- A.
N meningitidis (meningococcus)
- B.
S agalactiae (group B streptococcus)
- C.
E coli
- D.
S pneumoniae (pneumococcus)
- E.
Haemophilus influenzae type b
- 7.Neisseria Meningitidis is:
- A.
A heterotrophic gram-negative diplococcal
- B.
A heterotrophic gram-positive diplococcal
- C.
First discovered by Anton Weichselbaum in 1887
- D.
It exists as normal flora in the nasopharynx of up to 5-15% of adults.
- E.
Can be is spread through the exchange of saliva and chewing on toys
- 8.Associated signs in children with petechiae indicating high risk of having meningococcal disease include:
- A.
Spreading petechiae
- B.
The rash becoming purpuric or necrotic
- C.
The rash becoming pustular
- D.
Neck stiffness
- E.
Signs of shock
- 9.What are the two confirmatory investigations of meningococcal meningitis and septicaemia?
- A.
Whole blood real-time PCR testing (EDTA sample) for N meningitides
- B.
Lumbar puncture
- C.
FBC
- D.
CRP
- E.
Blood Culture
- 10.Signs of meningitis are:
- A.
Photophobia
- B.
Kernig’s sign or Brudzinski’s sign
- C.
Bulging fontanelle
- D.
Diarrhoea, abdominal pain, or distension
- E.
Focal neurological deficit
- 11.Signs of septicaemia are:
- A.
Toxic or moribund state
- B.
Shock
- C.
Hypotension
- D.
Leg pain
- E.
Sore throat or coryza
- 12.Contraindications to a lumbar puncture are:
- A.
Signs suggesting raised intracranial pressure
- B.
Shock
- C.
Extensive or spreading purpura
- D.
Extreme preterm neonate
- E.
After convulsions until stabilised
- 13.Signs of shock include:
- A.
Capillary refill time longer than 2 seconds
- B.
Unusual skin colour
- C.
Tachycardia or hypotension
- D.
Respiratory symptoms or breathing difficulty
- E.
Leg pain
- 14.Intravenous fluid resuscitation in meningococcal septicaemia include:
- A.
20 ml/kg 0.9% sodium chloride fluid bolus over 5–10 minutes if there are signs of shock
- B.
20 ml/kg 10% Glucose fluid bolus over 5–10 minutes if there is hypoglycaemia
- C.
A second bolus of 20 ml/kg of sodium chloride 0.9% if the signs of shock persist
- D.
A second bolus of 10 ml/kg of sodium chloride 0.9% if the signs of shock persist
- E.
A second bolus of 20 ml/kg of human albumin 4.5% solution if the signs of shock persist
- 15.You can give fluid boluses by which routes for management of shock:
- A.
Intravenous
- B.
Intraosseous
- C.
Subcutaneous
- D.
Intratracheal
- E.
Oral
- 16.How do you manage the patient further if the signs of shock still persist after the first 40 ml/kg:
- A.
Immediately give a third bolus of 20 ml/kg of 0.9% sodium chloride or human albumin 4.5% solution over 5–10 minutes
- B.
Call for anaesthetic assistance for urgent tracheal intubation and mechanical ventilation
- C.
Start treatment with vasoactive drugs and discuss further management with a paediatric intensivist
- D.
Avoid giving more than 40 ml/kg of fluid over a short period of time even if there is inadequate circulating volume
- E.
Consider giving further fluid boluses at 20 ml/kg normal saline or human albumin 4.5% solution over 5–10 minutes based on clinical signs and appropriate laboratory investigations including urea and electrolytes
- 17.Meningococci are susceptible to several antimicrobial agents:
- A.
Ceftriaxone, cefotaxime, and cefuroxime are cephalosporins that penetrate sufficiently into CSF from blood and are useful in the treatment of bacterial meningitis
- B.
Meningococci, are susceptible to chloramphenicol, rifampin, erythromycin, and tetracyclines and ciprofloxacin
- C.
Treat children aged older than 3 months with intravenous ceftriaxone
- D.
Most patients with uncomplicated meningococcemia defervesce within the first 24 hours of antibiotic therapy
- E.
Treat children younger than 3 months with intravenous cefotaxime plus amoxicillin or ampicillin
- 18.Clinical presentation of meningococcal disease include:
- A.
Mostly non-specific symptoms or signs, difficult to distinguish from other less important (viral) infections in children
- B.
A well child who has been exposed to a patient with meningococcal meningitis in the past 7 days
- C.
More specific symptoms and signs are more likely to be secondary to bacterial meningitis or meningococcal septicaemia
- D.
Symptoms and signs may become more severe and more specific over time
- E.
Shock
- 19.Possible complications of meningococcal septicaemia and meningitis include:
- A.
Hearing loss
- B.
Hepatosplenomegaly
- C.
Damage to bones and joints
- D.
Skin scarring from necrosis
- E.
Psychosocial problems
- 20.Chemoprophylaxis recommended for meningococcal disease include:
- A.
All recent significant contacts of the infected patient over the 7 days before onset of symptoms
- B.
Possible chemoprophylaxis with rifampicin, ceftriaxone, or ciprofloxacin, minocycline, and spiramycin
- C.
Chemoprophylaxis is not recommended during epidemics because of multiple sources of exposure and prolonged risk of exposure
- D.
Children could receive either a single IM injection of ceftriaxone or 4 oral doses of rifampin over 2 days, according to body weight
- E.
Ciprofloxacin is not recommended in persons older than 18 years
- 21.What constitutes significant exposure for meningococcal chemoprophylaxis?
- A.
Prophylaxis should be given to contact young children and their carers or nursery-school contacts
- B.
Anyone who had direct exposure to the patient through kissing, sharing utensils, or medical interventions such as mouth-to-mouth resuscitation
- C.
Anyone who frequently ate, slept or stayed at the patient's home during the 14 days before the onset of symptom
- D.
A person who sat beside the patient on an airplane flight of more than 8 hours
- E.
Co-workers and school classmates
- 22.Indications for Corticosteroids in meningococcal meningitis include:
- A.
Children younger than 3 months
- B.
Dose is 0.15 mg/kg to a maximum dose of 10 mg, four times daily for four days
- C.
Frankly purulent cerebrospinal fluid
- D.
CSF wbc count greater than 1000/μl count with protein concentration greater than 1 g/l
- E.
Bacteria CSF on Gram stain
- 23.When do you want to review children and young people with the results of their hearing test after discharge from hospital?
- A.
4–6 weeks
- B.
2-3 months
- C.
2 -3 weeks
- D.
4-6 months
- E.
6-8 months
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