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Meningitis & encephalitis flashcards

10 high-yield MRCP Part 1 cards from the Intellect Medicos Infectious Diseases course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.

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1. What is the commonest cause of bacterial meningitis in adults aged 18–50?

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   Streptococcus pneumoniae (Neisseria meningitidis second).

   Why? In neonates (<3 months) think group B streptococcus, E. coli and Listeria; over 50 and in immunosuppression add Listeria.

2. A GP suspects meningococcal disease. What should be given before transfer, if it will not delay transfer?

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   IM or IV ceftriaxone or benzylpenicillin.

   Why? Early antibiotics save lives in meningococcal disease, but transfer to hospital must not be delayed (NICE NG240).

3. What is the empirical antibiotic for suspected bacterial meningitis in hospital (NICE 2024)?

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   IV ceftriaxone (cefotaxime if ceftriaxone is contraindicated).

   Why? It covers pneumococcus, meningococcus and Haemophilus influenzae type b.

4. What is the treatment for confirmed Listeria meningitis?

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   IV amoxicillin (or ampicillin) for 21 days; an infection specialist may add IV co-trimoxazole for the first 7 days.

   Why? Listeria is naturally resistant to cephalosporins.

5. When should dexamethasone be given in suspected bacterial meningitis (NICE)?

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   IV dexamethasone with or just before the first antibiotic dose (patients over 3 months), without delaying antibiotics.

   Why? It reduces hearing loss and neurological damage, mainly in pneumococcal meningitis.

6. Name two features that mean brain imaging is needed before lumbar puncture in suspected meningitis.

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   Any two of: new focal neurology (including seizures), abnormal pupil responses, GCS ≤9 or falling consciousness, other signs of raised ICP.

   Why? These suggest raised ICP or a space-occupying lesion, when LP risks coning. Give antibiotics first — never delay them for imaging.

7. What is the typical CSF picture in bacterial meningitis?

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   Turbid; very high neutrophils (often >1000); protein >1 g/L; glucose low (CSF:serum ratio <0.4); raised opening pressure.

   Why? Viral meningitis gives lymphocytes, normal glucose and normal/mildly raised protein.

8. Which drug is preferred as chemoprophylaxis for close contacts of meningococcal disease (UKHSA)?

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   Single-dose oral ciprofloxacin.

   Why? It eradicates nasopharyngeal carriage; rifampicin or IM ceftriaxone are alternatives. Contacts may also be offered vaccine.

9. Which rapid CSF test is preferred for diagnosing TB meningitis?

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   NAAT (PCR) for M. tuberculosis DNA.

   Why? Ziehl–Neelsen staining of CSF has very low sensitivity; CSF culture is still sent for confirmation and sensitivities but takes weeks. CSF shows lymphocytes, high protein and low glucose.

10. A 40-year-old has 2 days of fever, confusion, odd behaviour and a seizure. MRI shows temporal lobe signal change. What should be started immediately?

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    IV aciclovir.

    Why? This is HSV encephalitis (usually HSV-1). Untreated mortality is very high; start treatment before CSF HSV PCR results.