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%
Correct Answer
B. 2-11%Explanation
Bacterial meningitis in children and young people is associated with case fatality rates of 2-11%, the rate being particularly high (10%) in neonatesRate this question:
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- 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
Correct Answer
A. NeonatesExplanation
The fatality rate for meningococcal disease in childhood is highest (10%) in neonates.Rate this question:
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- 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
Correct Answer(s)
A. Children under 2 years
D. Adolescence and early adulthoodExplanation
The highest incidence of meningococcal disease occurs in children under 2 years, with further peaks in incidence occurring in adolescence and early adulthood.Rate this question:
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- 4.
The NICE (UK) guideline was published in:
- A.
Jan 2010
- B.
June 2010
- C.
Jan 2009
- D.
Dec 2009
- E.
Oct 2010
Correct Answer
B. June 2010Explanation
The NICE (UK) guideline was published in June 2010.Rate this question:
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- 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
Correct Answer(s)
A. S agalactiae (group B streptococcus)
B. E coli
D. Strep pneumoniae
E. Listeria monocytogenesExplanation
In neonates, bacterial meningitis is often caused by organisms acquired from the maternal genital tract and gastrointestinal tract around the time of birth. Such organisms include S agalactiae (group B streptococcus), E coli, Strep pneumoniae, and Listeria monocytogenes.Rate this question:
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- 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
Correct Answer(s)
A. N meningitidis (meningococcus)
D. S pneumoniae (pneumococcus)
E. HaemopHilus influenzae type bExplanation
In older children and young people, bacterial meningitis is usually caused by N meningitidis (meningococcus), S pneumoniae (pneumococcus), or Haemophilus influenzae type b, which colonise the upper respiratory tract and can cause invasive disease in susceptible people.Rate this question:
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- 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
Correct Answer(s)
A. A heterotropHic gram-negative 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 toysExplanation
Neisseria Meningitidis is an heterotrophic gram-negative diplococcal first discovered by Anton Weichselbaum in 1887
It exists as normal flora in the nasopharynx of up to 5-15% of adults.Rate this question:
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- 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
Correct Answer(s)
A. Spreading petechiae
B. The rash becoming purpuric or necrotic
D. Neck stiffness
E. Signs of shockExplanation
Give intravenous ceftriaxone immediately to children and young people with a petechial rash if any of the following occur at any point during the assessment (these children are at high risk of having meningococcal disease):
− petechiae start to spread
− the rash becomes purpuric
− there are signs of bacterial meningitis
− there are signs of meningococcal septicaemia
− the child or young person appears ill to a healthcare professionalRate this question:
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- 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
Correct Answer(s)
A. Whole blood real-time PCR testing (EDTA sample) for N meningitides
B. Lumbar punctureExplanation
Special investigations for meningoccal disease are whole blood real time Polymerase chain reaction and LP to confirm a diagnosis of meningococcal disease.Rate this question:
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- 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
Correct Answer(s)
A. pHotopHobia
B. Kernig’s sign or Brudzinski’s sign
C. Bulging fontanelle
D. Diarrhoea, abdominal pain, or distension
E. Focal neurological deficitExplanation
Signs of meningitis are Photophobia, Kernig’s sign or Brudzinski’s sign, Paresis or Seizures, Bulging fontanelle, Diarrhoea, abdominal pain, or distension, Focal neurological deficit.Rate this question:
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- 11.
Signs of septicaemia are:
- A.
Toxic or moribund state
- B.
Shock
- C.
Hypotension
- D.
Leg pain
- E.
Sore throat or coryza
Correct Answer(s)
A. Toxic or moribund state
B. Shock
C. Hypotension
D. Leg painExplanation
Signs of septicaemia include Impaired consciousness, Toxic or moribund state, Shock, Hypotension, Leg pain, Cold hands or feetRate this question:
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- 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
Correct Answer(s)
A. Signs suggesting raised intracranial pressure
B. Shock
C. Extensive or spreading purpura
E. After convulsions until stabilisedExplanation
Contraindications to a lumbar puncture include signs suggesting raised intracranial pressure, shock, extensive or spreading purpura, after convulsions until stabilised, coagulation abnormalities, local superficial infection at the lumbar puncture site, respiratory insufficiencyRate this question:
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- 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
Correct Answer(s)
A. Capillary refill time longer than 2 seconds
B. Unusual skin colour
C. Tachycardia or hypotension
D. Respiratory symptoms or breathing difficulty
E. Leg painExplanation
Signs of shock include Capillary refill time longer than 2 seconds, Unusual skin colour, Tachycardia or hypotension, Respiratory symptoms or breathing difficulty, Leg pain, Altered mental state or decreased consciousness, Poor urine outputRate this question:
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- 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
Correct Answer(s)
A. 20 ml/kg 0.9% sodium chloride fluid bolus over 5–10 minutes if there are signs of shock
C. A second bolus of 20 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 persistExplanation
Do not restrict fluids unless there is evidence of − raised intracranial pressure, or increased antidiuretic hormone secretion.
If the signs of shock persist after the first 20ml/kg bolus, immediately give a second bolus of 20 ml/kg of intravenous or intraosseous normal saline or human albumin 4.5% solution over 5–10 minutesRate this question:
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- 15.
You can give fluid boluses by which routes for management of shock:
- A.
Intravenous
- B.
Intraosseous
- C.
Subcutaneous
- D.
Intratracheal
- E.
Oral
Correct Answer(s)
A. Intravenous
B. IntraosseousExplanation
You can give fluid boluses by the Intravenous or Intraosseous routes for management of shockRate this question:
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- 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
Correct Answer(s)
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
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 electrolytesExplanation
If the signs of shock still persist after the first 40 ml/kg:
◊ immediately give a third bolus of 20 ml/kg of intravenous or intraosseous sodium chloride 0.9% or human albumin 4.5% solution
◊ call for anaesthetic assistance for urgent tracheal intubation and mechanical ventilation and
◊ start treatment with vasoactive drugsRate this question:
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- 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
Correct Answer(s)
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 ampicillinExplanation
The given answer provides a comprehensive explanation about the antimicrobial agents that are effective against meningococci. It states that ceftriaxone, cefotaxime, and cefuroxime are cephalosporins that can penetrate into the cerebrospinal fluid (CSF) from the blood, making them suitable for the treatment of bacterial meningitis. It also mentions that meningococci are susceptible to chloramphenicol, rifampin, erythromycin, tetracyclines, and ciprofloxacin. Additionally, it provides specific treatment recommendations for children based on their age.Rate this question:
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- 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
Correct Answer(s)
A. Mostly non-specific symptoms or signs, difficult to distinguish from other less important (viral) infections in children
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. ShockExplanation
Clinical presentation of meningococcal disease include mostly non-specific symptoms or signs, difficult to distinguish from other less important (viral) infections in children or shock, more specific symptoms and signs are more likely to be secondary to bacterial meningitis or meningococcal septicaemia.Rate this question:
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- 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
Correct Answer(s)
A. Hearing loss
C. Damage to bones and joints
D. Skin scarring from necrosis
E. Psychosocial problemsExplanation
Possible complications of meningococcal septicaemia and meningitis include hearing loss, damage to bones and joints, skin scarring from necrosis, psychosocial problems
neurological disorders, delayed or impaired development and renal failure.
Rarer complications include Waterhouse-Friderichsen syndrome and DICRate this question:
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- 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
Correct Answer(s)
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 weightExplanation
The correct answer includes all the recommended measures for chemoprophylaxis in meningococcal disease. These measures include providing chemoprophylaxis to all recent significant contacts of the infected patient, using rifampicin, ceftriaxone, or ciprofloxacin, minocycline, and spiramycin as possible options for chemoprophylaxis, avoiding chemoprophylaxis during epidemics due to multiple sources of exposure and prolonged risk, and administering either a single IM injection of ceftriaxone or 4 oral doses of rifampin over 2 days to children based on their body weight. Ciprofloxacin is not recommended for individuals older than 18 years.Rate this question:
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- 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
Correct Answer(s)
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
D. A person who sat beside the patient on an airplane flight of more than 8 hoursExplanation
The correct answer includes individuals who had direct exposure to the patient through close contact activities such as kissing, sharing utensils, or medical interventions like mouth-to-mouth resuscitation. It also includes individuals who had significant exposure by sitting beside the patient on a long airplane flight of more than 8 hours. Additionally, prophylaxis should be given to contact young children and their carers or nursery-school contacts. This means that anyone who frequently ate, slept, or stayed at the patient's home during the 14 days before the onset of symptoms should also receive prophylaxis. Co-workers and school classmates are not mentioned as constituting significant exposure for meningococcal chemoprophylaxis.Rate this question:
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- 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
Correct Answer(s)
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 stainExplanation
The indications for corticosteroids in meningococcal meningitis include a dose of 0.15 mg/kg to a maximum dose of 10 mg, four times daily for four days. Other indications include the presence of frankly purulent cerebrospinal fluid, CSF white blood cell count greater than 1000/μl with a protein concentration greater than 1 g/l, and the presence of bacteria in the CSF on Gram stain. These criteria help determine when corticosteroids should be used as a treatment for meningococcal meningitis.Rate this question:
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- 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
Correct Answer
A. 4–6 weeksExplanation
It is recommended that children and young people should be reviewed with the results of their hearing test at least 4-6weeks after discharge from hospital.Rate this question:
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Mar 22, 2023Quiz Edited by
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Sep 11, 2010Quiz Created by
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