Meningitis MCQs With Answer

Meningitis MCQs With Answer for B.Pharm students offers a focused, exam-oriented review of meningitis epidemiology, pathophysiology, clinical presentation, CSF analysis, diagnostic techniques, pharmacotherapy and prevention. This concise introduction targets pharmacy learners preparing for exams and clinical rotations by emphasizing key concepts: CSF findings, common pathogens (bacterial, viral, fungal, TB), empiric antibiotic choices, blood-brain barrier drug penetration, adjunctive dexamethasone use, prophylaxis for contacts and vaccine strategies. The questions combine clinical reasoning with pharmacological details to deepen understanding and improve prescribing decisions in meningitis management. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which CSF pattern is most typical for acute bacterial meningitis?

• Clear fluid, lymphocytic predominance, normal glucose
• Turbid fluid, neutrophilic predominance, low glucose
• Xanthochromic fluid, eosinophilic predominance, high glucose
• Clear fluid, monocytic predominance, high protein

Correct Answer: Turbid fluid, neutrophilic predominance, low glucose

Q2. The most important initial empiric antibiotic regimen for community-acquired bacterial meningitis in an adult (not immunocompromised) is:

• Ampicillin alone
• Ceftriaxone plus vancomycin
• Azithromycin plus doxycycline
• Linezolid monotherapy

Correct Answer: Ceftriaxone plus vancomycin

Q3. Listeria monocytogenes should be covered empirically in meningitis for which patient group?

• Healthy young adults aged 20–30 years
• Neonates, elderly, and immunocompromised patients
• Patients with viral influenza only
• Patients with community-acquired aspiration pneumonia

Correct Answer: Neonates, elderly, and immunocompromised patients

Q4. Which CSF glucose value (relative to serum glucose) is most suggestive of bacterial meningitis?

• CSF glucose >80% of serum glucose
• CSF glucose 60–80% of serum glucose
• CSF glucose <40% of serum glucose
• CSF glucose equal to serum glucose

Correct Answer: CSF glucose <40% of serum glucose

Q5. Which statement best explains why antibiotic penetration into CSF increases during meningitis?

• Decrease in cerebral blood flow limits drug efflux
• Inflammation disrupts blood-brain barrier tight junctions
• CSF pH becomes highly alkaline enhancing drug diffusion
• CSF protein levels fall creating a sink effect

Correct Answer: Inflammation disrupts blood-brain barrier tight junctions

Q6. Dexamethasone is recommended adjunctively in suspected pneumococcal meningitis when given:

• After 48 hours of antibiotics
• Before or with the first dose of antibiotics
• Only if culture is positive for S. pneumoniae
• Never, because it reduces antibiotic penetration

Correct Answer: Before or with the first dose of antibiotics

Q7. The neonatal triad classically associated with meningitis includes fever, irritability and:

• Bradycardia
• Bulging fontanelle
• Joint swelling
• Absent reflexes only

Correct Answer: Bulging fontanelle

Q8. Which organism is most commonly implicated in adult meningitis following skull fracture or neurosurgery?

• Neisseria meningitidis
• Staphylococcus aureus and Gram-negative bacilli
• Group B Streptococcus
• Cryptococcus neoformans

Correct Answer: Staphylococcus aureus and Gram-negative bacilli

Q9. A contraindication to immediate lumbar puncture in suspected meningitis is:

• Fever of 38.5°C
• Signs of increased intracranial pressure or focal neurologic deficits
• Neck stiffness
• History of migraine

Correct Answer: Signs of increased intracranial pressure or focal neurologic deficits

Q10. Standard chemoprophylaxis for close contacts of a patient with meningococcal meningitis in adults is:

• Oral rifampicin for 4 days
• Oral ciprofloxacin single dose
• IM ceftriaxone single dose
• All of the above depending on situation

Correct Answer: All of the above depending on situation

Q11. Which CSF finding favors viral (aseptic) meningitis over bacterial meningitis?

• Markedly low glucose and neutrophil predominance
• Normal or mildly elevated protein and lymphocytic predominance
• Very high opening pressure and turbid fluid
• Positive Gram stain for Gram-positive cocci

Correct Answer: Normal or mildly elevated protein and lymphocytic predominance

Q12. Which antibiotic is recommended to cover Listeria in adults with suspected meningitis?

• Ampicillin
• Ceftriaxone alone
• Aztreonam
• Vancomycin alone

Correct Answer: Ampicillin

Q13. Which vaccine is most effective in preventing meningitis caused by Haemophilus influenzae type b?

• Conjugate Hib vaccine
• Meningococcal conjugate vaccine
• Pneumococcal polysaccharide vaccine (PPSV23)
• BCG vaccine

Correct Answer: Conjugate Hib vaccine

Q14. In tuberculous meningitis, CSF typically shows:

• Neutrophilic pleocytosis, very low protein
• Lymphocytic pleocytosis, very high protein, low glucose
• Absent cells, normal protein and glucose
• High eosinophils and normal glucose

Correct Answer: Lymphocytic pleocytosis, very high protein, low glucose

Q15. Which diagnostic test provides the fastest specific identification of bacterial pathogen in CSF?

• CSF culture (standard)
• Gram stain and rapid PCR antigen tests
• Serum antibody titers
• CT scan of the brain

Correct Answer: Gram stain and rapid PCR antigen tests

Q16. Which antibiotic property is most desirable for effective meningitis therapy?

• High oral bioavailability only
• Ability to achieve bactericidal concentrations in CSF
• Minimal renal excretion
• Only bacteriostatic activity

Correct Answer: Ability to achieve bactericidal concentrations in CSF

Q17. Which complication of meningitis is most closely linked to poor long-term neurological outcome?

• Transient fever
• Hearing loss
• Self-limited rash
• Mild headache lasting a week

Correct Answer: Hearing loss

Q18. When treating bacterial meningitis, vancomycin is added primarily to cover:

• Pseudomonas aeruginosa
• Methicillin-resistant Staphylococcus aureus (MRSA) and penicillin-resistant Streptococcus pneumoniae
• Viral pathogens
• Fungal organisms

Correct Answer: Methicillin-resistant Staphylococcus aureus (MRSA) and penicillin-resistant Streptococcus pneumoniae

Q19. Which laboratory parameter in CSF is most sensitive for bacterial infection early in disease?

• High CSF glucose
• Gram stain showing organisms
• Low CSF protein
• Negative culture always

Correct Answer: Gram stain showing organisms

Q20. Which antifungal is commonly used for cryptococcal meningitis induction therapy?

• Fluconazole monotherapy
• Amphotericin B plus flucytosine
• Terbinafine
• Ketoconazole

Correct Answer: Amphotericin B plus flucytosine

Q21. In suspected meningitis with papilledema and focal deficits, the next best step is:

• Immediate lumbar puncture
• Neuroimaging (CT/MRI) before LP
• Discharge home with oral antibiotics
• Wait 72 hours then re-evaluate

Correct Answer: Neuroimaging (CT/MRI) before LP

Q22. Which CSF opening pressure is suggestive of increased intracranial pressure?

• 50 mmH2O
• 100 mmH2O
• 180 mmH2O
• 10 mmH2O

Correct Answer: 180 mmH2O

Q23. The mechanism by which pneumococcal conjugate vaccines reduce meningitis incidence is mainly by:

• Enhancing mucosal IgA only
• Reducing nasopharyngeal carriage and invasive disease
• Directly neutralizing bacterial toxins in CSF
• Increasing renal excretion of bacteria

Correct Answer: Reducing nasopharyngeal carriage and invasive disease

Q24. Which statement about ceftriaxone in meningitis is true?

• It cannot be used in neonates due to hyperbilirubinemia risk
• It is ineffective against Streptococcus pneumoniae
• It has poor CSF penetration even with inflammation
• It is contraindicated with vancomycin

Correct Answer: It cannot be used in neonates due to hyperbilirubinemia risk

Q25. Which pathogen is most associated with meningitis in adult patients with HIV/AIDS?

• Neisseria meningitidis
• Cryptococcus neoformans
• Group A Streptococcus
• Haemophilus influenzae type b

Correct Answer: Cryptococcus neoformans

Q26. The primary pharmacodynamic parameter correlated with β-lactam efficacy in meningitis is:

• Peak/MIC ratio
• Time above MIC (T>MIC)
• Area under the curve only
• Post-antibiotic effect only

Correct Answer: Time above MIC (T>MIC)

Q27. Empiric therapy for neonatal meningitis commonly includes which combination?

• Ceftriaxone and doxycycline
• Ampicillin plus gentamicin or cefotaxime
• Vancomycin alone
• Ciprofloxacin monotherapy

Correct Answer: Ampicillin plus gentamicin or cefotaxime

Q28. Which feature helps differentiate meningitis from encephalitis clinically?

• Presence of fever
• Meningeal signs (neck stiffness) vs predominant altered mental status and focal deficits in encephalitis
• Both always have identical features
• Only encephalitis presents with CSF pleocytosis

Correct Answer: Meningeal signs (neck stiffness) vs predominant altered mental status and focal deficits in encephalitis

Q29. Latex agglutination tests on CSF are used primarily to:

• Quantify CSF protein concentration
• Rapidly detect bacterial antigens
• Measure CSF opening pressure
• Differentiate viral from bacterial DNA

Correct Answer: Rapidly detect bacterial antigens

Q30. A patient with suspected meningococcal meningitis should be isolated because the organism spreads via:

• Fecal-oral route
• Respiratory droplets and close contact
• Vector-borne transmission only
• Blood transfusions exclusively

Correct Answer: Respiratory droplets and close contact

Q31. Which choice best describes post-exposure prophylaxis for household contacts of meningococcal disease?

• No prophylaxis is needed
• Administer appropriate antibiotics (rifampicin, ciprofloxacin, or ceftriaxone) as recommended
• Only vaccinate, do not give antibiotics
• Use long-term antifungal therapy

Correct Answer: Administer appropriate antibiotics (rifampicin, ciprofloxacin, or ceftriaxone) as recommended

Q32. Which CSF Gram stain finding is most consistent with Neisseria meningitidis?

• Gram-positive rods in chains
• Gram-negative diplococci within neutrophils
• Gram-positive cocci in clusters
• Yeast forms with capsule

Correct Answer: Gram-negative diplococci within neutrophils

Q33. Which adverse effect is a major concern with aminoglycoside use in meningitis therapy?

• Ototoxicity and nephrotoxicity
• Severe QT prolongation only
• Bone marrow suppression exclusively
• Hyperglycemia

Correct Answer: Ototoxicity and nephrotoxicity

Q34. In patients with suspected fungal meningitis, CSF opening pressure is often:

• Normal and unremarkable
• Markedly elevated, especially in cryptococcal meningitis
• Always low
• Not a useful measurement

Correct Answer: Markedly elevated, especially in cryptococcal meningitis

Q35. Which lab test is most useful to confirm viral meningitis etiology?

• CSF viral PCR
• CSF Gram stain
• Bacterial culture of CSF
• Serum creatinine

Correct Answer: CSF viral PCR

Q36. In bacterial meningitis, high CSF protein level reflects:

• Increased blood-brain barrier permeability and inflammation
• Decreased synthesis of proteins in the liver
• Excessive CSF production only
• Improved barrier integrity

Correct Answer: Increased blood-brain barrier permeability and inflammation

Q37. Which pathogen commonly causes meningitis in young adults and outbreaks in dormitories?

• Staphylococcus epidermidis
• Neisseria meningitidis
• Eikenella corrodens
• Clostridium perfringens

Correct Answer: Neisseria meningitidis

Q38. Which statement about intrathecal antibiotic therapy is correct?

• It is first-line for all meningitis cases
• It may be used in ventriculitis or when systemic therapy fails to reach CSF
• It is used to treat viral meningitis
• It is free from toxicity concerns

Correct Answer: It may be used in ventriculitis or when systemic therapy fails to reach CSF

Q39. Which enzyme produced by pneumococci increases blood-brain barrier permeability?

• Beta-lactamase
• Pneumolysin
• Neuraminidase exclusively
• Protease inhibitors

Correct Answer: Pneumolysin

Q40. The recommended management of suspected bacterial meningitis when LP must be delayed is:

• Delay antibiotics until LP is performed
• Administer empiric antibiotics immediately after blood cultures
• Provide only supportive care without antibiotics
• Give steroids alone without antibiotics

Correct Answer: Administer empiric antibiotics immediately after blood cultures

Q41. Which sign is most specific for meningeal irritation?

• Photophobia
• Kernig’s and Brudzinski’s signs
• Fever alone
• Generalized malaise

Correct Answer: Kernig’s and Brudzinski’s signs

Q42. In pneumococcal meningitis, adjunctive dexamethasone primarily reduces the risk of:

• Renal failure
• Neurologic sequelae such as hearing loss
• Antibiotic resistance
• Requirement for mechanical ventilation

Correct Answer: Neurologic sequelae such as hearing loss

Q43. In CSF culture-negative meningitis where bacterial PCR is positive, this indicates:

• Contamination only
• Presence of bacterial DNA despite negative culture, often due to prior antibiotics
• Viral co-infection exclusively
• Fungal infection misidentified

Correct Answer: Presence of bacterial DNA despite negative culture, often due to prior antibiotics

Q44. Which antimicrobial is known for good CSF penetration and activity against many Gram-negative bacilli including Pseudomonas?

• Cefepime
• Amoxicillin
• Azithromycin
• Clindamycin

Correct Answer: Cefepime

Q45. A common long-term complication of bacterial meningitis that pharmacists should counsel about is:

• Permanent cardiac arrhythmias
• Hearing impairment and cognitive deficits
• Chronic liver disease
• Peripheral neuropathy only

Correct Answer: Hearing impairment and cognitive deficits

Q46. Which agent is NOT recommended for routine meningococcal prophylaxis in neonates?

• Rifampicin
• Oral ciprofloxacin
• IM ceftriaxone single dose (appropriate for certain ages)
• Topical mupirocin

Correct Answer: Topical mupirocin

Q47. The role of corticosteroids in bacterial meningitis is least supported for which pathogen?

• Streptococcus pneumoniae
• Haemophilus influenzae type b
• Neisseria meningitidis
• Cryptococcus neoformans

Correct Answer: Cryptococcus neoformans

Q48. Which pharmacokinetic factor is most altered in meningitis affecting antibiotic dosing?

• Gastrointestinal absorption becomes primary concern
• Increased BBB permeability leading to higher CSF drug concentrations during inflammation
• Hepatic clearance of drugs becomes negligible
• Distribution to adipose tissue increases dramatically

Correct Answer: Increased BBB permeability leading to higher CSF drug concentrations during inflammation

Q49. Which clinical laboratory finding in CSF is typical in early bacterial meningitis before the shift to lymphocytes?

• Lymphocytic predominance
• Neutrophilic predominance
• Predominant eosinophils
• No cells present

Correct Answer: Neutrophilic predominance

Q50. For community-acquired bacterial meningitis, duration of therapy for pneumococcal meningitis is typically:

• 3–5 days
• 10–14 days or longer depending on clinical response
• A single dose only
• Indefinite lifelong therapy

Correct Answer: 10–14 days or longer depending on clinical response

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