MCQ Quiz: Meningitis

Meningitis, an inflammation of the protective membranes covering the brain and spinal cord, is a medical emergency requiring rapid diagnosis and immediate intervention. For pharmacy students, understanding the nuances of meningitis management is critical, as appropriate pharmacotherapy can be life-saving. This complex infectious disease varies significantly in its etiology, from bacterial and viral to fungal causes, with treatment strategies tailored to the specific pathogen and patient population. This quiz will test your knowledge of the empiric and definitive treatment of meningitis, the role of adjunctive therapies like dexamethasone, the interpretation of cerebrospinal fluid (CSF) analysis, and preventive measures including vaccination and chemoprophylaxis.

1. Which of the following is a classic sign of meningeal irritation?

• a) Pitting edema
• b) Nuchal rigidity (stiff neck)
• c) Ascites
• d) Jaundice

Answer: b) Nuchal rigidity (stiff neck)

2. A lumbar puncture is performed on a patient with suspected bacterial meningitis. Which set of cerebrospinal fluid (CSF) findings is most consistent with this diagnosis?

• a) High glucose, low protein, lymphocytic pleocytosis
• b) Low glucose, high protein, neutrophilic pleocytosis
• c) Normal glucose, normal protein, no white blood cells
• d) High glucose, high protein, eosinophilic pleocytosis

Answer: b) Low glucose, high protein, neutrophilic pleocytosis

3. What is the most common cause of bacterial meningitis in adults and young children in the United States?

• a) Haemophilus influenzae type b
• b) Listeria monocytogenes
• c) Streptococcus pneumoniae
• d) Neisseria meningitidis

Answer: c) Streptococcus pneumoniae

4. Empiric antibiotic therapy for a 2-week-old neonate with suspected meningitis should include coverage for Group B Streptococcus, E. coli, and which other key pathogen?

• a) Neisseria meningitidis
• b) Listeria monocytogenes
• c) Staphylococcus aureus
• d) Pseudomonas aeruginosa

Answer: b) Listeria monocytogenes

5. What is the appropriate empiric antibiotic regimen for a healthy 35-year-old adult with suspected community-acquired bacterial meningitis?

• a) Ampicillin + Gentamicin
• b) Vancomycin + a third-generation cephalosporin (e.g., ceftriaxone)
• c) Penicillin G alone
• d) Azithromycin

Answer: b) Vancomycin + a third-generation cephalosporin (e.g., ceftriaxone)

6. Why is ampicillin added to the empiric regimen for suspected bacterial meningitis in patients over 50 years of age?

• a) To provide better coverage for S. pneumoniae.
• b) To cover for atypical pathogens.
• c) To provide coverage for Listeria monocytogenes.
• d) To overcome cephalosporin resistance.

Answer: c) To provide coverage for Listeria monocytogenes.

7. Dexamethasone is recommended as adjunctive therapy in certain types of bacterial meningitis to:

• a) Provide synergistic bactericidal activity.
• b) Reduce the inflammatory response and subsequent neurological damage.
• c) Increase the penetration of antibiotics into the CSF.
• d) Prevent antibiotic-associated diarrhea.

Answer: b) To reduce the inflammatory response and subsequent neurological damage.

8. For maximal benefit, when should the first dose of dexamethasone be administered in relation to the first dose of antibiotics?

• a) 24 hours after the first antibiotic dose.
• b) 6 hours after the first antibiotic dose.
• c) With or just before the first antibiotic dose.
• d) It does not matter when it is given.

Answer: c) With or just before the first antibiotic dose.

9. The most common cause of aseptic (viral) meningitis is:

• a) Herpes Simplex Virus (HSV)
• b) Influenza virus
• c) Enteroviruses
• d) Varicella-zoster virus

Answer: c) Enteroviruses

10. The management of most cases of viral meningitis primarily consists of:

• a) A 14-day course of intravenous acyclovir.
• b) High-dose corticosteroids.
• c) Broad-spectrum antibiotics.
• d) Supportive care, including analgesics and hydration.

Answer: d) Supportive care, including analgesics and hydration.

11. A college student living in a dormitory is diagnosed with meningococcal meningitis caused by Neisseria meningitidis. What is the most important public health measure?

• a) Closing the dormitory for disinfection.
• b) Administering chemoprophylaxis to all close contacts.
• c) Vaccinating all students on campus immediately.
• d) Placing the entire dormitory on empiric vancomycin.

Answer: b) Administering chemoprophylaxis to all close contacts.

12. Which of the following is a recommended agent for chemoprophylaxis for close contacts of a patient with meningococcal meningitis?

• a) Amoxicillin
• b) Doxycycline
• c) Rifampin
• d) Vancomycin

Answer: c) Rifampin

13. Which vaccine has dramatically reduced the incidence of meningitis and epiglottitis in young children caused by Haemophilus influenzae type b?

• a) MMR vaccine
• b) DTaP vaccine
• c) Hib vaccine
• d) PCV13 vaccine

Answer: c) Hib vaccine

14. A CSF analysis showing a very high opening pressure, low glucose, high protein, and a positive India ink stain is highly suggestive of meningitis caused by:

• a) Streptococcus pneumoniae
• b) Cryptococcus neoformans
• c) Mycobacterium tuberculosis
• d) Enterovirus

Answer: b) Cryptococcus neoformans

15. The induction phase of treatment for cryptococcal meningitis in an HIV-positive patient typically involves:

• a) High-dose fluconazole alone.
• b) Amphotericin B deoxycholate or a lipid formulation, plus flucytosine.
• c) Voriconazole.
• d) A third-generation cephalosporin.

Answer: b) Amphotericin B deoxycholate or a lipid formulation, plus flucytosine.

16. Why are higher doses of beta-lactam antibiotics (like ceftriaxone 2g IV q12h) used for meningitis compared to other infections?

• a) To overcome resistance in the bloodstream.
• b) To compensate for poor oral bioavailability.
• c) To achieve adequate therapeutic concentrations in the inflamed central nervous system.
• d) To reduce the frequency of administration.

Answer: c) To achieve adequate therapeutic concentrations in the inflamed central nervous system.

17. A patient develops a purpuric, non-blanching rash (petechiae) along with fever and signs of meningitis. This presentation is classic for an infection with:

• a) Listeria monocytogenes
• b) Streptococcus pneumoniae
• c) Neisseria meningitidis
• d) Cryptococcus neoformans

Answer: c) Neisseria meningitidis

18. What is the recommended duration of therapy for uncomplicated meningitis caused by Neisseria meningitidis?

• a) 3 days
• b) 7 days
• c) 14 days
• d) 21 days

Answer: b) 7 days

19. A lumbar puncture should be delayed and a head CT scan should be performed first in a patient with suspected meningitis if they present with:

• a) A headache
• b) A fever
• c) Papilledema or new-onset seizures
• d) Nuchal rigidity

Answer: c) Papilledema or new-onset seizures

20. A patient with a severe beta-lactam allergy is diagnosed with meningitis caused by a susceptible gram-negative bacillus. Which of the following antibiotics might be a suitable alternative?

• a) Meropenem
• b) Cefepime
• c) Aztreonam
• d) Ampicillin/Sulbactam

Answer: c) Aztreonam

21. Tuberculous (TB) meningitis CSF findings are typically characterized by:

• a) Very high neutrophil count.
• b) Markedly low glucose, very high protein, and a lymphocytic pleocytosis.
• c) Normal glucose and protein levels.
• d) Red blood cells in the CSF.

Answer: b) Markedly low glucose, very high protein, and a lymphocytic pleocytosis.

22. Which antibiotic is not recommended for the empiric treatment of meningitis in a neonate due to its ability to displace bilirubin from albumin?

• a) Ampicillin
• b) Cefotaxime
• c) Ceftriaxone
• d) Gentamicin

Answer: c) Ceftriaxone

23. What is the most common long-term complication of bacterial meningitis in children?

• a) Chronic headaches
• b) Sensorineural hearing loss
• c) Renal failure
• d) Liver damage

Answer: b) Sensorineural hearing loss

24. The recommended duration of antibiotic therapy for meningitis caused by Streptococcus pneumoniae is:

• a) 5-7 days
• b) 7-10 days
• c) 10-14 days
• d) 21 days

Answer: c) 10-14 days

25. A patient with a CSF shunt is at increased risk for healthcare-associated meningitis, often caused by what type of organisms?

• a) Respiratory viruses
• b) Enterococci and coagulase-negative staphylococci
• c) Atypical bacteria like Mycoplasma
• d) Fungi

Answer: b) Enterococci and coagulase-negative staphylococci

26. The Brudzinski sign is considered positive when:

• a) The patient cannot touch their chin to their chest.
• b) Flexion of the patient’s neck causes involuntary flexion of their hips and knees.
• c) The patient experiences pain upon extension of the knee.
• d) A petechial rash is present on the trunk.

Answer: b) Flexion of the patient’s neck causes involuntary flexion of their hips and knees.

27. Treatment of HSV encephalitis requires immediate initiation of:

• a) Oral valacyclovir
• b) Intravenous acyclovir
• c) Ganciclovir
• d) Foscarnet

Answer: b) Intravenous acyclovir

28. An important counseling point for a patient receiving rifampin for meningococcal prophylaxis is:

• a) It may cause permanent blue discoloration of the teeth.
• b) It can decrease the effectiveness of oral contraceptives.
• c) It should always be taken on an empty stomach to avoid GI upset.
• d) It is a one-time intravenous dose.

Answer: b) It can decrease the effectiveness of oral contraceptives.

29. What is the primary reason vancomycin is included in empiric regimens for community-acquired bacterial meningitis?

• a) To cover for Listeria monocytogenes.
• b) To cover for potential drug-resistant Streptococcus pneumoniae.
• c) To cover for atypical pathogens.
• d) To cover for Neisseria meningitidis.

Answer: b) To cover for potential drug-resistant Streptococcus pneumoniae.

30. The Kernig’s sign is positive if:

• a) The patient has photophobia.
• b) A rash appears on the patient’s palms and soles.
• c) The patient, in a supine position with hip flexed, experiences pain or resistance on knee extension.
• d) Passive neck flexion causes the patient’s knees and hips to flex.

Answer: c) The patient, in a supine position with hip flexed, experiences pain or resistance on knee extension.

31. Which of the following is a key goal of meningitis therapy?

• a) Sterilization of the CSF.
• b) Reduction of fever within the first hour.
• c) Prevention of all side effects from antibiotics.
• d) Immediate discharge from the hospital.

Answer: a) Sterilization of the CSF.

32. The empiric antibiotic regimen for a 1-month-old infant with suspected bacterial meningitis is:

• a) Vancomycin + Ceftriaxone
• b) Ampicillin + Cefotaxime
• c) Meropenem
• d) Penicillin G

Answer: b) Ampicillin + Cefotaxime

33. Dexamethasone has NOT been shown to provide a mortality benefit in meningitis caused by which pathogen?

• a) Streptococcus pneumoniae
• b) Haemophilus influenzae type b
• c) Neisseria meningitidis
• d) Listeria monocytogenes

Answer: d) Listeria monocytogenes

34. For patients with a severe, immediate hypersensitivity to beta-lactams, what is a potential alternative regimen for empiric coverage of bacterial meningitis?

• a) Clindamycin + Gentamicin
• b) Doxycycline + Rifampin
• c) Vancomycin + Moxifloxacin
• d) Azithromycin + Metronidazole

Answer: c) Vancomycin + Moxifloxacin

35. A “brain abscess” differs from meningitis in that it is a:

• a) Diffuse inflammation of the meninges.
• b) Focal, contained infection within the brain parenchyma.
• c) Purely viral infection.
• d) Chronic, slow-growing tumor.

Answer: b) Focal, contained infection within the brain parenchyma.

36. The recommended duration of therapy for meningitis caused by Listeria monocytogenes is:

• a) 7 days
• b) 10 days
• c) 14 days
• d) ≥ 21 days

Answer: d) ≥ 21 days

37. What is the role of the pharmacist in the management of a patient with meningitis?

• a) Performing the lumbar puncture.
• b) Ensuring appropriate antibiotic selection, dosing, and monitoring for adverse effects.
• c) Diagnosing the specific causative pathogen from a CSF sample.
• d) Deciding when to discharge the patient.

Answer: b) Ensuring appropriate antibiotic selection, dosing, and monitoring for adverse effects.

38. Cefotaxime is often preferred over ceftriaxone for treating meningitis in which patient population?

• a) The elderly
• b) Pregnant women
• c) Neonates
• d) Patients with renal failure

Answer: c) Neonates

39. A patient is diagnosed with amebic meningoencephalitis caused by Naegleria fowleri. This infection is typically acquired from:

• a) An insect bite.
• b) Inhaling respiratory droplets.
• c) Exposure to warm, fresh water.
• d) Consuming contaminated food.

Answer: c) Exposure to warm, fresh water.

40. Why is routine vancomycin trough monitoring important in patients being treated for meningitis?

• a) To prevent red-orange discoloration of urine.
• b) To ensure adequate CSF penetration and efficacy while minimizing nephrotoxicity.
• c) To monitor for optic neuritis.
• d) To check for hypersensitivity reactions.

Answer: b) To ensure adequate CSF penetration and efficacy while minimizing nephrotoxicity.

41. The meningococcal B (MenB) vaccine is recommended for which group?

• a) All infants at 2, 4, and 6 months of age.
• b) All adults over the age of 65.
• c) Adolescents and young adults aged 16-23 years, based on shared clinical decision-making.
• d) Only for international travelers.

Answer: c) Adolescents and young adults aged 16-23 years, based on shared clinical decision-making.

42. Which of the following best describes encephalitis?

• a) Inflammation of the meninges.
• b) Inflammation of the spinal cord.
• c) Inflammation of the brain tissue itself.
• d) A blood clot in the brain.

Answer: c) Inflammation of the brain tissue itself.

43. A common source of Listeria monocytogenes infection leading to meningitis in susceptible individuals is:

• a) Undercooked poultry
• b) Contaminated soft cheeses and deli meats
• c) Mosquito bites
• d) Respiratory droplets

Answer: b) Contaminated soft cheeses and deli meats

44. What is the target vancomycin trough concentration for treating CNS infections like meningitis?

• a) 5-10 mcg/mL
• b) 10-15 mcg/mL
• c) 15-20 mcg/mL
• d) >20 mcg/mL

Answer: c) 15-20 mcg/mL

45. After completing a course of therapy for bacterial meningitis, patients should be monitored for:

• a) Neurological sequelae
• b) Hearing loss
• c) Seizure disorders
• d) All of the above

Answer: d) All of the above

46. What is the mechanism of action of flucytosine (5-FC)?

• a) It binds to ergosterol in the fungal cell membrane.
• b) It inhibits fungal DNA and RNA synthesis.
• c) It inhibits fungal cell wall synthesis.
• d) It blocks fungal cytochrome P450 enzymes.

Answer: b) It inhibits fungal DNA and RNA synthesis.

47. A serious adverse effect of flucytosine that requires monitoring is:

• a) Hepatotoxicity
• b) Bone marrow suppression
• c) Nephrotoxicity
• d) Optic neuritis

Answer: b) Bone marrow suppression

48. Encephalitis is more likely than meningitis to present with:

• a) Nuchal rigidity
• b) Fever
• c) Altered mental status, focal neurological deficits, or seizures.
• d) Headache

Answer: c) Altered mental status, focal neurological deficits, or seizures.

49. A patient is being discharged after treatment for bacterial meningitis. An important counseling point is:

• a) They are now immune to all forms of meningitis.
• b) The importance of completing any remaining oral antibiotic therapy.
• c) The need for follow-up appointments to assess for long-term complications.
• d) They can immediately return to all normal activities without restriction.

Answer: c) The need for follow-up appointments to assess for long-term complications.

50. The “gold standard” for diagnosing meningitis is:

• a) Blood cultures
• b) A CT or MRI of the head
• c) The presence of a petechial rash
• d) Cerebrospinal fluid (CSF) analysis from a lumbar puncture.

Answer: d) Cerebrospinal fluid (CSF) analysis from a lumbar puncture.