Infectious diseases: bacterial meningitis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Infectious diseases: bacterial meningitis

Sample item

A 64-year-old diabetic man has fever, neck stiffness and drowsiness for one day. CSF is turbid with neutrophilic pleocytosis, low glucose and high protein. The Gram stain is awaited. Which empirical regimen is most appropriate?

AOral amoxicillin and observationBCeftriaxone, vancomycin and ampicillin, with dexamethasoneCCeftriaxone with metronidazoleDCeftriaxone alone

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Ceftriaxone, vancomycin and ampicillin, with dexamethasone

In adults older than 50 years or with immunosuppression, the commonest organisms are pneumococcus, meningococcus and Listeria monocytogenes. Empirical therapy is a third-generation cephalosporin plus vancomycin for resistant pneumococci, plus ampicillin to cover Listeria, which cephalosporins do not. Dexamethasone is started with or before the first antibiotic dose to reduce neurological sequelae in pneumococcal disease.

Option by option

A. Oral amoxicillin and observation
Meningitis is a medical emergency needing immediate intravenous therapy.
B. Ceftriaxone, vancomycin and ampicillin, with dexamethasone (correct)
Listeria cover with ampicillin is added for this age group, and steroids improve outcome in pneumococcal meningitis.
C. Ceftriaxone with metronidazole
Metronidazole adds anaerobic cover that is not needed, and still misses Listeria.
D. Ceftriaxone alone
Ceftriaxone alone leaves Listeria and cephalosporin-resistant pneumococci uncovered.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Ceftriaxone, vancomycin and ampicillin, with dexamethasone. In adults older than 50 years or with immunosuppression, the commonest organisms are pneumococcus, meningococcus and Listeria monocytogenes.

Why is "Oral amoxicillin and observation" not the answer?

Meningitis is a medical emergency needing immediate intravenous therapy.

Why is "Ceftriaxone with metronidazole" not the answer?

Metronidazole adds anaerobic cover that is not needed, and still misses Listeria.

Why is "Ceftriaxone alone" not the answer?

Ceftriaxone alone leaves Listeria and cephalosporin-resistant pneumococci uncovered.

What concept does this question test?

It tests Infectious diseases: bacterial meningitis in General Medicine. Empirical therapy is a third-generation cephalosporin plus vancomycin for resistant pneumococci, plus ampicillin to cover Listeria, which cephalosporins do not. Dexamethasone is started with or before the first antibiotic dose to reduce neurological sequelae in pneumococcal disease.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Infectious diseases: bacterial meningitis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.