Neurology: tuberculous 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 · Neurology: tuberculous meningitis

Sample item

A 22-year-old man from a crowded urban slum has 3 weeks of headache and low-grade fever, then drowsiness and a right sixth nerve palsy. CSF is clear with a cobweb clot, 180 cells per mm3 (85% lymphocytes), protein 220 mg/dL and glucose 24 mg/dL (blood glucose 96 mg/dL). MRI shows basal meningeal enhancement and hydrocephalus. What is the most appropriate management?

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

The answer and the reasoning

C. Start four-drug antituberculous therapy with corticosteroids without waiting for culture

A subacute meningitis with lymphocytic CSF, high protein, low glucose, cobweb clot and basal exudates with hydrocephalus is tuberculous meningitis. Delay worsens outcome, so treatment begins on suspicion; the Indian programme uses isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months followed by isoniazid, rifampicin and ethambutol to complete 12 months. Adjunct corticosteroids reduce mortality, and hydrocephalus may need a shunt.

Option by option

  • A. Start intravenous acyclovir

    Acyclovir treats herpes encephalitis, which presents acutely with temporal lobe signs and normal CSF glucose.

  • B. Start fluconazole

    Fluconazole treats cryptococcal meningitis, which is considered in HIV infection and is not supported by the CSF here.

  • C. Start four-drug antituberculous therapy with corticosteroids without waiting for culture (correct)

    Correct. Prompt empirical therapy with steroids is required, and cultures are slow.

  • D. Wait for CSF culture before starting treatment

    Culture takes weeks and delay causes irreversible neurological damage.

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.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Start four-drug antituberculous therapy with corticosteroids without waiting for culture. A subacute meningitis with lymphocytic CSF, high protein, low glucose, cobweb clot and basal exudates with hydrocephalus is tuberculous meningitis.

Why is "Start intravenous acyclovir" not the answer?

Acyclovir treats herpes encephalitis, which presents acutely with temporal lobe signs and normal CSF glucose.

Why is "Start fluconazole" not the answer?

Fluconazole treats cryptococcal meningitis, which is considered in HIV infection and is not supported by the CSF here.

Why is "Wait for CSF culture before starting treatment" not the answer?

Culture takes weeks and delay causes irreversible neurological damage.

What concept does this question test?

It tests Neurology: tuberculous meningitis in General Medicine. Delay worsens outcome, so treatment begins on suspicion; the Indian programme uses isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months followed by isoniazid, rifampicin and ethambutol to complete 12 months. Adjunct corticosteroids reduce mortality, and hydrocephalus may need a shunt.

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 Neurology: tuberculous 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.