Meningitis and Encephalitis Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Meningitis and Encephalitis. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Meningitis and Encephalitis Indian Medical PG Question 1: Which organism is most commonly associated with causing bacterial meningitis in adults?
- A. Streptococcus agalactiae (Group B Strep)
- B. Staphylococcus aureus
- C. Mycoplasma pneumoniae
- D. Streptococcus pneumoniae (Pneumococcus) (Correct Answer)
Meningitis and Encephalitis Explanation: ***Streptococcus pneumoniae (Pneumococcus)***
- *Streptococcus pneumoniae* is the most common bacterial cause of **meningitis** in adults and children worldwide.
- It often follows a primary infection like **otitis media**, sinusitis, or pneumonia.
*Staphylococcus aureus*
- While *S. aureus* can certainly cause meningitis, it is more commonly associated with **post-neurosurgical**, **post-traumatic**, or **hematogenous meningitis** from distant foci.
- It is not the most frequent cause of community-acquired meningitis in the general population.
*Streptococcus agalactiae (Group B Strep)*
- *Streptococcus agalactiae* is a leading cause of **neonatal meningitis** (in newborns).
- It is an important pathogen in infants but much less common in older children and adults.
*Mycoplasma pneumoniae*
- *Mycoplasma pneumoniae* is primarily known for causing **atypical pneumonia** and tracheobronchitis.
- While neurological complications can occur, such as encephalitis or Guillain-Barré syndrome, it is a very rare cause of meningitis itself.
Meningitis and Encephalitis Indian Medical PG Question 2: Complications of tubercular meningitis include all except
- A. Hydrocephalus
- B. Cerebral Artery Thrombosis
- C. Cortical venous thrombosis (Correct Answer)
- D. Cranial Nerve Palsy
Meningitis and Encephalitis Explanation: ***Cortical venous thrombosis***
- While TB meningitis can cause vascular complications, **isolated cortical venous thrombosis** is a rare and atypical complication.
- The inflammatory exudate in TB meningitis typically affects arteries and basal cisterns, leading to problems like arteritis and communicating or obstructive hydrocephalus [1].
*Hydrocephalus*
- This is a common complication due to the inflammatory exudate in the **basal cisterns**, which obstructs the flow of cerebrospinal fluid (CSF) [2].
- It can be either **communicating** (impaired absorption) or **non-communicating** (obstructive due to blockage) [2].
*Cerebral Artery Thrombosis*
- The **inflammatory exudate** surrounding basal cisterns in TB meningitis can lead to vasculitis and thrombosis of nearby arteries, especially the large cerebral arteries.
- This can result in **ischemic strokes** and focal neurological deficits [3].
*Cranial Nerve Palsy*
- The inflamed meninges and exudate can directly compress or damage **cranial nerves** as they exit the brainstem and travel through the basal cisterns.
- Cranial nerves III, IV, VI, VII, and VIII are particularly susceptible to this complication.
Meningitis and Encephalitis Indian Medical PG Question 3: Most common organism causing bacterial meningitis between 6 months and 2 years in vaccinated populations.
- A. E. coli
- B. Pneumococcus (Correct Answer)
- C. H. influenzae
- D. N. meningitidis
Meningitis and Encephalitis Explanation: ***Pneumococcus***
- **Pneumococcus (Streptococcus pneumoniae)** is now the most common cause of bacterial meningitis in children aged 6 months to 2 years in countries with high vaccination rates for *H. influenzae type b (Hib)* and *N. meningitidis*.
- The introduction of the **pneumococcal conjugate vaccine (PCV)** has significantly reduced the incidence of pneumococcal meningitis, but it still remains the leading cause among the remaining cases in this age group.
*E. coli*
- **E. coli meningitis** is primarily a concern in **neonates** (birth to 1 month of age), often acquired during passage through the birth canal.
- Its incidence significantly decreases after the neonatal period, making it a much less common cause in children aged 6 months to 2 years.
*H. influenzae*
- Before routine vaccination, **Haemophilus influenzae type b (Hib)** was the leading cause of bacterial meningitis in children under 5 years old.
- The widespread use of the **Hib vaccine** has drastically reduced its incidence, making it a rare cause in vaccinated populations.
*N. meningitidis*
- **Neisseria meningitidis** (meningococcus) is a significant cause of bacterial meningitis, especially in older children, adolescents, and young adults.
- While it can occur in children aged 6 months to 2 years, widespread **meningococcal vaccination** in many regions has reduced its overall prevalence, making *Pneumococcus* a more frequent cause in this specific vaccinated age group.
Meningitis and Encephalitis Indian Medical PG Question 4: An appropriate single antibiotic for the empiric treatment of presumed bacterial meningitis in a six month old child would be:
- A. Cefotaxime (Correct Answer)
- B. Ampicillin
- C. Cefadroxil
- D. Cefuroxime
Meningitis and Encephalitis Explanation: ***Cefotaxime***
- As a **third-generation cephalosporin**, cefotaxime has excellent penetration into the **cerebrospinal fluid (CSF)** and provides broad-spectrum coverage against common bacterial meningitis pathogens in young children, including *Streptococcus pneumoniae*, *Neisseria meningitidis*, and *Haemophilus influenzae*.
- In a 6-month-old child, cefotaxime is an excellent choice for empiric therapy. While both cefotaxime and ceftriaxone are appropriate at this age, cefotaxime is specifically preferred over ceftriaxone in **neonates younger than 28 days** due to concerns about biliary pseudolithiasis and bilirubin displacement, which can worsen jaundice and increase the risk of kernicterus.
*Ampicillin*
- While effective against *Listeria monocytogenes* (particularly important in neonates and infants <3 months) and Group B *Streptococcus*, ampicillin provides **insufficient coverage** for many other common causes of bacterial meningitis in this age group, particularly penicillin-resistant *Streptococcus pneumoniae* and *Haemophilus influenzae*.
- Its use alone as empiric therapy for bacterial meningitis in a 6-month-old would be inadequate, often warranting combination therapy with a third-generation cephalosporin in younger infants.
*Cefadroxil*
- Cefadroxil is a **first-generation cephalosporin** primarily used for skin, soft tissue, and urinary tract infections.
- It has **poor penetration into the CSF** and therefore is not an appropriate choice for treating meningitis.
*Cefuroxime*
- Cefuroxime is a **second-generation cephalosporin** with limited activity against *Streptococcus pneumoniae* and certain **Gram-negative bacteria** compared to third-generation cephalosporins.
- While it has some central nervous system penetration, its efficacy is **inferior to third-generation cephalosporins** like cefotaxime or ceftriaxone for treating bacterial meningitis, especially considering the potential for resistant strains.
Meningitis and Encephalitis Indian Medical PG Question 5: Meningitis with rash is seen in -
- A. Neisseria meningitidis (Correct Answer)
- B. H. influenzae
- C. Strepto. agalactae
- D. Pneumococcus
Meningitis and Encephalitis Explanation: **Neisseria meningitidis**
- **Meningococcal meningitis** is classically associated with an acute onset of fever, headache, stiff neck, and a characteristic **petechial or purpuric rash** [1].
- The rash is due to widespread **vasculitis** and disseminated intravascular coagulation (DIC) caused by the bacteria.
*H. influenzae*
- While *H. influenzae* type b (Hib) was a major cause of bacterial meningitis before vaccination, it typically does not cause a *rash*.
- Meningitis caused by *H. influenzae* presents with fever, headache, stiff neck, and altered mental status without dermatological manifestations.
*Strepto. agalactiae*
- *Streptococcus agalactiae* (Group B Strep) is a common cause of meningitis in **neonates** and infants.
- It usually presents with non-specific symptoms like fever, lethargy, and poor feeding, and a rash is not a typical feature of GBS meningitis.
*Pneumococcus*
- *Streptococcus pneumoniae* (Pneumococcus) is another leading cause of bacterial meningitis in adults and children [1].
- Symptoms include fever, headache, stiff neck, and altered mental status, but a cutaneous rash is not characteristic of pneumococcal meningitis [1].
Meningitis and Encephalitis Indian Medical PG Question 6: Neurological complications of meningitis include all of the following except:
- A. Increased intracranial pressure
- B. Brain abscess
- C. Subdural effusions
- D. Cerebral hamartoma (Correct Answer)
Meningitis and Encephalitis Explanation: Cerebral hamartoma
- A cerebral hamartoma is a benign, tumor-like malformation of abnormally organized mature brain tissue; it is a developmental anomaly and not a complication of meningitis.
- Unlike the other options, it does not represent an inflammatory, infectious, or pressure-related sequela of meningeal infection.
Increased intracranial pressure
- Increased intracranial pressure (ICP) is a common and serious complication of meningitis due to cerebral edema, hydrocephalus, or vasodilation.
- Elevated ICP can lead to herniation, neurological deficits, and even death if not managed promptly.
Brain abscess
- A brain abscess is a localized collection of pus within the brain parenchyma that can develop as a focal complication of bacterial meningitis, particularly in cases of hematogenous spread or direct extension of infection [1].
- This serious condition causes focal neurological deficits and requires aggressive treatment.
Subdural effusions
- Subdural effusions are accumulations of sterile or infected fluid in the subdural space, most commonly seen in infants and young children with bacterial meningitis.
- While they can be asymptomatic, large effusions may cause increased ICP or focal neurological signs requiring drainage.
Meningitis and Encephalitis Indian Medical PG Question 7: Child with generalized petechiae. CSF shows gram-negative diplococci. Treatment -
- A. IV Penicillin G
- B. Oral Penicillin V
- C. IV Ceftriaxone (Correct Answer)
- D. IV Cefotaxime
Meningitis and Encephalitis Explanation: ***IV Ceftriaxone***
- The presence of **generalized petechiae** and **gram-negative diplococci** in the CSF strongly suggests **meningococcal meningitis**, which is a severe infection requiring prompt and effective antibiotic treatment.
- **Ceftriaxone** is a third-generation cephalosporin that has excellent penetration into the CSF and is a first-line treatment for bacterial meningitis caused by *Neisseria meningitidis*.
*IV Penicillin G*
- While **Penicillin G** can be effective against penicillin-susceptible strains of *Neisseria meningitidis*, there is increasing concern about penicillin resistance.
- **Ceftriaxone** is generally preferred empirically due to its broader coverage and reliable efficacy against penicillin-resistant strains.
*IV Penicillin V*
- **Penicillin V** is an oral penicillin, and it is not suitable for the treatment of severe, invasive infections like **meningitis** due to inadequate systemic and CSF concentrations.
- It is typically used for less severe infections like pharyngitis.
*IV Cefotaxime*
- **Cefotaxime** is also a third-generation cephalosporin with good CSF penetration and is an effective treatment for bacterial meningitis.
- However, in many guidelines, **ceftriaxone** is often listed as the preferred agent due to its longer half-life, allowing for once-daily or twice-daily dosing, which is more convenient.
Meningitis and Encephalitis Indian Medical PG Question 8: The most common cause of meningitis in children aged 5 yrs is-
- A. Staphylococcus
- B. E.coli
- C. H. influenzae
- D. S. pneumoniae (Correct Answer)
Meningitis and Encephalitis Explanation: ***S. pneumoniae***
- **_Streptococcus pneumoniae_** (Pneumococcus) is the **most common cause of bacterial meningitis** in children aged 5 years and older, as well as in adults.
- Widespread vaccination has reduced its incidence but it remains a significant pathogen.
*H. influenzae*
- **_Haemophilus influenzae_ type b (Hib)** was a major cause of meningitis in young children, but its incidence has **drastically decreased** due to the routine **Hib vaccine**.
- Without vaccination, it would still be a significant cause in this age group, but with high vaccine coverage, it is less common than _S. pneumoniae_.
*Staphylococcus*
- **_Staphylococcus aureus_** and other staphylococcal species are **less common causes of meningitis** in otherwise healthy children.
- They are more typically associated with meningitis following **neurosurgery**, trauma, or in immunocompromised patients.
*E.coli*
- **_Escherichia coli_** is a common cause of **neonatal meningitis** (in infants less than 3 months old), often acquired during passage through the birth canal.
- It is **rarely a cause of meningitis** in children aged 5 years.
Meningitis and Encephalitis Indian Medical PG Question 9: Which virus is most commonly recognized as a prototypical viral hemorrhagic fever in endemic regions of West Africa?
- A. Lassa fever virus (Correct Answer)
- B. West Nile virus
- C. Yellow fever virus
- D. Crimean-Congo hemorrhagic fever virus
Meningitis and Encephalitis Explanation: ***Lassa fever virus***
- Lassa fever is a prototypical **viral hemorrhagic fever (VHF)** endemic to West Africa, caused by an **Arenavirus** transmitted through contact with rodent (Mastomys) excreta.
- Characterized by fever, hemorrhagic manifestations in severe cases (15-20%), and multi-organ involvement with high mortality in hospitalized patients.
- Represents one of the most important VHFs due to its **endemic nature** affecting millions annually in West Africa.
*Yellow fever virus*
- Yellow fever causes hemorrhagic fever with prominent **jaundice** and **hepatic necrosis**, transmitted by *Aedes* mosquitoes.
- A **Flavivirus** causing "yellow" fever due to liver damage, but vaccine-preventable and less commonly seen in modern practice in endemic regions.
*West Nile virus*
- A **Flavivirus** primarily causing **neuroinvasive disease** (meningitis, encephalitis) rather than hemorrhagic fever.
- Hemorrhagic manifestations are **extremely rare** and not characteristic of West Nile virus infection.
*Crimean-Congo hemorrhagic fever virus*
- CCHF is a severe **tick-borne VHF** (Nairovirus) with prominent hemorrhagic features and high mortality (10-40%).
- Endemic to **Africa, Asia, Eastern Europe, and Middle East** but NOT West Africa, distinguishing its geographic distribution from Lassa fever.
Meningitis and Encephalitis Indian Medical PG Question 10: A 10-year-old girl presented with fever, convulsions, and neck rigidity. CSF findings are protein 150 mg/dL, sugar 40 mg/dL with lymphocytic pleocytosis –
- A. Viral meningitis
- B. Pyogenic meningitis
- C. Tuberculous meningitis (Correct Answer)
- D. Cryptococcal meningitis
Meningitis and Encephalitis Explanation: ***Tuberculous meningitis***
- The combination of **fever, convulsions, neck rigidity** (suggesting meningitis), elevated **CSF protein (150 mg/dL)**, **low CSF sugar (40 mg/dL)**, and **lymphocytic pleocytosis** is highly characteristic of tuberculous meningitis.
- Tuberculous meningitis typically presents with a **subacute** or **chronic** course and CSF analysis reveals **elevated protein**, **low glucose**, and a **lymphocytic pleocytosis**.
*Viral meningitis*
- While viral meningitis presents with fever and meningeal signs, the **CSF protein** is usually mildly elevated (<100 mg/dL), and **CSF glucose** is typically normal.
- Often has a **benign and self-limiting course** with predominantly lymphocytic pleocytosis.
*Pyogenic meningitis*
- Characterized by very high **CSF protein (>100 mg/dL)**, very low **CSF glucose (<40 mg/dL)**, and a predominant **neutrophilic pleocytosis**.
- Symptoms are usually **acute and severe**, rapidly progressing over hours to days.
*Cryptococcal meningitis*
- This is more common in **immunocompromised individuals**, such as those with HIV/AIDS, and the clinical picture in a 10-year-old girl without immune compromise makes it less likely.
- While it can cause elevated CSF protein and low glucose, the presence of **lymphocytic pleocytosis** is less specific for cryptococcal infection compared to tuberculous meningitis in this clinical context.
More Meningitis and Encephalitis Indian Medical PG questions available in the OnCourse app. Practice MCQs, flashcards, and get detailed explanations.
