Typical exam stem
A patient presents with fever, severe headache, neck stiffness and confusion. How would you investigate and manage suspected bacterial meningitis?
Active exam mode
Plan the case before reading, then mark sections, reveal pearls and self-rate the viva.
1. Sixty-second answer plan
1:00Before reading the notes, say or write your assessment, investigations and management structure.
2. Section checklist
Mark each section only after you can explain its main decision points without reading.
3. Exam-pearl flashcards
Try to predict the pearl before revealing it.
4. Viva drill
Answer aloud before rating yourself. Anything marked “review” stays visible in your progress.
When should CT precede lumbar puncture?
Progress is saved on this device. Use “Reset session” when you want a fresh attempt.
Recognise meningitis as a medical emergency
The classic triad of fever, neck stiffness and altered mental state is not present in every patient. Headache, photophobia, vomiting, seizures, focal deficits and a rapidly progressive illness may occur. In suspected bacterial meningitis, diagnostic tests must not create a dangerous delay in antimicrobial treatment.
Lumbar puncture versus imaging first
- Obtain blood cultures promptly when feasible.
- Lumbar puncture is central to diagnosis when safe and should be performed early.
- Brain imaging before lumbar puncture is reserved for patients with features suggesting raised intracranial pressure, mass lesion or other contraindication according to local guidance.
- If lumbar puncture or imaging will delay treatment in a seriously ill patient, start empiric antimicrobial therapy first.
CSF interpretation
- Bacterial meningitis commonly shows neutrophilic pleocytosis, elevated protein and reduced CSF-to-blood glucose ratio.
- Viral, tuberculous and cryptococcal meningitis can produce different patterns; partially treated bacterial meningitis may be less typical.
- Send microscopy, culture and molecular tests where available, guided by epidemiology and immune status.
Management
Give age- and risk-appropriate empiric antimicrobials promptly and add adjunctive corticosteroid therapy when indicated by current guidance. Stabilise seizures, shock and respiratory failure. Use appropriate infection-control precautions and provide chemoprophylaxis to close contacts when meningococcal disease is confirmed or strongly suspected, following local public-health guidance.
Guideline source for further reading
This page is an original exam-revision summary. For clinical decisions, use current local protocols and the primary guidance below.