Chief Complaint: Fever and headache for the past 24 hours. Clinical Presentation: Sarah, a 5-year-old girl, was brought to the pediatric clinic by her parents with a complaint of fever and headache that started 24 hours ago. Her parents noticed that Sarah has been unusually irritable and complained of a stiff neck when they tried to touch it. She has also been experiencing episodes of vomiting and appears lethargy.

Medical History: Sarah has no significant medical history. She has received all routine childhood vaccinations and has had no prior hospitalizations or surgeries. She attends daycare and has been generally healthy.

Patient Information:

Name: Sarah

Age: 5 years old

Gender: Female

Physical Examination Findings:

  • Vital signs: Temperature 39.2°C, heart rate 110 bpm, respiratory rate 24 breaths per minute, blood pressure 100/60 mmHg.
  • Appearance: Sarah appears tired and irritable.
  • Skin: No rashes or petechiae noted.
  • Head and Neck: Neck stiffness observed when attempting neck flexion
  • Ears, Eyes, Nose, and Throat: No abnormalities detected.
  • Chest and Lungs: Clear breath sounds bilaterally.
  • Heart: Regular rate and rhythm, no murmurs.
  • Abdomen: Soft and non-tender.
  • Neurological Examination: No focal neurological deficits observed, but lethargy noted.
  • Extremities: No joint swelling or abnormalities.

Based on the history and physical examination findings, the possibility of meningitis is being considered. Further investigation and management are necessary.

Please answer the questions below in full sentences. Reference ATI and textbook

Questions:

  1. What is the most likely diagnosis in this case?
  2. What is meningitis, and what are its common causes?
  3. What are the risk factors for developing meningitis in children?
  4. What are the common symptoms of meningitis?
  5. How is meningitis diagnosed?
  6. What initial laboratory tests would you order for Sarah?
  7. What are the potential complications of meningitis?
  8. What is the most appropriate initial management for Sarah? List at least 3, with rationale.
  9. Which antibiotic(s) would be the first-line choice for treatment?
  10. Complete the MAR attached based on the medication chosen in your answer above (Seen attached).
  11. When should lumbar puncture be performed in suspected cases of meningitis?
  12. What is needed prior to a lumbar puncture?
  13. What cerebrospinal fluid (CSF) findings are consistent with bacterial meningitis?
  14. How would you interpret the CSF findings in viral meningitis?
  15. How is the presence of viral meningitis confirmed?
  16. What imaging studies, if any, would you consider ordering?
  17. What precautions should be taken to prevent the spread of meningitis?
  18. How would you educate Sarah’s parents regarding the disease and its prognosis?
  19. What is the recommended vaccination schedule to prevent meningitis?
  20. How would you manage Sarah’s fever and headache?
  21. What follow-up care should Sarah receive after discharge?
  22. Can Sarah attend daycare while recovering from meningitis?
  23. What other infectious diseases should be considered in the differential diagnosis?
  24. How would you differentiate meningitis from encephalitis?
  25. What are the signs of increased intracranial pressure in a pediatric patient? And what are the differences in infants vs the older adult?
  26. How would you manage increased intracranial pressure in Sarah?
  27. Are corticosteroids recommended in the treatment of bacterial meningitis?
  28. How can meningitis be prevented in close contacts of a patient?