6 month old boy presents to your office with a history of high grade fever of two days’ duration, irritability and refusal to feed. On examination he is alert but withdrawn, becomes very irritable on handling, has stable vital signs, and has a bulging fontanelle. Neurological examination is otherwise normal, there is no neck stiffness and Kernig sign is negative.
1. TRUE/FALSE?
a) Meningitis is unlikely in the absence of neck stiffness and a negative Kernig sign.

1. TRUE/FALSE?
b) Absence of papilloedema in an infant or child excludes significantly raised intracranial pressure.

1. TRUE/FALSE?
c) A bulging fontanelle is a contraindication for doing a lumbar puncture in a case of suspected meningitis.

1. TRUE/FALSE?
d) If you suspect meningitis in a child who is clinically stable and has no neurological signs, the child may be observed and managed conservatively for a period of 2 to 4 hours if you are uncertain about the clinical diagnosis.

1. TRUE/FALSE?
e) A CT scan of the head is ideal to rule out raised intracranial pressure prior to doing a lumbar puncture in a child with suspected meningitis.

f) A lumbar puncture is the investigation of choice in a child with suspected meningitis who does not have clinical features to suggest severely raised intracranial pressure.

2. TRUE/FALSE regarding bacterial meningitis?
a) Organisms most commonly causing meningitis in neonates are Streptococcus pneumoniae and Neisseria meningitidis.

2. TRUE/FALSE regarding bacterial meningitis?
b) Ampicillin and cefotaxime are the antibiotic combination of choice for empiric treatment of meningitis in the first six months of life.

2. TRUE/FALSE regarding bacterial meningitis?
c) Meningococcus type C is the commonest cause of meningococcal infection in Australia.

2. TRUE/FALSE regarding bacterial meningitis?
d) The Australian immunisation schedule includes routine immunisation of all children against type B meningococcal infection at 1 year of age.

2. TRUE/FALSE regarding bacterial meningitis?
e) Haemophilus influenzae type b vaccine has a 60% efficacy rate in terms of protection against bacterial meningitis caused by Haemophilus influenzae type b.