A patient with suspected meningitis has the following cerebrospinal fluid findings: white blood cells predominantly neutrophils, glucose 25 mg/dL, protein 180 mg/dL. Which type of meningitis is most likely?

1. A

   Viral meningitis

2. B

   Bacterial meningitis

3. C

   Tubercular meningitis

4. D

   Fungal meningitis

Appeared in: NORCET-11 Prelims

Explanation

• Bacterial meningitis shows neutrophilic pleocytosis, low CSF glucose, and high protein.
• Neutrophilic predominance is a hallmark of bacterial, not viral or fungal, meningitis.
• Low glucose and high protein in CSF are classic for bacterial infection due to increased permeability and bacterial metabolism.

Why Other Options Were Wrong

• Option A: Viral meningitis usually shows lymphocytic predominance in CSF, normal glucose, and only mildly elevated protein. Neutrophilic predominance and very low glucose are not typical.
• Option C: Tubercular meningitis often shows lymphocytic predominance, moderately low glucose (often 30–50 mg/dL), and protein between 100–200 mg/dL. Neutrophilic predominance is uncommon except in early disease.
• Option D: Fungal meningitis (e.g., cryptococcal) usually shows lymphocytic or mixed cell predominance, low or normal glucose, and high protein. Neutrophilic predominance is rare.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Interpretation of CSF findings to differentiate types of meningitis to guide bedside assessment, documentation, and the next nursing action.
• Rapid identification of bacterial meningitis is critical for early treatment and reducing morbidity and mortality.
• Nurses must recognize CSF patterns to escalate care and initiate infection control measures.
• What if? If the CSF showed lymphocytic predominance and normal glucose, viral meningitis would be more likely, and management would shift to supportive care rather than urgent antibiotics.

How to Approach the Question

• Identify the key CSF findings: cell type, glucose, and protein.
• Recall the classic CSF profiles for each type of meningitis.
• Match the findings to the most likely etiology.
• Rule out options that do not fit the cell type or biochemical profile.
• Use the most specific clues (neutrophils, very low glucose) to select the answer.

Concept Tested & Keywords

• Concept Tested: Interpretation of CSF findings to differentiate types of meningitis
• Stem keywords: suspected meningitis, CSF findings, neutrophils, glucose 25 mg/dL, protein 180 mg/dL
• Lead-in keywords: most likely
• Clinical cues: Predominant neutrophils in CSF
• Clinical cues: Markedly low glucose

Question ID

QgMCbrFMjV7IUy4WalgzkA

Copy ID

Reference Book

E6 Medicine Harrison 22e Part 1 pp. 1003-1005, 1161-1163