Which examination is done to confirm TB meningitis?

IGNOU PB Bsc Nsg Entrance-2017

Medical & Surgical Nursing

Easy

Appeared in: IGNOU PB Bsc Nsg Entrance-2017

Explanation

The definitive diagnosis for TB meningitis is established through the analysis of cerebrospinal fluid (CSF).
CSF examination in TB meningitis typically shows a lymphocytic pleocytosis (increased white blood cells, mainly lymphocytes), elevated protein levels, and low glucose levels.
The presence of Mycobacterium tuberculosis can be confirmed by methods such as Acid-Fast Bacilli (AFB) smear, culture (the gold standard), or nucleic acid amplification tests (NAAT) on the CSF sample.
The combination of clinical symptoms (headache, fever, stiff neck) and these characteristic CSF findings confirms the diagnosis.

Option A: Sputum examination is the primary method for diagnosing pulmonary tuberculosis (TB affecting the lungs), not TB affecting the central nervous system like meningitis.
Option C: Thoracentesis is a procedure to drain fluid from the pleural space (around the lungs). It has no role in diagnosing meningitis.
Option D: Lumbar puncture is the procedure used to obtain the cerebrospinal fluid sample. It is a necessary step but is not the examination itself. The question asks for the examination that confirms the diagnosis, which is the analysis of the collected fluid.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Diagnostic procedures for Tuberculous Meningitis as background academic context rather than a clinical decision trigger.
Nurses play a critical role in assisting with lumbar punctures, ensuring sterile technique, proper patient positioning (lateral recumbent or sitting), and post-procedure monitoring for complications like headache or bleeding.
Accurate and timely diagnosis of TB meningitis is crucial as delays can lead to severe neurological sequelae or death. Nurses must recognize the signs and symptoms and ensure diagnostic samples are collected and sent to the lab promptly.
What if? If a patient has signs of increased intracranial pressure (like papilledema), a lumbar puncture may be contraindicated due to the risk of brain herniation. In such cases, a CT scan of the head is typically performed first to rule out a mass effect.

How to Approach the Question

First, identify the key terms in the question: 'confirm' and 'TB meningitis'. This indicates you need to find the definitive diagnostic test.
Analyze the options provided. Think about what each test or procedure is used for.
Differentiate between a diagnostic 'examination' (the analysis) and a 'procedure' (the method of sample collection).
Sputum examination is for lung TB. Thoracentesis is for pleural fluid. This leaves CSF examination and Lumbar Puncture.
Recognize that Lumbar Puncture is the procedure to get the fluid, while CSF examination is the actual analysis of that fluid that confirms the diagnosis. Therefore, CSF examination is the more precise and correct answer to the question asked.

Concept Tested & Keywords

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E6 Medicine Harrison 22e Part 1 pp. 1168-1170, 1430-1432

E6 Pathology-Vandana Puri & Kavita Gaur Textbook of Pathology and Genetics p. 424-426