MBBS OSCE · Neurology / Emergency

Suspected meningococcal meningitis — emergency OSCE

OSCE on 1-hour antibiotics, NICE/UKHSA 2 g stat, dexamethasone timing, no LP through purpura, ciprofloxacin contacts.

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Exam tags

NEET-PGINICET

Candidate instructions

Manage the emergency presentation. Do not delay life-saving treatment for imaging.[1]

Candidate tasks

  1. ABC and treat shock before any LP.[1]
  2. Give the first antibiotic within 1 hour (state the sourced adult pre-hospital dose).[1][2]
  3. Explain when CT before LP is needed — after antibiotics if delay.
  4. Consider dexamethasone with the first antibiotic; stop routine steroids if this is meningococcal disease.
  5. Notify public health and prescribe contact prophylaxis.

Examiner checklist

  • Antibiotics within 1 hour; never delayed for CT/LP
  • Adult suspected-IMD dose: ceftriaxone 2 g IV/IM stat [2]
  • Dexamethasone 10 mg with or before first antibiotic if bacterial meningitis remains possible; NICE does not routinely continue steroids for meningococcal disease [1][3]
  • Do not LP through spreading purpura; bloods, antibiotics, stabilise before imaging [1]
  • Contact ciprofloxacin 500 mg once (12 years and over) [2]
  • Index case already on ceftriaxone does not need carriage eradication [2]

Model standard

Resuscitate and give ceftriaxone within 1 hour (UKHSA adult 2 g stat). Investigate in parallel. Do not LP through spreading purpura. Notify. Ciprofloxacin 500 mg once for close contacts aged 12+. Add amoxicillin only if Listeria risk factors are present. Aciclovir only if HSV encephalitis is strongly suspected.[1][2]

Common errors

  • Delaying antibiotics for CT[1]
  • Vancomycin as a NICE default[1]
  • Rifampicin-first contacts
  • LP through purpura
  • Age-over-50 as a numbered Listeria cutoff
References3Show
  1. [1]National Institute for Health and Care Excellence. Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management NICE guideline NG240, 2024.Source
  2. [2]UK Health Security Agency. Guidance for public health management of meningococcal disease in the UK UKHSA, 2025.Source
  3. [3]de Gans J, van de Beek D. Dexamethasone in adults with bacterial meningitis. New England Journal of Medicine, 2002.PMID 12432041
Suspected meningococcal meningitis — emergency OSCE · MBBS OSCE · NeetVellum