B. Physical examination:
Note for Meningeal signs: Altered mental status, seizures, nuchal rigidity, a bulging anterior fontanel, Kernig’s
sign (resistance to extension of the leg) and Brudzinski’s sign (the knees flex in response to rapid flexion of the neck).
Note for signs of increased intracranial tension (ICT): A fundus examination ismandatory to detect
Note for signs of Shock: Evaluate the hydration status and note for mottling of the skin, slow capillary refill,
Note for focal neurological deficits: Document focal deficits, weakness, or ataxia, Measure head circumference.
Note for clues to the probable organism causing meningitis: Petechiae or purpura (meningococcemia), bone and joint infection (H.influenza), otitis media (H. influenza), indwelling lines (Staphylococcus).
