Rosh Pediatrics Practice Exam

Which clinical feature is characteristic of viral meningitis?

1. Presence of seizures

2. Elevated protein levels in cerebrospinal fluid

3. Multiple bacterial growths in culture

4. High white blood cell count with neutrophil predominance

The correct answer is: Elevated protein levels in cerebrospinal fluid

The presence of elevated protein levels in cerebrospinal fluid (CSF) is indeed characteristic of viral meningitis. In viral meningitis, the protein levels in the CSF are typically increased, but they are usually not as significantly elevated as they would be in bacterial meningitis. The elevation of protein is a response to the inflammatory process occurring in the central nervous system due to the viral infection. The other features listed provide additional context. For instance, while seizures can occur in viral meningitis, they are more commonly associated with bacterial meningitis or other neurological complications. Bacterial cultures would typically show multiple growths in bacterial meningitis, not viral, as viral infections wouldn't present with growth in culture. High white blood cell counts are seen in both bacterial and viral meningitis; however, in viral meningitis, the white blood cells are predominantly lymphocytes rather than neutrophils, which are more frequently elevated in bacterial infections.