A 15-year-old adolescent is brought to the emergency department by his parents. The adolescent is febrile with chills that started suddenly. He states, "I had a sinus infection and sore throat a couple of days ago.”. The nurse suspects bacterial meningitis based on which findings? Select all that apply.

Choice A rationale A stiff neck, or nuchal rigidity, is a classic sign of meningeal irritation, which is characteristic of meningitis, especially the bacterial form. The stiffness and pain occur because inflammation of the meninges surrounding the brain and spinal cord causes muscle spasm when the neck is passively flexed, significantly restricting the range of motion. Choice B rationale Photophobia, an extreme sensitivity to light, is caused by the irritation and inflammation of the meninges, particularly those surrounding the optic nerve roots. This symptom is a common indicator of increased intracranial pressure and meningeal inflammation associated with bacterial meningitis, signaling a severe central nervous system infection. Choice C rationale Headache is one of the most common and prominent symptoms of meningitis, resulting from the combination of meningeal inflammation, increased intracranial pressure, and cerebral edema. Therefore, the absence of a headache would be an atypical finding, making its presence, not absence, a finding that supports the suspicion of bacterial meningitis. Choice D rationale A positive Brudzinski sign, which is the involuntary flexion of the hips and knees when the patient's neck is passively flexed, is a classic sign of meningeal irritation. A negative Brudzinski sign indicates the absence of this specific sign of meningeal irritation, suggesting a lower likelihood of meningitis, though its absence does not rule out the disease. Choice E rationale Vomiting, often projectile and without preceding nausea, is a common symptom in both children and adolescents with bacterial meningitis. This symptom is typically a direct consequence of the sudden increase in intracranial pressure caused by the inflammation and edema within the central nervous system, irritating the vomiting center in the brainstem.