American Board of Internal Medicine (ABIM) Certification Practice Exam

In the case of tuberculous meningitis, what additional treatment should be provided alongside antituberculous therapy?

1. Non-steroidal anti-inflammatory drugs

2. Glucocorticoids

3. Antiviral medications

4. Oral antibiotics

The correct answer is: Glucocorticoids

In the context of tuberculous meningitis, glucocorticoids are used as an essential adjunct to antituberculous therapy. The rationale for incorporating glucocorticoids lies in their ability to reduce inflammation and the associated complications that can occur in the central nervous system due to the infection. Tuberculous meningitis can lead to significant inflammatory responses that may contribute to increased intracranial pressure, vasculitis, and neurological deficits. By administering glucocorticoids, the inflammatory responses are moderated, which can help improve clinical outcomes and reduce the risk of neurological sequelae. While non-steroidal anti-inflammatory drugs may provide symptomatic relief, they do not address the specific inflammatory mechanisms associated with tuberculosis and are not recommended as a primary treatment strategy for this condition. Antiviral medications are designed to combat viral infections and are not effective against bacterial infections like TB. Oral antibiotics typically target different types of bacterial infections and do not play a role in the management of tuberculosis. Thus, the addition of glucocorticoids stands out as the critical complementary treatment that enhances the efficacy of the antituberculous therapy in managing tuberculous meningitis.