A 58-year-old woman presented with severe headache, fever, and neck stiffness. Routine ER Labs showed elevated WBC 20 (4.5-11) and normal chemistry. She had right hemiparesis on exam. Which of the following is the most appropriate next step in management?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
المصادر مختلفة. ملفات الدفعة فيها إجابتين، وما نرجّح وحدة على الثانية. سبب كل وحدة في الشرح تحت:
- إجابة: D. Ceftriaxone and dexamethasone.
- إجابة ثانية: B. CT brain.
Fever, headache and neck stiffness with right hemiparesis (a focal deficit) means LP is unsafe until a CT brain has excluded a mass, so the old exam key is B. However, the course material is explicit that in this 'LP unsafe' pathway empirical antibiotics are given before the CT and the LP (after blood cultures) so treatment is not delayed, which makes D the next step. D is imperfect because the full empirical regimen also includes vancomycin. LP first (A) is wrong because of the focal deficit; acyclovir alone (C) does not cover bacterial meningitis.
ليش كل خيار صح أو غلط
-
A
ليش غلط
LP is not the first move when there are focal neurological signs: CNS infection.pdf says CT head comes before LP to exclude a mass lesion, because of the risk of herniation.
✓ CNS infection.pdf · p. 2 -
B
ليش صح
Supported by CNS infection.pdf: focal neurological signs (here right hemiparesis) are a contraindication to going straight to LP, so CT head comes before LP to exclude a mass lesion because of the risk of herniation.
✓ CNS infection.pdf · p. 2 -
C
ليش غلط
Acyclovir is the empirical drug for encephalitis (fever + headache AND confusion) while HSV PCR is awaited. This patient has neck stiffness and a focal deficit, and no confusion is described.
✓ 3- CNS infections Y4C.pdf · p. 8 -
D
ليش صح
Supported by 3- CNS infections Y4C.pdf: in the 'LP is unsafe' pathway antibiotics are given before the CT and LP. That page lists vancomycin, high-dose ceftriaxone and steroids as the bacterial regimen.
✓ 3- CNS infections Y4C.pdf · p. 9
- المصدر
- 3- CNS infections Y4C.pdf · p. 9
CNS infection.pdf · p. 2 - المحاضرة
- CNS Infections · Neurology · Module C
- ظهر في
- MED42 Compre C · MED42 ♀ EOM C · MED41 ♀ EOM C