Very important Q - bijan - Printable Version +- USMLE Forum - Largest USMLE Community (https://www.usmleforum.com) +-- Forum: USMLE Forum (https://www.usmleforum.com/forumdisplay.php?fid=1) +--- Forum: Step 2 CK (https://www.usmleforum.com/forumdisplay.php?fid=3) +--- Thread: Very important Q - bijan (/showthread.php?tid=71459)

Very important Q - bijan - ArchivalUser - 01-23-2006 A previously healthy 16-year-old boy is brought to the emergency department 20 minutes after an episode of left arm shaking that lasted approximately 3 minutes.  Over the past 2 days, he has had fever and emotional lability.  On arrival, his temperature is 38.9 C (102 F).  He is somnolent and disoriented to person, place, and time.  He responds poorly to pain.  Neurologic examination shows no other abnormalities.  Laboratory studies show:    Hematocrit 34%  Leukocyte count 6000/mm3  Segmented neutrophils  50%  Lymphocytes 50%  Platelet count 280,000/mm3   Analysis of cerebrospinal fluid shows:  Leukocyte count 120/mm3  Segmented neutrophils 20%  Lymphocytes 80%  Erythrocyte count 300/mm3  Glucose 60 mg/dL  Protein 400 mg/dL What is the most likely cause of this patient's neurologic findings? Bacterial or Virus? 0 - ArchivalUser - 01-23-2006 Sounds like a viral infection. Since lymphocytes dominant. 0 - ArchivalUser - 01-23-2006 Yeh, me too. But my question is why there is Erythrocyte count? 0 - ArchivalUser - 01-23-2006 Because bleeding occurs inside the CNS. Infection can lead to bleeding, can't it? 0 - ArchivalUser - 01-23-2006 This patient looks like HSV encephalitis. Is it one of your choices? RBC can be increased in CSF, plus the high lymphocyte profile. Next time, could you give the full Q please? 0 - ArchivalUser - 01-23-2006 yes, that's right. you are excellent. 0 - ArchivalUser - 01-23-2006 any inflamation process causes inc in ESR 0 - ArchivalUser - 01-23-2006 He is not talking about ESR, but erythrocyte counts-RBC counts. 0 - ArchivalUser - 01-23-2006 ok purple 0 - ArchivalUser - 01-23-2006 Herpese encephalitis-