10-20-2014, 04:16 AM
34 y/o M know IVDA in the ED w/ worsening severe HA, N/V, high fever, chills, lethargy and blurry vision fo 1 wk. 6 yr ago he had infective endocarditis and was tested HIV negative. NKDA. PE with oral thrush, stiff neck and B/L papillemdema. Labs Hb 9.7, HCT 29, WBC 2.1, Head CT no mass, LP shows
Opening pressure : 345 mm H20
Prot : 105 mg/dl
Gluc : 30 mg/dl
RBC : 1/cubic mm
WBC : 40/cubic mm
Lymphocyte : 95%
What is Next step
A) IV Rocephine + Vanco
B) IV Amp + Genta
C) IV acyclovir
D) REpeat HIV testing
E) IV amphotericin B and Flucytosine
Pt improved rapidly, 6 hours hous later c/o of severe headache again and start vomiting, What Now?
A) Add IV methyl prednisone
B) Start Fluconazole
C) Start IV Rocephine + Vanco
D) Start high dose IV amphotericin B
E) Do Spinal Tap
Opening pressure : 345 mm H20
Prot : 105 mg/dl
Gluc : 30 mg/dl
RBC : 1/cubic mm
WBC : 40/cubic mm
Lymphocyte : 95%
What is Next step
A) IV Rocephine + Vanco
B) IV Amp + Genta
C) IV acyclovir
D) REpeat HIV testing
E) IV amphotericin B and Flucytosine
Pt improved rapidly, 6 hours hous later c/o of severe headache again and start vomiting, What Now?
A) Add IV methyl prednisone
B) Start Fluconazole
C) Start IV Rocephine + Vanco
D) Start high dose IV amphotericin B
E) Do Spinal Tap