Posts: 3,675,934
Threads: 734,342
Joined: Sep 2021
Reputation:
5
A 46-year-old man is evaluated in the emergency department because of loss of consciousness 2 hours ago. Yesterday, he slipped on ice and fell, injuring his lower back, and developed significant low-back pain. That evening, he awakened to urinate and fainted in the bathroom. His wife heard him fall and found him unconscious. She called an ambulance, and on arrival, the paramedics found him awake and oriented, with a heart rate of 90/min and blood pressure of 140/85 mm Hg. Other than back pain, he has no discomfort.
Physical examination shows no abnormalities, and there is no evidence of a head injury. He has no significant medical history. His electrocardiogram is normal.
Which of the following is the most appropriate next step in the management of this patient?
( A ) Carotid artery ultrasound
( B ) Computed tomography scan of the head
( C ) Exercise electrocardiography stress test
( D ) No further treatment or investigation
Posts: 3,675,934
Threads: 734,342
Joined: Sep 2021
Reputation:
5
Posts: 3,675,934
Threads: 734,342
Joined: Sep 2021
Reputation:
5
b
h.o of loss of conciousness needs ct evaluation
age 46 and no ho previous episodes of loss of conciosness , tia, stroke , and it context of fall is more in favor of sub DU hematome lucid int
no h/o coronary atrery disease in stem
Posts: 3,675,934
Threads: 734,342
Joined: Sep 2021
Reputation:
5
A 45-year-old woman is evaluated in the emergency department because she has been unresponsive for the past 2 hours. She was diagnosed with otitis media 3 days ago and was prescribed ciprofloxacin. Since that time, she has become increasingly lethargic. She has no allergies.
On physical examination, the patient is obtunded and has meningismus. Temperature is 40 °C (104 °F), pulse rate is 120/min, respiration rate is 32/min, and blood pressure is 80/50 mm Hg. A purpuric rash is present on her lower extremities.
The leukocyte count is 25,000/µL, and the platelet count is 20,000/µL. The cerebrospinal fluid is cloudy; the leukocyte count is 2500/µL, glucose level is 20 mg/dL, and protein level is 230 mg/dL. Gram stain of cerebrospinal fluid shows many neutrophils and gram-positive diplococci in pairs.
Which of the following empiric antimicrobial regimens is most appropriate?
( A ) Ceftriaxone
( B ) Penicillin
( C ) Vancomycin
( D ) Vancomycin plus ampicillin
( E ) Vancomycin plus ceftriaxone
Posts: 3,675,934
Threads: 734,342
Joined: Sep 2021
Reputation:
5
e
vanco + cefriaxone
vanco covers all pn resistant staph ,strep
ceftriaxone will cover g neg as well which might be asso with acute otitis media
Posts: 3,675,934
Threads: 734,342
Joined: Sep 2021
Reputation:
5
A 35-year-old woman who underwent cadaveric renal transplantation 12 months ago is hospitalized because of fever, headache, ataxia, and confusion of 24 hours' duration. Three weeks ago, she attended a party, where she ate processed meats and coleslaw. One day later, she developed loose stools and low-grade fever that lasted for 24 hours. The day prior to hospital admission, fever returned and she developed a headache.
Current medications are prednisone and azathioprine.
On physical examination, temperature is 39.4 °C (103 °F), pulse rate is 100/min, respiration rate is 30/min, and blood pressure is 90/60 mm Hg. She is confused. Her neck is supple. Plantar responses are extensor bilaterally.
The leukocyte count is 18,500/µL. Lumbar puncture is performed. Cerebrospinal fluid leukocyte count is 1500/µL, glucose is 30 mg/dL, and protein is 300 mg/dL. Gram stain of cerebrospinal fluid shows gram-positive bacilli.
Which of the following is the most likely diagnosis?
( A ) Anthrax meningitis
( B ) Haemophilus meningitis
( C ) Listeria meningitis
( D ) Staphylococcal meningitis
( E ) Streptococcal meningitis
An 80-year-old man is hospitalized because of headache, fever, and altered sensorium of 2 hours' duration. He was well until 2 days ago, when he developed a frontal headache. The next day, he felt feverish and had a stiff neck. This morning, he could not be aroused from sleep.
On physical examination, temperature is 38.9 °C (102 °F), pulse rate is 130/min, respiration rate is 40/min, and blood pressure is 110/50 mm Hg. He is obtunded and has a stiff neck. Lumbar puncture is performed. The opening pressure is high. Leukocyte count is 1200/µL, glucose is 22 mg/dL, and protein is 200 mg/dL. Gram stain of cerebrospinal fluid shows gram-positive diplococci. Empiric antimicrobial therapy with vancomycin and ceftriaxone is begun.
Which of the following adjuvant treatments is most likely to be beneficial?
( A ) Acyclovir
( B ) Aspirin
( C ) Dexamethasone
( D ) Warfarin
A 58-year-old man is brought for evaluation by family members because he has been acting œstrange for 2 days. Today, he spent several hours changing the channels on the remote control, even though the television set was turned off.
On physical examination, temperature is 38.4 °C (101.1 °F). He is confused about where he is and what occurred today. There is no nuchal rigidity. The physical examination is unremarkable.
Plasma glucose and serum electrolyte determinations are normal. Computed tomography scan of the head without contrast shows no abnormalities. Cerebrospinal fluid shows 84 leukocytes/µL (93% lymphocytes and 7% neutrophils), protein level of 90 mg/dL, and glucose level of 75 mg/dL (simultaneous plasma glucose level is 88 mg/dL).
Which of the following is the most likely diagnosis?
( A ) Alzheimer's disease
( B ) Central nervous system toxoplasmosis
( C ) Herpes simplex virus encephalitis
( D ) Meningococcal meningitis
Posts: 3,675,934
Threads: 734,342
Joined: Sep 2021
Reputation:
5
CCCCC......vanco for S.pneumoniae meningitis.....
vanco .....since most S.pnuemoniae r resistant to cephalosporins.....
anyone else????
Posts: 3,675,934
Threads: 734,342
Joined: Sep 2021
Reputation:
5
Posts: 3,675,934
Threads: 734,342
Joined: Sep 2021
Reputation:
5
|
