Fever, headache & confusion - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 06-29-2011
mle guy's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 264
Threads: 16
Thanked 350 Times in 165 Posts
Reputation: 360
Question Fever, headache & confusion

A 49 yr old man is brought to the ED with fever, headache and confusion. He was in his usual state of health 2 days ago. His medical history is notable for prostate cancer, DM and HTN. His meds include lisinopril daily and metformin twice a day. Vitals include BP 120/84, pulse 102, temp 103.5 F. On examination he is found to be confused and disoriented to time and place. Neck stiffness is noted; however there are no focal neurological findings. CBC, chemistry and blood cultures are sent and LP is performed. LP is consistent with bacterial meningitis and Gram stain of CSF shows gram positive cocci. Pending results from sensitivity, which is the most appropriate empiric therapy?
  1. Ampicillin plus gentamicin
  2. Cefotaxime
  3. Cefotaxime plus gentamicin
  4. Ceftriaxone plus vancomycin
  5. Ceftriaxone plus vancomycin plus ampicillin
  6. Penicillin G
  7. Rifampin
Reply With Quote Quick reply to this message



  #2  
Old 06-29-2011
mle guy's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 264
Threads: 16
Thanked 350 Times in 165 Posts
Reputation: 360
Arrow Answer

4. Pneumococcal meningitis. Empiric therapy is ceftriaxone plus vancomycin.
Therapy should be modified once cultures and sensitivity results are back.

My question is why don't we give ceftriaxone plus vancomycin plus ampicillin (option 5), as he has prostate cancer and he could possibly be immunocompromised.
Reply With Quote Quick reply to this message
  #3  
Old 06-30-2011
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 55
Threads: 3
Thanked 59 Times in 21 Posts
Reputation: 69
Default

we don't add ampicillin here because CSF already have shown gram positive cocci , so we rule out listeria ( gram positive bacilli )
Reply With Quote Quick reply to this message
The above post was thanked by:
mle guy (06-30-2011)



Reply

Tags
Neurology-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Sudden Severe Headache rasheed USMLE Step 1 Classic Clues 2 02-17-2013 11:37 PM
Headache and a Skull radiograph case USMLE-Syndrome USMLE Step 2 CK Forum 15 06-21-2011 01:09 PM
Headache Mnemonics amresh kumar USMLE Step 2 CK Mnemonics 0 05-05-2011 11:05 AM
Primary Headache Treatment Mnemonics FSUSTC USMLE Step 2 CK Mnemonics 0 03-23-2010 11:10 AM
Headache Case Hohepa USMLE Step 2 CK Forum 4 03-23-2010 10:42 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)