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  #1  
Old 10-09-2015
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Default answer this usmle question

A 25-year-old woman presents to the emergency department with her husband, who says that over the past two days, she has developed neck stiffness, headache, and fever and has grown increasingly sensitive to light. On physical examination, the patient’s hips and knees flex when she flexes her neck. Temperature is 38.9° C (102° F), and there is some papilledema. The rest of the physical examination is normal. Her HIV status is not known. Which of the following is the most appropriate procedure for further evaluation of this patient?


a Blood culture → start antibiotics → CT → LP
B. Blood culture → start antibiotics → LP → CT
C. LP → HIV test → start antibiotics
D. LP → start antibiotics → blood culture
E. Start antibiotics → blood culture → CT → L

Last edited by dr tee; 10-09-2015 at 12:26 PM.
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  #2  
Old 10-13-2015
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I think the answer should be E.

Doesn't make sense to do a blood culture at all really, they are mostly negative.
But the CT has to precede the LP since the patient has symptoms of possible herniation i.e papilledema and confusion
Obviously since the blood culture is pretty useless do something useful at the start by giving the antibiotics
Hope that was helpful
Whats your opinion?
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  #3  
Old 10-14-2015
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I think the answer should be A.
because if you are going to perform a blood culture , it should be before antibiotics. and you should start antibiotics in meningitis as soon as possible.
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  #4  
Old 10-16-2015
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its A .
something to note
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