Child with Meningitis; Antibiotics or CT or LP? - USMLE Forums
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  #1  
Old 05-25-2012
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Kids Child with Meningitis; Antibiotics or CT or LP?

A 4-year-old boy is brought to the emergency room 30 minutes after suddenly falling to the ground, becoming very stiff, and subsequently experiencing bilateral muscle jerking for 3 minutes. Prior to the episode, he had complained of a headache and had a temperature of 38.4C (101.1F). On arrival, he is irritable and distressed by light. His previous medical history is unremarkable, and he has received all age-appropriate immunizations. His mother denies any recent illnesses, sick contacts, travel, or head trauma. Examination demonstrates nuchal rigidity and involuntary flexion of the knees and hips following passive flexion of the neck. Complete extension of the legs is impossible, because of pain. The remainder of the examination is normal. What is the most appropriate next step in the management of this patient?

A. Ceftriaxone and vancomycin
B. Complete blood count (CBC)
C. Computed tomography (CT) scan
D. Lumbar puncture
E. Magnetic resonance imaging (MRI) scan
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Old 05-25-2012
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"CT" because minigitis + seizure

CT for brain in 4 subjects:
F focal deficit
P papilledema
S seizure
C confusion


Correct me if iam wrong,we are here to learn bro ..
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Old 05-25-2012
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Start Abx before doing CT scan, this case we can't do LP cuz of seizure like said above, and since this is a time consuming, we need to start Rx to avoid any possible neurological sequels
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Old 05-25-2012
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Yeah Rx before Dx is required.
I didnt notice Rx option,just thought about Dx..
My mistake...
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Old 05-25-2012
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most appropriate next step in the management will be Antibiotics.

In meningitis give Abs first and think later especially if the patient is this sick with focal signs. Ideally I would also give steroids along with Abs.
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Old 05-25-2012
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Quote:
Originally Posted by tyagee View Post
A 4-year-old boy is brought to the emergency room 30 minutes after suddenly falling to the ground, becoming very stiff, and subsequently experiencing bilateral muscle jerking for 3 minutes. Prior to the episode, he had complained of a headache and had a temperature of 38.4C (101.1F). On arrival, he is irritable and distressed by light. His previous medical history is unremarkable, and he has received all age-appropriate immunizations. His mother denies any recent illnesses, sick contacts, travel, or head trauma. Examination demonstrates nuchal rigidity and involuntary flexion of the knees and hips following passive flexion of the neck. Complete extension of the legs is impossible, because of pain. The remainder of the examination is normal. What is the most appropriate next step in the management of this patient?

A. Ceftriaxone and vancomycin
B. Complete blood count (CBC)
C. Computed tomography (CT) scan
D. Lumbar puncture
E. Magnetic resonance imaging (MRI) scan
-embaric Rx=A.
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tyagee (05-25-2012)



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