USMLE Question of the Week
Evaluating Fever, Headache, and Confusion in a Teenage Girl
In Episode 35 of Med School Question of the Week for USMLE, Faustine Ramirez, MedSchoolCoach expert tutor, answers this medical school question:
A 16-year-old girl is brought to the emergency room with 3 days of fever, headache, confusion, and sleepiness. She has no significant past medical history. Her family recently immigrated to the United States. Temperature is 39.5 C, heart rate is 130/min, respiratory rate is 30/min, and blood pressure is 135/80. On examination she is somnolent but arousable, oriented to person and place but not to time, and she has nuchal rigidity. Blood cultures are pending. A lumbar puncture is performed, and CSF analysis demonstrates:
- Opening pressure: 280 mm H2O
- Glucose: 25
- Protein: 180
- WBC: 3000 (PMNs: 90%; Lymphocytes: 10%)
- RBC: 50
- Ampicillin and gentamicin
- Ampicillin and cefotaxime
- Piperacillin and ciprofloxacin
- Piperacillin and ceftriaxone
- Vancomycin and ceftazidime
- Vancomycin and ceftriaxone
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Vancomycin and ceftriaxone
