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

What is the most appropriate pharmacotherapy?

  • Ampicillin and gentamicin
  • Ampicillin and cefotaxime
  • Piperacillin and ciprofloxacin
  • Piperacillin and ceftriaxone
  • Vancomycin and ceftazidime
  • Vancomycin and ceftriaxone

Watch to find out!

Faustine Ramirez

Faustine graduated from the University of Washington in Seattle with a B.A. in Medical Anthropology and Global Health. She attends medical school at University of California, San Francisco where she designed and taught a course on clinical reasoning skills, developed curriculum materials for the pre-clinical pediatrics course, and led case-based sessions in pediatrics and infectious disease. She received a 253 on Step 1 and a 266 on Step 2 CK, and she scored in the 90th percentiles on all of her shelf exams.

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