WBR0705

Author	[[PageAuthor::Mohamed Moubarak, M.D. [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Emergency Room
Sub Category	SubCategory::Infectious Disease
Prompt	[[Prompt::40 years old man IV drug abuser, present to ED complaining of fever, headache, vomiting, and blurring of vision. His symptoms started 10 days ago with a progressive course. He had never been tested for HIV before. Physical exam shows neck stiffness and bilateral papilledema. CSF fluid examination shows marked elevated opening pressure, low WBC count with lymphocyte predominance, low glucose, and elevated proteins. What is the best next step in the management of this patient?]]
Answer A	AnswerA::HIV testing
Answer A Explanation	[[AnswerAExp::Incorrect Although his HIV status should be checked, the treatment should come first.]]
Answer B	AnswerB::IV antiviral theraby
Answer B Explanation	[[AnswerBExp::Incorrect Viral meningitis CSF findings has normal glucose concentration, normal or slightly elevated opening pressure, normal or slightly elevated protein concentration.]]
Answer C	AnswerC::Start amphotericin B and flucytosine
Answer C Explanation	[[AnswerCExp::Correct amphotericin B and flucytosine are the treatment of choice in cryptococcal meningitis]]
Answer D	AnswerD::Start gentamicine and ceftriaxone
Answer D Explanation	[[AnswerDExp::Incorrect Bacterial meningitis CSF examination include: polymorphonuclear leukocytosis, decreased glucose concentration, increased opening pressure, and protein concentration.]]
Answer E	AnswerE::Start vancomycin
Answer E Explanation	[[AnswerEExp::Incorrect CSF examination don’t show bacterial meningitis]]
Right Answer	RightAnswer::C
Explanation	[[Explanation::The patient high risk behavior put him at risk of having HIV. The CSF findings are characteristic for cryptococcal meningitis , which is managed by amphotericin B and flucytosine. Educational Objective: References: ]]
Approved	Approved::No
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