WBR1097

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Author PageAuthor::Chetan Lokhande
Exam Type ExamType::USMLE Step 3
Main Category MainCategory::Emergency Room
Sub Category SubCategory::Infectious Disease, SubCategory::Neurology
Prompt [[Prompt::An 11-month-old previously healthy African American female from Haiti comes to Emergency room(ER) with generalized tonic clonic seizures with 1-day history of lethargy, fever and altered mental status. Enroute to hospital, emergency medical team intubated her and gave a dose of diazepam, with no remission. In the ER 1 more dose of diazepam was given and patient was transferred to ICU for further management, where vitals were within normal limits. Overnight EEG showed a pattern of status epileptics. The patient was medically paralyzed and put on a ventilator. Complete blood count, Chem 10 and CT scan all are within normal limits. She was given a dose of quinine for malaria, but stopped due to negative thick and thin smear. A Lumbar puncture was done which revealed:

CSF Glucose 60 mg/dl
CSF protein 90 mg/dl
CSF WBC 70 cell/ml
Culture negative for any organism
Opening pressure normal

A CSF antibody test revealed positive for HSV-1. What is the best treatment for this patient?]]

Answer A AnswerA::Ganciclovir plus acyclovir for 2 weeks.
Answer A Explanation AnswerAExp::
Answer B AnswerB::Acyclovir for 4 weeks.
Answer B Explanation AnswerBExp::
Answer C AnswerC::Acyclovir for 1 week.
Answer C Explanation AnswerCExp::
Answer D AnswerD::Acyclovir plus ganciclovir for 4 weeks.
Answer D Explanation AnswerDExp::
Answer E AnswerE::Acyclovir for 6 months.
Answer E Explanation AnswerEExp::
Right Answer RightAnswer::
Explanation [[Explanation::

Educational Objective:
References: ]]

Approved Approved::Yes
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