 |  NBME form1, q4
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| Author | 7 Posts |
Perhaps
Forum Elite
Topics: 61
Posts: 162
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A previously healthy 16-year-old boy is brought to the emergency department 20 minutes after an episode of left arm shaking that lasted approximately 3 minutes. Over the past 2 days, he has had fever and emotional lability. On arrival, his temperature is 38.9 C (102 F). He is somnolent and disoriented to person, place, and time. He responds poorly to pain. Neurologic examination shows no other abnormalities. Laboratory studies show:
Hematocrit 34%
Leukocyte count 6000/mm3
Segmented neutrophils 50%
Lymphocytes 50%
Platelet count 280,000/mm3
Analysis of cerebrospinal fluid shows:
Leukocyte count 120/mm3
Segmented neutrophils 20%
Lymphocytes 80%
Erythrocyte count 300/mm3
Glucose 60 mg/dL
Protein 400 mg/dL
Which of the following is the most likely cause of this patient's neurologic findings?
A) Bacterial infection
B) Congenital malformation
C) Fungal infection
D) Hemorrhage
E) Immune-mediated demyelination
F) Parasitic infection
G) Viral infection
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| shumaila
Forum Elite
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Posts: 347
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d
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| GDS2008
Forum Elite
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G) Viral infection. I am thinking in terms of Herpes encephalitis (which is usually hemorrhagic). Not sure but will go with this..
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| HighHopes
Forum Senior
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I also picked G,
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| achilles
Forum Guru
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Posts: 1,228
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i agree too with G-viral encephalitis. GDS2008 has already explained the reason for increased RBC's in CSF fluid analysis and another reason is emotional lability which points towards involvement of temporal lobe(herpes most commonly affects the temporal lobe)
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| Perhaps
Forum Elite
Topics: 61
Posts: 162
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Thanks everyone!
I agree with Herpes too.
So we don't worry about the trauma that can also give rbc in CSF? maybe in that case there will be very high RBC?
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| frank100
Forum Guru
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Posts: 586
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G
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