Aashi
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A 36-year-old woman comes to the emergency department because of a severe headache. She states that the headache woke her up from sleep 6 hours ago, and was not relieved by aspirin or acetaminophen. She also noticed that she has neck stiffness and that "it hurts" during neck extension and flexion. She was recently diagnosed with Hodgkin's disease, but before that, she was usually "pretty healthy," except for a few urinary tract infections and hypertension. Her temperature is 39.0 C (102.2 F), blood pressure is 130/80 mm Hg, pulse is 75/min, and respirations are 17/min. She appears lethargic. Physical examination shows nuchal rigidity, flank tenderness, and a mid-systolic click. Funduscopic examination shows bilateral optic disc swelling. After blood cultures are obtained the most appropriate next step is to
A. administer ceftriaxone, intravenously
B. order a CT scan of the head
C. order a MR angiogram of the head
D. order an MRI of the head
E. perform a lumbar puncture
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| CocaCola
Forum Guru
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??? Meningitis
A - ceftriaxone
bilateral optic disc swelling - don't do a Lumbar Puncture
metastic disease would not present so rapidly - no imaging
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| chemamr
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A
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| prathapdoctor
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i will go for option B,
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| drashishmahajan
Forum Senior
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A-- most common cause pneumococcus
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| Guptashutosh
Forum Elite
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meningitis 4 sure , veftraixon has good cns penetration
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| Aashi
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YEP 'A'...is right..
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| dr.wad
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i am confused,
this may be meningitis or subarachnoid hge.
1)hodgkins decrease immunity ----- predispose for meningitis but the patient give a rapid onset of headache that doesn't go with meningitis.(as i guess)
2)hodgkins may lead to meningeal infiltration but this occur late in the disease.
3)hodgkins may cause bleading disorders leading to sub arachnoid hge ( the patient also gives another risk factor for subarachnoid hge which is hypertension) , also the rapid onst of headache goes with subarachnoid hge.
in this case i will give ceftriaxone as empirical treatment thin i will do ct immediately.
if ct is negative i will do lumbar puncture.
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| Mahwish Mushtaq
Forum Junior
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i will go for A ceftriaxone,because u don't do lumbar puncture with optic disc swelling
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