 |  NBME ,1, Think with me plz
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| Author | 12 Posts |
dr_jojo
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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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| dr_jojo
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this is HSV
right
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| robin082006
Forum Hero
Topics: 471
Posts: 5,125
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i chose G,
But other chose Fungal infection, due to focal neurologic symptoms (shaiking arm)
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| doc_clotaire
Forum Guru
Topics: 159
Posts: 1,247
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Yes , seems like viral infection ( lymphocytes are too high )
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| 92306
Forum Senior
Topics: 14
Posts: 126
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In viral meningitis the Protein level should be less than 150 mg/dl.
in the Q stem it says 400mg/dl.
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| dr_jojo
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SO !!!
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| NE
Forum Guru
Topics: 53
Posts: 504
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300 RBC....I 'm thinking to hemorrhage!...
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| 92306
Forum Senior
Topics: 14
Posts: 126
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yes NE i was also thinking D) Hemorrhage .
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| Aashi
Forum Moderator
Topics: 113
Posts: 1,061
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Fever + confusion+ disorientation+ seizzures+ NO focal neurologic deficits + and NO neck rigidity+ RBC and inc Lymphocytes on CSF------>HSV encephalitis
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| dr in trouble
Forum Guru
Topics: 62
Posts: 601
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I will go with HSV encephalitis as in hemorrhage protein and cell count shoud not elvate that much.
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| dr_jojo
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the only thing i donot understand is why ptn is very high , i think in viral should be very mild not 400
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| eaguin
Forum Senior
Topics: 9
Posts: 162
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I think is HVS too.
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