elitoki
Forum Guru
Topics: 54
Posts: 508
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Q.
a female has fever, headache, photophobia and mild slurred speech for 2 days.
pe: t, bp, p, rr are all normal, but has mild facial droop.
history: she went camping in upstate new york 3 wks ago and was bitten by a tick and got a rash with central area of clearing on the biting site.
which is the most appropriate next management.?
1. lumbar puncture
2. intravenous ceftriaxone
3. oral doxycycline
4. get serum lyme ab titer
5. serum lyme pcr
A & Y?
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| elitoki
Forum Guru
Topics: 54
Posts: 508
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curiosly they said the answer is 1, lumbar puncture
 
Could someone explain why?
Thanks
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| neuroblastoma
Forum Guru
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Posts: 1,015
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my semi-educated guess
for meningitis--LP is the first step always.then treatment.
ct only before LP (if papilledema,focal findings, altered mental status present.
Before u sent for CT give ANTIBIOTIC first.
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| gr8doc
Forum Senior
Topics: 8
Posts: 210
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You are right Neuro, in this case where there is fever, headache, photophobia & mid facial drop. the diagnosis is meningitis, so you should do LP first.
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| liliaeliz
Forum Elite
Topics: 37
Posts: 342
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| MAGY17
Forum Elite
Topics: 30
Posts: 234
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if LP is positive the drug of choice is iv ceftrixone
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| Justice
Forum Fanatic
Topics: 100
Posts: 1,920
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1. lumbar puncture
___________________
Don't live in a town where there are no doctors
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| epica
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Yes, LP
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| elitoki
Forum Guru
Topics: 54
Posts: 508
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So, we have to rule out first meningitis.
Thanks.
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