GOGETA
I'm Dr. GOGETA
Topics: 299
Posts: 2,637
|
Q) A 45 year old man comes to the doctors office and complains of "the worst headache in his life".
He is awake and oriented. He refuses to have a CT.
A lumbar puncture yields lightly blood tinged sample with rbc count 300,000
wbc count 55000(90% polyps), protein-88,glucose-20
gram stain is negative.
Most appropriate treatment is
a)E aminocaproic acid
b)angiography
c)iv ceftriaxone
d)heparin
___________________
As a general rule, the better it felt when you said it, the more trouble it's going to get you into.
|
| hanialkhadher
Forum Elite
Topics: 16
Posts: 256
|
c)iv ceftriaxone 
___________________
"أقرأ بأسم ربك الذي خلق,خلق الأنسان من علق,أقرأ و ربك الأكرم, الذي علم بالقلم,علم الأنسان ما لم يعلم"
|
| dr.wad
Forum Senior
Topics: 3
Posts: 335
|
"the worst headache in his life". this sentence
is usually used to describe subarachnoid hge.
i dont know what is meant by ( gram stain is negative )......does it mean that there is no organisms dtected by the stain , or the stain reveal gram negative organisms.
however, i will choose ( A ) aminocaproic acid ...for SAH.
|
| chemamr
Moderator and PGY1
Topics: 703
Posts: 4,441
|
G(-), PMN, low gluc, high prot: I would consider bact mening and give him: Ceftriaxone.
___________________
Any time something is written against me, I not only share the sentiment but feel I could do the job far better myself.
|
| DrVirgo
Forum Hero
Topics: 1042
Posts: 3,344
|
answer?
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| RitaM
Forum Newbie
Topics: 1
Posts: 61
|
This sounds like a SAH as it is the worst headache of his life and there are so many RBCS on the LP I would go with angiography and manage the patient as an SAH
|
| sandra
Forum Guru
Topics: 178
Posts: 422
|
whtz the answer?
___________________
You become what you think you are!
|
| neurom
Forum Senior
Topics: 2
Posts: 127
|
Angio coiling - SAH..
___________________
"Nature magically suits a man to his fortunes, by making them the fruit of his character".
|
| DrVirgo
Forum Hero
Topics: 1042
Posts: 3,344
|
Sounds like SAH because worse headache of life. -angio
BUT then again the LP sounds like bacterial meningitis -ceftriaxone.
Which one is it?
Please post the answer!
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| neuroblastoma
Forum Guru
Topics: 99
Posts: 1,011
|
c)iv ceftriaxone
___________________
yahoo mesenger and skype ID asdvsd2003
|
| neurom
Forum Senior
Topics: 2
Posts: 127
|
SAH - WBC count can be high
___________________
"Nature magically suits a man to his fortunes, by making them the fruit of his character".
|
| multifactorial
Forum Guru
Topics: 28
Posts: 546
|
i think it should be angiography.
|
| anastamosis
Forum Senior
Topics: 34
Posts: 167
|
Angio
___________________
THE HIGHER YOU AIM, THE HIGHER YOU REACH !! My contacts are as follows ==> yahoo id --> anastamosis_e2e;gmail id --> anastamosis;Skype id --> anastamosis
|
| mildus
Forum Guru
Topics: 19
Posts: 614
|
Very interesting case, I am also in two minds, between SAH and meningitis. Erythrocytes can be of traumatic origin due to LP (there is so called "three tubes test" to differentiate SAH and arteficial blood in CST). It would be beneficial if we knew that the headache started suddenly, like a knife cut, it would also indicate SAH together with the complain of the worst headache in life. What's the answer?
|
| Aashi
Forum Moderator
Topics: 112
Posts: 919
|
SAH(Buzz word-->" worst headache of my life")------->Best initial is LP---->Done in this case, CT was refused by the pt-------->so the Next best is to get an ANGIOGRAM to localise the bleed before clipping it-------->So the answer is B
___________________
"Obstacles are those frightful things you see when you take your EYES off your goal."
|
| neurom
Forum Senior
Topics: 2
Posts: 127
|
Aashi wrote:
SAH(Buzz word-->" worst headache of my life")------->Best initial is LP---->Done in this case, CT was refused by the pt-------->so the Next best is to get an ANGIOGRAM to localise the bleed before clipping it-------->So the answer is B
SAH: Initial step is to do CT, then angio. If CT negative then LP.
___________________
"Nature magically suits a man to his fortunes, by making them the fruit of his character".
|
| Aashi
Forum Moderator
Topics: 112
Posts: 919
|
neurom wrote:
SAH: Initial step is to do CT, then angio. If CT negative then LP.
Right
___________________
"Obstacles are those frightful things you see when you take your EYES off your goal."
|
| GOGETA
I'm Dr. GOGETA
Topics: 299
Posts: 2,637
|
Answer is B….. SAH diagnosis is angiography….after LP and CT… tx is surgical Clipping
___________________
As a general rule, the better it felt when you said it, the more trouble it's going to get you into.
|
| tamerbashir
Forum Elite
Topics: 20
Posts: 284
|
in suspected SAH , U CAN DO LP before CT ??
and yes wbc count can be high in SAH but 55000?
|
| DrVirgo
Forum Hero
Topics: 1042
Posts: 3,344
|
tamerbashir wrote:
in suspected SAH , U CAN DO LP before CT ??
and yes wbc count can be high in SAH but 55000?
It would be necessary to do CT BEFORE LP if
-Papilledema
-Focal findings
or
-Confusion
Otherwise you can do LP first.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| cool doctor
Forum Junior
Topics: 1
Posts: 219
|
and how do you explain the low glucose and high protein, WBC in SAH?
I still feel its meningitis, you dont have the answer GOGETA, do you?
|
|
| |
| | | | | | | | | | | | | | | | | | | | | |
