tamerbashir
Forum Elite
Topics: 20
Posts: 284
|
19For each patient with papilledema, select the most likely diagnosis.
A
) Bacterial meningitis
B
) Cerebral infarction
C
) Cryptococcal meningitis
D
) Glioblastoma multiforme
E
) Herpes simplex encephalitis
F
) Hypertensive encephalopathy
G
) Idiopathic intracranial hypertension
H
) Intracerebral hemorrhage
I
) St. Louis encephalitis
. A 25-year-old man with a history of intravenous drug use comes to the emergency department because of a progressive diffuse headache, generalized malaise, and low-grade fever for 2 months. During this period, he has had a poor appetite resulting in a 6.8-kg (15-lb) weight loss. His temperature is 38 C (100.4 F). Examination shows ¬¬neck stiffness. Mental status examination shows no abnormalities. Cranial nerve examination shows weakness of the lateral rectus muscle on the right and bilateral papilledema. A CT scan of the head with and without contrast shows moderate ventricular enlargement. Examination of cerebrospinal fluid shows:
Opening pressure 220 mm H2O
Glucose 35 mg/dL
Protein 150 mg/dL
WBC 100/mm3
Lymphocytes 100%
RBC 1/mm
|
| tamerbashir
Forum Elite
Topics: 20
Posts: 284
|
how to differntiate between cryptococcal meningitis and hsv encephalitis ?
hsv encpahalitis presnted by personality changes ?
hsv encephalitis coz bloody csf ???
|
| Doc750
transfer:step 3 prison
Topics: 52
Posts: 636
|
A?
Lymphocytic pleuocytosis, mod increase in protein, RBC without evidence of trauma --> HSV encephalitis. HSV encephalitis presents with altered consciousness, headache, fever, seizures. Yes HSV has + RBC on the CSF analysis.
Cryptococcal meningitis LP wil show decrease glucose, increase protein; leukocyte count will be increased with predominance of monocytes. + india ink. Presents with headache, fever, impaired mentaion, and absent meningismus.
___________________
Experience is a hard teacher because she gives the test first, and the lesson afterwards.
|
| tamerbashir
Forum Elite
Topics: 20
Posts: 284
|
 thanks
|
| Doc750
transfer:step 3 prison
Topics: 52
Posts: 636
|
ok but what's the answer?
___________________
Experience is a hard teacher because she gives the test first, and the lesson afterwards.
|
| doyoudig
Forum Guru
Topics: 144
Posts: 613
|
Monocytes for Fungal???
Fungal also has Increased Opening pressures -- seen in fungal and TB...
He is a IV drug abuser and MCC is crypto in this case --ans is Crypto
1 RBC is not enough for HSV -- affects Primarily the Temporal Lobes, CN Invol, Ataxia, Personality chnages
|
| doyoudig
Forum Guru
Topics: 144
Posts: 613
|
also if HSV encephalitis than Sx occur suddenly Sx starting less 1 wk
and Glu may be nl or slightly incr i.e 40-70 = nl
in addition CT should have shown lesions in the Temporal lobe, but can be negative in 50% of cases hence MRi more specific
so Fungal
--Incr Opening Pressure, Incr Protein > 40, Decr Glucose
Viral
--Incr Opening Pressure, Incr Protein > 40, nl or incr Glucose, Numerous RBC on CSF
--Sudden Onset of Sx/ Fever, Headache, Confusion, Behv Sx's
|
| Doc750
transfer:step 3 prison
Topics: 52
Posts: 636
|
doyoudig wrote:
Monocytes for Fungal???
straight out of the 2007 FA pg 180
___________________
Experience is a hard teacher because she gives the test first, and the lesson afterwards.
|
| doyoudig
Forum Guru
Topics: 144
Posts: 613
|
I don;t have teh new version but I believe u even though I am suprised but my answer is still the same Crypto fits more with this case
|
| tamerbashir
Forum Elite
Topics: 20
Posts: 284
|
E 
|
| usmle12
Forum Senior
Topics: 19
Posts: 194
|
agreed with doyoudig...cz its high opening pressure,risk fator of iv drug abuse ,plus lack of personality changes
|
|
| |
| | | | | | | | | | | |
