WBR0705

Author	[[PageAuthor::Mohamed Moubarak, M.D. [1]]]
Exam Type	USMLE Step 3
Main Category	Emergency Room
Sub Category	Infectious Disease
Prompt	40 years old man IV drug abuser, present to ED complaining of fever, headache, vomiting, and blurring of vision. His symptoms started 10 days ago with a progressive course. He had never been tested for HIV before. Physical exam shows neck stiffness and bilateral papilledema. CSF fluid examination shows marked elevated opening pressure, low WBC count with lymphocyte predominance, low glucose, and elevated proteins. What is the best next step in the management of this patient?
Answer A	HIV testing
Answer A Explanation	Incorrect Although his HIV status should be checked, the treatment should come first.
Answer B	IV antiviral theraby
Answer B Explanation	Incorrect Viral meningitis CSF findings has normal glucose concentration, normal or slightly elevated opening pressure, normal or slightly elevated protein concentration.
Answer C	Start amphotericin B and flucytosine
Answer C Explanation	Correct amphotericin B and flucytosine are the treatment of choice in cryptococcal meningitis
Answer D	Start gentamicine and ceftriaxone
Answer D Explanation	Incorrect Bacterial meningitis CSF examination include: polymorphonuclear leukocytosis, decreased glucose concentration, increased opening pressure, and protein concentration.
Answer E	Start vancomycin
Answer E Explanation	Incorrect CSF examination don’t show bacterial meningitis
Right Answer	C
Explanation	The patient high risk behavior put him at risk of having HIV. The CSF findings are characteristic for cryptococcal meningitis , which is managed by amphotericin B and flucytosine. Educational Objective: References:
Approved	No
Keyword
Linked Question
Order in Linked Questions