tommyk
04-09-2006, 06:17 PM
Hy 2118
A 13-year-old pre-med bound girl is brought to the emergency department because of generalized seizures lasting for 10 minutes.
She has had purulent otitis for the last week, which has been poorly responsive to antibiotic treatment.
Her temperature is 39.5 C (103 F), blood pressure is 140/80 mm Hg, pulse is 86/min, and respirations are 18/min.
She appears oriented and cooperative during physical examination. Funduscopy reveals papilledema. AHHH! She is so young and needs to experience Homecoming, Prom, Marriage, Med school, etc. Save HER! Pick one to do: (You WILL see this) And tell me the main two bugs responsible for this.
1- Blood cultures for Neiserria
2- EEG studies
3-CT/MRI of the head
4- Lumbar puncture
5-NSAIDS
6-Ciprofloxacin
7-Gentamicin
A) #3, do a CT to examine what Streptococcus Pneumoniae or H. flu or Moraxella c. is doing to this poor girl. One of the most serious complications of sinusitis and otitis is the development of cerebral abscesses. This often manifests with persistent fever, variable neurologic deficits, headache, and seizures. Because of the accompanying edema around the abscess, intracranial pressure may develop, which explains papilledema or ptosis in this case. Cerebral abscesses are life-threatening conditions that often require surgical evacuation right away! Blood cultures are often negative in the case of an isolated cerebral abscess. On the other hand, the surgeon should submit samples for culture in case of surgical intervention. EEG studies may, at best, show non-specific (and thus non-diagnostic) focal changes in the temporal region. Lumbar puncture, as in all situations in which signs of increased intracranial pressure are detected, should be avoided. A lumbar tap may precipitate fatal cerebellar tonsillar herniation.
A 13-year-old pre-med bound girl is brought to the emergency department because of generalized seizures lasting for 10 minutes.
She has had purulent otitis for the last week, which has been poorly responsive to antibiotic treatment.
Her temperature is 39.5 C (103 F), blood pressure is 140/80 mm Hg, pulse is 86/min, and respirations are 18/min.
She appears oriented and cooperative during physical examination. Funduscopy reveals papilledema. AHHH! She is so young and needs to experience Homecoming, Prom, Marriage, Med school, etc. Save HER! Pick one to do: (You WILL see this) And tell me the main two bugs responsible for this.
1- Blood cultures for Neiserria
2- EEG studies
3-CT/MRI of the head
4- Lumbar puncture
5-NSAIDS
6-Ciprofloxacin
7-Gentamicin
A) #3, do a CT to examine what Streptococcus Pneumoniae or H. flu or Moraxella c. is doing to this poor girl. One of the most serious complications of sinusitis and otitis is the development of cerebral abscesses. This often manifests with persistent fever, variable neurologic deficits, headache, and seizures. Because of the accompanying edema around the abscess, intracranial pressure may develop, which explains papilledema or ptosis in this case. Cerebral abscesses are life-threatening conditions that often require surgical evacuation right away! Blood cultures are often negative in the case of an isolated cerebral abscess. On the other hand, the surgeon should submit samples for culture in case of surgical intervention. EEG studies may, at best, show non-specific (and thus non-diagnostic) focal changes in the temporal region. Lumbar puncture, as in all situations in which signs of increased intracranial pressure are detected, should be avoided. A lumbar tap may precipitate fatal cerebellar tonsillar herniation.