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Subject: Tommy's Concepts

Subject: Tommy's Concepts
Tommy's Concepts for the USMLE Step 1

Question

A Spectacular “Hyer recall” translated to a solid concept on Infections<br />
q) OK, now where were we? Oh, you open the door to see a <b><i><u>5</u></i></b>-year-old boy, who has a <b><u>ventriculoperitoneal shunt for<i> congenital hydrocephalus</i></u></b>, who develops fever, headache, irritability, lethargy, photophobia, and vomiting. His temperature is 104 F!!!!. He is noted to have <b>nuchal rigidity</b>. The shunt tract is <u>erythematous</u>. A lumbar puncture is performed and <u>shows a WBC of 60,000/mm3 with 80% neutrophils</u>, a glucose concentration of 50 mg/dL, and a protein concentration of 180 mg/dL! (Alarm bells sound…) There is no history of travel, he was born healthy in the U.S. and he has no indication of sexual abuse. Which of the following is the most likely <b><i><u>bug</u></i></b>? Is the bug coagulase positive or negative or neither cause it is a virus or fungi? If a bacteria bug, which will you choose, Vancomycin or Ceftriaxone???<br />
1-Haemophilus influenza<br />
2-Staph aureus<br />
3-Varicella zoster virus<br />
4-HIV virus<br />
5-Strep pneumonia<br />
6-Neisseria gonorrhea<br />
7-Pseudomonas aeruginosa<br />
8-Pneumocystis carinia<br />
9-Toxoplasmosis<br />
10-Candida albicans<br />
11-Streptococcus epidermidis

Answer