Hy 2804 This borders on Step 2CK, but I know that anyone taking Step 1 will have...

[tommyk]

to study step 2CK. So...

q- 80 yo F, URI, has generalized weakness, headache, blurry vision. Her FP doctor diagnosed her w/ sinusitis. She then took antibiotics for 2 days. Then she had chills, lightheadedness, vomiting, blurry vision, aches and pains, headaches. PE: high temp. of 103 F, nuchal rigidity and sleepiness. What to do next???

1- Get MRI, then lumbar puncture
2- Oral Zithromax
3- IV ceftriaxone w/ ampicillin
4- IV acyclovir








































































ans. is #3. Immediate concern is that pt. has bacterial meningitis. So go to it! Tell me why the other choices are wrong??

(for example, lumbar puncture is a good answer, but NOT the BEST ANSWER. LP will take days to come back, maybe too late for the patient.)

[IMG SURVIVOR]

1- Get MRI, then lumbar puncture



2- Oral Zithromax

To long to start doing action, is bacteriostatic you will want bactericida.

3- IV ceftriaxone w/ ampicillin

Ceftriaxone crossed and intial tx and the ampicilin is because patients over 55 are prone to also get listeria and ampicillin will cover that.

4- IV acyclovir

For virus not bacteria

There are MANY MANY Step2 questions in step1, so guys if you think is to clinical, THINK again.