A 43-year-old male presents to the emergency department in a ...

[acc299]

A 43-year-old male presents to the emergency department in a stupor accompanied by his wife. She called the ambulance because her husband was difficult to awaken this morning.
 
  She reports that for the last 3 days, he has had fever and upper respiratory infection. Yesterday he had a headache. He has had no medical treatment. On physical examination, the patient demonstrates 103 fever, sluggish pupil response, and nuchal rigidity. Which of the following should the clinician attempt to elicit next?
  A. Hallpike maneuver
  B. Kernig's sign
  C. Epley maneuver
  D. Babinski's sign

Question 2

Which of the following microorganisms is a common cause of meningitis?
 
  A. Enterococcus
  B. Haemophilus influenza
  C. Influenza virus
  D. Chlamydia

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Answer to Question 1

ANS: B
In meningitis fever, photophobia, phonophobia, nausea, vomiting, and nuchal rigidity occur. Patients can rapidly decline to delirium, seizures, and, if untreated, coma. On neurological examination, the patient may be lethargic and febrile and have altered mentation along with nuchal rigidity and/or guarding, contracted and sluggish pupils, and a generally toxic appearance. Brudzinski's and Kernig's signs are helpful in assessing potential meningeal conditions (see Box 15.6). Delirium or acute confusion necessitates immediate transfer to an emergency department for treatment, as the patient can rapidly deteriorate to coma.

Answer to Question 2

ANS: B
Meningitis involves inflammatory central nervous system (CNS) disease generally caused by either viral or bacterial infection. The etiology of meningitis includes community-acquired, post-traumatic, aseptic, carcinomatous, or transferred from another bodily source. The most common organisms belong to such genera as Streptococcus, Neisseria (meningitides), Haemophilus (influenzae), Listeria, Staphylococcus (aureus) as well as gram-negative bacilli and gram-positive cocci. Meningitis can affect persons of all ages, including children.

[acc299]

Excellent

[daiying98]

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