Case of the Week: Infectious Diseases

From Graber and Wilbur’s Family Medicine Examination and Board Review, 4th Edition: Infectious Diseases: Case 8.03
Case of the Week: Infectious Diseases


Question 1 of 4

You are called to the emergency department (ED) to examine a 40-year-old man with fever (temperature of 39°C) and headache. His past history is remarkable only for a splenectomy secondary to trauma at age 10. He is not allergic to any antibiotics. Upon examination you note that he has meningeal signs. Nondilated fundal examination shows sharp disc margins, and he is neurologically intact with a nonfocal examination.

The most appropriate action is:

A - Obtain a head CT so that you can safely proceed with lumbar puncture (LP). 

B - Order IV penicillin as you prepare to perform LP. 

C - Perform a LP immediately and begin antibiotic therapy empirically.

D - Order IV erythromycin as you prepare to perform LP.

E - Order IV vancomycin and IV ceftriaxone as you wait for the CBC. If the CBC is abnormal, you will do the LP.

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