#may2020mccqe1
A 19-year-old-woman who is a sophomore in college is evaluated in December for a 24-hour history of fever and headache. She lives in a dormitory on campus. Her medical history is unremarkable. She takes no medications and is up to date with all of her immunizations, including the meningococcal vaccine, which she received before entering college. Two cases of meningococcal serogroup B-associated meningitis have been reported on campus. On physical examination, the patient appears ill. Temperature is 39.1°C (102.4°F), blood pressure is 95/50 mm Hg, pulse rate is 125/min, and respiration rate is 25/min. A purpuric rash is appreciated over both lower extremities. Neck stiffness is present and jolt accentuation of the headache is elicited. A noncontrast CT scan of the head is normal. The leukocyte count is 19,500/μL (19.5 × 109/L) with 87% neutrophils and 13% lymphocytes; platelet count is 110,000/μL (110 × 109/L). Cerebrospinal fluid (CSF) leukocyte count is 2000/μL (2000 × 106/L), with 95% neutrophils and 5% lymphocytes; glucose level is 20 mg/dL (1.1 mmol/L); and protein level is 100 mg/dL (1000 mg/L). The CSF Gram stain reveals gram-negative diplococci. Which of the following is the most likely diagnosis?
(A) Neisseria meningitidis meningitis
(B) Rocky Mountain spotted fever
(C) Streptococcus pneumoniae meningitis
(D) Vibrio vulnificus meningitis
A 19-year-old-woman who is a sophomore in college is evaluated in December for a 24-hour history of fever and headache. She lives in a dormitory on campus. Her medical history is unremarkable. She takes no medications and is up to date with all of her immunizations, including the meningococcal vaccine, which she received before entering college. Two cases of meningococcal serogroup B-associated meningitis have been reported on campus. On physical examination, the patient appears ill. Temperature is 39.1°C (102.4°F), blood pressure is 95/50 mm Hg, pulse rate is 125/min, and respiration rate is 25/min. A purpuric rash is appreciated over both lower extremities. Neck stiffness is present and jolt accentuation of the headache is elicited. A noncontrast CT scan of the head is normal. The leukocyte count is 19,500/μL (19.5 × 109/L) with 87% neutrophils and 13% lymphocytes; platelet count is 110,000/μL (110 × 109/L). Cerebrospinal fluid (CSF) leukocyte count is 2000/μL (2000 × 106/L), with 95% neutrophils and 5% lymphocytes; glucose level is 20 mg/dL (1.1 mmol/L); and protein level is 100 mg/dL (1000 mg/L). The CSF Gram stain reveals gram-negative diplococci. Which of the following is the most likely diagnosis?
(A) Neisseria meningitidis meningitis
(B) Rocky Mountain spotted fever
(C) Streptococcus pneumoniae meningitis
(D) Vibrio vulnificus meningitis
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