#may2020mccqe1
A 20-year-old female college student is evaluated in December because of a 12-hour history of fever, myalgia, headache, and a rash. She takes no medications. On physical examination, the patient appears ill. Temperature is 38.8°C (101.8°F), blood pressure is 90/45 mm Hg, pulse rate is 112/min, and respiration rate is 24/min. A petechial rash, most prominent on the lower extremities, is present. Passive neck flexion causes discomfort.
Leukocyte count 10,500/μL (10.5 × 109/L)
Platelet count 105,000/μL (105 × 109/L)
Blood urea nitrogen 30 mg/dL (10.7 mmol/L)
Creatinine 2.5 mg/dL (221 μmol/L)
Bicarbonate 15 meq/L (15 mmol/L)
Lumbar puncture is performed. Opening pressure is 300 mm H2O. Cerebrospinal fluid leukocyte count is 1250/μL (1250 × 106/L) with 95% polymorphonuclear cells. Protein level is 100 mg/dL (1000 mg/L) and glucose level is 40 mg/dL (2.2 mmol/L). No organisms are seen Gram stain.
Which of the following is the most likely diagnosis?
(A) Listeria monocytogenes meningitis
(B) Neisseria meningitidis meningitis
(C) Rocky Mountain spotted fever
(D) Viral meningitis
A 20-year-old female college student is evaluated in December because of a 12-hour history of fever, myalgia, headache, and a rash. She takes no medications. On physical examination, the patient appears ill. Temperature is 38.8°C (101.8°F), blood pressure is 90/45 mm Hg, pulse rate is 112/min, and respiration rate is 24/min. A petechial rash, most prominent on the lower extremities, is present. Passive neck flexion causes discomfort.
Leukocyte count 10,500/μL (10.5 × 109/L)
Platelet count 105,000/μL (105 × 109/L)
Blood urea nitrogen 30 mg/dL (10.7 mmol/L)
Creatinine 2.5 mg/dL (221 μmol/L)
Bicarbonate 15 meq/L (15 mmol/L)
Lumbar puncture is performed. Opening pressure is 300 mm H2O. Cerebrospinal fluid leukocyte count is 1250/μL (1250 × 106/L) with 95% polymorphonuclear cells. Protein level is 100 mg/dL (1000 mg/L) and glucose level is 40 mg/dL (2.2 mmol/L). No organisms are seen Gram stain.
Which of the following is the most likely diagnosis?
(A) Listeria monocytogenes meningitis
(B) Neisseria meningitidis meningitis
(C) Rocky Mountain spotted fever
(D) Viral meningitis
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