#june2020mccqe1
A 45-year-old woman with a history of heavy alcohol use is evaluated in the emergency department for a headache and altered mental status of 2-day's duration. One week earlier she had a diarrheal illness that quickly resolved. On physical examination, she is lethargic and unable to follow commands. Temperature is 38.8°C (101.9°F), blood pressure is 110/70 mm Hg, pulse rate is 105/min, and respiration rate is 22/min. Jolt accentuation of her headache is present. The leukocyte count is 14,500/μL (14.5 × 109/L) with 44% neutrophils, 42% bands, and 13% lymphocytes; platelet count is 146,000/μL (146 × 109/L). The serum albumin is 2.6 mg/dL (26 g/L), the INR is 1.5, and the partial thromboplastin time is 44.1 seconds. A noncontrast head CT scan is normal. Cerebrospinal fluid (CSF) leukocyte count is 1500/μL (1500 × 106/L), with 60% neutrophils and 40% lymphocytes; glucose level is 5 mg/dL (0.3 mmol/L); and protein level is 328 mg/dL (3280 mg/L). The CSF Gram stain reveals intracellular gram-positive bacilli. Which of the following is the most likely diagnosis?
(A) Listeria monocytogenes meningitis
(B) Neisseria meningitidis meningitis
(C) Streptococcus pneumoniae meningitis
(D) Viral meningitis
A 45-year-old woman with a history of heavy alcohol use is evaluated in the emergency department for a headache and altered mental status of 2-day's duration. One week earlier she had a diarrheal illness that quickly resolved. On physical examination, she is lethargic and unable to follow commands. Temperature is 38.8°C (101.9°F), blood pressure is 110/70 mm Hg, pulse rate is 105/min, and respiration rate is 22/min. Jolt accentuation of her headache is present. The leukocyte count is 14,500/μL (14.5 × 109/L) with 44% neutrophils, 42% bands, and 13% lymphocytes; platelet count is 146,000/μL (146 × 109/L). The serum albumin is 2.6 mg/dL (26 g/L), the INR is 1.5, and the partial thromboplastin time is 44.1 seconds. A noncontrast head CT scan is normal. Cerebrospinal fluid (CSF) leukocyte count is 1500/μL (1500 × 106/L), with 60% neutrophils and 40% lymphocytes; glucose level is 5 mg/dL (0.3 mmol/L); and protein level is 328 mg/dL (3280 mg/L). The CSF Gram stain reveals intracellular gram-positive bacilli. Which of the following is the most likely diagnosis?
(A) Listeria monocytogenes meningitis
(B) Neisseria meningitidis meningitis
(C) Streptococcus pneumoniae meningitis
(D) Viral meningitis
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