acting childish

Discussion in 'USMLE STEP 2 CS' started by Dev., Apr 8, 2008.

  1. Dev.

    Dev. Guest

    A 58-year-old man is brought to your office by family members because he has been acting childish for 2 days. Today, he spent several hours changing the channels on the remote control, even though the television set was turned off.
    On physical examination, temperature is 38.4°C (101.1 °F). He is confused about where he is and what occurred today. There is no meningismus. Funduscopic examination and the remainder of the neurologic examination are normal, as is the general physical examination.

    Plasma glucose and serum electrolyte determinations are normal. CT scan of the head without contrast shows no abnormalities. Lumbar puncture is performed. Cerebrospinal fluid shows 84 leukocytes/μL (93% lymphocytes and 7% neutrophils), protein of 90 mg/dL, and glucose of 75 mg/dL (simultaneous plasma glucose is 88 mg/dL).

    Which of the following is most appropriate at this time?

    A. Begin acyclovir, 5 mg/kg intravenously every 8 hours
    B. Begin acyclovir, 10 mg/kg intravenously every 8 hours
    C. Await the results of a polymerase chain reaction test of CSF before beginning antiviral therapy
    D. Await the results of an MRI scan of the head before beginning antiviral therapy
    E. Await the results of a brain biopsy before beginning antiviral therapy

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