administration of adjunctive dexamethasone

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

  1. Dev.

    Dev. Guest

    An 80-year-old man is hospitalized because of headache, fever, and altered sensorium. He was in his usual state of health until 2 days prior to admission when he developed a frontal headache that kept him awake that night. The next day, he felt feverish and told his wife that his neck was aching. Acetaminophen provided some relief. The following morning, his wife was unable to arouse him from sleep, and he was brought to the emergency department.

    On physical examination in the emergency department, temperature is 38.9°C (102.0 °F), pulse rate is 130/ min, respiration rate is 40/mm, and blood pressure is 110/50 mm Hg. He is obtunded and has a stiff neck. Lumbar puncture is performed. The opening pressure is high. Leukocyte count is 1200/μL. (with 95% neutrophils), glucose is 22 mg/dL (simultaneous plasma glucose is 85 mg/dL), and protein is 200 mg/dL. Gram stain of cerebrospinal fluid is negative. Empiric antimicrobial therapy with vancomycin, ampicillin, and ceftriaxone is begun.

    Which of the following statements is correct regarding administration of adjunctive dexamethasone to this patient?

    A. Dexamethasone should be administered within 1 hour of the first dose of antimicrobial therapy
    B. Dexamethasone has no role in the adjunctive treatment of bacterial meningitis in an adult patient
    C. Dexamethasone will increase the risk of an unfavorable outcome in an adult patient with bacterial meningitis
    D. If this patient has pneumococcal meningitis, dexamethasone will improve his chance of survival
    E. If this patient hasListeria meningitis, dexamethasone will improve his chance of survival

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