MedBugs: SAQ #85

Case: Acute confusion

A 79-year-old woman presents to your metropolitan ED with acute confusional state. She was last seen well by her family 6 hours prior. She has a past medical history of ovarian cancer, type 2 diabetes mellitus, and depression. On examination you note that she has a central venous access device. Her vital signs are:

RR 26 /min
SpO2 95% RA
HR 113 bpm
BP 115/68 mmHg
Temp 38.0 C

1. Apart from CNS infection, list (3) emergent differential diagnoses 3 marks

You decide that a lumbar puncture is indicated as part of your work up.

2. Before performing the lumbar puncture, list and justify (3) other investigations that should be performed. 3 marks

You obtain the following preliminary CSF results : White cell count 2010 / mm3 Red cell count 2000 / mm3 Protein 3.39 g/L Glucose 1.9 mmol/L

3. List (2) antimicrobial agents you would use in your empirical treatment of this patient, and justify your responses 2 marks

4. Complete the table to list (4) early and (4) late complications of bacterial meningitis 4 marks

The next day, you are advised that the patient has been diagnosed with confirmed meningococcal meningitis

5. List (3) groups of people who should be offered chemoprophylaxis 3 marks

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