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* q21
 #137996  
  sith - 11/12/06 16:05
 
  21. A 42-year-old man comes to the emergency department because of a 2-week history of increasingly severe headaches and a 2-day history of nausea, vomiting, neck stiffness, and unsteadiness. He has type 2 diabetes mellitus treated with glyburide. His temperature is 38.1 C (100.5 F). Funduscopic examination shows bilateral papilledema. Neurologic examination shows mild meningismus and diffusely brisk deep tendon reflexes. He walks with a moderately broad-based gait. He is able to recall two out of three objects after 5 minutes and makes several errors on serial sevens. A CT scan of the head shows no abnormalities. Cerebrospinal fluid analysis shows a glucose level of 18 mg/dL, a protein level of 108 mg/dL, and a leukocyte count of 59/mm3 (1% segmented neutrophils and 99% lymphocytes); a cryptococcal antigen assay is positive. Which of the following is the most appropriate pharmacotherapy for this patient?

A
) Acyclovir

B
) Amphotericin B

C
) Itraconazole

D
) Penicillin

E
) Vancomycin
 
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* Re:q21
#555890
  malak - 11/12/06 16:22
 
  Amphotericin B
 
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* Re:q21
#555966
  leogeorge - 11/12/06 18:18
 
  whats the diagnosis? apart from the meningitis? why does he have neutropenia....  
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* Re:q21
#555978
  malak - 11/12/06 18:31
 
  Patients with high initial CSF pressure, decreased CSF glucose, low CSF leukocyte count , no cryptococcal antibody or high cryptococcal antigen titers tend to have a poor prognosis. Patients with low initial CSF pressure, higher CSF leukocyte counts, cryptococcal antibodies and low cryptococcal antigen levels tend to fare better .

cryptococcal meningitis common in HIV pt
 
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* Re:q21
#556037
  nida - 11/12/06 20:18
 
  agree. B)  
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