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* NBME Neuro 3
 #846034  
  kennychan - 12/03/17 16:33
 
  A previously healthy 22-year old woman comes the emergency department 6 hours after the onset of fever, chills, severe headache, and nausea. Her temperature is 38.5 (101.3), pulse is 100/min, and blood pressure is 100/70 mm Hg. Examination shows nuchal rigidity. There is a petechial rash on the trunk. A lumbar puncture is performed, and antibiotic therapy is begun. After 12 hours, culture of cerebrospinal fluid grows Neisseria meningitidis. Which of the following is the most appropriate next step in management for staff who have been in contact with the patients?

a) Measurement of serum immunoglobulin concentrations
b) Nasal cultures of N. meningitidis
c) Antibiotic prophylaxis
d) Antibiotic therapy if symptoms develop
e) Intramuscular immune globulin therapy

I think either c or d.
 
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* Re:NBME Neuro 3
#3354151
  kennychan - 12/03/17 18:32
 
  A 12 year-old boy is brought to the physician because of increasing pain in his back and both of his heels since he began playing for his middle basketball team 3 weeks ago. He also has had difficulty running and jumping because of the pain. He has not had fever. Treatment with ibuprofen has provide minimal relief. His father and paternal uncle have a history of low back pain. The patient is alert and active. He is at the 3rd percentile for height and weight. Examination of the spine shows no deformities or tenderness, but he has limited forward flexion and cannot touch his toes. Dorsiflexion of the ankles is limited to 70 degrees. There is tenderness over the heels bilaterally at the insertion site for the Achilles tendon. Range of motion is otherwise full, and there is no joint pain or swelling. Muscle strength is normal and symmetric all extremities. Deep tendon reflexes are 2+ in the upper and lower extremities. His gait is normal. The remainder of the examination shows no abnormalities. His erythrocyte sedimentation rate is 55 mm/h. Which of the following is the most likely cause of this patientís heel pain?
a) Ankylosing spondylitis
b) Growing pains
c) Inappropriate arch support
d) Pauciarticular juvenile arthritis
e) Tethered spinal cord

I think it is B)
 
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* Re:NBME Neuro 3
#3354168
  nelly88 - 12/03/17 22:45
 
  A previously healthy 22-year old woman comes the emergency department 6 hours after the onset of fever, chills, severe headache, and nausea. Her temperature is 38.5 (101.3), pulse is 100/min, and blood pressure is 100/70 mm Hg. Examination shows nuchal rigidity. There is a petechial rash on the trunk. A lumbar puncture is performed, and antibiotic therapy is begun. After 12 hours, culture of cerebrospinal fluid grows Neisseria meningitidis. Which of the following is the most appropriate next step in management for staff who have been in contact with the patients?

a) Measurement of serum immunoglobulin concentrations
b) Nasal cultures of N. meningitidis
c) Antibiotic prophylaxis
d) Antibiotic therapy if symptoms develop
e) Intramuscular immune globulin therapy

Answer: C. You have to give prophylaxis for all the respiratory contacts with rifampin, ciprofloxacin or ceftiazone


A 12 year-old boy is brought to the physician because of increasing pain in his back and both of his heels since he began playing for his middle basketball team 3 weeks ago. He also has had difficulty running and jumping because of the pain. He has not had fever. Treatment with ibuprofen has provide minimal relief. His father and paternal uncle have a history of low back pain. The patient is alert and active. He is at the 3rd percentile for height and weight. Examination of the spine shows no deformities or tenderness, but he has limited forward flexion and cannot touch his toes. Dorsiflexion of the ankles is limited to 70 degrees. There is tenderness over the heels bilaterally at the insertion site for the Achilles tendon. Range of motion is otherwise full, and there is no joint pain or swelling. Muscle strength is normal and symmetric all extremities. Deep tendon reflexes are 2+ in the upper and lower extremities. His gait is normal. The remainder of the examination shows no abnormalities. His erythrocyte sedimentation rate is 55 mm/h. Which of the following is the most likely cause of this patientís heel pain?
a) Ankylosing spondylitis
b) Growing pains
c) Inappropriate arch support
d) Pauciarticular juvenile arthritis
e) Tethered spinal cord

It couldn't be Growing pains because he has high ESR... so I would go more for Juvenile arthritis, he meets all the criteria.
 
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* Re:NBME Neuro 3
#3354178
  kennychan - 12/04/17 09:37
 
  For second question
Patient could have AS because of + family history and increased ESR.
 
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* Re:NBME Neuro 3
#3354185
  nelly88 - 12/04/17 10:52
 
  You're right, make a lot of sense if he has family history.  
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* Re:NBME Neuro 3
#3354223
  kennychan - 12/04/17 15:55
 
  For JIA, patients should have polyarthritis, LAD, fever, myalgias.  
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