10-24-2008, 04:43 AM
You are working in the emergency department and see a 28-year-old previously healthy woman with a recent upper respiratory infection who has generalized weakness, headache, and blurry vision. For the past 2 weeks she has had upper respiratory symptoms that started with a sore throat, nasal congestion, and excessive coughing. She went to your partner 4 days ago and was diagnosed with sinusitis. She was given a prescription for an antibiotic and took it for 2 days and stopped. After that she developed chills, a headache, lightheadedness, vomiting, blurry vision, and general "achiness." The blurry vision remains when she closes either eye. She has no drug allergies. Her temperature is 39.2 C (102.6 F). She appears lethargic, has eye tenderness with movement, mild photosensitivity, and nuchal rigidity. Ophthalmologic examination is unremarkable. The most appropriate next step is to
A. get an MRI of the head, then perform a lumbar puncture
B. give her a prescription for oral azithromycin and let her go home
C. immediately administer intravenous ceftriaxone
D. immediately start intravenous acyclovir
E. obtain cerebrospinal fluid and blood cultures and observe her until the results come back
A. get an MRI of the head, then perform a lumbar puncture
B. give her a prescription for oral azithromycin and let her go home
C. immediately administer intravenous ceftriaxone
D. immediately start intravenous acyclovir
E. obtain cerebrospinal fluid and blood cultures and observe her until the results come back