06-25-2014, 09:38 AM
Let me put a PN of meningitis:
CC: 40 yo F c/o HA, malaise, fever
HPI: “common cold” started 3 d ago, HA started this morning, constant, throbbing, 8/10, diffuse, no radiation, alleviated by nothing, aggravated by movement. + fever, chills, photophobia, confusion, n/v with no blood. No dizziness, aura, blurred vision, tearing, ear pain, rhinorrhea, LOC, SOB, seizures. No head trauma.
OB/GYN: LMP 5 d ago, regular, G2P2
ROS: no changes in GI, GU, or sleep.
ALLS: NKDA/NKA. Meds: none. PMH: no h/o similar episode, major illness, hosp, surg, injuries
SH: no cig, alcohol, rec drugs. SexHx: active with wife only
FH: noncontributory
PE:
BP, T, RR, p
Pt in severe distress
HEENT: NC/AT, no tenderness, no pallor, vision acuity wnl. no ear tenderness or discharge. No nasal discharge. No tonsillar erythema, exudate, no oral thrush.
Neck: +rigidity, +Brudzinski, no LAD.
UE: petechiae on forearms B/L,
Neuro: A&O x3, good concentration and memory, motor 5/5 B/L, DTR: 2+ R, 3+L, sensation intact B/L
DDx
#1 meningitis
HA NC/AT
Fever 103.5F
Photophobia +brudzinski
n/v + petechiae
Subacute +neck rigidity
confusion A&O x3
-LOC
-h/o trauma
#2 encephalitis
HA NC/AT
Fever 103.5F
Photophobia +Brudzinski
n/v +petechiae
Subacute +neck rigidity
confusion
-LOC
-h/o trauma
#3 subarachnoid hemorrhage
HA 103.5F
Fever +brudzinski
Photophobia +neck rigidity
n/v
confusion
-LOC
-ill contact
Workup
CBC w/diff, ESR, gluc, lytes
Blood C&S x3
CT-head
MRI-brain
LP, CSF analysis (G stain, cell count, gluc, protein, C&S x 3)
CC: 40 yo F c/o HA, malaise, fever
HPI: “common cold” started 3 d ago, HA started this morning, constant, throbbing, 8/10, diffuse, no radiation, alleviated by nothing, aggravated by movement. + fever, chills, photophobia, confusion, n/v with no blood. No dizziness, aura, blurred vision, tearing, ear pain, rhinorrhea, LOC, SOB, seizures. No head trauma.
OB/GYN: LMP 5 d ago, regular, G2P2
ROS: no changes in GI, GU, or sleep.
ALLS: NKDA/NKA. Meds: none. PMH: no h/o similar episode, major illness, hosp, surg, injuries
SH: no cig, alcohol, rec drugs. SexHx: active with wife only
FH: noncontributory
PE:
BP, T, RR, p
Pt in severe distress
HEENT: NC/AT, no tenderness, no pallor, vision acuity wnl. no ear tenderness or discharge. No nasal discharge. No tonsillar erythema, exudate, no oral thrush.
Neck: +rigidity, +Brudzinski, no LAD.
UE: petechiae on forearms B/L,
Neuro: A&O x3, good concentration and memory, motor 5/5 B/L, DTR: 2+ R, 3+L, sensation intact B/L
DDx
#1 meningitis
HA NC/AT
Fever 103.5F
Photophobia +brudzinski
n/v + petechiae
Subacute +neck rigidity
confusion A&O x3
-LOC
-h/o trauma
#2 encephalitis
HA NC/AT
Fever 103.5F
Photophobia +Brudzinski
n/v +petechiae
Subacute +neck rigidity
confusion
-LOC
-h/o trauma
#3 subarachnoid hemorrhage
HA 103.5F
Fever +brudzinski
Photophobia +neck rigidity
n/v
confusion
-LOC
-ill contact
Workup
CBC w/diff, ESR, gluc, lytes
Blood C&S x3
CT-head
MRI-brain
LP, CSF analysis (G stain, cell count, gluc, protein, C&S x 3)