A 21-Year-Old Man Is Brought to the Emergency Department by His

question 52

Multiple Choice

A 21-year-old man is brought to the emergency department by his roommate due to worsening fever, headache, and confusion.  The patient recently moved to a dormitory, and his prior medical problems and immunizations are unknown.  Temperature is 39.2 C (102.6 F) , blood pressure is 98/54 mm Hg, pulse is 112/min, and respirations are 24/min.  The patient appears acutely ill.  He is obtunded and has nuchal rigidity.  Leukocyte count is 19,000/mm³ with 20% band neutrophils.  Blood cultures are obtained and lumbar puncture is performed.  Gram stain of cerebrospinal fluid reveals gram-negative cocci in pairs.  Which of the following is the most likely way that this organism reached the meninges?

• A)Middle ear → contiguous tissues → meninges
• B)Pharynx → blood → choroid plexus → meninges
• C)Pharynx → lymphatic system → meninges
• D)Primary lung focus → blood → meninges
• E)Traumatic wound → leaking cerebral spinal fluid → meninges

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Definitions:

Initial Trauma

The first or original psychological shock or traumatic event that may lead to the development of stress-related or anxiety disorders.

Functional Neurological Symptom Disorder

A condition where patients experience neurological symptoms without a clear structural or biochemical cause.

Impaired Connectivity

Reduced or disrupted connections and communication between neurons or brain regions, which can affect cognitive and neurological functions.

Factitious Disorder

A mental disorder in which an individual deceives others by appearing sick, by purposely getting sick, or by self-injury.