A 16 year-old girl presents with the following acute symptoms: fever severe head

Question

A 16 year-old girl presents with the following acute symptoms:

fever

severe headache

nausea

neck pain

widespread red blotches on her skin

You look through her medical history and see that her last round of immunizations was at her 12 year visit and included: Tdap, HPV, and Hep B.

Answer the following questions:

What follow up questions would you ask? (2.5 points)

What is your initial diagnosis? Why? (7.5 points)

What test(s) would you order to verify your diagnosis? Why? (7.5 points)

What treatment(s) would you recommend? Why? (7.5 points)

Explanation / Answer

Ans) Follow up questions that need to be asked with girl complaining of symptoms like fever , nausea , stiff neck , blotches on skin. The assessing questions alongwith physical examination of the patient by the Doctor could be helpful in diagnosis of condition. Above symptoms suggest that of having Meningitis , as it is common among teenagers. Questions to be asked include -

------- Whether the girl is having any confusion back few days or having problem in talking specific things.

--------If she has visited to any crowded place may be college campus group or to any area like millitary troops , or the close group houses.

--------Any sensitivity towards light can be asked to girl to get the diagnosis.

--------Any History of upper respiratory tract infection like cold , sore throat.

-------- severity of headache and since when the symptoms persists.

--------Any other medical condition like HIV , diabetes , pneumococcal infection , sinusitis.

2-) Initial diagnosis according to symptoms and physical examination and complete assessment of teenage girl the diagnosis came out to be bacterial meningitis. Reason for diagnosing the condition as Meningitis are the symptoms , age , past immunization histoy. As immunization like hepatitis B can result meningitis in future, Stiffness of neck came out to be the most important symptom to diagnose as meningitis.

First step towards diagnosing Meningitis is physical examination as Brudzinski's sign - This is examined by flexing the stiff neck of patient forcefully and automatically flexion of knee and hip is positive sign for meningitis.

Kernig's sign is the one in which patient experiences pain in thigh if leg extension occurs.

Headache , stiff neck , nausea and fever are major symptoms which most patients show having meningitis. However less common symptoms include joint pain , swelling and red patches or blotches on skin. Meningitis is an infection that causes inflammation of meninges or membranes of brain and spinal cord.

3-) Tests to verify diagnosis includes proper assessment , physical examination and some tests. Healthcare practitioner may check signs of infection around ears , throat , and skin along spinal cord.

---Blood culture is done to check the resence of Bacteria in bloodstream that can cause bacterial meningitis.

---CT scan computerized tomography and Magnetic resonance imaging of Brain will be helpful in finding any swelling or inflammation of Brain.

----X-ray of chest and sinuses can also be helpful in checking infection which are also associated to meningitis.

----Lumbar puncture or spinal tap is the test that include collection of CSF( cerebrospinal fluid) in which there is low glucose levels with increased white blood cells and protein. This cerebrospinal examination is also helful in identifying the type of Bacteria that caused meningitis.

Other tests for fungal and viral meningitis should be done to rule out like DNA based polymer chain reaction test.

4-) Treatment for diagnosed meningitis will be recommended on the type of meningitis like

Bacterial meningitis is most common and also lifethreatning meningitis , hence immediate treatment protocol is to be doen by adminitering Antibiotics or combination of antibiotics Corticosteroids more frequently used. Antibiotic should be introduce by Intravenous mode for early treatment. If other infections like sinus and mastoid are found they must be drained. For more aggressive cases treatment is for placing on heart monitor , Breathing tube may be inserted to help in breathing. Bacterial meningitis is a hospitalised condition in which patient having sensitivity of light is given a darkroom and the infection is spreading hence all precautions are to be taken.

Viral meningitis is less threatned form in which antibiotics does not work. Rather condition sometimes gets stable after few days or use of pain medications specially Acetaminophen . Bed rest and introducing plenty of fluids . Follow ups are required if patient feels better after treatment. Antiviral medication is given if herpes virus is causative organism.

Fungal meningitis though is rare but if it is there then antifungal medications are administered. Plenty of fluids and pain medications.

So treatment protocol depends on type of meningitis though antibiotic is administered as soon as Doctor finds symptoms in patients.

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