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NBME Step 2 CK Form 7 Answers

step2ck_form7/Block 1/Question#8 (reveal difficulty score)
A 47-year-old woman comes to the physician ...
CT scan of the head ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: neuro

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 +7  upvote downvote
submitted by โˆ—step_prep5(246)
  • Patient presenting with signs/symptoms concerning for meningitis vs. subarachnoid hemorrhage who also has signs of increased intracranial pressure and should therefore have a CT scan performed before a lumbar puncture
  • Key idea: Optic fundi cannot be visualized = Papilledema = Increased intracranial pressure = Contraindication to lumbar puncture due to risk of cerebral herniation
  • Key idea: Both meningitis and subarachnoid hemorrhage can lead to fever and signs of meningismus (pain with neck flexion, Kernig sign, etc.)

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libya  Thank you so much for all your effort " your the best". +

 +3  upvote downvote
submitted by โˆ—keyseph(99)

Indications for CT scan before lumbar puncture: FAILS

  • Focal neurological deficit (as in this patient)
  • Altered mental status
  • Intoxication
  • Lesions in the brain near LP site
  • Seizures
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jlbae  ooo i like that, ty +1
charcot_bouchard  i though I for immunodef. immunodefi definitely is a indication not sure abt intoxication. +

 +2  upvote downvote
submitted by โˆ—russnels(20)

Bacterial meningitis... get a CT first due to signs of neurological deficit (R upper extremity + nystagmus). Otherwise lumbar puncture.

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russnels  Also optic fundi not visible +1

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