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NBME p2ck_form7 Answers

step2ck_form7/Block 1/Question#8 (7.0 difficulty score)
A 47-year-old woman comes to the physician ...
CT scan of the headπŸ”,πŸ“Ί

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submitted by russnels(12),

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

russnels  Also optic fundi not visible +  

submitted by step_prep5(74),
  • 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.)

submitted by keyseph(44),

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