QuestionSBA
QuestionChoice
The most likely diagnosis is meningitis. Local guidelines should always be referred to, but the BNF (and most hospital trusts) recommend empirical treatment with third-generation cephalosporins immediately, as these cover the most common bacteria that cause meningitis.
10035452
a
Cefotaxime
QuestionChoice
The most likely diagnosis is meningitis given the features of meningism. It is not uncommon for aciclovir to be given along with antibiotics to cover for viral encephalitis, however, this is not the most important drug to prescribe.
10035455
d
Aciclovir
QuestionChoice
The most likely diagnosis is meningitis. Amoxicillin (or ampicillin) should be added to cephalosporin therapy in patients susceptible to listeria infections (children under the age of 1 and adults over the age of 60).
10035453
b
Amoxicillin
QuestionChoice
Most clinical guidelines recommend cephalosporin therapy for meningitis. Vancomycin can be used if there is a history of travel to an area with cephalosporin-resistant pneumococci, or if there is a history of prolonged antibiotic use that might make infection by a resistant organism more likely.
10035456
e
Vancomycin
QuestionChoice
The most likely diagnosis is meningitis. Benzylpenicillin is recommended in the pre-hospital (i.e. GP or ambulance) setting for patients with suspected meningococcal meningitis. This patient is in hospital and should therefore receive a cephalosporin.
10035454
c
Benzylpenicillin
QuestionComment
i thought the absence of rash made it more likely to be viral?
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User
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Malignant Syndrome
Concept
Chapter
2693
4102
Meningitis
Topic
194
Infectious Diseases
19494
If meningitis is suspected, treatment should start with a third-generation cephalosporin, like cefotaxime, to target the most common bacterial causes.
A 48-year-old man is brought into hospital by ambulance feeling generally unwell. He provides minimal history, however, his wife describes a 3-day period of fevers, headaches, and drowsiness. She says he has no medical problems and only takes over-the-counter vitamins. He has no drug allergies.

On examination, he appears to be extremely photophobic, with nuchal rigidity and a positive Kernig's sign. No rashes are noted. He is also febrile and tachycardic.

What is the most important medication to prescribe?
a