High School

A 21-year-old history student is admitted to the acute medical unit with a headache. He says he has had it for the past 4 days and it is present all the time but worst when he is lying down or when he coughs. He has a temperature of 38.2ºC, a heart rate of 94 bpm, and complains that bright lights hurt his vision. On examination, he is drowsy, has a Glasgow Coma Score of 14, opening his eyes to voice, and has neck stiffness.

Which of the following investigations should be performed first?

Answer :

The described symptoms suggest possible meningitis. The first investigation to recommend is a lumbar puncture to analyze the cerebrospinal fluid for signs of infection.

The symptoms the student has presented suggest a possible case of meningitis, an inflammation of the brain and spinal cord membranes. Therefore, the recommended investigation to perform first would be a lumbar puncture (also known as a spinal tap). This procedure can help in analyzing the cerebrospinal fluid for signs of infection.

Additional symptoms such as sensitivity to light, neck stiffness, headache, and fever further strengthen the diagnosis of meningitis. A lumbar puncture can confirm this diagnosis by showing an increased white cell count, elevated protein, and decreased glucose in the cerebrospinal fluid.

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