Student Instructions
You are a junior doctor working in the Accident and Emergency Department.
Miss Vamos has come into the Department and is complaining or feeling generally run down an unwell. She has been brought in by her friends as she is too weak to walk into the Department herself.
Please take a focused history from her and formulate an Emergency Management plan.
The examiner will stop you at 7 minutes to ask you a few questions.
Patient Instructions
Name: Miss Judy Vamos
Age: 18 years old
Job: Student
PC
For the last 1-2 days you have been suffering with flu-like symptoms- in particular you have been feeling hot and cold, having generalised muscle weakness and nausea.
In the early hours of this morning, you vomited three times and in the last two hours you have started to feel a generalised crampy headache all over your head. It feels like it radiates into your neck and is getting increasingly more difficult to move your neck.
You also find bright red lights irritate your eyes and you have been spending the whole morning in bed with the covers over your head.
You currently feel very irritable and drowsy and keep falling asleep as the junior doctor tries to take your history.
You do not have any skin rashes but one of your friends took your temperature at home and said it was very high at 41 degrees Celsius.
PMH
You are generally fit and well.
DH
You don’t take any medications and have no allergies. You haven’t taken any medicines or painkillers today.
SH
You are a Spanish language student at University and love it.
You live with five flat mates in your student flat and share a communal kitchen and bathroom. You have not been abroad recently or eaten any strange foods. You don’t not know of any infectious Contacts that may have passed on any illnesses to you. You smoke and drink alcohol in small amounts and only in social settings.
ICE
You feel silly for coming to hospital and were made to come by your flat mates who you think are overreacting. You have your term examination soon and do not want to be kept in hospital. You keep begging the doctors to let you go home and start to get really irritable if they tell you that you need to be admitted.
Questions
What is the likely diagnosis?
Meningitis
What are your differentials?
Encephalitis
Subarachnoid haemorrhage
Brain abscess
What would you do next?
Immediate treatment: cefotaxime 2mg IM injection, IV fluids, supportive management and monitoring
Treat any seizures according to local protocols
Blood tests: FBC, U&E, LFTs, CRP, blood cultures, glucose, coagulation profile
Other tests: lumbar puncture, septic screen- to include MSU, sputum cultures and above blood tests
Radiological tests: CT head, CXR