A 2-year-old boy has been vomiting intermittently for 3 weeks and has been irritable, listless, and anorectic. His use of language has regressed to speaking single words. In your evaluation of this patient, which of the following is the most reasonable diagnosis to consider?
a. Expanding epidural hematoma
b. HSV encephalitis
c. Tuberculous meningitis
d. Food allergy
e. Bacterial meningitis
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is c; Tuberculous meningitis.
Of all the options, TB meningitis is the only one that would linger for three weeks; the other infectious causes lead to rapid deterioration, as would the epidural hematoma. A food allergy does not typically cause the CNS manifestations described. Unfortunately, the seriousness of the illness in a child such as this will often be unrecognized, and the patient will be diagnosed as having an incipient nondisease and treated symptomatically. Although it is true that many patients with nonspecific complaints have trivial diseases that resolve spontaneously, the patient presented here has a 3-week history with potentially grave implications. Diagnoses that cause a slowly progressive course should be considered foremost.