Internat Médecine (Côte D'Ivoire) Practice Questions - Concours National D'Internat Des Hôpitaux En Médecine (Côte D'Ivoire) Exam

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A 22-year-old university student is admitted with sudden onset of severe headache, photophobia, fever (39.5°C), neck stiffness, and positive Kernig and Brudzinski signs. Lumbar puncture reveals cloudy cerebrospinal fluid (CSF) with 2,500 leukocytes/mm³ (88% neutrophils), protein of 2.8 g/L, and CSF/blood glucose ratio of 0.18. Gram stain demonstrates Gram-negative diplococci. What is the immediate empiric antibiotic and adjunctive management?

Intravenous ceftriaxone 2 g every 12 hours plus intravenous dexamethasone 10 mg started prior to or with the first antibiotic dose Intravenous ampicillin 2 g every 4 hours plus gentamicin 5 mg/kg once daily Intravenous vancomycin 15 mg/kg every 12 hours monotherapy Oral ciprofloxacin 500 mg single dose plus oral rifampicin

Correct Answer:

Intravenous ceftriaxone 2 g every 12 hours plus intravenous dexamethasone 10 mg started prior to or with the first antibiotic dose

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