A new method of testing medical knowledge using an interactive format developed keeping the MediQuizzing fraternity in mind!

1. Case 1

2. Case Background
• A 7 year old healthy child went camping with
his scouting team at a lake, where he swam
for a long time. 7 days later, he developed a
severe headache, high fever, nausea,
vomiting, photophobia and meningismus.

3. What will be your next step?
A. Empiric broad spectrum antibiotics + Anti
epileptics
B. Acyclovir + Anti epileptics
C. Send for immediate Blood culture
D. Lumbar puncture
E. Wait and watch + Careful Mannitol Infusion
F. Order CT Scan

4. A.
• No response after days 2 and 3, patient
becomes comatose, has seizures, needs
airway protection:
– Continue Antibiotic therapy for days 4 and 5
– Go back to do list and restart!
+ 5

5. B.
• No Response after days 2 and 3, patient
becomes comatose, has seizures, needs
airway protection :
– Continue Anti Virals for Days 4 and 5
– Go back to first step and restart!
- 5

6. C.
• Methicillin Resistant, Coagulase Negative
Staphylococcus cultured.
• Start:
– IV Cefepime
– IV Quinupristine/Dalfopristine
– IV Vancomycin
– IV Linezolid
– Resend blood for culture
- 5

7. Resend Culture
• No growth
• Go back to starting list
+5

8. IV Drugs.
• No response after days 2 and 3:
– Continue Antibiotic therapy for days 4 and 5
– Go back to do list and restart!
- 5

9. D.
• High intracranial
pressure observed
during LP
• WBC = 15,000/microlit
• Protein = (very high)
• Glucose = (very low)
• More Slides
• Provisional Diagnosis
• Next step
+ 10

10. More Slides

11. Next step
• Start:
– Amphotericin B
– Fluconazole
– Anti TB drugs
– Albendazole + Ivermectin
– Piperacillin/Tazobactam
– Meropenem or Imipenem/Cilastatin

12. Amphotericin B.
• CORRECT drug choice
• Patient becomes comatose
• Respiratory failure
• Intubated and put on ventilator
• No response to empirical
antibiotic/antiviral/antifungal therapy
• Death on day 3!
• Provisional diagnosis? + 10

13. Other Drugs.
• INCORRECT drug choice
• Patient becomes comatose
• Respiratory failure
• Intubated and put on ventilator
• No response to empirical
antibiotic/antiviral/antifungal therapy
• Death on day 3!
• Provisional diagnosis? - 5

14. E.
• Patient becomes comatose
• Respiratory failure
• Intubated and put on ventilator
• No response to empirical
antibiotic/antiviral/antifungal therapy
• Death on day 5!
• Provisional diagnosis?
- 5

15. F.
• Back to List of options
+5

16. Continuing Drugs
• On Day 6 patient has severe seizures, becomes
comatose.
• Transferred to ICU.
• Further deterioration  Death!
- 5

17. Provisional Diagnosis
• Correct
• Incorrect
• Back to work up

18. Incorrect
• Incorrect Diagnosis: You missed, he hit!
- 10

19. Correct
• Early Diagnosis! Patient may have a chance if
properly treated!
• Choose treatment
+ 15