Question

Claire is a healthy 19 year-old college freshman enjoying her first few weeks of being on a college campus. She’s made lots of new friends, has been participating in many of the on-campus outdoor social activities, and is getting used to a hectic class schedule. For the last couple of days, she’s been feeling more tired than usual, and she’s had a sore throat. Her sore throat has been worsening, and she also has a low-grade fever and a headache that has been getting worse throughout the day. Although Claire thinks that her symptoms are due to exhaustion, Claire’s roommate urges her to go the student health center just to make sure that it’s nothing too major.

At the student health center, Claire is examined by Dr. Peterson. She takes a routine medical history and does some basic assessment of Claire’s condition including listening to her heart and lungs, checking her ears and eyes (for light responsiveness), looking at her throat, and feeling the lymph nodes in Claire’s neck. Claire expects that Dr. Peterson is going to tell her to go home, drink plenty of liquids, and get lots of rest and that she’ll be back to normal in a couple of days. Instead, Claire is surprised when Dr. Peterson tells her that there have been a couple of cases of meningitis reported in students living in Claire’s dorm and she would like to do further tests for meningitis. Claire informs Dr. Peterson that she has received the vaccine for meningitis. Although Dr. Peterson tells Claire that this is a good thing, she informs Claire that they need to conduct further tests to confirm the causative agent and proceed with treatment.

Part A

Claire’s symptoms are characteristic of many different infections. Why does Dr. Peterson suspect that Claire may have meningitis?

Select all that apply.

Claire’s attendance at the outdoor social functions with several hundred students present exposed her to hundreds of potential carriers.

The closed, mixed environment of the college dorm allows for infection of susceptible students.

There have been documented cases of meningitis in Claire’s dorm.

College students represent the population most affected by meningitis. Part B What diagnostic test would be most useful at this stage of Dr. Peterson’s diagnosis? A neurologic exam, X-ray, and CT Scan to determine what is causing Claire’s headache and its rapid progression. A blood draw followed by culture in order to determine if Claire is septicemic. A lumbar puncture to obtain a sample of cerebrospinal fluid (CSF). A throat swab followed by culture to determine the cause of Claire’s sore throat.

Answer 1

Part A	The closed, mixed environment of the college dorm allows for infection of susceptible students. There have been documented cases of meningitis in Claire’s dorm.
Part B	A lumbar puncture to obtain a sample of cerebrospinal fluid (CSF).

There are two factors which may lead to meningitis in Claire: Claire has been living with students suffering from meningitis and the room in which they stayed had no scope for ventilation, which increases likelihood of spread of infection.