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Altered mental status and fever
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History of Present Illness
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GA is a 23-year-old Caucasian female who presents to the emergency department with her parents who report that she has been behaving abnormally over the past several days. They report that she was withdrawn and would not speak. She has complained of a sore throat.
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Mother with HTN and depression, father with type II DM
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Smokes ½ ppd × 5 years and drinks alcohol socially
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Fluoxetine 40 mg PO once daily
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Temp 100.4°F, P 141, RR 31 breaths per minute, BP 151/89 mm Hg, pO2 98%, Ht 5′6″, Wt 60 kg
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Febrile, following limited commands, but in no acute distress
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+3 tonsils without exudate, normocephalic, atraumatic, EOMI, PERRLA
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Clear to auscultation bilaterally
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Tachycardic, regular rhythm, no m/r/g
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Soft, non-distended, no masses
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Oriented to person and situation, follows some instructions and nods head but does not speak
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Warm and dry, no edema, no rashes, ulcers, or lesions
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Colorless, hazy; RBC 0 cells/mm3, WBC 426 cells/mm3, 10% segs, 72% lymphs, 18% monos
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CSF Gram Stain/Culture
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CSF Meningitis Panel by ...