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Chlamydia trachomatis Infection — USMLE Step 2 CK MCQ

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HardInfectious DiseasesChlamydia trachomatis InfectionUSMLE Step 2 CK

A 49-year-old with aneurysmal subarachnoid hemorrhage becomes progressively somnolent. CT shows acute obstructive hydrocephalus, and the aneurysm has not yet been secured. Which immediate intervention addresses the neurologic deterioration?

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Correct answer: D — Place an external ventricular drain for hydrocephalus

Acute symptomatic hydrocephalus after subarachnoid hemorrhage requires urgent cerebrospinal-fluid diversion with an external ventricular drain. Serial lumbar punctures and a lumbar drain can precipitate herniation when outflow obstruction is present. Endoscopic third ventriculostomy is not the standard emergency diversion in this setting. Aneurysm securing is urgent, but progressive hydrocephalus should not wait until after securing when ventricular drainage is needed for stabilization.

Reference: 2023 AHA/ASA guideline for aneurysmal subarachnoid hemorrhage: https://professional.heart.org/en/science-news/2023-guideline-for-the-management-of-patients-with-aneurysmal-subarachnoid-hemorrhage