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Spinal epidural abscess — RCPSC EM MCQ

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HardInfectious disease emergenciesSpinal epidural abscessRCPSC EM

A febrile patient has meningismus, confusion and a new focal arm deficit. Bacterial meningitis is strongly suspected. CT is immediately available but lumbar puncture must follow imaging. What is the correct sequence?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Draw blood cultures, give dexamethasone and empiric antibiotics, then obtain CT

Explanation lettering: C = shown as A · E = shown as C · A = shown as D · D = shown as E

D is correct because focal deficit prompts imaging before LP, but neither CT nor CSF acquisition should postpone time-critical therapy. E and C defer treatment. A ignores a contraindicating feature. B makes empiric antibiotics contingent on a later insensitive test.

Reference: Emergency Care BC, Meningitis—Diagnosis: https://emergencycarebc.ca/clinical_resource/meningitis-diagnosis/