Viral Infections USMLE Step 1 Practice Question
A 32-year-old woman without significant medical history presents to the emergency department with a 2-day history of fever (39.2°C), severe frontal headache, and neck stiffness. She denies photophobia, rash, or recent sick contacts. Vital signs are HR 102/min, BP 118/76 mmHg, RR 18/min, SpO2 98% on room air. Physical examination reveals nuchal rigidity and a positive Kernig sign. Cerebrospinal fluid (CSF) analysis shows lymphocytic pleocytosis (180 cells/μL), glucose 60 mg/dL (serum glucose 100 mg/dL), and protein 95 mg/dL. HSV-1 PCR of the CSF returns positive. Blood cultures are pending. The patient received a single dose of IV acyclovir in the emergency department upon suspicion of meningitis. Which of the following is the most appropriate next step in management?
Answer choices
- ADiscontinue acyclovir and initiate supportive care only, as HSV-1 is self-limiting
- BContinue IV acyclovir 10 mg/kg every 8 hours for 10-14 daysCorrect answer
- CSwitch to oral valacyclovir 1 g three times daily to reduce nephrotoxicity risk
- DAdd vancomycin and ceftriaxone to cover for concurrent bacterial meningitis
- ERepeat lumbar puncture in 48 hours to document CSF sterilization before discontinuing antivirals
- FChange to IV ganciclovir given the positive HSV-1 PCR result
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