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A 56-Year-Old Man Is Brought to the Emergency Department Because

Question 235

Multiple Choice

A 56-year-old man is brought to the emergency department because of worsening confusion and weakness in his right arm and leg for 2 days. He has also had fever and headache that began 5 days ago. He has hypertension and type 2 diabetes mellitus. Current medications include metformin and lisinopril. His temperature is 39.3°C (102.7°F) , pulse is 103/min, and blood pressure is 128/78 mm Hg. He is confused and agitated. He is not oriented to person, place, or time. Neurologic examination shows nuchal rigidity. Muscle strength is 3/5 on the right upper and lower extremity but normal on the left side. His speech is incoherent. Cerebrospinal fluid analysis reveals an elevated opening pressure with a hemorrhagic lymphocytic pleocytosis, increased protein, and normal glucose.  MRI of the brain shows swelling of the temporal lobes.  A drug that inhibits which of the following would be most effective in treating this patient's condition?


A) Bacterial cell wall synthesis
B) Bacterial folic acid metabolism
C) Bacterial nucleic acid synthesis
D) Bacterial ribosomes
E) Viral DNA polymerase
F) Viral protease
G) Viral reverse transcriptase
H) Viral RNase H

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