طالب جامعي عمره ١٩ سنة يسكن في سكن الطلاب، عنده حمى ٣٩٫٦ وصداع شديد وتصلب رقبة وقيء منذ ساعات، وظهر طفح نزفي على ساقيه لا يختفي عند الضغط عليه. الضغط ٩٤/٥٦، والنبض ١٢٨. ما الأولوية؟

A 19-year-old university student living in halls has had fever 39.6 °C, severe headache, neck stiffness and vomiting for hours, and a purpuric rash on his legs that does not blanch. BP 94/56, HR 128. What is the priority?

1. Airborne isolation only, without treatment until morning
2. Give an antipyretic and observe for hours
3. Immediate IV antibiotics without delay, with droplet isolation
4. Wait for lumbar puncture results before antibiotics

Answer: C) Immediate IV antibiotics without delay, with droplet isolation. A non-blanching rash with meningeal signs suggests meningococcal disease, which can kill within hours. Antibiotics are given at once, even before LP if it will be delayed, with droplet isolation and contact prophylaxis.