American Board of Psychiatry and Neurology (ABPN) Practice Exam 2025 - Free ABPN Practice Questions and Study Guide

The situation presented in this question revolves around determining which condition does not prevent a lumbar puncture from being performed. In the case of suspected meningitis with obtundation, it is important to understand that a lumbar puncture can be critical for diagnosis and treatment.

In suspected meningitis, particularly when the patient is obtunded (showing decreased alertness), obtaining cerebrospinal fluid (CSF) is vital for confirming the diagnosis and initiating appropriate treatment, such as antibiotics. While there may be concerns regarding increased intracranial pressure, these potential risks must be balanced against the necessity of timely diagnosis and intervention. If the benefits of a lumbar puncture outweigh the risks in cases of suspected meningitis, it is often considered appropriate to proceed.

Conversely, the other conditions listed are traditional contraindications for lumbar puncture. Thrombocytopenia raises concerns about bleeding complications; cerebral mass lesions create a risk of herniation due to increased intracranial pressure; and papilledema may indicate elevated intracranial pressure, which can complicate the procedure. Therefore, in the context of this question, suspected meningitis with obtundation is not an absolute contraindication, as it may necessitate the procedure despite potential risks.