Q. You are working in the emergency room and a 19 year-old-male is rushed in by some of his fraternity brothers. The patient appears confused and is having trouble staying awake. On exam, his temperature is 102.4°F (39.1°C) and he appears stuporous. Your attending physician is busy with a trauma case but you are concerned that the patient may have meningitis. Which exam finding would most point to a diagnosis of possible meningitis?