Practice targeted AMC-style multiple-choice questions on fever.
A 45-year-old woman presents to the ED with right upper quadrant pain, fever, and nausea for 2 days. Her vital signs are: BP 130/80 mmHg, HR 105 bpm, Temp 38.5°C, RR 18 bpm, SpO2 98% on room air. An abdominal CT scan with contrast is performed, and a slice is shown. What is the MOST appropriate next step in management?
A 10-year-old boy presents to the pediatric clinic with a history of fever, a rash characterized by erythema marginatum, and migratory arthralgia. His mother reports that he had a sore throat about three weeks ago, which resolved without treatment. On examination, he has a temperature of 38.5°C, a heart rate of 110 bpm, and a faint erythematous rash on his trunk. His joints are tender but not swollen. Given the suspicion of acute rheumatic fever, which of the following is the most appropriate next step in management?
A 32-year-old woman presents to the emergency department with a 2-day history of fever, chills, and right flank pain. She has a history of recurrent urinary tract infections. On examination, she is febrile with a temperature of 38.5°C, her heart rate is 110 bpm, and her blood pressure is 110/70 mmHg. There is tenderness on palpation of the right costovertebral angle. Urinalysis shows pyuria and bacteriuria. What is the most appropriate initial management for this patient?
A 62-year-old male with a history of poorly controlled diabetes presents with fever, RUQ pain, and night sweats for 3 weeks. Initial blood cultures are negative. Imaging is performed, as shown. What is the MOST appropriate next step in management?
A 25-year-old man presents to the emergency department with a 2-day history of severe headache, photophobia, and neck stiffness. He has no significant past medical history and is not on any medications. On examination, he is febrile with a temperature of 39°C, and there is a positive Brudzinski's sign. What is the most appropriate initial investigation to confirm the diagnosis?
A 62-year-old male with a history of poorly controlled diabetes presents with right upper quadrant pain, fever, and night sweats for 3 weeks. He is on immunosuppressants following a renal transplant 5 years ago. Blood cultures are pending. Imaging is performed, as shown. What is the MOST appropriate next step in management?
A 25-year-old gentleman presents with 3 days of rhinorrhea, fever, cough, and abdominal pain. On examination, his temperature is 39.6°C, he has reduced breath sounds, and an enlarged spleen. Which of the following causative pathogens, if identified, would require mandatory notification in Australia?
A 45-year-old woman presents with RUQ pain, fever, and nausea. The image shows the likely cause. What is the MOST appropriate next step in management?
A 55-year-old man with a history of renal transplant on immunosuppression presents with a 2-week history of low-grade fever, malaise, and dull right upper quadrant discomfort. Physical examination is unremarkable except for mild tenderness on deep palpation of the right upper quadrant. Blood tests show a mild leucocytosis and elevated CRP. Imaging is performed. Based on the clinical presentation and imaging findings, what is the most appropriate next diagnostic step?
A 68-year-old man presents to the emergency department with a 2-day history of worsening left lower quadrant abdominal pain, associated with subjective fever, chills, and nausea. He reports some recent constipation. On examination, his temperature is 38.5°C, pulse 95 bpm, BP 130/80 mmHg. Abdominal examination reveals tenderness and guarding in the left iliac fossa. Bowel sounds are reduced. Blood tests show a white cell count of 15 x 10^9/L (neutrophils 85%) and C-reactive protein of 120 mg/L. Urea, electrolytes, and creatinine are within normal limits. A CT scan of the abdomen and pelvis is performed (image provided). Considering the clinical presentation and the findings demonstrated in the provided image, which of the following represents the most appropriate initial management strategy?
A 65-year-old man undergoes successful coil embolization of a ruptured anterior communicating artery aneurysm. Two days post-procedure, he develops a temperature of 38.1°C, generalized malaise, and a headache unresponsive to paracetamol. Neurological exam is unchanged from baseline. CRP is 45 mg/L (normal <5). Which of the following is the most likely cause of his current symptoms?
A 55-year-old farmer presents with a week of high fever, severe retro-orbital headache, and profound muscle aches. He denies cough, sore throat, or rash. On examination, temperature is 39.5°C, pulse 90, BP 120/80. Lungs are clear to auscultation. Abdomen is soft, non-tender. Initial bloods show mildly elevated transaminases. What is the most likely diagnosis?
A 68-year-old woman presents to the emergency department with right upper quadrant abdominal pain, fever, and jaundice. Her vital signs are: temperature 38.5°C, heart rate 110 bpm, blood pressure 110/70 mmHg, respiratory rate 20 breaths per minute, and oxygen saturation 97% on room air. Initial laboratory investigations reveal: white blood cell count 14,000/µL, total bilirubin 6.0 mg/dL, alkaline phosphatase 450 U/L, ALT 300 U/L, and AST 250 U/L. An ERCP is performed, and the image is obtained. Following successful intervention, what is the MOST appropriate next step in managing this patient's condition?
A 28-year-old female, recently emigrated from Southeast Asia, presents to her general practitioner with complaints of fatigue, a persistent low-grade fever (37.8°C), and a non-productive cough that has been present for approximately one month. She denies any significant past medical history and is not currently taking any medications. Physical examination reveals slightly diminished breath sounds in the upper right lobe, but is otherwise unremarkable. Initial blood work, including a complete blood count and comprehensive metabolic panel, are within normal limits. A chest X-ray revealed a suspicious lesion in the right upper lobe, prompting a PET-CT scan, an axial slice of which is shown. Given the patient's history, clinical presentation, and the findings on the PET-CT scan, which of the following is the MOST appropriate next step in the diagnostic workup?
A 72-year-old man with a history of cholelithiasis presents with a 2-day history of fever, jaundice, and severe right upper quadrant pain. His vital signs are stable, but laboratory tests show elevated bilirubin and alkaline phosphatase. He is undergoing urgent ERCP for management of suspected choledocholithiasis and cholangitis. Following successful cannulation and injection of contrast, the image is obtained. Considering the findings demonstrated in the image in the context of this patient's presentation, what is the most appropriate immediate next step during this procedure?
A 55-year-old renal transplant recipient on long-term immunosuppression presents with a 2-week history of low-grade fever, malaise, and dull right upper quadrant discomfort. Physical exam is unremarkable except for mild tenderness. Labs show mild leucocytosis and elevated CRP. Imaging is shown. Based on these findings, what is the most appropriate immediate management step?
A 24-year-old woman presents to the emergency department with a 3-day history of fever, sore throat, and fatigue. She also reports a rash that developed after taking amoxicillin prescribed by her GP for a presumed bacterial throat infection. On examination, she has cervical lymphadenopathy, a diffuse maculopapular rash, and mild splenomegaly. Her vital signs are stable. A monospot test is positive. Which of the following is the most likely explanation for the rash?
A 62-year-old male presents with LLQ pain and fever. The provided image was obtained. What is the most appropriate initial management?
A 10-year-old presents with a sore throat, fever, and tonsillar exudates. Rapid strep test is negative. What is the most appropriate next step?
A 28-year-old immunocompetent patient presents with a chronic cough and low-grade fever. Initial investigations, including sputum microscopy, are negative. A PET-CT scan was performed (image shown). What is the MOST appropriate next step?
A 45-year-old woman presents to the ED with right upper quadrant pain, fever, and nausea for 24 hours. Her vital signs are: HR 105 bpm, BP 130/80 mmHg, Temp 38.5°C. Physical exam reveals marked tenderness on palpation of the right upper quadrant. An abdominal CT scan is performed, as shown. What is the MOST appropriate next step in management?
A 35-year-old man presents to the clinic with a 3-month history of persistent cough, night sweats, and weight loss. He has a history of travel to Southeast Asia six months ago. On examination, he appears thin and has crackles in the upper zones of his lungs. A chest X-ray shows cavitary lesions in the right upper lobe. What is the most likely diagnosis?
A 65-year-old presents with 2 days of left lower quadrant pain, fever (38.5°C), and nausea. On examination, there is localised tenderness in the LLQ. Vitals: BP 130/80, HR 90, RR 16, SpO2 98%. CRP is 150 mg/L, WCC 18 x 10^9/L. This image is obtained as part of the workup. Based on the clinical presentation and imaging findings, what is the most appropriate initial management step?
A 45-year-old female presents to the emergency department with a 3-day history of right upper quadrant pain, nausea, and subjective fevers. She reports that the pain is constant and worsened by eating. She has no significant past medical history and takes no medications. On examination, she is noted to be uncomfortable, with a temperature of 38.2°C, heart rate of 110 bpm, blood pressure of 130/80 mmHg, and an oxygen saturation of 99% on room air. Abdominal examination reveals marked tenderness to palpation in the right upper quadrant with guarding. Murphy's sign is positive. Laboratory investigations reveal a white blood cell count of 15,000/µL with neutrophilic predominance, total bilirubin of 1.8 mg/dL, alkaline phosphatase of 280 U/L, ALT of 160 U/L, and AST of 130 U/L. The provided image was obtained. Considering the clinical presentation and the findings on the image, which of the following is the MOST appropriate next step in management?
A 72-year-old presents with acute cholangitis (fever, jaundice, RUQ pain). LFTs show obstructive pattern. ERCP is performed for biliary decompression and stone extraction. Following successful cannulation and cholangiography, the image is obtained. Based on the findings demonstrated in the image, what is the most appropriate immediate next step during this procedure?
A 35-year-old woman presents to the emergency department with a 3-day history of fever, chills, and a productive cough with greenish sputum. She has a history of asthma and is currently on inhaled corticosteroids. On examination, her temperature is 38.5°C, blood pressure is 120/80 mmHg, heart rate is 110 bpm, and respiratory rate is 24 breaths per minute. Auscultation of the chest reveals wheezing and crackles in the right lower lung field. A chest X-ray shows consolidation in the right lower lobe. What is the most appropriate initial antibiotic therapy for this patient, considering her asthma and current presentation?
A 32-year-old male with a history of Crohn's disease presents with worsening abdominal pain, diarrhea, and a low-grade fever. He reports that his symptoms have been progressively worsening over the past few weeks despite being compliant with his prescribed mesalamine. A CT scan of the abdomen and pelvis is performed, as shown. What is the MOST appropriate next step in management?
A 58-year-old male presents with left lower quadrant abdominal pain and a low-grade fever. The provided image was obtained. What is the most likely diagnosis?
A 68-year-old presents with a 3-day history of fever, jaundice, and severe RUQ pain radiating to the back. Vitals: T 38.5°C, BP 110/70, HR 95. LFTs show bilirubin 150, ALP 450, ALT 120. An ERCP is performed for stone extraction. The image is captured during the procedure after cannulation. Considering the findings demonstrated in the image, what is the most appropriate immediate next step in management during the current procedure?
A 28-year-old woman presents to the clinic with a 2-week history of fever, night sweats, and a non-productive cough. She has recently returned from a trip to rural Queensland. On examination, she has crackles in the right upper lung field. A chest X-ray shows a cavitary lesion in the right upper lobe. What is the most likely diagnosis?
A 10-year-old girl with a 3-day history of shortness of breath, fever, and headache has been diagnosed with pneumonia. What signs might be seen in severe pneumonia?
A 45-year-old farmer presents with a 10-day history of fever, severe retro-orbital headache, and myalgia. He denies cough or dyspnoea. Physical examination is unremarkable. What is the most appropriate initial investigation?
A 62-year-old male with LLQ pain and mild fever has the CT abdomen shown. What is the MOST appropriate next step in management?
A 55-year-old male presents to the emergency department with a 2-day history of left lower quadrant abdominal pain, associated with a low-grade fever (38.1°C) and mild nausea. He denies vomiting, diarrhoea, or rectal bleeding. On examination, he has localised tenderness in the left iliac fossa. His vital signs are stable: BP 130/80 mmHg, HR 78 bpm, RR 16/min, SpO2 98% on air. Blood tests show a white cell count of 12.5 x 10^9/L and CRP 45 mg/L. An abdominal CT scan is performed (image provided). Based on the clinical presentation and the provided image, what is the most appropriate initial management plan?
A 45-year-old woman presents to the ED with right upper quadrant pain, fever, and nausea for 24 hours. Her vital signs are: HR 110, BP 130/80, Temp 38.5°C. An abdominal CT scan is performed (image attached). What is the MOST appropriate next step in management?
A 62-year-old male presents with acute onset of LLQ pain, fever, and vomiting. His WBC count is elevated. A CT scan of the abdomen and pelvis is performed. Based on the image, what is the most appropriate next step in management?
A 45-year-old woman presents to the emergency department with acute onset of severe right upper quadrant abdominal pain radiating to the back, accompanied by nausea and vomiting. She has a history of gallstones but no previous surgeries. On examination, she is febrile with a temperature of 38.5°C, her heart rate is 110 bpm, and she has tenderness in the right upper quadrant with a positive Murphy's sign. Laboratory tests reveal elevated white blood cell count, elevated liver enzymes, and elevated serum amylase. An abdominal ultrasound shows gallstones and a thickened gallbladder wall. Which of the following is the most appropriate next step in management?
A 62-year-old male presents to the ED with left lower quadrant abdominal pain, fever, and nausea for 3 days. His WBC count is 14,000. A CT scan of the abdomen and pelvis is performed, the axial view is shown. What is the most appropriate next step in management?
A 30-year-old woman presents to the emergency department with a 2-day history of fever, sore throat, and a diffuse rash. She recently started taking a new medication for her epilepsy. On examination, she is febrile at 38.2°C, with a heart rate of 100 bpm and blood pressure of 110/70 mmHg. The rash is erythematous and involves the trunk and extremities, with some areas of desquamation. Laboratory tests reveal leukocytosis with eosinophilia and elevated liver enzymes. Which of the following is the most likely diagnosis?
A 55-year-old male presents with LLQ pain, fever, and increased WBC. A CT scan is performed. He is hemodynamically stable. Based on the image, which of the following is the MOST appropriate initial management strategy?
A 60-year-old man, post-chemotherapy, presents with fever and abdominal pain. The images are shown. What is the MOST appropriate initial therapy?
A 68-year-old male presents to the ED with left lower quadrant abdominal pain, fever, and nausea for 3 days. His WBC count is 14,000. A CT scan of the abdomen and pelvis is performed, the axial view is shown. What is the most appropriate next step in management?
A child has a sore throat and fever. Centor criteria are 3/4. What's the next step?
A 68-year-old woman presents to the emergency department with a 2-day history of right upper quadrant abdominal pain, fever, and yellowing of her eyes. Her vital signs are stable, but laboratory investigations reveal elevated inflammatory markers and liver function tests consistent with biliary obstruction and infection. An ERCP is performed, and the image is obtained. Following successful intervention to relieve the obstruction, the patient's symptoms begin to improve. Considering the likely underlying cause of this presentation and the findings during the procedure, what is the MOST appropriate next step in managing this patient's condition?
A 35-year-old man presents to the clinic with a 3-month history of fatigue, weight loss, and night sweats. He also reports a persistent cough that has recently become productive of blood-streaked sputum. He has no significant past medical history and is not on any medications. He recently returned from a trip to Southeast Asia. On examination, he is febrile and has bilateral crackles in the upper lung fields. A chest X-ray shows cavitary lesions in the upper lobes. What is the most likely diagnosis?
A 68-year-old woman presents to the emergency department with right upper quadrant abdominal pain, fever, and jaundice. Her past medical history is significant for hypertension and hyperlipidemia. Initial laboratory investigations reveal elevated bilirubin, alkaline phosphatase, and gamma-glutamyl transferase (GGT) levels. An ultrasound of the abdomen showed dilated intrahepatic ducts, but the common bile duct was difficult to visualize due to overlying bowel gas. An ERCP was performed, and an image obtained during the procedure is shown. Following successful removal of the obstruction, what is the MOST appropriate next step in managing this patient's condition?
A 62-year-old male with a history of poorly controlled diabetes presents with fever, RUQ pain, and recent travel to a rural area. Lab results show elevated ALP and GGT. Imaging is performed. What is the MOST appropriate next step in management?
A 65-year-old man presents to the emergency department with a 2-day history of worsening left lower quadrant abdominal pain, associated with fever and chills. He reports a change in bowel habit with increased constipation. On examination, he is febrile at 38.6°C and has significant tenderness and guarding in the left iliac fossa. His white cell count is 18 x 10^9/L. A CT scan of the abdomen and pelvis is performed (image provided). Considering the patient's presentation and the findings on the provided image, which of the following represents the most appropriate initial management strategy?
A 25-year-old woman presents to the clinic with a 2-week history of fatigue, sore throat, and swollen glands. She also reports a low-grade fever and mild headache. On examination, she has cervical lymphadenopathy and mild splenomegaly. A monospot test is positive. What is the most appropriate advice regarding her physical activity?
A 62-year-old woman presents with right upper quadrant pain, fever, and jaundice. Initial labs show elevated bilirubin and alkaline phosphatase. An ERCP is performed, and the image is obtained. What is the MOST appropriate next step in management?