← Back to Topics

fever

Practice targeted AMC-style multiple-choice questions on fever.

Related Topics

Acute cholecystitis with gallbladder wall thickening, a large gallstone, and a large gallbladder
Image by James Heilman, MD CC BY-SA 4.0 · Source

A 55-year-old female presents to the emergency department with a 24-hour history of severe right upper quadrant pain radiating to her back, associated with nausea, vomiting, and subjective fever. On examination, she is febrile (38.5°C) and has marked tenderness and guarding in the right upper quadrant. Her vital signs are otherwise stable. Blood tests reveal a white cell count of 15 x 10^9/L and C-reactive protein of 120 mg/L. Liver function tests, including bilirubin, are within normal limits. She is initiated on intravenous fluids and broad-spectrum antibiotics. Imaging is subsequently performed. Considering the patient's clinical presentation and the findings demonstrated in the provided imaging, what is the most appropriate definitive management strategy?

A. Endoscopic retrograde cholangiopancreatography (ERCP)
B. Delayed laparoscopic cholecystectomy in 6-8 weeks
C. Percutaneous cholecystostomy tube insertion
D. Early laparoscopic cholecystectomy within 72 hours
E. Continue conservative management with IV antibiotics and analgesia only
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Acute cholecystitis with gallbladder wall thickening, a large gallstone, and a large gallbladder
Image by James Heilman, MD CC BY-SA 4.0 · Source

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. Start intravenous antibiotics and observe
B. Surgical consultation for cholecystectomy
C. Hepatobiliary iminodiacetic acid (HIDA) scan
D. ERCP to rule out choledocholithiasis
E. Discharge home with oral antibiotics and analgesics
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 10-year-old presents with a sore throat, fever, and fatigue for 2 days. Examination reveals tonsillar exudates and tender anterior cervical lymph nodes. What is the most appropriate next step in management?

A. Advise symptomatic treatment with paracetamol
B. Refer to an ENT specialist
C. Perform a rapid strep test
D. Order a throat culture
E. Prescribe oral amoxicillin
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Figure 3 of paper: Alveolar echinococcosis in a patient with immunosuppression.

(a) Abdominal gray-scale US shows an abscess-like hepatic image.
(b) Axial unenhanced CT shows a typical aspect of pyogenic liver abscess.
Image by Wenya Liu, Éric Delabrousse, Oleg Blagosklonov, Jing Wang, Hongchun Zeng, Yi Jiang, Jian Wang, Yongde Qin, Dominique Angèle Vuitton, Hao Wen CC BY 4.0 · Source

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. Albendazole therapy
B. Percutaneous drainage and culture of the lesion
C. Surgical resection of the affected liver segment
D. Empiric broad-spectrum antibiotics
E. Observation with serial imaging
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 40-year-old man presents with fever, pleuritic chest pain, and cough. A chest X-ray shows a pleural effusion. What is the next step in management?

A. Start steroids.
B. Perform a thoracentesis.
C. Start antibiotics.
D. Observe and repeat imaging in 2 weeks.
E. Order a CT scan.
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 32-year-old woman presents to the emergency department with a 2-day history of fever, malaise, and a painful, swollen left knee. She denies any recent trauma or travel history. She has no significant past medical history and is not on any medications. On examination, her temperature is 38.7°C, heart rate is 110 bpm, and blood pressure is 120/80 mmHg. The left knee is erythematous, warm, and tender with a moderate effusion, and she has limited range of motion due to pain. Laboratory tests reveal leukocytosis with a left shift. Blood cultures are pending. What is the most appropriate next step in the management of this patient?

A. Start empirical intravenous antibiotics
B. Arthrocentesis of the left knee
C. Administer oral NSAIDs
D. Refer to rheumatology for further evaluation
E. Order an MRI of the knee
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

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. Blood cultures
B. Electroencephalogram (EEG)
C. MRI of the brain
D. Lumbar puncture
E. CT scan of the head
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Diverticulitis in the left lower quadrant. There is outpouching of the colonic wall, wall thickening, and surrounding fat stranding.
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 62-year-old male presents with left lower quadrant pain, fever, and leukocytosis. 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. Order a barium enema to assess for fistula
B. Prescribe oral antibiotics and a high-fiber diet
C. Perform a colonoscopy to rule out malignancy
D. Schedule elective sigmoid colectomy
E. Initiate intravenous antibiotics and bowel rest
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Figure 3 of paper: Alveolar echinococcosis in a patient with immunosuppression.

(a) Abdominal gray-scale US shows an abscess-like hepatic image.
(b) Axial unenhanced CT shows a typical aspect of pyogenic liver abscess.
Image by Wenya Liu, Éric Delabrousse, Oleg Blagosklonov, Jing Wang, Hongchun Zeng, Yi Jiang, Jian Wang, Yongde Qin, Dominique Angèle Vuitton, Hao Wen CC BY 4.0 · Source

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. Empiric antifungal therapy
B. Observation and serial imaging
C. Metronidazole and supportive care
D. Albendazole and surgical resection
E. Percutaneous drainage and antibiotics
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda CC BY 2.0 · Source

A 68-year-old woman with a history of hypertension presents with a severe headache and altered mental status. Aneurysmal coiling was performed. The image shows a post-operative angiogram. 6 hours later, she develops a fever of 38.5°C and worsening confusion. What is the MOST appropriate next step?

A. Obtain blood cultures and start broad-spectrum antibiotics
B. Increase the dose of her antihypertensive medication
C. Repeat CT angiogram of the head
D. Initiate nimodipine
E. Administer intravenous mannitol
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 70-year-old woman with a history of diabetes presents with fever, cough, and weight loss. A chest X-ray shows a cavitary lesion in the right upper lobe. What is the most likely diagnosis?

A. Sarcoidosis
B. Lung cancer
C. Tuberculosis
D. Lung abscess
E. Pneumocystis pneumonia
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Figure 3 of paper: Alveolar echinococcosis in a patient with immunosuppression.

(a) Abdominal gray-scale US shows an abscess-like hepatic image.
(b) Axial unenhanced CT shows a typical aspect of pyogenic liver abscess.
Image by Wenya Liu, Éric Delabrousse, Oleg Blagosklonov, Jing Wang, Hongchun Zeng, Yi Jiang, Jian Wang, Yongde Qin, Dominique Angèle Vuitton, Hao Wen CC BY 4.0 · Source

A 55-year-old patient with a history of solid organ transplant on immunosuppressive therapy presents with a two-week history of intermittent fever, chills, and dull right upper quadrant pain. On examination, there is mild tenderness in the right upper quadrant. Blood tests reveal a white cell count of 14 x 10^9/L and CRP of 120 mg/L. Imaging is performed. Considering the clinical context and the provided images, what is the most appropriate immediate next step in the management of this patient?

A. Arrange for repeat cross-sectional imaging in 4-6 weeks to assess for interval change
B. Schedule surgical exploration and debridement of the lesion
C. Order serological tests for common parasitic infections, including Echinococcus species
D. Percutaneous aspiration and drainage of the lesion for microbiological and pathological analysis
E. Initiate empirical broad-spectrum intravenous antibiotics covering typical bacterial pathogens
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 23-year-old backpacker doing farm work presents with a low-grade fever for 4 days. Q fever is suspected. What is the most appropriate diagnostic method for acute Q fever in Australia?

A. Chest X-ray
B. Serology (IFA for Phase II antibodies)
C. Serum PCR for C. burnetii.
D. Rapid antigen test for C. burnetii.
E. Serial blood cultures
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Acute cholecystitis with gallbladder wall thickening, a large gallstone, and a large gallbladder
Image by James Heilman, MD CC BY-SA 4.0 · Source

A 55-year-old woman presents with 2 days of worsening right upper quadrant pain radiating to her back, nausea, and subjective fever. On examination, she is tender in the RUQ. Vitals are stable. Labs show WCC 15.0, CRP 120. This image is obtained. Given the clinical context and imaging findings, what is the most appropriate definitive management strategy?

A. Percutaneous cholecystostomy tube insertion
B. Medical management with IV antibiotics and analgesia only
C. Discharge home with oral antibiotics and outpatient follow-up
D. Laparoscopic cholecystectomy within 24-72 hours
E. Urgent ERCP to relieve obstruction
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Acute cholecystitis with gallbladder wall thickening, a large gallstone, and a large gallbladder
Image by James Heilman, MD CC BY-SA 4.0 · Source

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. Observation and oral analgesics
B. IV antibiotics and analgesia
C. HIDA scan
D. ERCP with sphincterotomy
E. Laparoscopic cholecystectomy
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Figure 3 of paper: Alveolar echinococcosis in a patient with immunosuppression.

(a) Abdominal gray-scale US shows an abscess-like hepatic image.
(b) Axial unenhanced CT shows a typical aspect of pyogenic liver abscess.
Image by Wenya Liu, Éric Delabrousse, Oleg Blagosklonov, Jing Wang, Hongchun Zeng, Yi Jiang, Jian Wang, Yongde Qin, Dominique Angèle Vuitton, Hao Wen CC BY 4.0 · Source

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. Schedule surgical exploration and drainage
B. Percutaneous aspiration and microbiological analysis of the lesion
C. Order Echinococcus serology
D. Initiate broad-spectrum intravenous antibiotics
E. Repeat CT scan with intravenous contrast in 48 hours
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Acute cholecystitis with gallbladder wall thickening, a large gallstone, and a large gallbladder
Image by James Heilman, MD CC BY-SA 4.0 · Source

A 65-year-old male presents to the emergency department with 2 days of constant right upper quadrant pain radiating to the back, associated with nausea and subjective fever. On examination, he is febrile (38.5°C) with significant tenderness and a positive Murphy's sign in the right upper quadrant. His white cell count is elevated at 15 x 10^9/L, and CRP is 120 mg/L. Liver function tests are within normal limits. Considering the clinical findings and the provided imaging, what is the most appropriate next step in the management of this patient?

A. Laparoscopic cholecystectomy within 24-72 hours
B. Urgent endoscopic retrograde cholangiopancreatography (ERCP)
C. Percutaneous cholecystostomy insertion
D. Repeat abdominal CT scan in 24 hours
E. Continue medical management with intravenous antibiotics and analgesia only
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 78M presents with cough, fever, confusion. BP 90/60, RR 30, Temp 38.5, SpO2 90% on air. CXR shows LUL consolidation. What is the most appropriate initial management?

A. Arrange urgent viral PCR testing
B. Initiate oral antibiotics and admit to general ward
C. Discharge home with oral antibiotics
D. Perform urgent bronchoscopy
E. Initiate IV antibiotics and assess for ICU admission
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

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. Typhoid fever
B. Leptospirosis
C. Influenza
D. Dengue fever
E. Q fever
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
PET-CT of a tuberculoma
Image by Annemie Snoeckx, Pieter Reyntiens, Damien Desbuquoit, Maarten J. Spinhoven, Paul E. Van Schil, Jan P. van Meerbeeck, Paul M. Parizel CC BY 4.0 · Source

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. Prescribe a course of broad-spectrum antibiotics to cover community-acquired pneumonia.
B. Order a CT-guided needle biopsy of the lesion.
C. Start empiric treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE).
D. Refer the patient to a pulmonologist for bronchoscopy with bronchoalveolar lavage.
E. Initiate sputum acid-fast bacilli (AFB) smears and cultures.
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Acute cholecystitis with gallbladder wall thickening, a large gallstone, and a large gallbladder
Image by James Heilman, MD CC BY-SA 4.0 · Source

A 55-year-old female presents to the emergency department with a 24-hour history of severe right upper quadrant pain radiating to the back, associated with nausea, vomiting, and subjective fever. On examination, she is tachycardic (HR 105 bpm) and febrile (38.5°C), with marked tenderness and guarding in the right upper quadrant. Blood tests reveal a white cell count of 15 x 10^9/L and C-reactive protein of 120 mg/L. Liver function tests, including bilirubin, are within normal limits. She is initiated on intravenous fluids and broad-spectrum antibiotics. Imaging is obtained. Considering the patient's clinical status and the findings on the provided imaging, which of the following represents the most appropriate definitive management strategy?

A. Early laparoscopic cholecystectomy (within 24-72 hours)
B. Delayed laparoscopic cholecystectomy (after 6-8 weeks)
C. Urgent ERCP to relieve obstruction
D. Percutaneous cholecystostomy tube insertion
E. Continue medical management with antibiotics and analgesia only
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Acute cholecystitis with gallbladder wall thickening, a large gallstone, and a large gallbladder
Image by James Heilman, MD CC BY-SA 4.0 · Source

A 58-year-old woman with poorly controlled diabetes presents with severe RUQ pain, fever, and vomiting for 3 days. The provided CT was performed. What is the MOST appropriate initial management strategy?

A. Urgent cholecystectomy
B. Oral ursodeoxycholic acid
C. IV antibiotics and bowel rest
D. Percutaneous cholecystostomy tube placement
E. ERCP with stone extraction
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Figure 3 of paper: Alveolar echinococcosis in a patient with immunosuppression.

(a) Abdominal gray-scale US shows an abscess-like hepatic image.
(b) Axial unenhanced CT shows a typical aspect of pyogenic liver abscess.
Image by Wenya Liu, Éric Delabrousse, Oleg Blagosklonov, Jing Wang, Hongchun Zeng, Yi Jiang, Jian Wang, Yongde Qin, Dominique Angèle Vuitton, Hao Wen CC BY 4.0 · Source

A 55-year-old patient with a history of solid organ transplant on immunosuppressive therapy 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 in the right upper quadrant. Blood tests reveal a CRP of 85 mg/L (normal <5), WCC 11.5 x 10^9/L (normal 4-11), and mildly elevated alkaline phosphatase. Imaging is performed as shown. What is the most appropriate next step in management?

A. Schedule for surgical resection of the lesion
B. Prescribe oral analgesia and monitor symptoms
C. Image-guided percutaneous aspiration or biopsy of the lesion
D. Repeat imaging with contrast-enhanced CT in 1 week
E. Initiate broad-spectrum intravenous antibiotics
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

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. Scarlet fever
B. Allergic reaction to amoxicillin
C. Amoxicillin-induced rash in the context of infectious mononucleosis
D. Drug-induced lupus erythematosus
E. Stevens-Johnson syndrome
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 35-year-old lady who underwent laparoscopic appendicectomy presents 3 days later with diarrhea, fever (39.5°C), and erythematous port sites. She had a 5-day course of cefotaxime. What is the most likely diagnosis?

A. Pelvic abscess
B. Post-operative enteritis
C. Intra-abdominal abscess
D. Clostridium difficile infection
E. Surgical site infection
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Diverticulitis in the left lower quadrant. There is outpouching of the colonic wall, wall thickening, and surrounding fat stranding.
Image by James Heilman, MD CC BY-SA 3.0 · Source

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. Discharge home with oral antibiotics
B. Perform a colonoscopy to rule out malignancy
C. Schedule elective sigmoid colectomy
D. Order a barium enema to assess for fistula
E. Start intravenous antibiotics and bowel rest
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
PET-CT of a tuberculoma
Image by Annemie Snoeckx, Pieter Reyntiens, Damien Desbuquoit, Maarten J. Spinhoven, Paul E. Van Schil, Jan P. van Meerbeeck, Paul M. Parizel CC BY 4.0 · Source

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. Bronchoscopy with biopsy
B. Empiric antibiotic therapy
C. Referral for surgical resection
D. Repeat sputum cultures
E. Initiate anti-tuberculosis therapy
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

An 82-year-old man is brought from an aged care facility with a 2-day history of increased confusion and a new cough. He has a history of dementia and hypertension. On examination, his temperature is 38.1°C, pulse 98 bpm, BP 130/80 mmHg, and oxygen saturation 92% on room air. Chest auscultation reveals crackles in the right lower lung field. What is the most appropriate initial investigation?

A. Blood cultures
B. Sputum culture
C. ECG
D. Chest X-ray
E. CT scan of the head
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 62-year-old male presents to the emergency department with a 2-day history of right flank pain, fever, and nausea. He reports a history of recurrent urinary tract infections. On examination, he has right costovertebral angle tenderness. Urinalysis reveals pyuria and leukocyte esterase. Which of the following is the most likely underlying condition related to the organ primarily affected in the right lumbar region?

A. Cholecystitis with referred pain
B. Appendicitis with atypical presentation
C. Musculoskeletal strain
D. Pyelonephritis secondary to ascending urinary tract infection
E. Diverticulitis of the ascending colon
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Diverticular disease
Image by James Heilman, MD CC BY-SA 4.0 · Source

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. Admission for intravenous antibiotics and observation.
B. Outpatient oral antibiotics and pain relief.
C. Elective colonoscopy in 6-8 weeks.
D. Percutaneous drainage of any fluid collection.
E. Urgent surgical consultation for laparotomy.
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Acute cholecystitis with gallbladder wall thickening, a large gallstone, and a large gallbladder
Image by James Heilman, MD CC BY-SA 4.0 · Source

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. Order a hepatobiliary iminodiacetic acid (HIDA) scan
B. Administer analgesics and antiemetics, and discharge home with outpatient follow-up
C. Perform an ERCP to rule out choledocholithiasis
D. Initiate intravenous antibiotics and observe for 48 hours
E. Surgical consultation for cholecystectomy
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

An 80-year-old presents with cough, fever, and new confusion. Vital signs: T 38.5°C, HR 110, BP 100/60, RR 28, SpO2 90% on air. Chest X-ray shows consolidation. What is the most appropriate initial management step?

A. Oral antibiotics and outpatient management
B. Chest CT scan
C. Bronchoscopy
D. Sputum culture and sensitivity testing
E. Intravenous antibiotics and hospital admission
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 3-year-old boy is brought to the emergency department with a high fever, irritability, and a rash. The rash started on his face and has now spread to his trunk and limbs. On examination, he has conjunctivitis and Koplik spots are noted on the buccal mucosa. What is the most likely diagnosis?

A. Scarlet fever
B. Roseola
C. Rubella
D. Measles
E. Chickenpox
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Diverticulitis in the left lower quadrant. There is outpouching of the colonic wall, wall thickening, and surrounding fat stranding.
Image by James Heilman, MD CC BY-SA 3.0 · Source

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). Considering the clinical presentation and the findings on the provided image, which of the following investigations is most appropriate to recommend for this patient *after* resolution of the acute episode?

A. Colonoscopy in 6-8 weeks
B. Repeat CT scan of the abdomen and pelvis
C. Urgent colonoscopy within 48 hours
D. Faecal occult blood test
E. Barium enema
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Acute cholecystitis with gallbladder wall thickening, a large gallstone, and a large gallbladder
Image by James Heilman, MD CC BY-SA 4.0 · Source

A 52-year-old female presents with right upper quadrant pain, fever, and leukocytosis. The image shows the likely cause. What is the MOST appropriate initial management?

A. Ursodeoxycholic acid
B. Oral antibiotics and outpatient follow-up
C. IV fluids, analgesia, and surgical consultation
D. Hepatobiliary iminodiacetic acid (HIDA) scan
E. Endoscopic retrograde cholangiopancreatography (ERCP)
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 30-year-old woman presents with fever, hemoptysis, and night sweats. A chest X-ray shows a round lesion with an air-fluid level. What is the most likely diagnosis?

A. Tuberculosis
B. Pulmonary embolism
C. Bronchiectasis
D. Lung cancer
E. Lung abscess
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

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. Tuberculosis
B. Lung abscess
C. Pulmonary embolism
D. Sarcoidosis
E. Pneumonia
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Diverticulitis in the left lower quadrant. There is outpouching of the colonic wall, wall thickening, and surrounding fat stranding.
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 62-year-old male presents with left lower quadrant pain, fever, and leukocytosis. A CT scan of the abdomen and pelvis is performed (image attached). Assuming the diagnosis, which of the following is the MOST appropriate initial management?

A. Colonoscopy to rule out malignancy
B. Oral antibiotics and outpatient follow-up
C. IV antibiotics, bowel rest, and surgical consultation
D. Stool culture and empiric antibiotics
E. High-fiber diet and increased fluid intake
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 28-year-old woman presents to the clinic with a 3-day history of fever, sore throat, and difficulty swallowing. She has no significant past medical history and is not on any medications. On examination, she has swollen, tender anterior cervical lymph nodes and erythematous tonsils with white exudates. A rapid antigen detection test for group A Streptococcus is positive. What is the most appropriate treatment for her condition?

A. Azithromycin
B. Clindamycin
C. Penicillin V
D. Ceftriaxone
E. Amoxicillin
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Diverticulitis in the left lower quadrant. There is outpouching of the colonic wall, wall thickening, and surrounding fat stranding.
Image by James Heilman, MD CC BY-SA 3.0 · Source

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. Intravenous antibiotics and hospital admission for observation.
B. Urgent surgical consultation for Hartmann's procedure.
C. Immediate colonoscopy to evaluate the colonic mucosa.
D. Discharge with advice on dietary modification and follow-up in 6 weeks.
E. Outpatient oral antibiotics and analgesia.
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Acute cholecystitis with gallbladder wall thickening, a large gallstone, and a large gallbladder
Image by James Heilman, MD CC BY-SA 4.0 · Source

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. Percutaneous gallbladder drainage
B. ERCP for possible choledocholithiasis
C. Start intravenous antibiotics and observe
D. Surgical consultation for cholecystectomy
E. Discharge with oral antibiotics and follow-up
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Diverticular disease
Image by James Heilman, MD CC BY-SA 4.0 · Source

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. Flexible sigmoidoscopy
B. IV antibiotics and bowel rest
C. Stool softeners
D. Surgical resection
E. High-fiber diet
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 28-year-old male with Crohn's disease presents with increased abdominal pain, fever, and bloody stools. He is on azathioprine. What is the most appropriate next step?

A. Prescribe a high-fibre diet.
B. Start a course of oral metronidazole.
C. Increase the dose of azathioprine.
D. Order a CT scan of the abdomen and pelvis.
E. Reassure the patient and schedule a follow-up appointment.
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Figure 3 of paper: Alveolar echinococcosis in a patient with immunosuppression.

(a) Abdominal gray-scale US shows an abscess-like hepatic image.
(b) Axial unenhanced CT shows a typical aspect of pyogenic liver abscess.
Image by Wenya Liu, Éric Delabrousse, Oleg Blagosklonov, Jing Wang, Hongchun Zeng, Yi Jiang, Jian Wang, Yongde Qin, Dominique Angèle Vuitton, Hao Wen CC BY 4.0 · Source

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. Surgical resection
B. Amphotericin B
C. Albendazole
D. Broad-spectrum antibiotics
E. Percutaneous drainage
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Diverticular disease
Image by James Heilman, MD CC BY-SA 4.0 · Source

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. Stool culture to rule out infectious colitis
B. IV antibiotics and bowel rest
C. Surgical resection of the affected bowel segment
D. Oral antibiotics and outpatient follow-up
E. Flexible sigmoidoscopy to rule out malignancy
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Acute cholecystitis with gallbladder wall thickening, a large gallstone, and a large gallbladder
Image by James Heilman, MD CC BY-SA 4.0 · Source

A 65-year-old male presents with 2 days of constant right upper quadrant pain radiating to the back, associated with nausea and subjective fever. On examination, he is febrile (38.5°C) with significant tenderness and a positive Murphy's sign in the right upper quadrant. His white cell count is elevated at 15 x 10^9/L, and CRP is 120 mg/L. Liver function tests are within normal limits. Considering the clinical presentation and the provided imaging, what is the most appropriate timing for definitive surgical management?

A. Within 72 hours of admission
B. Only if symptoms fail to resolve with antibiotics
C. Following a trial of percutaneous drainage
D. Urgently, within 6 hours
E. After 6-8 weeks of medical management
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Diverticular disease
Image by James Heilman, MD CC BY-SA 4.0 · Source

A 68-year-old male presents to the ED with left lower quadrant abdominal pain, fever, and leukocytosis. A CT scan of the abdomen and pelvis is performed. Based on the image, what is the most appropriate next step in management?

A. Increase dietary fiber intake
B. Surgical resection of the affected bowel segment
C. Flexible sigmoidoscopy
D. IV antibiotics and bowel rest
E. Stool culture for C. difficile
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 58-year-old farmer presents with a 10-day history of fever, severe retro-orbital headache, myalgia, and profound fatigue. He denies cough or sore throat. Examination reveals mild scleral icterus. Liver function tests show elevated transaminases. He works closely with sheep and cattle. What is the most likely diagnosis?

A. Influenza
B. Leptospirosis
C. Brucellosis
D. Viral hepatitis A
E. Q fever
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 32-year-old woman presents to the emergency department with a 2-day history of fever, headache, and a rash that started on her wrists and ankles and has now spread to her trunk. She recently returned from a camping trip in the Northern Territory. On examination, she is febrile at 38.5°C, with a heart rate of 110 bpm and blood pressure of 100/70 mmHg. The rash is maculopapular and blanching. Laboratory tests reveal thrombocytopenia and elevated liver enzymes. Which of the following is the most likely diagnosis?

A. Systemic lupus erythematosus
B. Drug reaction
C. Rickettsial infection
D. Viral exanthem
E. Meningococcal infection
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Figure 3 of paper: Alveolar echinococcosis in a patient with immunosuppression.

(a) Abdominal gray-scale US shows an abscess-like hepatic image.
(b) Axial unenhanced CT shows a typical aspect of pyogenic liver abscess.
Image by Wenya Liu, Éric Delabrousse, Oleg Blagosklonov, Jing Wang, Hongchun Zeng, Yi Jiang, Jian Wang, Yongde Qin, Dominique Angèle Vuitton, Hao Wen CC BY 4.0 · Source

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. Metronidazole
B. Observation and serial imaging
C. Percutaneous drainage and antibiotics
D. Albendazole and surgical resection
E. Ceftriaxone and doxycycline
Mark this as a high-quality question
Mark this as a poor-quality or problematic question