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fever

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

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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
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A 28-year-old male presents to the emergency department with severe abdominal pain, fever, and bloody diarrhea for the past 2 days. He has a known history of Crohn's disease, diagnosed 5 years ago, and has been managed with azathioprine. He admits to inconsistent adherence to his medication regimen over the past year due to feeling well. On examination, he is febrile (38.9°C), tachycardic (110 bpm), and hypotensive (90/60 mmHg). His abdomen is distended and tender to palpation, particularly in the lower quadrants, with guarding. Laboratory investigations reveal a white blood cell count of 18,000/mm³ with a left shift, hemoglobin of 10 g/dL, platelets of 450,000/mm³, albumin of 28 g/L, and C-reactive protein (CRP) of 150 mg/L. An abdominal X-ray shows dilated loops of bowel. Which of the following is the MOST appropriate next step in the management of this patient?

A. Perform a colonoscopy to assess the extent of the inflammation and obtain biopsies
B. Administer intravenous corticosteroids and anti-diarrheal medications
C. Increase the dose of azathioprine and monitor the patient's symptoms
D. Intravenous fluids, broad-spectrum antibiotics, and urgent surgical consultation
E. Start infliximab infusion immediately after blood cultures are taken
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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
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A 3-year-old boy is brought to the emergency department by his parents due to a high fever and irritability. He has had a runny nose and cough for the past two days. On examination, he is lethargic and has a bulging fontanelle. A lumbar puncture is performed, and the cerebrospinal fluid (CSF) analysis shows elevated protein, low glucose, and a high white cell count with a predominance of neutrophils. What is the most likely diagnosis?

A. Tuberculous meningitis
B. Bacterial meningitis
C. Subdural hematoma
D. Viral meningitis
E. Encephalitis
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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. Intravenous fluids only
B. Observation and repeat urinalysis
C. Pain management with NSAIDs
D. Intravenous antibiotics
E. Oral antibiotics
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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
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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.
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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
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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
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A 48-year-old sheep farmer presents to his GP with a two-week history of persistent fever, severe retro-orbital headache, and profound fatigue. He denies cough, shortness of breath, or rash. On examination, his temperature is 38.5°C, pulse 85 bpm, BP 120/80 mmHg. The remainder of the examination, including chest auscultation, is unremarkable. He has not travelled outside the region recently.

A. Acute Q fever
B. Atypical pneumonia
C. Leptospirosis
D. Brucellosis
E. Influenza
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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
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Fluoroscopic image of common bile duct stone seen at the time of ERCP. The stone is impacted in the distal common bile duct.
Image by Samir धर्म at en.wikipedia CC BY-SA 3.0 · Source

A 68-year-old woman presents to the emergency department with a 2-day history of worsening right upper quadrant abdominal pain radiating to her back, associated with fever, chills, and yellowing of her eyes. She denies prior similar episodes but reports occasional post-prandial discomfort. On examination, she is jaundiced and tender in the right upper quadrant. 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 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. Referral for medical dissolution therapy for gallstones
B. Elective laparoscopic cholecystectomy during the same admission or shortly after discharge
C. Long-term antibiotic therapy to prevent recurrence
D. Discharge home with pain relief and follow-up in general practice
E. Repeat ERCP in 3 months to check for residual stones
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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
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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. Bacterial meningitis
B. Post-embolization syndrome
C. Re-rupture of the aneurysm
D. Vasospasm
E. Deep vein thrombosis
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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. Percutaneous drainage and antibiotics
B. Observation and serial imaging
C. Metronidazole and supportive care
D. Empiric amphotericin B
E. Albendazole and surgical resection
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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 emergency department complaining of left lower quadrant abdominal pain for the past three days. He describes the pain as constant and sharp, rating it an 8 out of 10. He also reports nausea, decreased appetite, and subjective fevers. His past medical history is significant for hypertension and hyperlipidemia, both well-controlled with medications. He denies any recent travel or sick contacts. On physical examination, his abdomen is tender to palpation in the left lower quadrant with guarding. Bowel sounds are present but diminished. The remainder of his examination is unremarkable. His vital signs are: Temperature 38.2°C, Heart Rate 98 bpm, Blood Pressure 140/90 mmHg, Respiratory Rate 18 breaths per minute, and Oxygen Saturation 98% on room air. Laboratory results show a white blood cell count of 14,000/µL with a neutrophilic predominance. A CT scan of the abdomen and pelvis with intravenous contrast is performed, and a representative image is shown. Assuming the patient has no allergies, what is the MOST appropriate initial management strategy?

A. Perform a colonoscopy to evaluate for inflammatory bowel disease.
B. Administer intravenous antibiotics covering gram-negative and anaerobic organisms, and admit the patient for observation and further management.
C. Schedule an elective laparoscopic sigmoid colectomy.
D. Prescribe oral antibiotics and instruct the patient to follow up with their primary care physician in one week.
E. Order a barium enema to assess for colonic strictures or masses.
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An 82-year-old woman from an aged care facility presents with a 2-day history of increased confusion and lethargy. Her baseline is independent living with mild cognitive impairment. She has a chronic cough but no recent change in sputum. Vital signs: T 37.8°C, HR 95 bpm, BP 110/70 mmHg, RR 22 breaths/min, SpO2 92% on room air. Chest examination reveals decreased breath sounds at the right base. Given the clinical presentation and setting, which of the following is the most appropriate initial management step while awaiting the chest X-ray result?

A. Perform a CT scan of the chest to confirm the diagnosis.
B. Administer empiric broad-spectrum antibiotics covering typical and atypical pathogens.
C. Transfer to a tertiary hospital for specialist respiratory review.
D. Administer supplemental oxygen and monitor vital signs closely.
E. Obtain sputum culture and sensitivity before initiating antibiotics.
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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 man, post-renal transplant, presents with RUQ pain and fever. Imaging is shown. What is the MOST appropriate next step in management?

A. Metronidazole
B. Amphotericin B
C. Observation and serial imaging
D. Percutaneous drainage and antibiotics
E. Albendazole and surgical resection
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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 setting for this patient's initial management?

A. Inpatient admission for intravenous antibiotics and observation.
B. Outpatient management with oral antibiotics and analgesia.
C. Admission for bowel rest and total parenteral nutrition.
D. Urgent surgical consultation for potential intervention.
E. Discharge home with only analgesia and dietary advice.
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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.
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Fluoroscopic image of common bile duct stone seen at the time of ERCP. The stone is impacted in the distal common bile duct.
Image by Samir धर्म at en.wikipedia CC BY-SA 3.0 · Source

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. Placement of a biliary stent
B. Mechanical lithotripsy
C. Balloon dilation of the common bile duct
D. Endoscopic sphincterotomy
E. Attempt stone extraction with a basket
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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
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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
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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. Throat culture
B. Start antibiotics
C. Refer to ENT
D. Prescribe analgesics and advise on symptomatic treatment
E. Order a monospot test
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Neuroblastoma, CT of the abdomen
Image by RadsWiki CC BY-SA 3.0 · Source

A 4-year-old child is brought to the emergency department with a 3-week history of increasing abdominal distension, intermittent pain, and decreased activity. Parents also report occasional flushing episodes and unexplained fevers. On examination, a large, firm, irregular mass is palpable in the upper abdomen, extending across the midline. Vital signs are stable, and routine blood tests, including full blood count, electrolytes, and liver function tests, are within normal limits. An abdominal CT scan is performed (image provided). Based on the findings demonstrated in the image and the clinical presentation, which of the following investigations is most critical for accurate staging and risk stratification in this likely diagnosis?

A. Serum alpha-fetoprotein and beta-human chorionic gonadotropin levels
B. Upper gastrointestinal series with small bowel follow-through
C. Iodine-123 metaiodobenzylguanidine (MIBG) scan
D. Renal biopsy
E. Colonoscopy
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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 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. Initiate broad-spectrum antibiotics and observe
B. Discharge with analgesics and outpatient follow-up
C. ERCP to rule out choledocholithiasis
D. Surgical consultation for cholecystectomy
E. Start ursodeoxycholic acid for gallstone dissolution
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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
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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
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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
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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
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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
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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. Liver function tests
B. Serology for Coxiella burnetii
C. Chest X-ray
D. Blood culture
E. PCR for Coxiella burnetii
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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
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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
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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 62-year-old woman presents with right upper quadrant pain, fever, and leukocytosis. An abdominal CT scan is performed, as shown. She has a history of similar episodes that resolved spontaneously. What is the MOST appropriate next step in management?

A. IV antibiotics and analgesia
B. Laparoscopic cholecystectomy
C. Oral ursodeoxycholic acid
D. ERCP with sphincterotomy
E. Percutaneous cholecystostomy tube placement
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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 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. What is the most appropriate next step to determine the specific aetiology of the findings?

A. Percutaneous aspiration and microbiological analysis
B. Repeat abdominal imaging in one week
C. Urgent surgical exploration and biopsy
D. Comprehensive liver function tests and viral hepatitis serology
E. Empirical broad-spectrum intravenous antibiotics
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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. Order a barium enema
B. Initiate intravenous antibiotics and bowel rest
C. Schedule elective colonoscopy
D. Proceed with immediate surgical resection
E. Perform flexible sigmoidoscopy
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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. Perform a colonoscopy to rule out malignancy
B. Start IV antibiotics and admit for observation
C. Schedule elective sigmoid colectomy
D. Prescribe oral antibiotics and discharge home
E. Order a barium enema to assess for obstruction
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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. Stevens-Johnson syndrome
B. Scarlet fever
C. Toxic shock syndrome
D. Kawasaki disease
E. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome
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An 80-year-old man presents with new confusion, cough, and fever. He has a history of COPD. On exam, he is tachypnoeic and has crackles at the right base. His oxygen saturation is 88% on room air. What is the most appropriate initial investigation?

A. Bronchoscopy
B. C-reactive protein
C. Sputum Gram stain and culture
D. High-resolution CT chest
E. Chest X-ray
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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
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A child has a sore throat and fever. Centor criteria are 3/4. What's the next step?

A. Order a rapid antigen detection test
B. Throat swab for Group A Streptococcus
C. Refer to ENT specialist
D. Prescribe antibiotics immediately
E. Reassure and recommend analgesia
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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 imaging, what is the MOST appropriate next step in management?

A. Flexible sigmoidoscopy to rule out malignancy
B. Stool culture to identify infectious etiology
C. Surgical resection of the affected bowel segment
D. IV antibiotics and bowel rest
E. High-fiber diet and increased fluid intake
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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
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A 45-year-old woman presents to the emergency department with a 3-day history of fever, productive cough with greenish sputum, and pleuritic chest pain. She has a history of asthma and is currently on salbutamol and fluticasone inhalers. On examination, her temperature is 38.5°C, respiratory rate is 24 breaths per minute, and oxygen saturation is 92% on room air. Auscultation reveals decreased breath sounds and crackles in the right lower lung field. A chest X-ray shows a right lower lobe consolidation. What is the most appropriate initial antibiotic therapy for this patient, considering Australian guidelines?

A. Doxycycline
B. Ceftriaxone
C. Amoxicillin-clavulanate
D. Azithromycin
E. Ciprofloxacin
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Fluoroscopic image of common bile duct stone seen at the time of ERCP. The stone is impacted in the distal common bile duct.
Image by Samir धर्म at en.wikipedia CC BY-SA 3.0 · Source

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. Prescribe oral ursodeoxycholic acid
B. Schedule a laparoscopic cholecystectomy
C. Administer intravenous antibiotics and monitor liver function tests
D. Perform a percutaneous transhepatic cholangiogram
E. Discharge the patient with instructions for a low-fat diet
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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
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A 5-year-old boy is brought to the clinic by his parents due to a 3-day history of fever, irritability, and refusal to eat. On examination, he has a temperature of 39°C, erythematous oropharynx, and tender cervical lymphadenopathy. There are also vesicular lesions on his hands and feet. What is the most likely diagnosis?

A. Varicella (chickenpox)
B. Scarlet fever
C. Hand, foot, and mouth disease
D. Kawasaki disease
E. Herpangina
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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. Engage in light exercise to improve symptoms
B. Resume normal activities immediately
C. Start a course of corticosteroids to reduce symptoms
D. Avoid all physical activity for 6 months
E. Avoid contact sports for at least 4 weeks
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Fluoroscopic image of common bile duct stone seen at the time of ERCP. The stone is impacted in the distal common bile duct.
Image by Samir धर्म at en.wikipedia CC BY-SA 3.0 · Source

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?

A. Ursodeoxycholic acid administration
B. Cholecystectomy
C. Observation with serial liver function tests
D. Sphincterotomy and stone extraction
E. Percutaneous transhepatic biliary drainage
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