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immunosuppression

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

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abdominal painfevertransplantinfectious diseasesgastroenterologyimagingmiddle-aged manabdominal imagingbiopsyliver disease
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 long-term immunosuppressive therapy presents with a 3-month history of intermittent right upper quadrant pain and unintentional weight loss. He denies fever or chills. Physical examination is unremarkable. Liver function tests show mild elevation of alkaline phosphatase and gamma-GT. Inflammatory markers (CRP, ESR) are slightly elevated. Imaging is performed as shown. Based on the findings and clinical context, what is the most appropriate next diagnostic step?

A. Repeat CT scan with intravenous contrast
B. Liver biopsy of the lesion
C. Percutaneous drainage and culture of the lesion
D. Serological testing for Echinococcus species
E. Empirical broad-spectrum antibiotic therapy
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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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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
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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 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
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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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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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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. Based on these findings, what is the most appropriate immediate management step?

A. Percutaneous aspiration and drainage of the lesion
B. Repeat CT scan with contrast in 48 hours
C. Obtain serological tests for Echinococcus and fungal markers
D. Initiate broad-spectrum intravenous antibiotics
E. Schedule for surgical exploration and debridement
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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 man with a history of renal transplant on long-term immunosuppressive therapy presents with a 3-month history of intermittent right upper quadrant pain and unintentional weight loss. He denies fever or chills. Physical examination is unremarkable. Liver function tests show mild elevation of alkaline phosphatase and gamma-GT. Inflammatory markers (CRP, ESR) are slightly elevated. Imaging is performed. Considering the clinical context and the findings on imaging, which of the following represents the most appropriate next diagnostic step to guide management?

A. Initiate empirical broad-spectrum intravenous antibiotics.
B. Proceed directly to surgical drainage or resection.
C. Perform serological testing for parasitic infections, including Echinococcus species.
D. Percutaneous biopsy of the lesion for histology and microbiological studies.
E. Arrange for a PET-CT scan to assess metabolic activity of the lesion.
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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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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
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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 58-year-old male, on chronic immunosuppressants, presents with vague abdominal pain. The images are shown. What is the MOST likely causative organism?

A. Klebsiella pneumoniae
B. Echinococcus multilocularis
C. Escherichia coli
D. Staphylococcus aureus
E. Entamoeba histolytica
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