A 21-Year-Old Man Is Brought to the Emergency Department in a Stuporous

question 232

Multiple Choice

A 21-year-old man is brought to the emergency department in a stuporous condition.  He returned from a family visit to Mexico 2 weeks ago.  One week ago, the patient began developing high-grade fever, headaches, severe myalgias, and joint pains.  He had similar symptoms following a trip to Mexico 5 years ago, but at that time the symptoms did not progress and instead resolved spontaneously within a few days.  Temperature is 38.3 C (101 F) , blood pressure is 80/50 mm Hg, and pulse is 128/min.  Examination shows a diffuse maculopapular rash, multiple purpuric lesions, and hepatomegaly.  Laboratory studies show marked thrombocytopenia, leukopenia, and elevated liver aminotransferases.  Which of the following is the most likely mechanism for this patient's current severe illness?

• A)Antigenic drift in the virus
• B)Blunted T-lymphocyte response
• C)Infection with a different viral serotype
• D)Larger viral inoculation dose
• E)Viral superinfection

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Definitions:

Fraudulent Use of Transit

The unauthorized use or manipulation of transportation systems or services for deceptive or unlawful purposes.

False Pretenses

Obtaining property, goods, or services from another by misrepresentation or deceit, typically involving a false statement of fact.

Check Kiting

A form of fraud involving the deliberate issuing of checks from insufficiently funded accounts to temporarily inflate financial balances.

Check Defalcation

The misappropriation or embezzlement of funds represented by a check, usually occurring when someone fraudulently misuses a check entrusted to them.