A 24-Year-Old Man Comes to the Emergency Department After 1

question 76

Multiple Choice

A 24-year-old man comes to the emergency department after 1 week of fever, chills, and headache.  He also complains of nausea and an episode of vomiting.  He has no abdominal pain or diarrhea.  Three weeks ago, he returned from travelling in southern Africa, where he volunteered at a medical clinic in rural Malawi for 3 months.  He took doxycycline for the entire trip until returning to the United States.  He drank mostly bottled water but did eat local cooked food.  He had no sexual activity, injected drug use, or freshwater exposure during his travels.
His temperature is 39.4 C (103 F) , blood pressure is 120/76 mm Hg, pulse is 106/min, and respirations are 18/min.  He is uncomfortable but nontoxic-appearing.  There is no skin rash.  Pupils are equal, round, and reactive and there is mild scleral icterus but no conjunctival lesions or suffusion.  There is no neck stiffness or meningeal signs.  Abdominal examination reveals tenderness in the left upper quadrant and mild splenomegaly.
Laboratory results are as follows:

Which test is most likely to establish the diagnosis in this patient?

• A)Blood cultures
• B)Lumbar puncture
• C)Peripheral blood smear
• D)Serology for viral hepatitis
• E)Stool sample for ova and parasites

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Definitions:

Dietary Therapy

The use of diet and nutritional intake as a means to prevent or treat disease and enhance health.

Canalized

Refers to a trait that follows a strictly defined path, regardless of most environmental and genetic variations.

Environmental Changes

Alterations in the surrounding conditions, whether natural or man-made, that can impact ecosystems and human societies.

Amniocentesis

A medical procedure used in prenatal diagnosis of chromosomal abnormalities and fetal infections, where a small amount of amniotic fluid is sampled from the amniotic sac surrounding a developing fetus.