Viral hemorrhagic fevers — MCQs

A 43-year-old male visits the emergency room around 4 weeks after getting bitten by a bat during a cave diving trip. After cleansing the wound with water, the patient reports that he felt well enough not to seek medical attention immediately following his trip. He does endorse feeling feverish in the past week but a new onset of photophobia and irritability led him to seek help today. What would the post-mortem pathology report show if the patient succumbs to this infection?

A 25-year-old woman comes to the physician because of a 2-week history of episodic bleeding from the nose and gums and one episode of blood in her urine. She was treated with chloramphenicol 1 month ago for Rickettsia rickettsii infection. Her pulse is 130/min, respirations are 22/min, and blood pressure is 105/70 mm Hg. Examination shows mucosal pallor, scattered petechiae, and ecchymoses on the extremities. Laboratory studies show: Hemoglobin 6.3 g/dL Hematocrit 26% Leukocyte count 900/mm3 (30% neutrophils) Platelet count 50,000/mm3 The physician recommends a blood transfusion and informs her of the risks and benefits. Which of the following red blood cell preparations will most significantly reduce the risk of transfusion-related cytomegalovirus infection?

A previously healthy 25-year-old man comes to the physician because of a 4-day history of fever, joint and body pain, diffuse headache, and pain behind the eyes. This morning he noticed that his gums bled when he brushed his teeth. He returned from a backpacking trip to the Philippines 4 days ago. His temperature is 39.4°C (103.0°F). Physical examination shows a diffuse maculopapular rash. His leukocyte count is 3,200/mm3 and platelet count is 89,000/mm3. Further evaluation shows increased serum levels of a flavivirus. Which of the following is the most likely causal pathogen?

A 30-year-old forest landscape specialist is brought to the emergency department with hematemesis and confusion. One week ago she was diagnosed with influenza when she had fevers, severe headaches, myalgias, hip and shoulder pain, and a maculopapular rash. After a day of relative remission, she developed abdominal pain, vomiting, and diarrhea. A single episode of hematemesis occurred prior to admission. Two weeks ago she visited rainforests and caves in western Africa where she had direct contact with animals, including apes. She has no history of serious illnesses or use of medications. She is restless. Her temperature is 38.0℃ (100.4℉); the pulse is 95/min, the respiratory rate is 20/min; and supine and upright blood pressure is 130/70 mm Hg and 100/65 mm Hg, respectively. Conjunctival suffusion is noted. Ecchymoses are observed on the lower extremities. She is bleeding from one of her intravenous lines. The peripheral blood smear is negative for organisms. Filovirus genomes were detected during a reverse transcription-polymerase chain reaction. The laboratory studies show the following: Laboratory test Hemoglobin 10 g/dL Leukocyte count 1,000/mm3 Segmented neutrophils 65% Lymphocytes 20% Platelet count 50,000/mm3 Partial thromboplastin time (activated) 60 seconds Prothrombin time 25 seconds Fibrin split products positive Serum Alanine aminotransferase (ALT) 85 U/L Aspartate aminotransferase (AST) 120 U/L γ-Glutamyltransferase (GGT) 83 U/L Creatinine 2 mg/dL Which of the following is the most appropriate immediate step in management?

A 29-year-old man presents to the clinic complaining of fatigue and loss of sensation in his lower legs. The patient notes no history of trauma or chronic disease but states that he spends a lot of time outside and often encounters wild animals. On examination, the patient has multiple dark lesions over the skin of his face and back, as well as a decreased sensation of fine touch and vibration bilaterally in the lower extremities. What is the morphology of the etiologic agent causing this patient’s symptoms?

A 45-year-old male presents to the emergency room complaining of severe nausea and vomiting. He returned from a business trip to Nigeria five days ago. Since then, he has developed progressively worsening fevers, headache, nausea, and vomiting. He has lost his appetite and cannot hold down food or water. He did not receive any vaccinations before traveling. His medical history is notable for alcohol abuse and peptic ulcer disease for which he takes omeprazole regularly. His temperature is 103.0°F (39.4°C), blood pressure is 100/70 mmHg, pulse is 128/min, and respirations are 22/min. Physical examination reveals scleral icterus, hepatomegaly, and tenderness to palpation in the right and left upper quadrants. While in the examination room, he vomits up dark vomitus. The patient is admitted and started on multiple anti-protozoal and anti-bacterial medications. Serology studies are pending; however, the patient dies soon after admission. The virus that likely gave rise to this patient’s condition is part of which of the following families?

A 57-year-old man presents to the emergency department for feeling weak for the past week. He states that he has felt much more tired than usual and has had a subjective fever during this time. The patient has a past medical history of IV drug use, hepatitis C, atrial fibrillation, cirrhosis, alcohol dependence, obesity, and depression. His temperature is 102°F (38.9°C), blood pressure is 157/98 mmHg, pulse is 110/min, respirations are 17/min, and oxygen saturation is 98% on room air. On physical exam, you note a fatigued man with diffuse yellowing of his skin. Cardiopulmonary exam is notable for bibasilar crackles on auscultation. Abdominal exam is notable for abdominal distension, dullness to percussion, and a fluid wave. The patient complains of generalized tenderness on palpation of his abdomen. The patient is started on piperacillin-tazobactam and is admitted to the medical floor. On day 4 of his stay in the hospital the patient is afebrile and his pulse is 92/min. His abdominal tenderness is reduced but is still present. Diffuse yellowing of the patient's skin and sclera is still notable. The nurses notice bleeding from the patient's 2 peripheral IV sites that she has to control with pressure. A few new bruises are seen on the patient's arms and legs. Which of the following is the best explanation for this patient's condition?

A 16-year-old female presents to her pediatrician complaining of 2 weeks of fever and 1 week of swollen lumps in her left armpit. Upon examination of the left upper extremity, her physician notes the presence of a single papule which the patient claimed appeared one week ago. The patient started her first job at a pet store 2.5 weeks ago. Which of the following is the vector of transmission of the causative agent?

A 32-year-old woman comes to the emergency department with a 2-day history of abdominal pain and diarrhea. She has had about 8 voluminous stools per day, some of which were bloody. She visited an international food festival three days ago. She takes no medications. Her temperature is 39.5°C (103.1°F), pulse is 90/min, and blood pressure is 110/65 mm Hg. Examination shows a tender abdomen, increased bowel sounds, and dry mucous membranes. Microscopic examination of the stool shows polymorphonuclear leukocytes. Stool culture results are pending. Which of the following most likely caused the patient's symptoms?

A previously healthy 24-year-old woman comes to the physician because of a 1-day history of nausea and weakness. She is sexually active with 2 male partners and uses an oral contraceptive; she uses condoms inconsistently. Her last menstrual period was 4 days ago. Her temperature is 38.4°C (101°F). Physical examination shows right costovertebral angle tenderness. Pelvic examination is normal. Which of the following is the most likely cause of this patient's condition?