06-20-2007, 10:50 PM
A 32-year-old woman comes to the clinic complaining of
malaise, severe pallor, and generalized weakness.
Approximately 2 months ago, while working at a rural
health clinic in the war-torn Congo, she became extremely
ill with a severe gastroenteritis. She was given antibiotics,
though she is not sure which ones, and quickly
recovered. Since returning to the United States approximately
6 weeks ago, however, she has felt progressively
more ill. She has never been sick in the past, takes no medications,
and knows of no diseases that run in her family.
A review of symptoms, aside from reduced exercise tolerance
and a mild decrease in appetite, is unremarkable. She
has suffered no recent fevers, chills, nausea, or diarrhea,
and denies any weight loss or night sweats.Vital signs are:
temperature 37.0 C (98.6 F), blood pressure 118/70 mm
Hg, pulse 103/min, and respirations 20/min. Examination
reveals a young, pale woman in no apparent distress.
Cardiac auscultation reveals a 2/6 midsystolic murmur
heard best at the right upper sternal border that does not
radiate. Lungs are clear to auscultation bilaterally, and
abdominal examination is benign, without evidence of
hepatosplenomegaly. There are no signs and stigmata of
liver disease or endocarditis. Laboratory studies show:
Hematologic
Hematocrit 17%
Hemoglobin 6.0 g/dL
Leukocytes 3000/mm3 (67% neutrophils,
25% lymphocytes,
7% monocytes)
Platelets 12,500/mm3
Reticulocytes 0.6%
The rest of the patient™s laboratory studies, including a
set of chemistries and liver function tests, are unremarkable.
Which of the following is the next most
appropriate diagnostic study?
(A) Blood and stool cultures
(B) Bone marrow biopsy
© CT scan of abdomen
(D) Echocardiogram
(E) Erythropoietin level
Internal Medicine
malaise, severe pallor, and generalized weakness.
Approximately 2 months ago, while working at a rural
health clinic in the war-torn Congo, she became extremely
ill with a severe gastroenteritis. She was given antibiotics,
though she is not sure which ones, and quickly
recovered. Since returning to the United States approximately
6 weeks ago, however, she has felt progressively
more ill. She has never been sick in the past, takes no medications,
and knows of no diseases that run in her family.
A review of symptoms, aside from reduced exercise tolerance
and a mild decrease in appetite, is unremarkable. She
has suffered no recent fevers, chills, nausea, or diarrhea,
and denies any weight loss or night sweats.Vital signs are:
temperature 37.0 C (98.6 F), blood pressure 118/70 mm
Hg, pulse 103/min, and respirations 20/min. Examination
reveals a young, pale woman in no apparent distress.
Cardiac auscultation reveals a 2/6 midsystolic murmur
heard best at the right upper sternal border that does not
radiate. Lungs are clear to auscultation bilaterally, and
abdominal examination is benign, without evidence of
hepatosplenomegaly. There are no signs and stigmata of
liver disease or endocarditis. Laboratory studies show:
Hematologic
Hematocrit 17%
Hemoglobin 6.0 g/dL
Leukocytes 3000/mm3 (67% neutrophils,
25% lymphocytes,
7% monocytes)
Platelets 12,500/mm3
Reticulocytes 0.6%
The rest of the patient™s laboratory studies, including a
set of chemistries and liver function tests, are unremarkable.
Which of the following is the next most
appropriate diagnostic study?
(A) Blood and stool cultures
(B) Bone marrow biopsy
© CT scan of abdomen
(D) Echocardiogram
(E) Erythropoietin level
Internal Medicine