12-17-2008, 03:51 AM
A 59 year old man presents to his physician because of persistent fever. He has noticed these fevers for the past four days and has felt some fatigue also. He has been relatively well up untilll this time, and he has been only recently diagnosed with hypertension for which he has been put on hydrochlorthiazide. He denies headache, neck stiffness, cough, shortness of breath, sputum production, abdominal pain, nausea, vomiting or diarrhoea. He has not noticed any rashes. He has not travelled outside of the united states for 2 years. He has not noticed any joint pains, night sweats,weight loss or anorexia. He denies smoking or alcohol consumption. He works as a lawyer at a local firm. On physical examination, he has a temperature of 101F, his pulse is 103/min. He is saturating 96% on room air. He is normotensive.Head and neck examination shows no oropharyngeal injection or lymphadenopathy. his chest auscultation is normal. Heart auscultation shows no murmurs, rubs or gallops although he is tachycardiac. Abdominal examination reveals no tenderness, hepatosplenomegaly or guarding. Extremity examination shows no clubbing cyanosis or edema. Pusles are 2+ throughout. he is admitted to the hospital where blood culture, sputum analysis, ppd,complete blood count, and CT chest, abdomen and pelvis shows no abnormalitiy. His ESR is elevated to 101/hr. His hydrochlorthiazide is discontinued but he remains febrile while in the hospital for the next week. What is the next step in the management of this patient?
A. Discharge from hospital
B. Echocardiography
C. Emperic antibiotics
D. Serum assay of rheumatoid factor
E. Temporal artery biopsy
A. Discharge from hospital
B. Echocardiography
C. Emperic antibiotics
D. Serum assay of rheumatoid factor
E. Temporal artery biopsy