Try this free febrile patient case Q&A courtesy of Med-Challenger.
A 39-year-old woman presents with a fever that has been present for the last 15 days. She has been seen at 2 different walk-in clinics, where she received a diagnosis of a viral illness.
She completed a course of azithromycin 4 days ago, but she now has generalized weakness with mild nausea. She has a significant past medical history of mitral valve prolapse.
On today's visit, she is tachycardic and febrile. She has a high-pitched, 3/6 holosystolic murmur that starts at the left sternal border and is heard into the axilla.
The patient also has foci of tenderness and discoloration on the palmar surface of his hand and fingers (see Figure 1).
Figure 1.
Initial evaluation of this patient should include which of the following?
Answer Options:
- transesophageal echocardiography, heparin, electrocardiography (ECG)
- transthoracic echocardiography (TTE), 2 sets of blood cultures, electrocardiography (ECG), chest x-ray
- chest x-ray, 2 sets of blood cultures, prescription for amoxicillin/clavulanic acid
- helical computed tomography (CT) of the chest, 2 blood cultures
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