Bedside Diagnostic Challenge – 37-year-old woman with fever

Paul Griner, MD, MACPBedside Diagnostic Challenge, Internal Medicine, Medical News

Bedside Diagnostic Skills Challenge on chest pain

Today’s Bedside Diagnostic Challenge question comes from the desk of Med-Challenger Internal Medicine Editor-in-Chief, Paul F. Griner, MD, MACP.

Test your bedside diagnostic skills with this review question.


A 37-year-old woman presents to a local hospital with the complaint of a high fever. She is visiting from another state and has not been ill until the onset of cough and fever 10 days ago. Temperature values have been as high as 104° F. She also complains of headache, an episode of diarrhea followed by constipation, vague abdominal pain, and a dry cough. She denies any other accompanying symptoms. Her only medication is a beta blocker, which she was prescribed for hypertension a week before the onset of fever.

Physical examination reveals a patient of normal body habitus. Her temperature is 104.5° F, pulse is 72 and regular, blood pressure is 116/70 in both arms and respirations are 16 per minute. The skin reveals a number of 2-4mm red, macular, non-tender lesions on the anterior chest and upper abdomen, in the midline. The lungs, abdomen, and extremities, including joints, appear normal.

A chest x-ray is normal; laboratory tests are pending.


Based on the diagnostic value of careful listening and looking …

Which of the following diagnoses, characterized by dissociation between pulse rate and temperature, is most likely in this patient?

Answer Options:

Legionella pneumonia

Typhoid fever

Adverse drug reaction

Factitious fever

Answer Explanation & References:

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About Bedside Diagnostic Challenge:

Except for Hospitalists, Emergency Medicine physicians, and Interventional Cardiologists, most internists will spend the bulk of their professional time with patients in an office setting.

Here is where finely tuned clinical skills are most important in leading to accurate diagnoses, fewer complications resulting from unnecessary tests and procedures, and lower costs. Med Challenger Bedside Diagnostic Challenge reinforces the value of these clinical skills and tests users on their knowledge of them.

Bedside Diagnostic Challenge questions are issued periodically every month as a free content benefit of Med-Challenger.

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About the Author:

Paul Griner MD, MACP graduated from the University of Rochester School of Medicine and completed his residency at the Massachusetts General Hospital, Boston, MA. He returned to Rochester as Chief Resident in Medicine and Hematology Fellow and remained in their Department of Medicine, rising to Professor. He served as a Senior Lecturer at Harvard Medical School and consultant at the Massachusetts General Hospital where he introduced a mentoring program for the faculty of General Internal Medicine.

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