Viral Infections USMLE Step 1 Practice Question
A 28-year-old woman presents to the emergency department 3 days after returning from travel to Southeast Asia. She reports fever (39.2°C), severe retro-orbital headache, myalgias, and arthralgias. Vital signs: HR 102/min, BP 98/64 mmHg, RR 18/min, SpO2 98% on room air. Physical examination reveals a petechial rash on the lower extremities and hepatomegaly (2 cm below costal margin). Laboratory results: platelet count 45,000/μL, AST 185 U/L, ALT 142 U/L, hemoglobin 13.2 g/dL, hematocrit 39%, PT/INR normal, aPTT normal. She denies active bleeding or abdominal pain. Which of the following is the most appropriate next step in management?
Answer choices
- AAdminister fresh frozen plasma and observe for evidence of disseminated intravascular coagulation
- BObtain a platelet transfusion threshold of 20,000/μL and establish IV access with aggressive fluid resuscitation protocolsCorrect answer
- CInitiate empiric broad-spectrum antibiotics for possible meningococcal sepsis
- DPerform an urgent abdominal ultrasound to evaluate for splenic rupture
- EStart high-dose corticosteroids to prevent progression to acute respiratory distress syndrome
- FAdminister intravenous immunoglobulin for presumed viral hemorrhagic fever
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