American College of Physicians: Internal Medicine — Doctors for Adults ®

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The MKSAP Challenge

From the September ACP Observer, copyright 2004 by the American College of Physicians.

Clinical scenario

A 67-year-old man in previously good health is hospitalized because of a 2-day history of fever and diminished consciousness. The patient responds inconsistently to verbal commands. His temperature is 39.5 C (103.1 F); he has tachycardia, and his blood pressure is 80/58 mm Hg. There is no bleeding. His hemoglobin is 12.1 g/dL, leukocyte count is 29,000/L with 80% neutrophils, and platelet count is 20,000/L.

Which of the following studies should be obtained in this patient?

A. Bone marrow aspiration and biopsy
B. Factor VIII level
C. Measurement of platelet-associated IgG
D. Measurements of fibrin D-dimer and total fibrinogen
E. Bleeding time

Answer

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