A 34-year-old man presents with five days of fever, drenching sweats, severe headache behind the eyes and aching muscles. He started work at a rural Queensland abattoir eight weeks ago and has not travelled overseas. On examination his temperature is 39.2°C; there is no rash, no jaundice, no red eyes and no neck stiffness. Investigations show ALT 142 U/L (<40), AST 118 U/L (<45), bilirubin 14 micromol/L (<20), creatinine 78 micromol/L (60–110) and platelets 118 x 10^9/L (150–400). Which one of the following is the most likely diagnosis?
Keep going — a set of ten like this one, one at a time.
Practise moreMore from General Practice and Population Health
See allA new screening blood test for a cancer has a sensitivity of 90% and a specificity of 95%. It is proposed for use in the general population aged 50–74, in whom…
Mechanisms of disease · common
A 47-year-old woman with no personal or family history of breast cancer asks whether to continue mammographic screening. She has no breast lump or nipple change…
Clinical rotations · common
A 46-year-old man with longstanding alcohol dependence has eaten little during two weeks of vomiting. He is inattentive, walks with a broad-based gait and repea…
Clinical rotations · common
A 47-year-old Aboriginal man from a regional town has type 2 diabetes and hypertension, for which metformin, perindopril and rosuvastatin are prescribed. At rev…
Clinical rotations · middle twist
A 29-year-old woman presents with painful genital lesions that began as small blisters 3 days ago. She describes burning on urination and has bilateral tender i…
Clinical rotations · common