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General Medicine · Infectious diseases
Sample itemA 22-year-old has had stepwise rising fever for 7 days, relative bradycardia, abdominal distension and a few rose spots on the trunk. Which investigation has the highest diagnostic yield at this stage?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. Blood culture
The picture is enteric fever. In the first week blood culture has the highest yield, and bone marrow culture is more sensitive still in those already on antibiotics. Stool culture becomes positive later, and a single Widal titre is unreliable.
Option by option
A. Widal test on a single sample
A single Widal titre has limited specificity and cannot reliably confirm the diagnosis.
B. Stool culture
Stool cultures are more often positive from the second or third week.
C. Urine routine examination
Routine urine examination does not identify the organism.
D. Blood culture (correct)
Correct. Salmonella Typhi is most often isolated from blood early in the illness.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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