Rosh Internal Medicine Boost Practice Exam

A 24-year-old woman presents with sudden onset of respiratory symptoms and fever. What is the most likely diagnosis?

1. Adenovirus

2. Influenza

3. Legionella

4. Pertussis

The correct answer is: Influenza

The symptoms described—a sudden onset of respiratory symptoms accompanied by fever—are highly characteristic of influenza. Influenza typically presents with an abrupt onset of fever, chills, body aches, and respiratory symptoms like cough and sore throat. The presence of fever is particularly noteworthy, as it often accompanies viral infections, and in the case of influenza, it tends to be high and can reach levels that lead to systemic symptoms. Adenovirus, while a possible cause of respiratory illness, often presents with more varied symptoms and may not have as rapid an onset as influenza. Additionally, adenovirus frequently occurs in outbreaks, particularly in certain settings like military barracks or schools, which may not align with a single patient presentation unless there is an outbreak context. Legionella typically causes a more severe pneumonia and is associated with specific risk factors, as well as environmental exposure that is not indicated in this scenario. Therefore, it is less likely to present with sudden respiratory symptoms and fever in a previously healthy young woman. Pertussis, or whooping cough, often begins with mild respiratory symptoms that can rapidly progress, but it usually has a distinctive prolonged cough and does not generally present with sudden onset fever to the degree seen in influenza. Thus, the combination of sudden onset respiratory