TABLE IV-114 Risk Factors for Active Tuberculosis Among Persons Who Have Been Infected With Tubercle Bacilli 19 page

B. Flat villi with crypt hyperplasia

C. Mononuclear cell infiltrate in the lamina propria

D. Normal small-bowel biopsy

E. PAS-positive macrophages containing small bacilli

VIII-12. A 54-year-old male presents with 1 month of diarrhea. He states that he has 8–10 loose bowel movements a day. He has lost 4 kg during this time. Vital signs and physical examination are normal. Serum laboratory studies are normal. A 24-hour stool collection reveals 500 g of stool with a measured stool osmolality of 200 mosmol/L and a calculated stool osmolality of 210 mosmol/L. Based on these findings, what is the most likely cause of this patient’s diarrhea?

A. Celiac sprue

B. Chronic pancreatitis

C. Lactase deficiency

D. Vasoactive intestinal peptide tumor

E. Whipple’s disease

VIII-13. Cobalamin absorption may occur in all of the following diseases EXCEPT:

A. Bacterial overgrowth syndrome

B. Chronic pancreatitis

C. Crohn’s disease

D. Pernicious anemia

E. Ulcerative colitis

VIII-14. Which of the following statements regarding the epidemiology of inflammatory bowel disease is correct?

A. Monozygotic twins are highly concordant for ulcerative colitis.

B. Oral contraceptive use decreases the incidence of Crohn’s disease.

C. Persons of Asian descent have the highest rates of ulcerative colitis and Crohn’s disease.

D. Smoking may decrease the incidence of ulcerative colitis.

E. Typical age of onset for Crohn’s disease is 40–50 years old.

VIII-15. A 24-year-old woman is admitted to the hospital with a 1-year history of severe abdominal pain and chronic diarrhea, which has been bloody for the past 2 months. She reports a 20-lb weight loss, frequent fevers, and night sweats. She denies vomiting. Her abdominal pain is crampy and primarily involves her right lower quadrant. She is otherwise healthy. Examination is concerning for an acute abdomen with rebound and guarding present. CT shows free air in the peritoneum. She is urgently taken to the operating room for surgical exploration, where she is found to have multiple strictures and a perforation of her bowel in the terminal ileum. The rectum was spared and a fissure from the duodenum to the jejunum is found. The perforated area is resected and adhesions lysed. Which of the following findings on pathology of her resected area confirms her diagnosis?

A. Crypt abscesses

B. Flat villi

C. Noncaseating granuloma throughout the bowel wall

D. Special stain for Clostridium difficile toxin

E. Transmural acute and chronic inflammation

VIII-16. A 45-year-old man with ulcerative colitis has been treated for the past 5 years with infliximab with excellent resolution of his bowel symptoms and endoscopic evidence of normal colonic mucosa. He is otherwise healthy. He is evaluated by a dermatologist for a lesion that initially was a pustule over his right lower extremity but has since progressed in size with ulceration. The ulcer is moderately painful. He does not recall any trauma to the area. On examination the ulcer measures 15 cm by 7 cm and central necrosis is present. The edges of the ulcer are violaceous. No other lesions are identified. Which of the following is the most likely diagnosis?

A. Erythema nodosum

B. Metastatic Crohn’s disease

C. Psoriasis

D. Pyoderma gangrenosum

E. Pyoderma vegetans

VIII-17. Inflammatory bowel disease (IBD) may be caused by exogenous factors. Gastrointestinal flora may promote an inflammatory response or may inhibit inflammation. Probiotics have been used to treat IBD. Which of the following organisms has been used in the treatment of IBD?

A. Campylobacter spp.

B. Clostridium difficile

C. Escherichia spp.

D. Lactobacillus spp.

E. Shigella spp.

VIII-18. Your 33-year-old patient with Crohn’s disease (CD) has had a disappointing disease response to glucocorticoids and 5-ASA agents. He is interested in steroid-sparing agents. He has no liver or renal disease. You prescribe once-weekly methotrexate injections. In addition to monitoring hepatic function and complete blood count, what other complication of methotrexate therapy do you advise the patient of?

A. Disseminated histoplasmosis

B. Lymphoma

C. Pancreatitis

D. Pneumonitis

E. Primary sclerosing cholangitis

VIII-19. Which of the following patients requires no further testing before making the diagnosis of irritable bowel syndrome and initiating treatment?

A. A 76-year-old woman with 6 months of intermittent crampy abdominal pain that is worse with
stress and associated with bloating and diarrhea.

B. A 25-year-old woman with 6 months of abdominal pain, bloating, and diarrhea that has
worsened steadily and now awakes her from sleep at night to move her bowels.

C. A 30-year-old man with 6 months of lower abdominal crampy pain relieved with bowel
movements, usually loose. Symptoms are worse during the daytime at work and better on the
weekend. Weight loss is not present.

D. A 19-year-old female college student with 2 months of diarrhea and worsening abdominal pain
with occasional blood in her stool.

E. A 27-year-old woman with 6 months of intermittent abdominal pain, bloating, and diarrhea
without associated weight loss. Crampy pain and diarrhea persist after a 48-hour fast.

VIII-20. A 29-year-old woman comes to see you in the clinic because of abdominal discomfort. She feels abdominal discomfort on most days of the week, and the pain varies in location and intensity. She notes constipation as well as diarrhea, but diarrhea predominates. In comparison to 6 months ago, she has more bloating and flatulence than she has had before. She identifies eating and stress as aggravating factors, and her pain is relieved by defecation. You suspect irritable bowel syndrome (IBS). Laboratory data include white blood cell (WBC) count 8000/μL, hematocrit 32%, platelets 210,000/μL, and erythrocyte sedimentation rate (ESR) of 44 mm/h. Stool studies show the presence of lactoferrin but no blood. Which intervention is appropriate at this time?

A. Antidepressants

B. Ciprofloxacin

C. Colonoscopy

D. Reassurance and patient counseling

E. Stool bulking agents

VIII-21. After a careful history and physical, and a cost-effective workup, you have diagnosed a 24-year-old female patient with irritable bowel syndrome. What other condition would you reasonably expect to find in this patient?

A. Abnormal brain anatomy

B. Autoimmune disease

C. History of sexually transmitted diseases

D. Psychiatric diagnosis

E. Sensory hypersensitivity to peripheral stimuli

VIII-22. A 78-year-old woman is admitted to the hospital with fever, loss of appetite, and left lower quadrant pain. She is not constipated, but has not moved her bowels recently. Laboratory examination is notable for an elevated WBC count. These symptoms began approximately 3 days ago and have steadily worsened. Which of the following statements regarding the use of radiologic imaging to evaluate her condition is true?

A. Air-fluid levels are commonly seen on plain abdominal films.

B. Barium enema should not be performed because of the risk of perforation.

C. Lower gastrointestinal bleeding will likely be visualized on CT angiography.

D. A thickened colonic wall is not required on CT for the diagnosis of her likely condition.

E. Ultrasound of the pelvis is the best modality to visualize the likely pathologic process.

VIII-23. Which of the following patients is MOST appropriate for surgical management of their acute diverticulitis?

A. A 45-year-old woman with rheumatoid arthritis treated with infliximab and prednisone.

B. A 63-year-old woman with diverticulitis in the descending colon and a distal stricture.

C. A 70-year-old woman with end-stage renal disease with colonic wall thickening of 8 mm on CT
scan.

D. A 77-year-old man with two episodes of diverticulitis in the past 2 years.

E. None of the above patients requires surgical management.

VIII-24. A 67-year-old man is evaluated in the emergency department for blood in the toilet bowl after moving his bowels. Blood was also present on the toilet paper after wiping. He reports straining and recent constipation. He has a history of systemic hypertension and hyperlipidemia. Vital signs are normal and he is not orthostatic. Anoscopy shows external hemorrhoids. Hematocrit is normal and bleeding does not recur during his 6-hour emergency department stay. Which of the following is the most appropriate management?

A. Ciprofloxacin and metronidazole

B. Cortisone suppositories, fiber supplementation

C. Hemorrhoidal banding

D. Operative hemorrhoidectomy

E. Upper endoscopy

VIII-25. Which of the following statements regarding anorectal abscess is true?

A. Anorectal abscess is more common in diabetic patients.

B. Anorectal abscess is more common in women.

C. Difficulty voiding is uncommon and should prompt further evaluation of anorectal abscess.

D. Examination in the operating room under anesthesia is required for adequate exploration in most
cases.

E. The peak incidence is the seventh decade of life.

VIII-26. An 88-year-old woman is brought to your clinic by her family because she has become increasingly socially withdrawn. The patient lives alone and has been reluctant to visit or be visited by her family. Family members, including seven children, also note a foul odor in her apartment and on her person. She has not had any weight loss. Alone in the examining room, she only complains of hemorrhoids. On mental status examination, she has signs of depression. Which of the following interventions is most appropriate at this time?

A. Head CT scan

B. Initiate treatment with an antidepressant medication

C. Physical examination including genitourinary and rectal examination

D. Screening for occult malignancy

E. Serum thyroid-stimulating hormone

VIII-27. A 37-year-old woman presents with abdominal pain, anorexia, and fever of 4 days’ duration. The abdominal pain is mostly in the left lower quadrant. Her past medical history is significant for irritable bowel syndrome, diverticulitis treated 6 months ago, and status post-appendectomy. Since her last bout of diverticulitis she has increased her fiber intake and avoids nuts and popcorn. Review of systems is positive for weight loss, daily chills and sweats, and “bubbles” in her urinary stream. Her temperature is 39.6°C. A limited CT scan shows thickened colonic wall (5 mm) and inflammation with pericolic fat stranding. She is admitted with a presumptive diagnosis of diverticulitis. What is the most appropriate management for this patient?

A. A trial of rifaximin and a high-fiber diet

B. Bowel rest, ciprofloxacin, metronidazole, and ampicillin

C. Examination of the urine sediment

D. Measurement of 24-hour urine protein

E. Surgical removal of the affected colon and exploration

VIII-28. An 85-year-old woman is brought to a local emergency department by her family. She has been complaining of abdominal pain off and on for several days, but this morning states that this is the worst pain of her life. She is able to describe a sharp, stabbing pain in her abdomen. Her family reports that she has not been eating and seems to have no appetite. She has a past medical history of atrial fibrillation and hypercholesterolemia. She has had two episodes of vomiting and in the ER experiences diarrhea that is hemoc-cult positive. On examination she is afebrile, with a heart rate of 105 beats/min and blood pressure of 111/69 mmHg. Her abdomen is mildly distended and she has hypoactive bowel sounds. She does not exhibit rebound tenderness or guarding. She is admitted for further management. Several hours after admission she becomes unresponsive. Blood pressure is difficult to obtain and at best approximation is 60/40 mmHg. She has a rigid abdomen. Surgery is called and the patient is taken for emergent laparotomy. She is found to have acute mesenteric ischemia. Which of the following is true regarding this diagnosis?

A. Mortality for this condition is greater than 50%.

B. Risk factors include low-fiber diet and obesity.

C. The “gold standard” for diagnosis is CT scan of the abdomen.

D. The lack of acute abdominal signs in this case is unusual for mesenteric ischemia.

E. The splanchnic circulation is poorly collateralized.

VIII-29. All of the following are potential causes of appendix obstruction and appendicitis EXCEPT:

A. Ascaris infection

B. Carcinoid tumor

C. Cholelithiasis

D. Fecalith

E. Measles infection

VIII-30. Which of the following organisms is most likely to be causative in acute appendicitis?

A. Clostridium species

B. Escherichia coli

C. Mycobacterium tuberculosis

D. Staphylococcus aureus

E. Yersinia enterocolitica

VIII-31. A 32-year-old woman is evaluated in the emergency department for abdominal pain. She reports a vague loss of appetite for the past day and has had progressively severe abdominal pain, initially at her umbilicus, but now localized to her right lower quadrant. The pain is crampy. She has not moved her bowels or vomited. She reports that she is otherwise healthy and has had no sick contact. Exam is notable for a temperature of 100.7°F, heart rate of 105 beats/min, and otherwise normal vital signs. Her abdomen is tender in the right lower quadrant and pelvic examination is normal. Urine pregnancy test is negative. Which of the following imaging modalities is most likely to confirm her diagnosis?

A. CT of the abdomen without contrast

B. Colonoscopy

C. Pelvic ultrasound

D. Plain film of the abdomen

E. Ultrasound of the abdomen

VIII-32. A 38-year-old male is seen in the urgent care center with several hours of severe abdominal pain. His symptoms began suddenly, but he reports several months of pain in the epigastrium after eating, with a resultant 10-lb weight loss. He takes no medications besides over-the-counter antacids and has no other medical problems or habits. On physical examination temperature is 38.0°C (100.4°F), pulse 130 beats/min, respiratory rate 24 breaths/min, and blood pressure 110/50 mmHg. His abdomen has absent bowel sounds and is rigid with involuntary guarding diffusely. A plain film of the abdomen is obtained and shows free air under the diaphragm. Which of the following is most likely to be found in the operating room?

A. Necrotic bowel

B. Necrotic pancreas

C. Perforated duodenal ulcer

D. Perforated gallbladder

E. Perforated gastric ulcer

VIII-33. Which of the following is the source of the peritonitis of the patient in question VIII-32?

A. Bile

B. Blood

C. Foreign body

D. Gastric contents

E. Pancreatic enzymes

VIII-34. Which of the following is the most common symptom or sign of liver disease? A. Fatigue

B. Itching

C. Jaundice

D. Nausea

E. Right upper quadrant pain

VIII-35. In women, what is the average amount of reported daily alcohol intake that is associated with the development of chronic liver disease?

A. 1 drink

B. 2 drinks

C. 3 drinks

D. 6 drinks

E. 12 drinks

VIII-36. Elevations in all of the following laboratory studies would be indicative of liver disease EXCEPT:

A. 5′-nucleotidase

B. Aspartate aminotransferase

C. Conjugated bilirubin

D. Unconjugated bilirubin

E. Urine bilirubin

VIII-37. A 61-year-old male is admitted to your service for swelling of the abdomen. You detect ascites on clinical examination and perform a paracentesis. The results show a white blood cell count of 300 leukocytes/μL with 35% polymorphonuclear cells. The peritoneal albumin level is 1.2 g/dL, protein is 2.0 g/dL, and triglycerides are 320 mg/dL. Peritoneal cultures are pending. Serum albumin is 2.6 g/dL. Which of the following is the most likely diagnosis?

A. Congestive heart failure

B. Peritoneal tuberculosis

C. Peritoneal carcinomatosis

D. Chylous ascites

E. Bacterial peritonitis

VIII-38. A 26-year-old male resident is noticed by his attending physician to have yellow eyes after his 24-hour call period. When asked, the resident states he has no medical history, but on occasion he has thought he might have mild jaundice when he is stressed or has more than 4–5 alcoholic drinks. He never sought medical treatment because he was uncertain, and his eyes would return fully to normal within 2 days. He denies nausea, abdominal pain, dark urine, light-colored stools, pruritus, or weight loss. On examination he has a body mass index of 20.1 kg/m², and his vital signs are normal. Scleral icterus is present. There are no stigmata of chronic liver disease. The patient’s abdomen is soft and nontender. The liver span is 8 cm to percussion. The liver edge is smooth and palpable only with deep inspiration. The spleen is not palpable. Laboratory examinations are normal except for a total bilirubin of 3.0 mg/dL. Direct bilirubin is 0.2 mg/dL. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase are normal. Hematocrit, lac-tate dehydrogenase

(LDH), and haptoglobin are normal. Which of the following is the most likely diagnosis?

A. Autoimmune hemolytic anemia

B. Crigler-Najjar syndrome type 1

C. Choledocholithiasis

D. Dubin-Johnson syndrome

E. Gilbert’s syndrome

VIII-39. What is the next step in the evaluation and management of the patient in question VIII-38?

A. Genotype studies

B. Peripheral blood smear

C. Prednisone

D. Reassurance

E. Right upper quadrant ultrasound

VIII-40. A 34-year-old man presents to the physician complaining of yellow eyes. For the past week, he has felt ill with decreased oral intake, low-grade fevers (~100°F), fatigue, nausea, and occasional vomiting. With the onset of jaundice, he has noticed pain in his right upper quadrant. He currently uses marijuana and ecstasy, and has a prior history of injection drug use with cocaine. He has no other past medical history, but he was unable to donate blood 4 years previously for reasons that he cannot recall. His social history is remarkable for working as a veterinary assistant. On sexual history, he reports five male sexual partners over the past 6 months. He does not consistently use condoms. On physical examination, he appears ill and has obvious jaundice with scleral icterus. His liver is 15 cm to percussion and is palpable 6 cm below the right costal margin. The edge is smooth and tender to palpation. The spleen is not enlarged. There are no stigmata of chronic liver disease. His AST is 1232 U/L, A LT is 1560 U/L, alkaline phosphatase is 394 U/L, total bilirubin is 13.4 mg/dL, and direct bilirubin is 12.2 mg/dL. His INR is 2.3, and aPTT is 52 seconds. Hepatitis serologies are sent and reveal the following:

Hepatitis A IgM negative Hepatitis A IgG negative Hepatitis B core IgM positive Hepatitis B core IgG negative Hepatitis B surface antigen positive Hepatitis B surface antibody negative Hepatitis B e antigen positive Hepatitis B e antibody negative Hepatitis C antibody positive

What is the cause of the patient’s current clinical presentation?

A. Acute hepatitis A infection

B. Acute hepatitis B infection

C. Acute hepatitis C infection

D. Chronic hepatitis B infection

E. Drug-induced hepatitis

VIII-41. In the scenario described in question VIII-40, what would be the best approach to prevent development of chronic hepatitis?

A. Administration of anti-hepatitis A virus IgG.

B. Administration of lamivudine.

C. Administration of pegylated interferon α plus ribavirin.

D. Administration of prednisone beginning at a dose of 1 mg/kg daily.

E. Do nothing and observe, as 99% of individuals with this disease recover.

VIII-42. Which of the following viral causes of acute hepatitis is most likely to cause fulminant hepatitis in a pregnant woman?

A. Hepatitis A

B. Hepatitis B

C. Hepatitis C

D. Hepatitis D

E. Hepatitis E

VIII-43. A 16-year-old woman had visited your clinic 1 month ago with jaundice, vomiting, malaise, and anorexia. Two other family members were ill with similar symptoms. Based on viral serologies, including a positive anti-hepatitis A virus (HAV) IgM, a diagnosis of hepatitis A was made. The patient was treated conservatively, and 1 week after first presenting, she appeared to have made a full recovery. She returns to your clinic today complaining of the same symptoms she had 1 month ago. She is jaundiced, and an initial panel of laboratory tests returns elevated transaminases. Which of the following offers the best explanation of what has occurred in this patient?

A. Coinfection with hepatitis C

B. Inappropriate treatment of initial infection

C. Incorrect initial diagnosis; this patient likely has hepatitis B

D. Reinfection with hepatitis A

E. Relapse of hepatitis A

VIII-44. A 26-year-old woman presents to your clinic and is interested in getting pregnant. She seeks your advice regarding vaccines she should obtain, and in particular asks about the hepatitis B vaccine. She works as a receptionist for a local business, denies alcohol or illicit drug use, and is in a monogamous relationship. Which of the following is true regarding hepatitis B vaccination?

A. Hepatitis B vaccine consists of two IM doses 1 month apart.

B. Only patients with defined risk factors need to be vaccinated.

C. Pregnancy is not a contraindication to the hepatitis B vaccine.

D. This patient’s hepatitis serologies should be checked before vaccination.

E. Vaccination should not be administered to children under 2 years old.

VIII-45. An 18-year-old man presents to a rural clinic with nausea, vomiting, anorexia, abdominal discomfort, myalgias, and jaundice. He describes occasional alcohol use and is sexually active. He describes using heroin and cocaine “a few times in the past.” He works as a short-order cook in a local restaurant. He has lost 15.5 kg since his last visit to the clinic and appears emaciated and ill. On examination he is noted to have icteric sclerae and a palpable, tender liver below the right costal margin. In regard to acute hepatitis, which of the following is true?

A. A distinction between viral etiologies cannot be made using clinical criteria alone.

B. Based on age and risk factors, he is likely to have hepatitis B infection.

C. He does not have hepatitis E virus, as this infects only pregnant women.

D. This patient cannot have hepatitis C because his presentation is too acute.

E. This patient does not have hepatitis A because his presentation is too fulminant.

VIII-46. A 36-year-old male presents with fatigue and tea-colored urine for 5 days. Physical examination reveals jaundice and tender hepatomegaly, but is otherwise unremarkable. Laboratories are remarkable for an aspartate aminotransferase (AST) of 2400 U/L and an alanine aminotransferase (ALT) of 2640 U/L. Alkaline phosphatase is 210 U/L. Total bilirubin is 8.6 mg/dL. Which of the following diagnoses is least likely to cause this clinical picture and these laboratory abnormalities?

A. Acute hepatitis A infection

B. Acute hepatitis B infection

C. Acute hepatitis C infection

D. Acetaminophen ingestion

E. Budd-Chiari syndrome

VIII-47. Which of the following drugs has a direct toxic effect on hepatocytes?

A. Acetaminophen

B. Chlorpromazine

C. Halothane

D. Isoniazid

E. Rosuvastatin

VIII-48. A 32-year-old woman is admitted to the intensive care unit following an overdose of acetaminophen with coingestion of alcohol. She was known to be alert and interactive about 4 hours before her presentation when she had a fight with her boyfriend who then left the home. When he returned 6 hours later, he found an empty bottle of acetaminophen 500 mg capsules as well as an empty vodka bottle. The exact number of pills in the bottle is unknown but the full bottle held as much as 50 capsules. The patient was unresponsive and had vomited, so her boyfriend called 911. Upon arrival to the emergency department, the patient is stuporous. Her vital signs are as follows: pulse 109 beats/min, respiratory rate 20 breaths/min, blood pressure 96/52 mmHg, and oxygen saturation 95% on room air. Her examination shows mild nonspecific abdominal pain with palpation. The liver is not enlarged. Her initial laboratory values show a normal CBC, and normal electrolytes and kidney function. The AST is 68 U/L, A LT is 46 U/L, alkaline phosphatase is 110 U/L, and total bilirubin is 1.2 mg/dL. Glucose and coagulation studies are normal. The serum alcohol level is 210 g/dL. The acetaminophen level is 350 μg/mL. What is the most appropriate next step in the treatment of this patient?

A. Administration of activated charcoal or cholestyramine.

B. Administration of N-acetylcysteine 140 mg/kg followed by 70 mg/kg every 4 hours for a total of
15–20 doses.

C. Continued monitoring of liver function, glucose, and coagulation studies every 4 hours with
administration of N-acetylcysteine if these begin to change.

D. Do nothing as normal liver function tests and coagulation studies are indicative of only a minor
ingestion.

E. Initiate hemodialysis for toxin clearance.

VIII-49. A 38-year-old woman is evaluated for elevated transaminase levels that were identified during routine laboratory testing for life insurance. She is originally from Thailand and immigrated to the United States 10 years previously. She has been married to an American for the past 12 years, having met him while he was living abroad for business. She previously worked in Thailand as a deputy tourism minister for the government, but is not currently employed. She has no significant past medical history. She had one uncomplicated pregnancy at the age of 22. When queried about risk factors for liver disease, she denies alcohol intake or drug abuse. She has never had a blood transfusion. She recalls an episode of jaundice that she did not seek evaluation for about 15 years ago. It resolved spontaneously. She currently feels well, and her husband wished to have her added to his life insurance policy. There are no stigmata of chronic liver disease. Her laboratory studies reveal an AST of 346 U/L, A LT of 412 U/L, alkaline phosphatase of 98 U/L, and total bilirubin of 1.5 mg/dL. Further workup includes the following viral studies: hepatitis A IgG +, hepatitis B surface antigen +, hepatitis B e antigen +, anti-HBV core IgG +, and hepatitis C IgG negative. The HBV DNA level is 4.8 × 10⁴ IU/mL. What treatment do you recommend for this patient?

A. Entecavir.

B. Pegylated interferon.

C. Pegylated interferon plus entecavir.

D. No treatment is necessary.

E. Either A or C.

VIII-50. A 46-year-old man is known to have chronic hepatitis C virus (HCV) infection. He is a former IV drug user for more than 20 years who has been abstinent from drug use for 1 year. He is asking whether he should receive treatment for his HCV infection. He has a prior history of hepatitis B virus (HBV) and has positive antibody to HBV surface antigen. He was treated for tricuspid valve endocarditis 3 years previously. He has no other medical history. He does not know when he acquired HCV. His laboratory studies show a positive HCV IgG antibody with a viral load of greater than 1 million copies. The virus is genotype 1. His AST is 62 U/L, and his ALT is 54 U/L. He undergoes liver biopsy, which demonstrates a moderate degree of bridging fibrosis. What do you tell him regarding his likelihood of progression and possibilities regarding treatment?

A. As he is infected with genotype 1, the likelihood of response to pegylated interferon and
ribavirin is less than 40%.

B. Following 12 weeks of treatment, the expected viral load should be undetectable.

C. Given his normal liver enzymes on laboratory testing, he is unlikely to develop progressive liver
injury.

D. If the patient elects to undergo treatment, the best regimen for individuals with genotype 1
disease is pegylated interferon and ribavirin for 24 weeks.

E. The presence of bridging fibrosis on liver biopsy is the most predictive factor of the
development of cirrhosis over the next 10–20 years.

VIII-51. A 34-year-old woman is evaluated for fatigue, malaise, arthralgias, and a 10-lb weight loss over the past 6–8 weeks. She has no past medical history. Since feeling poorly, she has taken approximately one or two tablets of acetaminophen 500 mg daily. On physical examination, her temperature is 100.2°F, respiratory rate is 18 breaths/min, blood pressure is 100/48 mmHg, heart rate is 92 beats/min, and oxygen saturation is 96% on room air. She has scleral icterus. Her liver edge is palpable 3 cm below the right costal margin. It is smooth and tender. The spleen is not enlarged. She has mild synovitis in the small joints of her hands. Her AST is 542 U/L, A LT is 657 U/L, alkaline phosphatase is 102 U/L, total bilirubin is 5.3 mg/dL, and direct bilirubin is 4.8 mg/dL. Which of the following tests would be LEAST likely to be positive in this diagnosis?

Date: 2016-04-22; view: 791