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+--- Thread: preventive medicine q? - gunny (/showthread.php?tid=521615)
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preventive medicine q? - gunny - ArchivalUser - 07-26-2010
A 22-year-old woman comes to the clinic complaining
of severe abdominal pain. About 10 days ago, shortly
after returning from a 2-week vacation in Mexico, she
developed fevers and diffuse, crampy, abdominal pain.
Additionally, she reports nausea, malaise, and dark
urine and that friends have commented more on her
yellow-tinged eyes than her dark tan. Given these symptoms
and recent travel history, as well as a marked
transaminitis, the patient is evaluated for a possible
viral hepatitis. A hepatitis screening panel shows:
IgM anti-HAV Positive
IgG anti-HAV Negative
Hep B surface Ag Negative
Hep B surface Ab Positive
IgG anti-Hep C Negative
The patient is treated symptomatically, and symptomatically
improves over the course of a month. By 3
months, her liver enzymes have normalized. Which of
the following is an additional step in the management
of this patient?
(A) Hepatitis A vaccination
(B) Hepatitis B vaccination
© Liver biopsy for evaluation of long-term sequela
(D) Reporting the case to public health officials
(E) Right upper quadrant ultrasound and alphafetoprotein level.
0 - ArchivalUser - 07-26-2010
A,
0 - ArchivalUser - 07-26-2010
not A.
0 - ArchivalUser - 07-26-2010
hep B vaccination....pt already have hep A...needs Hep B vaccination.
0 - ArchivalUser - 07-26-2010
oh yeah, i can't concenterate, i don't know why? LOL... i give up today. I should stop study..
0 - ArchivalUser - 07-26-2010
patient is immune to hep b already she doesnt need it
0 - ArchivalUser - 07-26-2010
hmmmmmmmm,patient have already antibodies to hep b.try again guys.
0 - ArchivalUser - 07-26-2010
The correct answer is D. In all states, hepatitis A is a
reportable illness. Given the ease of transmission, and
that most patients can transmit the disease to family
members, public health officials need to be notified
sooner rather than later.
This patient should have immunity to hepatitis A, and
does not appear to have risk factors for recurrent infection
in any case. In most patients, IgM levels are
detectable 5 to 10 days before symptoms, with IgG levels
rising later in the course of the infection.Hepatitis A
vaccination (choice A) is not necessary. Similarly, inasmuch
as this patient already has hepatitis B antibodies,
hep B vaccination (choice B) is not necessary.
Liver biopsy (choice C) is inappropriate because hepatitis
A, unlike B and C, does not cause chronic disease.
Liver biopsy is used in some risk-stratification algorithms
for approaching the diagnosis and treatment of
hepatitis C. In addition, some physicians use a right
upper quadrant ultrasound and measure alpha-fetoprotein
levels (choice E). Again, given the natural course of
hepatitis A, this degree of testing is inappropriate
0 - ArchivalUser - 07-26-2010
@gunny
Thanks for the post. I have a question pease. Can we subsititute choice D with HEV Vacci. and still would be correct answer?
Thanks
mie82
0 - ArchivalUser - 07-26-2010
do ppl with risk of recurrent hep A req vaccine or infx result in immunity?