10-07-2008, 05:30 PM
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
A 58-year-old man comes to the clinic complaining of
shortness of breath. He described the dyspnea as gradual
in onset over the last few weeks. The patient denies
any pleuritic pain, cough, or orthopnea, and has no
previous cardiac or respiratory medical history. Review
of systems, however, is concerning for an unexplained
20-lb weight loss over the last few months and intermittent
fevers and night sweats. The patient does not
smoke cigarettes currently, though he has a distant 20
pack-year history. He denies using illicit substances and
only rarely drinks alcohol. He has not had any major
illnesses in the past, has had no major operations, and
is employed as an accountant. Physical examination is
remarkable for reduced breath sounds and dullness to
percussion approximately halfway up the right
hemithorax. Chest radiograph confirms a right-sided
pleural effusion and some hilar and mediastinal lymphadenopathy.
A diagnostic thoracentesis is performed
that reveals a milky-white, opalescent fluid. Laboratory
studies reveal this fluid to have a markedly elevated
triglyceride level of 558 mg/dL, a high cell count composed
mainly of T lymphocytes, and numerous chylomicrons.
Cytologic examination is unremarkable.
Which of the following is the most likely cause of this
patient™s effusion?
(A) Infection with acid-fast organisms
(B) Lymphangioleiomyomatosis (LAM)
© Non-Hodgkin lymphoma
(D) Pancreatic adenocarcinoma
(E) Undiagnosed mesothelioma
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
A 58-year-old man comes to the clinic complaining of
shortness of breath. He described the dyspnea as gradual
in onset over the last few weeks. The patient denies
any pleuritic pain, cough, or orthopnea, and has no
previous cardiac or respiratory medical history. Review
of systems, however, is concerning for an unexplained
20-lb weight loss over the last few months and intermittent
fevers and night sweats. The patient does not
smoke cigarettes currently, though he has a distant 20
pack-year history. He denies using illicit substances and
only rarely drinks alcohol. He has not had any major
illnesses in the past, has had no major operations, and
is employed as an accountant. Physical examination is
remarkable for reduced breath sounds and dullness to
percussion approximately halfway up the right
hemithorax. Chest radiograph confirms a right-sided
pleural effusion and some hilar and mediastinal lymphadenopathy.
A diagnostic thoracentesis is performed
that reveals a milky-white, opalescent fluid. Laboratory
studies reveal this fluid to have a markedly elevated
triglyceride level of 558 mg/dL, a high cell count composed
mainly of T lymphocytes, and numerous chylomicrons.
Cytologic examination is unremarkable.
Which of the following is the most likely cause of this
patient™s effusion?
(A) Infection with acid-fast organisms
(B) Lymphangioleiomyomatosis (LAM)
© Non-Hodgkin lymphoma
(D) Pancreatic adenocarcinoma
(E) Undiagnosed mesothelioma