09-21-2014, 01:38 PM
A 14 year old girl is being seen by a neurologist bc of deterioration of school performance and behavioral changes over the past year. She also is now found to have decrease in coordination and balance and an intention tremor. Pertinent physical findings are liver edge 3cm below the right costal margin and a slit lamp. Her liver enzymes, total bilirubin and PT and PTT are all slightly elevated while her total protein and albumin are slightly decreased. The best next step in management of this patient is to:
a. Obtain a serum alpha-1-antitrypsin level
b. Obtain a serum ceruloplasmin level
c. Refer to a gastroenterologist for a liver biopsy
d. Obtain blood for ati-hepatitis C
e. Obtain a hepatobiliary ultrasound
a. Obtain a serum alpha-1-antitrypsin level
b. Obtain a serum ceruloplasmin level
c. Refer to a gastroenterologist for a liver biopsy
d. Obtain blood for ati-hepatitis C
e. Obtain a hepatobiliary ultrasound