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A 19-year-old college student comes to the clinic "to get some acne medication." He tells you that he has been using over-the-counter lotions with salicylic acid that have not been effective. He has a few open and closed comedones on his cheeks, chin, and forehead. After prescribing an appropriate therapy you look in his chart and notice that his immunization history is blank. You ask about previous immunizations and he tells you that he is up-to-date with his measles mumps rubella, tetanus, diphtheria, and polio vaccines. He remembers that he and his sister had the chicken pox virus when he was 7 years of age. He is generally very healthy, participates on the college wrestling team, and is pledging a fraternity. He admits that he drinks "quite a bit of alcohol" at fraternity "hazing events." He does not have a steady girlfriend, but is sexually active with a "few different girls." At this time you should A. do nothing
B. order liver function tests
C. order serologic testing for varicella-zoster virus
D. recommend the hepatitis B virus vaccine
E. send HIV serologic testing
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glory waiting gor ur answer.although hi is also imp here.he is acive wid other girls but further status is not mentioned here whether he uses condoms or not so i am going for d.whats the answer
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Explanation: The correct answer is D. The hepatitis B virus vaccine is recommended for all sexually active adolescents and college students. It is necessary to check vaccination histories on all college students to try to protect against vaccine-preventable diseases. Multiple sexual partners, injection drug use, and any other activities with exposures to blood or bodily fluids increase the risk of hepatitis B virus.Since he is sexually active with multiple partners, he should be given the hepatitis B vaccine and should be offered HIV counseling and testing. It is inappropriate to do nothing (choice A).Even though he admits to drinking a lot of alcohol, there is no indication to order liver function tests (choice B). Heavy drinking in an asymptomatic individual does not warrant any investigation.Since he remembers having the chicken pox virus at age 7, there is no reason to doubt his history and to order serologic testing for varicella-zoster virus (choice C). If he does not recall if he had the virus, serologic testing is indicated, and if seronegative, he should be immunized. HIV counseling and testing should be offered to sexually active adolescents and college students. However, consent must be obtained before testing and therefore sending HIV serologic testing (choice E) without first obtaining consent is incorrect.
