Internal-Medicine

86 4: Gastroenterology
39. A couple returns from a trip to Central America
and develops nonspecific abdominal symptoms
followed by clinical jaundice. They stayed
at a resort, and ate fresh fruits and salads.
Serology for hepatitis virus spread by the fecaloral
route is positive. (SELECT TWO)
40. A 23-year old sex trade worker develops acuteonset
jaundice and seeks medical attention.
There is no history of intravenous drug use or
travel. On examination, she is icteric, there is no
lymphadenopathy, and the heart and lungs are
normal. Her liver span is 14 cm and the liver
edge is smooth but tender. Her pelvic examination
is normal. Serology for viral hepatitis
transmitted via the sexual route is positive.
(SELECT TWO)
41. A 34-year-old man is seen for asymptomatic
elevations in his AST and ALT. He appears well
and the physical examination is normal. There
is no prior history of intravenous drug use,
blood transfusions, or multiple sex partners.
His hepatitis serology is positive for the virus,
most likely to lead to chronic infection.
(SELECT ONE)
42. A 45-year-old woman is evaluated for chronic
elevations in her liver enzymes (AST and ALT).
She feels well and her physical examination is
normal. Nonviral etiologies, such as medications
and autoimmune conditions, are ruled
out. Her serology is positive for the hepatitis
virus that can respond to specific antiviral therapy.
(SELECT TWO)
43. A 24-year-old woman is pregnant with her first
baby at 14 weeks. She feels well and the pregnancy
is noncomplicated. Routine screening is
positive for chronic viral hepatitis for which
perinatal transmission is of major epidemiologic
significance. (SELECT ONE)
44. A 38-year-old woman is worried about a recent
potential exposure to an individual with active
viral hepatitis. She is seeking treatment for viral
hepatitis for which passive immunotherapy
can provide some protection. (SELECT TWO)
45. A 28-year-old man, who emigrated from
North Africa, is evaluated for chronic elevations
in liver enzymes (AST and ALT). He has
no symptoms of acute hepatitis, and his physical
examination is normal with no characteristics
of chronic liver disease. His hepatitis
serology is positive for a virus that requires
presence of another infectious agent before
becoming clinically apparent. (SELECT ONE)
DIRECTIONS (Questions 46 through 71): Each of
the numbered items or incomplete statements in
this section is followed by answers or by completions
of the statement. Select the ONE lettered
answer or completion that is BEST in each case.
46. A 53-year-old man presents to the emergency
department with severe epigastric abdominal
pain. His temperature is 37.2°C, blood pressure
110/70 mm Hg, pulse 110/min, and respirations
20/min. Examination of the heart and lungs
is normal, and his abdomen is tender in the epigastric
region. His white count is 15,000/mL
and amylase is 450 U/L (25–125 U/L). Which of
the following laboratory abnormalities is also
most likely to be present?
(A)
(B)
(C)
(D)
(E)
hypoglycemia
hypercholesterolemia
hyperglycemia
hypercalcemia
hypercarbia
47. A 43-year-old man feels vaguely unwell.
Physical examination is unremarkable except
for evidence of scleral icterus. The skin appears
normal. Which of the following is the most
likely explanation for why early jaundice is visible
in the eyes but not the skin?
(A)
(B)
(C)
(D)
(E)
the high type II collagen content of
scleral tissue
the high elastin content of scleral tissue
the high blood flow to the head with
consequent increased bilirubin delivery
secretion via the lacrimal glands
the lighter color of the sclera