A 34-year-old woman comes to the office with recent onset of malaise. The patient reports feeling "run down and under the weather" but otherwise has no symptoms. She is an avid cyclist and is concerned about her ability to participate in a charity race in 3 days. The patient works as a nurse at a local hospital and lives at home with her husband and 2-year-old son. She occasionally smokes when she goes out, but since she began feeling ill, she no longer has the desire to smoke. Physical examination is notable for hepatomegaly. Laboratory results are as follows: Which of the following is most likely to be elicited on further history taking?

Question

A 34-year-old woman comes to the office with recent onset of malaise.  The patient reports feeling "run down and under the weather" but otherwise has no symptoms.  She is an avid cyclist and is concerned about her ability to participate in a charity race in 3 days.  The patient works as a nurse at a local hospital and lives at home with her husband and 2-year-old son.  She occasionally smokes when she goes out, but since she began feeling ill, she no longer has the desire to smoke.  Physical examination is notable for hepatomegaly.  Laboratory results are as follows:  Which of the following is most likely to be elicited on further history taking?

Quizplus · Accepted Answer

Hepatitis A infection is caused by an RNA picornavirus with an average incubation period of 30 days. Transmission occurs through the fecal-oral route and is common in areas with overcrowding and poor sanitation. Outbreaks frequently result from contaminated water or food, with raw or steamed shellfish being the typical (and classically tested) culprit in the United States. Onset is acute, and symptoms can include malaise, fatigue, anorexia, nausea, vomiting, mild abdominal pain, and an aversion to smoking (for unclear reasons). Hepatomegaly is commonly seen. Serum aminotransferases spike early in the illness, followed by increases in bilirubin and alkaline phosphatase. Anti-HAV IgM is positive and is a marker of active disease. Hepatitis A infection is a self-limiting disease and does not progress to chronic hepatitis, cirrhosis, or hepatocellular carcinoma. Treatment is largely supportive, with complete recovery expected in 3-6 weeks. People considered at high risk (eg, those living in or traveling to endemic areas, those with chronic liver disease or clotting factor disorders, men who have sex with men) should be given the hepatitis A vaccine as prophylaxis. Unvaccinated close contacts of individuals with hepatitis A should receive the vaccine or immune globulin. (Choices A, B, and E) Unsanitary tattooing (eg, with contaminated needles), accidental needlesticks, and unprotected sexual intercourse are important risk factors for hepatitis B and C. This patient is positive for HBsAb, which confirms that she has antibodies to hepatitis B surface antigen and, given the negative anti-HBc, suggests that she has been vaccinated and is now immune. (Choice C) The consumption of boiled eggs is not commonly associated with hepatitis A infection. If the boiled eggs were insufficiently cooked, Salmonella infection would be a risk. Educational objective: Transmission of the hepatitis A virus occurs through the fecal-oral route and is common in areas with overcrowding and poor sanitation. Outbreaks frequently result from contaminated water or food, and raw or steamed shellfish is a common culprit in the United States. __________ References: Risk assessment in shellfish-borne outbreaks of hepatitis A. (http://www.ncbi.nlm.nih.gov/pubmed/19820160)

A 34-Year-Old Woman Comes to the Office with Recent Onset