A 60-year-old rock musician presents to the office because he has been feeling increasingly tired for the past 6 months. He has a history of intravenous drug use and alcohol abuse. He states that he feels quite tired, but he otherwise has no complaints. Physical examination is noncontributory. His laboratory values are normal other than moderately elevated liver enzymes. Which of the following additional tests should you order first?
AHepatitis C virus antibodies
BHepatitis B surface antigen
CHepatitis E virus-specific IgM antibodies
DHepatitis D virus-specific IgG antibody
EHepatitis A virus-specific IgM antibodies
A 60-year-old man comes to the physician’s office with jaundice. Liver ultrasound reveals a shrunken liver and biopsy reveals cirrhosis. Hepatitis serologies are below: Anti-HAV: negative HBsAg: negative HBsAb: positive HBeAg: negative Anti-HBe: negative Anti-HBc: negative Anti-HCV: positive The hepatitis C viral load is 1,000,000 copies/mL. The patient is started on an antiviral regimen including sofosbuvir. What is the mechanism of action of this drug?
AInhibits reverse transcriptase
BInhibits integrase
CInhibits synthesis of DNA-dependent DNA polymerase
DInhibits RNA-dependent RNA polymerase
EInhibits hepatitis C protease
A 32-year-old woman comes to the physician because of a 3-month history of fatigue and myalgia. Over the past month, she has had intermittent episodes of nausea. She has a history of intravenous drug use, but she has not used illicit drugs for the past five years. She has smoked one pack of cigarettes daily for 14 years and drinks one alcoholic beverage daily. She takes no medications. Her last visit to a physician was 4 years ago. Her temperature is 37°C (98.6°F), pulse is 90/min, respirations are 20/min, and blood pressure is 110/70 mm Hg. Physical examination shows jaundice and hepatosplenomegaly. There are also blisters and erosions on the dorsum of both hands. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 12 g/dL Leukocyte count 8,300/mm3 Platelet count 250,000/mm3 Serum Glucose 170 mg/dL Albumin 3.0 g/dL Total bilirubin 2.2 mg/dL Alkaline phosphatase 80 U/L AST 92 U/L ALT 76 U/L Hepatitis B surface antigen negative Hepatitis B surface antibody positive Hepatitis B core antibody positive Hepatitis C antibody positive Which of the following is the most appropriate next step in diagnosis?
APCR for viral DNA
BWestern blot for HIV
CSerology for anti-HAV IgM
DPCR for viral RNA
ELiver biopsy
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