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 previously healthy 25-year-old woman comes to the physician because of a one-week history of diffuse abdominal pain. Her temperature is 39.1°C (102.3°F). Physical examination shows numerous scars and excoriations along both arms, scleral icterus, and tender hepatomegaly. Serum studies show: Alanine aminotransferase 927 U/L Aspartate aminotransferase 796 U/L Hepatitis B surface antigen positive Hepatitis B surface antibody negative Anti-hepatitis B core antibody positive Hepatitis C antibody negative Which of the following is the most likely outcome of this patient's infection?
AFulminant hepatitis
BAsymptomatic carrier state
CHepatocellular carcinoma
DLiver cirrhosis
ETransient infection
A 50-year-old man comes to the physician for the evaluation of recurrent episodes of chest pain, difficulty breathing, and rapid heart beating over the past two months. During this period, he has had a 4-kg (8.8-lb) weight loss, malaise, pain in both knees, and diffuse muscle pain. Five years ago, he was diagnosed with chronic hepatitis B infection and was started on tenofovir. His temperature is 38°C (100.4°F), pulse is 110/min, and blood pressure is 150/90 mm Hg. Cardiopulmonary examination shows no abnormalities except for tachycardia. There are several ulcerations around the ankle and calves bilaterally. Laboratory studies show: Hemoglobin 11 g/dL Leukocyte count 14,000/mm3 Erythrocyte sedimentation rate 80 mm/h Serum Perinuclear anti-neutrophil cytoplasmic antibodies negative Hepatitis B surface antigen positive Urine Protein +2 RBC 6-7/hpf Which of the following is the most likely diagnosis?
AGranulomatosis with polyangiitis
BGiant cell arteritis
CThromboangiitis obliterans
DPolyarteritis nodosa
ETakayasu arteritis
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