A 5-day-old male newborn is brought to the physician by his mother because of yellowish discoloration of the skin for 1 day. The discoloration first appeared on his face and then spread to his trunk. There have been no changes in his bowel habits or urination. He was born at 38 weeks' gestation via uncomplicated vaginal delivery. He is exclusively breastfed every 2–3 hours. Examination shows scleral icterus and jaundice of the face, chest, and abdomen. Laboratory studies show: Hemoglobin 17.6 g/dL Reticulocytes 0.3% Maternal blood group A, Rh-negative Fetal blood group 0, Rh-positive Serum Bilirubin, total 7 mg/dL Direct 0.6 mg/dL Free T4 12 μg/dL Which of the following is the most likely diagnosis?
ABiliary atresia
BDubin-Johnson syndrome
CPhysiological neonatal jaundice
DRhesus incompatibility
ECongenital hypothyroidism
A 3-week-old newborn male is brought to the physician because of increasing yellowing of his eyes and skin for 2 weeks. The mother has noticed that his stools have been paler than usual for the past week. He is exclusively formula fed, and feeds every 4 hours with a strong sucking reflex. The patient was delivered vaginally at 39 weeks' gestation to a healthy woman without any complications. Vital signs are within normal limits. He is at the 50th percentile for length and at the 65th percentile for weight. Examination shows scleral icterus and jaundice. Abdominal examination reveals a palpable liver 2 cm below the right costal margin without splenomegaly. Serum studies show: Bilirubin Total 17 mg/dL Direct 13.3 mg/dL Alkaline phosphatase 1700 U/L AST 53 U/L ALT 45 U/L γ-Glutamyl transferase 174 U/L Blood group B positive This patient is at increased risk of developing which of the following?
ADark pigmentation on liver biopsy
BHepatic encephalopathy
CKernicterus
DHepatocellular carcinoma
EEarly liver cirrhosis
A 28-year-old woman comes to the emergency department for a 1-week history of jaundice and nausea. She recalls eating some seafood last weekend at a cookout. She lives at home with her 2-year-old son who attends a daycare center. The child's immunizations are up-to-date, and his last hepatitis A vaccine was administered 6 weeks ago. The woman's temperature is 37.5°C (99.5°F), pulse is 82/min, and blood pressure is 134/84 mm Hg. Examination shows scleral icterus. The liver is palpated 2-cm below the right costal margin and is tender. Her serum studies show: Total bilirubin 3.4 mg/dL Alkaline phosphatase 89 U/L AST 185 U/L ALT 723 U/L Hepatitis A IgM antibody positive Hepatitis B surface antibody positive Hepatitis B surface antigen negative Hepatitis B core IgM antibody negative Hepatitis C antibody negative Which of the following health maintenance recommendations is most appropriate for the child at this time?
AIsolate the child
BAdminister hepatitis B immunoglobulin and hepatitis B vaccine
CNo additional steps are needed
DAdminister hepatitis B immunoglobulin only
EAdminister hepatitis A vaccine and hepatitis A immunoglobulin
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