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15 Sep 2018

32 year-old female with a history of poly-substance abuse, including IV drug use, who presented at the ER with fever, abdominal pain, nausea, vomiting, headaches and myalgia (muscle pain). She also had toothache for which she had taken approximately 50 acetaminophen tablets over a 24 hour period. She was transferred to a medical center ER for the acetaminophen overdose.

Physical exam showed patient alert and oriented with normal vital signs. Right upper quadrant pain was noted, as well as mild jaundice.

Diagnostic

Laboratory testing indicated the following liver function tests and other tests:

AST

ALT

GGT

LDH

BUN

Creatinine

Acetaminophen

791 U/liter

1,398 U/liter

166 U/liter

826 U/liter

83 mg/dl

10.1 mg/dl

15µg/ml

Hepatitis A IgM

Hepatitis A IgG

Hepatitis B Surface Antigen

Hepatitis B Surface Antibody

Hepatitis B Core IgM

Hepatitis C Total (IgM/IgG)

Negative

Negative

Negative

Negative

Negative

Positive

Her hospital course was significant for acute renal and liver failure, with improvement after dialysis was performed.

Based on the patient’s history, presenting symptoms and LFT results, which of the following viruses would be most likely to be the problem?

BK virus

JC virus

Hepatitis B or C

CMV

After reviewing the serologic test results, which organism is the causative virus?

Hepatitis B

Hepatitis C

Hepatitis A

Hepatitis D

What are the modes of transmission for this virus? Which was most likely in this case?

Based on how she was infected, would she be at risk for any other viral infections? Which ones?

Why would it be important to determine the genotype of the virus with which she is infected?

If she had received a vaccination for the virus, would this infection have been prevented? Why or why not?

please i need an answer for all of these questions. this is due 10/19.

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Sixta Kovacek
Sixta KovacekLv2
18 Sep 2018

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