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Chapter 24. Viral Hepatitis

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A 31-year-old Latino woman presents with complaints of fatigue. She returned from a business trip to Mexico 10 days ago. She visits her primary care physician who orders laboratory tests. The results indicate the ALT level is mildly elevated and hepatitis serologies are anti-HAV IgM(+), anti-HAV IgG (-), HBsAg(-), anti-HBc IgG(-), anti-HBc IgM (-) and anti-HCV (-). Which vaccine should be recommended?

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A. Immune globulin (IG)

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B. Hepatitis A vaccine only

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C. Hepatitis B vaccine only

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D. Hepatitis A and Immune globulin

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E. Hepatitis B and Immune globulin

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A 43-year-old black woman has HBeAg-negative chronic hepatitis B. Her risk factors include using intravenous drugs at the age of 15. Her past medical history is significant for hypertension, diabetes and severe rheumatoid arthritis. Her renal function is normal, and ALT levels are three times the upper limits of normal. Which one of the following is the best treatment option for her hepatitis B?

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A. Adefovir dipivoxil

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B. Sofosbuvir

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C. Simeprevir

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D. Pegylated interferon

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E. Entecavir

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A 53-year-old black man presents with hepatitis C, genotype 2 disease, and a baseline HCV RNA level of 64,145 IU/mL (64,145 kIU/L). He acquired the infection via a blood transfusion in the 1970s. He is presently on week 4 of pegylated interferon, ribavirin and simeprevir therapy. He states that he is doing well and has minimal complaints that include minimal fatigue and flulike symptoms the day after he gets his injection. Laboratory test results are within the reference range except for the hemoglobin level 10.3g/dL (103 g/L; 6.39 mmol/L) and ANC 0.4 × 103/mm3 (0.4 ×109/L). When these laboratory tests were repeated 2 days later, the hemoglobin was 10.4 g/dL(104 g/L; 6.46 mmol/L) and ANC was 0.4 × 103/mm3 (0.4 × 109/L). Which of the following treatment plans should be recommended because of adverse drug effects?

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A. Reduce the dose of pegylated interferon and ribavirin by half

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B. Add erythropoietin therapy

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C. Reduce the dose of pegylated interferon by a quarter

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D. Add granulocyte colony-stimulating factor

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E. Add granulocyte colony-stimulating factor and erythropoietin therapy

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A 27-year-old Asian woman is due to give birth ...

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