Answer :USMLE step 2 Mcq 293:Mary is a 22 year old IV drug user, light alcohol user, and cigarette smoker


Correct Answer: B

Hepatitis B infection is transmitted by exposure to blood or blood products. Sharing of needles with drug users and sexual contact are two common routes of transmission. During the prodromal phase of hepatitis, the symptoms include arthralgia, nausea and vomiting. There may also be a fever as well as right upper quadrant abdominal pain. A distaste for smoking can occur during the prodromal phase. During the icteric phase of hepatitis B, jaundice develops. The majority of the cases of hepatitis B demonstrate hepatomegaly. Liver tenderness is a common finding as are dramatically elevated liver enzymes. Primary biliary cirrhosis tends to occur in women age 40-60. There is no association with any of the risk factors given here. Hepatocellular carcinoma is associated with long-standing liver disease, such as cirrhosis or hepatitis B or C, which is not the case here. Alpha fetoprotein would be positive with hepatocellular carcinoma. Laennec's cirrhosis is associated with heavy alcohol use over many years. In Gilbert's syndrome, there is a mild intermittent unconjugated hyperbilirubinemia and normal liver function tests.


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