doyoudig
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A 52-year-old woman who is unhappy with her previous medical care comes to you for evaluation of a long-standing history of abnormal "liver tests." She is in generally good health and is on no medications. She has had only one sexual partner, her husband of 28 years, and denies any injection drug use. She has no family history of liver disease but did have multiple transfusions many years ago after an automobile accident. She has no current symptoms of liver disease and her physical examination is normal. An ultrasound of the liver is unremarkable. Laboratory studies show:
SGOT 146 U/L
SGPT 127 U/L
Hepatitis C antibody Positive
The next most appropriate step in the management of this patient is to
A. observe and repeat liver function tests in 3 months
B. observe and repeat ultrasound in 3 months
C. order an alpha-fetoprotein level
D. order an MRI of the abdomen
E. refer the patient for a liver biopsy
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| hanialkhadher
Forum Elite
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I would like to take a look at this long standing liver prb. so i go with
E. refer the patient for a liver biopsy
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| doc_clotaire
Forum Guru
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B. observe and repeat ultrasound in 3 months
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The elevator to succes is broke ,you must take the stairs
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| doc_clotaire
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Wait a minute 
I did not see that they already did an ultrasound so B would be very unlikely
The answer should be to tule out liver cancer
Yup , Either C or E but I would ' t put this patient to such an invasive procedure like liver biopsy at th first place so I would rather go for alfa feto protein level first .
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The elevator to succes is broke ,you must take the stairs
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| doyoudig
Forum Guru
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The correct answer is E. The patient has evidence of chronic hepatitis C infection and is a candidate for monotherapy with interferon or combination therapy with interferon plus ribavirin. Most authorities recommend that prior to the initiation of therapy a liver biopsy be performed to assess the severity of the disease and to obtain prognostic information.
While it is prudent to follow LFTs (choice A) in patients with chronic hepatitis C infection, in this patient with known long standing abnormalities it is more important to evaluate her for possible treatment with a biopsy.
Some authorities recommend that patients with chronic hepatitis be screened with ultrasounds (choice B) every 6–12 months for the development of liver cancer. But as discussed previously in this patient, it is imperative that she be evaluated now for possible treatment.
Alpha-fetoprotein levels (choice C) are elevated in some patients with liver cancer. In the past it has been used to screen patients with chronic hepatitis for cancer but there has been some recent controversy about the utility of this approach. In this patient with a normal ultrasound, a liver biopsy is a more pressing test than a AFP level
In the evaluation and management of this patient an MRI (choice D) is not necessary. If there was concern for a malignancy an MRI of the liver can provide useful information
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| haduytu7
Forum Newbie
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Posts: 24
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Good explain!
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| usmle12
Forum Senior
Topics: 19
Posts: 194
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hey do you dig i didnt get it do u treat asypmtomatic ppl with interferone,its throughout q bank n usmle world that we dont treat asymptomatic ppl also she has very slight elevation of liver enzymes is she still a candidate...ia m confused
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