Hepatitis A and E Quiz: Ace Your Exams
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A 36-year-old woman presents to the emergency department with yellow eyes and skin for one day. She has had abdominal pain, nausea, vomiting and malaise for one week. Her partner had similar gastrointestinal symptoms one month ago but recovered spontaneously and did not have testing for the presence of an infection. Her past medical history is significant for hypothyroidism, for which she takes levothyroxine daily. She drinks approximately two glasses of wine each evening and is sexually active with her biologically male spouse. Temperature is 37.8°C (100.1°F), pulse is 90/min, respiratory rate is 20/min, and blood pressure is 132/84 mmHg. Examination reveals scleral icterus and jaundice. There is mild tenderness to palpation in the right upper quadrant of the abdomen with hepatomegaly. Laboratory results are shown below. Which of the following is the best next step in management?
| Laboratory value | Result |
| AST | 802 units/L |
| ALT | 978 units/L |
| Total bilirubin | 8.1 mg/dL |
| INR | 1.9 |
| Anti-HAV IgM | positive |
| Anti-HEV IgM | negative |
| HEV RNA by PCR | negative |
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