A 68-Year-Old Woman Admitted for Community-Acquired Pneumonia 4 Days Ago

question 57

Multiple Choice

A 68-year-old woman admitted for community-acquired pneumonia 4 days ago is evaluated in the hospital for new-onset jaundice.  During morning rounds today, it is noted that she has yellowish discoloration of both eyes.  The patient has no abdominal pain, nausea, or prior history of liver disease, but she has a history of hypertension.  She does not use tobacco, alcohol, or illicit drugs.  Her current medications include azithromycin, ceftriaxone, lisinopril, and acetaminophen as needed.
Her temperature is 36.7 C (98 F) , blood pressure is 120/70 mm Hg, and pulse is 72 /min.  The patient's pulse oximetry shows 96% on 2 liters oxygen.  Examination reveals scleral icterus, rales in the right lower lobe, and normal heart sounds without murmurs.  The abdomen is soft and nontender with no organomegaly.
Laboratory results are as follows:

Acute viral hepatitis serologies are negative.  Abdominal ultrasound reveals normal liver size and echotexture, a thin-walled nondistended gallbladder, no gallstones or biliary sludge, and a normal common bile duct.
Which of the following is the best next step in management of this patient?

• A)Acetaminophen level
• B)Change antibiotics
• C)Cholescintigraphy (HIDA scan)
• D)Liver biopsy
• E)MR cholangiopancreatography

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Definitions:

Discount Rate

The discount rate is the interest rate used to determine the present value of future cash flows in discounted cash flow analysis, reflecting the opportunity cost of time and risk.

Cash Flows

The entire volume of cash flows into and from a business, importantly affecting its financial fluidity.

Treasury Bills

These are short-term government securities issued at a discount from their face value, maturing in one year or less.

Inflation Rate

The percentage rate at which the general level of prices for goods and services is rising, and subsequently, purchasing power is falling.