A 34-Year-Old Woman Returns to the Physician for the Results

question 348

Multiple Choice

A 34-year-old woman returns to the physician for the results of her liver function tests, which were initially drawn 2 days ago when she presented with malaise, low-grade fever, and scleral icterus.  She reports no significant change in her symptoms.  Her medical problems include migraine headaches and irritable bowel syndrome.  She takes intermittent ibuprofen for headaches.  She denies tobacco, alcohol, or any recreational drug use.  She works as a flight attendant and recently returned from Thailand.  Her household contacts include her 36-year-old husband and 2 healthy children (ages 5 and 8) .  None of the family members have ever received any hepatitis vaccine.
Her physical examination is unremarkable except for mild abdominal discomfort in the right upper quadrant and mild scleral icterus.
Laboratory results are as follows:

Which of the following is the most appropriate course of action?

• A)Administer anti-HAV immunoglobulin to all household contacts
• B)Administer anti-HAV immunoglobulin to children only
• C)Administer HAV vaccine and immunoglobulin to all household contacts
• D)Administer HAV vaccine to all household contacts
• E)Expectant management and contact precautions for now

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Definitions:

Sensory Nervous System

The part of the nervous system responsible for processing sensory information from the external and internal environment, sending it to the brain for interpretation.

Autonomic Nervous System

The part of the nervous system responsible for controlling involuntary body functions, like heart rate, digestion, and breathing.

Somatic Nervous System

A part of the peripheral nervous system that controls voluntary movements of the body and transmits sensory information to the central nervous system.

Sympathetic Nervous System

Part of the autonomic nervous system responsible for the body's 'fight or flight' response to stress.