A 48-Year-Old Man Comes to the Emergency Department Due to Fever

question 483

Multiple Choice

A 48-year-old man comes to the emergency department due to fever and malaise for the past 2 days.  He also complains of fatigue and lethargy but not nausea, vomiting, diarrhea, or dysuria.  Medical history is significant for alcoholic cirrhosis, which was treated with an orthotopic liver transplant 10 weeks ago.  Current medications include tacrolimus, mycophenolate mofetil, and low-dose prednisone.  Temperature is 38.1 C (100.6 F) , blood pressure is 125/82, pulse is 80/min, and respirations are 12/min.  The patient is awake and oriented to person, place, and time.  Scleral icterus is present.  Cardiopulmonary examination is unremarkable.  There is a well-healed surgical scar on the abdomen but no tenderness or distension.  Laboratory results are as follows: A liver biopsy shows inflammatory infiltration of the portal tracts consisting of lymphocytes, eosinophils, and neutrophils.  Interlobular bile duct destruction and prominent endotheliitis are both present.  Which of the following is the best next step in management?

• A)Administer high-dose corticosteroids
• B)Discontinue mycophenolate
• C)Initiate ursodeoxycholic acid therapy
• D)Reduce the tacrolimus dose
• E)Start metronidazole therapy

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Definitions:

Mean

A numerical indicator that signifies the mean value of a collection of figures, determined by totaling all the figures and then dividing by the count of those figures.

Cross-Sectional Study

A type of observational study that analyzes data from a population, or a representative subset, at a specific point in time.

Different Age Groups

Categories of individuals segmented by their age, often used for demographic, marketing, and social research purposes to identify and analyze behavioral patterns.

Greatest Probability

Refers to the highest chance or likelihood of a particular event or outcome occurring.