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:

Independent Variable

The variable that is manipulated or changed in an experiment to test its effects on the dependent variable.

Dependent Variable

The outcome variable in an experiment or study that is expected to change in response to manipulations of the independent variable.

Scatterplot

A graphical representation in which two variables are plotted along two axes, helping to show the relationship between them.

Positive

Characterized by or displaying affirmation, agreement, or constructive qualities or results.