American College of Physicians: Internal Medicine — Doctors for Adults ®

Advertisement

The MKSAP Challenge

From the January-February ACP Observer, copyright 2006 by the American College of Physicians.

Clinical scenario

A 44-year-old woman with a 10-year history of type 2 diabetes mellitus and hyperlipidemia is evaluated because of intermittent right upper quadrant abdominal discomfort and newly detected abnormal liver chemistry test results. Her only medication is glyburide, which she has taken for eight years. She does not drink alcoholic beverages.

Physical examination is remarkable only for overweight; she has a body mass index of 29. There are no stigmata of chronic liver disease.

Her laboratory results are:

  • hemoglobin, 13.3 g/dL
  • serum aspartate aminotransferase, 98 U/L
  • serum alanine aminotransferase, 81 U/L
  • serum total bilirubin, 0.4 mg/dL
  • serum albumin, 3.9 g/dL
  • hemoglobin A1C, 9.1%
  • serum iron studies, normal
  • serologic studies for hepatitis A, B, and C, negative
  • antinuclear antibody titer, negative
  • serum alpha1-antitrypsin, negative

Ultrasound examination of the abdomen and pelvis shows slightly echogenic hepatic parenchyma.

Which of the following is most appropriate for managing this patient?

A. Weight loss and improved glucose control
B. Pegylated interferon and ribavirin
C. High-dose prednisone
D. Referral for evaluation for liver transplantation

Answer

Top

This is a printer-friendly version of this page

Print this page  |  Close the preview

Share

 
 

Internist Archives Quick Links

Internal Medicine Meeting Early Registration Discount

Internal Medicine Meeting Early Registration Discount

Register early for Internal Medicine Meeting 2015 in Boston, MA to lock in the lowest possible rate. Learn more or register now!

Are You Using ACP Smart Medicine®?

Are You Using ACP Smart Medicine?

This online clinical decision support tool is a FREE benefit of ACP membership delivering point-of-care access to evidence-based recommendations. Includes more than 500 modules, images and reference tables. Start now or watch the video tour.