Percutaneous liver biopsy would most likely reveal which of the following in this patient?

[Medicoman]

previously healthy 5-year-old girl is brought to the emergency department with lethargy and altered mental status. She was in her

usual state of health until 5 days ago, when she developed a low-grade fever, malaise, headache, cough, coryza, and a sore throat.

The fever resolved with over-the-counter aspirin. The patient developed nausea, vomiting, and lethargy this morning. She has no

chronic medical problems and takes no other medications. The girl has not received the seasonal innuenza vaccine, but her other

vaccinations are up to date. The patient’s weight and stature are average. Examination shows a febrile, sleepy girl with

hepatomegaly . There is no jaundice or splenomegaly. The patient is not oriented to person, place, or time. Nasal antigen testing is

positive for innuenza B. Laboratory results are as follows

Hemoglobin 14.2 g/L

Platelets 180,000/mm’

Leukocytes 8,300/ mm’

Chemistry panel

Sodium 140 mEq/L

Potassium 3.8 mEq/L

Chloride 102 mEq/L

Bicarbonate 24 mEq/L

Blood urea nitrogen 16 mg/dL

Creatinine 0.6 mg/dl

Glucose 72 mg/dl

Total bilirubin 0.9 mg/dl

Direct bilirubin 0.3 mg/dl

Alkaline phosphatase 120 U/L

Aspartate aminotransferase 358 U/L

Alanine aminotransferase 410 U/L

Ammonia 94 mcg/dl {nonnal: <45 mcg/dL)

Coagulation studies

PT 18 sec

PTT 44 sec

Percutaneous liver biopsy would most likely reveal which of the following in this patient?

• O A . Bile plugs in the bile ducts, portal tract edema, and hepatic fibrosis
• Q B. Cirrhosis and periportal eosinophilic inclusion bodies
• Q C . Macrovesicular fatty infiltration
• Q 0. Microvesicular fatty infiltration
• O E. Sinusoidal congestion and hemorrhagic necrosis

56-year-old man comes to the office due to 3 months of dyspnea that was initially exertional but has progressively worsened to the

point that the patient is now breathless even at rest. He has not had any chest pain, palpitations, syncope, or ankle swelling The

patient has no significant past medical history, and he takes no medications. He has been smoking a pack of cigarettes daily for the

last 30 years and has been drinking alcohol heavily for the past 5 years His mother died of breast cancer at age 57. The patient’s

temperature is 37.1 C (98 8 F), blood pressure is 113/76 mm Hg, and pulse is 86/min. A third heart sound is heard on cardiac

auscultation; there are no murmurs. Chest auscultation indicates bibasilar crackles. His abdomen is soft and with no evidence of

ascites. Laboratory results are as follows

Hematocrit 32%

Mean corpuscular volume 101 μm3

Platelets 60,000/mm3

Leukocytes 6000/mm3

Liver function studies

Alkaline phosphatase 44 U/L

Aspartate aminotransferase 180 U/L

Alanine aminotransferase 66 U/L

Chest x-ray reveals cardiac silhouette enlargement and signs of pulmonary venous congestion Echocardiography shows a dilated

left ventricle with an estimated left ventricular ejection fraction of 25%. Coronary angiography reveals no evidence of obstructive

coronary artery disease. Which of the following measures is most likely to reverse this patient’s heart function?

• QA Abstinence from alcohol
• 0 B. Cessation of cigarette smoking
• 0 C. Initiation of ACE inhibitor therapy
• 0 D. Initiation of digoxin therapy
• 0 E. Niacin supplementation
• 0 F Prednisolone therapy
• 0 G. Reduction of salt intake