Items 76 through

You are a public health physician working at a city health department. You receive a report of a case of hepatitis A virus (HAV) infection in a 32-year-old man who lives with his wife and 1-year-old twins. He is a self-employed contractor who often eats on the run. His wife works part-time at a book store and his children attend day care. He has no history of travel, eating raw fish, or known contact with other cases of HAV infection.

7-6. The first step in investigating this case is to confirm the diagnosis of HAV with a. A report of the history and examination from the treating physician b. Stool cultures c. Total anti-HAV antibodies d. IgM anti-HAV

e. HAV RNA

7-8. A previously healthy 18-mo-old has been in a separate room from his family. The family notices the sudden onset of coughing, which resolves over a few minutes. Subsequently, the patient appears to be normal except for increased amounts of drooling and refusal to take foods orally. The most likely explanation for this toddler's condition is a. Severe gastroesophageal reflux b. Foreign body in the airway c. Croup d. Epiglottitis e. Foreign body in the esophagus

7-7. The most likely source of infection is a. A coworker b. Food c. The patient's wife d. Water e. The patient's children

7-9. A 37-year-old man developed involuntary twitching movements in his left thumb. Within 30 s he noticed that the twitching had spread to his entire left hand and involuntary movements had developed in his left forearm and the left side of his face. He cannot recall what happened subsequently, but his wife reports that he fell down and the entire left side of his body appeared to be twitching. The patient appeared to be unresponsive for about 3 min and confused for another 15 min. During the episode he bit his tongue and wet his pants. Which of the following seizure types did this person experience?

a. Generalized tonic-clonic b. Generalized absence c. Complex partial d. Epilepsia partialis continua e. Simple partial sensory f. Jacksonian march g. Psychomotor status h. Tonic-clonic status epilepticus i. Pseudoseizures j. Myoclonic

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