Case Study:
Bertha, a 58 - year - old Hispanic female, presents to the primary care clinic to establish care. She states that in 1985 she received a blood transfusion after sustained an MVA. She had tested positive for hepatitis C virus (HCV) in the past, but ignored any advice regarding treatment options. She brings a previous lab result with her today that shows: (ALT) level of 85 IU/mL (range 8 - 35 IU/mL). The lab form also states, "HCV antibody is positive by enzyme immunoassay - confirmation is suggested.
Past medical h story: Hypertension, dyslipidemia, hepatitis C.
Family history: Unremarkable
Social history: She works as a case manager of an HMO and is married with 2 children. Denies use of illegal drugs, denies alcohol abuse, and has no tattoos.
Medications: HCTZ, 12,5 mg daily; Atorvastatin 20 mg daily.
Allergies: No known drug or food allergies.
OBJECTIVE General a ppearance: 58 - year - old female; pleasant, in no acute distress; good eye contact. Vital signs: T: 96.8; P: 76; RR: 25; SaO2 : 91; BP: 138/80. Her weight is 174 lb, and her height is 63 inches.
HEENT: Negative. Neck: Thyroid nonpalpable. No lymphadenopathy.
Cardiovascular: Regular rate and rhythm. Apical Pulse (PMI) is at 5th intercostal space, left sternal border. Pulses + 2 all extremities.
Respiratory: Lungs clear to auscultation, No wheezes; no crackles.
Abdomen: Mild tenderness in right upper quadrant. BS x 4 no bruits. Nondistended, soft. No organomegaly. No ascites.
Neurological: A & O × 4, CN II - XII grossly intact.
Depression scale: negative. Musculoskeletal: Full ROM. No deformities. Muscle strength is 5/5.
Critical Thinking:
Which diagnostic or imaging studies should be considered confirm the diagnosis?
What is the most likely differential diagnosis?
What is your plan of treatment?
Are there any emergent referrals needed?