October 18, 2010

USMLE 2 Question 11

An 18 year old male works in a company where lunches are often catered. One day, the water at the company facility is not working, but they manage to have the lunch anyway. Two weeks later, he becomes sick. He develops anorexia, nausea, malaise and jaundice. During the course of the next four weeks, seven people who shared in the lunch become ill with similar symptoms. After a few weeks, each of the seven people completely recovers and they replace their caterer.

What is a likely diagnosis?

a) primary biliary cirrhosis
b) hepatitis B
c) hepatocellular carcinoma
d) Laennec's cirrhosis
e) hepatitis A

The correct answer is E

With no water working, but a catered lunch proceeding anyway, there was probably rampant poor sanitation present.

Hepatitis A is transmitted by the fecal oral route and is readily transmitted by poor sanitation. Hepatitis A can occur in epidemics, as in this scenario. The incubation period is two to six weeks, which was the time frame the employees developed symptoms. The symptoms include anorexia, nausea, malaise and jaundice.

Primary biliary cirrhosis tends to occur in women aged 40-60 and does not occur in clusters of people over a brief time frame.

The incubation period for hepatitis A is much shorter than for hepatitis B. Hepatitis A has an incubation period of 2-6 weeks, as seen in this scenario. Hepatitis B has an incubation period of 4 weeks to 6 month, which is not the time frame presented in this scenario.

Hepatocellular carcinoma is associated with long-standing liver disease, such as cirrhosis or hepatitis B or C, which is not the case here. Laennec's cirrhosis is associated with heavy alcohol use over many years.

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