a 25- year-old college student, is in your clinic because of sore throat. 7 days ago, he developed fever which was low (99 F) to moderate grade (101.1 F). This was associated with swollen and tender neck glands. He has sore throat but denies having cough. He has no abdominal pain but feels as if his upper abdomen has become swollen and he has lost his appetite. He has no nausea, vomiting or change in bowel movements. Since yesterday, he has noticed that his eyes and skin have turned a yellow color. He has no past medical history of jaundice, hepatitis, blood transfusion, body piercing, tattoos or eating shellfish. He does not drink, smoke cigarettes, or use illicit drugs. He doesn’t take any medications. He hasn’t traveled recently. He is sexually active and is in a monogamous relationship with his girlfriend of 2 years who is experiencing similar symptoms. He is heterosexual and has had two previous sexual partners. He always used condoms. He received Hepatitis B vaccination prior to starting college.
PPE: Patient is well-developed, in no acute distress. He appears concerned and anxious.
VS: BP – 130/80, PR- 110/min, RR – 20/min, T – 101.4 F, SpO2 – 99%.
HEENT: PERRLA, EOMI, icteric sclerae, pink conjunctivae, Tonsillo-pharyngeal area erythematous with exudate.
Neck: posterior cervical lymph nodes swollen, tender and movable, bilaterally. Supraclavicular lymph nodes not enlarged. Heart and lungs:
Normal abdomen: Normal bowel sounds, liver – 14 cm in midclavicular line by percussion, diffuse tenderness over both right and left upper quadrants on palpation. Neurological exam: no deficits.