10. A 68-year-old woman comes to the physician for a follow-up examination after a routine endoscopy for dyspepsia showed large esophageal varices. She has a 25-year history of type 2 diabetes mellitus. She also has hypertension and hyperlipidemia. She does not have any history of liver disease, blood transfusions, or intravenous drug use, and she does not drink alcohol. Her current medications are 81-mg aspirin, insulin, lisinopril, and simvastatin. She appears alert. She is 168 cm (5 ft 6 in) tall and weighs 110 kg (242 lb); BMI is 39 kg/m². Physical examination shows scattered spider angiomata over the chest and upper extremities. Abdominal examination shows no ascites. The spleen tip is palpated 4 cm below the left costal margin. Laboratory studies show. Hemoglobin Hematocrit Mean corpuscular volume Platelet count 12.2 g/dL 36% 102 μm³ 92,000/mm³ 1.8 mg/dL Serum Total bilirubin AST 65 U/L ALT 85 U/L Ferritin 62 ng/mL Hepatitis B surface antigen negative Hepatitis B surface antibody positive Hepatitis C virus negative Ultrasonography shows coarsened liver echotexture with increased echogenicity. Which of the following is the most likely cause of the liver findings in this patient? A) Adverse drug effect B) Chronic hepatitis B C) Fatty liver D) Hepatolenticular degeneration (Wilson disease) E) Prior excessive alcohol use

10. A 68-year-old woman comes to the physician for a follow-up examination after a routine endoscopy for dyspepsia showed large esophageal varices. She has a 25-year history of type 2 diabetes mellitus. She also has hypertension and hyperlipidemia. She does not have any history of liver disease, blood transfusions, or intravenous drug use, and she does not drink alcohol. Her current medications are 81-mg aspirin, insulin, lisinopril, and simvastatin. She appears alert. She is 168 cm (5 ft 6 in) tall and weighs 110 kg (242 lb); BMI is 39 kg/m². Physical examination shows scattered spider angiomata over the chest and upper extremities. Abdominal examination shows no ascites. The spleen tip is palpated 4 cm below the left costal margin. Laboratory studies show. Hemoglobin Hematocrit Mean corpuscular volume Platelet count 12.2 g/dL 36% 102 μm³ 92,000/mm³ 1.8 mg/dL Serum Total bilirubin AST 65 U/L ALT 85 U/L Ferritin 62 ng/mL Hepatitis B surface antigen negative Hepatitis B surface antibody positive Hepatitis C virus negative Ultrasonography shows coarsened liver echotexture with increased echogenicity. Which of the following is the most likely cause of the liver findings in this patient? A) Adverse drug effect B) Chronic hepatitis B C) Fatty liver D) Hepatolenticular degeneration (Wilson disease) E) Prior excessive alcohol use

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