A 54-Year-Old Woman Is Evaluated for Abdominal Discomfort

A 54-year-old woman is evaluated for abdominal discomfort.  She has been feeling weak for the past 7 days.  The patient is not eating well due to nausea and has noticed that her urine has become darker.  She has a history of hypertension and generalized anxiety disorder.  Her medications include amlodipine and chlorthalidone.  For the past 4 months she has also been using ginseng as an energy booster and kava kava to control her anxiety.  Two months ago, the patient started using Gingko biloba in an attempt to improve her memory.  She states that she had been feeling better, less anxious, and more alert until last week.  The patient does not use tobacco, alcohol, or illicit drugs.  Examination shows mild jaundice.  Heart sounds are normal and lung sounds are clear.  The liver is palpable 2 cm below the costal margin and tender.  Neurologic examination reveals no abnormalities.  Her laboratory tests are as follows: Which of the following is the most likely cause of the patient's disease?

A) Acute viral hepatitis
B) Chlorthalidone
C) Gingko biloba
D) Ginseng
E) Kava kava

Correct Answer:

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