She denies nasal congestion, diarrhea or vomiting. Kelly has not eaten since yesterday afternoon, and has taken minimal fluids. She has voided recently and describes it as being dark-amber colored. Kelly has not recently traveled to an other countries. She has volunteered on occasion in a soup kitchen feeding homeless individuals with her church s youth group.
Immunizations are up to date except for tetanus boost.
Kelly has not had the series of hepatitis vaccinations and cannot recall having a recent mantoux test. Kelly s mother appears anxious and frequently answers questions for Kelly. While you are alone with Kelly, she reveals that she is sexually active and is currently taking oral contraceptives. She has no allergies. Kelly s physical exam reveals an ill appearing and fatigues but non toxic looking adolescent.