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  #1  
Old 11-03-2012
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Arrow Billy Step 1 Questions # 74

Over the past 6 months, a 68-year-old woman has become increasingly tired and reports a 3-kg weight loss without dieting. Physical examination yields no remarkable findings except a stool sample that is positive for occult blood. Laboratory studies show total serum protein, 6.1 g/dL; albumin, 3.9 g/dL; total bilirubin, 1.1 mg/dL; AST, 38 U/L; ALT, 44 U/L; alkaline phosphatase, 294 U/L; glucose, 70 mg/dL; and creatinine, 0.9 mg/dL. CBC shows hemoglobin, 8.9 g/dL; hematocrit, 26.7%; MCV, 75 μm3; platelet count, 198,400/mm3; and WBC count, 5520/mm3. The prothrombin time is 13 seconds, and partial thromboplastin time is 25 seconds. Serologic test results for HAV, HBV, and HCV are negative. A chest radiograph shows no abnormal findings. What is the most likely diagnosis?


□ (A) Antiphospholipid syndrome
□ (B) Ascending cholangitis
□ (C) Chronic alcoholism
□ (D) Metastatic adenocarcinoma
□ (E) Sclerosing cholangitis
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  #2  
Old 11-03-2012
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D) metastatic adeno ca.???(due to age factor..)

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  #3  
Old 11-03-2012
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Default my answer :)

(D) Metastatic adenocarcinoma
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features of ca colon.... occult blood in stool with anemia ;
so metastatic adenoca
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I go with D too.
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  #6  
Old 11-04-2012
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Correct Answer D is correct

An elevated alkaline phosphatase level suggests obstruction of the biliary tract, but this case must be focal because the bilirubin is not elevated. The microcytic anemia and the blood in the stool suggest gastrointestinal tract hemorrhage, and a colonic adenocarcinoma should be suspected. Hepatic metastases from colon cancer are common. They appear as multiple masses within the hepatic parenchyma. Antiphospholipid syndrome predisposes to thrombosis with venous obstruction, in which case hepatic enzyme levels should be higher, and the partial thromboplastin time should be prolonged. Ascending cholangitis is typically caused by bacteria such as Escherichia coli or Klebsiella, and patients present acutely with fever, chills, jaundice, and abdominal pain. Chronic alcoholism is not accompanied by an increase in the alkaline phosphatase level, and there is often a macrocytic anemia. Sclerosing cholangitis would increase the bilirubin concentration and the alkaline phosphatase level.
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