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  #1  
Old 11-14-2012
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Arrow Billy Step 1 Questions # 82

A 3-week-old boy presents to his pediatrician because his mother has noticed that he “looks yellow.” On questioning, she elaborates that the jaundice began several days after birth and has been associated with dark urine and
acholic stools. Laboratory studies show a direct bilirubin level of 5.0 mg/dL and a total bilirubin level of 5.5 mg/dL. Which of the following is the most likely diagnosis?


(A) Congenital extrahepatic biliary atresia
(B) Crigler-Najjar syndrome type I
(C) Gilbert syndrome
(D) Hereditary spherocytosis
(E) Physiological jaundice
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  #2  
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A Coz its conjugated bilirubin
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Old 11-14-2012
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Default My Answer

I choose A. congenital extra hepatic biliary atresia - boy shows symptoms of obstructive jaundice with high direct bilirubin.. Hope Im right:sorry:
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Old 11-14-2012
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The dark urine and acholic stools (or in other words gray colored stools as referred to by some Qbank questions) are a sure sign of obstructive jaundice. Option A is the only option here which fills the criteria.
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Old 11-14-2012
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Default A?

Judging by the age of the patient, I think it should be A
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Old 11-14-2012
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(A) Congenital extrahepatic biliary atresia
All others have increased unconjugated bile.
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I choose 'A
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A!!!! That is an easy question!!!!
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Old 11-15-2012
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Correct Answer A is correct

The correct answer is A. The patient is presenting with congenital extrahepatic biliary atresia. Vignettes that describe a pure elevation in direct (conjugated) bilirubin strongly suggest an obstructive etiology, as the liver is able to effectively conjugate bilirubin but fails to excrete it into the small intestine. The absence of bilirubin in the small bowel results in acholic
stools while increased renal excretion of conjugated bilirubin causes a darkening of the urine. Congenital extrahepatic biliary atresia occurs
when the developing bile ducts close completely and fail to recanalize. Appropriate therapy of biliary atresia involves anastomosis of the small bowel directly to intrahepatic bile ducts, a maneuver known as the Kasai procedure.
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