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  #1  
Old 06-22-2011
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Liver liver disease 2 cases

For each patient with hyperbilirubinemia, select the most likely diagnosis.

Item 1 of 2

A 19-year-old man presents to the university health clinic with jaundice. He first noticed the jaundice this morning when he awoke. He was otherwise in excellent health and does not take any regular medications. He specifically denies pruritus, fatigue, abdominal pain, nausea, and vomiting. He is concerned because this is the third time this has occurred, and every episode has followed a night of heavy alcohol intake. Laboratory evaluation reveals the following:
Serum
 Erythrocyte count 4.5 million/mm3
 Hematocrit 45%
 Reticulocyte count 0.75%
 Alanine aminotransferase (ALT) 15 U/L
 Aspartate aminotransferase (AST) 12 U/L
 Phosphatase (alkaline) 55 U/L
 Bilirubin, total 3.1 mg/dL
 Bilirubin, direct 0.2 mg/dL
 Prothrombin time 12 seconds
Blood
 Hemoglobin 15.1 g/dL

Answer Choices
A. Choledocholithiasis
B. Crigler-Najjar syndrome
C. Dubin-Johnson syndrome
D. Gilbert disease
E. Hepatitis A
F. Hepatitis B
G. Hepatitis C
H. Pancreatic adenocarcinoma
I. Primary biliary cirrhosis
J. Primary sclerosing cholangitis

Item 2 of 2

A 19-year-old female presents to the university health clinic with a 2-day history of jaundice. She has been otherwise well, but is concerned that she is having a reaction to the oral contraceptive pill (OCP) she began a month ago. She specifically denies pruritus, abdominal pain, changes in the color of her urine or stool, recent fevers, or night sweats. She is sexually active with one male partner and regularly uses barrier contraception. She does not drink alcohol, does not use tobacco, and does not use illicit drugs. Examination reveals generalized jaundice and is otherwise within normal limits. Laboratory investigation reveals the following:
Serum
 Erythrocyte count 4.2 million/mm3
 Hematocrit 39%
 Reticulocyte count 0.6%
 Alanine aminotransferase (ALT) 12 U/L
 Aspartate aminotransferase (AST) 12 U/L
 Phosphatase (alkaline) 43 U/L
 Bilirubin, total 3.6 mg/dL
 Bilirubin, direct 2.5 mg/dL
 Prothrombin time 12 seconds
Blood
 Hemoglobin 13.6 g/dL

End of set

Answer Choices
A. Choledocholithiasis
B. Crigler-Najjar syndrome
C. Dubin-Johnson syndrome
D. Gilbert disease
E. Hepatitis A
F. Hepatitis B
G. Hepatitis C
H. Pancreatic adenocarcinoma
I. Primary biliary cirrhosis
J. Primary sclerosing cholangitis
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  #2  
Old 06-22-2011
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about the first one my option is gilbert..

causes elevated levels of unconjugated bilirubin
Crigler–Najjaris rare
phosphatase alt ast normal so cant be anything else i think

about the second i think Dubin-Johnson syndrome ..causes
increase of conjugated bilirubin with everything else normal
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