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Old 07-04-2014
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Default sample question NBME 4

section 2 item 36:

A 57 year old woman is admitted to the hospital because of a 2-week history of progressive jaundice and a 5kg (11lb) weight loss. She has had dark urine and pale stools during this period. She has no history of serious illness and takes no medications. Her temperature is 37.2 C (99F) and pulse is 80/min, and blood pressure is 120/80 mm Hg. Examination shows severe jaundice. The gallbladder is palpated in the right upper quadrant of the abdomen. Urine dipstick is positive for bilirubin. Abdominal ultrasonography shows a dilated gallbladder and dilated intrahepatic and extrahepatic biliary ducts; there are no calculi. Which of the following is the most appropriate next step in diagnosis?

a) Endoscopic ultrasonography
b) CT of the abdomen
c) Fine-needle aspiration of the pancreas
d) laparoscopic cholecystectomy
e) Surgical exploration of the common bile duct

I was debating between A and B. The patient has obstructive jaundice caused by tumor (my guess...) but I can't figure out which choice would be the better approach. Any feedback would be appreciated
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passusmlestep3 (07-05-2014)

Old 07-05-2014
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CT of the abdomen to look for pancreatic CA.
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