A 65-year-old man presents to his primary care physician for fatigue. The patient states that he has not been sleeping well and requests sleep medication to help him with his fatigue. He recently changed his diet to try to increase his energy and has been on a vegetarian diet for the past several months. The patient has no significant past medical history. He smokes 1 pack of cigarettes per day and drinks 5 alcoholic beverages per day. The patient has lost 12 pounds since his last visit 1 month ago. Physical exam demonstrates a tired man. He appears thin, and his skin and sclera are icteric. Abdominal ultrasound is notable for a thin-walled and enlarged gallbladder. A urine sample is collected and is noted to be amber in color. Which of the following is the most likely diagnosis?
ACholangiocarcinoma
BPancreatic adenocarcinoma
CGallbladder adenocarcinoma
DIron deficiency anemia
EAutoimmune hemolytic anemia
A previously healthy 37-year-old woman, gravida 3, para 2, at 29 weeks' gestation comes to the physician because of colicky postprandial abdominal pain. Her vital signs are within normal limits. Physical examination shows a uterus consistent in size with a 29-week gestation. Ultrasonography of the abdomen shows multiple 5-mm hyperechoic masses within the gallbladder lumen. Which of the following processes is most likely involved in the pathogenesis of this patient's condition?
AAccelerated gallbladder emptying
BIncreased secretion of bile acids
CIncreased secretion of cholesterol
DDecreased caliber of bile duct
EOverproduction of bilirubin
A 42-year-old woman is brought to the emergency department because of intermittent sharp right upper quadrant abdominal pain and nausea for the past 10 hours. She has vomited 3 times. There is no associated fever, chills, diarrhea, or urinary symptoms. She has 2 children who both attend high school. She appears uncomfortable. She is 165 cm (5 ft 5 in) tall and weighs 86 kg (190 lb). Her BMI is 32 kg/m2. Her temperature is 37.0°C (98.6°F), pulse is 100/min, and blood pressure is 140/90 mm Hg. She has mild scleral icterus. On physical examination, her abdomen is soft and nondistended, with tenderness to palpation of the right upper quadrant without guarding or rebound. Bowel sounds are normal. Laboratory studies show the following: Blood Hemoglobin count 14 g/dL Leukocyte count 9,000 mm3 Platelet count 160,000 mm3 Serum Alkaline phosphatase 238 U/L Aspartate aminotransferase 60 U/L Bilirubin Total 2.8 mg/dL Direct 2.1 mg/dL Which of the following is the most appropriate next step in diagnosis?
AEndoscopic retrograde cholangiopancreatography (ERCP)
BSupine and erect X-rays of the abdomen
CComputed tomography (CT) scan of the abdomen
DHepatobiliary iminodiacetic acid (HIDA) scan of the biliary tract
ETransabdominal ultrasonography
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