An 18-year-old lady comes to the clinic for her annual visit. Physical examination shows mild jaundice and scleral icterus. She says that she recently began taking oral contraceptives. Laboratory studies show only conjugated hyperbilirubinemia. Upon oral cholecystography, the biliary system can not be visualized, even with double contrast. Which of the following is the most likely diagnosis leading to these findings?

   A 2 day-old female infant is reviewed due to neonatal jaundice. She was born at term following an uncomplicated pregnancy. She has passed meconium. Physical examination shows she is alert, well-perfused, feeding normally, and afebrile. She is jaundiced over the face, trunk, and limbs, and has no organomegaly. Laboratory studies show an elevated unconjugated bilirubin of 426 μmol/L (25mg/dL) (reference range  2–14 μmol/L [0.1-0.8 mg/dL]),normal liver function tests, and no evidence of hemolysis. Which of the following diagnoses is the most likely cause of jaundice in this newborn?

 A 55-year-old man presents with increasing right upper quadrant pain and jaundice. Physical examination shows mild scleral icterus, a 12-cm (4.72-in) liver span and vague right upper quadrant pain on palpation. Laboratory studies show:

·        AST: 454 U/L

·        ALT: 206 U/L

·        Alkaline phosphatase: 126U/L

·        γ-glutamyl transpeptidase:174 IU/L

·        Total bilirubin: 2.5 mg/dL

·        Direct bilirubin:1.8 mg/dL

Which of the following is the most likely diagnosis?

A 60-year-old man who grew up in rural Australia before moving to the east coast of the United States last year comes to the office with gradual onset of jaundice. He reports abdominal pain, particularly in the right upper quadrant area. Physical examination shows hepatomegaly. An abdominal X-ray shows a single, large calcified cyst in the liver that is partially obstructing the common bile duct. A PET scan is negative. Based on the clinical presentation, which of the following treatments is most likely indicated?  

 A 75-year-old man presents with jaundice, light-coloured stools, and unintentional weight loss. He denied abdominal pain or irregularity of bowel function but has felt a bulging lump in his right upper quadrant (RUQ). A RUQ ultrasound does not show any abnormalities but a non-contrast abdominal CT shows dilated biliary ducts throughout the liver parenchyma. The hepatic ducts, gallbladder, cystic duct, and common biliary duct all appear normal. Which of the following is the most likely diagnosis?

A 46-year-old woman presents with abdominal pain, unintentional weight loss, and low-grade fever. The abdominal pain is dull and located in the right upper quadrant, and she has lost 4.35-kg (10-lb) in the last three months. The patient states she has intermittent yellowing of the skin, dark urine, and clay-coloured stool. Examination shows mild hepatomegaly and jaundice. Right upper quadrant ultrasound shows ductal dilatation and a mass along the lower margin of the liver. Which of the following is the most appropriate next step in management?

A 25-year-old man is evaluated for jaundice. Two days ago, the patient participated in a marathon race. He had a similar episode in college after an episode of binge drinking. Past medical history is notable for seasonal allergies and hepatitis A infection, which he acquired one year ago while travelling overseas. In the office, his temperature is 37.5°C (99.5°F), his blood pressure is 118/65 mmHg, and his pulse is 67/min. Physical examination shows scleral icterus and diffuse jaundice. Cardiac, pulmonary, and abdominal exams are noncontributory. Urinalysis reveals no significant findings. The patient's blood work reveals the following findings:

 Laboratory value              Result

·        Hemoglobin         14.2 mg.dL

·        Leukocyte count                6,800/mm3

·        Total bilirubin     4.1mg/dL

·        Conjugated bilirubin        0.2mg/dL

·        Alanine aminotransferase             14 U/L

·        Aspartate aminotransferase         17U/L

Which of the following best explains the underlying cause of this patient’s condition?

 A 42-year-old woman presented with abdominal pain which began 12 hours ago. The pain is localized in the right upper quadrant and is rated as 7 out of 10 in severity. In addition, she has had two episodes of non-bloody vomiting. Past medical history is notable for hypertension and types 2 diabetes mellitus. Her temperature is 37.2°C(99.0°F), her blood pressure is 152/88 mmHg, and her pulse is 76/min. Physical examination shows jaundice, and pain is elicited on palpation of the right upper quadrant. Laboratory testing reveals total serum bilirubin of 6.7mg/dL. Ultrasound reveals obstruction in a portion of the common bile duct. No obstruction or dilation of the pancreatic duct or hepatopancreatic duct is observed. Which of the following additional findings will be most likely present in this patient? 

A 26-year-old man presented with “yellowing of the skin.”Two days earlier, the patient was started on trimethoprim-sulfamethoxazole for bacterial cystitis. The patient previously had a similar episode during college after a viral upper respiratory tract infection. Past medical history is notable for asthma, for which he currently uses an albuterol inhaler. Family history is notable for hypertension in his mother and peripheral vascular disease in his father. The patient’s vitals are within normal limits. Physical examination shows scleral icterus and jaundice of the skin. Peripheral blood smear reveals Heinz body and bites cells. Which of the following laboratory findings will be most likely present in this patient? 

A 57-year-old man presents with abdominal pain and fatigue. His symptoms began 4 months ago and have progressively worsened. In addition, he reports a 5 kg (11 lb) unintentional weight loss since symptom onset. The patient often wakes up at night drenched in sweat. Past medical history is notable for peripheral vascular disease and alcohol use disorder. The patient has a 40-pack-year smoking history. Physical examination shows jaundice and scleral icterus. Abdominal pain is most prominent in the epigastric region. Laboratory testing reveals the following findings: 

 Laboratory value              Result

·        Total bilirubin     5.2mg/dL

·        Conjugated bilirubin        4.6mg/dL

·        Alkaline phosphatase      96U/L

·        Aspartate transaminase                 110 U/L

·        Alanine transaminase      112U/L

·        Lipase*                  95 U/L  *Normalrange: 12-70 U/L  

Which of the following additional findings will be most likely present on this patient’s physical examination?    

A 24-year-old man presents for a routine wellness visit. The patient has no acute complaints. However, he does recall having jaundice and abdominal pain 3 weeks ago, after completing a marathon. The symptoms self-resolved after a few days. Laboratory testing reveals a total bilirubin level of 4.8 mg/dL and a conjugated bilirubin level of 4.2 mg/dL. Urine testing is positive for elevated coproporphyrin I levels. Which of the following additional findings will most likely be present in this patient?