USMLE step 2 Mcq 306:Mary is a 22 year old IV drug user, light alcohol user, and cigarette smoker

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Question:
Mary is a 22 year old IV drug user, light alcohol user, and cigarette smoker. She has developed right upper quadrant abdominal pain and has had several days of nausea and vomiting along with a mild fever. She also has been noticing arthralgia. Ironically, Mary notices a paradoxical distaste for smoking. One week later, the sclera of her eyes become yellow and her skin develops a yellowish hue. She goes to the free clinic. Upon questioning during the medical history, she comments that she is 'very careful' who she shares her needles with. She only shares with her three sexual partners and her five best girlfriends. On physical exam, she is found to have an enlarged, tender liver. Her laboratory tests show dramatically elevated liver enzymes. Her alpha fetoprotein test is negative. What condition is most likely?

a) primary biliary cirrhosis
b) hepatitis B
c) hepatocellular carcinoma
d) Laennec's cirrhosis
e) Gilbert's syndrome


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