Answer :USMLE step 2 Mcq 30:A 67 year old man complains of pain in his epigastrium that radiates to his back and unexplained weight loss


Correct Answer: B
The most likely cause of the jaundice in this scenario is an obstruction of the common bile secondary to the pancreatic carcinoma. Since the obstruction is outside the liver, it is called extrahepatic obstructive jaundice. The obstruction is preventing the passageway of already conjugated bilirubin, thus explaining the conjugated hyperbilirubinemia and normal unconjugated bilirubin. Light colored stools and dark urine are constant with extrahepatic jaundice.If the obstruction to bile flow were within the bile canaliculi it would be called intrahepatic obstructive jaundice. There is nothing in this scenario suggests an intrahepatic obstruction to bile flow.When the liver is not functioning properly in the handling of bilirubin, it leads to hepatocellular jaundice. Nothing in this scenario suggests hepatocellular dysfunction.In hemolytic jaundice, red blood cells are destroyed faster than the bilirubin is able to be processed by the liver. In hemolytic jaundice one would see an unconjugated hyperbilirubinemia, not a conjugated hyperbilirubinemia, as in this case


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