USMLE step 2 Mcq 356:A 70 year old man presents to his general practitioner complaining of dull and boring pain which radiates to the back

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Question:
A 70 year old man presents to his general practitioner complaining of dull and boring pain which radiates to the back. He has found that the pain intensifies by lying down and tends to be relieved by crouching forward. On questioning he admits to smoking 25 cigarettes daily,and to losing 12 pounds(5 kg) over the last 2 months. On examination he is found to be cachexic, he was afebrile, and appears jaundiced. Abdominal palpation reveals a mass in the upper abdomen under the right costal margin. The most likely cause for this man's jaundice is

a) a malignant lesion of the head of the pancreas
b) stones in the common bile duct
c) hepatocellular carcinoma
d) hepatitis B
e) gall bladder carcinoma


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