Welcome to another MedGuide clinical presenation quiz. This time its jaundice. One of those medical terms, for once, not derived from Latin or Greek – but French! Bonne chance!
Reviewed by: awaiting review
Approach to the Patient with Jaundice
Stem 1 of 5
A 59YOM presents with his concerned partner. She has noticed weight loss over the last six months and the patient appears apathetic with sunken eyes. He states, with flat affect, that he has been unable to sleep recently as he has been constantly scratching his arms and torso.
What is the best matched differential?
Primary sclerosing cholangitis
Stem 2 of 5Which of the following examination findings are least likely in this patient?
Grey Turner sign
Stem 3 of 5Ultrasound scan shows a mass in the tail of the pancreas. When considering resection of this region of parenchyma, which major vessel runs superior to this structure?
Stem 4 of 5Which is the gold-standard diagnostic test in this patient?
Abdominal ultrasound scan
Endoscopic retrograde cholangiopancreatography
Liver function test
Pancreatic protocol CT
Stem 5 of 5Results show a resectable mass, stage II. Which of the following is the most appropriate first line management?
Stereotactic body insertion
Stem 1 of 3
A patient presents with worsening tiredness, concerned about early satiety and weight loss. He has a known diagnosis, and family history, of hereditary spherocytosis.
Given the most likely diagnosis, which of the following investigations would be most helpful in the work-up?
Hepatitis A screening antigen test
Hepatitis C screening antigen test
White blood cell count
Stem 2 of 3According to NICE (2020), when does serum bilirubin become outwardly noticeable?
Stem 3 of 3Gilbert’s syndrome has a 3% prevalence in the UK population. Whilst normally benign, it can cause prehepatic jaundice. Which of the following enzymes are deficient in this condition?
Stem 1 of 5
A home visit is undertaken at a shelter for a 44YOM who is a known IVDU. He has requested medical assistance because his sclera is getting “more yellow each week!”. He has felt very tired and been vomiting most mornings for the last two weeks. Collateral history from his counselor notes that the patient is becoming increasingly confused and agitated and a new onset resting tremor has developed in his right hand.
The patient has routine screenings ordered with a positive HBsAg. What does this tell you about the disease?
The patient has IgM antibodies to the hepatitis B virus.
The patient was infected with HBV but it now not contagious
The patient was infected within the last six months
The patient was likely contaminated via the faeco-oral route
The patient was most likely infected in the last two weeks.
Stem 2 of 5What does the routine HBcAg test screen for?
Mitochondria of HBV
Secretions of HBV
The cell membrane of HBV
The DNA of HBV
The flagellum of HBV
Stem 3 of 5Which of the following statements is true about the HBV?
HBcAg is present throughout the infection of the virus
Anti-HBs is when the patient is highly contagious
Anti-HBe is when HBeAg is active in the serum
HBsAg is an antigen to core cytosolic HBV matter
HBeAg is indicative of a difficult phase of HBV transmission
Stem 4 of 5Which of the following is best matched to the hepatitis D virus?
Commonly an outbreak agent in developing world regions.
HDV is usually spread haematogenously.
Hepatitis B vaccines confer immunity to HDV.
Mostly transmitted through contaminated food supply.
Present in the faeces of infective people.
Stem 5 of 5Which of the following titres are required to rise before the patient could have non-transmissible, non-barrier protection sex with a partner?
Spotted an error?
- BMJ. (2020). Jaundice. Available: https://bestpractice.bmj.com/topics/en-gb/127/aetiology. Last accessed Sept 2020.
- Moore’s Clinically Oriented Anatomy – 12th Edition
- NICE CKS. (2020). Jaundice. Available: https://cks.nice.org.uk/topics/jaundice-in-adults/background-information/causes/#gilberts-syndrome. Last accessed Sept 2020.
- World Health Organisation. (2020). Hepatitis Information. Available: https://www.who.int/news-room/q-a-detail/what-is-hepatitis. Last accessed Sept 2020.