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Review of Clinical Signs Review Questions

Pruritus: A Sign of Underlying Disease

Author: Bernard Karnath, MD

1. A 40-year-old woman presents for evaluation of mild pruritus, which she has had for the past year. She does not drink alcohol and takes no medications. Physical examination shows an enlarged, firm liver. Results of laboratory studies are: alkaline phosphatase, 736 U/L (normal, 70-230 U/L); aspartate aminotransferase, 100 U/L (normal, 7-40 IU/L); alanine aminotransferase, 160 U/L (normal, 0-40 IU/L); and serum bilirubin, 1.5 mg/dL (normal, 0.2-1.0 mg/dL). Hepatitis serologies are negative. Abdominal ultrasonography shows no focal hepatic lesions. What is this patient’s most likely diagnosis?
  1. Autoimmune hepatitis
  2. Laennec’s cirrhosis
  3. Nonalcoholic steatohepatitis
  4. Primary biliary cirrhosis
  5. Primary sclerosing cholangitis
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2. In addition to an ultrasound of the right upper quadrant, what is the next step in the management of the patient in question 1?

  1. Dermatology consultation
  2. Endoscopic retrograde cholangiopancreatography
  3. Liver biopsy
  4. Measurement of transferrin saturation
  5. Measurement of antimitochondrial antibody
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3. A 60-year-old man presents with progressive fatigue, dyspnea on exertion, and headaches over the past 8 months. He also reports intense pruritus after he takes a warm shower. On physical examination, splenomegaly is noted. Results of laboratory studies reveal: hematocrit, 61% (normal, 39%-54%); hemoglobin, 19.5 mg/dL (normal [male], 14-18 mg/dL); leukocyte count, 18 × 103/µL (normal, 4.5 × 11 - 103/µL]; and platelet count, 554 × 103/µL (normal, 150-450 × 103/µL). What is this patient’s most likely diagnosis?
  1. Chronic myelogenous leukemia (CML)
  2. Essential thrombocytosis
  3. Myelofibrosis
  4. Polycythemia vera
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4. What is the next step in evaluation of the patient in question 3?

  1. Red cell mass determination
  2. Bone marrow biopsy
  3. Serum protein electrophoresis
  4. Cytogenetic studies
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