A 43-Year-Old Man Comes to the Office Due to Yellowing

question 260

Multiple Choice

A 43-year-old man comes to the office due to yellowing of the skin over the past several days.  He has had no fever or abdominal pain and has not traveled recently or received blood transfusions.  The patient has also experienced increased shortness of breath with exercise over the past few months.  He has no other medical conditions and takes no medications.  The patient drinks 1 or 2 glasses of wine on social occasions and does not use tobacco or illicit drugs.  His father died of liver cirrhosis attributed to alcohol use.  On physical examination, expiration is prolonged and there are scattered bilateral wheezes.  Laboratory results show total bilirubin of 4.1 mg/dL and alanine aminotransferase of 90 U/L.  Viral hepatitis serology is negative.  Chest x-ray shows hyperlucency of lung fields and flattening of the diaphragm.  Abdominal ultrasound reveals increased liver span and echogenicity of the liver parenchyma but no masses.  Which of the following is the most likely underlying cause of this patient's symptoms?

• A)Autoimmune injury of the intrahepatic bile ducts
• B)Decreased UDP-glucuronosyltransferase activity
• C)Defective chloride transport at epithelial surfaces
• D)Defective transport and accumulation of copper
• E)Inherited deficiency of a serine protease inhibitor
• F)Unregulated gastrointestinal iron absorption

---

Definitions:

Government

The governing body of a nation, state, or community, which provides leadership, makes laws, and manages public services and resources.

Lives

The existence of individuals or organisms, characterized by growth, reproduction, and the capacity for continual change preceding death.

Liberties

Fundamental rights and freedoms that are protected from infringement by the government or other entities, such as freedom of speech and religion.

Written Constitution

A formally documented constitution that outlines the system of government and fundamental laws of a nation or state.