A 26-Year-Old Woman Comes to the Office Due to Yellowish

question 1685

Multiple Choice

A 26-year-old woman comes to the office due to yellowish discoloration of the eyes and dark urine for the past several days.  She has no abdominal pain, anorexia, or nausea.  The patient has been told a few times that her eyes look yellow in the past.  She has no significant medical history other than mild acne vulgaris.  The patient started taking oral contraceptives 2 weeks ago.  Her father has diabetes mellitus, and her grandfather has heart failure.  The patient is a doctoral student and moved to the United States from abroad a year ago.  Vitals signs are normal.  Examination shows mild scleral icterus.  Laboratory results are as follows: During further evaluation, the sample from a liver biopsy shows dark, granular pigments in the hepatocytes.  Which of the following is the most likely cause of this patient's current condition?

• A)Common bile duct obstruction
• B)Decreased bilirubin glucuronidation
• C)Episodic intravascular hemolysis
• D)Hepatic iron overload
• E)Impaired hepatocyte bilirubin excretion
• F)Viral hepatocyte infection

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