An Asymptomatic 48-Year-Old Caucasian Female with a History of Hypothyroidism Is

question 254

Multiple Choice

An asymptomatic 48-year-old Caucasian female with a history of hypothyroidism is being evaluated for abnormal liver function tests.  She has no other medical problems.  She takes thyroxine for the hypothyroidism.  She takes no herbal medication.  She never smoked or used IV drugs, and rarely drinks alcohol.  Her family history is unremarkable.  Her blood pressure is 120/80 mmHg, pulse is 72/min, temperature is 36.7C (98F) and respirations are 14/min.  The physical examination is normal, except for mild, painless hepatomegaly.  The initial lab test results are as follows:
What is the most appropriate next step in the management of this patient?

• A)Check gamma-glutamyl transferase
• B)Measure antinuclear antibodies and anti-smooth muscle antibodies
• C)Order antimitochondrial antibody tests
• D)Perform endoscopic retrograde cholangiopancreatography (ERC
• E)Test for alpha-1 antitrypsin deficiency