Question of the Week # 335

335) A 75 year old hispanic man presents with right upper quadrant abdominal pain for past two weeks. He reports that the pain is excruciating and sharp when he takes a deep breath. He denies any recent trauma or fever or night sweats or cough. He reports lack of appetite and 30 lbs weight loss in the past 3 months. He immigrated to United States from Mexico about 15 years ago. He has no significant medical problems and has never been to a doctor in the past 25 years. A chest x-ray does not reveal any significant abnormalities. An ultrasound of the abdomen shows normal appearing gall bladder with gall stones but no evidence of cholecystitis. Common bile duct is within normal limits. Murphy’s sign is negative. Laboratory investigations reveal:

Total Protein : 7.5gm%

Albumin : 4.0gm%

Total bilirubin : 0.4 mg% ( N = 0.3 to 1.0 mg%)

AST : 30U/L (  N= 5 to 40U/L

ALT : 28 U/L (  N= 8  to 55U/L)

Alkaline Phosphastase ( ALP) : 750 U/L (  N= 4 to 130U/L)

GGTP : 40U/L (  N= 3 to 60U/L)

Which of the following is the most appropriate next step in management ?

A) Laparoscopic Cholecystectomy

B) HIDA scan

C) Bone Scan and Prostate Specific Antigen

D) Quantiferon Gold Test

E) MRI of the Pancreas


16 Responses

  1. C) Bone Scan and Prostate Specific Antigen

  2. C) Bone Scan and Prostate Specific Antigen

  3. C) Bone Scan and Prostate Specific Antigen
    because of old age,loss of apetite ,loss of weight,pain increase with inspiration with free liver +increase in ALK phosphatase acquire excluding bone metastasis from cancer prostate

  4. c

  5. E,

  6. C is the Answer

  7. i think it shud b E.. if it was prostate dea shud hv bn signs like urine retention etc

  8. MRI
    of pancras

  9. Hi,
    Can any one help?
    Where do we find the correct answers to these questions?
    I notice that the answer key is available only for the first 100 questions.

  10. B-Hida Scan

  11. bone scan and prostate specific antigen

  12. E- to r/o the tumor of pancreas (not its head that is mostly associated with compression of common duct and jaundice). prostate cancer does not behave like this- most likely mets deposits in bone,liver (nothing on liver US) and lungs (again nothing on CXR)

  13. ~E.

  14. no clear explanation? just make D/d

    what is the ans Dr. Red?

  15. c
    The laboratory findings in patients with pancreatic cancer are usually nonspecific. As with many chronic diseases, a mild normochromic anemia may be present.

    Thrombocytosis is also sometimes observed in patients with cancer.

    Patients presenting with obstructive jaundice show significant elevations in bilirubin (conjugated and total), alkaline phosphatase, gamma-glutamyl transpeptidase, and to a lesser extent, aspartate aminotransferase and alanine aminotransferase.

  16. 1. increased Alkaline Phosphatase can be due to both: biliary stasis and bone diseases.
    2. Normal GGT excludes pathology of biliary tract, liver and pancreas.
    Now Look for pathology in bones: Bone Scan and Prostate Specific Antigen. Answer is C.

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