#oldrecallmccqe1
A 60-year-old woman presents with complaints of chronic fatigue and mild pruritus. She has a history of rheumatoid arthritis and autoimmune thyroiditis. On examination, her liver is modestly enlarged, firm, and nontender; skin xanthomas are noted. Routine serum chemistry studies show:
Sodium 141 mEq/L
Potassium 5.1 mEq/L
Chloride 102 mEq/L
Bicarbonate 25 mEq/L
Albumin 4.1 g/dL
Urea nitrogen 25 mg/dL
Bilirubin, total 1.3 mg/dL
Creatinine 0.8 mg/dL
AST 55 U/L
ALT 48 U/L
Alkaline phosphatase 240 U/L
Follow-up laboratory studies demonstrate a serum gamma-glutamyl transpeptidase level of 150 U/L, and a serum cholesterol of 240 mg/dL. Immunoglobulin studies reveal a marked elevation of serum IgM. Ultrasound demonstrates diffuse enlargement of the liver without marked echogenicity. Endoscopic retrograde cholangiography demonstrates an intact extrahepatic biliary tree accompanied by stricture and loss of ducts within the liver itself. Liver biopsy shows a florid bile duct lesion with patchy inflammation and destruction of septal and interlobular bile ducts. Antibodies directed against which of the following antigens are present in up to 95% of patients with this disease?
(A) Double-stranded DNA
(B) Hepatitis A virus
(C) Hepatitis B core antigen
(D) Hepatitis C virus
(E) Mitochondria
A 60-year-old woman presents with complaints of chronic fatigue and mild pruritus. She has a history of rheumatoid arthritis and autoimmune thyroiditis. On examination, her liver is modestly enlarged, firm, and nontender; skin xanthomas are noted. Routine serum chemistry studies show:
Sodium 141 mEq/L
Potassium 5.1 mEq/L
Chloride 102 mEq/L
Bicarbonate 25 mEq/L
Albumin 4.1 g/dL
Urea nitrogen 25 mg/dL
Bilirubin, total 1.3 mg/dL
Creatinine 0.8 mg/dL
AST 55 U/L
ALT 48 U/L
Alkaline phosphatase 240 U/L
Follow-up laboratory studies demonstrate a serum gamma-glutamyl transpeptidase level of 150 U/L, and a serum cholesterol of 240 mg/dL. Immunoglobulin studies reveal a marked elevation of serum IgM. Ultrasound demonstrates diffuse enlargement of the liver without marked echogenicity. Endoscopic retrograde cholangiography demonstrates an intact extrahepatic biliary tree accompanied by stricture and loss of ducts within the liver itself. Liver biopsy shows a florid bile duct lesion with patchy inflammation and destruction of septal and interlobular bile ducts. Antibodies directed against which of the following antigens are present in up to 95% of patients with this disease?
(A) Double-stranded DNA
(B) Hepatitis A virus
(C) Hepatitis B core antigen
(D) Hepatitis C virus
(E) Mitochondria
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