Anyone free to do cases today?

Just a disclaimer that these cases are not actual patients. Or they may be actual patients but they are certainly not mine since these questions come from the clinical vignettes from our in-service exams.

A 62/M presented at your clinic with a 1-month history of painless jaundice. On history, there is associated weight loss (5 kgs), tea-colored urine with no acholic stools. What other tests will you request to come up with a diagnosis?


Some sort of bile duct obstruction. Biliary POCUS & longitudinal view of gallbladder, UA bilirubin, AST/ALT/CBC. Maybe CT/ERCP later.


Ultrasound as the first step. Cheaper, easier, doesn't delay additional investigation if needed.
That's my answer as well but the answer key is very different LOL.

I'll wait for more ideas before I send the answers.

I'm not really sure why the answer key says something different.


Active member
I’m thinking hepatic malignancy (HCC) - CBP, LFT, serum enzymes, serum bilirubin, Hepatitis serologies, USG abdomen, CA 19-9, CEA, AFP, serum amylase, serum lipase, CECT abdomen, MRCP, PET, liver biopsy, (celiac angiography?)

I maybe totally wrong LMAO.
Which one of those tests could help arrive at the diagnosis? The answer key only states one and you have to explain what you're looking for in the test.


Active member
I don't know. Liver biopsy? Because it confirms cancer if present? But I think you’d have to rule out other causes of jaundice first before performing liver biopsy.
Yes, you should. Liver biopsy is done when you are almost certain that it's malignancy.

And most of the time you don't even biopsy anymore.
I'm also trying to understand why the answer key is different from my answer though. They gave us the answers but not the explanation.
Should I give the answer now? I wanted to have more opinions on it so I could find out if anyone would come up with it on their own.


"Most of the time you don't biopsy". What?

Unless you're sure it's a small hepatocellular carcinoma that you're ablating (which is unlikely to cause these symptoms) I think you'd always biopsy a liver mass. could be met, could be intrahepatic cholangio, etc.

And even the ones that get ablated usually are biopsied at the same time.