A 35-year-old male patient presents with right upper quadrant pain, fever for the past 48 hours, preceded by new onset jaundice over the past few weeks. He states that he has had diarrhea on and off for several years but never had this investigated. A liver ultrasound is negative for gallstones or evidence of cholecystitis. His lab tests reveal total bilirubin 6.2, alkaline phosphatase 450, AST 150, ALT 120, albumin 2.6. The next diagnostic test of choice would be

Correct Answer: B

Rationale: Magnetic resonance cholangiopancreatography to diagnose intrahepatic strictures associated with primary sclerosing cholangitis, and to exclude other causes of intrahepatic cholestasis. The patient likely has undiagnosed ulcerative colitis. If confirmed, an urgent endoscopic retrograde cholangiopancratogram may be helpful to drain any pockets of obstructed bile flow. Liver biopsy is nondiagnostic in PSC, and should not be performed in the setting of acute cholangitis.

Correct Answer: A

Rationale: The urea breath test detects H. pylori by measuring urease activity, which is crucial for diagnosing and managing PUD caused by this bacteria.

Correct Answer: B

Rationale: Clear fluids and a light diet can soothe the stomach and reduce nausea without exacerbating PUD symptoms.

Correct Answer: C

Rationale: A bland diet minimizes irritation and supports healing in a recovering bleeding ulcer.

Correct Answer: B

Rationale: Avoiding smoking and alcohol reduces irritation and acid production, key to preventing PUD recurrence.