A 48-year-old woman presents with fatigue, pruritus, and jaundice. She has a history of ulcerative colitis. Laboratory tests reveal elevated bilirubin and alkaline phosphatase. What is the most likely diagnosis?

Correct Answer: C

Rationale: The most likely diagnosis is primary sclerosing cholangitis (PSC) based on the patient's symptoms of fatigue, pruritus, jaundice, and elevated bilirubin and alkaline phosphatase levels. PSC is commonly associated with inflammatory bowel disease, such as ulcerative colitis. The characteristic findings of elevated alkaline phosphatase and bilirubin levels are indicative of cholestasis, which is a key feature of PSC. Additionally, PSC is characterized by fibrosis and inflammation of the bile ducts, leading to bile duct strictures and subsequent liver damage. Hepatitis B would present with viral hepatitis symptoms and different lab findings. Primary biliary cirrhosis typically presents with elevated alkaline phosphatase and antimitochondrial antibodies. Autoimmune hepatitis would have elevated transaminases and autoantibodies. Therefore, based on the clinical presentation and lab results, PSC is the most likely diagnosis.

Correct Answer: B

Rationale: The correct answer is B: Hemochromatosis. In this case, the patient's symptoms of fatigue, arthralgia, darkening of the skin, elevated liver enzymes, and high serum ferritin levels point towards iron overload disorder. Hemochromatosis is a genetic condition characterized by excessive absorption and accumulation of iron in various organs, leading to liver damage and skin pigmentation. Wilson's disease (A) presents with copper accumulation, not iron. Alpha-1 antitrypsin deficiency (C) primarily affects the lungs and liver, not causing iron overload. Autoimmune hepatitis (D) does not typically present with elevated ferritin levels.

Correct Answer: B

Rationale: The correct answer is B: Hyperthyroidism. In this case, the low TSH and high free T4 levels indicate overproduction of thyroid hormones, leading to symptoms like fatigue, weight gain, and constipation. Low TSH is a result of negative feedback due to high T4 levels. Hyperthyroidism is characterized by an overactive thyroid gland, resulting in excess thyroid hormone production. Other choices are incorrect because hypothyroidism would show high TSH levels, thyroiditis typically presents with thyroid tenderness and inflammation, and thyroid cancer usually does not cause these hormonal imbalances.

Correct Answer: A

Rationale: The correct answer is A: Ulcerative colitis. This chronic inflammatory condition affects the colon and rectum, leading to symptoms like abdominal pain, diarrhea, and rectal bleeding. The patient's recurrent episodes and history of similar symptoms point towards ulcerative colitis. Irritable bowel syndrome (choice B) typically presents with abdominal pain, bloating, and changes in bowel habits but not rectal bleeding. Celiac disease (choice C) presents with gastrointestinal symptoms after consuming gluten. Diverticulitis (choice D) presents with localized abdominal pain and fever due to inflammation or infection of the diverticula, not typically with rectal bleeding.

Correct Answer: C

Rationale: The most likely diagnosis for a 65-year-old man with weight loss, jaundice, palpable mass in the right upper quadrant, elevated bilirubin, and alkaline phosphatase levels is pancreatic cancer. This is because the symptoms and findings are classic for pancreatic cancer, which commonly presents with obstructive jaundice due to compression of the common bile duct by the tumor. Weight loss is also a common symptom of pancreatic cancer. Gallstones typically present with acute episodes of biliary colic, not a palpable mass. Hepatitis typically presents with elevated liver enzymes, but not a palpable mass. Primary biliary cirrhosis presents with chronic cholestasis and autoimmune features, not a palpable mass.