What is the most likely diagnosis in a 30-year-old woman with right upper quadrant pain, fever, and jaundice, along with elevated white blood cell count and bilirubin levels?

Correct Answer: C

Rationale: The correct answer is C: Acute cholangitis. In a 30-year-old woman with right upper quadrant pain, fever, jaundice, elevated white blood cell count, and bilirubin levels, acute cholangitis is the most likely diagnosis. This condition is characterized by inflammation of the bile ducts, often due to obstruction, leading to symptoms such as pain, fever, and jaundice. The combination of right upper quadrant pain, fever, jaundice, and elevated white blood cell count and bilirubin levels suggests an infection in the biliary system, which is typical of acute cholangitis. Acute hepatitis (choice A) typically presents with elevated liver enzymes but may not have the same degree of biliary obstruction symptoms. Acute cholecystitis (choice B) usually presents with gallbladder inflammation and may not cause jaundice. Pancreatic cancer (choice D) typically presents with different symptoms and is less common in a

Correct Answer: B

Rationale: The correct answer is B: Esophageal cancer. Given the patient's age, symptoms of difficulty swallowing and weight loss, along with a history of chronic heartburn not responding to proton-pump inhibitors, esophageal cancer is the most likely diagnosis. Esophageal cancer commonly presents with dysphagia, weight loss, and a history of chronic reflux. Peptic stricture (A) typically presents with dysphagia but is less likely given the worsening symptoms despite treatment. Achalasia (C) presents with dysphagia and regurgitation, but not typically with weight loss. Esophageal spasm (D) presents with chest pain and dysphagia, but not typically with weight loss or chronic heartburn.

Correct Answer: A

Rationale: The most likely diagnosis is Primary biliary cirrhosis (PBC). PBC typically presents with jaundice, pruritus, and dark urine due to impaired bile flow. Elevated bilirubin and alkaline phosphatase levels are common in PBC. Imaging findings of dilated intrahepatic bile ducts and a normal common bile duct support the diagnosis of PBC. Primary sclerosing cholangitis (Choice B) would show strictures and beading of bile ducts on imaging. Gallstones (Choice C) would typically present with a common bile duct obstruction. Pancreatic cancer (Choice D) may present with similar symptoms but is less likely given the specific imaging findings in this case.

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: Celiac disease. The patient's symptoms of abdominal pain, bloating, diarrhea, and improvement with fasting are classic for celiac disease, an autoimmune condition triggered by gluten ingestion. Her iron deficiency anemia can be attributed to malabsorption common in celiac disease. Irritable bowel syndrome (A) typically presents with abdominal pain relieved by defecation, not fasting. Lactose intolerance (C) results in symptoms after consuming dairy, not necessarily improved by fasting. Crohn's disease (D) may present similarly, but the improvement with fasting and iron deficiency anemia point more towards celiac disease in this case.