Question

A 59-year-old man develops fatigue and decreased appetite 3 months after receiving a mechanical aortic valve replacement. His pulse is 88/min, respirations are 12min, and blood pressure is 140/54 mm Hg. He appears tired. Physical examination shows mild scleral icterus. Jugular venous pressure is 8 cm H-0, and carotid upstrokes are normal. Lung fields are clear. Cardiac examination shows crisp prosthetic valve sounds and a grade 2/6, decrescendo diastolic murmur at the left sternal border. Abdominal examination shows no tenderness, normal liver size, and normal bowel sounds. Laboratory studies of serum show a total bilirubin concentration of 4 mg/dL and a direct bilirubin concentration of 1 mg/dL. Which of the following is the most likely cause of the jaundice in this patient? A) Cholelithiasis B) Cholestasis C) Hemolysis D) Hepatorellular disease E) Passive congestion

          A 59-year-old man develops fatigue and decreased appetite 3 months after receiving a mechanical aortic valve replacement. His pulse is 88/min, respirations are 12min, and blood
pressure is 140/54 mm Hg. He appears tired. Physical examination shows mild scleral icterus. Jugular venous pressure is 8 cm H-0, and carotid upstrokes are normal. Lung fields
are clear. Cardiac examination shows crisp prosthetic valve sounds and a grade 2/6, decrescendo diastolic murmur at the left sternal border. Abdominal examination shows no
tenderness, normal liver size, and normal bowel sounds. Laboratory studies of serum show a total bilirubin concentration of 4 mg/dL and a direct bilirubin concentration of 1 mg/dL.
Which of the following is the most likely cause of the jaundice in this patient?
A) Cholelithiasis
B) Cholestasis
C) Hemolysis
D) Hepatorellular disease
E) Passive congestion

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