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Retired NBME Step 2 CK Form 8 Answers

step2ck_form8/Block 4/Question#8 (reveal difficulty score)
A 32-year-old man comes to the physician ...
Primary sclerosing cholangitis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: GI DDX

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submitted by โˆ—step_prep2(66)
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  • Young man with ulcerative colitis who presents with fatigue, dark urine, mild jaundice, with a cholestatic pattern on LFTs (alk phos > ALT/AST), most consistent with primary sclerosing cholangitis
  • Primary sclerosing cholangitis: Classically seen in middle-aged men with ulcerative colitis, leads to beading of intra and extra-hepatic bile ducts on ERCP/MRCP, who has positive p-ANCA and elevated IgM
  • Primary biliary cholangitis: Classically seen in a middle-aged woman with other autoimmune diseases who has granulomas with lymphocytic infiltrate on biopsy, positive anti-mitochondrial antibody and elevated IgM

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