asmi
Forum Hero
Topics: 1043
Posts: 4,609
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A 27-year-old African-American male visits his primary care physician
because of recent onset of "yellowness in the white of his eyes." His
recent history is significant for a "chest cold" for which he is taking
trimethoprim-sulfamethoxazole; he is also taking fluoxetine for
depression. On exam, the sclera are icteric and the mucosa beneath
the tongue appears yellow. No hepatosplenomegaly is present.
Laboratory studies are as follows:
Hemoglobin-11.1 g/dl
Hematocrit-34%
Total bilirubin-6.2 mg/dl
Conjugated (direct) bilirubin-0.8 mg/dl
Alkaline phosphatase-77
AST (SGOT)-24
ALT (SGPT)-22
The most likely cause of this patient's jaundice is
A. acute infectious hepatitis
B. cholestatic liver disease
C. drug reaction from fluoxetine
D. drug reaction from trimethoprim-sulfamethoxazole
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| Sakaki-
Forum Senior
Topics: 1
Posts: 238
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B
The clinical symptoms seem to indicate scleral icterus, and the conjugated bilirubin is elevated without accompanying elevations in ALT and AST, suggesting a case of cholestatic liver disease.
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| asmi
Forum Hero
Topics: 1043
Posts: 4,609
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no..try again
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| usmleasr
Forum Guru
Topics: 105
Posts: 970
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it is ..D...drug reaction from sulfa.....(unconj hyper bilurubinemia.....african american..think of G6PD def) 
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| asmi
Forum Hero
Topics: 1043
Posts: 4,609
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u r right
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