6 Months Of Intermittent in Medicine / Internal Medicine — 38yo Woman | Gastroenterology | SMLE Q#17909
SMLE Question #17909
Medicine / Internal Medicine
Gastroenterology
Objective: OBJ-433
Last updated: January 2026
A 38-year-old woman presents to the outpatient clinic with 6 months of intermittent right upper quadrant abdominal pain that is worse after fatty meals. Episodes are sometimes associated with nausea and non-bloody vomiting. Over the last week, she noticed yellowing of her eyes and dark urine. She is afebrile.
Lab results:
- Total bilirubin: 4.2 mg/dL (direct 3.1 mg/dL)
- AST: 118 U/L
- ALT: 132 U/L
- Alkaline phosphatase: 410 U/L
- GGT: 220 U/L
Which is the most important initial diagnostic tool to evaluate her suspected biliary obstruction?
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