ROSH Gastrointestinal Practice Exam

What is the next best imaging study for a woman with dark urine and jaundice after physical examination?

1. Abdominal CT scan

2. Endoscopic retrograde cholangiopancreatography

3. Right upper quadrant ultrasound

4. Upper GI series

The correct answer is: Abdominal CT scan

In the context of a woman presenting with dark urine and jaundice, the clinical suspicion is often directed towards hepatobiliary issues, such as obstructive jaundice due to a stone in the bile duct or other conditions related to liver dysfunction. The most appropriate next step in imaging after physical examination is to perform a right upper quadrant ultrasound. This ultrasound is non-invasive and excellent for visualizing the liver, gallbladder, and biliary tree, making it an ideal first-line study in this scenario. It can help determine the cause of jaundice, assess for biliary obstruction, and identify gallstones or potential masses. While an abdominal CT scan is useful for a more comprehensive view of the abdomen, it is not the immediate next step in the evaluation of jaundice, particularly given the simpler and more direct benefits of an ultrasound. Endoscopic retrograde cholangiopancreatography is typically considered for therapeutic intervention after imaging has suggested a specific obstruction or issue but is not the recommended initial imaging study. An upper GI series primarily assesses the esophagus, stomach, and duodenum, which would not provide relevant information for the jaundice and dark urine symptoms. Hence, the right upper quadrant ultrasound stands out as the next best imaging study in