QuestionSBA
QuestionChoice
Hepatocellular carcinoma is another important differential but is unlikely in this case. HCC classically presents with signs of liver cirrhosis. These include jaundice, right upper quadrant pain, ascites, pruritis, and splenomegaly. Furthermore, the double duct sign is not seen in hepatocellular cancer.
10000282
b
Hepatocellular carcinoma
QuestionChoice
Chronic pancreatitis is an important differential but is not the diagnosis in this case. Chronic pancreatitis is most commonly caused by alcohol abuse which is not present in this patient's history. Dull epigastric pain is also present in 80% of chronic pancreatitis cases and is typically worst after a meal or on sitting forward. Finally, a CT scan would likely reveal pancreatic calcifications that are not present in this case.
10000284
d
Chronic pancreatitis
QuestionChoice
Acute cholangitis is an infection of the biliary tree and is an unlikely diagnosis in this case. Acute cholangitis often presents with fever, jaundice, and right upper quadrant pain. The absence of pain and fever and the 5-week history are strong factors against this diagnosis.
10000283
c
Acute cholangitis
QuestionChoice
Choledocholithiasis is the presence of gallstones in the bile ducts and is an important differential for obstructive jaundice. This condition presents with colicky right upper quadrant/epigastric pain often worse after a meal. As there is no pain in this presentation and the double duct sign is present, pancreatic cancer is the most likely diagnosis.
10000285
e
Choledocholithiasis
QuestionChoice
This patient is suffering from pancreatic cancer. Painless obstructive jaundice is a classical presentation of this disease. Smoking is also an important risk factor. Combined with dilatation of the common bile duct and pancreatic duct (double duct sign), these factors indicate a diagnosis of pancreatic cancer.
10000281
a
Pancreatic Cancer
Concept
Chapter
2693
3734
Pancreatic Cancer
Topic
136
Gastroenterology
12603
A 57-year-old female presents to General Practice with a 5-week history of painless jaundice, pale stools, and dark urine. She is referred for an abdominal CT scan which reveals the "double duct" sign. She reports a smoking history of 25 pack years.

Which of the following is the most likely diagnosis?
a