American Board of Internal Medicine (ABIM) Certification Practice Exam

What clinical presentation may indicate a need for liver biopsy in suspected primary sclerosing cholangitis?

1. Presence of jaundice

2. Small-duct disease

3. Recent weight gain

4. Elevated glucose levels

The correct answer is: Small-duct disease

The presence of small-duct disease is an important clinical presentation that can indicate a need for liver biopsy in suspected primary sclerosing cholangitis (PSC). Primary sclerosing cholangitis is typically characterized by the inflammation and scarring of the bile ducts, often associated with large duct involvement. However, small-duct PSC can present with symptoms and laboratory findings that mimic other chronic liver diseases, making diagnosis challenging. In patients suspected of having small-duct PSC, a liver biopsy can be crucial for differentiating between PSC and other diseases that may cause similar liver damage or biliary pathology, such as autoimmune hepatitis or primary biliary cholangitis. A liver biopsy can help assess for characteristic histological changes associated with PSC and provide clarity in cases where imaging does not reveal classic findings. While the presence of jaundice, recent weight gain, and elevated glucose levels may be seen in patients with liver disease, these signs do not specifically indicate the need for a biopsy in the context of suspected PSC. Jaundice is a common symptom in many liver conditions, and weight gain or elevated glucose levels could be due to a variety of non-specific causes unrelated to PSC. Thus, when small-duct disease is suspected, a liver biopsy is necessary to establish