Arab Board Pediatrics Final Written Practice Questions - Arab Board Pediatrics Final Written Examination (ABHS) Exam

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A 4-week-old full-term infant is evaluated for persistent jaundice that began on day 10 of life. The parents note that the infant's stools are persistently clay-colored (acholic) and urine stains the diaper dark yellow. Physical examination reveals firm hepatomegaly without splenomegaly. Laboratory studies show total bilirubin 145 umol/L, direct (conjugated) bilirubin 112 umol/L, AST 180 U/L, ALT 165 U/L, and GGT 680 U/L. Abdominal ultrasonography reveals an absent gallbladder and a triangular cord sign at the porta hepatis. What is the definitive management step?

Start oral phenobarbital and repeat ultrasound in 4 weeks Urgent intraoperative cholangiogram and Kasai portoenterostomy (hepatoportoenterostomy) Initiate exclusive extensively hydrolyzed protein formula Perform percutaneous liver biopsy followed by watchful waiting until 6 months of age

Correct Answer:

Urgent intraoperative cholangiogram and Kasai portoenterostomy (hepatoportoenterostomy)

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