Step 2

Pediatrics 1

An O+ four-week-old infant boy is brought into the office with his mother because over the last two weeks she has noticed her son is looking “yellow”. He was born at 39 weeks’ gestation by normal spontaneous vaginal delivery with no complications to a 30-year-old mother, with regular prenatal care, whose blood type is O+. The mother states he has been breastfeeding every 2-3 hours for 15 minutes on each breast. The boy currently has 5 wet diapers and 5-6 bowel movements with pale colored stools. Vitals are normal. Physical exam is notable for jaundice from head to toe, normal heart and lung sounds, and liver edge palpable 4 cm below the right costal margin. CBC and liver panel results are below:

Complete blood count:
Hemoglobin: 13.5
Hematocrit: 40%
Platelets: 145,000
Leukocytes: 4500

Liver panel:
Total Bilirubin: 9 mg/dL
Direct Bilirubin: 7.2 mg/dL
Alkaline Phosphatase: 600 IU/I
Gamma Glutamyl Transferase (GGT): 275 IU/I
Aspartate aminotransferase (AST): 190 IU/I
Alanine aminotransferase: (ALT): 150 IU/I

What is the next best step in managing this patient?

  • A) Coomb’s Test
  • B) Abdominal Ultrasound
  • C) Alpha-1 antitrypsin level
  • D) Intraoperative cholangiography
  • E) Magnetic Resonance Cholangiopancreatography (MRCP)


Dr. Raj Dasgupta


Dr. Raj Dasgupta

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