Primary biliary cholangitis — MCCQE Part 1 MCQ

Correct answer: D — Start ursodeoxycholic acid and assess fibrosis and associated autoimmune disease

Start ursodeoxycholic acid and assess fibrosis and associated autoimmune disease is the single best answer because the age, timing, examination findings and investigations in the vignette fit Primary biliary cholangitis better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to Canadian Association for the Study of the Liver guidance, with attention to acuity, safety-netting and local provincial pathways.

Reference: Canadian Association for the Study of the Liver guidance