Page Contents
OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is Gilbert syndrome. While this may seem a odd practice, it is useful to see multiple examples of how Gilbert syndrome will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each topic has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for Gilbert syndrome.
Chief Complaints:
- Jaundice with NO other symptoms (with the exception of a separate illness that is also being experienced by the patient)
Patient History:
- Young patient: typically seen in teenagers/young adults. Sometimes can be seen in older patients as well.
- Recent/current stress: recent operation, rigorous academic commitments, etc.
Clinical Workup:
- Indirect bilibrubinemia: this condition is characterized by an ISOLATED indirect bilibrubinemia
- No other findings should be present on the workup that could explain the bilibrubinemia
QUESTION EXAMPLES
Question # 1
Two days after undergoing surgery a 25 year old man develops jaundice. He has no fever, nausea, vomiting, or any abodminla pain. His physical exam is unremarkable except for mild scleral icterus. Labs are collected and shown below:
- Hemoglobin: 16.2 g/dL
- Total bilirubin: 3.7 mg/dL
- Direct bilirubin: 0.3 mg/dL
- Alkaline phosphatase: 36 U/L
- AST: 15 U/L
- ALT: 12 U/L
- Lactate dehydrogenase: 122 U/L
What is the likely diagnosis in this patient?
Explanation #1
Increased indirect bilirubin + recent stress (surgery) + no other abnormalities = Gilbert syndrome
Question # 2
A 20 year old man comes to the clinic because he has noticed the yellowing of his eyes, and he has also noticed that his urine is darker then it has been in the past. He has no other medical issues and does not have any other symptoms. He immigrated from Armenia as part of a student exchange program, and he has been feeling very stressed with his schoolwork. His temperature is 98.7°F, blood pressure is 125/80 mm Hg, and pulse is 78/min. He has scleral icterus, however the rest of his physical exam is unremarkable. Lab results are shown below:
- Total bilirubin: 3.5 mg/dL **
- Direct bilirubin: 0.7 mg/dL
- ALP: 45 U/L
- AST: 35 U/L
- ALT: 20 U/L
What is the likely diagnosis in this patient?
Explanation # 2
Increased indirect bilirubin + recent stress (surgery) + no other abnormalities = Gilbert syndrome
Question # 3
A 17 year old male comes to the surgery clinic for a follow up visit after having a laparoscopic appendectomy 4 days ago. He was initially hospitalized for abdominal pain, nausea, vomiting, and a fever. He was found to have a retrocecal appendicitis and an emergent appendectomy was performed without complications. He was discharged 1 day after the operation. Today his parents have noticed a yellowing of his eyes, however the patient denies any symptoms since his operation. He is recovering well and tolerating a regular diet without issue. His temperature is 98.6°C, blood pressure is 120/80 mm Hg, and pulse is 70/min. A physical examination shows mild scleral icterus, but is otherwise unremarkable. His abdominal exam reveals well healing surgical incisions. The rest of the physical exam is unremarkable. Labs are shown below:
CBC:
- Hemoglobin: 14.5 g/dL
- Platelets; 280,000/mm³
- Leukocytes: 7,600/mm³
LFTs:
- Total bilirubin: 3.5 mg/dL **
- Direct bilirubin: 0.5 mg/dL
- ALP: 65 U/L
- AST: 25 U/L
- ALT: 20 U/L
What is the likely diagnosis in this patient?
Explanation # 3
Jaundice + increased indirect bilirubin + recent stress (surgery) + no other abnormalities = Gilbert syndrome
Question # 4
A 21 year old male comes to the clinic with mild jaundice. A medical history reveals that he was just on a “intense” hiking trip. His vitals are within normal limits, and his physical exam is unremarkable. Labs are drawn and are listed below:
- Albumin: 4.0 mg/dL
- Total bilirubin: 3.0 mg/dL***
- Direct bilirubin: 0.3 mg/dL***
- ALP: 75 U/L
- AST: 30 U/L
- ALT: 33 U/L
What is the most likely diagnosis in this patient?
Explanation # 4
Jaundice + recent stress (hiking trip)+ increased indirect bilirubin + no other abnormalities = Gilbert syndrome
Question # 5
A 40 year old male comes to the clinic for a follow up visit a week after his recent appendectomy. A physical exam reveals a well healing surgical incision. Scleral icterus is also present. Labs are ordered and are shown below:
- Hemoglobin: 13.4 g/dL
- Total bilirubin: 3.3 mg/dL***
- Direct bilirubin: 0.3 mg/dL***
- ALT: 28 U/L
- AST: 31 U/L
What is the likely diagnosis in this patient?
Explanation # 5
Jaundice + recent stress (surgery)+ increased indirect bilirubin + no other abnormalities = Gilbert syndrome
Question # 6
A 25 year old male comes to the clinic because he has had muscle aches, chills, and a fever for the past week. His friends have also noticed that his eyes appear to be yellow. He denies any changes in color to his stool or urine. His past medical history is unremarkable, and he has no travel history. His vitals are currently within normal limits. A physical exam is only notable for scleral icterus. Labs are drawn and are shown below:
- Total bilirubin: 3.0 mg/dL***
- Direct bilirubin: 0.2 mg/dL***
- ALP: 35 U/L
- AST: 20 U/L
- ALT: 25 U/L
What is the likely diagnosis in this patient?
Explanation # 6
Jaundice + recent stress (surgery) + increased indirect bilirubin + no other abnormalities = Gilbert syndrome
Question # 7
A 24 year old male comes to the clinic because he has a long history of episodes where his eyes change color. He explains that at times his eyes become “yellow-tinged”. This seems to occur more frequently at times where he is studying for exams, or working late nights to meet deadlines at work. He has no other complaints at this time. A physical exam is notable for mild scleral icterus. Labs are collected and shown below:
- Total bilirubin: 3.4 mg/dL***
- Direct bilirubin: 0.3 mg/dL***
- ALP: 30 U/L
- AST: 18 U/L
- ALT: 22 U/L
Explanation # 7
Jaundice + stress induced symptoms + increased indirect bilirubin + no other abnormalities = Gilbert syndrome
TESTABLE FACTS ABOUT THIS TOPIC (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying topic. Often there are specific testable facts regarding some aspect of the topic’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:
Page Updated: 01.21.2017