376.A 65-year-old male presents with jaundice for 2–3 weeks, fatigue and
increasing epigastric pain. He has no history of peptic ulcers and says the pain
doesnotrelate to eating in anyway. His epigastric pain is midline and he has
had some recent back pain. His urinary bilirubinogen and serum bilirubin are
elevated (serum bilirubin 5.8 mg/dl). Helical CT reveals a suspicious mass in
the head of the pancreas adjacent to the descending duodenum. The gall-
bladder is significantly enlarged. Which of the following is the likely cause of
the elevated bilirubin?
a. Viral hepatitis
b. Blocked cystic duct
c. Open hepatic duct
d. Blocked duodenal papilla
e. Gilbert syndrome
377.A full-term male infant displays projectile vomiting 1 h after suck-
ling. There is failure to gain weight during the first 48 hours. The vomitus
is not bile-stained and no respiratory difficulty is evident. Examination
reveals an abdomen neithertensenorbloated. Which of the following is the
most probable explanation?
a. Congenital hypertrophic pyloric stenosis
b. Congenital absence of a kidney
c. Patent ileal diverticulum
d. Imperforate anus
e. Tracheoesophageal fistula
378.In Hirschsprung’s disease, there is a loss of peristalsis in the lower colon
and often fatal obstruction. Preganglionic neurons, which would innervate the
aganglionic segment of bowel, originate in which of the following?
a. The nucleus ambiguus
b. Cervical intermediolateral cell column
c. Sacral levels two to four of the spinal cord
d. The motor nucleus of the vagus nerve (CN X)
e. The ventral horn at spinal levels L1–L2
496 Anatomy, Histology, and Cell Biology