Repeated USMLE Questions Step 1- 277

A 20-year-old exchange male student from Greece presents to the office for evaluation. Two days ago, he noticed yellow discoloration of his conjunctiva. His family history is significant for hemolytic anemia due to glucose-6-phosphate dehydrogenase deficiency.

Which one of these findings is most likely revealed in this patient’s workup?

A-Increased plasma unconjugated bilirubin

B-Increased bilirubin in urine

C-Increased urobilinogen in urine

D-Clay colored stool

E-Dark brown urine


Hemolysis of RBCs results in a large amount of bilirubin delivered to the liver. The ability of the liver to conjugate all the bilirubin to glucuronic acid fails and unconjugated bilirubin increases in the plasma causing jaundice. Unconjugated bilirubin is unlikely to pass into the urine because it is bound to albumin and has low solubility in plasma. Clay colored stool occurs due to absence of bile pigments in the colon, which is not associated with hemolytic anemia.

The correct answer is A

1 thought on “Repeated USMLE Questions Step 1- 277”

  1. What about the option “C” increased urobilinogen in urine as UCB in plasma can be increased in other conditions too, isn’t option c would be more defining for hemolysis.

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