NBME CCSSA Form 13, Section 13, Question 26: patient presents w/ painless hyperbilirubinemia, wt loss, increases in alk phos/ALT/AST, c/f pancreatic HEAD cancer, per the answer description. CTAP w/ contrast is the answer and NOT ultrasound. Ultrasound is NEVER the PREFERRED method over CT for diagnosing pancreatic cancer if you know that's what is causing the issue. Sometimes you can order US if the presenting symptoms are that of acute obstruction and you don't know for sure that the cause is cancer, and in that case you can sometimes see bile duct dilation on CT which would indicate a distal tumor (such as pancreatic head cancer). But that is not preferred diagnostic imaging over CT.
Source: Other - NBME Form 13
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