Approach to jaundice (conjugated hyperbilirubinemia) Quiz: Ace Your Exams

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A 46-year-old woman comes to the clinic for evaluation of the insidious-onset of fatigue and yellowing of the skin. She reports feeling fatigued for years but attributed it to work-related stress and never sought medical attention. She also notes generalized itching and yellowing of her eyes. Medical history is significant for Sjogren syndrome for which she takes pilocarpine. Vitals are within normal limits. Physical examination shows jaundice, scleral icterus, and excoriations over the bilateral forearms. The initial laboratory evaluation is shown. Which of the following tests should be ordered next to help make the diagnosis?
 

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