View source for WBR0648

{{WBRQuestion
|QuestionAuthor={{Rim}}
|ExamType=USMLE Step 1
|MainCategory=Biochemistry
|SubCategory=Gastrointestinal
|MainCategory=Biochemistry
|SubCategory=Gastrointestinal
|MainCategory=Biochemistry
|SubCategory=Gastrointestinal
|MainCategory=Biochemistry
|MainCategory=Biochemistry
|SubCategory=Gastrointestinal
|MainCategory=Biochemistry
|SubCategory=Gastrointestinal
|MainCategory=Biochemistry
|SubCategory=Gastrointestinal
|MainCategory=Biochemistry
|SubCategory=Gastrointestinal
|MainCategory=Biochemistry
|MainCategory=Biochemistry
|SubCategory=Gastrointestinal
|Prompt=A 34 year old healthy man presents to the primary care clinic for a general check-up. The man has no complaints except some fatigue during the day, but he relates this to his stressful life style. Physical exam is unremarkable except for mild scleral icterus. The primary care physician decides to order some tests to rule out any serious illness. Lab results return with a  normal CBC, reticulocyte count, and blood smear. Transaminases, alkaline phosphatase, and GGT are also all within normal range. Indirect bilirubin is noted to be 2.6 mg/dL with direct bilirubin below the upper limit of normal. The patient remembers that he was noted to have an elevated indirect bilirubin several years earlier but his work-up back then also came back normal. Which of the following pathological mechanisms is involved in this patient's condition?
|Approved=No
}}