This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Medicine
Hyper pigmented skin with xanthelasma and xanthomas should lead to possibility of the diagnosis of: 
Select and explain. 
A. Primary biliary cirrhosis, B. Primary sclerosing cholangiti, C. Amyloidosis, D. Tuberculosis
A: Primary biliary cirrhosis
Answer: A: Primary biliary cirrhosis 
Explanation: The cholangiocyte is a target of an immune-mediated inflammatory response, as is characteristic of primary biliary cirrhosis Primary biliary cirrhosis Primary biliary cirrhosis is occurs predominantly in women. Patients may present with jaundice, pruritus and fatigue is common. The skin is often hyperpigmented and detection of xanthelasma or xanthomata related to hypercholesterolemia is highly suggestive of the diagnosis. Serologic testing (antimitochondrial antibodies) is generally sufficient to establish a diagnosis Ref:Sleisenger and Fordtran's,E-9,P-328