This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: G.I.T, Subject name: Anatomy
Commonest presentation of primary biliary cirrhosis 
Select and explain. 
A. Pruritus, B. Pain, C. Jaundice, D. Fever
A: Pruritus
Answer: A: Pruritus 
Explanation: Primary biliary cirrhosis Believed to be an autoimmune etiology, leading to progressive destruction of intrahepatic bile ducts More common in females Associated with autoimmune disorders (CREST, Sicca syndrome, Autoimmune thyroiditis, Renal tubular acidosis) Clinical features Most patients are asymptomatic, pruritus the commonest and earliest symptom. Pruritus precedes jaundice in PBC, Pruritus is most bothersome in evening Jaundice, fatigue, melanosis (gradual darkening of exposed areas of skin), deficiency of aft soluble vitamins due to malabsorption Xanthomas and xanthelesmas due to protracted elevation of serum lipids Ref: Sabiston 20th edition Pgno : 639