Chem Path - Liver

Question 1

A: negative urine bilirubin, urine UBG ^^, AST ^, ALT ALP and GGT normal
B: urine bilirubin ^^, negative urine UBG, AST ALP ^, ALP GGT ^^^
C: urine bilirubin ^, urine UBG ^^, AST ^^, ALT ^, ALP ^^, GGT ^^^
D: urine bilirubin ^, urine UBG ^^, AST ^^, ALT ^^^, ALP ^, GGT ^
E: negative urine bilirubin, normal everything

From the liver function test results below select the option that is most closely associated to a 24-year-old woman who has hereditary spherocytosis and jaundice.

Answer 1

A (the jaundice is from RBC breakdown)

Question 2

A: negative urine bilirubin, urine UBG ^^, AST ^, ALT ALP and GGT normal
B: urine bilirubin ^^, negative urine UBG, AST ALP ^, ALP GGT ^^^
C: urine bilirubin ^, urine UBG ^^, AST ^^, ALT ^, ALP ^^, GGT ^^^
D: urine bilirubin ^, urine UBG ^^, AST ^^, ALT ^^^, ALP ^, GGT ^
E: negative urine bilirubin, normal everything

A 32-year-old alcoholic has fever, jaundice, and tender hepatomegaly. A liver biopsy exhibits fatty change, Mallory’s bodies, and a neutrophilic infiltrate.

Answer 2

C

Question 3

A: negative urine bilirubin, urine UBG ^^, AST ^, ALT ALP and GGT normal
B: urine bilirubin ^^, negative urine UBG, AST ALP ^, ALP GGT ^^^
C: urine bilirubin ^, urine UBG ^^, AST ^^, ALT ^, ALP ^^, GGT ^^^
D: urine bilirubin ^, urine UBG ^^, AST ^^, ALT ^^^, ALP ^, GGT ^
E: negative urine bilirubin, normal everything

A 22-year-old medical student develops jaundice only when he stays up all night studying. His physical examination is normal. All hepatitis serologic tests are negative

Answer 3

E

Question 4

A: negative urine bilirubin, urine UBG ^^, AST ^, ALT ALP and GGT normal
B: urine bilirubin ^^, negative urine UBG, AST ALP ^, ALP GGT ^^^
C: urine bilirubin ^, urine UBG ^^, AST ^^, ALT ^, ALP ^^, GGT ^^^
D: urine bilirubin ^, urine UBG ^^, AST ^^, ALT ^^^, ALP ^, GGT ^
E: negative urine bilirubin, normal everything

A 25-year-old medical student returns from a trip to Mexico. Three weeks later, he develops low-grade fever and jaundice. Physical examination shows painful hepatomegaly. The urine is dark yellow and the stool is light-coloured.

Answer 4

D, must have elevated urine UBG to have dark wee.
Mixed picture hepatitis also affecting bile duct system

Question 5

Which of the following is true about bilirubin

Select one:
a.Obstruction of the bile ducts causes unconjugated hyperbilirubinaemia
b.Conjugated bilirubin is soluble in water and relatively non-toxic
c.Unconjugated bilirubin is soluble in water and excreted in the urine
d.Kupfer cells are important in processing bilirubin
e.Neonatal jaundice is usually due to conjugated bilirubinaemia

Answer 5

b.Conjugated bilirubin is soluble in water and relatively non-toxic

Question 6

A 22-year-old woman has a history of intermittent, abdominal pain that occurs after she has a glass of wine. Recently, after collecting a urine specimen for culture, she notices that the urine colour has changed from a yellow to a wine-red colour after sitting on the window sill in her kitchen. Which of the following compounds is most likely responsible for the colour change in the urine?
Select one:
a.
Haemoglobin
b.
Uroporphyrin I
c.
Myoglobin
d.
Urobilin
e.
Porphobilin

Answer 6

The correct answer is: Porphobilin

Question 7

A 27 year old man was referred with an acute hepatic illness. Which laboratory finding would indicate the need for inpatient management?
Question 4Select one:
a.
Serum alkaline phosphatase 1800 U/L (45–105)
b.
Aspartate aminotransferase: alanine aminotransferase ratio 1.0
c.
Serum alanine aminotransferase 1400 U/L (5-35)
d.
Serum conjugated bilirubin 110 umol L (<3.4)
e.
Prothrombin time 24 s (11.5-15.5)

Answer 7

e.
Prothrombin time 24 s (11.5-15.5)

Bleeding risk

Question 8

Which of the following statements about liver failure is correct?
Question 7Select one:
a.
There is an increased chance of a venous thrombosis
b.
Fat absorption is unaffected by liver failure
c.
Severe hyperglycaemia develops
d.
The hepatic storage of vitamin C is well preserved
e.
Plasma levels of ammonia will rise

Answer 8

Plasma levels of ammonia will rise

Question 9

A 33-year-old man has a history of chronic liver disease and a movement disorder. Physical examination also reveals a discoloration in Descemet’s membrane in the cornea. Which of the following laboratory findings would most likely be reported?
Question 9Select one:
a.
Increased serum iron
b.
Increased total serum copper
c.
Normal serum prothrombin time
d.
Increased iron saturation
e.
Decreased serum ceruloplasmin

Answer 9

Decreased serum ceruloplasmin

Wilson’s disease

Question 10

A 42 year old man was found to have abnormal liver function tests. He had had ulcerative colitis for 15 years. He had been treated initially with mesalazine but this had been stopped eight years previously when his disease had gone into remission.
Investigations:
Serum albumin 40 g/L (37-49)
Serum total bilirubin 15 Mmol/L (1-212)
Serum alanine aminotransferase 63 U/L (5-3)
Serum aspartate aminotransferase 41 U/L (1-31)
Serum alkaline phosphatase 741 U/L (45-105)
Serum gamma glutamyl transferase 221 U/L (<50)

What is the most likely cause of these blood results?
Question 10Select one:
a.
Primary biliary cirrhosis
b.
Fatty liver
c.
Liver metastases
d.
Autoimmune hepatitis
e.
Primary sclerosing cholangitis

Answer 10

Primary sclerosing cholangitis