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Gastroenterology > Jaundice > Flashcards

Jaundice Flashcards

1
Q

Sclerae have a p ticular affinity for bilirubin due to their high elastin content, and the presence of scleral icterus indicates a serum bilirubin level of at least _____

A

51 μmol/L (3 mg/dL).

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2
Q

If the examiner suspects scleral icterus, a second site to examine is _____.

A

underneath the tongue

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3
Q

About 80–85% of the 4 mg/kg body weight of bilirubin produced each day is derived from the ______

A

breakdown of hemoglobin in senescent red blood cells

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4
Q

The formation of bilirubin occurs in reticuloendothelial cells, primarily in the ______.

A

spleen and liver

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5
Q

Which enzyme catalyzes the conversion of biliverdin to bilirubin during the formation of bilirubin?

A. Heme oxygenase
B. Biliverdin reductase
C. Glutathione-S-transferase
D. UDP-glucuronosyl transferase

A

B

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6
Q

Which of the following conditions is most commonly associated with mild unconjugated hyperbilirubinemia and affects 3–7% of the population?

A. Crigler-Najjar syndrome type I
B. Crigler-Najjar syndrome type II
C. Gilbert’s syndrome
D. Paroxysmal nocturnal hemoglobinuria

A

C

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7
Q

In which condition does the complete absence of bilirubin UDPGT activity lead to severe jaundice and neurologic impairment (kernicterus) in neonates?

A. Crigler-Najjar syndrome type I
B. Crigler-Najjar syndrome type II
C. Sickle cell anemia
D. Gilbert’s syndrome

A

A

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8
Q

What is the maximum serum bilirubin level typically observed in patients with Gilbert’s syndrome?

A. 86 μmol/L (5 mg/dL)
B. 103 μmol/L (6 mg/dL)
C. 342 μmol/L (20 mg/dL)
D. 428 μmol/L (25 mg/dL)

A

B

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9
Q

Which of the following drugs can cause unconjugated hyperbilirubinemia by impairing hepatic uptake of bilirubin?

A. Phenobarbital and probenecid
B. Rifampin and phenobarbital
C. Rifampin and probenecid
D. Rifampin and rifaximin

A

C

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10
Q

Which genetic condition responds to phenobarbital treatment, which reduces serum bilirubin levels by inducing bilirubin UDPGT activity?

A. Gilbert’s syndrome
B. Crigler-Najjar syndrome type II
C. Spherocytosis
D. Hemolytic-uremic syndrome

A

B

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11
Q

Deficiency of the major hepatic drug reuptake transporter OATP1BA and OATP1B3

A

Rotor syndrome

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12
Q

Dubin Johnson syndrome mutations in what gene?

A

MRP2

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13
Q

Which of the following findings on physical examination is commonly associated with advanced alcohol-related cirrhosis?

A. Virchow’s node
B. Spider nevi
C. Murphy’s sign
D. Jugular venous distention

A

B

Stigmata of chronic liver disease, including spider nevi, palmar erythema, gynecomastia, caput medusae, Dupuytren’s contractures, parotid gland enlargement, and testicular atrophy, are commonly seen in advanced alcohol-related cirrhosis and occasionally in other types of cirrhosis

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14
Q

The presence of an enlarged left supraclavicular node (Virchow’s node) in a patient with jaundice suggests:

A. Right-sided heart failure
B. Advanced alcohol-related cirrhosis
C. Pancreatic cancer
D. Abdominal malignancy

A

D

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15
Q

What does severe right-upper-quadrant tenderness with respiratory arrest on inspiration (Murphy’s sign) indicate?

A. Cirrhosis
B. Cholecystitis
C. Hepatic congestion
D. Alcoholic hepatitis

A

B

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16
Q

In a patient with jaundice and ascites, which conditions should be suspected?

A. Cirrhosis or malignancy with peritoneal spread
B. Cholecystitis or amyloidosis
C. Right-sided heart failure or viral hepatitis
D. Alcoholic hepatitis or pancreatic cancer

A

A

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17
Q

Which of the following findings is most consistent with a cholestatic process in a jaundiced patient?

A. Prominent elevation in ALT and AST relative to ALP
B. Prominent elevation in ALP relative to ALT and AST
C. Equal elevation in ALT, AST, and ALP
D. Normal enzyme levels with elevated serum bilirubin

A

B

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18
Q

A low serum albumin level in a jaundiced patient suggests which of the following?

A. A chronic condition such as cirrhosis or cancer
B. An acute condition such as viral hepatitis or choledocholithiasis
C. Severe hepatocellular dysfunction with vitamin K deficiency
D. A benign condition requiring no further evaluation

A

A

19
Q

Failure of prothrombin time (PT) to correct with parenteral vitamin K administration indicates:

A. Vitamin K deficiency due to malabsorption
B. Acute choledocholithiasis
C. Severe hepatocellular injury
D. Chronic cirrhosis

A

C

20
Q

Which test result is not helpful in differentiating between a hepatocellular process and a cholestatic process?

A. Total and direct serum bilirubin
B. ALT and AST levels
C. ALP levels
D. Prothrombin time

A

A

21
Q

Which of the following is most consistent with alcoholic hepatitis?

A. ALT > AST with levels >500 U/L
B. AST-to-ALT ratio of at least 2:1 and AST <300 U/L
C. ALT and AST levels ≥25 times normal
D. Normal aminotransferase levels

A

B

22
Q

Which diagnostic test should be performed first when Wilson’s disease is suspected in a jaundiced patient?

A. Hepatitis B surface antigen test
B. Ceruloplasmin level
C. Anti-smooth muscle antibody assay
D. Hepatitis C viral RNA test

A

B

23
Q

Which laboratory finding is most indicative of acute hepatocellular injury?

A. ALT and AST levels <8 times normal
B. ALT and AST levels ≥25 times normal
C. AST-to-ALT ratio ≥2:1 with AST >300 U/L
D. Normal albumin and elevated prothrombin time

A

B

24
Q

While ALT and AST values <8 times normal may be seen in either _____

A

hepatocellular or cholestatic liver disease

25
Q

_____has the highest surgical cure rate of all the tumors that present as painless jaundice.

A

Ampullary carcinoma

26
Q

_____ is the most common cause of extrahepatic cholestasis.

A

Choledocholithiasis

27
Q

What is the best initial imaging test to differentiate intrahepatic from extrahepatic cholestasis?

A. Endoscopic retrograde cholangiopancreatography (ERCP)
B. Magnetic resonance cholangiopancreatography (MRCP)
C. Ultrasound
D. Computed tomography (CT)

A

C

28
Q

Which diagnostic test is the gold standard for identifying choledocholithiasis?

A. ERCP
B. MRCP
C. Ultrasound
D. Endoscopic ultrasound (EUS)

A

A

29
Q

What antibody is positive in 95% of patients with primary biliary cholangitis (PBC)?

A. Antinuclear antibody (ANA)
B. Anti-smooth muscle antibody
C. Antimitochondrial antibody (AMA)
D. Rheumatoid factor (RF)

A

C

30
Q

What is the most common cause of extrahepatic cholestasis?

A. Pancreatic cancer
B. Choledocholithiasis
C. Primary sclerosing cholangitis
D. Cholangiocarcinoma

A

B

31
Q

Which malignancy-related condition associated with intrahepatic cholestasis is specifically linked to renal cell cancer?

A. IgG4-associated cholangitis
B. Stauffer’s syndrome
C. Cholangiocarcinoma
D. Ampullary carcinoma

A

B

32
Q

_____ is an autoimmune disease predominantly affecting women and characterized by progressive destruction of interlobular bile ducts.

A

Primary biliary cholangitis

33
Q

Diagnosis of PBC by detection of ____

A

AMA

34
Q

______ is characterized by the destruction and fibrosis of larger bile ducts.

A

Primary sclerosing cholangitis

35
Q

The diagnosis of PSC is made with _____, which demonstrates the pathognomonic segmental strictures

A

cholangiography (either MRCP or ERCP)

36
Q

Vanishing bile duct syndrome also occurs in rare cases of sarcoidosis, in patients taking certain drugs (including ____), and idiopathically.

A

chlorpromazine

37
Q

Cholestasis of pregnancy occurs in the _____trimesters and resolves after delivery.

A

second and third

38
Q

Jaundice with associated liver dysfunction can be seen in severe cases of Plasmodium _____.

A

falciparum malaria

39
Q

Weil’s disease, a severe presentation of leptospirosis, is marked by _____

A

jaundice with renal failure, fever, headache, and muscle pain.

40
Q

Which inherited disorder is associated with direct hyperbilirubinemia?

A. Gilbert’s syndrome
B. Dubin-Johnson syndrome
C. Crigler-Najjar syndrome
D. Hemolytic anemia

A

B

41
Q

A patient has isolated indirect hyperbilirubinemia. Which of the following is a likely cause?

A. Rifampin
B. Rotor syndrome
C. Dubin-Johnson syndrome
D. Primary sclerosing cholangitis

A

A

42
Q

Which diagnostic test is most appropriate to confirm extrahepatic cholestasis after biliary duct dilation is noted on ultrasound?

A. Ceruloplasmin
B. MRCP, CT, or ERCP
C. Antimitochondrial antibody (AMA)
D. Serum protein electrophoresis (SPEP)

A

B

43
Q

What is the next step if AMA testing for suspected primary biliary cholangitis is negative?

A. Repeat AMA testing
B. Liver biopsy
C. ERCP
D. CT scan

A
44
Q
A

Gastroenterology (10 decks)

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