Jaundice

Question 1

Which of the following is an inherited cause of isolated indirect hyperbilirubinemia?
A. Criggler-Najjar syndrome
B. Dubin-Johnson syndrome
C. Paroxysmal nocturnal hemoglobinuria
D. Rotor syndrome

Answer 1

A

Question 2

Laboratory finding which points to alcoholic hepatitis more than other causes of jaundice from hepatocellular injury
A. AST:ALT ratio of >2
B. Transaminases >25 times the upper limit of normal
C. Prothrombin time prolongation that is at least 2x the control
D. Serum albumin of

Answer 2

A

Question 3

A 3 year old boy presents with a history of vague abdominal pain later associated with deepening jaundice. PE revealed that he had a RUQ mass. Which of the following is a likely diagnosis?
A. Pancreatic head mass
B. Choledochal cyst
C. Choledocholithiasis
D. Metastatic liver tumor

Answer 3

B

Question 4

Neonatal cholestatic jaundice is characterized by
A. Retention of unconjugated bilirubin
B. Conjugated bilirubin 90% of total bilirubin
D. Conjugated bilirubin >20% of total bilirubin

Answer 4

D

Question 5

Cause of pathologic jaundice that is anatomic in nature 
A. Galactosemia
B. Hereditary spherocytosis
C. Congenital TORCH
D. Inspissated bile syndrome

Answer 5

D

Question 6

Type of choledochal cyst where there is dilatation of the intraduodenal portion of the common bile duct
A. I
B. II
C. III
D. IV

Answer 6

C

Question 7

Which of the following conditions can cause pathologic jaundice in newborns
A. Neonatal infection
B. Breastmilk intake
C. G6PD deficiency
D. AOTA

Answer 7

D

Question 8

The best diagnostic modality to differentiate intrahepatic from extrahepatic disorder in a jaundiced neonate is
A. Ultrasound of the hepatobiliary tract
B. DISIDA scan
C. Percutaneous liver biopsy
D. Endoscopic retrograde cholangiopancreatography

Answer 8

C

Question 9

A 2 month old was brought to the ER for jaundice, acholic stool, and dark colored urine. Pertinent in the PE was a palpable abdominal mass. Immediately you make a request for
A. CT scan of the abdomen
B. CBC
C. Alpha-fetoprotein
D. UTZ of the hepatobiliary tract

Answer 9

D

Question 10

48/F sought consult due to icterus which started 2 weeks prior. She had passage of tea-colored urine and pruritus. She claims to have episodes of post-prandial abdominal pain which spontaneously resolves after several minutes. She denies having intake of any medications/alcohol. PE revealed scleral icterus, flabby abdomen, normal sized liver and spleen, no spider angiomata/palmar erythema, no abdominal tenderness. BP 110/70 HR 70 RR 16 Temp 37C Height 158 cm Weight 65 kg. 3 days prior she had some lab exams done which showed the following findings:
Unremarkable CBC
AST 90 IU/L (N 6-40 IU/L) ALT 75 IU/L (N 6-40 IU/L) Alkaline phosphatase 690 (N 30-120 IU/L) Total bilirubin 3.8 mg/dl (0.1-1.0 mg/dL) Direct bilirubin 2.9 mg/dL (0.1-0.4 mg/dL) Indirect bilirubin 0.9 mg/dl

What is the next step in the management of this case?
A. Request for viral serologies
B. Endoscopic retrograde pancreatography (ERCP)
C. Hepatobiliary tree UTZ
D. Liver biopsy

Answer 10

C

Question 11

In a patient with cholestatic pattern of liver test, the initial examination involves
A. Fractionate bilirubin
B. CT/BRCP
C. Review of drugs
D. Checking for anti-mitochondrial antibody

Answer 11

C

Question 12

A nontender, palpable mass at the RUQ of the abdomen in a patient with obstructive jaundice secondary to a periampullary malignancy is termed what?
A. Gallbladder hydrops
B. Gallbladder empyema
C. Courvoisier’s gallbladder
D. Murphy’s sign

Answer 12

C

Question 13

Which of the following is an invasive way to image the bile ducts in a patient with jaundice?
A. Ultrasound of the liver and bile ducts
B. Endoscopic retrograde cholangiopancreatography
C. CT scan of the abdomen
D. Magnetic resonance cholangiopancreatography

Answer 13

B

Question 14

Most common cause of extrahepatic cholestasis
A. Cholangiocarcinoma
B. Choledocholithiasis
C. Pancreatic malignancy
D. Primary sclerosing cholangitis

Answer 14

B

Question 15

A 51/F came to the ER due to fever (39.3 C) and chills that started 2 hours ago. She has a 10 month history of intermittent epigastric and right upper quadrant pain relieved by NSAIDS taken as needed. 1 week ago she developed jaundice with associated tea-colored urine and pruritus. Right upper quadrant and epigastric tenderness was elicited on PE. The most likely diagnosis is?
A. Fulminant viral hepatitis infection
B. Sepsis secondary to bowel perforation
C. Cholangitis secondary to choledocholithiasis
D. Obstructive jaundice secondary to periampullary malignancy

Answer 15

C

Question 16

What disease may present as both cholestatic or parenchymal type of jaundice?
A. Viral hepatitis
B. Primary biliary cirrhosis
C. Wilson’s disease
D. Pancreatic head adenocarcinoma

Answer 16

A

Question 17

A 60/F was clinically diagnosed with a pancreatic head tumor. What is the best test to confirm this diagnosis among the choices listed below?
A. Hepatobiliary-pancreatic ultrasound
B. Endoscopic retrograde cholangiopancreatography (ERCP)
C. Upper abdominal CT scan
D. Percutaneous transhepatic cholangiography (PTC)

Answer 17

C

Question 18

Cholestatic type of jaundice may be differentiated from parenchymal type of jaundice by?
A. AST/ALT elevation
B. Elevated indirect bilirubin
C. Presence of dilated ducts on ultrasound
D. Increased ceruloplasmin levels

Answer 18

C

Question 19

Drug-induced liver toxicity causes primarily?
A. Parenchymal pattern of jaundice
B. Parenchymal pattern of jaundice and intrahepatic cholestasis
C. Intrahepatic and extrahepatic cholestasis
D. Parenchymal pattern of jaundice and extrahepatic cholestasis

Answer 19

B

Question 20

Predisposing factors for cholesterol stone formation
A. Weight loss
B. Chronic hemolysis
C. Hemolytic anemia
D. Young age

Answer 20

A