Liver Function

Question 1

Which of the following enzymes would best aid in identifying hepatobiliary
disease?

a. Alkaline phosphatase (ALP)
b. Aspartate aminotransferase (AST)
c. Alanine aminotransferase (ALT)
d. Ammonia

Answer 1

a. Alkaline phosphatase (ALP)

Question 2

In which of the following types of cells does the conjugation of bilirubin take
place?
a. Hepatocytes
b. Kupffer cells
c. Macrophages
d. Phagocytic cells

Answer 2

a. Hepatocytes

Question 3

Which of the following enzymes is responsible for the conjugation of
bilirubin?
a. UDP-glucuronosyltransferase
b. Alkaline phosphatase
c. Glutamate dehydrogenase
d. Leucine aminopeptidase

Answer 3

a. UDP-glucuronosyltransferase

Question 4

Which of the following fractions of bilirubin is water soluble and reacts with a
diazo reagent without the addition of an accelerator?
a. Conjugated bilirubin
b. Unconjugated bilirubin
c. Total bilirubin
d. Indirect bilirubin

Answer 4

a. Conjugated bilirubin

Question 5

Which form of hepatitis is caused by a DNA virus?
a. Hepatitis B
b. Hepatitis A
c. Hepatitis C
d. Hepatitis D

Answer 5

a. Hepatitis B

Question 6

Which of the following enzymes is most useful in establishing the hepatic
origin of an elevated serum alkaline phosphatase?
a. 5′-Nucleotidase
b. Alanine aminotransferase (ALT)
c. Aspartate aminotransferase (AST)
d. Lactate dehydrogenase

Answer 6

a. 5′-Nucleotidase

Question 7

Hepatitis E is likely to cause serious consequences in
a. Pregnant women
b. Children
c. Travelers in Third World countries
d. Older people

Answer 7

a. Pregnant women

Question 8

8. Worldwide, most primary malignant tumors of the liver are related to
   a. Alcoholism
   b. Gallstones
   c. Reye’s syndrome
   d. Malaria

Answer 8

a. Alcoholism

Question 9

The reagent p-dimethylaminobenzaldehyde is used to measure which of the
following?
a. Urobilinogen
b. Total bilirubin
c. Ammonia
d. Alkaline phosphatase

Answer 9

a. Urobilinogen

Question 10

Which of the following conditions would result in elevations in primarily
conjugated bilirubin?
a. Dubin-Johnson syndrome
b. Physiologic jaundice of the newborn
c. Crigler-Najjar syndrome
d. Gilbert’s syndrome

Answer 10

a. Dubin-Johnson syndrome

Question 11

A urinalysis dipstick test indicated that urobilinogen was absent. Which
condition does this support?
a. Biliary obstruction.
b. Hepatitis A acute infection.
c. Defective liver cell function.
d. Hepatocellular disease.
e. This would support all of the above conditions.

Answer 11

a. Biliary obstruction.

Question 12

Measuring serum ammonia levels has the potential to be fraught with
preanalytical errors that may interfere with achieving an accurate result. Of
the following preanalytical steps, which is incorrect?
a. After phlebotomy, the patient’s blood should be immediately placed on ice.
b. The blood should be collected in a red clot tube without anticoagulant.
c. Hemolyzed samples should be rejected as this interferes by falsely
increasing ammonia levels.
d. Lipemia may also interfere with plasma ammonia measurements.
e. All of the above are correct.

Answer 12

b. The blood should be collected in a red clot tube without anticoagulant.

Question 13

. A patient presents with elevated levels of IgG anti-HAV, while levels of IgM
anti-HAV are nondetectable. This patient is likely to
a. Have an acute infection of HAV
b. Have a chronic infection of HAV
c. Have an immunity to HAV
d. Be a carrier of HAV

Answer 13

c. Have an immunity to HAV

Question 14

The product produced and measured when reacting bilirubin with a diazo
reagent is
a. NADPH
b. NAD
c. Azobilirubin
d. Bilirubin diglucuronide

Answer 14

c. Azobilirubin

Question 15

A healthy 28-year-old female sees her physician for a routine examination
and has received a “relatively” clean bill of health except for the result below

These results most likely indicate?
a. Normal bilirubin metabolism
b. Extrahepatic obstruction
c. Dubin-Johnson syndrome
d. Gilbert’s disease

Answer 15

d. Gilbert’s disease

Question 16

. Which of the following is measured using glutamate dehydrogenase and is a
measure of advanced stages, poor prognosis, and coma in liver disease?

a. Total bilirubin
b. Ammonia
c. Unconjugated bilirubin
d. Urea

Answer 16

b. Ammonia

Question 17

In which of the following disease states would you see an elevation in total
bilirubin and conjugated bilirubin only?
a. Biliary obstruction
b. Hemolysis
c. Neonatal jaundice
d. Gilbert’s disease

Answer 17

a. Biliary obstruction

Question 18

As a reduction product of bilirubin catabolism, this compound is partially
reabsorbed from the intestines through the portal circulation for reexcretion
by the liver. What is this compound?
a. Urobilinogen
b. Azobilirubin
c. Biliverdin
d. Urobilin
e. Bilirubin

Answer 18

a. Urobilinogen

Question 19

You are the technologist on duty and you are performing the following assay:
Patient sample + Diazo reagent + Accelerator → Product
Which fraction(s) of bilirubin will react in the above reaction?
a. Conjugated
b. Delta
c. Unconjugated
d. All of the above

Answer 19

d. All of the above

Question 20

Choose the diagnosis most consistent with the following laboratory findings:
a. Physiologic jaundice of the newborn
b. Posthepatic bile obstruction
c. Dubin-Johnson syndrome
d. Rotor’s syndrome
e. None of the above

Answer 20

a. Physiologic jaundice of the newborn