LE 2: Liver

Question 1

What percentage of cardiac output does the liver receive?

A) 10%
B) 20%
C) 30%
D) 40%

Answer 1

C) 30%

Rationale: The liver receives approximately 30% of the cardiac output.

Question 2

Which vessel supplies oxygenated blood to the liver?

A) Portal vein
B) Hepatic vein
C) Hepatic artery
D) Inferior vena cava

Answer 2

C) Hepatic artery

Rationale: The hepatic artery supplies oxygenated blood from the heart to the liver.

Question 3

Which vessel carries nutrient-rich blood from the gut to the liver?

A) Hepatic artery
B) Hepatic vein
C) Portal vein
D) Superior vena cava

Answer 3

C) Portal vein

Rationale: The portal vein carries blood directly from the gut to the liver.

Question 4

Which of the following is NOT a function of the liver?

A) Gluconeogenesis
B) Production of insulin
C) Deamination
D) Bilirubin conjugation

Answer 4

B) Production of insulin

Rationale: The liver does not produce insulin. Insulin is produced by the pancreas.

Question 5

Which process involves the removal of the amino group from amino acids?

A) Glycolysis
B) Deamination
C) Oxidation
D) Methylation

Answer 5

B) Deamination

Rationale: Deamination is the process of removing the amino group from amino acids.

Question 6

Which clotting factor is NOT produced by the liver?

A) II
B) V
C) VIII
D) X

Answer 6

C) VIII

Rationale: The liver produces several clotting factors, but factor VIII is not one of them.

Question 7

Which vitamin is NOT stored in the liver?

A) Vitamin A
B) Vitamin C
C) Vitamin D
D) Vitamin K

Answer 7

B) Vitamin C

Rationale: The liver stores vitamins A, D, K, B12, and folate, but not vitamin C.

Question 8

What is the primary storage form of glucose in the liver?

A) Glucose
B) Fructose
C) Glycogen
D) Galactose

Answer 8

C) Glycogen

Rationale: Glycogen is the storage form of glucose in the liver.

Question 9

Which enzyme breaks down certain drugs and neurotransmitters in the liver?

A) Lipase
B) Amylase
C) Plasma cholinesterases
D) Catalase

Answer 9

C) Plasma cholinesterases

Rationale: Plasma cholinesterases are enzymes in the liver that break down certain drugs and neurotransmitters.

Question 10

Which process transforms drugs in the liver to make them more water-soluble?

A) Deamination
B) Glycolysis
C) Conjugation
D) Hydrolysis

Answer 10

C) Conjugation

Rationale: Conjugation is one of the processes in the liver that transforms drugs to make them more water-soluble.

Question 11

Which mineral is stored in the liver?
A) Calcium
B) Iron
C) Magnesium
D) Potassium

Answer 11

B) Iron

Rationale: The liver stores essential minerals like iron and copper.

Question 12

Which of the following is a function of bile acids synthesized by the liver?
A) Blood clotting
B) Digestion and absorption of fats
C) Production of energy
D) Regulation of blood pressure

Answer 12

B) Digestion and absorption of fats

Rationale: Bile acids aid in the digestion and absorption of fats.

Question 13

Which protein synthesized by the liver maintains osmotic balance in the blood?
A) Hemoglobin
B) Collagen
C) Albumin
D) Myoglobin

Answer 13

C) Albumin

Rationale: Albumin plays a role in maintaining osmotic balance in the blood.

Question 14

Which process in the liver forms glucose from non-carbohydrate sources?
A) Glycogenesis
B) Glycolysis
C) Gluconeogenesis
D) Glycosylation

Answer 14

C) Gluconeogenesis

Rationale: Gluconeogenesis is the formation of glucose from non-carbohydrate sources.

Question 15

Which of the following is NOT a synthetic function of the liver?
A) Production of clotting factors
B) Synthesis of bile acids
C) Conversion of ammonia to urea
D) Synthesis of albumin

Answer 15

C) Conversion of ammonia to urea

Rationale: Conversion of ammonia to urea is a metabolic function of the liver, not a synthetic function.

Question 16

Which clotting factor is produced by the liver and is also known as prothrombin?
A) II
B) V
C) VII
D) X

Answer 16

A) II

Rationale: Factor II is also known as prothrombin.

Question 17

Which process in the liver makes bilirubin water-soluble?
A) Oxidation
B) Reduction
C) Conjugation
D) Hydrolysis

Answer 17

C) Conjugation

Rationale: Conjugation of bilirubin in the liver makes it water-soluble.

Question 18

Which of the following is a primary function of the liver in relation to fats?
A) Synthesis of fatty acids
B) Breakdown of triglycerides and cholesterol
C) Production of lipase enzyme
D) Storage of fatty acids

Answer 18

B) Breakdown of triglycerides and cholesterol

Rationale: The liver plays a role in the metabolism of triglycerides and cholesterol.

Question 19

Which vessel drains blood out of the liver?
A) Hepatic artery
B) Hepatic vein
C) Portal vein
D) Superior vena cava

Answer 19

B) Hepatic vein

Rationale: The hepatic vein drains blood out of the liver and into the inferior vena cava.

Question 20

Which of the following substances is transformed from lipid to water-soluble in the liver?
A) Oxygen
B) Carbon dioxide
C) Drugs
D) Water

Answer 20

C) Drugs

Rationale: The liver transforms drugs from lipid-soluble to water-soluble forms to aid in their excretion.

Question 21

Which enzyme is responsible for oxidation and reduction in Phase 1 drug metabolism?

A) Hemoglobin
B) Cytochrome P450
C) Myoglobin
D) Lysozyme

Answer 21

B) Cytochrome P450
Rationale: Cytochrome P450 performs oxidation and reduction reactions, which are part of Phase 1 drug metabolism.

Question 22

Where is Cytochrome P450 primarily located?

A) Cytoplasm
B) Mitochondria
C) Cell membrane
D) Nucleus

Answer 22

B) Mitochondria
Rationale: CYP enzymes are primarily found in the mitochondria of liver cells.

Question 23

What characteristic feature does Cytochrome P450 have?

A) Absorbs light at 450 nm when exposed to oxygen
B) Absorbs light at 450 nm when exposed to carbon monoxide
C) Absorbs light at 500 nm when exposed to carbon dioxide
D) None of the above

Answer 23

B) Absorbs light at 450 nm when exposed to carbon monoxide
Rationale: Cytochrome P450 contains a heme pigment that absorbs light at a wavelength of 450 nm when exposed to carbon monoxide.

Question 24

Which of the following is NOT a major CYP protein in drug metabolism?

A) CYP1A2
B) CYP2C9
C) CYP4A7
D) CYP3A5

Answer 24

C) CYP4A7
Rationale: CYP1A2, CYP2C9, CYP2D6, CYP3A4, and CYP3A5 are the major CYP proteins involved in drug metabolism.

Question 25

Which CYP enzyme metabolizes Codeine?

A) CYP2D6
B) CYP3A4
C) CYP1A2
D) CYP2C9

Answer 25

A) CYP2D6
Rationale: Codeine is a substrate of CYP2D6.

Question 26

Which substance inhibits CYP3A4?

A) Quinidine
B) Methadone
C) Grapefruit juice
D) Lidocaine

Answer 26

C) Grapefruit juice
Rationale: Grapefruit juice is an inhibitor of CYP3A4.

Question 27

What is the prevalence of ultrarapid metabolizers in the African or Ethiopian population?

A) 1-2%
B) 3.4-6.5%
C) 29%
D) 6%

Answer 27

Answer: C) 29%
Rationale: The prevalence of ultrarapid metabolizers in the African or Ethiopian population is 29%.

Question 28

Which of the following drugs is a substrate of CYP3A4?

A) Bufuralol
B) Erythromycin
C) Desipramine
D) Codeine

Answer 28

Answer: B) Erythromycin
Rationale: Erythromycin is a substrate of CYP3A4.

Question 29

Which enzyme is inhibited by Fluoxetine?

A) CYP2D6
B) CYP3A4
C) CYP1A2
D) CYP2C9

Answer 29

A) CYP2D6
Rationale: Fluoxetine is an inhibitor of CYP2D6.

Question 30

Which of the following is an inducer of CYP3A4?

A) Quinidine
B) Methadone
C) Phenobarbital
D) Cimetidine

Answer 30

C) Phenobarbital
Rationale: Phenobarbital is an inducer of CYP3A4.

Question 31

Which CYP enzyme is most crucial in drug metabolism?

A) CYP1A2
B) CYP2C9
C) CYP3A4
D) CYP2D6

Answer 31

C) CYP3A4
Rationale: CYP3A4 and CYP2D6 are the most crucial in drug metabolism, with CYP3A4 being one of the most important.

Question 32

Which of the following reactions is NOT dependent on CYP450 enzymes in the liver?

A) Oxidation of dopamine
B) Hydrolysis of amides
C) Oxidation of Codeine
D) Reduction of Erythromycin

Answer 32

A) Oxidation of dopamine
Rationale: The liver carries out non-CYP450 dependent reactions, including the oxidation of dopamine.

Question 33

Which substance is hydrolyzed in the liver and is NOT dependent on CYP450?

A) Lignocaine
B) Pethidine
C) Codeine
D) Nifedipine

Answer 33

A) Lignocaine
Rationale: Lignocaine undergoes hydrolysis of amides in the liver, which is a non-CYP450 dependent reaction.

Question 34

Which of the following is NOT an inhibitor of CYP2D6?

A) Quinidine
B) Methadone
C) Ketoconazole
D) Cimetidine

Answer 34

C) Ketoconazole
Rationale: Ketoconazole is an inhibitor of CYP3A4, not CYP2D6.

Question 35

Which of the following is an inhibitor of CYP3A4?

A) Lidocaine
B) Ritonavir
C) Bufuralol
D) Desipramine

Answer 35

B) Ritonavir
Rationale: Ritonavir is an inhibitor of CYP3A4.

Question 36

Which population has a prevalence of ultrarapid metabolizers between 3.4-6.5%?

A) African or Ethiopian
B) Asian
C) African American
D) Hungarian

Answer 36

C) African American
Rationale: The prevalence of ultrarapid metabolizers in the African American population is between 3.4-6.5%.

Question 37

Which of the following drugs is NOT a substrate of CYP2D6?

A) Bufuralol
B) Codeine
C) Nifedipine
D) Lidocaine

Answer 37

C) Nifedipine
Rationale: Nifedipine is a substrate of CYP3A4, not CYP2D6.

Question 38

Which of the following is an inducer of CYP3A4?

A) Rifampin
B) Fluoxetine
C) Quinidine
D) Methadone

Answer 38

A) Rifampin
Rationale: Rifampin is an inducer of CYP3A4.

Question 39

Which population has the lowest prevalence of ultrarapid metabolizers?

A) Asian
B) Greek
C) African or Ethiopian
D) Caucasian

Answer 39

A) Asian
Rationale: The prevalence of ultrarapid metabolizers in the Asian population is between 1.2-2%.

Question 40

Which of the following is NOT a substrate of CYP3A4?

A) Nifedipine
B) Erythromycin
C) Desipramine
D) Testosterone

Answer 40

C) Desipramine
Rationale: Desipramine is a substrate of CYP2D6, not CYP3A4.

Question 41

Which of the following is a substrate of CYP2D6?

A) Lidocaine
B) Nifedipine
C) Erythromycin
D) Midazolam

Answer 41

A) Lidocaine
Rationale: Lidocaine is a substrate of CYP2D6.

Question 42

Which of the following is NOT an inhibitor of CYP3A4?

A) Ketoconazole
B) Erythromycin
C) Grapefruit juice
D) Methadone

Answer 42

D) Methadone
Rationale: Methadone is an inhibitor of CYP2D6, not CYP3A4.

Question 43

Which of the following is an inhibitor of CYP2D6?

A) Quinidine
B) Ritonavir
C) Phenobarbital
D) Rifampin

Answer 43

A) Quinidine
Rationale: Quinidine is an inhibitor of CYP2D6.

Question 44

Which of the following is NOT an inducer of CYP3A4?

A) Carbamazepine
B) Phenobarbital
C) Quinidine
D) Phenytoin

Answer 44

C) Quinidine
Rationale: Quinidine is an inhibitor of CYP2D6, not an inducer of CYP3A4.

Question 45

Which of the following reactions is dependent on CYP450 enzymes in the liver?

A) Oxidation of dopamine
B) Hydrolysis of amides
C) Oxidation of Codeine
D) Reduction of Erythromycin

Answer 45

C) Oxidation of Codeine
Rationale: Codeine is a substrate of CYP2D6, which is a CYP450 enzyme.

Question 46

Which of the following is a substrate of CYP3A4?

A) Lidocaine
B) Ritonavir
C) Bufuralol
D) Midazolam

Answer 46

D) Midazolam
Rationale: Midazolam is a substrate of CYP3A4.

Question 47

Which of the following is NOT an inhibitor of CYP2D6?

A) Quinidine
B) Methadone
C) Grapefruit juice
D) Cimetidine

Answer 47

C) Grapefruit juice
Rationale: Grapefruit juice is an inhibitor of CYP3A4, not CYP2D6.

Question 48

Which of the following is an inhibitor of CYP3A4?

A) Lidocaine
B) Ritonavir
C) Bufuralol
D) Desipramine

Answer 48

B) Ritonavir
Rationale: Ritonavir is an inhibitor of CYP3A4.

Question 49

Which population has a prevalence of ultrarapid metabolizers of 6%?

A) Asian
B) Greek
C) African or Ethiopian
D) Caucasian

Answer 49

B) Greek
Rationale: The prevalence of ultrarapid metabolizers in the Greek population is 6%.

Question 50

Which of the following is NOT a substrate of CYP3A4?

A) Nifedipine
B) Erythromycin
C) Desipramine
D) Testosterone

Answer 50

C) Desipramine
Rationale: Desipramine is a substrate of CYP2D6, not CYP3A4.

Question 51

1. Which enzyme is indicative of hepatocellular injury?
   a) ALP
   b) GGT
   c) AST
   d) Bilirubin

Answer 51

c) AST
Rationale: A rise in AST (and ALT) signals hepatocellular injury or death

ALT - Alanine transaminase
AST - Aspartase transaminase

Question 52

Which condition is NOT a cause of hepatocellular injury pattern in LFTs?
a) Viral hepatitis
b) Wilson’s disease
c) Primary biliary cirrhosis
d) Alcoholic hepatitis

Answer 52

c) Primary biliary cirrhosis
Rationale: Primary biliary cirrhosis is associated with an obstructive pattern, indicated by a rise in ALP and GGT.

Question 53

Which drug can cause hepatocellular injury due to toxicity?
a) Paracetamol
b) Anabolic steroids
c) Oral contraceptives
d) Antibiotics

Answer 53

a) Paracetamol
Rationale: Paracetamol toxicity can lead to hepatocellular injury, indicated by a rise in AST and ALT.

Question 54

Which enzymes suggest cholestasis in LFTs?
a) AST and ALT
b) ALP and GGT
c) Bilirubin and Albumin
d) None of the above

Answer 54

b) ALP and GGT
Rationale: A rise predominantly in ALP and GGT suggests cholestasis, indicating an obstructive pattern.

Question 55

Which of the following is NOT a cause of an obstructive pattern in LFTs?
a) Primary biliary cirrhosis
b) Alcoholic hepatitis
c) Obstruction due to calculi
d) Tumors

Answer 55

b) Alcoholic hepatitis
Rationale: Alcoholic hepatitis is associated with hepatocellular injury, not an obstructive pattern.

Question 56

The SARS-CoV-2 virus uses which receptor to enter cells?
a) ACE-1
b) ACE-2
c) GGT
d) ALP

Answer 56

b) ACE-2
Rationale: The SARS-CoV-2 virus uses angiotensin-converting enzyme 2 (ACE-2) receptors to gain entry into cells.

Question 57

Which region of the liver has an abundance of ACE-2 receptors?
a) Hepatocellular region
b) Canalicular region
c) Ducal region
d) Lobular region

Answer 57

c) Ducal region
Rationale: The ducal region of the liver has an abundance of ACE-2 receptors, making it susceptible to SARS-CoV-2.

Question 58

What percentage of COVID-19 patients may present with hepatic decompensation without respiratory symptoms, as suggested by an international registry?
a) 10%
b) 25%
c) 50%
d) 75%

Answer 58

b) 25%
Rationale: An international registry has suggested that as many as 25% of patients with COVID-19 may present with hepatic decompensation in the absence of respiratory symptoms.

Question 59

Which of the following is NOT a pharmacokinetic effect of liver disease?
a) Altered absorption
b) Increased volume of distribution
c) Enhanced protein synthesis
d) Reduced protein synthesis

Answer 59

c) Enhanced protein synthesis
Rationale: Liver disease can lead to reduced protein synthesis, not enhanced.

Question 60

Which protein’s synthesis may be reduced in liver disease, affecting drug binding and pharmacokinetics?
a) Hemoglobin
b) Fibrinogen
c) Albumin
d) Globulin

Answer 60

c) Albumin
Rationale: Albumin synthesis may be reduced in liver disease, affecting drug binding, volume of distribution, half-life, and action duration.

Question 61

Which condition can cause an isolated rise in unconjugated bilirubin?
a) Alcoholic hepatitis
b) Gilbert’s syndrome
c) Primary biliary cirrhosis
d) Viral hepatitis

Answer 61

b) Gilbert’s syndrome
Rationale: An isolated rise in unconjugated bilirubin can be attributed to Gilbert’s syndrome.

Question 62

Which of the following can cause a mixed pattern in LFTs?
a) Sepsis
b) Wilson’s disease
c) Paracetamol toxicity
d) Primary biliary cirrhosis

Answer 62

a) Sepsis
Rationale: A mixed pattern can be seen in conditions like sepsis, some drug reactions, cholangitis, and others.

Question 63

Which drug can cause raised liver enzyme assays, raised bilirubin, and jaundice?
a) Paracetamol
b) Anabolic steroids
c) Halothane
d) Oral contraceptives

Answer 63

c) Halothane
Rationale: Halothane hepatitis can cause raised liver enzyme assays, raised bilirubin, and jaundice.

Question 64

Which of the following is NOT a cause of hepatocellular injury?
a) Ischaemic hepatitis
b) Autoimmune hepatitis
c) Cholangitis
d) Viral hepatitis

Answer 64

c) Cholangitis
Rationale: Cholangitis can cause a mixed pattern in LFTs, not specifically hepatocellular injury.

Question 65

In liver failure, the absorption of drugs given orally or nasogastrically can be affected by:
a) Increased gastric emptying
b) Reduced gastric transit time
c) Splanchnic vasodilation
d) Delayed gastric emptying

Answer 65

d) Delayed gastric emptying
Rationale: The absorption of drugs can be affected by delayed gastric emptying or reduced absorption due to diarrhea and increased gastric transit time seen in liver failure.

Question 66

Which of the following drugs is NOT associated with an obstructive pattern in LFTs?
a) Anabolic steroids
b) Oral contraceptives
c) Paracetamol
d) Antibiotics

Answer 66

c) Paracetamol
Rationale: Paracetamol is associated with hepatocellular injury, not an obstructive pattern.

Question 67

Which of the following conditions is associated with a rise in AST and ALT?
a) Hepatocellular injury
b) Cholestasis
c) Hemolysis
d) Gilbert’s syndrome

Answer 67

a) Hepatocellular injury
Rationale: A rise in AST and ALT signals hepatocellular injury or death.

Question 68

Which of the following is NOT a cause of a mixed pattern in LFTs?
a) Sepsis
b) Cholangitis
c) Wilson’s disease
d) Alcoholic liver disease

Answer 68

c) Wilson’s disease
Rationale: Wilson’s disease causes hepatocellular injury, not a mixed pattern.

Question 69

Which of the following conditions can cause fluid retention, affecting the volume of drug distribution?
a) Hepatic dysfunction
b) Renal dysfunction
c) Cardiac dysfunction
d) Pulmonary dysfunction

Answer 69

a) Hepatic dysfunction
Rationale: Hepatic dysfunction can cause fluid retention, increasing the volume within which drugs are present.

Question 70

20. Which of the following drugs can cause hepatocellular injury due to toxicity?
    a) Paracetamol
    b) Halothane
    c) Both a and b
    d) Neither a nor b

Answer 70

c) Both a and b
Rationale: Both paracetamol and halothane can cause hepatocellular injury due to toxicity.

Question 71

21. Which enzyme is NOT indicative of cholestasis?
    a) ALP
    b) GGT
    c) AST
    d) Bilirubin

Answer 71

c) AST
Rationale: ALP and GGT are indicative of cholestasis, while AST indicates hepatocellular injury.

Question 72

22. Which of the following conditions can cause an isolated rise in unconjugated bilirubin?
    a) Hemolysis
    b) Alcoholic hepatitis
    c) Cholangitis
    d) Viral hepatitis

Answer 72

a) Hemolysis
Rationale: An isolated rise in unconjugated bilirubin can be attributed to hemolysis.

Question 73

23. Which of the following is NOT a pharmacokinetic effect of liver disease?
    a) Altered absorption
    b) Increased volume of distribution
    c) Enhanced protein synthesis
    d) Reduced protein synthesis

Answer 73

c) Enhanced protein synthesis
Rationale: Liver disease can lead to reduced protein synthesis, not enhanced.

Question 74

Which protein’s synthesis may be reduced in liver disease, affecting drug binding and pharmacokinetics?
a) Hemoglobin
b) Fibrinogen
c) Albumin
d) Globulin

Answer 74

c) Albumin
Rationale: Albumin synthesis may be reduced in liver disease, affecting drug binding, volume of distribution, half-life, and action duration.

Question 75

25. Which of the following conditions is associated with a rise in AST and ALT?
    a) Hepatocellular injury
    b) Cholestasis
    c) Hemolysis
    d) Gilbert’s syndrome

Answer 75

a) Hepatocellular injury
Rationale: A rise in AST and ALT signals hepatocellular injury or death.

Question 76

Which of the following is NOT a cause of a mixed pattern in LFTs?
a) Sepsis
b) Cholangitis
c) Wilson’s disease
d) Alcoholic liver disease

Answer 76

c) Wilson’s disease
Rationale: Wilson’s disease causes hepatocellular injury, not a mixed pattern.

Question 77

Which of the following conditions can cause fluid retention, affecting the volume of drug distribution?
a) Hepatic dysfunction
b) Renal dysfunction
c) Cardiac dysfunction
d) Pulmonary dysfunction

Answer 77

a) Hepatic dysfunction
Rationale: Hepatic dysfunction can cause fluid retention, increasing the volume within which drugs are present.

Question 78

Which of the following drugs can cause hepatocellular injury due to toxicity?
a) Paracetamol
b) Halothane
c) Both a and b
d) Neither a nor b

Answer 78

c) Both a and b
Rationale: Both paracetamol and halothane can cause hepatocellular injury due to toxicity.

Question 79

Which enzyme is NOT indicative of cholestasis?
a) ALP
b) GGT
c) AST
d) Bilirubin

Answer 79

c) AST
Rationale: ALP and GGT are indicative of cholestasis, while AST indicates hepatocellular injury.

Question 80

Which of the following conditions can cause an isolated rise in unconjugated bilirubin?
a) Hemolysis
b) Alcoholic hepatitis
c) Cholangitis
d) Viral hepatitis

Answer 80

a) Hemolysis
Rationale: An isolated rise in unconjugated bilirubin can be attributed to hemolysis.

Question 81

1. Which of the following is a late consequence of portal hypertension in cirrhosis?
   A) Hepatic encephalopathy
   B) Ascites
   C) Hyperdynamic syndrome
   D) Hepatorenal syndrome

Answer 81

C) Hyperdynamic syndrome
Rationale: The hyperdynamic syndrome is a late consequence of portal hypertension in cirrhosis, characterized by high cardiac output, increased heart rate, and increased total blood volume.

Question 82

. In liver failure, what happens to the drug’s extraction ratio?
A) Increases
B) Decreases
C) Remains the same
D) Doubles

Answer 82

B) Decreases
Rationale: In liver failure, the degree of metabolism is reduced, leading to a decreased extraction ratio.

Question 83

3. Which drug has been implicated in causing hepatitis?
   A) Sevoflurane
   B) Isoflurane
   C) Halothane
   D) Desflurane

Answer 83

C) Halothane
Rationale: Halothane has been associated with causing hepatitis, especially in the context of oxidative metabolism in the liver.

Question 84

4. What percentage of critically ill patients have hepatic dysfunction?
   A) 5-10%
   B) 11-54%
   C) 55-70%
   D) 71-85%

Answer 84

B) 11-54%
Rationale: 11-54% of critically ill patients are reported to have hepatic dysfunction.

Question 85

5. What is the extraction ratio (ER) of a drug?
   A) The fraction of drug metabolized in the liver
   B) The fraction of drug excreted in the urine
   C) The fraction of drug that is removed from the blood as it crosses the eliminating organ
   D) The fraction of drug bound to plasma proteins

Answer 85

C) The fraction of drug that is removed from the blood as it crosses the eliminating organ
Rationale: ER represents the fraction of a drug removed from the blood or plasma as it passes through an eliminating organ like the liver or kidney.

Question 86

6. Which type of hepatitis caused by Halothane is characterized by fever, jaundice, and elevated serum transaminases?
   A) Type 1
   B) Type 2
   C) Type 3
   D) Type 4

Answer 86

B) Type 2
Rationale: Type 2 hepatitis caused by Halothane is characterized by oxidative metabolism of halothane in the liver leading to symptoms like fever, jaundice, and elevated serum transaminases.

Question 87

7. In cirrhosis, what happens to first-pass metabolism?
   A) Increases
   B) Decreases
   C) Remains the same
   D) Doubles

Answer 87

B) Decreases
Rationale: First-pass metabolism is decreased in cirrhosis, leading to increased bioavailability of drugs.

Question 88

8. Which of the following drugs has its clearance dependent on blood flow?
   A) Drugs with high extraction ratios
   B) Drugs with low extraction ratios
   C) Both
   D) Neither

Answer 88

A) Drugs with high extraction ratios
Rationale: Drugs with high extraction ratios have their clearance dependent on blood flow.

Question 89

9. What is the main effect of vasopressors on liver blood flow?
   A) Increase
   B) Decrease
   C) No effect
   D) Variable effect

Answer 89

B) Decrease
Rationale: Vasopressors reduce liver blood flow, which can further reduce the extraction ratios of drugs.

Question 90

10. Which of the following is NOT a manifestation of the hyperdynamic syndrome?
    A) High cardiac output
    B) Increased heart rate
    C) Reduced total systemic vascular resistance
    D) Reduced cardiac output

Answer 90

D) Reduced cardiac output
Rationale: The hyperdynamic syndrome is characterized by high cardiac output, not reduced.

Question 91

11. Which inhalational agent is associated with the generation of trifluoroacetyl chloride (TFA)?
    A) Sevoflurane
    B) Isoflurane
    C) Halothane
    D) Desflurane

Answer 91

C) Halothane
Rationale: Halothane undergoes oxidative metabolism leading to the generation of trifluoroacetyl chloride (TFA).

Question 92

Which type of hepatitis caused by Halothane is mild and transient?
A) Type 1
B) Type 2
C) Type 3
D) Type 4

Answer 92

A) Type 1
Rationale: Type 1 hepatitis caused by Halothane is mild, transient, and has a relatively high incidence.

Question 93

13. What effect can IV anesthetics have on blood pressure?
    A) Gradual increase
    B) Gradual decrease
    C) Sudden precipitous fall
    D) No effect

Answer 93

C) Sudden precipitous fall
Rationale: IV anesthetics can cause a sudden and sharp drop in blood pressure.

Question 94

14. In liver failure, what happens to the bioavailability of drugs?
    A) Increases
    B) Decreases
    C) Remains the same
    D) Variable effect

Answer 94

A) Increases
Rationale: In liver failure, more drug reaches the systemic circulation due to a decreased extraction ratio, thus increasing bioavailability.

Question 95

15. What is the main consequence of reduced first-pass metabolism in cirrhosis?
    A) Reduced drug effect
    B) Increased drug effect
    C) No change in drug effect
    D) Variable drug effect

Answer 95

B) Increased drug effect
Rationale: Reduced first-pass metabolism in cirrhosis leads to increased bioavailability of drugs, potentially increasing their effect.

Question 96

16. Which of the following drugs has its clearance limited by reduced metabolism, not blood flow?
    A) Drugs with high extraction ratios
    B) Drugs with low extraction ratios
    C) Both
    D) Neither

Answer 96

B) Drugs with low extraction ratios
Rationale: Drugs with low extraction ratios have their clearance limited by metabolism, not by blood flow.

Question 97

7. Which of the following is a consequence of the oxidative metabolism of Halothane in the liver?
   A) Generation of trifluoroacetyl chloride (TFA)
   B) Reduced first-pass metabolism
   C) Increased extraction ratio
   D) Reduced bioavailability

Answer 97

A) Generation of trifluoroacetyl chloride (TFA)
Rationale: Oxidative metabolism of Halothane in the liver leads to the generation of trifluoroacetyl chloride (TFA).

Question 98

18. Which of the following is NOT a characteristic of the hyperdynamic syndrome?
    A) Reduced heart rate
    B) High cardiac output
    C) Increased total blood volume
    D) Reduced total systemic vascular resistance

Answer 98

A) Reduced heart rate
Rationale: The hyperdynamic syndrome is characterized by an increased heart rate, not a reduced one.

Question 99

19. In the context of drug metabolism, what is the role of the liver?
    A) Excretion
    B) Absorption
    C) Metabolism
    D) Distribution

Answer 99

C) Metabolism
Rationale: The liver plays a crucial role in the metabolism of drugs, converting them into metabolites.

Question 100

20. Which of the following is a potential effect of drugs with high extraction ratios in the presence of reduced liver blood flow?
    A) Increased clearance
    B) Decreased clearance
    C) No change in clearance
    D) Variable effect on clearance

Answer 100

B) Decreased clearance
Rationale: Drugs with high extraction ratios have their clearance dependent on blood flow. Reduced liver blood flow can lead to decreased clearance of these drugs.

Question 101

1. Which of the following is an active metabolite of morphine?
   a) Codeine
   b) Fentanyl
   c) Morphine-6-glucuronide
   d) Alfentanil

Answer 101

c) Morphine-6-glucuronide

Rationale: Morphine is metabolized in the liver to produce active metabolites, namely morphine-6-glucuronide and morphine-3-glucuronide.

Question 102

In liver failure, what happens to the extraction ratio of morphine?
a) Increases
b) Decreases
c) Remains the same
d) Doubles

Answer 102

b) Decreases

Rationale: In the event of liver failure, the extraction ratio of morphine is reduced, leading to an accumulation of morphine in the body.

Question 103

3. Codeine is converted to which substance in the liver?
   a) Fentanyl
   b) Alfentanil
   c) Morphine
   d) NSAID

Answer 103

c) Morphine

Rationale: Codeine is converted to morphine in the liver by the CYP2D6 enzyme.

Question 104

4. Which enzyme is responsible for the conversion of codeine to morphine?
   a) CYP3A4
   b) CYP2D6
   c) CYP1A2
   d) CYP2C9

Answer 104

b) CYP2D6

Rationale: Codeine is converted to morphine in the liver by the CYP2D6 enzyme.

Question 105

5. In patients with liver disease, what happens to the bioavailability of NSAIDs?
   a) Increases
   b) Decreases
   c) Remains the same
   d) Is halved

Answer 105

a) Increases

Rationale: In patients with liver disease, there’s an increased bioavailability of NSAIDs.

Question 106

6. Which of the following is NOT a substitute for NSAIDs in patients with liver disease?
   a) Pregabalin
   b) Gabapentin
   c) Paracetamol
   d) Morphine

Answer 106

d) Morphine

Rationale: Pregabalin and gabapentin can be used as alternatives to NSAIDs in patients with liver disease. Morphine is an opioid analgesic and not a direct substitute for NSAIDs.

Question 107

7. How much paracetamol can lead to hepatocellular necrosis?
   a) 1.5g
   b) 3.5g
   c) 5.5g
   d) 7.5g

Answer 107

d) 7.5g

Rationale: Ingesting as little as 7.5g of paracetamol can lead to hepatocellular necrosis.

Question 108

8. Which of the following is NOT a symptom of severe paracetamol poisoning?
   a) Nausea
   b) Hypoglycaemia
   c) Hypertension
   d) Metabolic acidosis

Answer 108

c) Hypertension

Rationale: Indicators of severe paracetamol poisoning include nausea, hypoglycaemia, and metabolic acidosis. Hypertension is not a direct symptom of paracetamol poisoning.

Question 109

9. Which drug, when used for COVID-19, can lead to elevated liver enzymes?
   a) Remdesivir
   b) Tocilizumab
   c) Dexamethasone
   d) Paracetamol

Answer 109

a) Remdesivir

Rationale: Clinical trials have observed elevated liver enzymes in patients treated with remdesivir.

Question 110

10. Which of the following steroids may reactivate HBV in high doses?
    a) Dexamethasone
    b) Prednisolone
    c) Methylprednisolone
    d) Hydrocortisone

Answer 110

c) Methylprednisolone

Rationale: Use of methylprednisolone in high doses might reactivate HBV.

Question 111

11. Which of the following is NOT to be avoided in liver disease?
    a) Abacavir
    b) COX-2 inhibitors
    c) Sertraline
    d) Aspirin
    e) AOTA

Answer 111

e) AOTA
Acetaminophen, COX 2 inh, NSAID (aspirin)

Question 112

12. Which opioid is contraindicated in breastfeeding mothers?
    a) Morphine
    b) Fentanyl
    c) Codeine
    d) Alfentanil

Answer 112

c) Codeine

Rationale: Breastfeeding mothers should avoid codeine as it can be passed to the infant through breast milk, potentially causing harm.

Question 113

13. Which of the following is NOT an effect of NSAIDs in liver disease?
    a) Increased bioavailability
    b) Reduced risk of GI bleeding
    c) Risk of renal failure
    d) Potential hepatotoxicity

Answer 113

b) Reduced risk of GI bleeding

Rationale: In patients with liver disease, there’s an increased bioavailability of NSAIDs and a higher risk of GI bleeding.

Question 114

14. Which enzyme is elevated in patients treated with Remdesivir?
    a) Amylase
    b) Lipase
    c) ALT
    d) AST

Answer 114

c) ALT

Rationale: Clinical trials have observed elevated ALT levels in patients treated with remdesivir.

Question 115

15. Which drug used in COVID-19 therapy can lead to ALT elevations but rarely causes fulminant hepatitis?
    a) Dexamethasone
    b) Tocilizumab
    c) Remdesivir
    d) Hydroxychloroquine

Answer 115

b) Tocilizumab

Rationale: While ALT elevations are common with Tocilizumab, fulminant hepatitis is rare.

Question 116

16. In patients with chronic liver disease, what is the recommended daily dosage of paracetamol?
    a) 1-2 g/day
    b) 2-3 g/day
    c) 3-4 g/day
    d) 4-5 g/day

Answer 116

b) 2-3 g/day

Rationale: For patients with chronic liver disease, the recommended daily dosage of paracetamol as an analgesic is reduced to 2-3 g/day.

Question 117

17. Which of the following is NOT a symptom of severe paracetamol poisoning?
    a) Encephalopathy
    b) Hypoglycaemia
    c) Diarrhea
    d) Hypotension

Answer 117

c) Diarrhea

Rationale: Diarrhea is not a direct symptom of paracetamol poisoning. Other symptoms like encephalopathy, hypoglycaemia, and hypotension are indicators of severe poisoning.

Question 118

18. Which of the following drugs can reactivate HBV when used in high doses?
    a) Dexamethasone
    b) Methylprednisolone
    c) Tocilizumab
    d) Remdesivir

Answer 118

b) Methylprednisolone

Rationale: Use of methylprednisolone in high doses might reactivate HBV.

Question 119

19. Which of the following is NOT an opioid?
    a) Codeine
    b) Fentanyl
    c) Pregabalin
    d) Morphine

Answer 119

c) Pregabalin

Rationale: Pregabalin is an anticonvulsant and neuropathic pain agent, not an opioid.

Question 120

20. Which of the following drugs is contraindicated in CYP2D6 ultra-rapid metabolizers?
    a) Morphine
    b) Fentanyl
    c) Codeine
    d) Alfentanil

Answer 120

c) Codeine

Rationale: Codeine is contraindicated in individuals known to be CYP2D6 ultra-rapid metabolizers due to the risk of rapid conversion to morphine.

Question 121

21. Which of the following is a potential side effect of NSAIDs in liver disease?
    a) Decreased bioavailability
    b) Reduced risk of renal failure
    c) Increased risk of GI bleeding
    d) Reduced risk of hepatotoxicity

Answer 121

c) Increased risk of GI bleeding

Rationale: In patients with liver disease, there’s a higher risk of GI bleeding due to NSAIDs.

Question 122

22. Which of the following drugs, when used for COVID-19, can lead to elevated liver enzymes but rarely requires treatment discontinuation?
    a) Dexamethasone
    b) Tocilizumab
    c) Remdesivir
    d) Hydroxychloroquine

Answer 122

c) Remdesivir

Rationale: Clinical trials have observed elevated liver enzymes in patients treated with remdesivir, but these elevated values rarely necessitate discontinuation of the drug.

Question 123

23. Which of the following is NOT a treatment option for fulminant liver failure due to paracetamol overdose?
    a) Liver transplantation
    b) N-acetylcysteine
    c) Dialysis
    d) High-dose vitamin C

Answer 123

d) High-dose vitamin C

Rationale: Liver transplantation and N-acetylcysteine are treatment options for fulminant liver failure due to paracetamol overdose. High-dose vitamin C is not a standard treatment for this condition.

Question 124

24. Which of the following drugs can lead to ALT elevations and has a risk of reactivating HBV in patients with viral etiology liver disease?
    a) Dexamethasone
    b) Tocilizumab
    c) Remdesivir
    d) Hydroxychloroquine

Answer 124

b) Tocilizumab

Rationale: Tocilizumab can lead to ALT elevations, and there’s a risk of HBV reactivation if the patient has chronic liver disease due to viral etiology.

Question 125

25. Which of the following drugs is probably safe in low doses for patients with chronic stable liver disease?
    a) Dexamethasone
    b) Methylprednisolone
    c) Tocilizumab
    d) Remdesivir

Answer 125

a) Dexamethasone

Rationale: Low-dose dexamethasone is likely safe for patients with stable chronic liver disease.

Question 126

26. Which of the following is NOT an opioid?
    a) Codeine
    b) Gabapentin
    c) Morphine
    d) Fentanyl

Answer 126

b) Gabapentin

Rationale: Gabapentin is an anticonvulsant and neuropathic pain agent, not an opioid.

Question 127

27. Which of the following drugs can increase the risk of spontaneous bacterial peritonitis (SBP) in severe cases?
    a) Dexamethasone
    b) Methylprednisolone
    c) Tocilizumab
    d) Remdesivir

Answer 127

b) Methylprednisolone

Rationale: Use of methylprednisolone in high doses may increase the risk of spontaneous bacterial peritonitis (SBP) in severe cases.

Question 128

28. Which of the following is NOT to be avoided in liver disease?
    a) Green tea extract
    b) COX-2 inhibitors
    c) Tacrolimus
    d) Metformin

Answer 128

d) Metformin

Rationale: Green tea extract, COX-2 inhibitors, and tacrolimus are among the medications that can have adverse effects on the liver or exacerbate existing liver conditions. Metformin, while used for diabetes, is not specifically listed among the medications to avoid in the provided list.

Question 129

29. Which of the following drugs, when used for COVID-19, can lead to ALT elevations but rarely causes fulminant hepatitis?
    a) Dexamethasone
    b) Tocilizumab
    c) Remdesivir
    d) Hydroxychloroquine

Answer 129

b) Tocilizumab

Rationale: While ALT elevations are common with Tocilizumab, fulminant hepatitis is rare.

Question 130

30. Which of the following is a potential side effect of NSAIDs in liver disease?
    a) Decreased bioavailability
    b) Reduced risk of renal failure
    c) Increased risk of GI bleeding
    d) Reduced risk of hepatotoxicity

Answer 130

c) Increased risk of GI bleeding

Rationale: In patients with liver disease, there’s a higher risk of GI bleeding due to NSAIDs.