Liver Function

Question 1

Which of the following conditions will cause significantly elevated aminotransferases?
a. Biliary obstruction
b. Space-occupying lesion
c. Fulminant hepatic failure
d. Cirrhosis

Answer 1

c. Fulminant hepatic failure

Question 2

What is the best screening test for hepatitis C infection?
a. HCV viral load
b. Anti-hepatitis C antibody
c. AST and ALT
d. Hepatitis C antigen

Answer 2

b. Anti-hepatitis C antibody

THE BEST SCREENING TEST FOR HEPATITIS C IS ANTI
HEPATITIS C ANTIBODY (95% SENSITIVITY, 99%
SPECIFICITY).

Question 3

A 42-year old female consulted because of abdominal pain and jaundice. Laboratory work-up showed increased ALP and GGT. What is the most likely cause of the elevated ALP?

a. Cirrhosis
b. Alcoholic liver disease
c. Hepatitis B infection
d. Gall stone

Answer 3

d. Gall stone

ALP BLOOD LEVELS CAN BE GREATLY INCREASED, FOR EXAMPLE, IN CASES WHERE ONE OR MORE BILE DUCTS ARE BLOCKED. THIS CAN OCCUR AS A RESULT OF INFLAMMATION OF THE GALLBLADDER (CHOLECYSTITIS) OR GALLSTONES

Question 4

Which of the following is correctly paired?
a. Canalicular = LD
b. Cytoplasmic = GGT
c. Mitochondrial = ALT
d. Cytoplasmic = AST

Answer 4

d. Cytoplasmic = AST

ALT IS MAINLY LOCATED IN THE CYTOPLASM, WHILE AST IS PRESENT BOTH IN THE CYTOPLASM AND IN THE MITOCHONDRIA.

Question 5

In the first 24 hours of acute hepatocellular injury, why is AST higher than ALT?

a. AST has an upper range limit
b. AST is ubiquitously distributed in the body tissues/organs
c. AST has higher activity in the hepatocyte
d. AST has a longer half-life

Answer 5

c. AST has higher activity in the hepatocyte

WITH MOST FORMS OF ACUTE HEPATOCELLULAR INJURY, SUCH AS HEPATITIS, AST WILL BE HIGHER THAN ALT INITIALLY BECAUSE OF THE HIGHER ACTIVITY OF AST IN HEPATOCYTES. WITHIN 24 TO 48 HOURS, PARTICULARLY IF ONGOING DAMAGE OCCURS, ALT WILL BECOME HIGHER THAN AST, BASED ON ITS LONGER HALF-LIFE.

Question 6

Which of the following is CORRECT?
a. Hepatitis A: RNA virus
b. Hepatitis E: DNA virus
c. Hepatitis B: RNA virus
d. Hepatitis C: DNA virus

Answer 6

a. Hepatitis A: RNA virus

Hepatitis A RNA Virus
Hepatitis B DNA Virus
Hepatitis C RNA Virus
Hepatitis D RNA Virus
Hepatitis E RNA Virus

Question 7

Enzymes primarily reflecting canalicular injury include the following EXCEPT:

a. ALP
b. GGT
c. LD
d. 5ʹ-nucleotidase

Answer 7

c. LD

THESE ENZYMES ARE LOCATED PREDOMINANTLY ON THE CANALICULAR MEMBRANE OF THE HEPATOCYTE AND INCLUDE:
1. ALP
2. Γ-GLUTAMYL TRANSFERASE
3. 5ʹ-NUCLEOTIDASE

Question 8

Permanent immunity in Hepatitis B is conferred by which of the following?
a. HBsAg
b. Anti-HBe
c. Anti-HBc IgM
d. Anti-HBs

Answer 8

d. Anti-HBs

HEPATITIS B: PERMANENT IMMUNITY IS CONFERRED BY ANTI-HBSAG IGG (ANTI-HBS).

Question 9

Which of the following can cause conjugated hyperbilirubinemia?

a. Dubin Johnson Syndrome & Gilbert Syndrome
b. Cholelithiasis & Septicemia
c. Gilbert Syndrome & Crigler-Najar Syndrome
d. Hemolytic anemia & Gilbert Syndrome

Answer 9

b. Cholelithiasis & Septicemia

ADULTS, BLOCKADE OF ANY OF THE MAJOR BILE DUCTS, ESPECIALLY THE COMMON BILE DUCT, BY STONES OR SPACE -OCCUPYING LESIONS SUCH A S TUMORS, IS THE MOST COMMON CAUSE OF CONJUGATED HYPERBILIRUBINEMIA.

Question 10

Which of the following can be detected during the “window period” of Hepatitis B infection?

a. HBsAg & HBc
b. Anti-HBs & Anti-HBe
c. Anti-HBs & Anti-HBc
d. Anti-HBc & Anti-HBe

Answer 10

d. Anti-HBc & Anti-HBe

IN THIS TIME PERIOD, THE TITERS OF ANTI -HBV CORE ANTIGEN (ANTIHBC) IGM (PURPLE CURVE) AND IGG (BLACK CURVE) RISE, INDICATING ACUTE HBV INFECTION O THIS IS THE SO-CALLED CORE WINDOW. IGG ANTI -HBV E ANTIGEN (ANTI-HBE) (CYAN OR LIGHT -BLUE CURVE) ALSO RISES DURING THIS CORE WINDOW PERIOD.

Question 11

What is the most important test of hepatic metabolic function?
A. Bilirubin
B. Ammonia
C. Albumin
D. Lipid profile

Answer 11

A. Bilirubin

Question 12

What major metabolite of hemoglobin is measured in liver function?
A. ALT
B. AST
C. Ammonia
D. Bilirubin

Answer 12

D. Bilirubin

Question 13

Which of the following will cause elevated unconjugated bilirubin
A. Dubin-Johnson Syndrome & Cholelithiasis
B. Hemolytic anemia & Gilbert Syndrome
C Crigler-Najjar Syndrome & Dubin-Johnson Syndrome
D. Cholelithiasis & hemolysis

Answer 13

B. Hemolytic anemia & Gilbert Syndrome

Question 14

Which of the following is correctly paired?
A. Gilbert Syndrome - unconjugated hyperbilirubinemia
B. Dubin-Johnson Syndrome - unconjugated hyperbilirubinemia
C. Crigler-Najjar Syndrome - conjugated hyperbilirubinemia
D. Hemolytic anemia - conjugated hyperbilirubinemia

Answer 14

A. Gilbert Syndrome - unconjugated hyperbilirubinemia

Question 15

What is the usual method used in serum protein determination?
A. Dry slide method
B. Dye binding method
C. Biuret method
D. Diazo test

Answer 15

C. Biuret method

Question 16

Why is ALP elevated in cases of biliary obstruction?
A. Increased synthesis and excretion
B. Increased synthesis and decreased excretion
C. Decreased synthesis and excretion
D. Decreased synthesis and increased excretion

Answer 16

B. Increased synthesis and decreased excretion

Question 17

A 5 year-old male had Hepatitis A infection. When will the patient cease to be infectious?
A. After anti-HAV IgM falls to undetectable levels
B. Upon the appearance of the Hepatitis A antigen
C. When AST/ALT becomes normal
xise of Anti-HBc IgM & IgG
D. Once he becomes asymptomatic

Answer 17

A. After anti-HAV IgM falls to undetectable levels

Question 18

Which of the following findings will indicate acute HBV infection during “core window”?
A. Rise of Anti-HBc IgM and IgG
B. Rise of HBsAg
C. Rise of HBeAg
D. Rise of Anti-HBs

Answer 18

A. Rise of Anti-HBc IgM and IgG

Question 19

A 50-year-old male consulted because his hepatitis profile was reactive for Anti-HCV and HCV RNA. He denied
any symptoms even in the past few weeks. What is your interpretation of his hepatitis status?
A. Acute HCV infection
B. Possible HCV clearance
C. Active HCV infection
D. False-positive HCV test

Answer 19

C. Active HCV infection

Question 20

A 40 year old male was admitted because of jaundice. He was reactive for HBsAg and HBeAg. He was given anti-viral medications for several months. Repeat Hepatitis profile showed that he was reactive for Total Anti-HBc, Anti-HBs, and Anti-HBe. What is the present status of the patient?
A. Chronic HBV carrier
B Acute chronic HBV infection
C. Resolved HBV infection
D. Acute HBV infection in the “core window”

Answer 20

C. Resolved HBV infection

Question 21

A previously healthy 38-year-old man complains of yellow discoloration of his eyes, abdominal pain, and low-
quadrant tenderness, and a palpable ilver edge 2 cm below the right costal margin. Total serum billrubin is
grade fever of 1-month duration. Physical examination demonstrates a distended abdomen, right upper
7,4 mg/dL. Serum levels of AST and ALT are elevated (229 and 495 U/L, respectively). The prothrombin time
is prolonged (18 seconds). A liver biopsy shows Councilman bodies. These findings are indicative of which
of the following liver disease?
A. Acute viral hepatitis
B. Alcoholic cirrhosis
C. Cholecystitis
D. Primary biliary cirrhosis

Answer 21

A. Acute viral hepatitis

Question 22

A 30-year-old male consulted because of reactive HBsAg, Total Anti-HBc, and Anti-HBe. Other tests are non-reactive. What is the status of the patient’s HBV infection?
A. Resolved infection
B. Active infection
C. Chronic carrier state
D. Active chronic infection

Answer 22

C. Chronic carrier state

Question 23

A 20-year-old male, street vendor complained of a few weeks’ history of on and off fever, malaise, abdominal
discomfort, and diarrhea. On PE, he was noted to have icteric sclerae and jaundice. Laboratory results
showed reactive Anti-HAV IgM only. What is your interpretation of the result?
A. Patient is still in the incubation phase of the disease
B. Patient is in the acute phase of the disease
C. Patient already recovered from the disease
D. Patient is in the early acute phase of the disease

Answer 23

B. Patient is in the acute phase of the disease

Question 24

A 22-year-old female underwent annual physical examination in her work. She consulted because of reactive
anti-HBs in her hepatitis profile. PE findings were unremarkable. Other test results were also unremarkable.
What will you tell her?
A. She should monitor her hepatitis profile regularly.
B. She should watch out for jaundice.
C. She had to take anti-viral medications.
D. She has immunity due to vaccination.

Answer 24

D. She has immunity due to vaccination.

Question 25

A 65-year-old female consulted because of fever, abdominal pain, diarrhea, and jaundice. Laboratory results showed reactive anti-HEV IgM. What will you request to confirm your diagnosis?
A. Total anti-HEV
B. HEV PCR
C. Anti-HEV IgG
D. AST and ALT

Answer 25

B. HEV PCR

Question 26

A 62-year-old man is brought to the emergency room in a disoriented state. Physical examination reveals
signs of poor hygiene and an odor of alcohol, as well as jaundice, splenomegaly, and ascites. The patient
has a coarse flapping tremor of the hands, palmar erythema, and diffuse spider angiomata. The abdomen
displays dilated periumbilical veins. Serum levels of ammonia, alkaline phosphatase, and bilirubin are all elevated. Soon after admission, the patient vomits a large amount of blood. Which of the following is the
most likely underlying disease of the patient?
A. Hepatitis
B. Cholecystitis
C. Cirrhosis
D. Passive congestion

Answer 26

C. Cirrhosis

Question 27

An 18-year-old man presents with a 2-week history of yellow skin and sclerae but is otherwise asymptomatic.
He recalls a similar episode 2 years previously. His brother also has recurrent jaundice. The serum bilirubin is 5.2 mg/dL, mostly in the unconjugated form. Serum AST and ALT levels are normal, as is the urinalysis.Two weeks later, the jaundice resolves spontaneously. What is the most likely diagnosis?
A. Gilbert Syndrome
B. Crigler-Najjar type I
C. Dubin-Johnson syndrome
D. Wilson disease

Answer 27

A. Gilbert Syndrome

Question 28

A 60-year-old man is found in a state of disorientation and is brought to the emergency room in a comatose
state. He lived alone, ate poorly, and drank large amounts of hard liquor. Physical examination reveals an emaciated man with a distended abdomen, jaundice, ascites, and a slightly enlarged liver and spleen. What laboratory test will be the most helpful in establishing the diagnosis?
A. Alanine aminotransferase
B. Alkaline phosphatase
C. Ammonia
D. Bilirubin

Answer 28

C. Ammonia

Question 29

A 47-year-old woman presents with a 3-month history of vague upper abdominal pain after fatty meals, some
abdominal distension, and frequent indigestion. Physical examination shows an obese woman (BMI = 30
kg/m*) with right upper quadrant tenderness. An ultrasound examination discloses multiple echogenic objects in the gallbladder. Which of the following will most likely be the liver function test profile of this patient?
A. High ALP & Bilirubin
B. High AST & ALT
C. High ammonia & low albumin
D. High Lactate dehydrogenase & ALP

Answer 29

A. High ALP & Bilirubin

Question 30

A 68-year-old man complains of vague abdominal pain, intermittent fever, and a 20-1b (9-kg) weight loss over
the past 6 months. For the past 12 years, he has suffered from chronic hepatitis B. On physical examination, the patient shows diffuse abdominal tenderness, hepatomegaly, and mild jaundice. A CT scan of the abdomen reveals a diffusely nodular liver, with a dominant mass measuring 3 cm in diameter, Biopsy done
showed hepatocytes that are larger than normal and often with enlarged, multiple, pleomorphic nuclei, without an increase in nuclear-to cytoplasmic ratio. Which of the following serum markers is useful for monitoring the progression of disease in this patient?
A. Alkaline phosphatase
B. Alpha-fetoprotein
C. Anti-HiBc antibody
D. Aminotransferase

Answer 30

B. Alpha-fetoprotein