Self evaluation exercise for the study of Jaundice
Dr A.J. Chandrasekhar

1.All of the statements regarding unconjugated bilirubin is true except

A. 80% of bilirubin is derived from RBC's

B. Heme moiety gets converted to biliverdin, which is metabolized to bilirubin

C. Unconjugated bilirubin can cross blood brain barrier

D. Unconjugated bilirubin is excreted in urine

Unconjugated bilirubin is tightly bound to albumin and cannot be excreted in urine.

2. All of the following statements regarding conjugated bilirubin is true except

A. Kidney conjugates bilirubin to glucuronic acid

B. Conjugated bilirubin is water soluble and is excreted in urine

C. Presence of bilirubin in urine is indicative of conjugated bilirubinemia

D. Bilirubin glucuronyl transferace catalyses and conjugates bilirubin

Liver conjugates bilirubin glucuronic acid. Conjugation is the last function to go.

3. The rate limiting step in the metabolism of bilirubin is

A. Bilirubin uptake

B. Bilirubin conjugation

C. Bilirubin excretion

4. Following statements regarding urobilinogen is true except

A. Ileal and Colonic bacteria convert bilirubin to urobilinogen

B. Urobilinogen is absorbed from Ileum and colon

C. Urobilnogen is excreted by Kidney

D. Urobilinogen is absorbed from GI tract and enters systemic circulation

Urobilinogen is absorbed from GI tract and enters portal circulation

5. Unconjugated hyperbilrubinemia can be seen in all of the following except

A. Gilbert's syndrome

B. Thalassemia

C. Dubin johnson syndrome

D. Hemolysis

Dubin Johnson syndrome

6. Jaundice in primary biliary cirrhosis is due to

A. Hepatocellualr failure

B. Cholestatic jaundice

C. Extrahepatic biliary Obstruction

D. Metabolic disorder

7. Jaundice in sclerosing cholangitis is due to

A. Hepatocellualr failure

B. Cholestatic jaundice

C. Obstructive jaundice

D. Metabolic disorder

8. When Jaundice is associated with nausea, vomiting and anorexia, you should consider

A. Hepatitis

B. Cancer Pancreas

C. Sickle cell anemia

D. Dubin Johnson syndrome

9. When Jaundice is associated with weight loss, you should consider

A. Hepatitis

B. Cholangitis

C. Pancreatitis

D. Primary biliary cirrhosis

Cancer and cholangitis are considerations when jaundice is associated with weight loss.

10. When Jaundice is associated with pruritus, you should consider

A. Obstructive jaundice

B. Hepatocellular jaundice

C. Unconjugated hyperbilirubinemia

D. Metabolic disorder

Bile salt deposition occurs in obstructive jaundice which is responsible for itching.

11. Darkening of urine and scleral icterus precedes yellowing of skin.

A. True

B. false

12. Carotenemia does not cause scleral icterus.

A. True

B. false

13. A patient with alchoholic hepatitis sustains a minor injury of shoulder . You would prescribe

A. Aspirin

B. Tylenol

Tylenol can be toxic in patients with liver disease due to increased p-450 enzyme activity

14. Elevated bilirubin per se has no patho-physiological consequence in adults

A. True

B. false

In children the unconjugated bilirubin can cross blood brain barrier and has affinity for basal ganglia. (Kernicterus)

15. Post-op jaundice . Select the wrong statement.

A. Self limited

B. 15% of open heart surgery

C. Patients feel well with no anorexia

D. Workup for gallbladder disease

It is common and is  multifactorial (hemolysis, drugs, anesthesia, ischemia, hypoxia, sepsis)

16. Liquid protein diet for weight loss carries the risk for gall bladder disease

A. True

B. false

Liqud protein diet promotes gall bladder stasis and resultant in sludge/stone.

17. Gilbert's syndrome

A. Is a genetic enzymatic defect in the liver

B. Is due to increased hemolysis