BIO- GD 2

GIT Block
Jaundice - liver function- Markers of
Liver and GIT dysfunction
Dr. Ayat Sayed
Department of Medical Biochemistry
Assiut Faculty of Medicine
1. A newborn presents to the pediatrician with kernicterus, jaundice,
and elevation of serum unconjugated bilirubin; the patient dies soon
after her first birthday. This patient most likely had a deficiency in
which of the following enzymes?
(A) Aldolase B
(B) Galactose-1-phosphate uridyltransferase
(C) Glucose 6-phosphatase
(D) Uridine diphosphate-glucuronosyltransferase
(E) Uroporphyrinogen decarboxylase
2- Obstructive liver disease is usually characterized by which of the
following qualities?
3. A 58-year-old woman with a body mass index (BMI) of 34 presents with nausea and sudden, severe
pain in the right epigastrium which sometimes radiates to the right shoulder. Her temperature is 38.5 C,
and she is mildly jaundiced. Endoscopic retrograde cholangiopancreatography (ERCP) identifies a
gallstone in the biliary tree. Which combination of enzymes would expect to be elevated in this patient?

(A) Increased serum alkaline phosphate, GGT, AST and ALT

(B) NORMAL serum alkaline phosphatase, GGT, AST and ALT

(C) Increased serum alkaline phosphatase and GGT & normal AST and ALT

(D) Normal serum alkaline phosphatase and GGT & high AST and ALT
1. In patients with hemolytic jaundice, which one of the following substances
is the most likely cause of the dark coloration of their urine that develops
on exposure to air?
A. Biliverdin
B. Conjugated bilirubin
C. Unconjugated bilirubin
D.Urobilin
5. A 35-year-old woman who is HIV-positive presents to the physician with jaundice and
right upper quadrant abdominal pain. The patient reports having had multiple episodes
of jaundice over the past 10 years. A hepatitis panel is positive for HBsAg and anti-HBc
IgM, but negative for HBsAb and anti- HAV IgM. Which of the following would most likely
be lower than normal in this patient?

(A)Albumin
(B)Alkaline phosphatase
(C)Bilirubin
(D)Prothrombin time
(E)Transaminases
6. A newborn was brought to the pediatrician with kernicterus, jaundice, and
elevation of serum unconjugated bilirubin (30 mg/dl). He died few days later. This
baby most likely had which one of the following syndromes?
A. Crigler-Najjar
B. Dubin-Johnson
C. Gilbert syndrome
D. Rotor
 7. A 65-year-old known alcoholic is brought unconscious into the A&E department. On e
examination he is jaundiced, confused, and has multiple bruises and gynaecomastia. Ascites
and bilateral peripheral leg oedema are also found.
From the following options choose the best answer for Questions below
A. Detoxification of ammonia

B. Detoxification of endogenous estrogens

C. Excretion of bile pigments

D. Synthesis of albumin

E. Synthesis of clotting factors

1. Failure of which single liver function is most likely to be responsible for this man’s
unconsciousness?
2. Failure of which single liver function is most likely to be responsible for this man’s ascites?
3. Failure of which single liver function is most likely to be responsible for this man’s bruises?
4. Failure of which single liver function is most likely to be responsible for this man’s
gynaecomastia?
8. Liver catabolism of xenobiotic compounds is meant to increasing the
solubility of such compounds for safe excretion from the body. This can
occur via the addition of which compound below to the xenobiotic?
a. Phenylalanine
b. Palmitate
c. Linoleate
d. Glucuronate
e. Cholesterol
9. A 75-year-old chronic alcoholic man presents to the emergency
room after being found unconscious on the floor of his home. His
blood glucose level was 50 mg/dl (hypoglycaemic). Ethanol decreases
gluconeogenesis by:
a. Inhibiting glucose-6-phosphatase
b. Inhibiting PEP carboxykinase
c. Inhibiting glucokinase
d.Converting NAD+ into NADH and decreasing the availability of
pyruvate
e. Converting NAD+ into NADH and decreasing the availability of lactate
10. Fatty liver may be caused by
A. Deficiency of methionine
B. Deficiency of essential fatty acids
C. Chronic alcoholism
D. All of these
11. 40-year-old man, with a BMI of 37, has a fasting blood glucose level
of 165 mg/dL, a value that has been steadily increasing over the past 5
years. His HbA1c level is 8.9. Which of the following medical disorders
would you expect this patient to also have?
(A) Low blood pressure
(B) Polycystic ovary syndrome (PCOS)
(C) Fatty liver-nonalcoholic hepatitis (NASH––nonalcoholic steatohepatitis)
(D) Hypouricemia
(E) High HDL cholesterol
12. A 58-year-old woman with a body mass index (BMI) of 34 presents with nausea
and sudden, severe pain in the right epigastrium which sometimes radiates to the right

shoulder. Her temperature is 38.5 C, and she is mildly jaundiced and tachycardic. You are

suspecting acute pancreatitis. Which of the following enzymes

would you order to confirm your diagnosis?

A. Serum amylase

B. Serum AST

C. Serum ALT

D. Serum alkaline phosphatase

E. Gama glutamyltransferase