Jaundice

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Question 1 of 10

1. Question
A 50-year-old man presents to the emergency department with lethargy and itching. His wife has noticed he has become yellow over the last three days.

He is on Mesalazine for ulcerative colitis and drinks approx 15 units of alcohol per week. His initial blood tests reveal bilirubin 70, ALT 220, ALP 1530. His pANCA is positive and Abdominal USS shows no dilatation of intra or extrahepatic bile ducts.

Which one of the following is correct.
- Liver biopsy is the next most appropriate investigation to determine the cause of this man’s jaundice
- Endoscopic retrograde cholangio-panctreatography would be diagnostic of primary sclerosing cholangitis
- Abdominal USS would be sensitive at detecting intraductal gallstones
- CT is sensitive at detecting intraductal gallstones
- cANCA would be positive in 70% of patients with primary sclerosing cholangitis
Correct

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Question 2 of 10

2. Question
Which of the following statements is correct regarding causes of jaundice:
- Fever, right upper quadrant tenderness and vomiting is suggestive of biliary colic
- Painless jaundice, epigastric mass and weight loss indicates alcoholic liver disease (ALD)
- A family history of mild jaundice is most consistent with Gilbert’s syndrome
- A brief prodrome of myalgia, malaise and recent foreign travel is suggestive of pancreatitis
- Spider naevi, ascites, portal hypertension and fetor hepaticus is consistent with massive haemolysis
Correct

Incorrect
Question 3 of 10

3. Question
Breakdown of haem is responsible for the majority of bililrubin produced but 20% comes from other sources.

Which of the following sources do NOT produce bilirubin?
- Haemaglobin
- Catalase
- Cytochromes
- Cholesterol
- Myoglobin
Correct

Incorrect
Question 4 of 10

4. Question
Which one of the following statements is correct regarding metabolism of haem?
- The initial reaction in the metabolism of haem is the reduction to biliverdin
- Unconjugated bilirubin travels unbound to the liver where it is conjugated
- In the biliary and cystic ducts conjugated bilirubin is enzymatically converted to urobilinogen
- Urobilinogen can be transported in the blood to the kidney where it is oxidised to urobilin and passed out with the urine
- Haemaglobin is broken down to haem and globin by phospolipases in the reticuloendothelial system when red blood cells reach their 120 day lifespan
Correct

Incorrect
Question 5 of 10

5. Question
Which of the following does NOT cause obstructive jaundice?
- Pancreatic carcinoma
- Cholangiocarcinoma
- Pancreatitis
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
Correct

Incorrect
Question 6 of 10

6. Question
A previously fit and well 75-year-old female is admitted for elective total hip replacement.

Intra-operatively she requires red cell transfusion of 4 units, fully cross matched. One week post operation, one of the nurses notes her to be jaundice. An FBC reveals Hb 8.5 g/dl, WCC 10.5 x10, plt 445 x10.

The most likely cause of her jaundice is:
- Paracetamol toxicity
- Hepatitis C
- Delayed haemolytic transfusion reaction
- Pancreatitis
- Myelodysplasia
Correct

Incorrect
Question 7 of 10

7. Question
In pre-hepatic (unconjugated) hyperbilirubinaemia the urinalysis will show:
- No bilirubin with raised urobilinogen
- Bilirubin present with raised urobilinogen
- Raised bilirubin with reduced or absent urobilinogen
- Raised bilirubin with raised urobilinogen
- No bilirubin with reduced or absent urobilinogen
Correct

Incorrect
Question 8 of 10

8. Question
With regards to management of patients presenting to the emergency department with jaundice, which of the following statements is correct?
- Newborns with neonatal jaundice may be discharged with no follow-up if the bilirubin level is <15 mg/dL
- Patients with acute hepatocellular injury, PT 150 and disorientation to time should be admitted to a general medical ward
- Quick and accurate treatment of neonatal jaundice reduces the risk of the newborn developing kernicterus (deposition of bilirubin in the lentiform nucleus)
- Patients with jaundice, ALT 564, ALP 97, GGT 44, PT 10s, APPT 31 always require admission for further investigation of hepatocellular injury
- Patients with ALP346, GGT 660 are likely to have biliary tract obstruction and should have abdominal USS requested
Correct

Incorrect
Question 9 of 10

9. Question
A 60-year-old male with a longstanding history of alcohol excess, presents with weight loss, jaundice and abdominal pain. His total and conjugated bilirubin levels are raised. His ALT, GGT and amylase are raised. CT abdomen reveals nodular liver and cysts within his pancreas and a mass at the head of the pancreas. The most likely cause of jaundice is:
- Cirrhosis
- Liver metastases
- Haemolytic anaemia secondary to tumour
- Biliary duct stricture
- Reduced resorption of bile acids
Correct

Incorrect
Question 10 of 10

10. Question
Which one of the following is true in jaundice caused by cholangiocarcinoma?
- Urinary bilirubin is absent
- Serum total bilirubin is increased with conjugated bilirubin reduced
- Faecal stercobilinogen is reduced
- Urobilinogen is increased in the urine
- Serum unconjugated bilirubin is increased
Correct

Incorrect

Jaundice – Post Test

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