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A 23-year-old woman enters the hospital with dark urine and yellow eyes complaining of tiredness and not feeling well for the 2 previous weeks. What would be the most likely diagnosis of this patient?

  • Bilirubin 9.5 (direct- 6.0; indirect- 3.5)
  • Alkaline phosphatase 220 (normal is up to 80)
  • LDH 8,040 (Normal is up to 150)

a. Hepatitis

b. Cirrhosis

c. Hemolytic anemia

d. Gall stones

e. A drug that is competing with bilirubin for albumin

a. Hepatitis


The slow-moving fraction of LD 5 is typically elevated in patients with:

a)       Heart disease

b)      Stroke

c)       Hepatitis

d)      Pancreatitis

e)      Peptic ulcers

c)       Hepatitis


Increased serum levels of direct reacting bilirubin are characteristic of:

a)       Dubin-Johnson syndrome

b)      Gilbert’s disease

c)       Sherlock syndrome

d)      Prematurity

e)      Crigler-Najjar syndrome

a)       Dubin-Johnson syndrome


What happens if there is an under-function of the anterior pituitary gland?



What does the luteinizing hormone do in men and women?

Stimulates interstitial cells of testes to produce sex hormones and ovulation, promotes ovarian secretion of estrogen and progestins and prepares the body for pregnancy.


1)      The effects of under-function include a decrease in the endocrine gland functions and:

a)       Fatigue

b)      Mood swings

c)       Elephantitis

d)       Dwarfism

d)       Dwarfism


The release of the seven hormones secreted by the anterior pituitary gland are controlled by which other gland?



Where is the anterior pituitary gland located?

Sella turcica at the base of the brain


Which of the following is not a general function of the pituitary gland?

a. growth

b. breast milk production

c. thyroid function

d. hair growth

d. Hair growth


What is the hormone secreted by the anterior pituitary gland that stimulates the mammary glands to produce milk?



Where does the anterior pituitary gland receive releasing hormones from?



What does the growth hormone stimulate?

Growth and cell reproduction in only humans and other vertebrates


What is the general function of the posterior pituitary gland?

To store and later release hormones


What is NOT a way that drugs can cause jaundice?

By selective toxic effect on Kupffer cells


What is bilirubin NOT derived from?

a. Destroyed RBCs

b. Cytochromes

c. Coenzymes

d. Hemoglobin

e. Myoglobin

c. Coenzymes


What enzyme is responsible for the conjugation of bilirubin?

Glycyronyl transferase


Decreased uptake of bilirubin in the liver is the cause of hyperbilirubinemia in what syndrome?

Gilbert's Syndrome


Impaired conjugation of bilirubin is the cause of hyperbilirubinemia is what syndrome?

Crigler-Najjar Syndrome


Indirect reacting bilirubin is:

a)       Water soluble and excreted in the urine

b)      Conjugated with glucuronide

c)       Unable to cause jaundice

d)       Elevated in hemolytic anemia

d)       Elevated in hemolytic anemia


Jaundice usually first becomes visible when the serum bilirubin concentration is about __________.

2.0 mg/dl


When jaundice results from hepatitis, the unconjugated fraction of the total serum bilirubin is usually:

a)       At least 85%

b)      50-85%

c)       Less than 50%

d)      85-90%

e)      90-100%

c)       Less than 50%


In patients with cirrhosis, the percent of unconjugated bilirubin is:

a)       5-15%

b)      15-50%

c)       50-70%

d)      70-90%

e)      90-100%

c)       50-70%


In patients with hepatocellular jaundice, as compared to those with purely obstructive jaundice, tend to have

a)       Higher serum alkaline phosphatase, LD, and AST activity

b)      Lower serum alkaline phosphatase, LD, and AST activity

c)       Higher serum ALP, lower LD and AST activity

d)       Lower serum ALP, higher LD and AST activity

d)       Lower serum ALP, higher LD and AST activity


If the results of serum bilirubin, ALP, LD, and AST determinations suggest obstructive jaundice the best confirmatory test of the following would be the determination of:

a)       Serum urobilinogen

b)      5-nucleotidase

c)       Protein electrophoresis

d)      ALT

e)      Choline esterase

b)      5-nucleotidase


Intrahepatic cholestasis simulating extra hepatic obstructive jaundice, can be caused by all the following except:

a)       Estrogens

b)      Oral contraceptives

c)       Cholangiolitic hepatitis

d)      Biliary cirrhosis

e)      Alcoholism

e)      Alcoholism


What is a breakdown product of hemoglobin?



What is bilirubin converted to in the liver?

Bilirubin glucuronide


Kernicterus is an abnormal accumulation of bilirubin in what tissue?

Brain tissue


A stool specimen that appears black and tarry should be tested for the presence of what?

Occult blood


What substance gives feces its normal color?