Disorders of lipid metabolism – Fatty liver MCQs With Answer

Disorders of lipid metabolism – Fatty liver MCQs With Answer
This concise introduction helps B. Pharm students grasp disorders of lipid metabolism, focusing on hepatic steatosis (fatty liver), NAFLD, NASH, triglyceride handling, and pharmacologic implications. Expect clear coverage of pathogenesis — insulin resistance, altered VLDL secretion, oxidative stress, mitochondrial dysfunction — plus diagnostic markers (ALT/AST, imaging, FibroScan) and drug-related causes. Emphasis is on drug mechanisms, therapeutic choices (statins, fibrates, pioglitazone, vitamin E, omega‑3), adverse effects, and monitoring parameters relevant to pharmacy practice. Keywords: Disorders of lipid metabolism, Fatty liver, hepatic steatosis, triglycerides, NAFLD, NASH, B. Pharm, MCQs. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which cellular organelle is primarily responsible for beta-oxidation of long-chain fatty acids in hepatocytes?

• Mitochondria
• Golgi apparatus
• Ribosome
• Lysosome

Correct Answer: Mitochondria

Q2. Which metabolic change induced by excessive alcohol metabolism contributes most to hepatic steatosis?

• Increased NADH/NAD+ ratio
• Decreased ATP production
• Increased glucagon secretion
• Decreased lactate levels

Correct Answer: Increased NADH/NAD+ ratio

Q3. Which apolipoprotein is essential for VLDL assembly and secretion from hepatocytes?

• ApoA-I
• ApoB100
• ApoC-II
• ApoE

Correct Answer: ApoB100

Q4. Nonalcoholic steatohepatitis (NASH) is best characterized by which histological features?

• Steatosis with hepatocellular ballooning and inflammation
• Pure glycogen accumulation without inflammation
• Portal tract lymphoid aggregates only
• Cholestasis and bile duct proliferation

Correct Answer: Steatosis with hepatocellular ballooning and inflammation

Q5. Which ratio of liver enzymes is more suggestive of alcoholic liver disease than NAFLD?

• ALT:AST > 2:1
• AST:ALT > 2:1
• ALT = AST
• GGT markedly decreased

Correct Answer: AST:ALT > 2:1

Q6. Which imaging modality is most commonly used as first-line to detect hepatic steatosis?

• Abdominal ultrasound
• CT with contrast
• MRI spectroscopy only
• Plain abdominal X-ray

Correct Answer: Abdominal ultrasound

Q7. What is the primary pathophysiologic driver of NAFLD in metabolic syndrome?

• Insulin resistance
• Autoimmune attack
• Viral infection
• Excessive copper accumulation

Correct Answer: Insulin resistance

Q8. Which drug class is considered safe and often recommended for dyslipidemia in patients with fatty liver?

• Statins
• Amiodarone
• High-dose niacin without monitoring
• Ketoconazole

Correct Answer: Statins

Q9. Which dietary intervention has strongest evidence to reduce hepatic steatosis?

• Weight loss through calorie restriction and exercise
• High-sugar, low-fat diet
• Complete fasting for weeks
• Excessive protein supplementation

Correct Answer: Weight loss through calorie restriction and exercise

Q10. Which molecular defect leads to decreased VLDL secretion and can contribute to fatty liver?

• Deficiency of microsomal triglyceride transfer protein (MTP)
• Overexpression of ApoA-I
• Excess bile acid synthesis
• Upregulated CYP3A4 activity

Correct Answer: Deficiency of microsomal triglyceride transfer protein (MTP)

Q11. Which adipokine is typically decreased in obesity and linked to worsened hepatic steatosis?

• Leptin
• Adiponectin
• Resistin
• TNF-alpha

Correct Answer: Adiponectin

Q12. Which of the following drugs is a well-known cause of drug-induced steatosis?

• Valproic acid
• Metformin
• Atorvastatin
• Penicillin

Correct Answer: Valproic acid

Q13. Which laboratory marker best correlates with hepatic necroinflammation in NASH?

• Serum ALT elevation
• Serum albumin increase
• Decreased INR only
• Urinary bilirubin

Correct Answer: Serum ALT elevation

Q14. FibroScan measures liver stiffness primarily to assess what complication of chronic fatty liver?

• Hepatic fibrosis
• Acute cholangitis
• Hepatic adenoma
• Portal vein thrombosis

Correct Answer: Hepatic fibrosis

Q15. Which cytokine is implicated in progression from simple steatosis to steatohepatitis?

• Interleukin-10
• TNF-alpha
• Insulin-like growth factor 1
• Interleukin-2 only

Correct Answer: TNF-alpha

Q16. Pioglitazone improves NASH primarily through which mechanism?

• Enhancing insulin sensitivity via PPAR-gamma activation
• Inhibiting HMG-CoA reductase
• Blocking bile acid reabsorption
• Direct antiviral activity

Correct Answer: Enhancing insulin sensitivity via PPAR-gamma activation

Q17. Which lipid fraction is most directly associated with hepatic triglyceride accumulation?

• VLDL-triglycerides
• HDL-cholesterol
• LDL-cholesterol
• Lipoprotein(a)

Correct Answer: VLDL-triglycerides

Q18. In NAFLD, mitochondrial dysfunction leads to increased production of which damaging species?

• Reactive oxygen species (ROS)
• Anti-inflammatory prostaglandins
• Glutathione only
• Nicotinamide adenine

Correct Answer: Reactive oxygen species (ROS)

Q19. Which scoring system uses clinical and lab variables to estimate fibrosis risk in NAFLD?

• NAFLD Fibrosis Score
• Child-Pugh only
• MELD exclusively
• APGAR score

Correct Answer: NAFLD Fibrosis Score

Q20. Which vitamin has evidence to improve histology in non-diabetic adults with NASH?

• Vitamin E (alpha-tocopherol)
• Vitamin A
• Vitamin D only
• Vitamin K

Correct Answer: Vitamin E (alpha-tocopherol)

Q21. Which of the following is a common extrahepatic complication of advanced NAFLD?

• Cardiovascular disease
• Acute appendicitis
• Type I diabetes only
• Peripheral neuropathy unrelated to metabolism

Correct Answer: Cardiovascular disease

Q22. Which mechanism best explains triglyceride accumulation in hepatocytes in insulin resistance?

• Increased lipolysis in adipose tissue raising free fatty acid flux to liver
• Complete blockade of intestinal fat absorption
• Reduced hepatic glycolysis only
• Excess hepatic bile production

Correct Answer: Increased lipolysis in adipose tissue raising free fatty acid flux to liver

Q23. Which laboratory profile is most typical in early NAFLD?

• Mild to moderate ALT elevation with normal bilirubin
• Marked hyperbilirubinemia and low ALT
• Severe coagulopathy at onset
• High urine ketones only

Correct Answer: Mild to moderate ALT elevation with normal bilirubin

Q24. Hepatic steatosis becomes macrovesicular when?

• Large lipid droplets displace the nucleus to the cell periphery
• Lipid is stored in mitochondria only
• Small droplets cluster without nuclear displacement
• Cholesterol crystals form

Correct Answer: Large lipid droplets displace the nucleus to the cell periphery

Q25. Which therapeutic agent lowers triglycerides by activating PPAR-alpha?

• Fenofibrate
• Metformin
• Warfarin
• Spironolactone

Correct Answer: Fenofibrate

Q26. Drug-induced steatohepatitis risk is increased by which feature of a medication?

• High lipophilicity and mitochondrial toxicity
• Exclusively renal excretion
• Absence of hepatic metabolism
• Purely topical application

Correct Answer: High lipophilicity and mitochondrial toxicity

Q27. Which marker is used to assess hepatic synthetic function relevant to advanced fatty liver?

• Serum albumin level
• Serum CK-MB
• Serum amylase
• Urine creatinine

Correct Answer: Serum albumin level

Q28. Which of the following is an evidence-based pharmacologic therapy for biopsy-proven NASH in patients with type 2 diabetes?

• Pioglitazone
• Isotretinoin
• High-dose corticosteroids
• Infliximab

Correct Answer: Pioglitazone

Q29. Which biochemical change in the liver favors triglyceride synthesis over oxidation?

• High insulin and high NADPH availability
• Low substrate for fatty acid synthase only
• Excess glucagon predominance
• Low acetyl-CoA carboxylase activity

Correct Answer: High insulin and high NADPH availability

Q30. Which dietary fatty acid supplement has been shown to reduce serum triglycerides and may benefit hepatic steatosis?

• Omega-3 polyunsaturated fatty acids
• Trans fats
• Excess saturated fats
• Medium-chain triglycerides in excess

Correct Answer: Omega-3 polyunsaturated fatty acids

Q31. Which genetic disorder is associated with defective peroxisomal beta-oxidation and hepatic lipid accumulation?

• Zellweger spectrum disorder
• Hemophilia A
• Phenylketonuria
• Sickle cell disease

Correct Answer: Zellweger spectrum disorder

Q32. Which histologic finding indicates progression from NASH toward fibrosis?

• Pericellular collagen deposition
• Only macrovesicular steatosis without inflammation
• Isolated glycogenated nuclei
• Fatty change limited to centrilobular zone without scarring

Correct Answer: Pericellular collagen deposition

Q33. Which biochemical parameter is included in the NAFLD Fibrosis Score?

• Platelet count
• Serum sodium only
• Urine protein
• Serum troponin

Correct Answer: Platelet count

Q34. Which antiviral agent is most associated with hepatic steatosis in hepatitis C infection?

• Interferon-alpha therapy historically associated with metabolic effects
• Oseltamivir
• Acyclovir
• Ribavirin alone prevents steatosis

Correct Answer: Interferon-alpha therapy historically associated with metabolic effects

Q35. Which lipid parameter change would you expect in a patient with metabolic syndrome and hepatic steatosis?

• High triglycerides and low HDL
• Very high HDL and low triglycerides
• Isolated low LDL only
• Markedly low total cholesterol only

Correct Answer: High triglycerides and low HDL

Q36. In the context of fatty liver, which mechanism explains hepatocyte ballooning?

• Cytoskeletal collapse due to cellular injury and swelling
• Excess bile secretion stretching cells
• Immediate apoptosis with shrinkage
• Accumulation of glycogen alone

Correct Answer: Cytoskeletal collapse due to cellular injury and swelling

Q37. Which laboratory test best detects cholestatic versus hepatocellular pattern of liver injury?

• Alkaline phosphatase relative to ALT/AST
• Serum ferritin only
• Serum lipase
• Urine urobilinogen only

Correct Answer: Alkaline phosphatase relative to ALT/AST

Q38. Which pharmacologic action of statins is most relevant to reducing cardiovascular risk in patients with NAFLD?

• Inhibition of HMG-CoA reductase lowering LDL cholesterol
• Direct removal of hepatic fat droplets
• Inhibition of bile salt export pump only
• Stimulation of hepatic gluconeogenesis

Correct Answer: Inhibition of HMG-CoA reductase lowering LDL cholesterol

Q39. Which diagnostic test can quantify hepatic fat fraction noninvasively with high sensitivity?

• Proton density fat fraction MRI (MRI-PDFF)
• Plain ultrasound without Doppler
• Chest X-ray
• Serum ceruloplasmin

Correct Answer: Proton density fat fraction MRI (MRI-PDFF)

Q40. Which of the following is a clinical sign suggesting progression to cirrhosis in a patient with chronic fatty liver?

• Development of ascites and hepatic encephalopathy
• Transient skin flushing only
• Improved appetite and weight gain
• Resolution of splenomegaly

Correct Answer: Development of ascites and hepatic encephalopathy

Q41. Which laboratory alteration suggests advanced hepatic synthetic failure?

• Prolonged INR
• Low serum amylase only
• High alkaline phosphatase alone
• Elevated serum creatinine only

Correct Answer: Prolonged INR

Q42. Which medication used for obesity has shown improvements in liver histology in clinical trials?

• SGLT2 inhibitors and GLP-1 receptor agonists show benefit; GLP-1 receptor agonists like liraglutide
• Orlistat exclusively cures NASH
• Amphetamine derivatives without supervision
• Benzodiazepines

Correct Answer: SGLT2 inhibitors and GLP-1 receptor agonists show benefit; GLP-1 receptor agonists like liraglutide

Q43. Which hepatic zone is most susceptible to hypoxic injury and typically shows initial fat accumulation in many liver diseases?

• Zone 3 (centrilobular zone)
• Zone 1 (periportal)
• Zone 2 only
• Lobular septa exclusively

Correct Answer: Zone 3 (centrilobular zone)

Q44. Which laboratory marker is more specific for cholestasis than for fatty liver?

• Alkaline phosphatase (ALP)
• ALT
• AST
• Serum triglycerides

Correct Answer: Alkaline phosphatase (ALP)

Q45. Which mechanism explains why hepatic insulin resistance promotes de novo lipogenesis?

• Insulin-resistant liver retains lipogenic signaling while failing to suppress gluconeogenesis
• Insulin completely blocks SREBP-1c activation
• Insulin directly inhibits fatty acid synthase
• Insulin reduces citrate availability for lipogenesis

Correct Answer: Insulin-resistant liver retains lipogenic signaling while failing to suppress gluconeogenesis

Q46. Which pharmacologic agent reduces hepatic steatosis by decreasing intestinal fat absorption?

• Orlistat
• Fenofibrate
• Atorvastatin
• Metformin

Correct Answer: Orlistat

Q47. Which feature on ultrasound suggests moderate to severe hepatic steatosis?

• Diffuse increased echogenicity of liver with poor visualization of diaphragm
• Liver size reduction with bright portal walls only
• Hypoechoic liver with hyperactive bile ducts
• Calcifications throughout liver parenchyma

Correct Answer: Diffuse increased echogenicity of liver with poor visualization of diaphragm

Q48. For a B. Pharm student, which monitoring parameter is essential when initiating statin therapy in a patient with fatty liver?

• Baseline and follow-up liver function tests (ALT/AST)
• Routine serum ceruloplasmin monthly
• Daily serum amylase
• Frequent urine pregnancy tests only

Correct Answer: Baseline and follow-up liver function tests (ALT/AST)

Q49. Which compound accumulates in hepatocytes as lipid droplets during steatosis?

• Triglycerides
• Glycogen exclusively
• Uric acid crystals
• Ferritin only

Correct Answer: Triglycerides

Q50. Which preventive strategy is most important at public health level to reduce NAFLD prevalence?

• Address obesity and metabolic risk factors through lifestyle and policy measures
• Universal liver biopsy screening
• Mass prophylactic vitamin K administration
• Elimination of all dietary fats

Correct Answer: Address obesity and metabolic risk factors through lifestyle and policy measures

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

Mail- Sachin@pharmacyfreak.com