Jaundice MCQs With Answer

Jaundice MCQs With Answer for B. Pharm students offers a concise, exam-focused review of bilirubin metabolism, types of jaundice, diagnostic markers, and pharmacological management. This set emphasizes clinical correlations—prehepatic, hepatic, and posthepatic mechanisms—laboratory interpretation of total and direct bilirubin, liver function tests, and complications like kernicterus and drug-induced liver injury. Questions probe UGT1A1 defects, inherited syndromes, therapeutic approaches including phototherapy, exchange transfusion and ursodeoxycholic acid, and implications for drug dosing in hepatic impairment. Ideal for revision, practice tests, and improving clinical reasoning in hepatology and pharmacotherapy. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. What is the primary pigment responsible for the yellow discoloration seen in jaundice?

• Hemoglobin
• Bilirubin
• Urobilinogen
• Albumin

Correct Answer: Bilirubin

Q2. Which fraction of bilirubin increases in obstructive (posthepatic) jaundice?

• Unconjugated bilirubin
• Conjugated (direct) bilirubin
• Delta bilirubin only
• Indirect non-albumin bilirubin

Correct Answer: Conjugated (direct) bilirubin

Q3. Which enzyme catalyzes the conjugation of bilirubin in hepatocytes?

• UDP-glucuronosyltransferase (UGT1A1)
• Glutathione S-transferase
• Cytochrome P450 3A4
• Biliverdin reductase

Correct Answer: UDP-glucuronosyltransferase (UGT1A1)

Q4. A newborn with high unconjugated bilirubin is at risk for which neurological complication?

• Hepatic encephalopathy
• Kernicterus
• Spinal muscular atrophy
• Seizure due to hypoglycemia only

Correct Answer: Kernicterus

Q5. Which inherited disorder is characterized by complete absence of UGT1A1 activity and severe unconjugated hyperbilirubinemia?

• Gilbert syndrome
• Crigler-Najjar syndrome type I
• Dubin-Johnson syndrome
• Rotor syndrome

Correct Answer: Crigler-Najjar syndrome type I

Q6. Which laboratory pattern suggests hemolytic (prehepatic) jaundice?

• High direct bilirubin, high ALP
• High indirect bilirubin, elevated reticulocyte count
• Normal bilirubin, prolonged PT
• High conjugated bilirubin, pale stools

Correct Answer: High indirect bilirubin, elevated reticulocyte count

Q7. In obstructive jaundice, which stool/urine changes are typically seen?

• Dark urine, pale stools
• Bright yellow stools, clear urine
• No change in stool color, concentrated urine
• Green stools, normal urine

Correct Answer: Dark urine, pale stools

Q8. Which liver enzyme is most specific for cholestatic liver injury when elevated alongside ALP?

• AST
• ALT
• GGT (gamma-glutamyl transferase)
• Lactate dehydrogenase

Correct Answer: GGT (gamma-glutamyl transferase)

Q9. Which drug is commonly associated with cholestatic jaundice?

• Acetaminophen in therapeutic doses
• Chlorpromazine
• Metformin
• Insulin

Correct Answer: Chlorpromazine

Q10. Which test distinguishes between conjugated and unconjugated bilirubin?

• Serum albumin level
• Direct (conjugated) bilirubin measurement
• Serum ammonia
• Prothrombin time

Correct Answer: Direct (conjugated) bilirubin measurement

Q11. Gilbert syndrome typically presents with which laboratory finding?

• Markedly elevated conjugated bilirubin
• Mild unconjugated hyperbilirubinemia that worsens with fasting or stress
• Elevated ALP and GGT
• Severe neonatal jaundice requiring exchange transfusion

Correct Answer: Mild unconjugated hyperbilirubinemia that worsens with fasting or stress

Q12. What is the primary mechanism of jaundice in hepatitis viral infection?

• Excess hemolysis
• Impaired hepatocellular uptake, conjugation and excretion of bilirubin
• Gallstone obstruction of common bile duct
• Renal failure reducing bilirubin clearance

Correct Answer: Impaired hepatocellular uptake, conjugation and excretion of bilirubin

Q13. Which investigation is most useful to evaluate structural biliary obstruction?

• Serum ceruloplasmin
• Ultrasound abdomen
• Serum alpha-fetoprotein
• Blood culture

Correct Answer: Ultrasound abdomen

Q14. Elevated direct bilirubin with normal or mildly increased AST/ALT suggests what pattern?

• Predominantly hepatocellular injury
• Predominantly cholestatic or obstructive pattern
• Isolated hemolysis
• Renal dysfunction

Correct Answer: Predominantly cholestatic or obstructive pattern

Q15. Which bile acid therapy is indicated for certain cholestatic liver diseases?

• Ursodeoxycholic acid (UDCA)
• Chenodeoxycholic acid exclusively contraindicated
• Deoxycholic acid IV
• Oral taurocholic acid only

Correct Answer: Ursodeoxycholic acid (UDCA)

Q16. Which viral hepatitis is most associated with chronic liver disease and cholestatic features in adults?

• Hepatitis A
• Hepatitis E in pregnant women only
• Hepatitis C
• Hepatitis D only as a coinfection

Correct Answer: Hepatitis C

Q17. In drug dosing for jaundiced patients with hepatic impairment, which pharmacokinetic parameter often requires adjustment?

• Renal clearance only
• Hepatic clearance and protein binding
• Volume of distribution but never clearance
• Gastrointestinal absorption exclusively

Correct Answer: Hepatic clearance and protein binding

Q18. Which inherited condition causes conjugated hyperbilirubinemia with a black liver on gross pathology?

• Crigler-Najjar syndrome
• Dubin-Johnson syndrome
• Gilbert syndrome
• Rotor syndrome

Correct Answer: Dubin-Johnson syndrome

Q19. Which laboratory parameter reflects hepatic synthetic function and predicts severity in liver disease?

• Serum creatinine
• Prothrombin time / INR
• Serum sodium
• Urine urobilinogen

Correct Answer: Prothrombin time / INR

Q20. Phototherapy treats neonatal jaundice by:

• Enhancing conjugation via UGT1A1 induction
• Converting unconjugated bilirubin to photoisomers that are water-soluble
• Increasing hemolysis to reduce bilirubin production
• Promoting hepatic regeneration

Correct Answer: Converting unconjugated bilirubin to photoisomers that are water-soluble

Q21. Which of the following causes predominantly unconjugated hyperbilirubinemia?

• Extrahepatic bile duct obstruction
• Hemolytic anemia
• Primary biliary cholangitis
• Choledocholithiasis

Correct Answer: Hemolytic anemia

Q22. A significant rise in ALT relative to ALP suggests which pattern?

• Cholestatic pattern
• Obstructive biliary tract disease
• Hepatocellular injury pattern
• Normal liver function

Correct Answer: Hepatocellular injury pattern

Q23. Which condition produces conjugated hyperbilirubinemia without significant cholestasis and normal liver architecture?

• Dubin-Johnson syndrome
• Crigler-Najjar syndrome
• Hemolysis
• Acute viral hepatitis

Correct Answer: Dubin-Johnson syndrome

Q24. Which pharmacologic agent can increase the risk of hyperbilirubinemia by inhibiting UGT1A1?

• Isoniazid
• Atazanavir
• Metformin
• Propranolol

Correct Answer: Atazanavir

Q25. Rotor syndrome differs from Dubin-Johnson syndrome mainly by:

• Presence of a darkly pigmented liver in Rotor
• Absence of black liver pigment in Rotor syndrome
• Rotor has severe hemolysis
• Rotor is characterized by defective hemoglobin conjugation

Correct Answer: Absence of black liver pigment in Rotor syndrome

Q26. Which bile duct imaging modality provides both diagnostic and therapeutic capability for obstructive jaundice?

• Abdominal X-ray
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Plain ultrasound only
• HIDA scan exclusively

Correct Answer: Endoscopic retrograde cholangiopancreatography (ERCP)

Q27. Which laboratory finding is typical in neonates with physiologic jaundice?

• Severe conjugated hyperbilirubinemia within 24 hours
• Gradual rise of unconjugated bilirubin after 24 hours, peaking at day 3–5
• Persistent direct hyperbilirubinemia beyond 2 weeks
• Markedly elevated GGT only

Correct Answer: Gradual rise of unconjugated bilirubin after 24 hours, peaking at day 3–5

Q28. In hepatic jaundice due to hepatocellular damage, which lab trend is expected?

• Isolated ALP elevation with normal transaminases
• Marked elevation of AST and ALT with variable bilirubin increases
• Only conjugated bilirubin rises with normal transaminases
• Decreased serum bilirubin

Correct Answer: Marked elevation of AST and ALT with variable bilirubin increases

Q29. Which of the following drugs is a known hepatotoxin causing centrilobular necrosis and severe hyperbilirubinemia in overdose?

• Paracetamol (acetaminophen)
• Penicillin
• Enalapril
• Metformin

Correct Answer: Paracetamol (acetaminophen)

Q30. An increase in serum conjugated bilirubin bound to albumin and not readily excreted is called:

• Unconjugated bilirubin
• Delta bilirubin
• Urobilinogen
• Free bilirubin

Correct Answer: Delta bilirubin

Q31. Which clinical sign suggests chronic cholestasis rather than simple hyperbilirubinemia?

• Pruritus and xanthomas
• Transient fever only
• Acute abdominal pain without jaundice
• Polyuria

Correct Answer: Pruritus and xanthomas

Q32. Which laboratory measurement helps assess hepatocyte uptake and canalicular excretion function indirectly?

• Serum sodium
• Serum bilirubin fractions and ALP/GGT
• Serum potassium only
• Urinary ketones

Correct Answer: Serum bilirubin fractions and ALP/GGT

Q33. Which condition would most likely cause a disproportionately high unconjugated bilirubin fraction with normal liver enzymes?

• Acute cholangitis
• Hemolytic transfusion reaction
• Primary sclerosing cholangitis
• Biliary atresia

Correct Answer: Hemolytic transfusion reaction

Q34. Which enzyme elevation is more indicative of alcohol-related liver injury?

• ALT > AST significantly
• AST > ALT, often with AST:ALT ratio >2
• ALP only increased
• GGT suppressed

Correct Answer: AST > ALT, often with AST:ALT ratio >2

Q35. For neonates with extreme hyperbilirubinemia unresponsive to phototherapy, the recommended intervention is:

• Oral UDCA only
• Exchange transfusion
• Phlebotomy
• High-dose vitamin K

Correct Answer: Exchange transfusion

Q36. In the evaluation of jaundice, which marker helps to detect hemolysis?

• Low LDH and low reticulocyte count
• Elevated reticulocyte count and elevated LDH
• High conjugated bilirubin only
• Normal haptoglobin with low bilirubin

Correct Answer: Elevated reticulocyte count and elevated LDH

Q37. Which pathology blocks bilirubin excretion at the level of hepatocyte canalicular transporters?

• Crigler-Najjar type I
• Rotor syndrome
• Progressive familial intrahepatic cholestasis (PFIC)
• Hemolytic anemia

Correct Answer: Progressive familial intrahepatic cholestasis (PFIC)

Q38. Which of the following increases unconjugated bilirubin by displacing bilirubin from albumin binding sites?

• Sulfonamides and ceftriaxone
• Vitamin C supplements only
• Oral contraceptives exclusively
• Insulin

Correct Answer: Sulfonamides and ceftriaxone

Q39. In cholestatic liver disease, accumulation of which substances contributes to pruritus?

• Urea and creatinine
• Bile acids and lysophosphatidic acid
• Glucose and insulin
• Albumin only

Correct Answer: Bile acids and lysophosphatidic acid

Q40. Which imaging is most sensitive in detecting small common bile duct stones?

• Plain abdominal radiograph
• Endoscopic ultrasound (EUS)
• Chest X-ray
• DEXA scan

Correct Answer: Endoscopic ultrasound (EUS)

Q41. A drug metabolized by the liver has high first-pass extraction; in hepatic dysfunction this results in:

• Decreased systemic exposure and less effect
• Increased bioavailability and potential toxicity
• No change in pharmacokinetics
• Exclusive renal elimination compensation

Correct Answer: Increased bioavailability and potential toxicity

Q42. Which bilirubin-derived compound gives stool its brown color?

• Conjugated bilirubin only
• Urobilinogen and stercobilin
• Hemoglobin
• Albumin-bound bilirubin

Correct Answer: Urobilinogen and stercobilin

Q43. Which hepatic transporter mutation is implicated in Dubin-Johnson syndrome?

• ATP7B copper transporter
• MRP2 (ABCC2) canalicular transporter
• OATP1B1 only
• CFTR chloride channel

Correct Answer: MRP2 (ABCC2) canalicular transporter

Q44. Which condition often presents with conjugated hyperbilirubinemia and markedly elevated alkaline phosphatase in young women?

• Primary biliary cholangitis (PBC)
• Acute hemolytic anemia
• Neonatal physiologic jaundice
• Crigler-Najjar syndrome

Correct Answer: Primary biliary cholangitis (PBC)

Q45. In evaluating drug-induced liver injury with jaundice, which clinical sign indicates worse prognosis (Hy’s law)?

• Mild ALT elevation with normal bilirubin
• ALT or AST >3x ULN with bilirubin >2x ULN without cholestasis
• Isolated ALP elevation only
• Low platelet count only

Correct Answer: ALT or AST >3x ULN with bilirubin >2x ULN without cholestasis

Q46. Which therapeutic measure reduces enterohepatic circulation of bilirubin and may lower serum bilirubin?

• Administering bile acid sequestrants (e.g., cholestyramine)
• High-fat diet supplementation
• IV glucose infusion only
• Increased oral iron intake

Correct Answer: Administering bile acid sequestrants (e.g., cholestyramine)

Q47. Which laboratory finding is characteristic of obstructive jaundice due to common bile duct stone?

• Markedly low ALP and normal bilirubin
• Elevated ALP and conjugated bilirubin with cholestatic pattern
• Isolated high unconjugated bilirubin only
• Normal LFTs with high ammonia

Correct Answer: Elevated ALP and conjugated bilirubin with cholestatic pattern

Q48. Which molecule is the immediate precursor formed from heme breakdown before conversion to bilirubin?

• Biliverdin
• Urobilin
• Porphyrin
• Urobilinogen only

Correct Answer: Biliverdin

Q49. Which strategy is indicated to prevent kernicterus in high-risk neonates?

• Delay feeding to reduce bilirubin load
• Early and aggressive phototherapy and exchange transfusion when indicated
• Avoid all vaccinations
• Give routine adult doses of UDCA

Correct Answer: Early and aggressive phototherapy and exchange transfusion when indicated

Q50. Which test distinguishes hepatocellular from cholestatic jaundice by pattern analysis?

• Comparing ratios of ALT or AST to ALP
• Measuring only serum creatinine
• Serum glucose level
• Complete blood count alone

Correct Answer: Comparing ratios of ALT or AST to ALP

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.

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