Jaundice and viral hepatitis: pharmacotherapy and supportive care MCQs With Answer

Jaundice and viral hepatitis are core topics in Pharmacotherapeutics for M.Pharm students, demanding a firm grasp of pathophysiology, diagnostic interpretation, specific antiviral pharmacology, adverse effects, drug interactions, and supportive care strategies. This quiz set of focused MCQs covers hepatocellular versus cholestatic patterns, antiviral choices for HBV and HCV (including direct-acting antivirals), management of complications such as hepatic encephalopathy, ascites, pruritus, and acetaminophen toxicity, plus practical clinical considerations like pregnancy, monitoring, and transplantation criteria. These questions are aimed to deepen clinical pharmacology understanding, improve decision-making about therapy selection, dosing caveats, and safety monitoring relevant to postgraduate pharmacy practice.

Q1. Which laboratory pattern most strongly suggests hemolytic (pre-hepatic) jaundice?

• Elevated direct (conjugated) bilirubin with pale stools
• Elevated indirect (unconjugated) bilirubin with increased reticulocyte count
• Markedly elevated alkaline phosphatase with normal bilirubin
• Isolated rise in gamma-glutamyl transferase (GGT)

Correct Answer: Elevated indirect (unconjugated) bilirubin with increased reticulocyte count

Q2. An AST:ALT ratio >2:1 is classically associated with which condition?

• Acute viral hepatitis
• Nonalcoholic fatty liver disease (NAFLD)
• Alcoholic hepatitis
• Primary biliary cholangitis

Correct Answer: Alcoholic hepatitis

Q3. Which antiviral is considered a first-line nucleos(t)ide analogue for chronic hepatitis B with high viral load or cirrhosis?

• Lamivudine
• Interferon alfa
• Tenofovir disoproxil fumarate (TDF)
• Acyclovir

Correct Answer: Tenofovir disoproxil fumarate (TDF)

Q4. Which hepatitis C drug is a nucleotide NS5B RNA-dependent RNA polymerase inhibitor?

• Ledipasvir
• Simeprevir
• Sofosbuvir
• Ribavirin

Correct Answer: Sofosbuvir

Q5. Which statement about ribavirin in hepatitis C therapy is correct?

• It is safe in pregnancy and recommended in all women of childbearing potential
• It is teratogenic and contraindicated in pregnancy
• It directly inhibits NS5A protein
• It is a protease inhibitor used as monotherapy

Correct Answer: It is teratogenic and contraindicated in pregnancy

Q6. Which adverse effect is most clinically significant and frequently limits the use of pegylated interferon-alpha in hepatitis treatment?

• Renal failure
• Severe psychiatric depression and suicidal ideation
• Permanent sensorineural hearing loss
• Marked hyperglycemia

Correct Answer: Severe psychiatric depression and suicidal ideation

Q7. What is the specific antidote and mainstay treatment for acute acetaminophen (paracetamol) overdose to prevent fulminant hepatic failure?

• Activated charcoal only
• High-dose vitamin K
• N-acetylcysteine (NAC)
• Ribavirin

Correct Answer: N-acetylcysteine (NAC)

Q8. First-line pharmacologic treatment for hepatic encephalopathy due to accumulated ammonia is:

• Lactulose to trap ammonia in the gut
• High-protein diet
• Loop diuretics
• Systemic corticosteroids

Correct Answer: Lactulose to trap ammonia in the gut

Q9. Which therapy is typically first-line for severe pruritus due to cholestasis in obstructive jaundice?

• Cholestyramine (bile acid sequestrant)
• High-dose antihistamines alone
• Oral corticosteroids
• Ribavirin

Correct Answer: Cholestyramine (bile acid sequestrant)

Q10. Ledipasvir used in HCV combination therapy primarily inhibits which viral target?

• NS3/4A protease
• NS5A replication complex
• NS5B polymerase
• Viral entry into hepatocytes

Correct Answer: NS5A replication complex

Q11. Which direct-acting antiviral regimen is pangenotypic for hepatitis C?

• Sofosbuvir + Ledipasvir (SOF/LDV)
• Glecaprevir + Pibrentasvir (GLE/PIB)
• Simeprevir monotherapy
• Telaprevir + interferon

Correct Answer: Glecaprevir + Pibrentasvir (GLE/PIB)

Q12. Which liver enzyme is considered more specific to hepatocellular injury and is preferred for monitoring liver inflammation?

• Alkaline phosphatase (ALP)
• Gamma-glutamyl transferase (GGT)
• Aspartate aminotransferase (AST)
• Alanine aminotransferase (ALT)

Correct Answer: Alanine aminotransferase (ALT)

Q13. For a highly viremic pregnant woman with chronic HBV, which intervention in the third trimester reduces vertical transmission risk?

• Immediate postpartum ribavirin to the mother
• Start tenofovir in the third trimester
• Administer interferon-alpha during pregnancy
• Delay any antiviral therapy until after breastfeeding

Correct Answer: Start tenofovir in the third trimester

Q14. Entecavir’s primary antiviral mechanism against hepatitis B virus is:

• Protease inhibition of HBV virion assembly
• Inhibition of HBV DNA polymerase (reverse transcriptase) as a guanosine analogue
• Direct neutralization of HBsAg particles
• Blockade of viral entry into hepatocytes

Correct Answer: Inhibition of HBV DNA polymerase (reverse transcriptase) as a guanosine analogue

Q15. Which antiretroviral is known to cause unconjugated hyperbilirubinemia by inhibiting UGT1A1, often producing benign jaundice?

• Atazanavir
• Efavirenz
• Lamivudine
• Tenofovir

Correct Answer: Atazanavir

Q16. Initial medical management of ascites in cirrhosis typically includes:

• Intravenous albumin and immediate paracentesis without sodium restriction
• Sodium restriction and a potassium-sparing diuretic such as spironolactone
• High-sodium diet and loop diuretics alone
• Ribavirin therapy

Correct Answer: Sodium restriction and a potassium-sparing diuretic such as spironolactone

Q17. The recommended prophylactic vaccine to prevent hepatitis A infection is which of the following?

• Live attenuated hepatitis A oral vaccine only
• Inactivated hepatitis A vaccine administered IM
• Recombinant hepatitis C vaccine
• Conjugate vaccine against HAV and HBV

Correct Answer: Inactivated hepatitis A vaccine administered IM

Q18. Presence of which serologic marker indicates high infectivity and active hepatitis B viral replication?

• Anti-HBs (antibody to HBsAg)
• HBsAg only without other markers
• HBeAg (hepatitis B e antigen)
• Anti-HBc IgG alone

Correct Answer: HBeAg (hepatitis B e antigen)

Q19. Which medication is classically associated with microvesicular fatty change and mitochondrial toxicity leading to acute liver injury?

• Acetaminophen (therapeutic doses)
• Valproic acid
• Cholestyramine
• Interferon beta

Correct Answer: Valproic acid

Q20. In acute liver failure, an important clinical indicator that often prompts urgent consideration for liver transplantation listing is:

• Mild transaminase elevation without encephalopathy
• Hepatic encephalopathy accompanied by prolonged INR (coagulopathy)
• Isolated low albumin with normal INR
• Stable bilirubin with absent encephalopathy

Correct Answer: Hepatic encephalopathy accompanied by prolonged INR (coagulopathy)

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