Jaundice MCQs With Answer

Jaundice MCQs With Answer is a focused study resource tailored for B. Pharm students preparing for pharmacology and therapeutics exams. This introduction explains jaundice pathophysiology, diagnostic markers, drug-induced causes, neonatal management, and pharmacological interventions such as phenobarbital, rifampicin, phototherapy, and ursodeoxycholic acid. Emphasis is on bilirubin metabolism, UGT1A1, conjugated vs unconjugated patterns, cholestasis signs, and relevant liver function tests (ALT, AST, ALP, GGT, PT). These concise, clinically oriented MCQs help strengthen understanding of mechanisms, drug interactions, adverse effects, and treatment strategies encountered in pharmacy practice. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. What is the primary biochemical cause of clinical jaundice?

• Accumulation of bilirubin in blood and tissues
• Excess hemoglobin in plasma
• Increased serum albumin concentration
• Decreased bile salt synthesis

Correct Answer: Accumulation of bilirubin in blood and tissues

Q2. Which enzyme is primarily responsible for bilirubin conjugation in the liver?

• UDP-glucuronosyltransferase 1A1 (UGT1A1)
• CYP3A4
• Sulfotransferase SULT1A1
• N-acetyltransferase 2 (NAT2)

Correct Answer: UDP-glucuronosyltransferase 1A1 (UGT1A1)

Q3. A rise in indirect (unconjugated) bilirubin with normal urine bilirubin suggests which type of jaundice?

• Prehepatic (hemolytic) jaundice
• Posthepatic (obstructive) jaundice
• Cholestatic drug-induced jaundice
• Hepatocellular cholestasis

Correct Answer: Prehepatic (hemolytic) jaundice

Q4. Which lab pattern is most consistent with obstructive (posthepatic) jaundice?

• Elevated direct bilirubin, high alkaline phosphatase and GGT
• Isolated elevated indirect bilirubin with normal ALP
• Low bilirubin with high transaminases only
• High unconjugated bilirubin with increased urobilinogen

Correct Answer: Elevated direct bilirubin, high alkaline phosphatase and GGT

Q5. Which condition is characterized by near absence of UGT1A1 activity and severe unconjugated hyperbilirubinemia?

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

Correct Answer: Crigler-Najjar syndrome type I

Q6. Phenobarbital is useful in which bilirubin disorder due to its enzyme-inducing effect?

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

Correct Answer: Crigler-Najjar syndrome type II

Q7. Which drug is known to inhibit UGT1A1 and cause unconjugated hyperbilirubinemia as an adverse effect?

• Atazanavir
• Rifampicin
• Phenobarbital
• Ursodeoxycholic acid

Correct Answer: Atazanavir

Q8. Phototherapy in neonatal jaundice acts primarily by:

• Converting bilirubin to water-soluble photoisomers excretable without conjugation
• Inducing hepatic UGT1A1 synthesis immediately
• Increasing albumin binding of bilirubin
• Stimulating bile flow through bile ducts

Correct Answer: Converting bilirubin to water-soluble photoisomers excretable without conjugation

Q9. Which laboratory test best assesses hepatic synthetic function relevant to severe liver disease?

• Prothrombin time (INR)
• Serum bilirubin alone
• Gamma-glutamyl transferase (GGT)
• Serum alkaline phosphatase

Correct Answer: Prothrombin time (INR)

Q10. Dark urine and pale stools are most typical of which mechanism?

• Obstructive (posthepatic) jaundice with conjugated bilirubin excretion into urine
• Hemolytic jaundice with increased urobilinogen in stool
• Gilbert syndrome with intermittent mild jaundice
• Crigler-Najjar type II with normal stools

Correct Answer: Obstructive (posthepatic) jaundice with conjugated bilirubin excretion into urine

Q11. Which transporter defect is classically associated with Dubin-Johnson syndrome?

• MRP2 (ABCC2) defective canalicular excretion
• NTCP defective uptake
• OATP1B1 defective hepatic uptake
• BSEP defective bile salt export

Correct Answer: MRP2 (ABCC2) defective canalicular excretion

Q12. An elevated serum unconjugated bilirubin with normal liver enzymes during fasting most likely indicates:

• Gilbert syndrome
• Obstructive cholestasis
• Acute viral hepatitis
• Dubin-Johnson syndrome

Correct Answer: Gilbert syndrome

Q13. Which neonatal factor increases risk of severe hyperbilirubinemia and kernicterus?

• Prematurity
• High birth weight
• Maternal hypothyroidism
• Maternal use of ursodeoxycholic acid

Correct Answer: Prematurity

Q14. Exchange transfusion in severe neonatal jaundice is indicated primarily to:

• Remove bilirubin and circulating antibodies and lower risk of kernicterus
• Increase neonatal albumin to bind bilirubin
• Stimulate neonatal UGT1A1 expression
• Enhance enterohepatic circulation of bilirubin

Correct Answer: Remove bilirubin and circulating antibodies and lower risk of kernicterus

Q15. A positive direct antiglobulin (Coombs) test suggests which cause of jaundice?

• Immune hemolytic anemia causing prehepatic jaundice
• Obstructive jaundice from gallstones
• Crigler-Najjar syndrome
• Dubin-Johnson syndrome

Correct Answer: Immune hemolytic anemia causing prehepatic jaundice

Q16. Which imaging modality is first-line to evaluate suspected obstructive jaundice?

• Abdominal ultrasound
• CT brain
• Chest X-ray
• DEXA scan

Correct Answer: Abdominal ultrasound

Q17. Which drug is commonly used to improve bile flow in cholestatic liver disease?

• Ursodeoxycholic acid
• Atorvastatin
• Rifampicin for all cholestatic conditions
• Acetaminophen

Correct Answer: Ursodeoxycholic acid

Q18. Which of the following drugs is most associated with cholestatic liver injury?

• Chlorpromazine
• Metformin
• Insulin
• Penicillin G

Correct Answer: Chlorpromazine

Q19. Increased serum alkaline phosphatase with proportionally lesser increase in transaminases suggests:

• Cholestatic or obstructive liver injury
• Acute hepatocellular necrosis
• Isolated hemolysis
• Muscle injury only

Correct Answer: Cholestatic or obstructive liver injury

Q20. In hemolytic jaundice, which urine finding is expected?

• Normal urine bilirubin with increased urine urobilinogen
• High urine bilirubin and low urobilinogen
• Hematuria with bilirubinuria
• Conjugated bilirubin present in urine

Correct Answer: Normal urine bilirubin with increased urine urobilinogen

Q21. Rotor syndrome differs from Dubin-Johnson syndrome by:

• Lack of black-pigmented liver and storage defect affecting hepatic uptake and storage
• Presence of severe neuropsychiatric features
• Complete absence of conjugated bilirubin
• Marked hemolysis as the primary mechanism

Correct Answer: Lack of black-pigmented liver and storage defect affecting hepatic uptake and storage

Q22. Which antibiotic is known to displace bilirubin from albumin and increase kernicterus risk in neonates?

• Sulfonamides
• Penicillin V
• Azithromycin
• Amoxicillin

Correct Answer: Sulfonamides

Q23. Which test distinguishes conjugated from unconjugated hyperbilirubinemia?

• Sulfanilic acid (direct) bilirubin test showing direct and indirect fractions
• Serum albumin concentration alone
• Serum creatinine measurement
• Serum ammonia concentration

Correct Answer: Sulfanilic acid (direct) bilirubin test showing direct and indirect fractions

Q24. Which hepatitis marker indicates active viral replication and infectivity in hepatitis B?

• HBeAg
• Anti-HBs
• Anti-HBc IgG only
• HBsAb

Correct Answer: HBeAg

Q25. Which of the following is a pharmacologic therapy used to reduce enterohepatic circulation of bilirubin in neonates?

• Oral charcoal or cholestyramine to interrupt enterohepatic recycling
• Oral phenobarbital to inhibit conjugation
• High-dose vitamin K to conjugate bilirubin
• Intravenous albumin infusion to increase bilirubin synthesis

Correct Answer: Oral charcoal or cholestyramine to interrupt enterohepatic recycling

Q26. A markedly elevated ALT and AST with modest bilirubin elevation is most typical of:

• Acute hepatocellular injury such as viral hepatitis or toxic hepatitis
• Obstructive jaundice due to gallstones
• Hemolytic anemia
• Crigler-Najjar syndrome

Correct Answer: Acute hepatocellular injury such as viral hepatitis or toxic hepatitis

Q27. Rifampicin’s effect on bilirubin metabolism is mainly due to:

• Induction of hepatic enzymes and transporters enhancing bilirubin conjugation and excretion
• Direct inhibition of UGT1A1 causing unconjugated hyperbilirubinemia
• Blocking bile flow causing cholestasis
• Displacing bilirubin from albumin

Correct Answer: Induction of hepatic enzymes and transporters enhancing bilirubin conjugation and excretion

Q28. Which of the following is a clinical sign more specific to obstructive jaundice than hemolytic jaundice?

• Pruritus due to bile salt deposition in skin
• Splenomegaly due to extravascular hemolysis
• Marked anemia as primary finding
• High reticulocyte count only

Correct Answer: Pruritus due to bile salt deposition in skin

Q29. In drug-induced cholestasis, measurement of which enzyme helps distinguish hepatic from bone origin of ALP?

• Gamma-glutamyl transferase (GGT)
• Creatine kinase
• Lactate dehydrogenase
• Amylase

Correct Answer: Gamma-glutamyl transferase (GGT)

Q30. A newborn with blood group incompatibility leading to immune hemolysis would most likely have which therapeutic intervention?

• Intravenous immunoglobulin and phototherapy, possible exchange transfusion
• High-dose phenobarbital alone
• Ursodeoxycholic acid therapy
• Oral rifampicin

Correct Answer: Intravenous immunoglobulin and phototherapy, possible exchange transfusion

Q31. Which factor increases unconjugated bilirubin in adults without liver disease?

• Increased hemolysis
• Obstructive gallstone in common bile duct
• Primary biliary cholangitis
• Cholestasis from tumor compression

Correct Answer: Increased hemolysis

Q32. What is the primary reason conjugated bilirubin appears in urine?

• Conjugated bilirubin is water-soluble and can be excreted in urine when plasma levels are high
• Conjugated bilirubin binds albumin and is filtered in kidneys
• Unconjugated bilirubin is water-soluble and appears in urine first
• Conjugated bilirubin stimulates hematuria

Correct Answer: Conjugated bilirubin is water-soluble and can be excreted in urine when plasma levels are high

Q33. Which congenital disorder shows mild intermittent jaundice aggravated by fasting or stress?

• Gilbert syndrome
• Crigler-Najjar type I
• Dubin-Johnson syndrome
• Primary sclerosing cholangitis

Correct Answer: Gilbert syndrome

Q34. Which hepatic transport protein is important for canalicular secretion of conjugated bilirubin into bile?

• MRP2 (multidrug resistance-associated protein 2)
• Glutathione peroxidase
• Albumin transporter
• CYP2E1

Correct Answer: MRP2 (multidrug resistance-associated protein 2)

Q35. Which therapeutic is indicated for intrahepatic cholestasis of pregnancy to improve bile flow and maternal pruritus?

• Ursodeoxycholic acid
• Rifampicin
• Chlorpromazine
• Phenobarbital

Correct Answer: Ursodeoxycholic acid

Q36. In adults, the most common cause of painless obstructive jaundice is likely:

• Pancreatic head carcinoma
• Acute viral hepatitis
• Hemolytic anemia
• Crigler-Najjar syndrome

Correct Answer: Pancreatic head carcinoma

Q37. Which of the following laboratory findings supports hemolysis as the cause of jaundice?

• Elevated LDH, low haptoglobin, elevated reticulocyte count
• Low reticulocyte count with normal LDH
• High conjugated bilirubin with normal LDH
• Isolated elevated ALP

Correct Answer: Elevated LDH, low haptoglobin, elevated reticulocyte count

Q38. Which medication can precipitate cholestatic jaundice due to anabolic steroid effects?

• Stanozolol (anabolic steroids)
• Metformin
• Lisinopril
• Simvastatin at low doses

Correct Answer: Stanozolol (anabolic steroids)

Q39. A B. Pharm student should recognize that bilirubin undergoes which phase II reaction?

• Glucuronidation
• Sulfation only
• Methylation exclusively
• Acetylation

Correct Answer: Glucuronidation

Q40. In a patient with obstructive jaundice, which vitamin deficiency is most likely to develop due to fat malabsorption?

• Vitamin K deficiency leading to prolonged PT
• Vitamin C deficiency causing scurvy
• Vitamin B12 deficiency leading to neuropathy
• Vitamin B1 deficiency causing beriberi

Correct Answer: Vitamin K deficiency leading to prolonged PT

Q41. Which hepatitis medication can cause cholestatic or hepatocellular liver injury as an adverse effect?

• Halothane (volatile anesthetic historically) and some antituberculars like isoniazid
• Insulin glargine
• Metoprolol
• Levofloxacin with consistent hepatoprotective effect

Correct Answer: Halothane (volatile anesthetic historically) and some antituberculars like isoniazid

Q42. Which of the following is an immediate bedside test to estimate bilirubin level in neonates?

• Transcutaneous bilirubinometry
• Liver biopsy
• Serum albumin assay only
• Chest auscultation

Correct Answer: Transcutaneous bilirubinometry

Q43. Which clinical feature helps distinguish hepatic (hepatocellular) jaundice from prehepatic jaundice?

• Both direct and indirect bilirubin can be elevated along with elevated transaminases in hepatic jaundice
• Hepatic jaundice always has normal transaminases
• Prehepatic jaundice causes dark urine with bilirubinuria
• Hepatic jaundice never causes pruritus

Correct Answer: Both direct and indirect bilirubin can be elevated along with elevated transaminases in hepatic jaundice

Q44. Which of the following bile pigments is responsible for the brown color of feces?

• Stercobilin
• Urobilinogen in urine
• Unconjugated bilirubin in plasma
• Conjugated bilirubin in urine

Correct Answer: Stercobilin

Q45. A B. Pharm student should remember that bilirubin is derived from which molecule?

• Heme (from hemoglobin breakdown)
• Cholesterol
• Glucose
• Triglycerides

Correct Answer: Heme (from hemoglobin breakdown)

Q46. Which clinical scenario is most likely to show markedly elevated conjugated bilirubin with minimal urobilinogen in stool?

• Complete extrahepatic biliary obstruction
• Hemolytic anemia with increased urobilinogen
• Gilbert syndrome during fasting
• Crigler-Najjar syndrome type II

Correct Answer: Complete extrahepatic biliary obstruction

Q47. Which medication can be used to treat pruritus associated with cholestasis by modulating bile acid signaling?

• Rifampicin (off-label for pruritus in cholestasis)
• Atazanavir to inhibit UGT1A1
• High-dose acetaminophen
• Oral iron supplementation

Correct Answer: Rifampicin (off-label for pruritus in cholestasis)

Q48. In neonatal breastfeeding jaundice, the mechanism often involves:

• Increased enterohepatic circulation of bilirubin due to breast milk constituents and poor intake
• Inherited UGT1A1 absence at birth identical to Crigler-Najjar type I
• Viral hepatitis transmission via breast milk
• Direct conjugation defect caused by maternal antibodies

Correct Answer: Increased enterohepatic circulation of bilirubin due to breast milk constituents and poor intake

Q49. Which lab finding is typical in alcoholic hepatitis with jaundice?

• AST > ALT, often with moderate bilirubin elevation
• ALT > AST with very high ALP only
• Isolated high conjugated bilirubin without transaminase change
• Normal liver enzymes with severe unconjugated hyperbilirubinemia

Correct Answer: AST > ALT, often with moderate bilirubin elevation

Q50. For pharmacology students, recognizing drug interactions that increase free bilirubin is important; which class commonly displaces bilirubin from albumin?

• Sulfonamides and certain NSAIDs
• Beta-blockers exclusively
• Oral antivirals that always reduce bilirubin
• Short-acting insulin analogs

Correct Answer: Sulfonamides and certain NSAIDs

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