A jaundiced man has bilirubin in his urine, no urine urobilinogen and pale, clay-coloured stools. What type of jaundice is most likely?

Hepatocellular (early hepatitis)

A 40-year-old with chronic diarrhoea and weight loss excretes very little xylose in urine after an oral D-xylose load; kidney function is normal. This suggests:

Small-intestinal mucosal disease

Exocrine pancreatic insufficiency

Organ function tests and profiles

24 Kerala PSC Lab Technician Gr II practice questions on Organ function tests and profiles, part of Biochemistry. The first 24 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Hard
A woman at 26 weeks of pregnancy has a fasting 75 g OGTT: fasting 88, 1-hour 186, 2-hour 150 mg/dL. By IADPSG criteria (cut-offs 92, 180 and 153 mg/dL), the result is:
1. ANormal glucose tolerance
2. BGestational diabetes
3. CImpaired glucose tolerance
4. DOvert diabetes in pregnancy
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Answer: B · Gestational diabetes
IADPSG criteria diagnose gestational diabetes when any one value meets or exceeds its cut-off: fasting 92, 1-hour 180 or 2-hour 153 mg/dL. Here the fasting (88) and 2-hour (150) values are below their cut-offs, but the 1-hour value of 186 mg/dL is above 180, and one value is enough. Overt diabetes would need much higher values, such as a fasting glucose of 126 mg/dL or more. Impaired glucose tolerance is a category for non-pregnant adults, based on the 2-hour value.
- A: One abnormal value is enough under IADPSG; two are not needed.
- C: Impaired glucose tolerance is a non-pregnancy category; IADPSG has no such grade.
- D: Overt diabetes needs much higher values, such as a fasting glucose of 126 mg/dL or more.
Question 2 · Medium
A jaundiced man has bilirubin in his urine, no urine urobilinogen and pale, clay-coloured stools. What type of jaundice is most likely?
1. AHepatocellular (early hepatitis)
2. BObstructive (post-hepatic)
3. CHemolytic (pre-hepatic)
4. DUnconjugated (Gilbert type)
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Answer: B · Obstructive (post-hepatic)
Conjugated bilirubin is water-soluble, so it appears in urine when bile cannot reach the gut. If no bilirubin enters the intestine, no urobilinogen is formed, so urine urobilinogen is absent and the stools lose their colour. This complete pattern points to blockage of the bile ducts, for example by a stone or a tumour of the head of the pancreas. Alkaline phosphatase and GGT are usually markedly raised.
- A: In early hepatitis urine urobilinogen is usually increased and the stools keep some colour.
- C: Hemolytic jaundice is unconjugated, so urine bilirubin is absent and urobilinogen is increased.
- D: Gilbert syndrome gives a mild unconjugated rise with no bilirubin in urine.
Question 3 · Easy
CA-125 is mainly used to monitor carcinoma of the:
1. AOvary
2. BPancreas
3. CProstate
4. DBreast
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Answer: A · Ovary
CA-125 is a glycoprotein antigen raised in most non-mucinous epithelial ovarian cancers, and serial levels are used to follow treatment and detect recurrence. It is a poor screening test on its own, because it also rises in endometriosis, pelvic inflammation, pregnancy and ascites. CA 19-9 is used for pancreatic cancer, PSA for prostate cancer and CA 15-3 for breast cancer. Like most tumour markers, it is most useful as a trend over time.
- B: Pancreatic cancer is followed with CA 19-9.
- C: Prostate cancer is followed with PSA.
- D: Breast cancer is followed with CA 15-3.
Question 4 · Easy
In two-step screening for gestational diabetes, how much glucose is given orally for the glucose challenge test?
1. A25 g glucose
2. B100 g glucose
3. C50 g glucose
4. D75 g glucose
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Answer: C · 50 g glucose
The glucose challenge test gives 50 g of glucose by mouth at any time of day, without fasting, and plasma glucose is measured at 1 hour. A value at or above the chosen cut-off, commonly 140 mg/dL, is followed by a full diagnostic glucose tolerance test. The 100 g, 3-hour test is the diagnostic step of the two-step approach, and 75 g is used for the standard OGTT. In India the single-step DIPSI test uses 75 g without fasting.
- A: 25 g is not a standard glucose load in adults.
- B: 100 g is used for the 3-hour diagnostic test that follows a positive screen.
- D: 75 g is used for the standard OGTT and the DIPSI single-step test.
Question 5 · Medium
A 40-year-old with chronic diarrhoea and weight loss excretes very little xylose in urine after an oral D-xylose load; kidney function is normal. This suggests:
1. AExocrine pancreatic insufficiency
2. BSmall-intestinal mucosal disease
3. CLack of gastric acid secretion
4. DObstruction of the bile duct
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Answer: B · Small-intestinal mucosal disease
D-xylose is a pentose absorbed by the upper small-intestinal mucosa without any digestion by pancreatic enzymes or bile. Low urinary excretion with normal kidney function therefore means the mucosa is not absorbing, as in celiac disease or tropical sprue. In pancreatic insufficiency xylose absorption is normal even though fat is poorly digested, which helps to separate the two causes of malabsorption. Bacterial overgrowth can also lower the result.
- A: Pancreatic insufficiency impairs digestion, but xylose needs no digestion and is absorbed normally.
- C: Gastric acid is not needed to absorb xylose.
- D: Bile is needed for fat absorption, not for xylose absorption.
Question 6 · Medium
A jaundiced patient's prolonged prothrombin time becomes normal 24 hours after injected vitamin K. This suggests:
1. AInherited deficiency of clotting factor VII
2. BObstruction with vitamin K malabsorption
3. CHemolytic jaundice
4. DSevere liver cell failure
Answer and explanation in LearnFree account
Question 7 · Easy
The bromsulphthalein (BSP) test assesses which function of the liver?
1. ASynthetic function
2. BDetoxifying function
3. CExcretory (dye clearance) function
4. DCarbohydrate storage function
Answer and explanation in LearnFree account
Question 8 · Medium
Quantitative fecal fat in suspected malabsorption is measured on a 72-hour stool collection rather than a single stool because:
1. AFat breaks down if stool is tested fresh
2. BDaily fat output varies, so 3 days average it out
3. CA single stool contains too little fat to measure accurately
4. DThe test needs three different stains
Answer and explanation in LearnFree account
Question 9 · Easy
In the lactose tolerance test, which analyte is measured in blood after the oral lactose load?
1. AGlucose
2. BLactic acid
3. CGalactose only
4. DLactose
Answer and explanation in LearnFree account
Question 10 · Hard
A man who had a partial gastrectomy has a 75 g OGTT: fasting 86, 30 min 215, 1 hour 172, 2 hours 92 mg/dL. Urine at 30 minutes contains glucose. Which description fits?
1. ALag storage (alimentary) curve
2. BDiabetic curve
3. CImpaired glucose tolerance
4. DFlat glucose tolerance curve
Answer and explanation in LearnFree account
Question 11 · Medium
In a jaundiced patient, an AST:ALT ratio of more than 2 most suggests:
1. AObstructive jaundice
2. BAcute viral hepatitis
3. CHemolytic jaundice
4. DAlcoholic liver disease
Answer and explanation in LearnFree account
Question 12 · Easy
By WHO and ADA criteria, an HbA1c at or above which value is diagnostic of diabetes mellitus?
1. A5.7%
2. B6.5%
3. C8.0%
4. D7.5%
Answer and explanation in LearnFree account
Question 13 · Hard
A child's fasting serum is milky, with triglycerides 1,800 mg/dL and cholesterol 260 mg/dL. After standing overnight at 4 °C, a creamy layer forms on top and the serum below is clear. Which lipoprotein is raised?
1. AChylomicrons and VLDL
2. BLDL alone
3. CChylomicrons alone
4. DVLDL alone
Answer and explanation in LearnFree account
Question 14 · Medium
Above what serum triglyceride level does a Friedewald estimate of LDL become unreliable?
1. A1,000 mg/dL
2. B150 mg/dL
3. C400 mg/dL
4. D200 mg/dL
Answer and explanation in LearnFree account
Question 15 · Hard
A 22-year-old has fever, vomiting and jaundice. Bilirubin 6.2 mg/dL (mostly conjugated), ALT 1,850 U/L, AST 1,420 U/L, ALP 160 U/L (40-140). Urine has bilirubin and urobilinogen. The most likely diagnosis is:
1. AObstructive jaundice
2. BHemolytic jaundice
3. CAcute viral hepatitis
4. DAlcoholic hepatitis
Answer and explanation in LearnFree account
Question 16 · Medium
A dehydrated man has BUN 60 mg/dL and serum creatinine 1.5 mg/dL. What does his BUN:creatinine ratio suggest?
1. ALiver failure
2. BPrerenal azotemia
3. CLow protein intake
4. DIntrinsic renal failure
Answer and explanation in LearnFree account
Question 17 · Medium
During a water deprivation test, a man's urine stays dilute, but it concentrates well after a dose of desmopressin. This indicates:
1. ANephrogenic diabetes insipidus
2. BPrimary polydipsia
3. CDiabetes mellitus
4. DCranial diabetes insipidus
Answer and explanation in LearnFree account
Question 18 · Medium
Serum alkaline phosphatase is raised. Which accompanying result shows that it comes from the liver rather than bone?
1. ARaised phosphate
2. BRaised GGT
3. CRaised creatinine
4. DRaised calcium
Answer and explanation in LearnFree account
Question 19 · Medium
A raised maternal serum alpha-fetoprotein at 16-18 weeks of pregnancy should first raise suspicion of:
1. APre-eclampsia
2. BDown syndrome
3. COpen neural tube defect
4. DGestational diabetes
Answer and explanation in LearnFree account
Question 20 · Hard
A woman at 26 weeks is screened by the two-step approach. One hour after a 50 g glucose drink, taken without fasting, her plasma glucose is 152 mg/dL (screen cut-off 140). What is the next step?
1. ARely on an HbA1c result alone
2. BDiagnose gestational diabetes now
3. CDo a fasting 100 g, 3-hour OGTT
4. DRepeat the 50 g test after a fast
Answer and explanation in LearnFree account
Question 21 · Easy
The most specific biochemical marker of injury to heart muscle is:
1. ACardiac troponin
2. BLactate dehydrogenase
3. CTotal CK
4. DMyoglobin
Answer and explanation in LearnFree account
Question 22 · Easy
In suspected acute pancreatitis, which serum enzyme is more specific than amylase and stays raised longer?
1. AAlkaline phosphatase
2. BLipase
3. CTrypsin
4. DAldolase
Answer and explanation in LearnFree account
Question 23 · Easy
Which tumour marker is most used in the diagnosis and follow-up of hepatocellular carcinoma?
1. ACarcinoembryonic antigen
2. BProstate-specific antigen
3. CCA 19-9
4. DAlpha-fetoprotein
Answer and explanation in LearnFree account
Question 24 · Easy
Glycated hemoglobin (HbA1c) reflects a patient's average blood glucose over the previous:
1. A2-3 days
2. B2-3 months
3. C2-3 weeks
4. D6-12 months
Answer and explanation in LearnFree account

Organ function tests and profiles

A woman at 26 weeks of pregnancy has a fasting 75 g OGTT: fasting 88, 1-hour 186, 2-hour 150 mg/dL. By IADPSG criteria (cut-offs 92, 180 and 153 mg/dL), the result is:

A jaundiced man has bilirubin in his urine, no urine urobilinogen and pale, clay-coloured stools. What type of jaundice is most likely?

CA-125 is mainly used to monitor carcinoma of the:

In two-step screening for gestational diabetes, how much glucose is given orally for the glucose challenge test?

A 40-year-old with chronic diarrhoea and weight loss excretes very little xylose in urine after an oral D-xylose load; kidney function is normal. This suggests:

A jaundiced patient's prolonged prothrombin time becomes normal 24 hours after injected vitamin K. This suggests:

The bromsulphthalein (BSP) test assesses which function of the liver?

Quantitative fecal fat in suspected malabsorption is measured on a 72-hour stool collection rather than a single stool because:

In the lactose tolerance test, which analyte is measured in blood after the oral lactose load?

A man who had a partial gastrectomy has a 75 g OGTT: fasting 86, 30 min 215, 1 hour 172, 2 hours 92 mg/dL. Urine at 30 minutes contains glucose. Which description fits?

In a jaundiced patient, an AST:ALT ratio of more than 2 most suggests:

By WHO and ADA criteria, an HbA1c at or above which value is diagnostic of diabetes mellitus?

A child's fasting serum is milky, with triglycerides 1,800 mg/dL and cholesterol 260 mg/dL. After standing overnight at 4 °C, a creamy layer forms on top and the serum below is clear. Which lipoprotein is raised?

Above what serum triglyceride level does a Friedewald estimate of LDL become unreliable?

A 22-year-old has fever, vomiting and jaundice. Bilirubin 6.2 mg/dL (mostly conjugated), ALT 1,850 U/L, AST 1,420 U/L, ALP 160 U/L (40-140). Urine has bilirubin and urobilinogen. The most likely diagnosis is:

A dehydrated man has BUN 60 mg/dL and serum creatinine 1.5 mg/dL. What does his BUN:creatinine ratio suggest?

During a water deprivation test, a man's urine stays dilute, but it concentrates well after a dose of desmopressin. This indicates:

Serum alkaline phosphatase is raised. Which accompanying result shows that it comes from the liver rather than bone?

A raised maternal serum alpha-fetoprotein at 16-18 weeks of pregnancy should first raise suspicion of:

A woman at 26 weeks is screened by the two-step approach. One hour after a 50 g glucose drink, taken without fasting, her plasma glucose is 152 mg/dL (screen cut-off 140). What is the next step?

The most specific biochemical marker of injury to heart muscle is:

In suspected acute pancreatitis, which serum enzyme is more specific than amylase and stays raised longer?

Which tumour marker is most used in the diagnosis and follow-up of hepatocellular carcinoma?

Glycated hemoglobin (HbA1c) reflects a patient's average blood glucose over the previous: