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Question 1
Correct
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In liver failure there is likely to be?
Your Answer: Raised blood urea
Explanation:Liver failure results in decreased production of all proteins. This causes a decreased albumin: globulin ratio and coagulation dysfunction due to decreased production of coagulation factors. Decreased storage capacity and enzyme reduction affects glucose level regulation and also decreased bile production decreases fat absorption. Liver failure causes blood urea levels to rise due to decreased metabolism and conversion to more soluble forms.
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This question is part of the following fields:
- Hepatobiliary
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Question 2
Correct
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Choose the correct statement. The cells of the liver…
Your Answer: Help to maintain the normal blood glucose level.
Explanation:Synthesis of vitamin D3 takes place in both the liver and in the kidneys. The liver is responsible for an intermediate step and final synthesis takes place in the kidneys. Immunoglobulins are manufactured by plasma cells in respective organs where there is antigen exposure. The liver plays a major role in maintaining blood glucose levels by converting excess glucose to glycogen and converting glycogen back to glucose in time of need. Hepatocytes have enzymes that can deactivate steroid hormones.
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This question is part of the following fields:
- Hepatobiliary
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Question 3
Correct
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The conversion of haem to bilirubin is catalysed by which of these enzymes
Your Answer: Biliverdin reductase
Explanation:Bilirubin is created by the activity of biliverdin reductase on biliverdin, a green tetrapyrrolic bile pigment that is also a product of haem catabolism.
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This question is part of the following fields:
- Hepatobiliary
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Question 4
Incorrect
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Where is the lower border of the liver usually found?
Your Answer: 10th rib midclavicular line on right
Correct Answer: 10th rib anterior axillary line on right
Explanation:Assessment of liver margins is important clinically to determine the size of the liver and is done via percussion during the physical examination. The liver typically extends from the fifth intercostal space or 6th rib to the right costal margin in the midclavicular line and the 10th rib on anterior axillary line.
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This question is part of the following fields:
- Hepatobiliary
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Question 5
Correct
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A 21-year-old student presents with yellowish discolouration of her sclera. She says she has had severe headaches over the last few weeks for which she has been taking paracetamol. What is the most likely cause of her jaundice?
Your Answer: Gilbert’s syndrome
Explanation:Gilbert’s syndrome is a mild liver disorder in which the liver does not properly process bilirubin. Many people never have symptoms. Occasionally a slight yellowish colour of the skin or whites of the eyes may occur. Other possible symptoms include feeling tired, weakness, and abdominal pain.
The enzymes that are defective in Gilberts – UDP glucuronosyltransferase 1 family, polypeptide A1 (UGT1A1) – are also responsible for some of the liver’s ability to detoxify certain drugs. While paracetamol (acetaminophen) is not metabolized by UGT1A1,[10] it is metabolized by one of the other enzymes also deficient in some people with Gilberts. Therefore a subset of people with Gilberts may have an increased risk of paracetamol toxicity. -
This question is part of the following fields:
- Hepatobiliary
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Question 6
Correct
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Select the correct statement regarding the portal vein.
Your Answer: It drains most of the gastrointestinal tract and the spleen.
Explanation:The portal vein supplies 75% of total blood flow to the liver and enters the liver centrally via the porta hepatis. Portal venous flow increases after meals. The portal vein receives blood from the intestines via the superior and inferior mesenteric veins, from the stomach via gastric veins and from the spleen and pancreas via the splenic vein.
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This question is part of the following fields:
- Hepatobiliary
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Question 7
Incorrect
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Question 8
Correct
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Bile salts are responsible for:
Your Answer: The emulsification of fats
Explanation:The main function of bile acids is to allow digestion of dietary fats and oils by acting as a surfactant that emulsifies them into micelles, allowing them to be colloidally suspended in the chyme before further processing.
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This question is part of the following fields:
- Hepatobiliary
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Question 9
Correct
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The hepatic portal vein is a large vessel formed by which of the following veins?
Your Answer: All of the above
Explanation:The portal vein is usually formed by the confluence of the superior mesenteric and splenic veins and also receives blood from the inferior mesenteric, gastric, and cystic veins.
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This question is part of the following fields:
- Hepatobiliary
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Question 10
Correct
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What is the blood supply to the liver?
Your Answer: Hepatic artery and hepatic portal vein
Explanation:The liver receives a dual blood supply from the hepatic portal vein and hepatic arteries. The hepatic portal vein delivers approximately 75% of the liver’s blood supply, and carries venous blood drained from the spleen, gastrointestinal tract, and its associated organs. The hepatic arteries supply arterial blood to the liver, accounting for the remaining quarter of its blood flow. Oxygen is provided from both sources; approximately half of the liver’s oxygen demand is met by the hepatic portal vein, and half is met by the hepatic arteries
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This question is part of the following fields:
- Hepatobiliary
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Question 11
Correct
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The liver is the principal site for?
Your Answer: Storage of iron
Explanation:The liver mainly synthesizes proteins including albumin, globulins and coalgulative factors. Vitamin B12 is taken in via the diet and stored by the liver. Vitamin C is not stored and excessive vitamin C is excreted via urine. Liver is the main site of iron storage, where it is stored in the form of ferritin.
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This question is part of the following fields:
- Hepatobiliary
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Question 12
Correct
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The endothelium of the sinusoids has the following important function:
Your Answer: Highly fenestrated, large subendothelial spaces, many macrophages
Explanation:Substances absorbed in the intestines reach the liver via the portal vein and contain toxic substances that needs to be detoxified in hepatocytes. Thus, hepatic sinusoids are fenestrated and contain large spaces which allows passage of substances freely. These fenestrations are rich in Kupffer cells which are macrophages.
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This question is part of the following fields:
- Hepatobiliary
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Question 13
Correct
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A 57 year old, alcoholic male was admitted to the medical ward for an ascitic tap. The ascitic fluid was found to be yellow in colour. Which of the following had most likely lead to this observation?
Your Answer: Decompensated cirrhosis
Explanation:Uncomplicated cirrhotic ascites is usually translucent. If the patient is deeply jaundiced, the fluid might appear yellow/brown.
Turbidity or cloudiness of the ascites fluid suggests that infection is present and further diagnostic testing should be performed.
Pink or bloody fluid is most often caused by mild trauma, with subcutaneous blood contaminating the sample.
Bloody ascites is also associated with hepatocellular carcinoma or any malignancy-associated ascites.
Milky-appearing fluid usually has an elevated triglyceride concentration. Such fluid, commonly referred to as chylous ascites, can be related to thoracic duct injury or obstruction or lymphoma, but it is often related primarily to cirrhosis. -
This question is part of the following fields:
- Hepatobiliary
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Question 14
Correct
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Where is the normal upper border of the liver situated?
Your Answer: 6th rib midclavicular line on right
Explanation:Assessment of liver margins is important clinically to determine the size of the liver and is done via percussion during the physical examination. The liver typically extends from the fifth intercostal space or 6th rib to the right costal margin in the midclavicular line and the 10th rib on anterior axillary line.
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This question is part of the following fields:
- Hepatobiliary
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Question 15
Incorrect
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The hepatic plates in the liver parenchyma consist of how many cell layers?
Your Answer: 2 – 10 cell layers
Correct Answer: 1 – 2 cell layers
Explanation:Hepatic plates in a hepatic lobule are arranged in 1-2 cell layers.
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This question is part of the following fields:
- Hepatobiliary
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Question 16
Correct
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The main source of nutrients in the liver is via the
Your Answer: Portal vein
Explanation:The portal vein or hepatic portal vein is a blood vessel that carries blood from the gastrointestinal tract and spleen to the liver. This blood is rich in nutrients that have been extracted from food, and the liver processes these nutrients; it also filters toxins that may have been ingested with the food. 75% of total liver blood flow is through the portal vein, with the remainder coming from the hepatic artery proper.
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This question is part of the following fields:
- Hepatobiliary
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Question 17
Correct
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Cytochrome p450 enzymes expressed in hepatocytes serve to?
Your Answer: Facilitate oxidations or hydrolysis of drugs.
Explanation:Cytochrome p 450 are a family of proteins involved in drug metabolism which accounts for about 75% of the total metabolism. Most drugs are deactivated directly or by facilitated excretion from the body.
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This question is part of the following fields:
- Hepatobiliary
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Question 18
Correct
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Question 19
Correct
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Which of the following portocaval anastomoses can cause problems in preterm infants?
Your Answer: Patent ductus venosus.
Explanation:The ductus venosus is open at the time of the birth and closes during the first week of life in most full-term neonates; however, it may take much longer to close in pre-term neonates. After it closes, the remnant is known as ligamentum venosum. If the ductus venosus fails to occlude after birth, it remains patent (open), and the individual is said to have a patent ductus venosus and thus an intrahepatic portosystemic shunt (PSS).
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This question is part of the following fields:
- Hepatobiliary
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Question 20
Correct
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What is the three main structures in the portal triad ( portal space )?
Your Answer: Branch of hepatic artery, branch of portal vein, bile ductules
Explanation:A portal triad (also known as portal field, portal area, or portal tract) is a distinctive arrangement in the liver. It is a component of the hepatic lobule. It consists of the following five structures:
– Proper hepatic artery
– Hepatic portal vein
– Common bile duct
– Lymphatic vessels
– Branch of the vagus nerve -
This question is part of the following fields:
- Hepatobiliary
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Question 21
Incorrect
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Select the correct statement regarding portal hypertension.
Your Answer: Portal venous pressure is approximately 10mmhg.
Correct Answer: The total vascular resistance of the hepatic sinusoids is increased.
Explanation:Portal hypertension is increased blood pressure within the portal venous system. This happens mainly due to liver damage which increases the vascular resistance of hepatic sinusoids by interfering with the normal blood flow. Portal blood pressure increases and flow through the liver decreases. Normal portal venous pressure is between 5-10 mmHg and in portal hypertension it’s usually more than 10 mmHg. This high pressure can cause accumulation of fluid in the peritoneal cavity known as ascites. To overcome the pressure, the portal vein starts to drain blood to systemic circulation via porto-systemic shunts. The connection between the portal vein and inferior vena cava is known as the porto caval shunt. Due to damaged hepatocytes, detoxification of substances absorbed in the intestine is impaired and the former shunt mixes non-detoxified blood with the systemic circulation. These toxic substances may affect neurons causing hepatic encephalopathy which is a major complication of portal hypertension.
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This question is part of the following fields:
- Hepatobiliary
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Question 22
Correct
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The production of bile is increased by: Stimulation of the ____ nerve and the hormone ____.
Your Answer: Vagus, CCK
Explanation:Cholecystokinin is synthesized and secreted by enteroendocrine cells in the duodenum, the first segment of the small intestine, and causes the release of digestive enzymes and bile from the pancreas and gallbladder, respectively. It also acts as a hunger suppressant. Release of CCK is stimulated by monitor peptide released by pancreatic acinar cells as well as CCK-releasing protein, a paracrine factor secreted by enterocytes in the gastrointestinal mucosa. In addition, release of acetylcholine by the parasympathetic nerve fibers of the vagus nerve also stimulate its secretion.
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This question is part of the following fields:
- Hepatobiliary
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Question 23
Correct
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Concerning the functional unit of the liver, which segment is most susceptible to hypoxic damage?
Your Answer: Zone 3
Explanation:From a metabolic perspective, the functional unit is the hepatic acinus (terminal acinus), each of which is centred on the line connecting two portal triads and extends outwards to the two adjacent central veins. The periportal zone I is nearest to the entering vascular supply and receives the most oxygenated blood, making it least sensitive to ischemic injury while making it very susceptible to viral hepatitis. Conversely, the centrilobular zone III has the poorest oxygenation, and will be most affected during a time of ischemia.
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This question is part of the following fields:
- Hepatobiliary
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Question 24
Incorrect
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Select the CORRECT statement regarding bile salts…
Your Answer: Contain enzymes required for the digestion of fat.
Correct Answer: Are necessary for any bile acid secretion by hepatocytes.
Explanation:Bile salts stimulate bile secretion by the liver. Bile salts do not have an enzymatic action on digestion of fat but rather emulsify fat for the action of enzymes secreted mainly by the pancreas. Bile salts are polar cholesterol derivatives and are not derived from amino acids.
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This question is part of the following fields:
- Hepatobiliary
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Question 25
Correct
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A child with jaundice and pale stools would most likely be evaluated by which of the following tests?
Your Answer: US
Explanation:Blood tests do not help in the diagnosis of jaundice except of course by telling the level of jaundice (bilirubin) and providing some corroborative evidence such as autoantibodies, tumour markers or viral titres in the case of hepatitis. Classifying causes of jaundice on the basis of ultrasound provides a quick and easy schema for diagnosing jaundice which is applicable in primary care as well as hospital based practice.
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This question is part of the following fields:
- Hepatobiliary
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Question 26
Incorrect
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Which is true of the composition of bile in the human hepatic duct?
Your Answer: The solution is acidic
Correct Answer: Contains only actively secreted substances
Explanation:Hepatic bile is an isotonic fluid and its electrolyte composition resembles that of plasma. 97% of water is found in the gallbladder bile, not hepatic duct. Hepatic bile is alkaline. The ratio of bile acids: phosphatidylcholine: cholesterol is 20:1:3. Hepatic bile contai9ns only actively secreted substances.
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This question is part of the following fields:
- Hepatobiliary
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Question 27
Correct
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Question 28
Correct
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In the functional unit of the liver (acinus), the oxygenation…
Your Answer: Reduces towards the centre
Explanation:Cells located close to the portal triad or peripheral zone which consist of arterioles from the hepatic artery are the most oxygenated cells. Cells in the central zone are least oxygenated and mainly receive blood supply from the central vein which is a branch of the hepatic vein.
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This question is part of the following fields:
- Hepatobiliary
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Question 29
Correct
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Question 30
Correct
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The functional unit of the liver is called?
Your Answer: Acini
Explanation:From a metabolic perspective, the functional unit is the hepatic acinus (terminal acinus), each of which is centred on the line connecting two portal triads and extends outwards to the two adjacent central veins. The periportal zone I is nearest to the entering vascular supply and receives the most oxygenated blood, making it least sensitive to ischemic injury while making it very susceptible to viral hepatitis. Conversely, the centrilobular zone III has the poorest oxygenation, and will be most affected during a time of ischemia.
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This question is part of the following fields:
- Hepatobiliary
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SESSION STATS - PERFORMANCE PER SPECIALTY
