Download EDAPT Altered Hepatobiliary Function Ultimate Exam and more Exams Technology in PDF only on Docsity!
Function Ultimate Exam
Question 1. Which hepatic lobe is located entirely within the right upper quadrant and is demarcated by the gallbladder fossa? A) Left lobe B) Right lobe C) Caudate lobe D) Quadrate lobe Answer: B Explanation: The right lobe occupies most of the right upper quadrant and is bounded laterally by the right diaphragm and medially by the falciform ligament; the gallbladder fossa is part of its inferior surface. Question 2. The functional unit of the liver is the hepatic lobule. What structure runs from the portal triad to the central vein within each lobule? A) Sinusoid B) Canaliculus C) Hepatic vein D) Bile ductule Answer: A Explanation: Hepatic sinusoids are capillary-like vessels that receive blood from the portal triad (portal vein, hepatic artery, bile duct) and drain into the central vein. Question 3. Which vessel provides the liver with oxygen-rich blood? A) Portal vein B) Hepatic artery C) Inferior vena cava D) Hepatic vein
Function Ultimate Exam
Answer: B Explanation: The hepatic artery supplies ~25% of hepatic blood flow but delivers most of the liver’s oxygen. Question 4. Kupffer cells are specialized macrophages located in: A) Bile canaliculi B) Hepatic sinusoids C) Portal triads D) Central veins Answer: B Explanation: Kupffer cells line the hepatic sinusoids and phagocytose bacteria, debris, and senescent red cells. Question 5. Which hepatic process converts excess glucose to glycogen for storage? A) Gluconeogenesis B) Glycogenolysis C) Glycogenesis D) Glycolysis Answer: C Explanation: Glycogenesis is the synthesis of glycogen from glucose, occurring primarily in the liver and muscle. Question 6. During fasting, the liver maintains blood glucose by: A) Glycogenesis B) Glycogenolysis
Function Ultimate Exam
B. Vitamin D C. Vitamin A D. Vitamin K Answer: C Explanation: The liver stores vitamin A as retinol, releasing it when needed. Question 10. Bile salts are derived from which hepatic substance? A) Cholesterol B) Phospholipids C) Bilirubin D) Albumin Answer: A Explanation: Bile acids are synthesized from cholesterol and then conjugated to form bile salts. Question 11. The hormone that primarily stimulates gallbladder contraction is: A) Secretin B) Gastrin C) Cholecystokinin (CCK) D) Motilin Answer: C Explanation: CCK released from I cells of the duodenum triggers gallbladder contraction and sphincter of Oddi relaxation. Question 12. Unconjugated bilirubin is produced from:
Function Ultimate Exam
A) Hemoglobin breakdown in the spleen B) Direct conjugation in the liver C) Bile pigment oxidation D) Dietary bilirubin Answer: A Explanation: Unconjugated (indirect) bilirubin results from heme catabolism in reticuloendothelial cells, especially the spleen. Question 13. Which type of gallstone is most commonly associated with hemolytic anemia? A) Cholesterol stones B) Pigment stones (black) C) Mixed stones D) Calcium bilirubinate stones Answer: B Explanation: Black pigment stones contain calcium bilirubinate and form in conditions with increased unconjugated bilirubin, such as chronic hemolysis. Question 14. The “Five Fs” risk factors for cholelithiasis include all EXCEPT: A) Female B) Fat C) Forty D) Fever Answer: D Explanation: Fever is not a classic risk factor; the “Five Fs” are Female, Fat, Forty, Fertile, and Fair.
Function Ultimate Exam
Answer: A Explanation: Dilated abdominal wall veins (caput medusae) develop due to collateral circulation from portal hypertension. Question 18. Which of the following is the earliest clinical sign of chronic liver disease? A) Ascites B) Spider angiomas C) Palmar erythema D) Jaundice Answer: C Explanation: Palmar erythema can appear early due to altered estrogen metabolism before overt jaundice or ascites develop. Question 19. Asterixis is best described as: A) Tremor of the hands when extended B) Involuntary facial grimacing C) Hyperreflexia of the lower limbs D) Loss of deep tendon reflexes Answer: A Explanation: Asterixis (flapping tremor) is a negative myoclonus seen in hepatic encephalopathy. Question 20. In hepatic encephalopathy, lactulose works primarily by: A) Increasing renal excretion of ammonia B) Acidifying the colon to trap NH₃ as NH₄⁺
Function Ultimate Exam
C) Enhancing hepatic urea cycle activity D) Binding ammonia in the bloodstream Answer: B Explanation: Lactulose is metabolized by colonic bacteria producing acidic metabolites that convert ammonia (NH₃) to non-absorbable ammonium (NH₄⁺). Question 21. Which medication is commonly added to lactulose for refractory hepatic encephalopathy? A) Metronidazole B) Rifaximin C) Ciprofloxacin D) Vancomycin Answer: B Explanation: Rifaximin is a non-systemic antibiotic that reduces ammonia-producing gut bacteria. Question 22. The most appropriate nursing intervention for a patient with esophageal variceal bleeding is: A) Encourage oral fluids immediately B) Insert a nasogastric tube for lavage C) Administer octreotide and arrange for band ligation D) Place the patient in Trendelenburg position Answer: C Explanation: Octreotide reduces portal pressure; endoscopic band ligation is definitive therapy. Nasogastric tubes may worsen bleeding.
Function Ultimate Exam
Explanation: Hepatitis B e-antigen (HBeAg) correlates with high infectivity and active replication. Question 26. Which hepatitis virus is most commonly transmitted via the fecal-oral route? A) Hepatitis A B) Hepatitis B C) Hepatitis C D) Hepatitis D Answer: A Explanation: HAV spreads through ingestion of contaminated food or water. Question 27. The most common cause of drug-induced acute liver failure in the United States is: A) Isoniazid B) Acetaminophen overdose C) Amoxicillin-clavulanate D) Methotrexate Answer: B Explanation: Overdose of acetaminophen leads to toxic metabolite NAPQI accumulation causing centrilobular necrosis. Question 28. Non-alcoholic steatohepatitis (NASH) is strongly associated with: A) Chronic hepatitis B infection B) Obesity and insulin resistance C) Wilson disease
Function Ultimate Exam
D) Alpha-1 antitrypsin deficiency Answer: B Explanation: NASH is the inflammatory form of non-alcoholic fatty liver disease linked to metabolic syndrome. Question 29. In a patient with right-sided heart failure causing cardiac cirrhosis, the primary pathophysiologic mechanism is: A) Hepatic artery vasoconstriction B) Portal vein thrombosis C) Chronic passive congestion of the liver D) Autoimmune destruction of bile ducts Answer: C Explanation: Elevated right atrial pressure leads to hepatic venous congestion and fibrosis (cardiac cirrhosis). Question 30. Which imaging modality is most sensitive for detecting gallstones? A) Plain abdominal X-ray B) Abdominal ultrasound C) CT abdomen with contrast D) MRI cholangiopancreatography (MRCP) Answer: B Explanation: Ultrasound readily visualizes gallstones as echogenic foci with posterior acoustic shadowing. Question 31. A patient’s liver biopsy shows portal tract fibrosis with bridging septa. This pattern is characteristic of:
Function Ultimate Exam
Question 34. The primary purpose of administering cholestyramine to a pruritic cholestatic patient is to: A) Increase bile flow B) Bind bile acids in the gut, reducing systemic pruritus mediators C) Stimulate hepatic regeneration D) Provide essential fatty acids Answer: B Explanation: Cholestyramine is a bile-acid sequestrant that reduces circulating bile acids that cause pruritus. Question 35. Which of the following is the most common cause of post-ERCP pancreatitis? A) Bacterial infection B) Mechanical trauma to the pancreatic duct C) Contrast allergy D) Over-distension of the duodenum Answer: B Explanation: Instrumentation or contrast injection into the pancreatic duct can cause inflammation. Question 36. During a liver biopsy, the nurse should verify that the patient’s INR is ≤ 1.5. This is to ensure: A) Adequate sedation B) Minimal risk of bleeding C) Proper liver function for metabolism of anesthetic
Function Ultimate Exam
D) Normal platelet count Answer: B Explanation: An INR ≤ 1.5 indicates acceptable coagulation status for percutaneous biopsy. Question 37. Which of the following best describes the “shifting dullness” test? A) Percussion of the abdomen after the patient lies supine, then turns to the side, revealing movement of fluid wave B) Auscultation of bowel sounds in different quadrants C) Palpation of liver edge during deep inspiration D) Assessment of skin turgor on the abdomen Answer: A Explanation: Shifting dullness detects free fluid in the abdomen by noting change from tympany to dullness when the patient rolls. Question 38. In patients with chronic liver disease, serum albumin is often low because: A) Increased hepatic synthesis B) Decreased renal excretion C) Impaired hepatic synthetic function D) Enhanced gastrointestinal absorption Answer: C Explanation: The diseased liver cannot produce adequate albumin, leading to hypoalbuminemia. Question 39. Which of the following is a characteristic finding on a peripheral blood smear of a patient with hereditary hemochromatosis?
Function Ultimate Exam
Question 42. A patient with chronic hepatitis C develops mixed cryoglobulinemia. This complication is due to: A) Direct viral cytotoxicity B) Autoimmune immune-complex deposition C) Bacterial superinfection D) Iron overload Answer: B Explanation: HCV can trigger production of immune complexes that precipitate in the cold, leading to cryoglobulinemia. Question 43. In the setting of acute liver failure, the most urgent indication for liver transplantation is: A) Bilirubin > 5 mg/dL B) Grade III hepatic encephalopathy with refractory intracranial hypertension C) Elevation of ALT > 500 U/L D) Mild ascites Answer: B Explanation: Severe encephalopathy with rising intracranial pressure signifies life-threatening cerebral edema, a transplant indication. Question 44. Which of the following statements about the enterohepatic circulation of bile acids is correct? A) Bile acids are excreted unchanged in urine B) Approximately 95% of bile acids are reabsorbed in the ileum and returned to the liver via the portal vein C) Bile acids are synthesized de novo each day without recycling
Function Ultimate Exam
D) The colon is the primary site of bile acid reabsorption Answer: B Explanation: Most bile acids are efficiently reclaimed in the terminal ileum and returned to the liver for reuse. Question 45. The presence of “spider angiomas” on the skin of a cirrhotic patient is primarily due to: A) Increased estrogen metabolism B) Decreased bilirubin conjugation C) Elevated prostaglandin levels D) Chronic alcohol intake Answer: A Explanation: Impaired hepatic clearance of estrogen leads to vasodilation and formation of spider angiomas. Question 46. Which of the following is the most appropriate initial nursing action for a patient who develops a sudden increase in abdominal girth after paracentesis? A) Administer a rapid IV bolus of normal saline B) Re-check the drainage site for ongoing leak C) Obtain a STAT abdominal CT scan D) Encourage the patient to ambulate immediately Answer: B Explanation: A rapid rise may indicate bleeding or fluid re-accumulation; inspecting the puncture site is first.
Function Ultimate Exam
Answer: A Explanation: Mallory-Denk bodies (eosinophilic cytoplasmic inclusions) are characteristic of alcoholic liver disease. Question 50. The “hepatic venous pressure gradient” (HVPG) > 12 mm Hg is associated with: A) Development of hepatic encephalopathy only B) Increased risk of variceal bleeding C) Decreased portal hypertension D) Improved liver synthetic function Answer: B Explanation: An HVPG > 12 mm Hg predicts formation of varices and risk of hemorrhage. Question 51. Which medication is contraindicated in patients with severe hepatic impairment due to risk of accumulation? A) Acetaminophen at standard doses B) Metformin C) Lactulose D) Ursodeoxycholic acid Answer: B Explanation: Metformin is cleared renally but can precipitate lactic acidosis in severe liver disease; caution/avoidance is advised. Question 52. In the setting of acute viral hepatitis, the most common symptom is: A) Severe right upper quadrant pain
Function Ultimate Exam
B) Dark urine C) Pruritus D) Jaundice Answer: D Explanation: Jaundice from elevated bilirubin is the hallmark presentation of acute hepatitis. Question 53. The classic “double-peak” pattern on a liver function test (elevated ALT/AST then a later rise in ALP) suggests: A) Acute viral hepatitis progressing to cholestasis B) Isolated hepatocellular injury C) Renal failure D) Muscle injury Answer: A Explanation: Initial hepatocellular injury raises transaminases; subsequent cholestasis elevates ALP. Question 54. Which of the following best describes the role of the hepatic “sinusoidal endothelium” in detoxification? A) It secretes bile salts B) It filters blood, allowing selective passage of substances to hepatocytes C) It produces clotting factors D) It stores iron as ferritin Answer: B Explanation: The fenestrated sinusoidal endothelium permits plasma, toxins, and nutrients to reach hepatocytes for metabolism.
