QUIZ: Signs of liver dysfunction

🩺 Quiz: Signs of liver dysfunction

 

Test your understanding of liver function and its role in metabolism, clotting, bilirubin clearance, and neurological complications. Choose the best answer for each case, then check your score and explanations.

1. A 45-year-old man with advanced liver disease presents with confusion and sweating first thing in the morning. His blood glucose is 2.5 mmol/L (below normal range). Which of the following best explains his hypoglycaemia?

A. Impaired insulin secretion
B. Enhanced peripheral glucose uptake
C. Impaired gluconeogenesis and glycogenolysis
D. Hyperplasia of pancreatic β-cell
E. Impaired intestinal glucose absorption

2. A 60-year-old woman with liver cirrhosis presents with easy bruising and prolonged bleeding after minor cuts. Laboratory tests reveal abnormal coagulation studies. Which of the following best explains her bleeding tendency?

A. Thrombocytosis
B. Decreased metabolism of Vitamin C
C. Increased fibrinolysis
D. Decreased synthesis of clotting factors
E. Enhanced platelet aggregation

3. A 50-year-old man with cholestatic jaundice reports dark urine and pale stools. Which of the following best explains these findings?

A. Increased excretion of urobilinogen in the urine
B. Decreased bilirubin production
C. Impaired conjugation of bilirubin
D. Obstruction of bile flow leading to decreased bilirubin excretion
E. Increased enterohepatic circulation of bile acids

4. A 55-year-old man with chronic liver disease presents with confusion and a flapping tremor (asterixis). He is suspected to have hepatic encephalopathy. Which of the following best explains his neurological symptoms?

A. Hypoglycaemia-induced neuronal dysfunction
B. Cerebral oedema from hyponatraemia
C. Accumulation of ammonia due to impaired detoxification
D. Thiamine deficiency leading to Wernicke's encephalopathy
E. Hypercalcaemia-induced neuronal excitability

5. A 48-year-old woman with primary biliary cholangitis reports intense itching, especially on her palms and soles. Laboratory tests show elevated alkaline phosphatase and bilirubin levels. What is the most likely cause of her pruritus?

A. Histamine release from mast cells
B. Accumulation of bile salts in the skin
C. Dry skin due to dehydration
D. Peripheral neuropathy
E. Autoimmune-mediated skin inflammation

---

Answer Explanations

1. Correct answer: C. Impaired gluconeogenesis and glycogenolysis
The liver maintains blood glucose during fasting via gluconeogenesis and glycogenolysis. In liver dysfunction, these processes are impaired, resulting in fasting hypoglycaemia.

2. Correct answer: D. Decreased synthesis of clotting factors
The liver synthesises most clotting factors. Impairment leads to coagulopathy, which presents as prolonged bleeding and bruising.

3. Correct answer: D. Obstruction of bile flow leading to decreased bilirubin excretion
Biliary obstruction prevents excretion of conjugated bilirubin into the gut. It accumulates in the blood (→ jaundice), appears in urine (→ dark), and is absent in stool (→ pale).

4. Correct answer: C. Accumulation of ammonia due to impaired detoxification
In liver failure, the urea cycle is impaired. Ammonia builds up, crosses the blood-brain barrier, and causes encephalopathy with signs like asterixis and confusion.

5. Correct answer: B. Accumulation of bile salts in the skin
In cholestasis, bile salts deposit in the skin, especially on the palms and soles, causing pruritus. This is a hallmark symptom in conditions like primary biliary cholangitis.

Want to try more quizzes?

• 📝 Browse all quiz questions →