Q: About an adult patient with jaundice


While attending a 21 years old male black patient who complains of abdominal pain, you observe a pale light yellow color of the skin and sclerotics. You suspect that the patient has jaundice; urine dipstick test is negative for bilirrubin but positive for urobilinogen.


When laboratory reports of blood tests arrive, they show the following results:


– Hematocrite: 28% (reference range from 41% to 53%)


– Hemoglobin: 8 g/dL (13.5-17.5 g/dL)


– Alanin aminotransferase (ALT) : 12 U/L (reference range 8-20 U/L)


– Aspartate aminotransferase (AST): 18 U/L (reference range 8-20 U/L)


– Alkaline Phosphatase (ALP): 80 U/L (reference range: 44-147 U/L)


– Total Bilirrubin: 3.5 mg/dL (normal = 0.1 to 1 mg/dL)


– Direct bilirrubin 0.2 mg/dL (normal from 0 to 0.3 mg/dL).



Which of the following options are compatible with the results shown above?


a)     jaundice of prehepatic cause


b)     jaundice of hepatic cause  because of deficiency in the intake of bilirrubin


c)      jaundice of hepatic cause because of deficiency in the conjugation of bilirrubin


d)     jaundice of hepatic cause because of deficiency in the excretion of bilirrubin from the hepatocyte.


e)     jaundice of posthepatic cause (extrahepatic biliary obstruction)


Q: About a patient with Jaundice


 In a  patient, already diagnosed as suffering from a carcinoma of pancreas head, the tumor provokes a gradual compression of the common bile duct and the patient begins to develop jaundice. The findings related with bilirrubin metabolism that you expect to see in this patient include:


a)     high concentration of conjugated bilirrubin in serum , dark urine (bilirrubinuria) and light-colored stools.

b)     high concentration of unconjugated bilirrubin in serum, dark urine, and light-colored stools.

c)      high concentration of conjugated bilirrubin in serum , dark urine (bilirrubinuria) and dark stools

d)     high concentration of conjugated bilirrubin in serum , urine with a normal color and dark stools

e)     normal concentration of conjugated bilirrubin in serum, dark urine and dark colored stools.

f)       normal concentration of unconjugated bilirrubin in serum, urine and stools with normal colors.

g)     normal concentration of bilirrubin in serum, normal urine and light-colored stools 



The case of the Greek Icteric Patient


Question CM-03



                                 Athens, Acropolis, Parthenon. Photo from Wallyg, Flickr




G. Stepanopoulos, a 21 year-old male patient, son of  the president of the Greek association in your town, attend to your office because of the presence of dark urine and a slight yellow color in his skin. At the exam, you detect jaundice and splenomegaly.  During the interview, the patient refers that a week ago, he had some “migraine” crisis during a few days and he began to take great quantity of analgesics.


The headaches disappeared but his skin and eyes became yellowish, a problem that he know have happened in his family when they ate some kind of beans, but that he had never experienced before.


A mutation in which of the following enzymes would be the most probable cause of this situation?


a)     Glucokinase


b)     Glucose 6 phosphate dehydrogenase


c)      Pyruvate quinase


d)     Glutamate Oxalacetate Aminotransferase


e)     Galactokinase


f)       Aldolase II


g)     Glucuronyl transferase


h)    Hem synthase


i)       Hem oxidase