[MCQ] Toxic and drug-induced hepatitis Part 1

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Toxic and drug-induced hepatitis Part 1

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Question 1

Name of the prognostic law stating that a pure drug-induced liver injury (DILI) leading to jaundice, without a hepatic transplant, has a case fatality rate of 10% to 50% is ?

A	Zy's law
B	Ky's law
C	Hy's law
D	Wy's law

Question 1 Explanation:

Hy’s Law criteria: >3x ULN AST or ALT + >2x ULN TBL, no initial cholestasis (normal AP), no other prior or concomitant reason for liver function abnormality. Rezulin Rule is also a prognostic rule of DILI. Rezulin is the trade name of banned drug troglitazone.

Question 2

Phase I reaction in drug metabolism include which of the following chemical process ?

A	Oxidation
B	Reduction
C	Hydrolysis
D	All of the above

Question 3

Phase II reaction in drug metabolism include which of the following chemical process ?

A	Glucuronidation
B	Sulfation
C	Acetylation
D	All of the above

Question 4

Phase II reactions in drug metabolism include all except ?

A	Sulfation
B	Glucuronidation
C	Acetylation
D	Hydrolysis

Question 4 Explanation:

Drugs may be metabolized by sequential or competitive chemical processes involving oxidation, reduction & hydrolysis (phase I reactions) or glucuronidation, sulfation, acetylation & methylation (phase II reactions). CYP is important for phase I metabolism and are located primarily in endoplasmic reticulum, while phase 2 conjugation enzymes are cytosolic.

Question 5

Which of the following is not a feature of direct toxic hepatitis ?

A	Predictable regularity
B	Dose-dependent
C	Latent period usually long
D	Morphologic abnormalities reproducible for each toxin

Question 5 Explanation:

In direct toxic hepatitis, latent period between exposure and liver injury is usually short (often several hours), although clinical manifestations may be delayed for 24 - 48 hours

Question 6

Which of the following is not a feature of idiosyncratic drug hepatotoxicity ?

A	Unpredictability
B	Not dose-dependent
C	Extrahepatic manifestations of hypersensitivity
D	None of the above

Question 7

Cytochrome P450 (CYP) was first discovered in 1954 by ?

A	Wilhelm Kuhnz & Hille Gieschen
B	Bernhardt
C	Martin Klingenberg & David Garfinkel
D	Akio Suzuki

Question 8

Cytochrome P-450 enzymes (CYPs) are important in the biosynthesis and degradation of ?

A	Steroids
B	Lipids
C	Vitamins
D	All of the above

Question 8 Explanation:

Cytochrome P-450 enzymes (CYPs) are important in biosynthesis & degradation of endogenous compounds like steroids, lipids, and vitamins

Question 9

Antibody to liver-kidney microsomes associated with drug induced hepatitis is ?

A	Anti LKM 1
B	Anti LKM 2
C	Anti LKM 3
D	All of the above

Question 9 Explanation:

Drug hepatotoxicity may be associated with the appearance of autoantibodies, including a class of antibodies to liver-kidney microsomes, anti-LKM2, directed against a cytochrome P450 enzyme.

Question 10

Cytochrome P-450 enzymes (CYPs) are important in the biosynthesis & degradation of endogenous compounds like ?

A	Steroids
B	Lipids
C	Vitamins
D	All of the above

Question 11

The P in P450 stands for ?

A	Particle
B	Pigment
C	Pattern
D	Protein

Question 11 Explanation:

The P in P450 stands for "pigment".

Question 12

“450” in Cytochrome P450 isoenzymes is related to ?

A	Number of isoenzymes in liver
B	Number of chemical reactions
C	Number of electron needed for its activity
D	Spectrophotometric absorption peak

Question 12 Explanation:

Name cytochrome P450 is derived from the fact that these are colored ('chrome') cellular ('cyto') proteins, with a "pigment at 450 nm", so named for the characteristic spectrophotometric absorption peak formed by absorbance of light at wavelengths near 450 nm when the heme iron is reduced and complexed to carbon monoxide

Question 13

In CYP2E1, letter ‘2’ indicates ?

A	Gene family
B	Gene subfamily
C	Individual gene
D	None of the above

Question 13 Explanation:

CYP" stands for cytochrome P450, followed by a numeral indicating gene family, a capital letter indicating subfamily and another numeral for the individual gene

Question 14

Which of the following about cytochrome P450 is false ?

A	Hemoprotein
B	Monooxygenase reaction
C	Pigment at 450 nm
D	None of the above

Question 14 Explanation:

Cytochrome P450 belongs to a superfamily of hemoproteins. Most common reaction catalysed by cytochrome P450 is a monooxygenase reaction, i.e. insertion of one atom of oxygen into an organic substrate (RH) while the other oxygen atom is reduced to water: RH + O2 + 2H+ + 2e- = ROH + H2O

Question 15

Which of the following enzyme is responsible for metabolism of most of the drugs used ?

A	CYP3A4
B	CYP3A5
C	CYP2D6
D	CYP2C19

Question 15 Explanation:

CYP3A4 is the most abundant hepatic and intestinal CYP and is also the enzyme responsible for metabolism of the greatest number of drugs in therapeutic use

Question 16

In liver, the family of cytochrome P450 (CYP) isoforms is present in ?

A	Endoplasmic reticulum
B	Cell membrane
C	Golgi bodies
D	Nucleus

Question 17

The catalytic activity of CYP2D6 in humans is best assessed by using which of the following drug ?

A	Debrisoquin
B	Fluoxetine
C	Perphenazine
D	Dextromethorphan

Question 17 Explanation:

CYP2D6 is second to CYP3A4 in the number of commonly used drugs that it metabolizes.

Question 18

The catalytic activity of CYP2D6 in humans is best assessed by using which of the following drug ?

A	Debrisoquin
B	Fluoxetine
C	Perphenazine
D	Dextromethorphan

Question 18 Explanation:

CYP2D6 is second to CYP3A4 in the number of commonly used drugs that it metabolizes.

Question 19

Which of the following cytochrome P-450 is present in enterocytes ?

A	CYP1A2
B	CYP2D6
C	CYP2C9
D	CYP3A

Question 19 Explanation:

CYP3A is present in the enterocytes

Question 20

Which of the following CYP is found mainly in the glomerulosa zone of adrenal gland ?

A	CYP11B2
B	CYP3A5
C	CYP2D6
D	CYP2C19

Question 20 Explanation:

CYP11B2 is found mainly if not exclusively in the glomerulosa zone of the adrenal gland

Question 21

Which of the following CYP is not expressed in neonates ?

A	CYP1A2
B	CYP3A5
C	CYP2D6
D	CYP2C19

Question 21 Explanation:

CYP1A2 is not expressed in neonates, making them particularly susceptible to toxicity from drugs such as caffeine

Question 22

Drugs having a narrow range between the plasma levels yielding therapeutic and adverse effects include all except ?

A	Digoxin
B	Theophylline
C	Lidocaine
D	Amiodarone

Question 23

Which of the following anti-HIV agent is not a CYP3A inhibitor ?

A	Indinavir
B	Ritonavir
C	Saquinavir
D	Nevirapine

Question 24

Which of the following macrolide antibiotics is not a CYP3A Inhibitor ?

A	Clarithromycin
B	Erythromycin
C	Troleandomycin
D	Azithromycin

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See all quizzes of Acute viral hepatitis at here:

1.Name of the prognostic law stating that a pure drug-induced
liver injury (DILI) leading to jaundice, without a hepatic
transplant, has a case fatality rate of 10% to 50% is ?
A. Zy’s law
B. Ky’s law
C. Hy’s law
D. Wy’s law

2. Phase I reaction in drug metabolism include which of the
following chemical process ?
A. Oxidation
B. Reduction
C. Hydrolysis
D. All of the above
3. Phase II reaction in drug metabolism include which of the
following chemical process ?
A. Glucuronidation
B. Sulfation
C. Acetylation
D. All of the above
4. Phase II reactions in drug metabolism include all except ?
A. Sulfation
B. Glucuronidation
C. Acetylation
D. Hydrolysis

5. Which of the following is not a feature of direct toxic hepatitis ?
A. Predictable regularity
B. Dose-dependent
C. Latent period usually long
D. Morphologic abnormalities reproducible for each toxin

6. Which of the following is not a feature of idiosyncratic drug
hepatotoxicity ?
A. Unpredictability
B. Not dose-dependent
C. Extrahepatic manifestations of hypersensitivity
D. None of the above
7. Cytochrome P450 (CYP) was first discovered in 1954 by ?
A. Wilhelm Kuhnz & Hille Gieschen
B. Bernhardt
C. Martin Klingenberg & David Garfinkel
D. Akio Suzuki
8. Cytochrome P-450 enzymes (CYPs) are important in the
biosynthesis and degradation of ?
A. Steroids
B. Lipids
C. Vitamins

D. All of the above

9. Antibody to liver-kidney microsomes associated with drug
induced hepatitis is ?
A. Anti LKM 1
B. Anti LKM 2
C. Anti LKM 3
D. All of the above

10. Cytochrome P-450 enzymes (CYPs) are important in the
biosynthesis & degradation of endogenous compounds like ?
A. Steroids
B. Lipids
C. Vitamins
D. All of the above
11. The P in P450 stands for ?
A. Particle
B. Pigment
C. Pattern
D. Protein

12. “450” in Cytochrome P450 isoenzymes is related to ?
A. Number of isoenzymes in liver
B. Number of chemical reactions
C. Number of electron needed for its activity
D. Spectrophotometric absorption peak

13. In CYP2E1, letter ‘2’ indicates ?
A. Gene family
B. Gene subfamily
C. Individual gene
D. None of the above

14. Which of the following about cytochrome P450 is false ?
A. Hemoprotein
B. Monooxygenase reaction
C. Pigment at 450 nm
D. None of the above

15.Which of the following enzyme is responsible for metabolism
of most of the drugs used ?
A. CYP3A4
B. CYP3A5
C. CYP2D6
D. CYP2C19

16. In liver, the family of cytochrome P450 (CYP) isoforms is present
in ?
A. Endoplasmic reticulum
B. Cell membrane
C. Golgi bodies
D. Nucleus
17. The catalytic activity of CYP2D6 in humans is best assessed by
using which of the following drug ?
A. Debrisoquin
B. Fluoxetine
C. Perphenazine
D. Dextromethorphan

18. Which of the following cytochrome P-450 is present in
enterocytes ?
A. CYP1A2
B. CYP2D6
C. CYP2C9
D. CYP3A
19. Which of the following CYP is found mainly in the glomerulosa
zone of adrenal gland ?
A. CYP11B2
B. CYP3A5
C. CYP2D6
D. CYP2C19
.
20. Which of the following CYP is not expressed in neonates ?
A. CYP1A2
B. CYP3A5
C. CYP2D6
D. CYP2C19

21. Drugs having a narrow range between the plasma levels
yielding therapeutic and adverse effects include all except ?

A. Digoxin
B. Theophylline
C. Lidocaine
D. Amiodarone
22.Which of the following anti-HIV agent is not a CYP3A inhibitor ?
A. Indinavir
B. Ritonavir
C. Saquinavir
D. Nevirapine
23. Which of the following macrolide antibiotics is not a CYP3A
Inhibitor ?
A. Clarithromycin
B. Erythromycin
C. Troleandomycin
D. Azithromycin

Toxic and drug-induced hepatitis

[MCQ] Toxic and drug-induced hepatitis Part 1

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Toxic and drug-induced hepatitis Part 1

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