Gastrointestinal: cholestatic coagulopathy: practice question

A Physiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Physiology · Gastrointestinal: cholestatic coagulopathy

Sample item

A patient with complete obstruction of the common bile duct has pale stools and easy bruising with a prolonged prothrombin time. What is the mechanism of the coagulopathy?

AConsumption of clotting factors by disseminated intravascular coagulationBPlatelet deficiency from hypersplenismCMalabsorption of fat-soluble vitamin K because bile salts cannot reach the gutDFailure of hepatocytes to synthesise fibrinogen

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Malabsorption of fat-soluble vitamin K because bile salts cannot reach the gut

Bile salts are needed to form micelles for the absorption of fat and fat-soluble vitamins A, D, E and K. In biliary obstruction vitamin K is not absorbed, and the vitamin K-dependent factors II, VII, IX and X are made in an inactive form, so the PT is prolonged. It corrects with parenteral vitamin K.

Option by option

A. Consumption of clotting factors by disseminated intravascular coagulation
There is no trigger for DIC in this picture.
B. Platelet deficiency from hypersplenism
Platelet deficiency would not prolong the prothrombin time.
C. Malabsorption of fat-soluble vitamin K because bile salts cannot reach the gut (correct)
Correct. Lack of bile salts causes vitamin K malabsorption and a prolonged PT.
D. Failure of hepatocytes to synthesise fibrinogen
Hepatocyte function is initially preserved in simple obstruction, and fibrinogen synthesis is not the problem.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Physiology question

What is the answer to this Physiology question?

The best answer is C, Malabsorption of fat-soluble vitamin K because bile salts cannot reach the gut. Bile salts are needed to form micelles for the absorption of fat and fat-soluble vitamins A, D, E and K.

Why is "Consumption of clotting factors by disseminated intravascular coagula…" not the answer?

There is no trigger for DIC in this picture.

Why is "Platelet deficiency from hypersplenism" not the answer?

Platelet deficiency would not prolong the prothrombin time.

Why is "Failure of hepatocytes to synthesise fibrinogen" not the answer?

Hepatocyte function is initially preserved in simple obstruction, and fibrinogen synthesis is not the problem.

What concept does this question test?

It tests Gastrointestinal: cholestatic coagulopathy in Physiology. In biliary obstruction vitamin K is not absorbed, and the vitamin K-dependent factors II, VII, IX and X are made in an inactive form, so the PT is prolonged. It corrects with parenteral vitamin K.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastrointestinal: cholestatic coagulopathy?

For each system, sketch the key graph (pressure–volume loop, oxygen dissociation curve, nephron handling) and explain it aloud. Then use the flashcards and the other Physiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.