Acing The Boards Liver 1

Question 1

college student + hyperthermia + muscular rigidity with bruxism + acute hepatitis

Answer 1

MDMA

Question 2

Sexually active woman + fever + pleuritic right upper quadrant pain

Answer 2

Futz-Hugh-Curtis syndrome (gonorrhea)

Question 3

Abrupt onset ascites + abdominal pain + Hepatomegaly

Especially seen in?

Answer 3

Budd-Chiari 

Pregnancy, polycythemia vera

Question 4

Caudate lobe hypertrophy?

Why?

Answer 4

Budd-Chiari

Separate blood supply draining into the IVC

Question 5

Cirrhosis + platypnea + hypoxemia

Indication for liver transplant?

Answer 5

Hepatopulmonary syndrome

PaO2<60

Question 6

Cirrhotic + cyanosis + clubbing

Answer 6

Hepatopulmonary syndrome

Question 7

Avoid TIPS when MELD is greater than

Answer 7

18

Question 8

Highest HBV risk of vertical transmission?

Answer 8

High HBV DNA + HBeAg positive

Question 9

Young patient + Neurologic symptoms + liver disease

Answer 9

Wilson’s disease

Question 10

Wilson’s disease diagnosis?

Answer 10

1. Serum ceruloplasmin <20 mg/dL
2. 24-hour urinary copper excretion >100 mcg
3. Hepatic copper concentration >250 mcg/g dry weight
4. Serum ALP level <40 IU/L in acute liver failure

Question 11

Arrhythmias + LFT abnormalities + phospholipid-laden lysosomal lamellar bodies

Answer 11

Amiodarone toxicity

Question 12

cholestasis after URI. Cause?

Answer 12

Augmentin

Question 13

cholestasis after UTI. Cause?

Answer 13

Bactrim

Question 14

New cholestasis in gastroparetic. Cause?

Answer 14

Erythromycin

Question 15

NSAID used then liver trouble - drug?

Answer 15

Diclofenac

Question 16

IBD patient gets elevated liver enzymes after starting AZA/6-MP

Answer 16

Low TPMT

Question 17

IBD patient develops painful hepatomegly + high bilirubin. Cause?

Answer 17

VOD/SOS from AZA

Question 18

AIDS + Elevated ALP + enlarged liver + blood filled cystic spaces

Answer 18

Bartonella (hepatitis peliosis)

Question 19

Health freak + lipid-filled stellate cells

Answer 19

Vitamin A toxicity

Question 20

Diabetes + arthopathy + high ferritin

Answer 20

Hereditary hemochromatosis

Question 21

HCV + bullae/vesicles on sun exposed skin

Answer 21

Porphyria cutanea tarda

Question 22

noncirrhotic liver with an 8 cm lesion with calcifications within a central scar

Answer 22

fibrolamellar hepatocellular carcinoma (FLHCC)

Not FNH because of calcifications

Question 23

benign hepatocytes separated by fibrous bands with prominent bile duct proliferation and malformed blood vessels

Answer 23

FNH

Question 24

Leukocytosis + Elevated bilirubin/ALP + fever + alcohol

Answer 24

Acute alcoholic hepatitis

Question 25

Prolonged cholestasis and/or relapsing hepatitis

Treatment

Answer 25

HAV; supportive

Question 26

Polyarteritis nodosa (GI association)

Answer 26

HBV

Question 27

ALF after withdrawal of immunosuppression?

Answer 27

HBV

Question 28

Pancreatitis + Elevated ALT

Answer 28

Gallstone pancreatitis

Question 29

PBC - know these 3 associations (biopsy, endocrine)

Answer 29

Nodular regenerative hyperplasia
Osteoporosis
Hypothyroidism

Question 30

Mallory bodies + granulomatous destruction of the bile ducts with infiltration by lymphocytes and plasma cells

Answer 30

PBC

Question 31

Hepatitis + low ALP + Mallory bodies

Answer 31

Wilson’s disease

Question 32

Wilson’s disease - the acute hepatitis and acute liver failure phases are heralded by

Answer 32

Abrupt hemolytic anemia

Question 33

Metabolic syndrome + low AST:ALT ratio + Mallory bodies

Answer 33

NAFLD

Question 34

Right lobe abscess + right hemidiaphragm elevation + recent travel

When to aspirate?

Answer 34

Amebic love abscess

-lack of improvement in 3-5 days
-seronegative
-left lobe abscess
-rim surrounding abscess

Question 35

Cirrhotic with painful gynecomastia

Treatment?

Answer 35

Spironolactone

Switch to amiloride or add tamoxifen