Liver

Question 1

AST to ALT ratio 2:1
Is a sign of […]

Answer 1

Alcoholic hepatitis

Question 2

Young female with fatigue and juandice.
MRCP: multiple foci of stricture and dilatation

Diagnosis: […]

Answer 2

Primary Biliary Cholangitis

Question 3

PSC is associated with […] and […] is done to look for it

Answer 3

Ulcerative colitis
Colonoscopy

Question 4

Which antibodies associated with PBC?

Answer 4

Anti-mitochondrial (AMA)

Question 5

Which antibodies associated with Autoimmune hepatitis?

Answer 5

Anti-soluble Liver antigen (ASL)
Anti-nuclear (ANA)
Anti-smooth muscle (ASmA)

Question 6

On MRCP there is intra & extra hepatic stricture:

Answer 6

PSC

Question 7

[…] is most common source of liver metastasis

Answer 7

CRC
“Do colonoscopy if liver cancer”

Question 8

[…] is a marker of HCC

Answer 8

AFB (alpha fetoprotein)

Question 9

Chronic […] increase risk of HCC

Answer 9

Hepatitis B & C

Question 10

Screen for HCC by […] and confirm diagnosis with […]

Answer 10

Screen: US
Confirm: Triphasic CT

Question 11

Patient with HCV currently asymptomatic has:
+ Antibodies, - RNA

Answer 11

No need to follow up

Question 12

Patient with HCV currently symptomatic has:
+ Antibodies, - RNA

Answer 12

Repeat RNA now

Question 13

Patient with HCV has:
+ Antibodies, - RNA
There is a possible recent exposure

Answer 13

Repeat RNA in 6 months

Question 14

Patient with HCV and liver cirrhosis has:
+ Antibodies, - RNA

Answer 14

Regular screening with US every 6 months

Question 15

Management of HCC:

Answer 15

Surgical excision
Unless (>5cm or multiple) = TACE

Question 16

Contraindications for liver transplant:

Answer 16

1. Active alcoholic 🥂
2. Extrahepatic malignancy <5 yr 🦀
3. Advanced cardiopulmonary disease
4. Active uncontrolled infection 🦠

Question 17

Hepatic adenoma and hemangioma have strong association with […] use in female

Answer 17

OCP
Stop OCP

Question 18

The most important advice in patient with liver hemangioma is to avoid […]

Answer 18

Contact sports

Question 19

Most common cause of liver cirrhosis in Diabetic patients: […]

Answer 19

NAFLD

Question 20

🔺🔺ALT/AST (aminotransferases) >1000
Differential diagnosis:

Answer 20

1. Ischemic hepatitis
2. Acute viral hepatitis
3. Drug-induced liver injury

Question 21

In hemochromatosis
[…] iron, […] ferritin, […] TIBC

Answer 21

🔺 iron, 🔺 ferritin, 🔻 TIBC

Question 22

Classic triad of
- cirrhosis
- DM
- skin pigmentation

Is associated with […]

Answer 22

Hemochromatosis

Question 23

Initial management of hydatid cyst:

Answer 23

Albendazole
Unless calcified : observation

Question 24

Definitive management of hydatid cyst:

Answer 24

Depend on size:
🔹 <6: only albendazole
🔹 6-10: +PAIR
🔹>10 / daughter cysts: +Surgical deroofing

Question 25

Causative organism of hydatid cyst is […]

Answer 25

Echinococcus

Question 26

CT: “THICK WALLED hypodense fluid cavity with peripheral enhancement” in the liver

Dx:
Tx:

Answer 26

”Target sign”

Dx: Pyogenic abscess
Initial: broad spectrum ABx
Best: percutaneous drainage

Question 27

CT: “homogenous hypoechoic mass with peripheral rum of edema” in liver
Usually with history of travelling (india/mexico)

Dx:
Tx:

Answer 27

Dx: Amoebic liver abscess
Tx: Metronidazole

Question 28

Amebiasis main presentation :
[…] and […] with recent travelling

Answer 28

Dysentery (bloody stool, tenesmus) & Fever

Question 29

Patient know to have HBV found to have liver nodule on US, CT showed 6 cm HCC with high vascularity, normal portal vein with no invasion. He is well now with controlled ascites on medication
Albumin: 3.1 Bili: 40 INR: 1.5 AST/ALT: nl
Next step in management:

A. Surgical resection
B. Radiotherapy
C. Transcatheter arterial embolization

Answer 29

C. Transcatheter arterial embolization

Single mass <5 cm: surgical
Multiple or >5 cm: TACE