Liver diseases

Question 1

Male patient with liver cirrhosis is admitted to the hospital with massive hematemesis, with the possibility of variceal rupture. The followings should be done, except:
A) ensuring venous access with cannulation of 2 peripheral vein
B) determining blood group, INR, blood count
C) administration of iv. terlipressin
D) oesophagogastroscopy and ligation or sclerotherapy of esophageal varices after hemodynamic stability is reached
E) blood transfusion to increase hemoglobin level above 100 g/l

Answer 1

E) blood transfusion to increase hemoglobin level above 100 g/l

Question 2

The extrahepatic complication of chronic hepatitis B might be:
A) periarteritis nodosa, immuncomplex vasculitis
B) glomerulonephritis
C) cryoglobulinaemia
D) arthritis
E) all of the above

Answer 2

E) all of the above

Question 3

Characteristics of drug-induced liver injury, except:
A) it is always dose-dependent
B) indiosyncratic reaction is also possible
C) it can manifest few days or several weeks after drug intake
D) it is forbidden to readminister the drug which caused liver injury
E) cholestasis can be present

Answer 3

A) it is always dose-dependent

Question 4

A 65-year-old male patient presented with jaundice started 3 weeks before. What is the first step?
A) abdominal ultrasound
B) computer tomography (CT)
C) endoscopic retrograde cholangiopancreatography (ERCP)
D) percutaneous transhepatic cholangiography (PTC)
E) MR cholangio-pancreatography (MRCP)

Answer 4

A) abdominal ultrasound

Question 5

The most frequent cause of liver cirrhosis nowadays, which was earlier labeled as “cryptogen” cirrhosis:
A) Wilson’s disease
B) Hepatitis E virus (HEV) infection
C) Non alcoholic steatohepatitis (NASH)
D) Hemochromatosis
E) Drugs and other toxic agents

Answer 5

C) Non alcoholic steatohepatitis (NASH)

Question 6

Select the tumor where serum alpha-fetoprotein (AFP) is mostly pathognomic.
A) prostate cancer
B) osteogenic carcinoma
C) gastric cancer
D) colon cancer
E) hepatocellular cancer (HCC)

Answer 6

E) hepatocellular cancer (HCC)

Question 7

Characteristics of alcoholic hepatitis, except:
A) excessive alcohol consumption recently
B) corticosteroid administration is always necessary
C) elevated bilirubin, high INR, leukocytosis can be present
D) high mortality in severe cases
E) alcohol abstinence is essential during treatment

Answer 7

B) corticosteroid administration is always necessary

Question 8

Characteristics of primary biliary cholangitis (PBC), except:
A) antimitochondrial antibody (AMA) is present
B) serum-IgM is frequently elevated
C) female dominance
D) corticosteroid is indicated for treatment
E) it might be associated with scleroderma

Answer 8

D) corticosteroid is indicated for treatment

Question 9

Which of the following medication can dose-dependently cause liver failure?
A) halothane
B) paracetamol (acetaminophen)
C) chlorpromazine
D) methyldopa
E) erythromycin

Answer 9

B) paracetamol (acetaminophen)

Question 10

It can trigger hepatic encephalopathy in severe liver cirrhosis, except:
A) gastrointestinal bleeding
B) metabolic acidosis
C) aggressive diuretic therapy
D) enteral infection
E) high amount of oral protein intake

Answer 10

B) metabolic acidosis

Question 11

Jaundice appears on the 3rd postoperative day after aortic aneurysms surgery in a female patient, who is afebrile, otherwise asymptomatic. Lab results: SeBi: direct 220 μmol/l, indirect 80 μmol/l, ALP 500 IU, AST, ALT, LDH are normal. What is the most likely diagnosis?
A) biliary tract obstruction
B) halothane-induced hepatitis
C) portal vein thrombosis
D) haemolysis
E) benign postoperative cholestasis

Answer 11

E) benign postoperative cholestasis

Question 12

Predisposing factor(s) for gallstone formation:
A) obesity
B) chronic hemolysis
C) octreotide therapy
D) bowel resection
E) all of the above

Answer 12

E) all of the above

Question 13

67-year-old patient sees a doctor with dull right hypochondriac pain, fever, weight loss. Lab findings: GGT 600 E, ALP 740 E, LDH: 900 E. What additional lab tests would be helpful to confirm the diagnosis?
A) antinuclear antibody (ANA)
B) serum α-fetoprotein (AFP)
C) antimitochondrial antibody (AMA)
D) anti smooth muscle antibody (SMA)
E) prostate specific antigen (PSA)

Answer 13

B) serum α-fetoprotein (AFP)

Question 14

True for esophageal variceal bleeding, except:
A) sclerotherapy is needed only when recurrent bleeding occurs after portocaval shunt operation
B) iv. terlipressin is important to stop bleeding
C) deep jaundice and ascites increase the risk of mortality
D) per os propranolol or carvediol are useful in prevention of bleeding
E) portocavalis shunt increases the risk of hepatic encephalopathy

Answer 14

A) sclerotherapy is needed only when recurrent bleeding occurs after portocaval shunt operation

Question 15

Liver biopsy is indicated, except:
A) suspected liver adenoma
B) unexplained abnormal liver function tests
C) for diagnosis of NASH
D) for diagnosis of autoimmune hepatitis
E) suspected hemangioma

Answer 15

E) suspected hemangioma

Question 16

The risk of following disorders is increased in female patients who are taking oral contraceptive pills, except:
A) liver adenoma
B) peliosis hepatis
C) focal nodular hyperplasia
D) angiosarcoma
E) thromboembolism

Answer 16

D) angiosarcoma

Question 17

The effect of acetaldehyde produced in the metabolism of alcohol:
A) induces immunoreaction through neoantigen formation
B) damage of microtubular functions in hepatocytes
C) decrease of the glutathione reserve of liver
D) increase of superoxide formation
E) all of the above

Answer 17

E) all of the above

Question 18

Characteristic laboratory values in chronic heavy drinkers, except:
A) high MCV, usually above 100 fl
B) elevated GGT
C) elevated triglyceride
D) AST/ALT ratio > 1
E) AST/ALT ratio < 1

Answer 18

E) AST/ALT ratio < 1

Question 19

Characteristics of HCV infection, except:
A) infection can cause cirrhosis for decades
B) only the IFN-based therapy can lead to total recovery
C) it was transmitted through blood transfusion before 1992
D) infection spreads among intravenous drug users nowadays
E) it increases the risk of hepatocellular carcinoma

Answer 19

B) only the IFN-based therapy can lead to total recovery

Question 20

True for paracetamol- (acetaminophen) toxicity:
A) toxicity is dose-dependent
B) it is based on immune-allergy
C) it never results in severe toxicity
D) antidote is not known
E) it can safely be administered to alcoholics

Answer 20

A) toxicity is dose-dependent

Question 21

Septic complications mostly occur in obstructive jaundice caused by Klatskin tumor:
A) after percutaneous transhepatic cholangiography
B) after MRCP
C) after duodenoscopy
D) after ERCP
E) none of the above

Answer 21

D) after ERCP

Question 22

Characteristics of ursodeoxycholic acid, except:
A) it has hydrophilic property
B) it is used in treatment of primary biliary cholangitis
C) it increases the risk of colorectal cancer in patients with primary sclerosing cholangitis
D) it takes part in the enterohepatic cycle
E) it is non-toxic bile acid

Answer 22

C) it increases the risk of colorectal cancer in patients with primary sclerosing cholangitis

Question 23

True for hepatocellular carcinoma (HCC), except:
A) metastasis always occurs in the early phase
B) it has bad prognosis
C) it often develops in cirrhotic liver
D) serum-α-fetoprotein (AFP) level increases in half of the cases
E) it develops more frequently in males than in females

Answer 23

A) metastasis always occurs in the early phase

Question 24

True for the ascites in liver cirrhosis without further cirrhotic complications:
A) it is bloody
B) protein content is always above 30 g/l
C) malignant cells are found in the sediment
D) serum albumin - ascites albumin gradient >11 g/l
E) neutrophil granulocyte count is above 1000/mm3

Answer 24

D) serum albumin - ascites albumin gradient >11 g/l

Question 25

Characteristics of cholestatic jaundice, except:
A) level of conjugated bilirubin is high in serum
B) it can be accompanied by pruritus
C) it is associated with elevated level of ALP
D) it is always accompanied by increased level of AST
E) it is associated with elevated GGT

Answer 25

D) it is always accompanied by increased level of AST

Question 26

Characteristics of Wilson’s disease, except:
A) biliary secretion of copper is damaged
B) level of serum ceruloplasmin decreases
C) Kayser–Fleischer-ring is visible with slit lamp examination in half of the cases
D) fulminant hepatitis can occur as acute liver failure
E) it always leads to development of HCC

Answer 26

E) it always leads to development of HCC

Question 27

Duration of development of hepatocellular carcinoma (HCC) after infection with hepatitis B virus (HBV) or hepatitis C virus (HCV):
A) 1–2 years
B) 5–10 years
C) 10–15 years
D) 20–25 years
E) few months

Answer 27

D) 20–25 years

Question 28

The earliest sign of primary biliary cholangitis (PBC) can be:
A) spider nevi
B) dilated abdominal wall veins
C) skin hematomas
D) jaundice
E) pruritus

Answer 28

E) pruritus

Question 29

45-year-old alcoholic male patient is admitted to the hospital with ascites, restlessness, bizarre behavior. In his sudden deterioration provoking factors might be, except:
A) asymptomatic duodenal bleeding
B) aggressive diuretic therapy
C) he discontinued lactulose, consumed large amount of protein
D) his protein intake was insufficient
E) spontaneous bacterial peritonitis developed

Answer 29

D) his protein intake was insufficient

Question 30

Hepatic encephalopathy can be provoked by:
A) after TIPS procedure
B) gastrointestinal bleeding
C) aggressive diuretic therapy
D) spontaneous bacterial peritonitis
E) all of the above

Answer 30

E) all of the above

Question 31

Characteristics of autoimmune hepatitis, except:
A) mostly younger females are affected
B) high IgG level
C) it does not require liver biopsy to make diagnosis
D) good response to corticosteroid therapy
E) it leads to liver cirrhosis at a young age without treatment

Answer 31

C) it does not require liver biopsy to make diagnosis

Question 32

Characteristics of hepatic encephalopathy, except:
A) confusion
B) signs of focal neurological lesions
C) increased blood ammonia level
D) foetor
E) asterixis

Answer 32

B) signs of focal neurological lesions

Question 33

Cause of fatty liver can be, except:
A) metabolic syndrome
B) coeliac disease
C) Wilson’s disease
D) autoimmune liver disease
E) drugs

Answer 33

D) autoimmune liver disease

Question 34

Characteristics of hepatitis B virus infection, except:
A) it is prevented by vaccination
B) chronic hepatitis develops mostly when newborns are infected
C) HBV incorporates into the host’s genome
D) it increases the risk of HCC
E) diagnosis is based on detection of HBV RNA

Answer 34

E) diagnosis is based on detection of HBV RNA

Question 35

Which medication is advised in acetaminophen / paracetamol overdose induced fulminant liver failure?
A) methylene blue
B) desferoxamine
C) atropin
D) silimarin
E) N-acetilcystein

Answer 35

E) N-acetilcystein

Question 36

Characteristics of primary biliary cholangitis, except:
A) it remains asymptomatic for a long time
B) pruritus might be the first symptom
C) antimitochondrial antibody (AMA) is often positive
D) circulating immuncomplexes, increased IgM level
E) usually younger females are affected

Answer 36

E) usually younger females are affected

Question 37

In haemochromatosis frequent complication can be, except:
A) diabetes mellitus
B) diabetes insipidus
C) impotence
D) hepatocellular carcinoma
E) pseudogout

Answer 37

B) diabetes insipidus

Question 38

Side effects of interferon therapy, except:
A) leukopenia
B) autoimmune thyreoiditis
C) fever
D) depression
E) excess of body hair

Answer 38

E) excess of body hair

Question 39

Enzyme which is responsible for alcohol metabolism:
A) alcohol reductase
B) alcohol oxidase
C) alcohol dehydrogenase
D) alcohol synthetase

Answer 39

C) alcohol dehydrogenase

Question 40

First investigation(s) when alkaline phosphatase (ALP) is increased:
A) abdominal ultrasound, GGT, serum bilirubin measurement
B) liver-CT
C) bone scintigraphy
D) liver biopsy
E) ERCP

Answer 40

A) abdominal ultrasound, GGT, serum bilirubin measurement

Question 41

Protein electrophoresis shows increased polyclonal gammopathy in primary biliary cholangitis, which is mostly:
A) IgA
B) IgM
C) IgG
D) IgD
E) IgE

Answer 41

B) IgM

Question 42

It is important in the pathogenesis of non-alcoholic steatohepatitis (NASH):
A) inflammatory cytokines
B) altered gut microbiome, increased LPS level in the portal circulation
C) genetic factors
D) high level of free fatty acids
E) all of the above

Answer 42

E) all of the above

Question 43

The extrahepatic manifestation of chronic HCV might be, except:
A) cryoglobulinemia
B) chronic fatigue
C) immunthrombocytopenia
D) acute glomerulonephritis
E) atrial fibrillation

Answer 43

E) atrial fibrillation

Question 44

Characteristic(s) of haemochromatosis:
1) it is familial disorder
2) hepatocellular carcinoma can be frequent sequelae
3) it is based on inherited disorder of iron metabolism
4) it is more frequent in females

A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct

Answer 44

A) 1., 2. and 3. answers are correct

Question 45

Which parameters can indicate the development of hepatocellular cancer in a patient with long-standing cirrhosis?
1) right hypochondriac pain and cachexia
2) fever of unknown origin
3) high LDH in serum
4) increased AFP level

A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all 4 answers are correct

Answer 45

E) all 4 answers are correct

Question 46

It can cause chronic hepatitis in immunocompromised patients:
1) hepatitis B-virus
2) hepatitis E-virus
3) hepatitis C-virus
4) hepatitis A-virus

A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct

Answer 46

A) 1., 2. and 3. answers are correct

Question 47

Characteristics of primary biliary cholangitis:
1) it is asymptomatic, never causes pruritus
2) it might be associated with antineutrophil cytoplasmic antibody (ANCA) positivity
3) it significantly increases the risk of cholangiocellular carcinoma
4) middle-age females are mostly affected

A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct

Answer 47

D) only 4. answer is correct

Question 48

True for hepatocellular carcinoma:
1) it might be associated with HBV genome integration
2) HCV-infection also might be the etiology
3) it can be caused by aflatoxin
4) it characteristically develops after hepatitis A infection

A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct

Answer 48

A) 1., 2. and 3. answers are correct

Question 49

Characteristic(s) of primary sclerosing cholangitis:
1) it is more frequent in males
2) it can be associated with ulcerative colitis
3) it can increase the risk of cholangiocellular carcinoma
4) it can be associated with antineutrophil cytoplasmatic antibody (ANCA) positivity

A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct

Answer 49

E) all of the answers are correct

Question 50

It is useful in the therapy of primary sclerosing cholangitis:
1) ursodeoxycholic acid
2) ballondilatation of dominant biliary stricture
3) liver transplantation
4) cyclophosphamide

A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct

Answer 50

A) 1., 2. and 3. answers are correct

Question 51

Characteristic(s) of autoimmune hepatitis:
1) low level of serum IgG
2) antinuclear antibody (ANA) positivity
3) young males are affected
4) good response to corticosteroid therapy

A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct

Answer 51

C) 2. and 4. answers are correct

Question 52

It can be used for the treatment of chronic hepatitis B:
1) interferon
2) entecavir
3) tenofovir
4) azathioprin

A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct

Answer 52

A) 1., 2. and 3. answers are correct

Question 53

Characteristic(s) of hepatitis E viral infection:
1) it can be transmitted with consumption of undercooked pork meet
2) it can become chronic infection in immunocompromised patients
3) it can cause central nervous system symptoms
4) it never causes cirrhosis

A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct

Answer 53

A) 1., 2. and 3. answers are correct

Question 54

It plays a role in the transmission of hepatitis C virus infection:
1) iv. narcotic users
2) tattoo
3) blood transfusion before 1992
4) prostitution, male homosexuality

A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct

Answer 54

E) all of the answers are correct

Question 55

It can cause obstructive jaundice:
1) neoplasia of papilla of Vater
2) common bile duct stone
3) cancer of pancreatic head
4) cancer of pancreatic tail

A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct

Answer 55

A) 1., 2. and 3. answers are correct

Question 56

Antiviral therapy of chronic hepatitis C:
1) it is suggested only in cases of elevated ALT
2) it is suggested only under age of 60 years
3) it is suggested only if Fibroscan shows severe liver fibrosis
4) it can be considered in every HCV infected patients independently of ALT level and degree of fibrosis

A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct

Answer 56

D) only 4. answer is correct

Question 57

Characteristics of Gilbert syndrome:
1) increased level of indirect bilirubin
2) increased reticulocyte count
3) normal LDH level
4) low serum haptoglobin level

A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct

Answer 57

B) 1. and 3. answers are correct

Question 58

Characteristics of alcoholic hepatitis:
1) granulocyte infiltration in liver tissue
2) leukocytosis, fever
3) increased level of GGT
4) increased level of LDH

A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct

Answer 58

A) 1., 2. and 3. answers are correct

Question 59

It can be administered to prevent rebleeding of esophageal varicosity:
1) endoscopic variceal sclerotherapy or ligation
2) portocaval shunt insertion
3) propranolol
4) carvediol

A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all 4 answers are correct

Answer 59

E) all 4 answers are correct

Question 60

Hepatitis B virus infection frequently occurs in:
1) West-Europe
2) the USA
3) Hungary
4) Far-East, Taiwan

A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct

Answer 60

D) only 4. answer is correct

Question 61

Biological effects of interferon therapy in chronic B hepatitis:
1) antiproliferative, antineoplastic
2) immunmodulatory
3) antiviral
4) antibacterial

A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct

Answer 61

A) 1., 2. and 3. answers are correct

Question 62

It can be the side effects of interferon therapy:
1) flu-like symptoms
2) leukopenia
3) depression
4) relapse of autoimmune diseases

A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct

Answer 62

E) all of the answers are correct

Question 63

True for hepatitis C virus infection:
1) it can lead to cirrhosis for decades
2) acute hepatitis is usually asymptomatic
3) it increases the risk of HCC
4) liver transplantation is never recommended

A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct

Answer 63

A) 1., 2. and 3. answers are correct

Question 64

The following symptoms indicate liver disease. Choose the most probable diagnosis for each case.
A) primary biliary cholangitis
B) viral hepatitis
C) acute cholecystitis
D) autoimmune hepatitis
E) hepatic encephalopathy

INT - 7.68 - Pruritus, xanthomas, hepatosplenomegaly, high cholesterol level
INT - 7.69 - Jaundice, anorexia, nausea, elevated ALT, normal ALP
INT - 7.70 - Hepatosplenomegaly, hypergammaglobulinaemia, anti-smooth muscle antibody
INT - 7.71 - Fever, right hypochondric pain, leukocytosis
INT - 7.72 - Confusion, flapping tremor, jaundice, high plasma ammonia level

Answer 64

68- A
69- B
70- D
71- C
72- E

Question 65

Chronic hepatitis C can be cured with new direct antiviral therapies in approximately 90% of the cases, because these medications can be given to patients with cirrhosis.
A) both parts are correct, causative relation exists
B) both parts are correct, causative relation does not exist
C) first part is correct, the second is incorrect
D) first part is incorrect, second part is correct
E) both parts are incorrect

Answer 65

B) both parts are correct, causative relation does not exist

Question 66

Gynocomasty is frequent abnormality in cirrhotic males, because the ratio of oestrogen/androgen shifts to the former.
A) both parts are correct, causative relation exists
B) both parts are correct, causative relation does not exist
C) first part is correct, the second is incorrect
D) first part is incorrect, second part is correct
E) both parts are incorrect

Answer 66

A) both parts are correct, causative relation exists

Question 67

Gallstone can be impacted into the cystic duct, therefore biliary pancreatitis develops as a complication of gallstone disease.
A) both parts are correct, causative relation exists
B) both parts are correct, causative relation does not exist
C) first part is correct, the second is incorrect
D) first part is incorrect, second part is correct
E) both parts are incorrect

Answer 67

B) both parts are correct, causative relation does not exist

Question 68

Portal hypertension might develop as a consequence of liver cirrhosis; therefore liver cirrhosis can be accompanied by jaundice.
A) both parts are correct, causative relation exists
B) both parts are correct, causative relation does not exist
C) first part is correct, the second is incorrect
D) first part is incorrect, second part is correct
E) both parts are incorrect

Answer 68

B) both parts are correct, causative relation does not exist

Question 69

Hepatitis B virus infection is acquired in newborns in the Far-East, therefore the hepatocellular carcinoma is more common there.
A) both parts are correct, causative relation exists
B) both parts are correct, causative relation does not exist
C) first part is correct, the second is incorrect
D) first part is incorrect, second part is correct
E) both parts are incorrect

Answer 69

A) both parts are correct, causative relation exists

Question 70

Chronic hepatitis C is susceptible of spontaneous healing; therefore chronic HCV infection should be rarely treated.
A) both parts are correct, causative relation exists
B) both parts are correct, causative relation does not exist
C) first part is correct, the second is incorrect
D) first part is incorrect, second part is correct
E) both parts are incorrect

Answer 70

E) both parts are incorrect

Question 71

Autoimmune disorders might relapse as a side effect of interferon therapy; therefore interferon therapy is contraindicated in autoimmune hepatitis.
A) both parts are correct, causative relation exists
B) both parts are correct, causative relation does not exist
C) first part is correct, the second is incorrect
D) first part is incorrect, second part is correct
E) both parts are incorrect

Answer 71

A) both parts are correct, causative relation exists

Question 72

In haemolyticus icterus unconjugated bilirubin is increased in blood; therefore the patient has direct hyperbilirubinaemia in hemolysis.
A) both parts are correct, causative relation exists
B) both parts are correct, causative relation does not exist
C) first part is correct, the second is incorrect
D) first part is incorrect, second part is correct
E) both parts are incorrect

Answer 72

C) first part is correct, the second is incorrect

Question 73

Postransfusion hepatitis was significantly decreased by the screening of blood donors for HBsAg and anti-HCV antibody, therefore post-transfusion hepatitis does not occur nowadays.
A) both parts are correct, causative relation exists
B) both parts are correct, causative relation does not exist
C) first part is correct, the second is incorrect
D) first part is incorrect, second part is correct
E) both parts are incorrect

Answer 73

C) first part is correct, the second is incorrect

Question 74

What is the diagnosis?
50-year-old alcoholic male patient visits his physician with following symptoms: fatigue for months, abdominal girth is increased, distended, swelling of the legs, jaundice appeared, lost some weight. He became febrile few days ago and felt abdominal pain. Physical examination reveals jaundice, ascites, enlarged liver with finely irregular surface, mild diffuse abdominal tenderness. Laboratory parameters: serum bilirubin 65 μmol/l, AST 60 E, GGT 560 E, albumin 26 g/l, INR: 1.7, leucocyte count 12 000 G/l, platelet count: 75 000 G/l.
A) alcoholic hepatitis
B) hepatocellular carcinoma
C) liver cirrhosis
D) right-sided cardiac failure

Answer 74

C) liver cirrhosis

Question 75

What type of investigation would be the next step?
50-year-old alcoholic male patient visits his physician with following symptoms: fatigue for months, abdominal girth is increased, distended, swelling of the legs, jaundice appeared, lost some weight. He became febrile few days ago and felt abdominal pain. Physical examination reveals jaundice, ascites, enlarged liver with finely irregular surface, mild diffuse abdominal tenderness. Laboratory parameters: serum bilirubin 65 μmol/l, AST 60 E, GGT 560 E, albumin 26 g/l, INR: 1.7, leucocyte count 12 000 G/l, platelet count: 75 000 G/l.
A) diagnostic ascites tapping
B) oesophagogastroscopy
C) MR cholangiography
D) endoscopic retrograde cholangiography (ERCP)
E) none of the above

Answer 75

A) diagnostic ascites tapping

Question 76

What other investigations would be recommended?
50-year-old alcoholic male patient visits his physician with following symptoms: fatigue for months, abdominal girth is increased, distended, swelling of the legs, jaundice appeared, lost some weight. He became febrile few days ago and felt abdominal pain. Physical examination reveals jaundice, ascites, enlarged liver with finely irregular surface, mild diffuse abdominal tenderness. Laboratory parameters: serum bilirubin 65 μmol/l, AST 60 E, GGT 560 E, albumin 26 g/l, INR: 1.7, leucocyte count 12 000 G/l, platelet count: 75 000 G/l.
A) percutaneous liver biopsy
B) liver scintigraphy
C) abdominal ultrasound
D) echocardiography
E) none of the above

Answer 76

C) abdominal ultrasound

Question 77

What can be the complication of disease, based on the laboratory findings and symptomatology?
50-year-old alcoholic male patient visits his physician with following symptoms: fatigue for months, abdominal girth is increased, distended, swelling of the legs, jaundice appeared, lost some weight. He became febrile few days ago and felt abdominal pain. Physical examination reveals jaundice, ascites, enlarged liver with finely irregular surface, mild diffuse abdominal tenderness. Laboratory parameters: serum bilirubin 65 μmol/l, AST 60 E, GGT 560 E, albumin 26 g/l, INR: 1.7, leucocyte count 12 000 G/l, platelet count: 75 000 G/l.
A) acute cholecystitis
B) spontaneous bacterial peritonitis
C) acute pancreatitis
D) hepatic encephalopathy
E) duodenal erosion

Answer 77

B) spontaneous bacterial peritonitis

Question 78

What would be the recommended drug therapy for this complication?
50-year-old alcoholic male patient visits his physician with following symptoms: fatigue for months, abdominal girth is increased, distended, swelling of the legs, jaundice appeared, lost some weight. He became febrile few days ago and felt abdominal pain. Physical examination reveals jaundice, ascites, enlarged liver with finely irregular surface, mild diffuse abdominal tenderness. Laboratory parameters: serum bilirubin 65 μmol/l, AST 60 E, GGT 560 E, albumin 26 g/l, INR: 1.7, leucocyte count 12 000 G/l, platelet count: 75 000 G/l.
A) penicillin
B) rifaximin
C) lactulose
D) norfloxacin or ceftriaxon
E) all of the above

Answer 78

D) norfloxacin or ceftriaxon