Liver diseases Flashcards by O.K .

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

E) blood transfusion to inc hg level above 100g/L

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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

E) all of the above

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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

A) always dose dependent

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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)

A) abd US

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The most frequent cause of liver cirrhosis 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

C) NASH

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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)

E) HCC

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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

B) corticosteroids are always necessary

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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

D) corticosteroids are indicated in treatment

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Which of the following medication can dose-dependently cause liver failure?

A)  	halothane
B)  	paracetamol (acetaminophen)
C)  	chlorpromazine
D)  	methyldopa
E)  	erythromycin

B) paracetamol

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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

B) metabolic acidosis

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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

E) benign postop cholestasis

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Predisposing factor(s) for gallstone formation:

A)  	obesity
B)  	chronic hemolysis
C)  	octreotide therapy
D)  	bowel resection
E)  	all of the above

E) all

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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)

B) serum AFP

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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

A) scelrotherapy is needed only when recurrecnt bleeding occurs after PCS operation

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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

E) suspected hemangioma

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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

D) angiosarcoma

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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

E) all of the above

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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

E) AST/ALT ratio < 1

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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

B) only IFN tx can lead to total recovery

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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

A) toxicity if dose dependent

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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

D) after ERCP

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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

C) inc the risk of colorectal cancer in pts with PSC

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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

A) mets always happen in the early phase

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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

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

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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

D) it's always accompanied by inc level of AST

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

E) it always leads to dev of HCC

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 ```

D) 20-25 years after

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 ```

E) puritus

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

D) protein intake was insufficient

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 ```

E) all of the above

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

C) liver biopsy isn't needed for the diagnosis

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

B) signs of focal neurological lesions

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

D) autoimmune liver disease

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

E) diagnosis is based on detection of HBV RNA it's DNA not RNA

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

E) N acetylcystein

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

E) usually younger females affected

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

B) diabetes insipidus

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

E) excess of body hair

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

C) alcohol DH

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 ```

A) abd US, GGT, se-bilirubin

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

B) IgM

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 ```

E) all of the above

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

E) a fib

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 ```

1 2 3

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 ```

E) all

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 ```

1 2 3

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 ```

D) only 4 is correct

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 ```

1 2 3

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 ```

E) all

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 ```

1 2 3

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 ```

2 4

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 ```

1 2 3

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 ```

1 2 3

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 ```

E) all

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 ```

1 2 3

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 ```

4 only

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 ```

1 3

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. és 4. answers are correct D) only 4. answer is correct E) all 4 answers are correct ```

1 2 3

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 ```

E) all

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 ```

4 only

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 ```

1 2 3

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 ```

E) all

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 ```

1 2 3

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

``` A - 7. 68 B - 7. 69 C - 7.71 D - 7.70 E - 7.72 ```

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

B) both are correct but they don't relate

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

A) both are right with relation

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

B) both are right but no relation

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

B) both are correct but no relation

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

A) both are right with relation

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

E) both are wrong

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

A) both are right with relation

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

C) first is right but second is wrong

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

C) first is right and second is wrong

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

C) liver cirrhosis

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 ```

A) ascites tapping

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 ```

C) abd US

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 ```

B) spontaneous bacterial peritonitis

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 ```

D) norfloxacin or cetriaxon