GI 5 practice

Question 1

What occurs in 20-45% US population?
a) Alcoholic liver disease
b) Metabolic Associated fatty liver disease (MAFLD)
c) Hepatitis A
d) Cirrhosis of the liver
e) Acute (secondary) peritonitis

Answer 1

b) Metabolic Associated fatty liver disease (MAFLD)

Question 2

Most common cause of acute viral hepatitis in the U.S. is what?

Answer 2

Hep A

Question 3

Which form of hepatitis can be most easily vertically transmitted (rate of infection = 90%)?

Answer 3

Hep D

Question 4

RUQ tenderness & mild hepatomegaly are found on PE in 85% of patients with what?

Answer 4

Hep A

Question 5

Who is most likely to have a worse outcome with Hepatitis B (such as HCC)?
a) An 85 year old man
b) A 25 year old with chronic illnesses
c) A toddler
d) A newborn baby

Answer 5

d) A newborn baby

Question 6

A patient has had positive _________ results for over 6 months, so they have a chronic Hep B infection.

Answer 6

HBsAg

Question 7

A patient has a positive HBsAg & negative HBcAb. What does this mean?

Answer 7

Recovering from acute infection or presence of chronic infection

Question 8

Which of the following would mean you have a low risk of contracting Hep C?
a) Blood transfusion
b) Accidental needlestick
c) Multiple sexual partners
d) Men who have sex with men

Answer 8

b) Accidental needlestick

Question 9

What is the most common symptom of Hep C?
a) Dermatologic conditions
b) Autoimmune disorders
c) Renal disorders
d) Asymptomatic

Answer 9

d) Asymptomatic

Question 10

How long is treatment for Hep B and Hep C?

Answer 10

12 weeks

Question 11

Formation of regenerative nodules, digital clubbing, & thrombocytopenia are characteristic of what?
a) Alcoholic liver disease
b) Metabolic Associated fatty liver disease (MAFLD)
c) Cirrhosis of the liver
d) Hepatitis A
e) Acute (secondary) peritonitis

Answer 11

c) Cirrhosis of the liver

Question 12

Patients with hepatic encephalopathy should not do what? Select all that apply
a) Run
b) Drive
c) Fast
d) Eat

Answer 12

b) Drive
c) Fast

Question 13

What is the diagnostic study of choice for fulminant hepatic failure?
a) Ultrasound with doppler
b) CT with IV and PO contrast
c) CT without contrast
d) MRI

Answer 13

a) Ultrasound with doppler

Question 14

What is the only way to truly get rid of ascites?
a) Diuretics & sodium restriction (< 2G/day)
b) Therapeutic paracentesis
c) Beta blockers
d) TIPS

Answer 14

d) TIPS

Question 15

Guarding, rigidity, distention, and rebound pain, are all Sx of what?

Answer 15

Acute peritonitis

Question 16

What are the Child-Pugh and MELD scores for?

Answer 16

Determining the severity of liver damage and how much a cirrhosis pt needs a liver transplant

Question 17

How is SBP (spontaneous bacterial peritonitis) diagnosed? What is the most common organism(s) found?

Answer 17

Paracentesis; E. coli

Question 18

Which of the following may cause hepatorenal syndrome?
a) Ascites due to severe portal HTN in cirrhosis
b) Compensated cirrhosis
c) Metabolic Associated fatty liver disease (MAFLD)
d) Alcoholic liver disease

Answer 18

a) Ascites due to severe portal HTN in cirrhosis

Question 19

How do you detect pneumoperitoneum with acute (secondary) peritonitis?
a) Ultrasound with doppler
b) CT with IV and PO contrast
c) CT without contrast
d) MRI

Answer 19

b) CT with IV and PO contrast

Question 20

Hepatorenal syndrome presents with which of the following? Select all that apply
a) Progressive rise in serum creatinine
b) Progressive fall in serum creatinine
c) Prolific proteinurea
d) Minimal proteinuria
e) Polyurea (depending on severity)
f) Oligurea (depending on severity)

Answer 20

a) Progressive rise in serum creatinine
c) Prolific proteinurea
f) Oligurea (depending on severity)

Question 21

Which are common causes of cirrhosis? Select all that apply
a) Alcohol
b) Hep A
c) Hep B
d) Hep C

Answer 21

a) Alcohol
c) Hep B
d) Hep C

Question 22

A 15 year old patient presents with an INR of 2.0, T bili of 15 (<18; low) encephalopathy, and impaired synthetic function. Their ALT & AST are >10X ULN. They’ve previously been perfectly healthy.

What do they likely have, and what is their prognosis?

Answer 22

Fulminant hepatic failure; good prognosis

Question 23

Jaundice usually presents with bilirubin ≥ ____ mg/dL

Answer 23

≥3

Question 24

Which of the following is NOT a cause of unconjugated hyperbilirubinemia?
a) Increased bilirubin production
b) Decreased hepatic uptake
c) Impaired conjugation
d) Biliary obstruction (extra-hepatic)

Answer 24

d) Biliary obstruction (extra-hepatic)

Question 25

What is the only instance where steroids are helpful for hepatitis?

Answer 25

Methylprednisolone x 1 month in alcoholic hepatitis may reduce short-term mortality

Question 26

Porphyria is a symptom of which curable form of hepatitis?

Answer 26

Hep C

Question 27

A patient has HCV Ab but undetectable HCV RNA. What does this mean?

Answer 27

Prior Hep C infection; not immune

Question 28

T/F: For cirrhosis, you should have a high index of suspicion/low threshold early antibiotics for Spontaneous Bacterial Peritonitis

Answer 28

True

Question 29

T/F: Steroids are usually appropriate for alcoholic liver disease

Answer 29

False (only with severe disease)

Question 30

T/F: HCV Ab is not protective, but it will remain positive after a patient has been treated

Answer 30

True

Question 31

T/F: Hepatorenal syndrome is a diagnosis of exclusion

Answer 31

True

Question 32

T/F: Patients with advanced parenchymal liver disease will respond to exogenous vit K

Answer 32

False (they will NOT respond bc the liver is also not manufacturing other proteins/factors needed to reverse the anticoagulopathy)

Question 33

T/F: Liver disease patients can have complications with both coagulation and anticoagulation

Answer 33

True

Question 34

T/F: Decreased platelet sequestration in the spleen can contribute to clotting issues with cirrhosis

Answer 34

False (Increased platelet sequestration)

Question 35

T/F: Insulin resistance is the primary mechanism of MAFLD

Answer 35

True

Question 36

T/F: Coffee consumption increases risk of MAFLD

Answer 36

False

Question 37

T/F: You need to administer a vaccine within 24 hrs of birth to prevent the development of Hep B in an infant

Answer 37

True

Question 38

T/F: The only definitive Tx of decompensated cirrhosis is liver transplant

Answer 38

True

Question 39

T/F: A MELD score of 15 does not qualify you for a liver transplant

Answer 39

False (it does)

Question 40

T/F: Acetaminophen is most commonly associated with fulminant hepatic failure

Answer 40

True