Hepatobiloary

Question 1

MC and most characteristic symptom of liver disease

Answer 1

Fatigue

Question 2

Hallmark symptom of liver disease, the most reliable marker of severity

Answer 2

Jaundice

Question 3

Jaundice is detectable in what bilirubin levels

Answer 3

> 25 mg/dL (>43 umol/L)

Question 4

Clinically helpful approach to diagnosis of alcohol dependence and abuse

Answer 4

CAGE questionnaire

Question 5

Suggestive of chronic alcoholism and chronic alcoholic disease

Answer 5

Dupuytren contracture

Parotid enlargement

Question 6

Kaysher-Fleischer rings

Answer 6

Wilson’s Disease

Question 7

pANCA

Answer 7

Primary sclerosing cholangitis

Question 8

Mitochondrial antibody

Answer 8

Primary biliary cirrhosis

Question 9

Useful assessment of the severity and stage of liver damage, prediction of prognosis and monitoring and respinse to treatment

Answer 9

Liver biopsy

Question 10

Evaluation of liver transplantation candidates

Answer 10

MELD

Question 11

Clinical staging of cirrhosis

Answer 11

Chikd-Pugh

Question 12

MELD components

Answer 12

bilirubin
crea
protime

Question 13

More specific transaminase indicator of liver injury

Answer 13

SGPT/ALT

Question 14

Albumin levels suggesting chronic liver diseases

Answer 14

<3 g/dL

Question 15

Inactivates HAV

Answer 15

Boiling for 1 min
Contact with formaldehyde and chlorine
UV irradiation

Question 16

First virologic marker detectable in the serum

Answer 16

HBs

Question 17

May be the only serologic evidence of current or recent HBV infection during the gap or window period

Answer 17

Anti HBc

Question 18

Qualitative marker of early chronic HBV infection

Answer 18

HBe

Question 19

Quantitative marker of early chronic HBV infection

Answer 19

HBV DNA

Question 20

Major route of transmission of HBV

Answer 20

percutaneous inoculation

Question 21

Account for most casesnof transfusion-transmitted hepatitis

Answer 21

HCV

Question 22

Greatest impact on transmission in HBV

Answer 22

Perinatal transmission

Intimate sexual contact

Question 23

Pathogenesis of Chronic HBV infection

Answer 23

Defective Cellular Immunity

Question 24

Requires HBV for its replication and expression

Answer 24

HDV

Question 25

MC genotype of HCV

Answer 25

Genotype 1

Question 26

Associated with essential mixed cryoglobinemia

Answer 26

HCV

Question 27

Severe histologic findings in Acute Viral Hepatitis

Answer 27

Bridging hepatic necrosis | may be seen in methyldopa toxicity

Question 28

Fulminant Hepatitis

Answer 28

B E D (with massive hepatic necrosis)

Question 29

False-positive IgM Anti-HAV is seen

Answer 29

Presence of Rheumatoid Factor

Question 30

Gold standard to establish diagnosis of HCV

Answer 30

HCV RNA assay

Question 31

More sensitive test for HBV replication

Answer 31

HBV DNA

Question 32

May produce serum-sickness like syndrome

Answer 32

Acute HBV

Question 33

Likelihood of chronicity after acute infection

Answer 33

HCV

Question 34

Treatment of Acute Hep C

Answer 34

PEG + Ribavirin

Question 35

MCC of acute liver failure

Answer 35

Drug-induced liver injury

Question 36

May cause centrilobular zonal necrosis

Answer 36

Carbon tetrachloride | Trichloroethylene

Question 37

May cause periportal injury

Answer 37

Yellow phosphorus poisoning

Question 38

May cause massive hepatic necrosis

Answer 38

Octapeptides of Amanita phalloides

Question 39

May cause hepatocellular injury indistinguishable from that of viral hepatitis

Answer 39

Isoniazid | Ciprofloxacin

Question 40

MC form of hepatocellular injury

Answer 40

Spotty necrosis in the liver lobule with predominantly lymphocytic infiltrate

Question 41

Most frequently implicated antibiotic among cases of drug-induced liver injury

Answer 41

Amoxicillin-Clavulanic

Question 42

“Ductopenic” cholestasis

Answer 42

Carbamazepine | Levofloxacin

Question 43

Hepatocellular vs cholestatic reaction

Answer 43

R value > 5: hepatocellular injury R value < 2: cholestatic 2-5 mixed

Question 44

Gastric lavage in Acetaminophen ingestion

Answer 44

Should be done within 30 mins otherwise ineffective

Question 45

Blood levels of acetaminophen predictive of development of severe damage

Answer 45

>300 ug/mL 4 hours after ingestion

Question 46

Treatment for sodium valproate toxicity

Answer 46

IV carnitine

Question 47

Causative agent in TMP-SMX hepatotoxicity

Answer 47

Sulfamethoxazole component

Question 48

Causes chronic viral hepatitis

Answer 48

B C D (superimposed on chronic hep B)

Question 49

Three major forms of ALD

Answer 49

Fatty Liver Alcoholic Hepatitis Cirrhosis

Question 50

Quantity of ethanol in men produces fatty liver

Answer 50

40-80 g/day | 1 beer = 12 g of alcohol

Question 51

Quantity of ethanol in men produces hepatitis or cirrhosis

Answer 51

160 g/day x 10-20 years

Question 52

Initial and MC histologic response to increased alcohol ingestion

Answer 52

Fatty Liver

Question 53

Hallmark of Alcoholic hepatitis

Answer 53

Injured hepatocyte with ballooning degeneration, spotty necrosis, PMN infiltration and fibrosis in the perivenulae and perisinusoidal space of Disse

Question 54

Heralds severe alcoholic hepatitis

Answer 54

``` PT >5s Anemia Alb <2.5 mg/dL Bil >8 mg/dL renal failure ascites ```

Question 55

MELD score with significant mortality

Answer 55

>/= 21

Question 56

Cornerstone of Alcoholic hepititis

Answer 56

Complete abstinence from alcohol

Question 57

Preferred treatment for Alcoholic Hep with Discriminant function >/= 32 or MELD = 21 without comorbids

Answer 57

Prednisolone x 4 weeks then taper for 4 weeks Alternative: Pentoxyfylline x 4 weeks

Question 58

MC chronic liver disease in many parts of the world

Answer 58

NAFLD

Question 59

Highest risk of advanced liver fibrosis

Answer 59

NASH in >45-50 years old + overweight/obese or with T2DM

Question 60

Gold standard for establishing the severity of liver injury and fibrosis

Answer 60

Liver biopsy