Liver Disorders

Question 1

Which liver mass is characterized by a solitary mass with a hypodense central stellate scar or “spoke wheel” vascular pattern on CT imaging?

Answer 1

Focal nodular hyperplasia (FNH)

Question 2

Up to 50% of cases of hepatocellular carcinoma (HCC) occur secondary to:

Answer 2

Chronic HBV infection

Question 3

What is the most likely diagnosis in a patient with the following serology: - HBeAg: + - Anti-HBc IgG: + - HBsAg: + - LFTs:

Answer 3

Mild ↑ Active chronic HBV

Question 4

HBeAg in inactive carriers with chronic hepatitis B virus (HBV) infections is:

Answer 4

Undetectable

Question 5

What are the agents used to lower NH3 levels in hepatic encephalopathy?

Answer 5

First-line: Lactulose
Second-line: Rifaximin

Question 6

What is the next step in management for a patient found to have positive HCV antibodies?

Answer 6

HCV RNA testing

Question 7

What is the likely underlying infection in a patient with recurrent blisters on sun-exposed areas with fatigue, nausea, and elevated LFTs?

Answer 7

Chronic hepatitis C infection

Question 8

What combined antiviral therapy is effective against most strains of hepatitis C (e.g. genotypes 1-6)?

Answer 8

Sofosbuvir-velpatasvir

Question 9

Options for antiviral therapy against immune-active chronic HBV include:

Answer 9

Tenofovir, entecavir, and pegylated interferon alpha (IFN-α)

Question 10

All patients with cirrhosis should have a screening:

Answer 10

ultrasound every 6 months ± alpha-fetoprotein

Question 11

What serologic markers should be measured to diagnose acute HBV infection?

Answer 11

HBsAg and anti-HBc IgM

Question 11

All patients with cirrhosis should be regularly screened for major complications, in particular:

Answer 11

Esophageal varices and hepatocellular carcinoma (HCC)

Question 11

Patients with resolved HBV infection after acute phase
will have:
- HBsAg:
- Anti-HBs:
- Anti-HBc:
- Anti-HBe:

Answer 11

• Negative
• Positive
• Positive
• Positive

Question 11

Chronic HBV infection, which is characterized serologically by:
- HBsAg :
- Anti-HBs:
- IgG anti-HBc:

Answer 11

• Positive for a period of ≥ 6 months,
• Negative
• Positive

Question 12

First-line treatment for patients with Early-stage hepatocellular carcinoma (A solitary hepatocellular carcinoma > 2 cm in size or up to three small (≤ 3 cm) tumors confined to the liver, with no evidence of portal hypertension or macrovascular invasion in patients with preserved liver function)

Answer 12

Surgical resection of the affected hepatic lobe

Question 13

What is the likely diagnosis in a young woman that presents with sudden RUQ pain, hypovolemic shock, and a solid liver mass with free fluid in the abdomen on U/S?

Answer 13

Ruptured hepatic adenoma

Question 14

What is the recommended management for a pregnant patient with chronic hepatitis C infection and no immunity to hepatitis A/B?

Answer 14

Administer hepatitis A and B vaccines (prevent further liver damage)

Question 15

Immunization against HBV is characterized serologically by:
- HBsAg :
- Anti-HBs:
- IgG anti-HBc:

Answer 15

• Negative
• Positive
• Negative

Question 16

What is the treatment for acute cases of HBV?

Answer 16

Supportive

Question 17

What is the likely diagnosis in a cirrhotic patient with decreasing GFR, normal urinalysis, lack of improvement with IV fluids, and no other renal dysfunction?

Answer 17

Hepatorenal syndrome

Question 18

Amebic liver abscess symptoms:

Answer 18

Fever, bloody diarrhea, RUQ pain, smooth/cystic subcapsular liver mass

Question 19

Amebic liver abscess caused by Entamoeba histolytica appears on ultrasound as a(n):

Answer 19

Hypoechoic lesion

Question 20

Hemochromatosis classically presents with a triad of:

Answer 20

• Cirrhosis
• Diabetes mellitus
• Bronze skin

Question 21

What is the underlying cause of impotence in a middle-aged male with hepatomegaly and arthropathy?

Answer 21

Hypogonadism (due to hereditary hemochromatosis)

Question 22

What is a common cause of death in hemochromatosis?

Answer 22

Hepatocellular carcinoma

Question 23

What is the most common condition that causes chylous ascites?

Answer 23

Lymphoma

Question 24

What is the likely diagnosis in a young patient that has hepatosplenomegaly, resting tremor, dysarthria, parkinsonism, and dementia?

Answer 24

Wilson disease

Question 25

The presence of a fluid filled cavity in the liver in conjunction with fevers, chills, and RUQ pain is suggestive of a(n):

Answer 25

Hepatic abscess

Question 26

Pyogenic liver abscess is managed with:

Answer 26

Broad spectrum IV antibiotics + percutaneous drainage

Question 27

Recurrent GI bleeding from esophageal varices is managed with:

Answer 27

TIPS

Question 28

What is the likely diagnosis in a patient with cirrhosis and ascites who presents with low-grade fever, diffuse abdominal discomfort, and altered mental status (AMS)?

Answer 28

Spontaneous bacterial peritonitis

Question 29

Spontaneous bacterial peritonitis is diagnosed by paracentesis with ascitic fluid absolute neutrophil count:

Answer 29

≥ 250 cells/mm3

Question 30

Which diuretics are commonly co-administered to cirrhotic patients with volume overload and ascites?

Answer 30

Furosemide and spironolactone

Question 31

Pyogenic bacteria typically gain access to the liver through either a(n)______or ______

Answer 31

biliary tract infection (ascending cholangitis) portal vein pyemia

Question 32

Common cardiac complications in patients with hemochromatosis:

Answer 32

- Paroxysmal atrial fibrillation - Dilated cardiomyopathy - Restrictive cardiomyopathy - Heart failure.

Question 33

Alcoholic hepatitis typically has what AST/ALT ratio?

Answer 33

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