Show questions one by one

1. Regarding the liver, all are true except

A. ? 15% of the liver is composed of cells other than
hepatocytes
B. ? clearance of bacteria, viruses and erythrocytes is done by
Kupffer cells
C. ? Ito cells have a role in the uptake and storage of vitamin A
D. ? Vitamin K and folic acids are stored in a huge amount
E. ? hapatic synthesis of urea, endogenous proteins and amino
acid release by the liver all are suppressed during fasting
2. The following statements are true except
A. ? low blood urea is seen in many acute and chronic liver
diseases
B. ? high blood urea in the context of severe liver damage may
indicates gastrointestinal hemorrhage or hepatorenal syndrome
C. ? hyponatremia is very common in severe liver disease and
usually multifactorial
D. ? raised gamma GT enzyme level may occur during
treatment with carbamazepin
E. ? large increase in serum aminotrnsferases activity with a
small rise in alkaline phsophatase activity is in favor of biliary
obstruction
3. Drugs that induce hepatic microsomal enzymes, all are true except
A. ? chronic ethanol ingestion
B. ? glucocorticoids
C. ? Grisofulvin
D. ? carbamazepin
E. ? Cimetidin
4. Imaging in liver diseases, all are true except:
A. ? ultrasound of the liver is a rapid, cheap and easy method
and usually the first imaging to be done, yet its main limitation is
that small focal lesions less than 2 cm will be missed
B. ? color Doppler studies are very useful and used to
investigate hepatic veins, portal vein and hepatic artery diseases
C. ? MRI is usually used for pancreaticobiliary diseases rather
than parenchymal liver diseases
D. ? outlining the biliary tree can be done by injecting a contrast
medium into the biliary tree through the skin or by an
endoscopic approach
E. ? plain abdominal radiographs are very helpful in liver
diseases
5. Regarding liver biopsy, all are true except
A. ? the patient should be cooperative
B. ? the PT prolongation if present, should be less than 4
seconds above the upper normal control value
C. ? severe COPD is a contraindication
D. ? marked ascites will make the procedure easier
E. ? local skin infection should not be present
6. Regarding the metabolism of bilirubins , all are true except
A. ? every day, about 300 mg of indirect bilirubin is produced
B. ? jaundice will be seen clinically if the total bilirubin exceeds
50 micromole / L
C. ? about 100-200 mg of stercobilinogen is lost in stool
D. ? about 40 mg of urobilinogen is passed outside in urine
E. ? the indirect bilirubin will be conjugated in the endoplasmic
reticulum of hepatocytes to be water soluble
7. Causes of indirect hyperbilirubinemia ,all are true except
A. ? B12 deficiency
B. ? Wilson's disease
C. ? Gilbert's syndrome
D. ? Rotor syndrome
E. ? major ABO incompatibility reaction
8. When examining a patient with a direct bilirubin of 30 micromole / L, all
are useful signs in guessing the diagnosis, except
A. ? a palpable gall bladder
B. ? an upper abdominal paramedian scar
C. ? irregular hard liver
D. ? upper midline abdominal mass
E. ? scratcing marks
9. Local measure to stop a variceal upper GIT bleeding, all are true
except
A. ? banding
B. ? sclerotherapy
C. ? esophageal transection
D. ? ballon tamponade
E. ? terlipressin infusion
10. Measures to prevent variceal recurrent upper GIT bleeding, all are true
except
A. ? oral propranolol
B. ? sclerotherapy / banding
C. ? transjugular intra hepatic portosystemic shunt ( TIPSS
D. ? esophageal transection
E. ? selective or non selective portosystemic shunt surgery
11. A patient with chronic liver disease presents with upper GIT bleeding ,
all are true except
A. ? upper GIT endoscope should be done in all cases as 20%
of cases the bleeding is non variceal
B. ? despite all advances in the management, the mortality rate
is still high
C. ? portosystemic shunt surgery in this patient may have a
mortality of 50%
D. ? vasopressin is contraindicated in ischemic heart disease
E. ? esophageal transection is commonly used as a first line
treatment
12. TIPSS ( transjugular intrahepatic Porto-systemic shunt ) , all are true
except
A. ? it is done by placing a stent between the hepatic vein and
the portal vein in the liver under radiological control.
B. ? the objective is to produce a Porto systemic shunt to
reduce the portal pressure and hence the variceal bleeding
C. ? prior patency of the portal vein should checked before hand
by angiography
D. ? may precipitate or worsen hepatic encephalopathy
E. ? when rebleeding occurs, the shunt should be removed
13. Spontaneous bacterial peritonitis in the context of cirrhosis, all are true
except
A. ? unfortunaterly, up to one third of cases the abdominal signs
are mild or absent
B. ? almost always a mono-microbial infection state
C. ? recurrence is common but unfortunately there is no way to
prevent it
D. ? The commonest organisms are enteric gram negatives, but
no source of infection is usually present
E. ? the ascitic fluid is cloudy with more than 250 neutrophils /
mm3
14. Precipitating factors for hepatic encephalopathy in a patient with
cirrhosis, all are true except
A. ? occult infection
B. ? aggressive diuresis
C. ? diarrhea or constipation
D. ? treamtent with oral neomycin
E. ? excesss dietary proteins
15. Differential diagnosis of hepatic encephalopathy, all are true except:
A. ? primary psychiatric disease
B. ? hypoglycemia
C. ? Wernick's encephalopathy
D. ? subdural hematoma
E. ? treamtent by enemas
16. Acute fulminant hepatic failure, all are true except
A. ? the commonest causes are viral hepatitis and medications-
induced
B. ? the hallmark is the presence of acute hepatic
encephalopathy
C. ? the absence of jaundice is against the diagnosis
D. ? there are long listed complications and these usually
complicates the picture further
E. ? the patient should be managed in an intensive care unit or
a high dependency unit once the PT is prolonged
17. Hepatorenal failure, all are true except
A. ? carries a very bad prognosis unless hepatic transplantation
is carried out
B. ? one of the causes of fractional Na excretion of more than 1
.
C. ? characterictically presents as rapidly evolving uremia with
bland urinary sediment
D. ? seen in advanced cirrhosis and ascites is almost always
present
E. ? Renal dose dopamine has a role in the management, yet
the improvement in renal function depends entirely on
improvement of the liver function
18. Causes of micro-vesicular steatosis, all are true except
A. ? fatty liver of pregnancy
B. ? Rye's syndrome
C. ? treatment with didanosine
D. ? Wolman's disease and Alpers syndrome
E. ? treatment with amiodarone
19. Causes of acute hepatitis, all are true except
A. ? Halothane
B. ? Wilson's disease
C. ? autoimmune hepatitis
D. ? CMV
E. ? hemochromatosis
20. Causes of chronic liver disease and cirrhosis, all are true except
A. ? alpha 1 anti-trypsin deficiency
B. ? Hepatitis C
C. ? hemochromatosis
D. ? autoimmune hepatitis
E. ? EBV
21. Liver cirrhosis, all are true except
A. ? hyperpigmentation is seen in hemochromatosis and
prolonged biliary obstruction
B. ? spider telangiectasias are seen early in the course of
cirrhosis but 2 % in normal healthy population
C. ? parotid gland enlargement goes with liver etiology
D. ? ascites is seen early
E. ? finger clubbing is a non specific sign
22. The hepatitis viruses, all are true except
A. ? hepatitis A is an RNA enterovirus which does not lead to a
carrier state
B. ? hepatitis B is a DNA virus that 42 nm in diameter and leads
to chronic infection up to 10% of adults versus 90% of neonatal
hepatitis B infection
C. ? hepatitis C is an RNA flavivirus that is the commonest
cause of chronic liver disease in USA and of those infected ,up
to 20 % of them will develop cirrhosis after 20 years
D. ? hepatitis D is a defective RNA virus that can be prevented
by preventing hepatitis B infection in high risk groups by using
hepatitis B vaccine and immunoglobulin
E. ? hepatitis E is a RNA calicivirus that carries a mortality of
2% if the infection occurs in pregnancy
23. The followings predict poor response to INF alpha treatment in chronic
hepatitis B viral infection, except
A. ? being a male
B. ? pre-core mutant strains
C. ? being an Asian
D. ? very high pretreatment serum hepatitis B viral DNA level by
PCR
E. ? absence of cirrhosis
24. Autoimmnue hepatitis, all are true except
A. ? type I is ANA and antismooth muscle antibodies positive,
while type II is anti LKM antibodies positive
B. ? amenorrhea is the rule and cushingoid faces may be seen
C. ? 25% of cases present as a hepatitis like picture
D. ? corticosterois are effective in the treatment of acute attacks
and at prevention of future attacks but do not prevent the
progression to frank cirrhosis
E. ? hepatocelluar carcinoma as a complication is common
25. Histological changes in alcoholic liver disease, all are true except
A. ? mitochonsrial swelling
B. ? siderosis
C. ? lipogranulomas
D. ? autoimmune (interface) hepatitis
E. ? few endoplasmic reticula
26. Primary biliary cirrhosis, all are true except
A. ? anti mitochondrial antibodies are seen up to 96% of cases
B. ? early, there is proliferation of small bile ductules
C. ? hypercholesteremia is common and greatly increases the
risk of coronary artery disease
D. ? polished nails with clubbing is a good clue in an appropriate
clinical setting
E. ? ursodeyoxycholic acid has been shown to improve the liver
function tests.
27. Primary sclerosing cholangitis , all are true except
A. ? 80% of cases are seen in the context of ulcerative colitis
B. ? spontaneuos ascending cholangitis is uncommon but
usually occur after biliary instrumentation like post ERCP
C. ? Is risk factor for cholangiocarcinoma
D. ? there is an association with HIV infection and
retroperitoneal fibrosis
E. ? corticosterois and immune-suppressants are useful in the
treatment
28. Hepatocelluar carcinoma (HCC ), all are true except
A. ? occurs in the background of cirrhosis in up to 80% of cases
B. ? chronic hepatitis B infection is the commonest cause world-
wide
C. ? may be treated by liver transplantation
D. ? any patient with cirrhosis should be screened for the
development of HCC by serial serum alpha fetoprotein and liver
ultrasound
E. ? the fibrolammellar variant has a very poor prognosis
29. Criteria for giving ursodeoxycholic acid as a medical treatment for gall
stones solubilization , all are true except
A. ? the stone should be radiolucent
B. ? the stone size is up 15 mm
C. ? functioning gall bladder
D. ? moderate obesity
E. ? prominent symptoms ascribed to the stone
30. Risk factors for pigment gall stones, all are true except
A. ? liver cirrhosis
B. ? biliary parasites
C. ? chronic long term hemolysis
D. ? ileal resection / disease
E. ? pregnanacy