3. Liver Diseases and Conditions.

1. Hepatic Encephalopathy.

***) Hepatic encephalopathy may be precipitated by all of the following, except:

1. Barbiturate

2. Morphine

3. High protein diet

4. Lactulose

5. Gastrointestinal hemorrhage

Answer: D* Lactulose

***) The following can precipitate hepatic encephalopathy in a patient with liver cirrhosis, except:

1. Infection

2. High carbohydrate diet

3. Gastrointestinal bleeding

4. Hypokalemia

5. Sedation

Answer: B* High carbohydrate diet

***) Hepatic encephalopathy in a cirrhotic patient may be precipitated by all of the following, except:

1. Use of diuretics

2. Constipation

3. Narcotics

4. Neomycin

5. Paracentesis

Answer: D* Neomycin

***) All of the following are factors precipitating portosystemic encephalopathy, except:

1. Diarrhea

2. Infection

3. Diuretic therapy

4. Narcosis

5. Shunt operations

Answer: A* Diarrhea

***) Hepatic encephalopathy in cirrhosis is typically precipitated by all the following, except:

1. Infection

2. Hypokalemia

3. Gastrointestinal bleeding

4. Lactulose therapy

5. Abdominal surgery

Answer: D* Lactulose therapy

2. Cirrhosis.

***) All of the following can cause liver cirrhosis, except:

1. Hemochromatosis

2. Hepatitis B, C

3. Budd-Chiary syndrome

4. Hepatitis A

5. Biliary cirrhosis

Answer: D* Hepatitis A

***) All of the following are signs of chronic liver disease, except:

1. Parotid gland enlargement

2. Increase of body hair

3. Spider Naeyia

4. Gynecomastia

5. Palmar erythema

Answer: B* Increase of body hair

***) The Budd-Chiary syndrome is due to occlusion of the:

1. Hepatic veins

2. Portal veins

3. Mesenteric veins

4. Pancreatic veins

5. Splenic veins

Answer: A* Hepatic veins

***) All of the following can cause hemorrhagic ascites, except:

1. Malignancy

2. Liver cirrhosis

3. Ruptured ectopic pregnancy

4. Abdominal trauma

5. Acute pancreatitis

Answer: B* Liver cirrhosis

3. Hemochromatosis.

***) A 35 years old male comes for evaluation of abdominal discomfort, tiredness and arthralgia. The examination reveals slate-grey skin pigmentation, hepatomegaly and hypogonadism. Random blood sugar is 250mg/dl. The most likely diagnosis is:

1. Cirrhosis

2. Wilson disease

3. Hemochromatosis

4. SLE

5. Chronic pancreatitis

Answer: C* Hemochromatosis

4. Autoimmune Hepatitis.

***) 30 years old female (DM type 1) presented with jaundice, labs show increased in ALT, AST, positive ANA, ASMA, negative antimitochondrial antibodies and normal alkaline phosphatase. The most likely diagnosis is: Q2012

1. Primary biliary cirrhosis

2. Primary sclerosing cholangitis

3. Viral hepatitis

4. Autoimmune hepatitis

5. Hepatocellular carcinoma

Answer: D* Autoimmune hepatitis

5. Wilson's disease.

***) Wilson disease is a disorder of plasma protein of one of the following elements:

1. Iron

2. Cobalt

3. Zinc

4. Copper

5. Magnesium

Answer: D* Copper

6. Jaundice.

***) Causes of conjugated hyperbilirubinemia include: Q2012

1. Crigler Najar syndrome type 1

2. Gilbert's syndrome

3. Hemolysis

4. Dubin-Johnson syndrome

5. Carotenemia

Answer: B* Gilbert's syndrome

***) Bilirubin in the plasma is tightly bound to which of the following:

1. Gamma globulin

2. Albumin

3. Haptoglobin

4. Ceruloplasmin

5. Fibrinogen

Answer: B* Albumin

***) All of the following are etiologies of conjugated hyperbilirubinemia, except:

1. Dubin-Johnson syndrome

2. Methyltestosterone ingestion

3. Rotor's syndrome

4. Gilbert's syndrome

5. Carcinoma of the ampulla of Vater's nipple

Answer: D* Gilbert's syndrome

***) All of the following are manifestations with indirect hyperbilirubinemia, except:

1. Gilbert's syndrome

2. Dubin Johnson syndrome

3. Crigler Najar syndrome

4. ABO incompatibility

5. Physiologic neonatal jaundice

Answer: D* Dubin Johnson syndrome

***) Direct hyperbilirubinemia may be associated with all the following except:

1. Hemolysis

2. Periampullary neoplasm

3. Common bile duct stricture

4. CA head of pancreas

5. Stone in common bile duct

Answer: A* Hemolysis