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Hepatology Exam For FCPS part 1 with Dr Sohrab
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Hepatology Exam For FCPS part 1 with Dr Sohrab
Hepatology Exam For FCPS part 1 with Dr Sohrab
1
Personal infomations
2
True and false
3
multiple choice
Name
*
Phone number
*
Email
Features of liver cirrhosis -- a) Diffuse fibrosis with nodules b) Hepatocyte convert to fibroblast and produce collagen c) Raised billirubin d) Raised PT e) Decreased globulin
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Drug causing Acute Liver injury - a) NSAID b) Barbiturates c) Halothane d) Methotrexate е) INH
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Regarding Hepatitis B Virus a) HBSAg disappear after 6 months b) HBcAg may be presented in serum c) AntiHBsAg appear after 3-6 months d) Causes HCC but never cirrhosis e) HBeAg is an indicator of viral replication
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Wilson's diseases -- La) KF ring disappears with treatment b) Neurological symptoms appear before hepatological symptoms c) Low ceruloplasmin level d) Penicillin drug of choice e) Cu is excreted out through bile
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Liver is the main site of store of a) Vitamin A b) Vitamin C c) Iron d) 7-dehydrocholesterol to more active compound e) Folic acid
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
HCV infection -- a) It's acute infection is rare b) HCV ìnfection may causes carcinoma without cirrhosis liver c) It produces always chronic infection d) Is associated with Hepatitis E virus e) It produces Zoonotic infection
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Regarding hepatitis in pregnancy a) Acute fulminant hepatitis in 1st trimester b) HELLP Syndrome can also appear for then first time in the postnatal period c) Acute fatty liver of pregnancy(AFLP) d) AFLP is more common in 1ST trimester e) More risk of contracting HEV
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Which one is most correct regarding liver abscess? a) Pyogenic liver abscess is more common b) Amoebic liver abscess shows large & multiple lesion c) Liver abscess may occur following cholangitis d) About 95% of amoebic liver abscss occurs following amoebic dysentery e) Eosinophilia is common in pyogenic liver abscess
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Liver stores - a) Glucose b) Glycogen c) Vit. C d) Vit. B12 e) Bile salts
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Serum alkaline phosphåtase -- a) Hydrolyses phosphate in alkaline pH b) Increased during bile duct obstruction c). Increased in viral hepatitis d) Decreased in paget's disease of bone e) Decreased in osteomalacia
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Regarding HBV seromarkers -- a) HBeAg indicates active replication b) Anti HBeAb indicates immunity c) HBsAg persistently present more than 6 month indicates chronicity d) HBV DNA is a marker of active replication e) Anti HBS appears in blood usually after 6 weeks
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Lymphatic drainage of liver -- a) Coeliac trunk b) Paracardial node c) Peripyloric node d) Posterior mcdiastinal lymph nodc e) Hepatic lymph node
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Hepatic microsomal enzyme inhibitors are a) Ciprofloxacin b) Cimetidine c) Rifampicin d) Spironolactone e) Penicillin
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Kupffer cells in liver-- a) Originates from bone marrow b) Remain in space of disse c) Found in sinusoids d) Has role in immunity and in fibrosis e) Store vitamin B12
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Portal HTN a) The total vascular resistance of the hepatic sinusoids b) Portal blood flow through the liver is increased c) The volume of fluid in the peritoneal cavity increased d) A porto-caval shunt (anastomosis between portal vein & inferior vena cava) can decrase bleeding into the GIT e) A porto-caval shunt increases the risk of coma after bleeding into the alimentary tract.
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Site of portocaval anastomosis a) Lower anal canal b) Pancreas c) Liver sinusoid d) Esophagus e) Around umbilicus
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Liver gets blood supply from a) Portal vein b) Hepatic vein c) Sup. mesenteric a d) Coeliac artery e) Portal artery
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Complications of liver failure a) Hypoglycaemia b) Renal failure c) Metabolic alkalosis d) Encephalopathy e) Bacterial infection
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Drugs causing cholestatic jaundice a) Rifampicin b) Ampicillin c) Methotrexate d) Chlorpromazine e) Chlorpropamide
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Causes of unconjugated hyperbilirubinaemia a) Rotor's syndrome b) Gilbert's syndrome c) Dubin jhonson syndrome d) Crigler-Najjar syndrome types I & II e) Thalassaemia
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Causes of conjugated bilirubinemia a) Gilbert's syndrome b) Rotor's syndrome c) Sclerosing cholangitis d) Primaquine e) Chloroquine
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
The liver is the main site for synthesis of a) Plasma albumin b) Plasma globulins c) Cyanocobalamin d) Transferrin e) Ascorbic acid
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Causes of steatosis -- a) Obesity b) Whipple's disease c) Sodium valproate toxicity d) Amiodarone toxicity e) Diabetes mellitus
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Micro vesicular steatosis can be found in a) Obesity b) Alcohol c) Fatty liver in pregnancy d) Sodium Valproate Therapy e) Aspirin therapy
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
In liver zone-I a) Gluconeogenesis b) Glycolysis c) Bile salt formation d) Good O2 supply e) Glucoronidation
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
A 37-year-old man presented complaining of severe epigastric pain that was becoming increasingly constant. A screening test for Helicobacter pylori was positive. Which condition is most strongly associated with this infection?
A. Autoimmune gastritis
B. Erosive gastropathy
C. Gastric B-cell lymphoma
D. Gastric stromal tumour
E. Gastro-oesophageal reflux disease
You are asked to review a 42-year-old man with a history of Crohn’s disease, who has been admitted to the surgical ward for a partial small bowel resection. The dietician is asking about the usual requirements for potassium replacement each day. He weighs 80 kg. Which of the following is a reasonable total daily potassium replacement?
A. 20 mmol
B. 40 mmol
C. 60 mmol
D. 120 mmol
E. 170 mmol
Which one of the following statements best describes the hepatorenal syndrome?
A. Almost all patients have ascites and are usually jaundiced
B. Complete recovery is expected in the majority of cases
C. E. coli is often present on blood culture
D. It is due to glomerulonephritis associated liver disease
E. Marked proteinuria is the hallmark of the disease
An icteric patient is seen agitated on his bed. What is the most significant bed side examination to defect the condition?
Asterix (Flapping tremor)
Hepatomegaly
Bruise
Purpura
Ascites
A 20 years Muslim male presented with mild jaundice on the 5th day of Ramadan. He gave similar history on previous Ramadan. What is your diagnosis?
Gilberts syndrome
Crigler-Najjar syndrome Type I
Dubin-Johnson syndrome
Crigler-Najjar syndrome Type II
Rotors syndrome
A 50-year-old woman presented with a 1-year history of recurrent episodes of right upper abdominal pain. She has now had jaundice and fever for the past 4 days. On examination she had a temperature of 38.4oC, was hypotensive and tachycardic. Abdominal ultrasonography demonstrated calculi in the common bile duct.What is the next best step once she has been stabilised?
A. Endoscopic retrograde cholangiopancreatography (ERCP)
B. Laparoscopic cholecystectomy
C. Laparotomy and stone extraction
D. Lithotripsy
E. Open cholecystectomy
A 48-year-old patient has a history of worsening heartburn and nocturnal cough. He feels otherwise well and has no other relevant past medical history. Gastroscopy showed Barrett's oesophagus (3 cm segment) with biopsies revealing no dysplastic change. What should be the next step in management?
A. Acid suppression and subsequent surveillance gastroscopy
B. Acid suppression and lifestyle modification
C. Fundoplication
D. Oesophagectomy
E. Multidisciplinary team (MDT) discussion
A 22-year-old man presented with unexplained jaundice that occurred repeatedly during episodes of fasting (starvation). What is the most likely diagnosis?
A. Alcohol abuse
B. Gilbert syndrome
C. Haemochromatosis
D. Hepatitis B virus infection
E. Wilson's disease
A 42-year-old man presents to the GP with indigestion and is sent for a breath test for Helicobacter which is found to be positive. Which of the following pathologies is most associated with H pylori infection?
A. Duodenal ulcer
B. Gastric carcinoma
C. Gastric ulcer
D. Gastro-oesophageal reflux disease (GORD)
E. Non-ulcer dyspepsia
A patient with symptoms of heart-burn wants to modify his diet to reduce his symptoms. He believes he can do this by reducing secretion of gastrin. Which of the following most stimulates secretion of gastrin?
A. Amino acids
B. Complex carbohydrates
C. Disaccharide sugars
D. Saturated fats
E. Soluble fibre
A 23-year-old woman was referred with abnormal liver biochemistry in the third trimester of pregnancy. Which feature would be most consistent with pregnancy-related cholestasis as the underlying diagnosis?
A. Elevated serum bile acids
B. Elevated urate
C. Hypoalbuminaemia
D. Macrocytosis
E. Thrombocytopenia
Which of the following describes the primary mechanism of action of lactulose in the gastrointestinal tract?
A. Increased intestinal motility
B. Chloride channel activator
C. Stool softeners
D. Bulk-forming agent
E. Osmotic laxative
A 40 year old woman with chronic hepatitis C comes to the gastroenterology clinic for review. She has been diagnosed with mixed cryoglobulinaemia. Which of the following would be an unusual finding?
A. Livedo reticularis
B. Positive rheumatoid factor
C. Palpable purpura
D. Severe pulmonary fibrosis
E. Glomerulonephritis
Which condition is most strongly associated with gastric acid hypersecretion?
A. Cushing syndrome
B. Large-bowel resection
C. Pernicious anaemia
D. Systemic mastocytosis
E. Vasoactive intestinal polypeptide- (VIP-)secreting tumour
A patient was diagnosed as a case of advanced CLD., What is the prognostic parameter to assess the progression of the disease process?
РT
Gamma glutamyl transferase
SGPT
ALP
SGOT
Highest levels of transaminases are found in which?
Hepatitis B
Pre-eclampsia
Paracetamol overdose
DIC
Нерatitis C
A 56-year-old man with polycythaemia rubra vera is admitted with acute abdominal pain, nausea, vomiting and abdominal distension. He is apyrexial, with tender hepatomegaly and ascites. An ascitic tap reveals fluid with a high SAAG and no organisms. What is the most likely diagnosis?
Budd–Chiari syndrome
Haemochromatosis
Malignant liver disease
Mesenteric artery occlusion
Spontaneous bacterial peritonitis
A 62-year-old woman is sent to the Gastroenterology Clinic for review. Her medical history of note includes ulcerative colitis and prolonged use of oral ketoconazole for recurrent nail-bed infections. On examination in the clinic she is jaundiced and has two-finger-breadth hepatomegaly. Biochemistry results show: bilirubin 260 μmol/l (normal range 1–22 μmol/), alanine aminotransferase (ALT) of 410 U/l (5–35 U/l) and a non-specific increase in globulin levels. You note that her LFTs were normal 1 year earlier. Autoantibody screen reveals anti-LKM2 antibodies. What diagnosis fits best with this clinical picture?
Autoimmune hepatitis
Primary sclerosing cholangitis (PSC)
Gallstones
Primary biliary cholangitis (PBC)
Drug-induced hepatitis
A social worker had been diagnosed with hepatitis C virus (HCV) infection. Which test will conclusively establish the presence of this infection?
IgM anti-HAV
HCV RNA
HBV DNA
ELISA-3
Anti-HCV
A 61-year-old man with known cirrhosis secondary to hepatitis C infection attends for review. There is a past history of intravenous heroin abuse and alcoholism. He has been feeling progressively more unwell during the past six months, with weight loss and worsening ascites. A pre-clinic α-fetoprotein is elevated. He is on long-term sick leave and has been closely monitored by flatmate, who maintains there has been no further drug abuse or consumption of alcohol. Which of the following is the most likely diagnosis, given this clinical picture?
Superimposed hepatitis B infection
Alcoholism
Chronic active hepatitis
Spontaneous bacterial peritonitis
Hepatocellular carcinoma
A 63-year-old patient presents to the GP with a history of 1 stone weight loss in the last 3 months and some non-specific right upper quadrant discomfort. He is found to be anaemic and have a raised ALT and AST on blood tests and so an abdominal ultrasound is arranged. It is reported as being suspicious of a hepatocellular carcinoma. Which of the following conditions is associated with the greatest increased risk of developing hepatocellular carcinoma?
Diabetes mellitus
Secondary haemochromatosis
Aspergillus infection
α1-antitrypsin deficiency
Hepatitis E
A 36-year-old woman was referred to the Hepatology Clinic by her general practitioner to investigate abnormal liver enzymes. She was obese, and her past history of note included gestational diabetes during her last pregnancy 2 years earlier. She had a strong family history of type 2 diabetes. There was no history of excess alcohol consumption. Her general practitioner had checked her liver enzymes as part of a routine health screen and found a raised alanine aminotransferase (ALT) level. An infective hepatitis screen and an autoimmune profile were negative. Abdominal ultrasound demonstrated evidence of fatty infiltration of the liver. Liver biopsy revealed fat infiltration, parenchymal inflammation and some evidence of fibrosis. What is the most likely diagnosis?
Alcohol-related cirrhosis
Cholecystitis
Autoimmune hepatitis
Hepatocellular carcinoma
Non-alcoholic steatohepatitis
A 54-year-old man attends his GP with feelings of lethargy. Routine screening reveals raised gamma-glutamyltransferase (GGT). Which of following statements concerning GGT is true?
Increased GGT is found in cases of fatty liver
Isolated elevation of GGT in a patient with prostatic carcinoma indicates the presence of hepatic metastases
It is a better indicator of infectious hepatitis than of cholestasis
It is only present in liver
Serum activity is typically elevated in pregnancy
A 30 year old female came to you with fatigue, pruritas, hepatosplenomegaly .Which one is the diagnostic investigation
Alkaline phosphatase
MRCP
Anti-L.K.M
ANA
Mitochondrial antibody
A 36-year-old man with diabetes is referred with abnormal liver biochemistry. Which blood test result is most suggestive of haemochromatosis?
A. Alkaline phosphatase 178 U/l (45–105)
B. Ferritin 324 μg/l (15–300)
C. Serum iron 25 μmol/l (12–30)
D. Total iron-binding capacity (TIBC) 43 μmol/l (45–75)
E. Transferrin saturation 78% (20–50)
