Liver Disease
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1
A 58 year old man with cirrhosiis develops portal hypertension.
Which structual change most directly increases resistance to portal blood flow in this patient?
Which structual change most directly increases resistance to portal blood flow in this patient?
- Accumulation of lipids within hepatocytes
- Deposition of fibrous septa within liver
- Dilation of intrahepatic bile ducts
- Formation of regenerative nodules within the liver
- Loss of fenestrations in sinusoidal endothelial cells
2
A 64 year old woman with cirrhosis undergoes liver blood tests.
An increase in which parameter most directly indicates impaired hepatic synthesis?
An increase in which parameter most directly indicates impaired hepatic synthesis?
- Alkaline phosphatase activity
- Prothrombin time
- Serum ammonia concentration
- Serum biliburin concentration
- Urinary biliburin concentration
3
Oliver is positive for hepatitis C antibodies, but hepatitis C RNA is not detected.
What is the most likely explanation for these results?
What is the most likely explanation for these results?
- Chronic hepatitis C that contributes to his cirrhosis
- False negative test for the RNA
- False positive test for the antibody
- Past hepatitis C infection that has cleared
- Prior vaccination against hepatitis C
4
A 61 year old man with a long history of heavy alcohol consumption has abnormal liver blood tests.
Which enyzyme pattern can support alcohol related liver disease in this patient?
Which enyzyme pattern can support alcohol related liver disease in this patient?
- AST:ALT ratio greater than 2 with elevated GGT
- AST: ALT ratio less than 1 with elevated GGT
- Isolated marked elevation of ALT
- Markedly elevated ALP with normal GGT
- Markedly elevated GGT with normal AST and ALT
5
A patient with decompensated liver cirrhosis has ALT and AST concentrations within the reference range .
Which explanation best accounts for this finding?
Which explanation best accounts for this finding?
- Advanced cirrhosis reduces the number of viable hepatocytes available ti release aminotransferases
- Aminotransferases concentrations reflect hepatic synthetic function rather than hepatocellular injury
- Fibrosis prevents aminotransferases entering the circulation from injured hepatocytes
- Normal aminotransferases conentrations indicate stable liver function
- Portal systemic shunting prevents aminotransferases reaching the systemic circulation
6
A 67 year old man with decompensated cirrhosis develops bilateral ankle oedema.
Which factors most direct;y contributes to this finding?
Which factors most direct;y contributes to this finding?
- Decreased albumin synthesis reducing plasma oncotic pressure
- Decreased biliburin excretion reducing plasma osmotic pressure
- Increased clotting factor synthesis increasing plasma viscosity
- Increased portal hypertenstion forcing fluid into the interstitial compartments
- Increase ankle veinous pressure forcing fluid into the interstitial compartment
7
A 52 year old woman with chronic liver disease requires assessment of hepatic fibrosis.
Which investigation provides an estimate of liver fibrosis by measuring liver stiffness.
Which investigation provides an estimate of liver fibrosis by measuring liver stiffness.
- Abdominal computed tomogrpahy
- Standard magnetic resonance imaging of the liver
- Serum alanine aminotransferase concentration
- Transient Elastography
- Upper GI endoscopy
8
A 68 year old man with decompensated cirrhosis develops confusion and flapping tremor.
Accumulation of which substance is most directly implicated?
Accumulation of which substance is most directly implicated?
- Ammonia
- Biliburin
- Creatinine
- Lactate
- Thiamine
9
A 58 year old man with decompensated alcohol related cirrhosis is admitted with poor nutrtional intake and is started on intravenous glucose.
What is the main reason for thiamine being adminstered before glucose in this patient?
What is the main reason for thiamine being adminstered before glucose in this patient?
- Enhance glycogen formation
- Increase lactate clearance
- Prevent acute cerebral injury
- Prmote fatty acid utilisation
- Reduce ammonia production
10
A 54 year old woman is treated for hepatic encephalopathy.
How does a non absorbable disaccharide laxative ( lactulose ) reduce intestinal ammonia absoprtion?
How does a non absorbable disaccharide laxative ( lactulose ) reduce intestinal ammonia absoprtion?
- Acidifies the colon and traps ammonia as ammonium
- Activates the hepatic urea cycle to metabolise ammonia
- Blocks intestinal amino acid uptake and ammonia production
- Increases renal filtration and urinary ammonia excretion
- Stimulates hepatic enzymes responsible for ammonia metabolism
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