[MCQ] Alcoholic liver disease

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Alcoholic liver disease

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Question 1

Which of the following is the major lesion in the pathology of alcoholic liver disease ?

A	Fatty liver
B	Alcoholic hepatitis
C	Cirrhosis
D	All of the above

Question 1 Explanation:

Major lesions in the pathology of alcoholic liver disease are fatty liver, alcoholic hepatitis & cirrhosis

Question 2

Which of the following is considered to be a precursor to cirrhosis ?

A	Fatty liver
B	NASH
C	Alcoholic hepatitis
D	All of the above

Question 2 Explanation:

Alcoholic hepatitis is thought to be a precursor to cirrhosis.

Question 3

One beer (12 oz), four ounces of wine or one ounce of 80% spirits contain how many grams of alcohol ?

A	~ 8 grams
B	~ 10 grams
C	~ 12 grams
D	~ 14 grams

Question 3 Explanation:

One beer, four ounces of wine, or one ounce of 80% spirits all contain ~12 grams of alcohol.

Question 4

In men, what quantity of ethanol produces fatty liver ?

A	10 - 20 gm / day
B	20 - 40 gm / day
C	40 - 80 gm / day
D	80 - 120 gm / day

Question 4 Explanation:

In men, 40–80 g/d of ethanol produces fatty liver

Question 5

In men, what quantity & duration of ethanol consumption causes hepatitis or cirrhosis ?

A	80 gm / day for 5 - 10 years
B	160 gm / day for 5 - 10 years
C	80 gm / day for 10 - 20 years
D	160 gm / day for 10 - 20 years

Question 5 Explanation:

In men, 160 gm / day for 10 - 20 years of ethanol consumption causes hepatitis or cirrhosis

Question 6

What proportion of alcoholics develop alcoholic liver disease ?

A	15 %
B	30 %
C	45 %
D	75 %

Question 6 Explanation:

Only 15% of alcoholics develop alcoholic liver disease.

Question 7

Which of the following statements about alcohol consumption is false ?

A	Alcohol is a direct hepatotoxin
B	Men more susceptible to alcoholic liver injury than women
C	Alcohol injury does not require malnutrition
D	15% of alcoholics develop alcoholic liver disease

Question 7 Explanation:

Women are more susceptible to alcoholic liver disease than men.

Question 8

Which of the following is related to the genetic risk factors for alcoholic liver disease ?

A	Cytochrome P450 3A
B	Cytochrome P450 2C19
C	Cytochrome P450 2D6
D	Cytochrome P-450 2E1

Question 8 Explanation:

Genepolymorphisms may include alcohol dehydrogenase, cytochrome P4502E1, and those associated with alcoholism (twin studies)

Question 9

Cytochrome P-450 2E1 converts alcohol to ?

A	Acetate
B	Carbon dioxide
C	Free fatty acids
D	Acetaldehyde

Question 9 Explanation:

In liver, there are two main pathways of alcohol metabolism, alcohol dehydrogenase and cytochrome P-450 2E1. They converts alcohol to acetaldehyde. Acetaldehyde subsequently is metabolized to acetate via acetaldehyde dehydrogenase

Question 10

In men, what is the threshold daily alcohol intake necessary to produce pathologic changes of alcoholic hepatitis ?

A	10 grams
B	20 grams
C	40 grams
D	60 grams

Question 10 Explanation:

Threshold for developing alcoholic liver disease in men is an intake of >60 - 80 gm/day of alcohol for 10 years. Ingestion of 160 gm/day increases risk of developing alcoholic cirrhosis by 25-folds.

Question 11

Which of the following accelerates progression of alcoholic liver disease to cirrhosis in chronic and excessive drinkers ?

A	Acute hepatitis B
B	Acute hepatitis C
C	Chronic hepatitis B
D	Chronic hepatitis C

Question 11 Explanation:

Chronic infection with hepatitis C (HCV) is an important comorbidity in the progression of alcoholic liver disease to cirrhosis in chronic and excessive drinkers. Alcohol intake also decreases efficacy of interferon-based antiviral therapy in them

Question 12

Chronic alcohol ingestion lead to which of the following ?

A	Autoimmune response
B	Fibrotic response
C	Inflammatory response
D	All of the above

Question 13

Major enzyme responsible for alcohol metabolism is ?

A	Alcohol dehydrogenase
B	Alcohol reductase
C	Alcohol oxidase
D	All of the above

Question 13 Explanation:

In fatty liver secondary to alcohol induced liver injury, accumulation of fat within the perivenular hepatocytes coincides with the location of alcohol dehydrogenase which is the major enzyme responsible for alcohol metabolism

Question 14

Which of the following hepatic pathologic features may be associated with progressive liver injury ?

A	Giant mitochondria
B	Perivenular fibrosis
C	Macrovesicular fat
D	All of the above

Question 15

Histologically, the earliest changes in alcoholic hepatitis are located predominantly in ?

A	Zone 1
B	Zone 2
C	Zone 3
D	All of the above

Question 15 Explanation:

Histologically, the earliest changes in alcoholic hepatitis are located predominantly around the central vein i.e. centrilobular (perivenular) areas (zone 3 of Rappaport).

Question 16

The hallmark features of hepatocyte injury in alcoholic hepatitis are all except ?

A	Polymorphonuclear infiltrate
B	Ballooning degeneration
C	Mallory bodies
D	Fibrosis in perisinusoidal space of Disse

Question 16 Explanation:

Hallmark of alcoholic hepatitis is hepatocyte injury characterized by ballooning degeneration, spotty necrosis, polymorphonuclear infiltrate, and fibrosis in the perivenular and perisinusoidal space of Disse. Mallory bodies are often present in florid cases but are neither specific nor necessary for substantiating diagnosis.

Question 17

Which of the following is false about Terry's nails ?

A	Ground glass appearance of fingernails
B	No lunula
C	Frequent in severe liver disease
D	None of the above

Question 17 Explanation:

Terry's nails refers to finger/toe nails that have a "ground glass" appearance, with no lunula (white crescent-shaped area of finger). It frequently occurs in hepatic failure, cirrhosis, DM, CHF, hyperthyroidism, malnutrition.

Question 18

Skin texture of cheeks & nasolabial folds in patient with alcohol related liver disease is called ?

A	Gooseberry skin
B	Cheese wind skin
C	Weather heat skin
D	Paper-money skin

Question 19

In alcoholic hepatitis, which of the following can occur in the absence of cirrhosis ?

A	Portal hypertension
B	Ascites
C	Variceal bleeding
D	All of the above

Question 19 Explanation:

In alcoholic hepatitis, portal hypertension, ascites, or variceal bleeding can occur in the absence of cirrhosis. Patients with alcoholic cirrhosis often exhibit clinical features identical to other causes of cirrhosis.

Question 20

In alcoholic hepatitis, AST : ALT ratio is ?

A	> 0.25
B	> 0.50
C	> 0.75
D	> 1

Question 20 Explanation:

In alcoholic hepatitis, the AST : ALT ratio is >1. AST:ALT ratio is higher in pericentral hepatocytes than other regions in liver lobule & pericentral zone is more selectively affected in acute alcoholic hepatitis

Question 21

In alcoholic hepatitis, AST and ALT are rarely more than ?

A	100 IU/L
B	200 IU/L
C	300 IU/L
D	400 IU/L

Question 21 Explanation:

In alcoholic hepatitis, AST & ALT are usually elevated 2-7 fold. They are rarely >400 IU/L.

Question 22

Which of the following is a laboratory feature alcoholic fatty liver ?

A	Increased gamma-glutamyl transpeptidase (GGTP)
B	Hypertriglyceridemia
C	Hypercholesterolemia
D	All of the above

Question 23

Which of the following in ultrasonography indicates serious liver injury with less potential for complete reversal ?

A	Portal vein flow reversal
B	Ascites
C	Intraabdominal collaterals
D	All of the above

Question 24

Discriminant function (DF) formula predicting the outcome of severe alcoholic hepatitis is named after ?

A	Nathan
B	Cushin
C	Maddrey
D	George

Question 24 Explanation:

The discriminant function (DF) formula of Maddrey is based on PT and bilirubin

Question 25

Which of the following is the correct formula of Discriminant function (DF) ?

A	2.6 x PT prolongation + total S. bilirubin in mg/dL
B	3.6 x PT prolongation + total S. bilirubin in mg/dL
C	4.6 x PT prolongation + total S. bilirubin in mg/dL
D	5.6 x PT prolongation + total S. bilirubin in mg/dL

Question 25 Explanation:

Modified Maddrey's discriminant function predicts prognosis in alcoholic hepatitis. It is calculated as 4.6 x [prothombin time - control value (seconds)] + serum bilirubin (mg/dl). A value >32 implies poor outcome with one month mortality > 50% if only supportive treatment is given. Cut off value of 32 &/or hepatic encephalopathy has been used as a threshold to consider corticosteroid treatment

Question 26

What count of polymorphonuclear cells predicts severe alcoholic hepatitis when discriminant function >32 ?

A	> 500 / µL
B	> 500 / µL
C	> 3500 / µL
D	> 5500 / µL

Question 27

Formula for assessment of prognosis of alcoholic hepatitis is ?

A	Combined clinical & laboratory index of University of Toronto
B	Model for end-stage liver disease (MELD) score
C	Glasgow alcoholic hepatitis score (GAHS)
D	All of the above

Question 27 Explanation:

Besides the above ones and also the classical Child-Turcotte-Pugh (CTP) score, Asymmetric dimethylarginine (ADMA) score is the most recently proposed predictor of adverse clinical outcome in patients with severe alcoholic hepatitis.

Question 28

Variables included in Glasgow alcoholic hepatitis score (GAHS) are all except ?

A	Age
B	Hemoglobin
C	Bilirubin
D	BUN

Question 28 Explanation:

Five variables included in GAHS are age, bilirubin, BUN, PT, and TLC. Glasgow Alcoholic Hepatitis score >= 9 requires treatment.

Question 29

MELD score is calculated based on all except ?

A	Prothrombin time
B	Serum albumin
C	Serum creatinine
D	Serum bilirubin

Question 29 Explanation:

MELD score is based on a patient’s prothrombin time, serum creatinine & bilirubin. Patients with severe alcoholic hepatitis are defined as a discriminant function >32 or MELD >20.

Question 30

Model for End-Stage Liver Disease (MELD) score was introduced in USA in year ?

A	1995
B	1998
C	2002
D	2005

Question 30 Explanation:

In 2002, MELD score derived from measurements of serum bilirubin, international normalized ratio of prothrombin time and serum creatinine to evaluate pretransplantation renal function was introduced as an aid to organ allocation among candidates for liver transplantation.

Question 31

Which of the following is advocated for severe alcoholic hepatitis ?

A	Glucocorticoids
B	Thiamine
C	Proton pump inhibitors
D	All of the above

Question 31 Explanation:

Patients with severe alcoholic hepatitis, Women with encephalopathy in particular, should be given prednisone, 40 mg/day, or prednisolone, 32 mg/day, for 4 weeks, followed by a steroid taper

Question 32

Use of which of the following improves survival in severe alcoholic hepatitis ?

A	Pentoxifylline
B	Propylthiouracil
C	Infliximab
D	Colchicine

Question 33

Use of Infliximab in severe alcoholic hepatitis was stopped due to the increased risk of ?

A	Bone marrow suppression
B	Seizure
C	Infection
D	Jaundice

Question 33 Explanation:

Use of Infliximab in severe alcoholic hepatitis was stopped due to the increased risk of increased deaths secondary to infection and renal failure.

Question 34

Most liver transplantation centers require alcoholics to have documented abstinence of at least ?

A	3 months
B	6 months
C	9 months
D	12 months

Question 34 Explanation:

Most transplantation centers currently require patients with a history of alcohol abuse to have documented abstinence of at least 6 months before undergoing transplantation (“6-month abstinence rule”).

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See all quizzes of Alcoholic liver disease at here:

1.Which of the following is the major lesion in the pathology of
alcoholic liver disease ?
A. Fatty liver
B. Alcoholic hepatitis
C. Cirrhosis
D. All of the above

2.Which of the following is considered to be a precursor to
cirrhosis ?
A. Fatty liver
B. NASH

C. Alcoholic hepatitis
D. All of the above

3. One beer (12 oz), four ounces of wine or one ounce of 80%
spirits contain how many grams of alcohol ?

A. ~ 8 grams
B. ~ 10 grams
C. ~ 12 grams
D. ~ 14 grams

4. In men, what quantity of ethanol produces fatty liver ?
A. 10 – 20 gm / day
B. 20 – 40 gm / day
C. 40 – 80 gm / day
D. 80 – 120 gm / day

5. In men, what quantity & duration of ethanol consumption
causes hepatitis or cirrhosis ?
A. 80 gm / day for 5 – 10 years
B. 160 gm / day for 5 – 10 years
C. 80 gm / day for 10 – 20 years
D. 160 gm / day for 10 – 20 years

6. What proportion of alcoholics develop alcoholic liver disease ?

A. 15 %
B. 30 %
C. 45 %
D. 75 %

7. Which of the following statements about alcohol consumption
is false ?
A. Alcohol is a direct hepatotoxin
B. Men more susceptible to alcoholic liver injury than women
C. Alcohol injury does not require malnutrition
D. 15% of alcoholics develop alcoholic liver disease
Women are more susceptible to alcoholic liver disease than men.
8. Which of the following is related to the genetic risk factors for
alcoholic liver disease ?
A. Cytochrome P450 3A
B. Cytochrome P450 2C19
C. Cytochrome P450 2D6

D. Cytochrome P-450 2E1

9. Cytochrome P-450 2E1 converts alcohol to ?
A. Acetate
B. Carbon dioxide
C. Free fatty acids
D. Acetaldehyde

10. In men, what is the threshold daily alcohol intake necessary to
produce pathologic changes of alcoholic hepatitis ?

A. 10 grams
B. 20 grams
C. 40 grams
D. 60 grams

11. Which of the following accelerates progression of alcoholic
liver disease to cirrhosis in chronic and excessive drinkers ?
A. Acute hepatitis B
B. Acute hepatitis C
C. Chronic hepatitis B
D. Chronic hepatitis C

12.Chronic alcohol ingestion lead to which of the following ?
A. Autoimmune response
B. Fibrotic response
C. Inflammatory response
D. All of the above
13.Major enzyme responsible for alcohol metabolism is ?
A. Alcohol dehydrogenase
B. Alcohol reductase
C. Alcohol oxidase
D. All of the above

16. Which of the following hepatic pathologic features may be
associated with progressive liver injury ?
A. Giant mitochondria
B. Perivenular fibrosis
C. Macrovesicular fat
D. All of the above

17. Histologically, the earliest changes in alcoholic hepatitis are
located predominantly in ?
A. Zone 1
B. Zone 2
C. Zone 3
D. All of the above

18. The hallmark features of hepatocyte injury in alcoholic
hepatitis are all except ?
A. Polymorphonuclear infiltrate
B. Ballooning degeneration
C. Mallory bodies
D. Fibrosis in perisinusoidal space of Disse

19. Which of the following is false about Terry’s nails ?
A. Ground glass appearance of fingernails
B. No lunula
C. Frequent in severe liver disease
D. None of the above

20. Skin texture of cheeks & nasolabial folds in patient with alcohol
related liver disease is called ?
A. Gooseberry skin
B. Cheese wind skin
C. Weather heat skin
D. Paper-money skin
21. In alcoholic hepatitis, which of the following can occur in the
absence of cirrhosis ?
A. Portal hypertension
B. Ascites
C. Variceal bleeding
D. All of the above

22. In alcoholic hepatitis, AST : ALT ratio is ?
A. > 0.25
B. > 0.50
C. > 0.75
D. > 1

23. In alcoholic hepatitis, AST and ALT are rarely more than ?
A. 100 IU/L
B. 200 IU/L
C. 300 IU/L
D. 400 IU/L

24. Which of the following is a laboratory feature alcoholic fatty
liver ?
A. Increased gamma-glutamyl transpeptidase (GGTP)
B. Hypertriglyceridemia,
C. Hypercholesterolemia
D. All of the above
25. Which of the following in ultrasonography indicates serious
liver injury with less potential for complete reversal ?
A. Portal vein flow reversal
B. Ascites
C. Intraabdominal collaterals
D. All of the above
26. Discriminant function (DF) formula predicting the outcome of
severe alcoholic hepatitis is named after ?
A. Nathan
B. Cushin
C. Maddrey
D. George

27. Which of the following is the correct formula of Discriminant
function (DF) ?
A. 2.6 x PT prolongation + total S. bilirubin in mg/dL
B. 3.6 x PT prolongation + total S. bilirubin in mg/dL
C. 4.6 x PT prolongation + total S. bilirubin in mg/dL
D. 5.6 x PT prolongation + total S. bilirubin in mg/dL

28.What count of polymorphonuclear cells predicts severe
alcoholic hepatitis when discriminant function >32 ?

A. > 500 / µL
B. > 1500 / µL
C. > 3500 / µL
D. > 5500 / µL
29. Formula for assessment of prognosis of alcoholic hepatitis
is ?
A. Combined clinical & laboratory index of University of Toronto
B. Model for end-stage liver disease (MELD) score

C. Glasgow alcoholic hepatitis score (GAHS)
D. All of the above

30. Variables included in Glasgow alcoholic hepatitis score
(GAHS) are all except ?
A. Age
B. Hemoglobin
C. Bilirubin
D. BUN

31.MELD score is calculated based on all except ?
A. Prothrombin time
B. Serum albumin
C. Serum creatinine
D. Serum bilirubin

32. Model for End-Stage Liver Disease (MELD) score was
introduced in USA in year ?
A. 1995
B. 1998
C. 2002
D. 2005

33. Which of the following is advocated for severe alcoholic
hepatitis ?
A. Glucocorticoids
B. Thiamine
C. Proton pump inhibitors
D. All of the above

34. Use of which of the following improves survival in severe
alcoholic hepatitis ?
A. Pentoxifylline
B. Propylthiouracil
C. Infliximab
D. Colchicine

35. Use of Infliximab in severe alcoholic hepatitis was stopped
due to the increased risk of ?

A. Bone marrow suppression
B. Seizure
C. Infection
D. Jaundice

36. Most liver transplantation centers require alcoholics to have
documented abstinence of at least ?
A. 3 months
B. 6 months
C. 9 months
D. 12 months

Alcoholic liver disease

[MCQ] Alcoholic liver disease

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Alcoholic liver disease

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