[MCQ] Cirrhosis- Part 2

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Cirrhosis- Part 2

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Question 1

In alcoholics, which concomitant hepatitis infection accelerates development of alcoholic cirrhosis ?

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

Question 1 Explanation:

Concomitant chronic hepatitis C virus (HCV) infection significantly accelerates development of alcoholic cirrhosis

Question 2

In alcoholic cirrhosis, liver size may be ?

A	Enlarged
B	Normal
C	Decreased
D	All of the above

Question 2 Explanation:

In alcoholic cirrhosis, liver may be either enlarged, normal, or decreased in size. With continuing hepatocyte destruction and collagen deposition, the liver shrinks in size, acquires a nodular appearance, and becomes hard as ‘end-stage’ cirrhosis develops.

Question 3

Anemia in alcoholic cirrhosis may be due to ?

A	Acute/chronic GI blood loss
B	Coexistent folic acid & vitamin B12 deficiency
C	Hypersplenism
D	All of the above

Question 4

Anemia in alcoholic cirrhosis may be due to ?

A	Psychogenic factors
B	Direct suppressive effect of alcohol on bone marrow
C	Deficiency of iron
D	All of the above

Question 4 Explanation:

Anemia results from acute & chronic gastrointestinal blood loss, coexistent folic acid & vitamin B12 deficiency, hypersplenism, & suppressive effect of alcohol on bone marrow.

Question 5

Laboratory finding unusual in alcoholic cirrhosis is ?

A	Hemolytic anemia
B	Hyperbilirubinemia
C	Elevated serum alkaline phosphatase
D	Serum AST levels > 300 units

Question 5 Explanation:

Hemolytic anemia due to effects of hypercholesterolemia or erythrocyte membranes resulting in unusual spurlike projections (acanthocytosis) may occur. Hyperbilirubinemia is found in association with elevated serum alkaline phosphatase levels. Levels of serum AST are frequently elevated, but levels > 300 units are unusual

Question 6

Levels of serum AST in alcoholic cirrhosis are ?

A	< 300 units
B	< 400 units
C	< 500 units
D	< 600 units

Question 6 Explanation:

In alcoholic cirrhosis, levels of serum AST are frequently elevated but levels > 300 units are unusual and should prompt one to look for other coincident or complicating factors.

Question 7

In alcoholic liver disease, AST / ALT ratio is ?

A	> 0.5
B	> 1.0
C	> 1.5
D	> 2.0

Question 8

In alcoholic liver disease, AST levels > ALT are due to ?

A	Greater inhibition of ALT synthesis by ethanol
B	Greater production of AST by ethanol
C	Greater clearance of ALT by ethanol
D	Lesser clearance of AST by ethanol

Question 8 Explanation:

In alcoholic liver disease & in contrast to viral hepatitis, serum AST is usually disproportio-nately elevated relative to ALT (AST/ALT ratio >2) due to proportionally greater inhibition of ALT synthesis by ethanol which may be partially reversed by pyridoxal phosphate.

Question 9

Altered albumin/globulin ratio in alcoholic cirrhosis is due to ?

A	Hypoalbuminemia due to impaired hepatic protein synthesis
B	Hyperglobulinemia due to stimulation of RE system
C	A+B
D	None of the above

Question 9 Explanation:

The serum albumin level is usually depressed, while serum globulins are increased. Hypoalbuminemia reflects impairment in hepatic protein synthesis, while hyperglobulinemia result from nonspecific stimulation of reticuloendothelial system.

Question 10

Metabolic disturbances seen in alcoholic cirrhosis are all except ?

A	Glucose intolerance
B	Respiratory alkalosis
C	Metabolic alkalosis
D	Prerenal azotemia

Question 11

Metabolic disturbances seen in alcoholic cirrhosis are all except ?

A	Hypomagnesemia
B	Hyperphosphatemia
C	Dilutional hyponatremia
D	Hypokalemia

Question 11 Explanation:

In cirrhosis, glucose intolerance due to endogenous insulin resistance may be present, however clinical diabetes is uncommon. Central hyperventilation leads to respiratory alkalosis. Dietary deficiency and increased urinary losses lead to hypomagnesemia and hypophosphatemia. In patients with ascites and dilutional hyponatremia, hypokalemia may occur from increased urinary potassium losses due in part to hyperaldosteronism. Prerenal azotemia is also observed in such patients.

Question 12

What percentage of individuals with excessive alcohol intake develop cirrhosis ?

A	5 to 10 %
B	10 to 15 %
C	20 to 25 %
D	30 to 35 %

Question 12 Explanation:

Alcoholic cirrhosis should be strongly suspected in patients with a history of prolonged or excessive alcohol intake and physical signs of chronic liver disease. Only 10 to 15% of individuals with excessive alcohol intake develop cirrhosis, therefore other causes & types of liver disease should be considered.

Question 13

Complicating conditions that can deteriorate clinical status of an otherwise stable cirrhotic patient include ?

A	Infection
B	Portal vein thrombosis
C	Hepatocellular carcinoma
D	All of the above

Question 13 Explanation:

When clinical status of an otherwise stable cirrhotic patient deteriorates without an obvious explanation, complicating conditions like infection, portal vein thrombosis & hepatocellular carcinoma, should be looked for

Question 14

Which of the following about alcoholic cirrhosis is true ?

A	Glucocorticoids are helpful in severe alcoholic hepatitis & encephalopathy
B	Survival benefit has been reported for S-adenosyl methionine in balcoholic cirrhosis
C	Diuretics, sedatives, aspirin, acetaminophen should be used with caution
D	All of the above

Question 14 Explanation:

Glucocorticoids in moderately large doses for 4 weeks is helpful in patients with severe alcoholic hepatitis and encephalopathy but have no role in the treatment of established alcoholic cirrhosis. Sadenosyl methionine decreases proinflammatory cytokines and has survival benefit in alcoholic cirrhosis. Diuretics, sedatives, aspirin, acetaminophen should be used with caution

Question 15

Which of the following medications is approved for treating alcoholism by reducing craving ?

A	Naltrexone
B	Acamprosate
C	Tiapride
D	All of the above

Question 15 Explanation:

Tiapride is a dopamine antagonist. Acamprosate helps restore balance of excitatory & inhibitory neurotransmission in nucleus accumbens by blocking GABA receptors and Glutamate receptors and activating GABA-A receptors. Naltrexone is an opioid antagonist.

Question 16

Which of the following terms are synonymous with posthepatitic cirrhosis ?

A	Coarsely nodular cirrhosis
B	Multilobular cirrhosis
C	Cryptogenic cirrhosis
D	All of the above

Question 16 Explanation:

Coarsely nodular cirrhosis and multilobular cirrhosis are terms synonymous with posthepatitic cirrhosis. The term cryptogenic cirrhosis has been used interchangeably with posthepatitic cirrhosis, but this designation should be reserved for those cases in which the etiology of cirrhosis is unknown (~10% of all patients with cirrhosis).

Question 17

Viral infections that can lead to chronic liver disease include all except ?

A	Cytomegalovirus
B	Epstein-Barr virus
C	Hepatitis C
D	Hepatitis E

Question 17 Explanation:

Viral infections that lead to chronic liver disease include hepatitis B, C, D, cytomegalovirus, EBV

Question 18

Which of the following is a cause of chronic cholestatic syndrome ?

A	Primary biliary cirrhosis (PBC)
B	Autoimmune cholangitis
C	Primary sclerosing cholangitis (PSC)
D	All of the above

Question 18 Explanation:

Causes of chronic cholestatic syndromes are primary biliary cirrhosis (PBC), autoimmune cholangitis, primary sclerosing cholangitis (PSC) and idiopathic adulthood ductopenia.

Question 19

Histopathologic features of chronic cholestasis are all except ?

A	Copper deposition
B	Xanthomatous transformation of hepatocytes
C	Iron deposition
D	Biliary fibrosis

Question 19 Explanation:

Histopathologic features of chronic cholestasis are cholate stasis, copper deposition, xanthomatous transformation of hepatocytes, and biliary fibrosis. There may also be chronic portal inflammation, interface activity and chronic lobular inflammation. Ductopenia is a result of this progressive disease as patients develop cirrhosis.

Question 20

Steatosis is often present in patients with which HCV genotype ?

A	1
B	2
C	3
D	4

Question 21

Nonalcoholic steatohepatitis (NASH) is nowadays diagnosed as what was earlier diagnosed as ?

A	Autoimmune cholangiopathy
B	Cardiac cirrhosis
C	Cardiac cirrhosis
D	Autoimmune hepatitis

Question 21 Explanation:

Many patients who were thought to have cryptogenic cirrhosis in fact have nonalcoholic steatohepatitis

Question 22

Primary biliary cirrhosis (PBC) is characterized by ?

A	Fibrous obliteration of intrahepatic bile ductules
B	Fibrous obliteration of larger extrahepatic ducts
C	Fibrous obliteration of intrahepatic bile ductules and larger extrahepatic ducts both
D	None of the above

Question 22 Explanation:

PBC is characterized by portal inflammation & necrosis of cholangiocytes in small and mediumsized bile ducts.

Question 23

In PBC, pruritus is most bothersome in ?

A	Morning
B	Afternoon
C	Evening
D	Night

Question 23 Explanation:

In PBC, pruritus is most bothersome in the evening.

Question 24

Features unique to PBC include all except ?

A	Hypopigmentation
B	Xanthelasma
C	Xanthomata
D	Bone pain

Question 24 Explanation:

Features unique to PBC include hyperpigmentation, xanthelasma, xanthomata & bone pain. The first three are related to the altered cholesterol metabolism seen in PBC.

Question 25

In PBC, hyperpigmentation is evident on ?

A	Trunk
B	Face
C	Areas of exfoliation and lichenification
D	All of the above

Question 25 Explanation:

In PBC, hyperpigmentation is evident on trunk and arms and in areas of exfoliation and lichenification

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See all quizzes of Cirrhosis at here:

1.In alcoholics, which concomitant hepatitis infection
accelerates development of alcoholic cirrhosis ?
A. Acute hepatitis A
B. Acute hepatitis B
C. Chronic hepatitis B
D. Chronic hepatitis C

2. In alcoholic cirrhosis, liver size may be ?
A. Enlarged
B. Normal
C. Decreased
D. All of the above

3. Anemia in alcoholic cirrhosis may be due to ?
A. Acute/chronic GI blood loss
B. Coexistent folic acid & vitamin B
12 deficiency
C. Hypersplenism
D. All of the above

4. Anemia in alcoholic cirrhosis may be due to ?
A. Psychogenic factors
B. Direct suppressive effect of alcohol on bone marrow
C. Deficiency of iron
D. All of the above

5. Laboratory finding unusual in alcoholic cirrhosis is ?
A. Hemolytic anemia
B. Hyperbilirubinemia
C. Elevated serum alkaline phosphatase
D. Serum AST levels > 300 units

6. Levels of serum AST in alcoholic cirrhosis are ?
A. < 300 units
B. < 400 units
C. < 500 units
D. < 600 units

7. In alcoholic liver disease, AST / ALT ratio is ?
A. > 0.5
B. > 1.0
C. > 1.5
D. > 2.0
8. In alcoholic liver disease, AST levels > ALT are due to ?
A. Greater inhibition of ALT synthesis by ethanol
B. Greater production of AST by ethanol
C. Greater clearance of ALT by ethanol
D. Lesser clearance of AST by ethanol

9. Altered albumin/globulin ratio in alcoholic cirrhosis is due
to ?
A. Hypoalbuminemia due to impaired hepatic protein synthesis
B. Hyperglobulinemia due to stimulation of RE system
C. A+B
D. None of the above

10.Metabolic disturbances seen in alcoholic cirrhosis are all
except ?
A. Glucose intolerance
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Prerenal azotemia
11. Metabolic disturbances seen in alcoholic cirrhosis are all except ?
A. Hypomagnesemia
B. Hyperphosphatemia
C. Dilutional hyponatremia
D. Hypokalemia

12. What percentage of individuals with excessive alcohol intake
develop cirrhosis ?
A. 5 to 10 %
B. 10 to 15 %
C. 20 to 25 %
D. 30 to 35 %

13. Complicating conditions that can deteriorate clinical status of
an otherwise stable cirrhotic patient include ?
A. Infection
B. Portal vein thrombosis
C. Hepatocellular carcinoma
D. All of the above

14. Which of the following about alcoholic cirrhosis is true ?
A. Glucocorticoids are helpful in severe alcoholic hepatitis &
encephalopathy
B. Survival benefit has been reported for S-adenosyl methionine in
alcoholic cirrhosis
C. Diuretics, sedatives, aspirin, acetaminophen should be used
with caution
D. All of the above

15. Which of the following medications is approved for treating
alcoholism by reducing craving ?
A. Naltrexone

B. Acamprosate
C. Tiapride
D. All of the above

16. Which of the following terms are synonymous with
posthepatitic cirrhosis ?
A. Coarsely nodular cirrhosis
B. Multilobular cirrhosis
C. Cryptogenic cirrhosis
D. All of the above

17. Viral infections that can lead to chronic liver disease include
all except ?
A. Cytomegalovirus
B. Epstein-Barr virus
C. Hepatitis C
D. Hepatitis E

18.Which of the following is a cause of chronic cholestatic
syndrome ?
A. Primary biliary cirrhosis (PBC)
B. Autoimmune cholangitis
C. Primary sclerosing cholangitis (PSC)
D. All of the above

19. Histopathologic features of chronic cholestasis are all except ?
A. Copper deposition
B. Xanthomatous transformation of hepatocytes
C. Iron deposition
D. Biliary fibrosis

20. Steatosis is often present in patients with which HCV
genotype ?
A. 1
B. 2
C. 3
D. 4

21.Nonalcoholic steatohepatitis (NASH) is nowadays diagnosed
as what was earlier diagnosed as ?
A. Autoimmune cholangiopathy
B. Cardiac cirrhosis
C. Cryptogenic cirrhosis
D. Autoimmune hepatitis

22. Primary biliary cirrhosis (PBC) is characterized by ?
A. Fibrous obliteration of intrahepatic bile ductules
B. Fibrous obliteration of larger extrahepatic ducts
C. Fibrous obliteration of intrahepatic bile ductules and larger
extrahepatic ducts both
D. None of the above

23.In PBC, pruritus is most bothersome in ?
A. Morning
B. Afternoon
C. Evening
D. Night

24. Features unique to PBC include all except ?
A. Hypopigmentation
B. Xanthelasma
C. Xanthomata
D. Bone pain

25. In PBC, hyperpigmentation is evident on ?
A. Trunk
B. Face
C. Areas of exfoliation and lichenification
D. All of the above

Cirrhosis

[MCQ] Cirrhosis- Part 2

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Cirrhosis- Part 2

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