[MCQ] Cirrhosis- Part 4

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Cirrhosis- Part 4

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Question 1

Inherited & metabolic disorders that can lead to chronic liver disease include all except ?

A	α1-antitrypsin deficiency
B	Fanconi’s syndrome
C	Wilson’s disease
D	Lyme’s disease

Question 2

Inherited & metabolic disorders that can lead to chronic liver disease include all except ?

A	Galactosemia
B	Gaucher’s disease
C	Hemochromatosis
D	Renal tubular acidosis

Question 2 Explanation:

Inherited and metabolic disorders that can lead to chronic liver disease include 1-Antitrypsin deficiency, Alagille’s syndrome, Biliary atresia, Familial intrahepatic cholestasis (FIC) types 1-3, Fanconi’s syndrome, Galactosemia, Gaucher’s disease, Glycogen storage disease, Hemochromatosis, Hereditary fructose intolerance, Hereditary tyrosinemia, Wilson’s disease.

Question 3

Drugs & toxins that can lead to chronic liver disease include all except ?

A	Oral contraceptives
B	Amioradone
C	Testosterone
D	Arsenicals

Question 3 Explanation:

Drugs & toxins that can lead to CLD include alcohol, amioradone, arsenicals, oral contraceptives (Budd-Chiari), pyrrolidizine alkaloids & antineoplastic agents.

Question 4

Disorders that can lead to chronic liver disease include all except ?

A	Biliary obstruction (chronic)
B	Cystic fibrosis
C	Wegener’s granulomatosis
D	Graft-versus-host disease

Question 5

Disorders that can lead to chronic liver disease include all except ?

A	Jejunoileal bypass
B	Sarcoidosis
C	Primary biliary cirrhosis
D	Porphyria

Question 5 Explanation:

Disorders that can lead to chronic liver disease include Biliary obstruction (chronic), Cystic fibrosis, Graft-versus-host disease, Jejunoileal bypass, Nonalcoholic fatty liver disease, Primary biliary cirrhosis, Primary sclerosing cholangitis, Sarcoidosis.

Question 6

Which of the following about Primary Sclerosing Cholangitis (PSC) is false ?

A	Chronic cholestatic syndrome
B	Obliteration of intrahepatic biliary tree
C	Obliteration of extrahepatic biliary tree
D	None of the above

Question 7

Which of the following is seen frequently in Primary Sclerosing Cholangitis (PSC) ?

A	Hodgekin’s lymphoma
B	Ulcerative colitis (UC)
C	Azoospermia
D	Amenorrhoea

Question 7 Explanation:

Over 50% of patients with PSC also have ulcerative colitis (UC). Therefore, once a diagnosis of PSC is established, colonoscopy should be performed to look for evidence of UC.

Question 8

Pathologic change occurs in PSC is ?

A	Bile duct proliferation
B	Ductopenia
C	Fibrous cholangitis (pericholangitis)
D	All of the above

Question 8 Explanation:

Pathologic changes that can occur in PSC show bile duct proliferation as well as ductopenia and fibrous cholangitis (pericholangitis).

Question 9

Which of the following antibody is seen frequently in Primary Sclerosing Cholangitis (PSC) ?

A	Anti-DNA antibody
B	Cryoglobulins
C	Perinuclear antineutrophil cytoplasmic antibody (p-ANCA)
D	Antiphospholipid antibody

Question 9 Explanation:

Perinuclear antineutrophil cytoplasmic antibody (p-ANCA), is positive in ~65% of patients of PSC

Question 10

Typical cholangiographic findings in PSC is ?

A	Multiple calculi in biliary tree
B	Multifocal stricturing & beading of biliary tree
C	Diffuse fibrotic narrowing of biliary tree
D	All of the above

Question 10 Explanation:

Typical cholangiographic findings in PSC are multifocal stricturing and beading with intervening segments of normal or dilated ducts involving both the intrahepatic and extrahepatic biliary tree

Question 11

Primary or idiopathic sclerosing cholangitis may be associated with ?

A	Autoimmune pancreatitis
B	Multifocal fibrosclerosis syndromes
C	Riedel’s struma
D	All of the above

Question 11 Explanation:

Primary or idiopathic sclerosing cholangitis may be associated with autoimmune pancreatitis; multifocal fibrosclerosis syndromes (retroperitoneal, mediastinal, and/or periureteral fibrosis), Riedel’s struma or pseudotumor of the orbit.

Question 12

Which of the following has biochemical & cholangiographic features indistinguishable from PSC ?

A	Immunoglobulin G1 - associated cholangitis
B	Immunoglobulin G2 - associated cholangitis
C	Immunoglobulin G3 - associated cholangitis
D	Immunoglobulin G4 - associated cholangitis

Question 12 Explanation:

Immunoglobulin G4–associated cholangitis is a recently described biliary disease of unknown etiology that presents with biochemical and cholangiographic features indistinguishable from PSC. Often associated with autoimmune pancreatitis & other fibrosing conditions but not inflammatory bowel disease, it is characterized by elevated serum IgG4 and infiltration of IgG4-positive plasma cells in bile ducts and liver tissue. Glucocorticoids and/or azathioprine are helpful.

Question 13

Independent predictor of a bad prognosis in PSC is ?

A	Age
B	Serum bilirubin concentration
C	Liver histologic changes
D	All of the above

Question 13 Explanation:

Independent predictors of a bad prognosis in PSC are age, serum bilirubin concentration, liver histologic changes and splenomegaly. Cholangiocarcinoma is a dreaded consequence.

Question 14

Which of the following has cholangiographic appearance similar to that of PSC ?

A	AIDS cholangiopathy
B	Traumatic biliary injury
C	Chronic pancreatitis
D	All of the above

Question 14 Explanation:

AIDS cholangiopathy is a condition, usually due to infection of the bile duct epithelium with CMV or cryptosporidia, which has a cholangiographic appearance similar to that of PSC. These patients usually present with greatly elevated serum alkaline phosphatase levels (mean, 800 IU/L), but the bilirubin is often near normal. These patients do not typically present with jaundice

Question 15

Which of the following is efficacious in PSC ?

A	Glucocorticoids
B	Methotrexate
C	Cyclosporine
D	UDCA

Question 15 Explanation:

Glucocorticoids, methotrexate, and cyclosporine have not been shown to be efficacious in PSC. UDCA in high dosage (20 mg/kg) improves serum liver tests, but an effect on survival has not been documented.

Question 16

“Nutmeg liver” is the term used to describe liver in ?

A	Cardiac cirrhosis
B	Primary Biliary Cirrhosis
C	Secondary Biliary Cirrhosis
D	None of the above

Question 16 Explanation:

In right heart failure, hepatic sinusoids become dilated & engorged with blood, along with hepatic ischemia from poor perfusion leading to necrosis of centrilobular hepatocytes with fibrosis in central areas. Centrilobular fibrosis extends outward in a characteristic stellate pattern from central vein.

Question 17

In “nutmeg liver”, gross examination of liver shows which of the following ?

A	Nodules on the surface of liver
B	Alternating red and pale areas
C	Pyramid like elevations on surface of liver
D	Brownish black discolouration of liver

Question 17 Explanation:

In nutmeg liver, gross examination shows alternating red (congested) & pale (fibrotic) areas.

Question 18

Which of the following is false in hepatomegaly due to prolonged right-sided heart failure ?

A	Enlarged
B	Firm
C	Tender
D	None of the above

Question 18 Explanation:

With prolonged right heart failure, liver becomes enlarged, firm, & is usually nontender.

Question 19

Levels of which of the following is characteristically elevated in cardiac cirrhosis ?

A	S. Bilirubin
B	SGOT
C	SGPT
D	S. Alkaline phosphatase

Question 19 Explanation:

ALP levels are characteristically elevated in cardiac cirrhosis, Aminotransferases may be normal or slightly increased with AST usually higher than ALT

Question 20

Which of the following could lead to cardiac cirrhosis ?

A	Valvular heart disease
B	Constrictive pericarditis
C	Cor pulmonale of long duration (>10 years)
D	All of the above

Question 20 Explanation:

The presence of a firm, enlarged liver with signs of chronic liver disease in a patient with valvular heart disease, constrictive pericarditis, or cor pulmonale of long duration (>10 years) should suggest cardiac cirrhosis

Question 21

Inherited metabolic liver disease that can progress to cirrhosis is ?

A	Hemochromatosis
B	Wilson’s disease
C	Cystic fibrosis
D	All of the above

Question 21 Explanation:

Inherited metabolic liver diseases that can progress to cirrhosis include hemochromatosis, Wilson’s disease, 1 antitrypsin deficiency, and cystic fibrosis

Question 22

Which of the following points against the diagnosis of Budd Chiari syndrome ?

A	Tender hepatomegaly
B	Intractable ascites
C	Right-sided heart failure
D	Centrilobular congestion & sinusoidal dilatation on liver biopsy

Question 22 Explanation:

In Budd-Chiari syndrome, liver is grossly enlarged, tender & severe intractable ascites is present. Signs & symptoms of heart failure are notably absent. Hepatic venography or liver biopsy showing centrilobular congestion & sinusoidal dilatation in absence of right heart failure characterize BuddChiari syndrome

Question 23

Toxicity of which of the following vitamins can cause veno occlusive disease of liver ?

A	A
B	D
C	E
D	K

Question 24

Acute Budd-Chiari syndrome has all the features except ?

A	Abdominal pain
B	Jaundice
C	Ascites
D	Caudate lobe hypertrophy

Question 25

Initial investigation of choice in suspected Budd-Chiari syndrome is ?

A	USG abdomen
B	Doppler studies
C	CT abdomen
D	MR angiography

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See all quizzes of Cirrhosis at here:

1.Inherited & metabolic disorders that can lead to chronic liver
disease include all except ?
A. 1-antitrypsin deficiency
B. Fanconi’s syndrome
C. Wilson’s disease
D. Lyme’s disease
2. Inherited & metabolic disorders that can lead to chronic liver
disease include all except ?
A. Galactosemia
B. Gaucher’s disease
C. Hemochromatosis
D. Renal tubular acidosis

3.Drugs & toxins that can lead to chronic liver disease include
all except ?
A. Oral contraceptives
B. Amioradone
C. Testosterone
D. Arsenicals

4. Disorders that can lead to chronic liver disease include all
except ?
A. Biliary obstruction (chronic)
B. Cystic fibrosis
C. Wegener’s granulomatosis
D. Graft-versus-host disease
5. Disorders that can lead to chronic liver disease include all
except ?
A. Jejunoileal bypass

B. Sarcoidosis
C. Primary biliary cirrhosis
D. Porphyria

6. Which of the following about Primary Sclerosing Cholangitis
(PSC) is false ?
A. Chronic cholestatic syndrome
B. Obliteration of intrahepatic biliary tree
C. Obliteration of extrahepatic biliary tree
D. None of the above
7. Which of the following is seen frequently in Primary Sclerosing
Cholangitis (PSC) ?
A. Hodgekin’s lymphoma
B. Ulcerative colitis (UC)
C. Azoospermia
D. Amenorrhoea

8. Pathologic change occurs in PSC is ?
A. Bile duct proliferation
B. Ductopenia
C. Fibrous cholangitis (pericholangitis)
D. All of the above

9. Which of the following antibody is seen frequently in Primary
Sclerosing Cholangitis (PSC) ?
A. Anti-DNA antibody
B. Cryoglobulins
C. Perinuclear antineutrophil cytoplasmic antibody (p-ANCA)
D. Antiphospholipid antibody

10.Typical cholangiographic findings in PSC is ?
A. Multiple calculi in biliary tree
B. Multifocal stricturing & beading of biliary tree
C. Diffuse fibrotic narrowing of biliary tree
D. All of the above

11. Primary or idiopathic sclerosing cholangitis may be associated
with ?
A. Autoimmune pancreatitis

B. Multifocal fibrosclerosis syndromes
C. Riedel’s struma
D. All of the above

12. Which of the following has biochemical & cholangiographic
features indistinguishable from PSC ?
A. Immunoglobulin G1 – associated cholangitis
B. Immunoglobulin G2 – associated cholangitis
C. Immunoglobulin G3 – associated cholangitis
D. Immunoglobulin G4 – associated cholangitis

13. Independent predictor of a bad prognosis in PSC is ?
A. Age
B. Serum bilirubin concentration
C. Liver histologic changes
D. All of the above

14.Which of the following has cholangiographic appearance
similar to that of PSC ?
A. AIDS cholangiopathy
B. Traumatic biliary injury
C. Chronic pancreatitis
D. All of the above

15.Which of the following is efficacious in PSC ?
A. Glucocorticoids
B. Methotrexate
C. Cyclosporine
D. UDCA

16. “Nutmeg liver” is the term used to describe liver in ?
A. Cardiac cirrhosis
B. Primary Biliary Cirrhosis
C. Secondary Biliary Cirrhosis
D. None of the above

17. In “nutmeg liver”, gross examination of liver shows which of
the following ?
A. Nodules on the surface of liver
B. Alternating red and pale areas
C. Pyramid like elevations on surface of liver
D. Brownish black discolouration of liver

18. Which of the following is false in hepatomegaly due to
prolonged right-sided heart failure ?
A. Enlarged
B. Firm
C. Tender
D. None of the above

19. Levels of which of the following is characteristically elevated
in cardiac cirrhosis ?
A. S. Bilirubin
B. SGOT
C. SGPT
D. S. Alkaline phosphatase

20. Which of the following could lead to cardiac cirrhosis ?
A. Valvular heart disease
B. Constrictive pericarditis
C. Cor pulmonale of long duration (>10 years)
D. All of the above

21. Inherited metabolic liver disease that can progress to cirrhosis
is ?
A. Hemochromatosis
B. Wilson’s disease
C. Cystic fibrosis
D. All of the above

22. Which of the following points against the diagnosis of Budd
Chiari syndrome ?
A. Tender hepatomegaly

B. Intractable ascites
C. Right-sided heart failure
D. Centrilobular congestion & sinusoidal dilatation on liver biopsy

23. Toxicity of which of the following vitamins can cause veno
occlusive disease of liver ?
A. A
B. D
C. E
D. K
24. Acute Budd-Chiari syndrome has all the features except ?
A. Abdominal pain
B. Jaundice
C. Ascites
D. Caudate lobe hypertrophy
25. Initial investigation of choice in suspected Budd-Chiari
syndrome is ?
A. USG abdomen
B. Doppler studies
C. CT abdomen
D. MR angiography

Cirrhosis

[MCQ] Cirrhosis- Part 4

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Cirrhosis- Part 4

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