[MCQ] Cirrhosis- Part 5

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Cirrhosis- Part 5

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Question 1

Portal hypertension is defined as elevation of hepatic venous pressure gradient to ?

A	> 2 mm Hg
B	> 3 mm Hg
C	> 4 mm Hg
D	> 5 mm Hg

Question 1 Explanation:

Portal hypertension is defined as elevation of hepatic venous pressure gradient (HVPG) to >5 mmHg. Varices may develop but do not bleed if HVPG is <12 mm Hg. HVPG is equal to wedged hepatic venous pressure (portal venous pressure) minus free hepatic venous pressure (intraabdominal pressure).

Question 2

In variceal hemorrhage, mortality associated with each episode of bleeding is ?

A	10 - 20 %
B	20 - 30 %
C	30 - 40 %
D	40 - 50 %

Question 2 Explanation:

Mortality associated with each episode of variceal bleeding is 20 - 30 %. Even if the patient survives an initial episode of variceal bleeding, probability of another episode is high. Rebleeding rate without treatment is 70% within 1 year. The mortality rate with rebleeding is 33%.

Question 3

Portal vein is formed by the confluence of splenic vein with ?

A	Superior mesenteric vein
B	Inferior mesenteric vein
C	Gastric vein
D	All of the above

Question 3 Explanation:

Portal vein is formed by the confluence of superior mesenteric and splenic veins

Question 4

Normal pressure in the portal vein is ?

A	2 to 5 mm Hg
B	5 to 10 mm Hg
C	10 to 15 mm Hg
D	20 to 25 mm Hg

Question 4 Explanation:

Normal pressure in portal vein is 5 to 10 mm Hg because of low vascular resistance in hepatic sinusoids

Question 5

Esophageal varices are present in what percentage of compensated and decompensated cirrhosis ?

A	10 & 40 %
B	20 & 50 %
C	20 & 50 %
D	40 & 70 %

Question 5 Explanation:

Esophageal varices are present in 30% of patients with compensated cirrhosis and in up to 60% of those with decompensated cirrhosis (with evidence of ascites or encephalopathy)

Question 6

Which of the following is a posthepatic cause of portal hypertension ?

A	Portal vein thrombosis
B	Budd-Chiari syndrome (BCS)
C	Splenic vein thrombosis
D	Venoocclusive disease

Question 7

Which of the following is a posthepatic cause of portal hypertension ?

A	Budd-Chiari syndrome (BCS)
B	Venoocclusive disease
C	Venoocclusive disease
D	All of the above

Question 8

Which of the following accounts for most cases of portal hypertension ?

A	Prehepatic
B	Intrahepatic
C	Posthepatic
D	Any of the above

Question 8 Explanation:

Intrahepatic causes of portal hypertension account for over 95% of cases of portal hypertension and are represented by the major forms of cirrhosis

Question 9

Budd-Chiari syndrome is an example of ?

A	Budd-Chiari syndrome is an example of ?
B	Sinusoidal obstruction
C	Post sinusoidal obstruction
D	Any of the above

Question 9 Explanation:

Postsinusoidal obstruction may also occur outside the liver at the level of the hepatic veins (BuddChiari syndrome), the inferior vena cava so that the liver parenchyma is exposed to elevated venous pressures

Question 10

When cirrhosis is complicated by portal hypertension, the increased resistance is ?

A	Pre sinusoidal
B	Sinusoidal
C	Post sinusoidal
D	All of the above

Question 10 Explanation:

Portal hypertension (>10 mm Hg) mostly results from increased resistance to portal blood flow. When hepatic cirrhosis is complicated by portal hypertension, increased resistance is usually sinusoidal.

Question 11

Symmers’ clay-pipe stem fibrosis in liver is due to ?

A	Brucellosis
B	Toxoplasmosis
C	Echinococcosis
D	Schistosomiasis

Question 11 Explanation:

Intrahepatic presinusoidal causes of portal hypertension include congenital hepatic fibrosis and schistosomiasis. Schistosomiasis alone results in pure fibrotic lesions in liver. Cirrhosis occurs when other nutritional or infectious agents (hepatitis B or C virus) are involved. It is characteristically periportal (Symmers’ clay pipe–stem fibrosis).

Question 12

Portal vein obstruction may occur in association with ?

A	Cirrhosis
B	Abdominal trauma
C	Pancreatitis
D	Pancreatitis

Question 13

Portal vein thrombosis may develop in ?

A	Polycythemia vera
B	Deficiencies of protein C, protein S, or antithrombin III
C	Resistance to activated protein C (factor V Leiden)
D	All of the above

Question 13 Explanation:

Idiopathic portal vein thrombosis may develop in hypercoagulable states like polycythemia vera, essential thrombocythemia, deficiencies of protein C / protein S / antithrombin III, resistance to activated protein C (factor V Leiden) & mutation of prothrombin gene (G20210A)

Question 14

Primary complication of portal hypertension is ?

A	Gastroesophageal varices with hemorrhage
B	Ascites
C	Hypersplenism
D	All of the above

Question 14 Explanation:

Three primary complications of portal hypertension are gastroesophageal varices with hemorrhage, ascites, and hypersplenism

Question 15

On screening of histologically confirmed cirrhosis cases, what proportion of patients have esophageal varices ?

A	One - fourth
B	One - third
C	One - half
D	Three - fourth

Question 15 Explanation:

On screening of histologically confirmed cirrhosis cases, one - third of patients have esophageal varices

Question 16

In cirrhosis, factor predict the risk of esophageal variceal bleeding is ?

A	Severity of cirrhosis
B	Wedged-hepatic vein pressure
C	Tense ascites
D	All of the above

Question 16 Explanation:

In cirrhosis, factors that predict risk of esophageal variceal bleeding include severity of cirrhosis (Child’s class, MELD score), height of wedged-hepatic vein pressure, size of varix, location of varix, endoscopic stigmatas (red wale signs, hematocystic spots, diffuse erythema, bluish color, cherry red spots, or white-nipple spots0 and tense ascites.

Question 17

Marker of the presence of cirrhosis in a patient being followed for chronic liver disease is ?

A	Progressive decrease in platelet count
B	Progressive increase in platelet count
C	Progressive decrease in lymphocyte count
D	Progressive increase in lymphocyte count

Question 17 Explanation:

Progressive increase in lymphocyte count

Question 18

Marker of the presence of cirrhosis in a patient being followed for chronic liver disease is ?

A	Appearance of an enlarged spleen
B	Appearance of an enlarged spleen
C	Hepatic encephalopathy
D	All of the above

Question 18 Explanation:

Progressive decrease in platelet count, appearance of enlarged spleen, development of ascites, encephalopathy, and/or esophageal varices with or without bleeding serve as markers of the presence of cirrhosis in a patient being followed for chronic liver disease.

Question 19

The risk of variceal hemorrhage is related to ?

A	Size of varices
B	Appearance of varices
C	Severity of liver dysfunction
D	All of the above

Question 19 Explanation:

Risk of variceal hemorrhage is related to size of varices (varices <=5 mm in diameter have a 7% risk of bleeding in 2 years, while those >5 mm have a 30% risk of bleeding within 2 years), appearance of the varices (red wale sign i.e. red streaks of mucosa overlying varix) have an increased risk of hemorrhage & severity of liver dysfunction (high Child-Pugh score - B or C represents decompensated cirrhosis & is associated with an increased risk of bleeding)

Question 20

In liver disease, development of portal hypertension is revealed by the appearance of which of the following ?

A	Splenomegaly
B	Ascites
C	Encephalopathy
D	All of the above

Question 20 Explanation:

In patients with liver disease, development of portal hypertension is revealed by the appearance of splenomegaly, ascites, encephalopathy, and/or esophageal varices.

Question 21

Which of the following statements about free and wedged hepatic vein pressure is false ?

A	Wedged hepatic vein pressure is usually normal in presinusoidal portal hypertension
B	Wedged hepatic vein pressure is elevated in sinusoidal portal hypertension
C	Wedged hepatic vein pressure is elevated in postsinusoidal portal hypertension
D	None of the above

Question 21 Explanation:

Wedged hepatic vein pressure is elevated in sinusoidal and postsinusoidal portal hypertension, it is normal in presinusoidal portal hypertension

Question 22

What level of portal hypertension threatens bleeding from gastroesophageal varices ?

A	> 6 mm Hg
B	> 8 mm Hg
C	> 10 mm Hg
D	> 12 mm Hg

Question 22 Explanation:

Wedged and free hepatic vein pressures allow calculation of a wedged-to-free gradient, which is equivalent to the portal pressure. Average normal wedged-to-free gradient is 5 mmHg, and patients with a gradient >12 mmHg are at risk for variceal hemorrhage.

Question 23

Apart from propranolol, which other -adrenergic blocker is used to reduce portal pressure ?

A	Atenolol
B	Nadolol
C	Sotalol
D	Carvedilol

Question 23 Explanation:

-adrenergic blockade with nonselective agents (propranolol or nadolol) reduces portal pressure through vasoconstrictive effects on both splanchnic arterial bed & portal venous system in combination with reduced cardiac output. Such therapy is effective in preventing both a first variceal bleed & subsequent episodes.

Question 24

Doses of propranolol to treat portal hypertension should aim to reduce the resting pulse rate by ?

A	5 %
B	10 %
C	25 %
D	33 %

Question 24 Explanation:

In treatment of portal hypertension, especially variceal bleeding, reduction of resting pulse through -adrenergic blockade with nonselective agents such as propranolol by 25% is reasonable

Question 25

The goal of treatment in patients of portal hypertension is to reduce hepatic venous pressure gradient (HVPG) to ?

A	<20 mmHg or by 50% from baseline
B	<15 mmHg or by 40% from baseline
C	<12 mmHg or by 20% from baseline
D	<6 mmHg or by 10% from baseline

Question 25 Explanation:

Treatment of patients with clinically significant sequelae of portal hypertension, especially variceal bleeding, is titrated to reduce the hepatic venous pressure gradient (HVPG = wedged hepatic venous pressure – free hepatic venous pressure) to <12 mmHg or by 20% from baseline.

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See all quizzes of Cirrhosis at here:

1.Portal hypertension is defined as elevation of hepatic venous
pressure gradient to ?
A. > 2 mm Hg
B. > 3 mm Hg
C. > 4 mm Hg
D. > 5 mm Hg

2. In variceal hemorrhage, mortality associated with each episode
of bleeding is ?
A. 10 – 20 %
B. 20 – 30 %
C. 30 – 40 %
D. 40 – 50 %

3. Portal vein is formed by the confluence of splenic vein with ?
A. Superior mesenteric vein
B. Inferior mesenteric vein

C. Gastric vein
D. All of the above

4. Normal pressure in the portal vein is ?
A. 2 to 5 mm Hg
B. 5 to 10 mm Hg
C. 10 to 15 mm Hg
D. 20 to 25 mm Hg

5. Esophageal varices are present in what percentage of
compensated and decompensated cirrhosis ?
A. 10 & 40 %
B. 20 & 50 %
C. 30 & 60 %
D. 40 & 70 %

6. Which of the following is a posthepatic cause of portal
hypertension ?
A. Portal vein thrombosis
B. Budd-Chiari syndrome (BCS)
C. Splenic vein thrombosis
D. Venoocclusive disease
7. Which of the following is a posthepatic cause of portal
hypertension ?
A. Budd-Chiari syndrome (BCS)
B. Venoocclusive disease
C. Chronic right-sided cardiac congestion
D. All of the above
8. Which of the following accounts for most cases of portal
hypertension ?
A. Prehepatic
B. Intrahepatic
C. Posthepatic
D. Any of the above

9. Budd-Chiari syndrome is an example of ?
Harrison’s 18th Ed. 2598
A. Pre sinusoidal obstruction
B. Sinusoidal obstruction
C. Post sinusoidal obstruction
D. Any of the above

10. When cirrhosis is complicated by portal hypertension, the
increased resistance is ?
A. Pre sinusoidal
B. Sinusoidal
C. Post sinusoidal
D. All of the above

11. ‘Symmers’ clay-pipe stem fibrosis in liver is due to ?
A. Brucellosis
B. Toxoplasmosis
C. Echinococcosis
D. Schistosomiasis

12. Portal vein obstruction may occur in association with ?
A. Cirrhosis
B. Abdominal trauma
C. Pancreatitis
D. All of the above

13. Portal vein thrombosis may develop in ?
A. Polycythemia vera
B. Deficiencies of protein C, protein S, or antithrombin III
C. Resistance to activated protein C (factor V Leiden)
D. All of the above

14. Primary complication of portal hypertension is ?
A. Gastroesophageal varices with hemorrhage
B. Ascites
C. Hypersplenism
D. All of the above

15. On screening of histologically confirmed cirrhosis cases, what
proportion of patients have esophageal varices ?
A. One – fourth
B. One – third
C. One – half
D. Three – fourth

16.In cirrhosis, factor predict the risk of esophageal variceal
bleeding is ?
A. Severity of cirrhosis
B. Wedged-hepatic vein pressure
C. Tense ascites
D. All of the above

17. Marker of the presence of cirrhosis in a patient being followed
for chronic liver disease is ?
A. Progressive decrease in platelet count
B. Progressive increase in platelet count
C. Progressive decrease in lymphocyte count
D. Progressive increase in lymphocyte count

18. Marker of the presence of cirrhosis in a patient being followed
for chronic liver disease is ?
A. Appearance of an enlarged spleen
B. Development of ascites
C. Hepatic encephalopathy
D. All of the above

19. The risk of variceal hemorrhage is related to ?
A. Size of varices
B. Appearance of varices
C. Severity of liver dysfunction
D. All of the above

20. In liver disease, development of portal hypertension is revealed
by the appearance of which of the following ?
A. Splenomegaly
B. Ascites
C. Encephalopathy
D. All of the above

21. Which of the following statements about free and wedged
hepatic vein pressure is false ?

A. Wedged hepatic vein pressure is usually normal in
presinusoidal portal hypertension
B. Wedged hepatic vein pressure is elevated in sinusoidal portal
hypertension
C. Wedged hepatic vein pressure is elevated in postsinusoidal
portal hypertension
D. None of the above

22. What level of portal hypertension threatens bleeding from
gastroesophageal varices ?
A. > 6 mm Hg
B. > 8 mm Hg
C. > 10 mm Hg
D. > 12 mm Hg

23. Apart from propranolol, which other -adrenergic blocker is
used to reduce portal pressure ?
A. Atenolol
B. Nadolol
C. Sotalol
D. Carvedilol

24. Doses of propranolol to treat portal hypertension should aim
to reduce the resting pulse rate by ?
A. 5 %
B. 10 %
C. 25 %
D. 33 %

25. The goal of treatment in patients of portal hypertension is to
reduce hepatic venous pressure gradient (HVPG) to ?
A. <20 mmHg or by 50% from baseline
B. <15 mmHg or by 40% from baseline
C. <12 mmHg or by 20% from baseline
D. <6 mmHg or by 10% from baseline

[MCQ] Cirrhosis- Part 5

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Cirrhosis- Part 5

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