[MCQ] Cirrhosis- Part 3

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Cirrhosis- Part 3

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Question 1

Which of the following about primary biliary cirrhosis is false ?

A	Most prevalent in northern Europe
B	Slowly progressive autoimmune disease of liver
C	Primarily affects men
D	Peak incidence is in fifth decade of life

Question 1 Explanation:

Among patients with symptomatic disease, 90% are women between age 35 to 60 years

Question 2

Which of the following about primary biliary cirrhosis is true ?

A	Antimitochondrial antibodies are present in ~90%
B	Antimitochondrial antibodies are detectable years before clinical signs appear
C	Autoantibodies recognize three to five inner mitochondrial membrane proteins
D	All of the above

Question 3

Which of the following about primary biliary cirrhosis is true ?

A	Fatigue & pruritus are the commonest presenting symptoms
B	Pruritus precedes onset of jaundice by months to years
C	Pruritus is usually worse at night and is exacerbated by contact with wool, other fabrics, or heat
D	All of the above

Question 3 Explanation:

In PBC, the earliest symptom is pruritus, which may be either generalized or limited initially to palms and soles. Fatigue is a prominent early symptom.

Question 4

Associated findings in primary biliary cirrhosis include all except ?

A	Hyperlipidemia
B	Autoimmune thyroid disease
C	Osteomalacia
D	Fibroadenoma breast

Question 4 Explanation:

Protracted elevation of serum lipids, especially cholesterol, leads to subcutaneous lipid deposition around the eyes (xanthelasmas) and over joints and tendons (xanthomas). Clinical evidence of sicca syndrome is found in about 75%, and serologic evidence of autoimmune thyroid disease in 25% of patients. Osteomalacia occurs due to diminished vitamin D absorption. Accelerated osteoporosis is common.

Question 5

Coexisting autoimmune disease in primary biliary cirrhosis is ?

A	Type I diabetes mellitus
B	Scleroderma
C	Pernicious anemia
D	All of the above

Question 6

Coexisting autoimmune disease in primary biliary cirrhosis is ?

A	Rheumatoid arthritis
B	CREST syndrome
C	Renal tubular acidosis
D	All of the above

Question 7

Coexisting autoimmune disease in primary biliary cirrhosis is ?

A	Keratoconjunctivitis sicca
B	IgA deficiency
C	CREST syndrome
D	All of the above

Question 7 Explanation:

PBC is frequently associated with a variety of autoimmune disorders, such as syndrome of calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia (CREST); keratoconjunctivitis sicca syndrome (dry eyes and dry mouth); autoimmune thyroiditis; type 1 diabetes mellitus; IgA deficiency; rheumatoid arthritis, scleroderma, pernicious anemia, and renal tubular acidosis.

Question 8

Which of the following is true for “autoimmune cholangitis” ?

A	Histological features similar to PBC
B	Negative AMA
C	Antinuclear or smooth-muscle antibodies present
D	All of the above

Question 8 Explanation:

In autoimmune cholangitis, histological features are similar to PBC. The AMA titre is negative. Antinuclear or smooth-muscle antibodies are present

Question 9

Antimitochondrial antibody (AMA) found in primary biliary cirrhosis is of which type of immunoglobulin ?

A	IgG
B	IgM
C	IgA
D	IgE

Question 9 Explanation:

A circulating IgG antimitochondrial antibody (AMA) is detected in ~90% of patients with PBC and only rarely in other forms of liver disease.

Question 10

Which of the following is an autoreactive mitochondrial antigen in primary biliary cirrhosis ?

A	Pyruvate dehydrogenase complex (PDC)
B	2-oxoglutarate dehydrogenase complex (OGDC)
C	Branched-chain 2-oxoacid dehydrogenase complex
D	All of the above

Question 10 Explanation:

In PBC, circulating IgG antimitochondrial autoantibodies (AMA) recognize inner mitochondrial membrane proteins identified as enzymes of the pyruvate dehydrogenase complex (PDC), branched chain 2- oxoacid dehydrogenase complex (BCOADC), and 2-oxoglutarate dehydrogenase complex (OGDC).

Question 11

T cells infiltrating the liver in primary biliary cirrhosis are specific for ?

A	Pyruvate dehydrogenase E2 complex (PDC-E2)
B	E3-binding protein (E3-BP)
C	Ketoglutaric acid dehydrogenase E2 complex (OGDC-E2)
D	Branched-chain 2-oxo-acid dehydrogenase E2 complex (BCKDE2

Question 12

Hyperlipidemia seen in primary biliary cirrhosis shows a characteristic rise in ?

A	Serum unesterified cholesterol
B	Serum triglycerides
C	Serum LDLc
D	Serum VLDLc

Question 13

Asymptomatic patients of PBC are initially detected by ?

A	Elevated serum alkaline phosphatase levels
B	Elevated AST levels
C	Elevated ALT levels
D	All of the above

Question 13 Explanation:

Most patients with PBC are asymptomatic, and the disease is initially detected by elevated serum alkaline phosphatase levels during routine screening.

Question 14

Which of the following is false about ursodiol therapy in PBC ?

A	Dose is 13 to 15 mg/kg per day
B	Should be given with food
C	As a single dose daily
D	None of the above

Question 14 Explanation:

Ursodiol is given in doses of 13 to 15 mg/kg per day, with food and as a single dose daily.

Question 15

Drugs used to treat pruritus in primary biliary cirrhosis include all except ?

A	Cholestyramine
B	Ondansetron
C	Rifampin
D	Tetracycline

Question 15 Explanation:

Rifampin, opiate antagonists (naloxone or naltrexone), ondansetron, plasmapheresis, and ultraviolet light have been tried for control of pruritus with varying results. Cholestyramine, an oral bile salt sequestering resin, may be helpful in doses of 12 to 16 gm/day to decrease both pruritus and hypercholesterolemia

Question 16

Which of the following drugs is not used in the treatment of primary biliary cirrhosis ?

A	Ursodeoxycholic acid
B	Colchicine
C	Methotrexate
D	Imatinib mesylate

Question 16 Explanation:

Glucocorticoids, colchicine, methotrexate, azathioprine, cyclosporine & tacrolimus are effective

Question 17

The only established “cure” in the treatment of primary biliary cirrhosis is ?

A	Liver transplantation
B	Long term Cyclosporine therapy
C	Long term Tacrolimus therapy
D	All of the above

Question 17 Explanation:

Ursodiol therapy may not prevent ultimate progression of PBC and the only established ‘cure’ is liver transplantation.

Question 18

In PBC, when night blindness is refractory to vitamin A therapy, which element should be supplemented ?

A	Copper
B	Zinc
C	Cobalt
D	Selenium

Question 18 Explanation:

In PBC, fat-soluble vitamins A, D, E, and K should be given at regular intervals. Zinc supplementation may be necessary if night blindness is refractory to vitamin A therapy.

Question 19

Which of the following represent the pathological Stage I of PBC ?

A	Chronic nonsuppurative destructive cholangitis
B	Reduction in number of bile ducts and proliferation of smaller bile ductules
C	Decrease in interlobular ducts, loss of liver cells, and expansion of periportal fibrosis into a network of connective tissue scars
D	Micronodular or macronodular cirrhosis

Question 19 Explanation:

PBC is divided morphologically into 4 stages. Stage I is termed chronic nonsuppurative destructive cholangitis. It is a necrotizing inflammatory process of portal triads characterized by destruction of medium & small bile ducts, a dense infiltrate of acute & chronic inflammatory cells, mild fibrosis & occasionally, bile stasis. In stage II, inflammatory infiltrate becomes less prominent, number of bile ducts are reduced & smaller bile ductules proliferate. Over months to years there is a decrease in interlobular ducts, loss of liver cells & expansion of periportal fibrosis into a network of connective tissue scars marking stage III. Stage IV represents cirrhosis - micronodular or macronodular

Question 20

Secondary biliary cirrhosis (SBC) 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 20 Explanation:

Biliary cirrhosis results from injury to or prolonged obstruction of either the intrahepatic or extrahepatic biliary system. It is associated with impaired biliary excretion, destruction of hepatic parenchyma, and progressive fibrosis. Primary biliary cirrhosis (PBC) is characterized by chronic inflammation and fibrous obliteration of intrahepatic bile ductules. Secondary biliary cirrhosis (SBC) is the result of longstanding obstruction of the larger extrahepatic ducts

Question 21

Prolonged cholestasis can lead to all of the following except ?

A	Presence of Lipoprotein X
B	Elevated liver copper levels
C	Hypoprothrombinemia
D	Serum aminotransferase > 300

Question 21 Explanation:

An abnormal serum lipoprotein (lipoprotein X) and elevated liver copper levels may be present in PBC, though not specific. Deficiency of bile salts in intestine leads to moderate steatorrhea and impaired absorption of fat soluble vitamins and hypoprothrombinemia. Serum aminotransferase values rarely exceed 150 to 200 units

Question 22

What duration of biliary obstruction is required to result in secondary biliary cirrhosis (SBC) ?

A	At least 1 to 3 months
B	At least 3 to 12 months
C	At least 12 to 18 months
D	At least 18 to 36 months

Question 22 Explanation:

At least 3 to 12 months is required for biliary obstruction to result in finely nodular secondary biliary cirrhosis

Question 23

In children, which of the following is a common cause of SBC ?

A	Primary sclerosing cholangitis
B	Gallstones
C	Cystic fibrosis
D	Chronic pancreatitis

Question 24

Which of the following rarely causes SBC ?

A	Primary sclerosing cholangitis
B	Malignant tumors of common bile duct or pancreas
C	Chronic pancreatitis
D	Postoperative CBD strictures

Question 24 Explanation:

In children, congenital biliary atresia & cystic fibrosis are common causes of SBC. In adults, biliary tract obstruction is mostly caused by postoperative strictures, gallstones, chronic pancreatitis or primary sclerosing cholangitis. Patients with malignant tumors of CBD or pancreas rarely survive long enough to develop SBC

Question 25

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

A	Brucellosis
B	Toxoplasmosis
C	Echinococcosis
D	Leptospirosis

Question 25 Explanation:

Infections that can lead to chronic liver disease include Brucellosis, Capillariasis, Echinococcosis, Schistosomiasis, Toxoplasmosis

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See all quizzes of Cirrhosis at here:

1.Which of the following about primary biliary cirrhosis is false ?
A. Most prevalent in northern Europe
B. Slowly progressive autoimmune disease of liver
C. Primarily affects men
D. Peak incidence is in fifth decade of life

2. Which of the following about primary biliary cirrhosis is true ?
A. Antimitochondrial antibodies are present in ~90%
B. Antimitochondrial antibodies are detectable years before
clinical signs appear
C. Autoantibodies recognize three to five inner mitochondrial
membrane proteins
D. All of the above
3. Which of the following about primary biliary cirrhosis is true ?
A. Fatigue & pruritus are the commonest presenting symptoms
B. Pruritus precedes onset of jaundice by months to years
C. Pruritus is usually worse at night and is exacerbated by contact
with wool, other fabrics, or heat
D. All of the above

4. Associated findings in primary biliary cirrhosis include all
except ?
A. Hyperlipidemia
B. Autoimmune thyroid disease
C. Osteomalacia
D. Fibroadenoma breast

5. Coexisting autoimmune disease in primary biliary cirrhosis is ?
A. Type I diabetes mellitus
B. Scleroderma
C. Pernicious anemia
D. All of the above
6. Coexisting autoimmune disease in primary biliary cirrhosis is ?
A. Rheumatoid arthritis
B. CREST syndrome
C. Renal tubular acidosis
D. All of the above
7. Coexisting autoimmune disease in primary biliary cirrhosis is ?
A. Keratoconjunctivitis sicca
B. IgA deficiency
C. CREST syndrome
D. All of the above

8.Which of the following is true for “autoimmune cholangitis” ?
A. Histological features similar to PBC
B. Negative AMA
C. Antinuclear or smooth-muscle antibodies present
D. All of the above

9. Antimitochondrial antibody (AMA) found in primary biliary
cirrhosis is of which type of immunoglobulin ?
A. IgG
B. IgM
C. IgA
D. IgE

10. Which of the following is an autoreactive mitochondrial antigen
in primary biliary cirrhosis ?
A. Pyruvate dehydrogenase complex (PDC)
B. 2-oxoglutarate dehydrogenase complex (OGDC)
C. Branched-chain 2-oxoacid dehydrogenase complex
D. All of the above

11. T cells infiltrating the liver in primary biliary cirrhosis are
specific for ?
A. Pyruvate dehydrogenase E2 complex (PDC-E2)
B. E3-binding protein (E3-BP)
C. Ketoglutaric acid dehydrogenase E2 complex (OGDC-E2)
D. Branched-chain 2-oxo-acid dehydrogenase E2 complex (BCKD
E2)

12. Hyperlipidemia seen in primary biliary cirrhosis shows a
characteristic rise in ?
A. Serum unesterified cholesterol
B. Serum triglycerides
C. Serum LDLc
D. Serum VLDLc

13. Asymptomatic patients of PBC are initially detected by ?
A. Elevated serum alkaline phosphatase levels
B. Elevated AST levels
C. Elevated ALT levels

D. All of the above

14. Which of the following is false about ursodiol therapy in PBC ?
A. Dose is 13 to 15 mg/kg per day
B. Should be given with food
C. As a single dose daily
D. None of the above

15. Drugs used to treat pruritus in primary biliary cirrhosis include
all except ?
A. Cholestyramine
B. Ondansetron
C. Rifampin
D. Tetracycline

16. Which of the following drugs is not used in the treatment of
primary biliary cirrhosis ?
A. Ursodeoxycholic acid
B. Colchicine
C. Methotrexate
D. Imatinib mesylate

17.The only established “cure” in the treatment of primary biliary
cirrhosis is ?
A. Liver transplantation
B. Long term Cyclosporine therapy
C. Long term Tacrolimus therapy
D. All of the above

18.In PBC, when night blindness is refractory to vitamin A therapy,
which element should be supplemented ?
A. Copper
B. Zinc
C. Cobalt
D. Selenium

19.Which of the following represent the pathological Stage I of
PBC ?
A. Chronic nonsuppurative destructive cholangitis

B. Reduction in number of bile ducts and proliferation of smaller
bile ductules
C. Decrease in interlobular ducts, loss of liver cells, and
expansion of periportal fibrosis into a network of connective
tissue scars
D. Micronodular or macronodular cirrhosis

20. Secondary biliary cirrhosis (SBC) 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

21. Prolonged cholestasis can lead to all of the following except ?
A. Presence of Lipoprotein X
B. Elevated liver copper levels
C. Hypoprothrombinemia
D. Serum aminotransferase > 300

22. What duration of biliary obstruction is required to result in
secondary biliary cirrhosis (SBC) ?
A. At least 1 to 3 months
B. At least 3 to 12 months
C. At least 12 to 18 months
D. At least 18 to 36 months

23. In children, which of the following is a common cause of SBC ?
A. Primary sclerosing cholangitis
B. Gallstones
C. Cystic fibrosis
D. Chronic pancreatitis
24. Which of the following rarely causes SBC ?
A. Primary sclerosing cholangitis
B. Malignant tumors of common bile duct or pancreas
C. Chronic pancreatitis

D. Postoperative CBD strictures

25. Infections that can lead to chronic liver disease include all
except ?
A. Brucellosis
B. Toxoplasmosis
C. Echinococcosis
D. Leptospirosis

Cirrhosis

[MCQ] Cirrhosis- Part 3

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Cirrhosis- Part 3

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