Alcoholic liver disease — MCQs

A 40-year-old G1P0010 presents to the clinic with nausea and vomiting 8 weeks after a spontaneous abortion at 10 weeks gestation. She admits to heavy drinking (7–8 glasses of wine per day) for the last 20 years; however, after the pregnancy loss, she increased her drinking to 8–9 glasses per day. Hepatomegaly, right upper quadrant pain, and jaundice are noted on abdominal examination. The lungs are clear to auscultation with no abnormalities on chest X-ray. Liver function tests are obtained and a biopsy is performed. Which of the following findings is most likely to be true in her condition?

A 59-year-old woman comes to the physician for a routine health maintenance examination. She feels well. She has systemic lupus erythematosus and hypertension. She does not drink alcohol. Her current medications include lisinopril and hydroxychloroquine. She appears malnourished. Her vital signs are within normal limits. Examination shows a soft, nontender abdomen. There is no ascites or hepatosplenomegaly. Serum studies show: Total bilirubin 1.2 mg/dL Alkaline phosphatase 60 U/L Alanine aminotransferase 456 U/L Aspartate aminotransferase 145 U/L Hepatitis A IgM antibody negative Hepatitis A IgG antibody positive Hepatitis B surface antigen positive Hepatitis B surface antibody negative Hepatitis B envelope antigen positive Hepatitis B envelope antibody negative Hepatitis B core antigen IgM antibody negative Hepatitis B core antigen IgG antibody positive Hepatitis C antibody negative Which of the following is the most appropriate treatment for this patient?

A 45-year-old man comes to the physician for a routine health maintenance examination. He feels well. He has type 2 diabetes mellitus. There is no family history of serious illness. He works as an engineer at a local company. He does not smoke. He drinks one glass of red wine every other day. He does not use illicit drugs. His only medication is metformin. He is 180 cm (5 ft 11 in) tall and weighs 100 kg (220 lb); BMI is 31 kg/m2. His vital signs are within normal limits. Examination shows a soft, nontender abdomen. The liver is palpated 2 to 3 cm below the right costal margin. Laboratory studies show an aspartate aminotransferase concentration of 100 U/L and an alanine aminotransferase concentration of 130 U/L. Liver biopsy shows hepatocyte ballooning degeneration, as well as inflammatory infiltrates with scattered lymphocytes, neutrophils, and Kupffer cells. Which of the following is the most likely diagnosis?

A 43-year-old man is brought to the emergency department because of severe epigastric pain and vomiting for 6 hours. The pain radiates to his back and he describes it as 9 out of 10 in intensity. He has had 3–4 episodes of vomiting during this period. He admits to consuming over 13 alcoholic beverages the previous night. There is no personal or family history of serious illness and he takes no medications. He is 177 cm (5 ft 10 in) tall and weighs 55 kg (121 lb); BMI is 17.6 kg/m2. He appears uncomfortable. His temperature is 37.5°C (99.5°F), pulse is 97/min, and blood pressure is 128/78 mm Hg. Abdominal examination shows severe epigastric tenderness to palpation. Bowel sounds are hypoactive. The remainder of the physical examination shows no abnormalities. Laboratory studies show: Hemoglobin 13.5 g/dL Hematocrit 62% Leukocyte count 13,800/mm3 Serum Na+ 134 mEq/L K+ 3.6 mEq/L Cl- 98 mEq/L Calcium 8.3 mg/dL Glucose 180 mg/dL Creatinine 0.9 mg/dL Amylase 150 U/L Lipase 347 U/L (N = 14–280) Total bilirubin 0.8 mg/dL Alkaline phosphatase 66 U/L AST 19 U/L ALT 18 U/L LDH 360 U/L Which of the following laboratory studies is the best prognostic indicator for this patient's condition?

A 55-year-old man comes to the physician for a follow-up examination. During the past month, he has had mild itching. He has alcoholic cirrhosis, hypertension, and gastroesophageal reflux disease. He used to drink a pint of vodka and multiple beers daily but quit 4 months ago. Current medications include ramipril, esomeprazole, and vitamin B supplements. He appears thin. His temperature is 36.8°C (98.2°F), pulse is 68/min, and blood pressure is 115/72 mm Hg. Examination shows reddening of the palms bilaterally and several telangiectasias over the chest, abdomen, and back. There is symmetrical enlargement of the breast tissue bilaterally. His testes are small and firm on palpation. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 10.1 g/dL Leukocyte count 4300/mm3 Platelet count 89,000/mm3 Prothrombin time 11 sec (INR = 1) Serum Albumin 3 g/dL Bilirubin Total 2.0 mg/dL Direct 0.2 mg/dL Alkaline phosphatase 43 U/L AST 55 U/L ALT 40 U/L α-Fetoprotein 8 ng/mL (N < 10) Anti-HAV IgG antibody positive Anti-HBs antibody negative Abdominal ultrasonography shows a nodular liver surface with atrophy of the right lobe of the liver. An upper endoscopy shows no abnormalities. Which of the following is the most appropriate next step in management?

A 53-year-old homeless woman is brought to the emergency department by the police after she was found in the park lying unconscious on the ground. Both of her pupils are normal in size and reactive to light. There are no signs of head trauma. Finger prick test shows a blood glucose level of 20 mg/dL. She has been brought to the emergency department for acute alcohol intoxication several times before. Her vitals signs include: blood pressure 100/70 mm Hg, heart rate 90/min, respiratory rate 22/min, and temperature 35.0℃ (95.0℉). On general examination, she looks pale, but there is no sign of icterus noted. On physical examination, the abdomen is soft and non-tender and no hepatosplenomegaly noted. She spontaneously opens her eyes after the administration of a bolus of intravenous dextrose, thiamine, and naloxone. Blood and urine samples are drawn for toxicology screening. Finally, the blood alcohol level turns out to be 300 mg/dL. What will be the most likely laboratory findings in this patient?

A 67-year-old man presents with fatigue, progressive abdominal distention and yellow skin coloration for the past 2 weeks. He denies fever, chills, or other symptoms. Past medical history is unremarkable. He reports heavy alcohol consumption for the past several years but says he quit recently. On physical examination, the patient appears jaundiced and is ill-appearing. There is shifting dullness present on abdominal percussion with a positive fluid wave. Sclera are icteric. Bilateral gynecomastia is present. Laboratory findings are significant for the following: Hgb 13 g/dL Leukocyte count 4,500/mm3 Platelets 86,000/mm3 Aspartate transaminase (AST) 108 U/L Alanine transaminase (ALT) 55 U/L GGT 185 U/L Urea 23 mg/dL Iron 120 μg/dL Ferritin 180 μg/dL Transferrin saturation 40% Which of the following is the most likely diagnosis in this patient?

A 67-year-old man comes to the physician for a routine examination. He does not take any medications. He drinks 6 to 7 bottles of beer every night, and says he often has a shot of whiskey in the morning “for my headache.” He was recently fired from his job for arriving late. He says there is nothing wrong with his drinking but expresses frustration at his best friend no longer returning his calls. Which of the following is the most appropriate initial response by the physician?

A 38-year-old woman comes to the physician because of a 3-month history of moderate abdominal pain that is unresponsive to medication. She has a history of two spontaneous abortions at 11 and 12 weeks' gestation. Ultrasound examination of the abdomen shows normal liver parenchyma, a dilated portal vein, and splenic enlargement. Upper endoscopy shows dilated submucosal veins in the lower esophagus. Further evaluation of this patient is most likely to show which of the following findings?

A 72-year-old man comes to the emergency department for progressively worsening abdominal pain. The pain began 2 weeks ago and is localized to the right upper quadrant. He feels sick and fatigued. He also reports breathlessness when climbing the stairs to his first-floor apartment. He is a retired painter. He has hypertension and type 2 diabetes mellitus. He is sexually active with one female partner and does not use condoms consistently. He began having sexual relations with his most recent partner 2 months ago. He smoked 1 pack of cigarettes daily for 40 years but quit 10 years ago. He does not drink alcohol. Current medications include insulin and enalapril. He is 181 cm (5 ft 11 in) tall and weighs 110 kg (264 lb); BMI is 33.5 kg/m2. His vital signs are within normal limits. Physical examination shows jaundice, a distended abdomen, and tender hepatomegaly. There is no jugular venous distention. A grade 2/6 systolic ejection murmur is heard along the right upper sternal border. Laboratory studies show: Hemoglobin 18.9 g/dL Aspartate aminotransferase 450 U/L Alanine aminotransferase 335 U/L Total bilirubin 2.1 mg/dL Which of the following is the most likely cause of his symptoms?