Liver disease — MCQs

A 36-year-old woman is brought to the emergency department after being involved in a motor vehicle collision. She is alert, awake, and oriented. There is no family history of serious illness and her only medication is an oral contraceptive. Her temperature is 37.3°C (99°F), pulse is 100/min, respirations are 20/min, and blood pressure is 102/80 mm Hg. Physical examination shows ecchymoses over the trunk and abdomen. A FAST scan of the abdomen is negative. An x-ray of the chest shows no fractures. A contrast-enhanced CT scan of the chest and abdomen is performed that shows a 4-cm sharply defined liver mass with a hypoattenuated central scar. Which of the following is the most appropriate next step in management?

A 39-year-old woman presents to the family medicine clinic to be evaluated by her physician for weight gain. She reports feeling fatigued most of the day despite eating a healthy diet and exercising regularly. The patient smokes a half-pack of cigarettes daily and has done so for the last 23 years. She is employed as a phlebotomist by the Red Cross. She has a history of hyperlipidemia for which she takes atorvastatin. She is unaware of her vaccination history, and there is no documented record of her receiving any vaccinations. Her heart rate is 76/min, respiratory rate is 14/min, temperature is 37.3°C (99.1°F), body mass index (BMI) is 33 kg/m2, and blood pressure is 128/78 mm Hg. The patient appears alert and oriented. Lung and heart auscultation are without audible abnormalities. The physician orders a thyroid panel to determine if that patient has hypothyroidism. Which of the following recommendations may be appropriate for the patient at this time?

A 62-year-old man with a history notable for alpha-thalassemia now presents to an urgent care clinic with complaints of increased thirst and urinary frequency. The physical exam is unremarkable, although there is a bronze discoloration of his skin. The laboratory analysis reveals a fasting blood glucose of 192 mg/dL, and a HbA1c of 8.7. Given the following options, what is the best treatment for the patient’s underlying disease?

A 57-year-old man is brought to the emergency department by a social worker from the homeless shelter. The man was acting strangely and then found unresponsive in his room. The social worker says she noticed many empty pill bottles near his bed. The patient has a past medical history of multiple hospital admissions for acute pancreatitis, dehydration, and suicide attempts. He is not currently taking any medications and is a known IV drug user. His temperature is 99.2°F (37.3°C), blood pressure is 107/48 mmHg, pulse is 140/min, respirations are 22/min, and oxygen saturation is 98% on room air. Physical exam is notable for a man with a Glasgow coma scale of 6. Laboratory values are ordered as seen below. Hemoglobin: 10 g/dL Hematocrit: 30% Leukocyte count: 5,500/mm^3 with normal differential Platelet count: 147,000/mm^3 Serum: Albumin: 1.9 g/dL Na+: 139 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L HCO3-: 25 mEq/L BUN: 29 mg/dL Glucose: 65 mg/dL Creatinine: 1.5 mg/dL Ca2+: 10.2 mg/dL Prothrombin time: 27 seconds Partial thromboplastin time: 67 seconds AST: 12 U/L ALT: 10 U/L Which of the following is the most appropriate immediate management for this patient?

A 56-year-old female presents for initial evaluation by a rheumatologist with a chief complaint of back and joint pain. She says that she has been having mild pain for years, but that the pain has become worse over the course of the last 6 months. She clarifies that the pain is most severe in the mornings just after waking up but seems to improve throughout the day. She also notices that her mouth feels dry and she has difficulty eating dry food such as crackers. Finally, she has the sensation of having bits of sand in her eyes. She denies any past medical history or medication use. Serology for which of the following would most likely be positive in this patient?

A 15-year-old boy is brought to the emergency room for evaluation of malaise, dyspnea, and yellow skin and sclera. On examination, he is tachycardic, tachypneic, and the O2 saturation is less than 90%. The levels of unconjugated bilirubin and hemoglobinemia are increased, and there is an increased number of reticulocytes in the peripheral blood. What is the most likely diagnosis?

A 42-year-old woman comes to the physician because of a 2-month history of generalized itching and worsening fatigue. There is no personal or family history of serious illness. She takes eye drops for dry eyes. She occasionally takes acetaminophen for recurrent headaches. She drinks one alcoholic beverage daily. Vital signs are within normal limits. Examination shows jaundice and a nontender abdomen. The liver is palpated 3 cm below the right costal margin and the spleen is palpated 2 cm below the left costal margin. Laboratory studies show: Hemoglobin 15.3 g/dL Leukocyte count 8,400/mm3 Prothrombin time 13 seconds Serum Bilirubin Total 3.5 mg/dL Direct 2.4 mg/dL Alkaline phosphatase 396 U/L Aspartate aminotransferase (AST, GOT) 79 U/L Alanine aminotransferase (ALT, GPT) 73 U/L A liver biopsy specimen shows inflammation and destruction of small- and medium-sized intrahepatic bile ducts. Magnetic resonance cholangiopancreatography (MRCP) shows multiple small stones within the gallbladder and a normal appearance of extrahepatic bile ducts. Which of the following is the most appropriate next step in management?

A 59-year-old man comes to the emergency department because of progressive abdominal swelling and shortness of breath for 1 week. He drinks 12 to 13 alcoholic beverages daily. He appears emaciated. Examination shows pallor, jaundice, hepatomegaly, gynecomastia, and a protuberant abdomen with a fluid wave and shifting dullness. Periodic monitoring of which of the following markers is most appropriate for this patient?

A 45-year-old man comes to the clinic complaining of yellow skin and eyes, loss of appetite, and severe nausea over the last month or so. He drinks 2–3 beers everyday and about 5–6 on the weekend. He does not take any over-the-counter medications. He has smoked one pack of cigarettes every day for the last 20 years but does not use illicit drugs. Additionally, he reports no history of vomiting, abdominal pain, altered bowel habits, or unintentional weight loss. His temperature is 37°C (98.6°F), blood pressure is 135/85 mm Hg, pulse is 78/ min, respiratory rate is 14/ min, and BMI is 19 kg/m2. On physical examination his skin and sclera are icteric, and his abdomen is tender with a mildly enlarged liver. On laboratory investigations: Complete blood count Hemoglobin 11 g/dL MCV 105 µm3 White blood cell 14,000/mm3 Platelets 110,000/mm3 Which of the following liver function analyses is expected in this patient?

A 54-year-old male presents to the emergency department after an episode of bloody vomiting. He is a chronic alcoholic with a history of cirrhosis, and this is the third time he is presenting with this complaint. His first two episodes of hematemesis required endoscopic management of bleeding esophageal varices. His hemoglobin on admission laboratory evaluation was 11.2 g/dL. The patient is stabilized, and upper endoscopy is performed with successful banding of bleeding varices. Follow-up lab-work shows hemoglobin levels of 10.9 g/dL and 11.1 g/dL on days 1 and 2 after admission. Which of the following is the best next step in the management of this patient?