Hepatitis C and hepatocellular carcinoma — MCQs

A scientist is researching the long term effects of the hepatitis viruses on hepatic tissue. She finds that certain strains are oncogenic and increase the risk of hepatocellular carcinoma. However, they appear to do so via different mechanisms. Which of the following answer choices correctly pairs the hepatitis virus with the correct oncogenic process?

A 32-year-old woman comes to the physician because of a 3-month history of fatigue and myalgia. Over the past month, she has had intermittent episodes of nausea. She has a history of intravenous drug use, but she has not used illicit drugs for the past five years. She has smoked one pack of cigarettes daily for 14 years and drinks one alcoholic beverage daily. She takes no medications. Her last visit to a physician was 4 years ago. Her temperature is 37°C (98.6°F), pulse is 90/min, respirations are 20/min, and blood pressure is 110/70 mm Hg. Physical examination shows jaundice and hepatosplenomegaly. There are also blisters and erosions on the dorsum of both hands. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 12 g/dL Leukocyte count 8,300/mm3 Platelet count 250,000/mm3 Serum Glucose 170 mg/dL Albumin 3.0 g/dL Total bilirubin 2.2 mg/dL Alkaline phosphatase 80 U/L AST 92 U/L ALT 76 U/L Hepatitis B surface antigen negative Hepatitis B surface antibody positive Hepatitis B core antibody positive Hepatitis C antibody positive Which of the following is the most appropriate next step in diagnosis?

A 56-year-old African American presents to the emergency department due to abdominal pain, fatigue, and weight loss over the past 3 months. He has a long-standing history of chronic hepatitis B virus infection complicated by cirrhosis. On examination, he has jaundice, leg edema, and a palpable mass in the right upper abdominal quadrant. Abdominal ultrasound shows a 3-cm liver mass with poorly defined margins and coarse, irregular internal echoes. Lab results are shown: Aspartate aminotransferase (AST) 90 U/L Alanine aminotransferase (ALT) 50 U/L Total bilirubin 2 mg/dL Albumin 3 g/dL Alkaline phosphatase 100 U/L Alpha-fetoprotein 600 ng/mL Which of the following is a feature of this patient's condition?

A 47-year-old woman comes to the physician because of a 3-week history of generalized fatigue, mild fever, abdominal pain, and nausea. She attended the state fair over a month ago, where she tried a number of regional foods, and wonders if it might have been caused by something she ate. She has also noticed darkening of her urine, which she attributes to not drinking enough water recently. She has type 2 diabetes mellitus. She drinks 1–2 beers daily. She works as nursing assistant in a rehabilitation facility. Current medications include glyburide, sitagliptin, and a multivitamin. She appears tired. Her temperature is 38.1°C (100.6°F), pulse is 99/min, and blood pressure is 110/74 mm Hg. Examination shows mild scleral icterus. The liver is palpated 2–3 cm below the right costal margin and is tender. Laboratory studies show: Hemoglobin 10.6 g/dL Leukocyte count 11600/mm3 Platelet count 221,000/mm3 Serum Urea nitrogen 26 mg/dL Glucose 122 mg/dL Creatinine 1.3 mg/dL Bilirubin 3.6 mg/dL Total 3.6 mg/dL Direct 2.4 mg/dL Alkaline phosphatase 72 U/L AST 488 U/L ALT 798 U/L Hepatitis A IgG antibody (HAV-IgG) positive Hepatitis B surface antigen (HBsAg) positive Hepatitis B core IgG antibody (anti-HBc) positive Hepatitis B envelope antigen (HBeAg) positive Hepatitis C antibody (anti-HCV) negative Which of the following is the most likely diagnosis?

A previously healthy 48-year-old man comes to the physician because of a 2-month history of weight loss and yellowing of the skin. He works as a farmer and cultivates soybean and corn. He does not smoke, drink alcohol, or use illicit drugs. His vital signs are within normal limits. Physical examination shows scleral icterus and tender hepatomegaly. Ultrasonography of the abdomen shows a 5-cm nodular lesion in the right lobe of the liver. Further evaluation of the lesion confirms hepatocellular carcinoma. The activity of which of the following enzymes most likely contributed to the pathogenesis of this patient's condition?

An investigator is studying the rate of multiplication of hepatitis C virus in hepatocytes. The viral genomic material is isolated, enzymatically cleaved into smaller fragments and then separated on a formaldehyde agarose gel membrane. Targeted probes are then applied to the gel and visualized under x-ray. Which of the following is the most likely structure being identified by this test?

A 42-year-old male with a history significant for IV drug use comes to the emergency department complaining of persistent fatigue and malaise for the past three weeks. On physical exam, you observe a lethargic male with icteric sclera and hepatomegaly. AST and ALT are elevated at 600 and 750, respectively. HCV RNA is positive. Albumin is 3.8 g/dL and PT is 12. A liver biopsy shows significant inflammation with bridging fibrosis. What is the current first-line treatment?

A 63-year-old man presents to his primary care physician because he has been having headaches and hearing loss. In addition, he says that he has been having difficulty opening his jaw to eat and recurrent middle ear infections. Physical exam reveals enlarged neck lymph nodes and a mass in the nasopharynx. Biopsy of the mass reveals undifferentiated squamous epithelial cells. The organism that is most likely associated with this patient's disease is also associated with which of the following disorders?

A 30-year-old woman presents to the clinic because of fever, joint pain, and a rash on her lower extremities. She admits to intravenous drug use. Physical examination reveals palpable petechiae and purpura on her lower extremities. Laboratory results reveal a negative antinuclear antibody, positive rheumatoid factor, and positive serum cryoglobulins. Which of the following underlying conditions in this patient is responsible for these findings?

A 48-year-old homeless male presents to the ED because he hasn’t felt well recently. He states that he has been feeling nauseous and extremely weak over the past few days. He has several previous admissions for alcohol intoxication and uses heroin occasionally. His temperature is 100.9°F (38.3°C), blood pressure is 127/89 mmHg, and pulse is 101/min. His physical examination is notable for palmar erythema, tender hepatomegaly, and gynecomastia. His laboratory findings are notable for: AST: 170 U/L ALT: 60 U/L GGT: 400 (normal range: 0-45 U/L) Alkaline phosphatase: 150 IU/L Direct bilirubin: 0.2 mg/dL Total bilirubin: 0.8 mg/dL WBC: 10,500 Serum iron: 100 µg/dL TIBC: 300 µg/dL (normal range: 250–370 µg/dL) Serum acetaminophen screen: Negative Serum AFP: 6 ng/mL (normal range: < 10ng/mL) Which of the following is the most likely cause of this patient’s symptoms?