Ch 12 disorders of the liver and biliary tract

1. Which way does blood flow in the hepatic lobule?

A. From the central vein to the portal triad

B. From the portal vein to the intestinal vein

C. From the central vein to the hepatic sinusoid

D. From the portal vein to the central vein

D

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

2. Which one of the following is true about the enterohepatic circulation?

A. It carries fat from intestine to liver.

B. It recirculates bile acids.

C. It distributes blood within the hepatic lobule.

D. It distributes intrahepatic bile.

B

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

3. Which one of the following is true for unconjugated bilirubin?

A. It is produced directly from dead or hemolyzed red blood cells.

B. It is produced by the liver.

C. It is excreted into bile.

D. It is converted into urobilinogen.

A

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

4. Which one of the following is true about prehepatic jaundice?

A. It features increased conjugated bilirubin.

B. It is the same as cholestatic jaundice.

C. It suggests bile duct obstruction.

D. It can be caused by hemolysis.

D

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

5. Which one of the following is true in the presence of cholestasis?

A. It is usually accompanied by jaundice and sometimes by severe pruritus.

B. It is always accompanied by marked conjugated hyperbilirubinemia.

C. Blood cholesterol level is unusually low.

D. Liver enzyme levels are normal.

A

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

6. Which one of the following is a feature of hepatic failure?

A. Hemolysis

B. Asterixis

C. Thromboemboli

D. Increased plasma albumin

B

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

7. Which one of the following statements is true?

A. Most biliary cirrhosis is caused by hepatitis.

B. In most cases of cirrhosis, the cause can be determined by study of the liver.

C. Portal cirrhosis is the most common type of cirrhosis and is caused by diffuse liver cell injury.

D. Alcoholic cirrhosis can be reversed by abstinence from alcohol.

C

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

8. Which one of the following is a consequence of portal hypertension?

A. Palmar erythema and spider angiomas

B. Hypoalbuminemia

C. Esophageal varices

D. Jaundice

C

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

9. Which one of the following is true about the carrier state of hepatitis infection?

A. It is especially likely with hepatitis A.

B. It is asymptomatic.

C. It is more common for hepatitis B than for hepatitis C.

D. It is not infectious.

B

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

10. Which of the following is true about hepatitis B surface antigen (HBsAg) in blood?

A. It indicates hepatitis B virus is present and infectious.

B. It indicates immunity to reinfection.

C. It is replaced by antibodies in chronic hepatitis or the carrier state.

D. It signifies rapid virus replication.

A

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

11. In the United States, which one of the following is the principal risk factor for hepatitis C infection?

A. Blood or blood product transfusion

B. Sexual activity

C. Intravenous drug use

D. Accidental needle stick

C

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

12. Which one of the following statements about alcoholic liver disease is true?

Most alcoholics develop cirrhosis.

Most alcoholic cirrhosis is caused by bile duct inflammation.

Alcoholic cirrhosis is second only to chronic viral hepatitis as a cause of adult liver transplantation in the United States.

Most cirrhotic livers are enlarged.

C

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

13. Concerning hemochromatosis, which is true?

A. Iron deposits mainly occur in the brain and bile ducts.

B. Hemochromatosis is caused by a genetic defect.

C. Females are far more often affected than males are.

D. Acquired (secondary) hemochromatosis is usually caused by dietary iron overload.

B

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

14. Which one of the following is true about primary biliary cirrhosis?

A. It usually occurs in patients with ulcerative colitis.

B. It features the presence of antimitochondrial antibody in blood.

C. It may involve the extrahepatic bile ducts.

D. It carries marked increased risk for hepatocellular carcinoma.

B

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

15. Concerning hepatocellular carcinoma, which one of the following is true?

A. It is more common in the United States than worldwide.

B. Most patients survive 5 years.

C. The most common cause is chronic hepatitis B or hepatitis C infection.

D. It is a tumor of bile duct epithelium.

C

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

16. Concerning cholesterol gallstones, which one of the following is true?

A. They are less common than pigment stones.

B. They occur because liver cholesterol production and excretion are increased.

C. They are especially common in whites of northern European extraction.

D. Men are three times more likely to have cholesterol gallstones than women.

B

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

17. Concerning cholelithiasis and cholecystitis, which one of the following is true?

A. Escherichia coli is commonly found in the bile in acute cholecystitis.

B. Most patients with cholecystitis have gallstones in the gallbladder.

C. Most people in the United States experience gallstones at some time in their life.

D. Cholesterol stones form only in the bile ducts, not in the gallbladder.

B

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

18. In cirrhosis which one of the following is caused by accumulations of estrogen?

A. Spider angiomas

B. Fetor hepaticus

C. Coagulation defects

D. Jaundice

A

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

19. The carrier state in chronic hepatitis infection is defined by which one of the following?

A. Mild jaundice

B. Increased blood alkaline phosphatase

C. Mild cholestasis

D. No symptoms

D

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

20. Which one of the following is a marker that indicates that hepatitis B virus is present in blood?

A. HBsAg

B. IgM anti-HBsAg

C. IgA anti-HBsAg

D. IgG anti-HBsAg

A

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

21. Which one of the following is true?

Few patients with autoimmune hepatitis have other autoimmune disease.

In nations with poor sanitary facilities, the most common cause of liver abscess is bacterial infection by Escherichia coli.

The most common cause of toxic injury to the liver is unpredictable (idiosyncratic) reaction to chemicals or drugs, where the injury is not dose related.

Anatomically, alcoholic cirrhosis is distinctive and unlike most other types of cirrhosis.

C

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

22. A 43-year-old female, with a past medical history of schizophrenia, is brought to ER after she began to vomit blood. An upper endoscopy demonstrates multiple enlarged/bleeding varices and an abdominal ultrasound is remarkable for cirrhosis. When you attempt to discuss your findings with the patient, she tells you it all runs in the family as her mother was just like her. Blood tests for hepatitis and iron are normal, but a blood copper level is markedly elevated. What is your diagnosis?

A. Hemochromatosis

B. Nonalcoholic steatohepatitis

C. Alpha-1-antitrypsin deficiency

D. Wilson disease

D

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

23. A 25-year-old college student visits your office prior to going on a mission trip to Mexico. She requests that you check the titers of her hepatitis vaccine to make sure that she does not need to repeat the series. Which vaccine is she talking about?

A. HEV

B. HBV

C. HCV

D. HDV

B

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

24. A 63-year-old female presents to the clinic complaining of fatigue and pruritis. Her physical exam is notable for a rash across her cheeks and the bridge of her nose, jaundice, and hepatomegaly. Her labs are notable for antimitochondrial antibody and elevated alkaline phosphate. Which of the following biopsy results would confirm your suspicion of primary biliary cirrhosis?

A. An accumulation of lymphocytes surrounding bile ducts

B. Onionskin fibrosis that encircles bile ducts

C. Ground glass nuclear inclusions within hepatocytes

D. Portal triad fibrosis with intraepithelial lymphocytes

A

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

25. True or False? Blood flows from the portal areas of the hepatic lobule to the central vein.

True

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

26. True or False? Bile flows from the center of the hepatic lobule to the periphery.

True

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

27. True or False? The liver produces all immunoglobulin proteins.

False

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

28. True or False? The liver produces unconjugated bilirubin.

False

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

29. True or False? Prehepatic jaundice refers to increased conjugated bilirubin.

False

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

30. True or False? Gilbert syndrome is a rare inherited syndrome of conjugated hyperbilirubinemia.

False

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

31. True or False? Cholestasis refers to impaired bile formation and bile flow that leads to accumulation of bile pigments in the liver.

True

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

32. True or False? The palmar erythema and spider angiomata of liver failure are caused by an accumulation of ammonia.

False

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

33. True or False? Portal cirrhosis is the type of cirrhosis that results from extrahepatic biliary obstruction.

False

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

34. True or False? In cirrhosis, liver failure is caused by massive necrosis of hepatocytes.

False

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

35. True or False? Worldwide, the most common cause of epidemic hepatitis is hepatitis A.

True

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

36. True or False? Among hepatitis carriers only those with symptomatic chronic hepatitis are infectious.

False

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

37. True or False? In the antibody response to hepatitis, IgM antibodies are last to appear, and they convey permanent immunity.

False

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

38. True or False? The most common cause of viral hepatitis infection in the United States is hepatitis C infection.

False

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

39. True or False? Hepatitis B and C are spread mainly by needles or sexual contact.

True

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

40. True or False? Among all hepatitis viruses, hepatitis B virus is the most likely to produce chronic hepatitis or cirrhosis.

False

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

41. True or False? Most patients with autoimmune hepatitis also have other autoimmune disease.

True

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

42. True or False? Worldwide, most liver abscesses are amebic abscesses caused by Entameba histolytica.

True

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

43. True or False? The number of Reye syndrome cases has been decreased by treatment with aspirin.

False

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

44. True or False? Alcoholic cirrhosis is the leading cause of transplants in the United States.

False

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

45. True or False? The first sign of alcoholic liver injury is fatty metamorphosis (steatosis) of hepatocytes.

True

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

46. True or False? Episodes of alcoholic hepatitis have about a low (1-5%) mortality risk.

False

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

47. True or False? Alcoholic cirrhosis is not reversible.

True

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

48. True or False? Patients with hemochromatosis develop cirrhosis regardless of therapy.

False

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

49. True or False? Most neonates with hereditary alpha-1-antitrypsin (AAT) deficiency develop neonatal hepatitis.

False

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

50. True or False? Gilbert syndrome and Crigler-Najjar syndrome are caused by defects in the same gene.

True

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

51. True or False? Reye syndrome is a combination of fatty liver and heart failure attributable to viral illness and aspirin therapy.

False

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

52. True or False? Most patients with ascending cholangitis have ulcerative colitis.

False

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

53. True or False? Primary sclerosing cholangitis features inflammation of the hepatic bile ducts.

True

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

54. True or False? Wilson disease is an inherited disease that causes copper to accumulate mainly in the brain and the liver.

True

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

55. True or False? All forms of viral hepatitis are associated with an increase in conjugated bilirubin and jaundice.

False

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

56. True or False? Most patients with ascending cholangitis have gallstones in the bile ducts.

True

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

57. True or False? Gallstones are more common in women, southwestern Native Americans, Hispanics, and the obese than they are in the average population.

True

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

58. True or False? Large, single gallstones are the cause of most symptomatic cholelithiasis and cholecystitis.

False

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

59. True or False? Gallstones usually do not cause symptoms until they begin to move through bile ducts.

True

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

60. True or False? Ascending cholangitis is a bacterial infection of the biliary tree caused by intestinal bacteria.

True

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

61. True or False? Fever is a common symptom associated with cholelithiasis and is not a cause for concern.

False

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

62. True or False? An estimated two-thirds of all obese persons have some degree of nonalcoholic fatty liver disease.

True

Subject: Chapter 12: Disorders of the Liver and Biliary Tract

63. True or False? Hepatic adenoma is a benign neoplasm of hepatocytes that can cause life-threatening hemorrhage, especially during pregnancy.

True

Subject: Chapter 12: Disorders of the Liver and Biliary Tract