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Multiple Choice Questions (MCQ)

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Category: Gastrointestinal, Nutrition and Genitourinary Disorders--->Liver
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Question 1#Print Question

A 53-year-old male with past medical history significant for alcoholic cirrhosis complicated by esophageal varices presents to the intensive care unit (ICU) with hypoxia. He has noticed dyspnea on exertion that has been worsening over the last several months and complains of platypnea (shortness of breath relieved by lying down). Breath sounds are clear. Chest radiography is normal and contrast chest CT is negative for pulmonary embolus.

Which of the following is the MOST definitive treatment option for his disease?

A. Broad spectrum antibiotics
B. Therapeutic paracentesis
C. Nebulized bronchodilators
D. Listing for liver transplantation
E. Bronchoscopy


Question 2#Print Question

A patient presents with elevated aminotransferases approximately 15 times the upper limit of normal. Other laboratory values include:

  • international normalized ratio of 1.9
  • creatinine 0.9 mg/dL
  • lactate of 1.9 mmol/L

The systemic arterial blood pressure is 90/50 mm Hg and the central venous pressure is 6 mm Hg. 

Which of the following is LEAST likely to be the etiology of the liver dysfunction?

A. Acute viral hepatitis
B. Ischemic hepatitis
C. Acetaminophen toxicity
D. Portal vein thrombosis
E. HELLP syndrome


Question 3#Print Question

A 63-year-old female with history of cirrhosis complicated by ascites requiring previous paracentesis presents with fever, abdominal pain, and hypotension. Diagnostic paracentesis shows gramnegative bacteria on Gram stain and neutrophil count of 400 cells/mm3

Which of the following is the BEST next step in management?

A. Abdominal CT scan
B. Initiate therapy with cefotaxime
C. Right upper quadrant ultrasound
D. Initiate therapy with vancomycin
E. Large volume paracentesis


Question 4#Print Question

A 63-year-old male is in the ICU waiting to be listed for liver transplantation. He has become increasingly agitated and combative. His :

  • white blood cell count is 8200 cells/µL
  • sodium is 132 mEq/L
  • potassium is 3.1 mEq/L
  • creatinine is 0.9 mg/dL
  • blood urea nitrogen is 15 mg/dL

Head CT reveals mild cerebral edema with no bleed or focal abnormality. He is receiving lactulose and having bowel movements three times daily. 

Which of the following is MOST LIKELY to improve his agitation?

 

A. Intermittent midazolam
B. Bisacodyl suppository
C. Soft restraints
D. Broad spectrum antibiotics
E. Potassium repletion


Question 5#Print Question

A 62-year-old male with a history of hepatic cirrhosis complicated by ascites and esophageal varices presents with decreased urine output. His creatinine is elevated at 1.4 mg/dL. Investigation of the urine reveals fractional excretion of sodium <1%, no casts or blood cells, no protein, and renal ultrasound was normal. No improvement in urine output or creatinine is achieved after several doses of albumin. His white blood cell count is 7600 cells/µL, diagnostic paracentesis was not suggestive of infection, and his blood pressure is 98/62 mm Hg. 

Which of the following is the MOST effective next treatment?

A. Norepinephrine infusion
B. 2 L of normal saline bolus
C. Broad spectrum antibiotics
D. Corticosteroids
E. Diuretics




Category: Gastrointestinal, Nutrition and Genitourinary Disorders--->Liver
Page: 1 of 2