Show questions one by one1. Regarding the liver, all are true except A. ? 15% of the liver is composed of cells other than hepatocytes B. ? clearance of bacteria, viruses and erythrocytes is done by Kupffer cells C. ? Ito cells have a role in the uptake and storage of vitamin A D. ? Vitamin K and folic acids are stored in a huge amount E. ? hapatic synthesis of urea, endogenous proteins and amino acid release by the liver all are suppressed during fasting 2. The following statements are true except A. ? low blood urea is seen in many acute and chronic liver diseases B. ? high blood urea in the context of severe liver damage may indicates gastrointestinal hemorrhage or hepatorenal syndrome C. ? hyponatremia is very common in severe liver disease and usually multifactorial D. ? raised gamma GT enzyme level may occur during treatment with carbamazepin E. ? large increase in serum aminotrnsferases activity with a small rise in alkaline phsophatase activity is in favor of biliary obstruction 3. Drugs that induce hepatic microsomal enzymes, all are true except A. ? chronic ethanol ingestion B. ? glucocorticoids C. ? Grisofulvin D. ? carbamazepin E. ? Cimetidin 4. Imaging in liver diseases, all are true except: A. ? ultrasound of the liver is a rapid, cheap and easy method and usually the first imaging to be done, yet its main limitation is that small focal lesions less than 2 cm will be missed B. ? color Doppler studies are very useful and used to investigate hepatic veins, portal vein and hepatic artery diseases C. ? MRI is usually used for pancreaticobiliary diseases rather than parenchymal liver diseases D. ? outlining the biliary tree can be done by injecting a contrast medium into the biliary tree through the skin or by an endoscopic approach E. ? plain abdominal radiographs are very helpful in liver diseases 5. Regarding liver biopsy, all are true except A. ? the patient should be cooperative B. ? the PT prolongation if present, should be less than 4 seconds above the upper normal control value C. ? severe COPD is a contraindication D. ? marked ascites will make the procedure easier E. ? local skin infection should not be present 6. Regarding the metabolism of bilirubins , all are true except A. ? every day, about 300 mg of indirect bilirubin is produced B. ? jaundice will be seen clinically if the total bilirubin exceeds 50 micromole / L C. ? about 100-200 mg of stercobilinogen is lost in stool D. ? about 40 mg of urobilinogen is passed outside in urine E. ? the indirect bilirubin will be conjugated in the endoplasmic reticulum of hepatocytes to be water soluble 7. Causes of indirect hyperbilirubinemia ,all are true except A. ? B12 deficiency B. ? Wilson's disease C. ? Gilbert's syndrome D. ? Rotor syndrome E. ? major ABO incompatibility reaction 8. When examining a patient with a direct bilirubin of 30 micromole / L, all are useful signs in guessing the diagnosis, except A. ? a palpable gall bladder B. ? an upper abdominal paramedian scar C. ? irregular hard liver D. ? upper midline abdominal mass E. ? scratcing marks 9. Local measure to stop a variceal upper GIT bleeding, all are true except A. ? banding B. ? sclerotherapy C. ? esophageal transection D. ? ballon tamponade E. ? terlipressin infusion 10. Measures to prevent variceal recurrent upper GIT bleeding, all are true except A. ? oral propranolol B. ? sclerotherapy / banding C. ? transjugular intra hepatic portosystemic shunt ( TIPSS D. ? esophageal transection E. ? selective or non selective portosystemic shunt surgery 11. A patient with chronic liver disease presents with upper GIT bleeding , all are true except A. ? upper GIT endoscope should be done in all cases as 20% of cases the bleeding is non variceal B. ? despite all advances in the management, the mortality rate is still high C. ? portosystemic shunt surgery in this patient may have a mortality of 50% D. ? vasopressin is contraindicated in ischemic heart disease E. ? esophageal transection is commonly used as a first line treatment 12. TIPSS ( transjugular intrahepatic Porto-systemic shunt ) , all are true except A. ? it is done by placing a stent between the hepatic vein and the portal vein in the liver under radiological control. B. ? the objective is to produce a Porto systemic shunt to reduce the portal pressure and hence the variceal bleeding C. ? prior patency of the portal vein should checked before hand by angiography D. ? may precipitate or worsen hepatic encephalopathy E. ? when rebleeding occurs, the shunt should be removed 13. Spontaneous bacterial peritonitis in the context of cirrhosis, all are true except A. ? unfortunaterly, up to one third of cases the abdominal signs are mild or absent B. ? almost always a mono-microbial infection state C. ? recurrence is common but unfortunately there is no way to prevent it D. ? The commonest organisms are enteric gram negatives, but no source of infection is usually present E. ? the ascitic fluid is cloudy with more than 250 neutrophils / mm3 14. Precipitating factors for hepatic encephalopathy in a patient with cirrhosis, all are true except A. ? occult infection B. ? aggressive diuresis C. ? diarrhea or constipation D. ? treamtent with oral neomycin E. ? excesss dietary proteins 15. Differential diagnosis of hepatic encephalopathy, all are true except: A. ? primary psychiatric disease B. ? hypoglycemia C. ? Wernick's encephalopathy D. ? subdural hematoma E. ? treamtent by enemas 16. Acute fulminant hepatic failure, all are true except A. ? the commonest causes are viral hepatitis and medications- induced B. ? the hallmark is the presence of acute hepatic encephalopathy C. ? the absence of jaundice is against the diagnosis D. ? there are long listed complications and these usually complicates the picture further E. ? the patient should be managed in an intensive care unit or a high dependency unit once the PT is prolonged 17. Hepatorenal failure, all are true except A. ? carries a very bad prognosis unless hepatic transplantation is carried out B. ? one of the causes of fractional Na excretion of more than 1 . C. ? characterictically presents as rapidly evolving uremia with bland urinary sediment D. ? seen in advanced cirrhosis and ascites is almost always present E. ? Renal dose dopamine has a role in the management, yet the improvement in renal function depends entirely on improvement of the liver function 18. Causes of micro-vesicular steatosis, all are true except A. ? fatty liver of pregnancy B. ? Rye's syndrome C. ? treatment with didanosine D. ? Wolman's disease and Alpers syndrome E. ? treatment with amiodarone 19. Causes of acute hepatitis, all are true except A. ? Halothane B. ? Wilson's disease C. ? autoimmune hepatitis D. ? CMV E. ? hemochromatosis 20. Causes of chronic liver disease and cirrhosis, all are true except A. ? alpha 1 anti-trypsin deficiency B. ? Hepatitis C C. ? hemochromatosis D. ? autoimmune hepatitis E. ? EBV 21. Liver cirrhosis, all are true except A. ? hyperpigmentation is seen in hemochromatosis and prolonged biliary obstruction B. ? spider telangiectasias are seen early in the course of cirrhosis but 2 % in normal healthy population C. ? parotid gland enlargement goes with liver etiology D. ? ascites is seen early E. ? finger clubbing is a non specific sign 22. The hepatitis viruses, all are true except A. ? hepatitis A is an RNA enterovirus which does not lead to a carrier state B. ? hepatitis B is a DNA virus that 42 nm in diameter and leads to chronic infection up to 10% of adults versus 90% of neonatal hepatitis B infection C. ? hepatitis C is an RNA flavivirus that is the commonest cause of chronic liver disease in USA and of those infected ,up to 20 % of them will develop cirrhosis after 20 years D. ? hepatitis D is a defective RNA virus that can be prevented by preventing hepatitis B infection in high risk groups by using hepatitis B vaccine and immunoglobulin E. ? hepatitis E is a RNA calicivirus that carries a mortality of 2% if the infection occurs in pregnancy 23. The followings predict poor response to INF alpha treatment in chronic hepatitis B viral infection, except A. ? being a male B. ? pre-core mutant strains C. ? being an Asian D. ? very high pretreatment serum hepatitis B viral DNA level by PCR E. ? absence of cirrhosis 24. Autoimmnue hepatitis, all are true except A. ? type I is ANA and antismooth muscle antibodies positive, while type II is anti LKM antibodies positive B. ? amenorrhea is the rule and cushingoid faces may be seen C. ? 25% of cases present as a hepatitis like picture D. ? corticosterois are effective in the treatment of acute attacks and at prevention of future attacks but do not prevent the progression to frank cirrhosis E. ? hepatocelluar carcinoma as a complication is common 25. Histological changes in alcoholic liver disease, all are true except A. ? mitochonsrial swelling B. ? siderosis C. ? lipogranulomas D. ? autoimmune (interface) hepatitis E. ? few endoplasmic reticula 26. Primary biliary cirrhosis, all are true except A. ? anti mitochondrial antibodies are seen up to 96% of cases B. ? early, there is proliferation of small bile ductules C. ? hypercholesteremia is common and greatly increases the risk of coronary artery disease D. ? polished nails with clubbing is a good clue in an appropriate clinical setting E. ? ursodeyoxycholic acid has been shown to improve the liver function tests. 27. Primary sclerosing cholangitis , all are true except A. ? 80% of cases are seen in the context of ulcerative colitis B. ? spontaneuos ascending cholangitis is uncommon but usually occur after biliary instrumentation like post ERCP C. ? Is risk factor for cholangiocarcinoma D. ? there is an association with HIV infection and retroperitoneal fibrosis E. ? corticosterois and immune-suppressants are useful in the treatment 28. Hepatocelluar carcinoma (HCC ), all are true except A. ? occurs in the background of cirrhosis in up to 80% of cases B. ? chronic hepatitis B infection is the commonest cause world- wide C. ? may be treated by liver transplantation D. ? any patient with cirrhosis should be screened for the development of HCC by serial serum alpha fetoprotein and liver ultrasound E. ? the fibrolammellar variant has a very poor prognosis 29. Criteria for giving ursodeoxycholic acid as a medical treatment for gall stones solubilization , all are true except A. ? the stone should be radiolucent B. ? the stone size is up 15 mm C. ? functioning gall bladder D. ? moderate obesity E. ? prominent symptoms ascribed to the stone 30. Risk factors for pigment gall stones, all are true except A. ? liver cirrhosis B. ? biliary parasites C. ? chronic long term hemolysis D. ? ileal resection / disease E. ? pregnanacy