Multiple Choice Questions

Abstract

1.Regarding drug induced liver injury (DILI) the following are TRUE EXCEPT:1.Most common cause of drug induced acute liver failure in India is paracetamol.2.Most common cause of drug induced liver injury in India is antitubercular drugs.3.Degree of liver enzyme elevation correlates with severity of liver disease.4.Clinical jaundice is a predictor of mortality.5.Cholestatic pattern of DILI can be prolonged even on stopping the offending drug.2.Regarding surgery in patients with liver disease the following are TRUE:1.Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) scores can reliably predict operative mortality in chronic liver disease.2.Acute viral hepatitis is not a contraindication for surgery.3.Laparoscopic cholecystectomy can be safely performed in compensated cirrhotics.4.Umbilical hernias have low risk of complications in cirrhotics and elective repair should not be attempted.5.Preferred anaesthetic agents include sevoflurane, desflurane and isoflurane.3.Regarding peri-operative monitoring after liver transplantation the following are TRUE:1.Cardiovascular events are the most common cause of readmission to intensive care and non-graft related deaths after liver transplantation.2.Conventional tests of coagulation like prothrombin time, activated partial thromboplastin time, platelet count and plasma fibrinogen levels are sufficient measure of coagulation intra-operatively.3.Hyperglycemia is an ominous sign of poor graft function.4.Serum potassium levels are independent predictors of death after liver transplantation.5.Commonest acid-base disorder in the immediate post-operative period is metabolic acidosis.4.Regarding tuberculosis (TB) in chronic liver disease the following are TRUE EXCEPT:1.Cirrhotic patients have a higher chance of developing extra-pulmonary tuberculosis than those without cirrhosis.2.Adenosine deaminase for diagnosis of TB in cirrhosis with ascites has high sensitivity.3.Tuberculin skin testing is sensitive for the diagnosis of TB in cirrhotic patients.4.Likelihood of anti-tubercular drug induced hepatotoxicity is higher in pre-existing liver disease patients.5.Isoniazid induced hepatotoxicity is more common in slow acetylators.5.Regarding hepatotoxicity of anti-tubercular therapy (ATT) the following are TRUE:1.Rechallenge with isoniazid is contraindicated if patient has history of isoniazid induced hepatotoxicity.2.Isoniazid induced transaminitis is self limited and asymptomatic in majority of patients.3.Isolated conjugated hyperbilirubinemia is seen with rifampicin.4.Pyrazinamide mainly causes idiosyncratic hepatotoxicity.5.Inactive carriers of hepatitis B do not have increased risk of ATT induced hepatotoxicity.6.Regarding Budd-Chiari syndrome (BCS) the following are TRUE EXCEPT:1.Most common cause of BCS in India is membranous obstruction of inferior vena cava.2.Ascites with high protein and high serum ascitic albumin gradient is suggestive of BCS.3.Initial imaging modality of choice to diagnose BCS is magnetic resonance venogram.4.Failure to visualize the hepatic veins on Doppler is diagnostic of BCS.5.Direct intrahepatic portosystemic shunt can be done even if all hepatic vein ostia are blocked.7.Regarding the role of gut microbiota in hepatic encephalopathy (HE) the following are TRUE:1.Markers of systemic inflammation are better correlated with HE than the severity of liver disease.2.Pathogen associated molecular patterns (PAMPs) are microbial components that initiate inflammatory cascade.3.Gut microbiota of patients with cirrhosis and normal controls is similar.4.Lactulose exerts its actions in HE predominantly by altering the composition of gut microbiota.5.Stool microbiota is an accurate estimate of intestinal microbiota.8.Regarding primary sclerosing cholangitis (PSC) the following are TRUE:1.Majority of patients with PSC have isolated extrahepatic disease.2.Magnetic resonance cholangiography is the diagnostic modality of choice.3.Dominant stricture is a stenosis with a diameter of <1.5 mm in the hepatic duct or of <1 mm in the common bile duct.4.Inflammatory bowel disease is usually diagnosed after diagnosis of PSC.5.Cholecystectomy is recommended in a patient with PSC with a gallbladder mass lesion, irrespective of its size.9.Regarding primary biliary cirrhosis (PBC) the following are TRUE EXCEPT:1.Antimitochondrial antibodies (AMA) are highly sensitive and specific for the diagnosis of PBC.2.AMA negative cases of PBC have less aggressive disease and better prognosis.3.Ursodeoxycholic acid improves symptoms but does not alter natural course of PBC.4.Modafinil may improve fatigue in patients with PBC.5.Sjogren's syndrome occurs more frequently in PBC than matched controls.10.Regarding overlap syndromes the following are TRUE:1.Overlap of autoimmune hepatitis (AIH) and PBC is the most common variant.2.Overlap of PSC and PBC is common.3.Autoimmune sclerosing cholangitis refers to features of PSC in children with AIH.4.The components of the overlap syndrome may develop sequentially with one appearing years after the first.5.UDCA does not have a beneficial role in overlap syndromes.