diff --git "a/enqa.json" "b/enqa.json" new file mode 100644--- /dev/null +++ "b/enqa.json" @@ -0,0 +1,7704 @@ +[ + { + "question": "In a child with active liver failure, the most important prognosis factor for death is –\n ", + "options": "A. Increasing transaminases\n B. Increasing bilirubin\n C. Increasing prothrombin time\n D. Gram (–)ve sepsis", + "answer": "D" + }, + { + "question": "Which one of the following is a muscle splitting incision?\n ", + "options": "A. Kocher's incision\n B. Rutherford-Morrison incision\n C. Pfannenstiel incision\n D. Lanz incision", + "answer": "D" + }, + { + "question": "Child of Vasanthi was weaned from breast milk on the 5th day and was given sugarcane juice the child developed hypoglycemia and hepatomegaly biochemical examination showed hypophosphatemia and enzyme deficiencies–reducing substances in urine. The child is probably suffering from which of the following enzyme deficiencies –\n ", + "options": "A. Fructokinase\n B. Aldolase B\n C. Glucose 6 Phosphatase\n D. Beta galactosidase", + "answer": "B" + }, + { + "question": "A neonate is being investigated for jaundice. A liver biopsy shows features of a \"Giant Cell/Neonatal hepatitis\". Which one of the following conditions usually results in this case –\n ", + "options": "A. Congenital hepatic fibrosis\n B. Hemochromatosis\n C. Alpha–1–antitrypsin deficiency\n D. Glycogen storage disease Type 1", + "answer": "C" + }, + { + "question": "In a child, surgery was done for biliary stricture with hepatojejunal anastomosis. Postoperative bilirubin level after 2 weeks was 6 mg/dL from a preoperative level 12mg/dL. The reason for this could be:\n ", + "options": "A. Normal lowering of bilirubin takes time\n B. Anastomotic stricture\n C. Delta bilirubin\n D. Mistake in lab technique", + "answer": "C" + }, + { + "question": "A neonate on routine examination at bih was found to have hepatomegaly. Rest of the examination was essentially unremarkable. On investigations, Anti-HCMV antibodies were found to be positive. What sequelae in later life is the child at risk of?\n ", + "options": "A. Renal failure\n B. Mental retardation\n C. Hepatic fibrosis\n D. Sensorineural hearing loss", + "answer": "D" + }, + { + "question": "Patient with increased PT, APTT & TT and normal fibrinogen and platelet counts, diagnosis is?\n ", + "options": "A. DIC\n B. Fac. VIII def.\n C. Liver disease\n D. Vitamin K deficiency", + "answer": "D" + }, + { + "question": "A child presented with abdominal distension, hepatomegaly, doll like facies and recurrent episodes of hypoglycemia. Which of the following is the most likely diagnosis?\n ", + "options": "A. Menkes disease\n B. Down syndrome\n C. Von gierke disease\n D. Lesch nyhan syndrome", + "answer": "C" + }, + { + "question": "A child has bilirubin of 4 mg. Conjugated bilirubin and alkaline phosphatase are normal, bile salts and bile in urine are absent. However urobilinogen in urine is raised. What is the likely diagnosis –\n ", + "options": "A. Obstructive jaundice\n B. Rotor's syndrome\n C. Biliary cholestasis\n D. Hemolytic jaundice", + "answer": "D" + }, + { + "question": "A 42 years old male patient presented with jaundice. His AST was 48 U, ALT was 51 U, ALP, GGTP were normal. Ultrasound of liver was suggestive of cirrhosis. Viral markers were done and the following results were obtained.TestResultAnti-HAVNegativeAnti-HBsAgNegativeAnti-HBeAgNegativeAnti-HBcAg IgGPositiveAnti-HBcAg IgMNegativeHBsAgNegativeAnti-HCVPositiveAnti-HEVNegativeWhat is the next best step in management of this patient?\n ", + "options": "A. Sta interferon therapy\n B. Liver biopsy\n C. -PCR for hepatitis C virus\n D. PCR for HBV-DNA", + "answer": "C" + }, + { + "question": "A case of jaundice with 50% direct bilirubin, other LFTs normal. Diagnosis is –\n ", + "options": "A. Rotor syndrome\n B. Gilbert syndrome\n C. Glucuronyl transferase deficiency\n D. Primary biliary cirrhosis", + "answer": "A" + }, + { + "question": "A patient underwent laparoscopic cholecystectomy and was discharged on the same day. On postoperative day 3, he presented to the hospital with fever. Ultra-sonography showed a 5 x 5 cm collection in the right sub diaphragmatic region. What will be the manage!ment?\n ", + "options": "A. Observe with antibiotic cover\n B. Re-explore the wound with T-tube inseion\n C. Pigtail inseion and drainage\n D. ERCP and proceed", + "answer": "C" + }, + { + "question": "A pregnant lady is diagnosed to be HBs Ag positive. Which of the following is the best way to prevent infection to the child:\n ", + "options": "A. Hepatitis vaccine to the child\n B. Full course of Hepatitis B vaccine and immunoglobulin to the child\n C. Hepatitis B immunoglobulin to the mother\n D. Hepatitis B immunization to mother", + "answer": "B" + }, + { + "question": "Which of the following statements concerning hepatitis infection in pregnancy is true?:\n ", + "options": "A. Hepatitis B core antigen status is the most sensitive indicator of positive vertical transmission of disease\n B. Hepatitis B is the most common form of hepatitis after blood transfusion\n C. The proper treatment of infants born to infected mothers includes the administration of hepatitis B immune globulin as well as vaccine\n D. Patients who develop chronic active hepatitis should undergo MTP", + "answer": "C" + }, + { + "question": "A 4-year old girl presents with severe vomiting after a viral fever of 5 days. She is hospitalized and develops cerebral edema. Liver biopsy is most likely to demonstrate w hich of the following?\n ", + "options": "A. Centrizonal hemorrhagic necrosis\n B. Non-alcoholic steatohepatitis\n C. Ring granulomas\n D. Marked microvesicular steatosis", + "answer": "D" + }, + { + "question": "A 60-year-old chronic smoker presented with progres-sive jaundice, pruritus and clay colored stools for 2 months. History of waxing and waning of jaundice was present. A CT scan revealed dilated main pancre-atic duct and common bile duct. What is the likely di-agnosis?\n ", + "options": "A. Carcinoma head of pancreas\n B. Periampullary carcinoma\n C. Chronic pancreatitis\n D. H lar cholangiocarcinoma", + "answer": "B" + }, + { + "question": "40-year male patient who was a known smoker presents in AIIMS OPD with fever, latigue, jaundice, yellow colored urine with clay colored stools. For the past few days he had developed aversion to cigarette smoking. On examination scleral icterus was present. LFT are:Total Bill18.5Direct Bill7.5SGOT723SGPT812What investigations will you send for ruling out acute viral hepatitis?\n ", + "options": "A. HBsAg, IgM antiHBC, AntiHCV AntiHEV\n B. AntiHAV, HBsAg, IgM antiHBc, AntiHCV\n C. HBsAg, IgM antiHBC,AntiHDV AntiHCV AntiHEV\n D. AntiHAV IgMantiHBC, AntiHCV, AntiHEV.", + "answer": "B" + }, + { + "question": "A surgeon with less experience of laparoscopic cholecystectomy while doing laparoscopic surgery found some stone in common bile duct. What should he ideally do?\n ", + "options": "A. Open cholecystectomy with choledochoduodenostomy\n B. Laparoscopic exploration of CBD and removal of stone\n C. Laparoscopic CBD exploration through the cystic duct\n D. Open CBD exploration", + "answer": "D" + }, + { + "question": "A young female patient presents with jaundice and elevated liver enzymes. She has a history of two smilar episodes in the past. Her serum ANA was 1:40 and IgG was 2400 IU. Her serum copper levels were normal and viral markers were negative. A liver biopsy was carried out and based on the pathology repo, you treated her with immunosuppressants and the patient's condition improved. What was the most likely finding on pathology repo to suggest the treatment?\n ", + "options": "A. Non-alcoholic steatohepatitis\n B. Hemosiderosis\n C. Autoimmune hepatitis\n D. Primary biliary cirrhosis", + "answer": "C" + }, + { + "question": "Morris retractor is most commonly used to retract\n ", + "options": "A. Left hypochondrium\n B. Right hypochondrium\n C. Hernia surgery\n D. None", + "answer": "A" + }, + { + "question": "The case of biliary duct stricture with retching and vomiting, given 3mg morphine epiduraly daily, one day 12 mg mistakenly dose of epidural, morphine given. Not present:-\n ", + "options": "A. Itching\n B. Urinary retention\n C. Increase vomiting\n D. Overstimulation of respiratory centre", + "answer": "D" + }, + { + "question": "A 30–year old lady delivered a healthy baby at 37 week of gestation. She was a known case of chronic hepatitis B infection She was positive for HBsAG o but negative for HBeAG. Which of the following is the most appropriate treatment for the baby –\n ", + "options": "A. Both active and passive immunization soon after birth\n B. Passive immunization soon afte birth and active immunization at 1 year of age\n C. Only passive immunization soon after birth\n D. Only active immunization soon after birth", + "answer": "A" + }, + { + "question": "A 1-month-old child presented with conjugated bilirubinemia and intrahepatic cholestasis. On Liver biopsy staining with PAS, red colored granules were seen inside the hepatocytes. Probable diagnosis is:\n ", + "options": "A. Congenital hepatic fibrosis\n B. Wilson's disease\n C. Alpha-1 antitrypsin deficiency\n D. Hemochromatosis", + "answer": "C" + }, + { + "question": "Which of the following is used for laboratory diagnosis of alcoholic hepatitis?\n ", + "options": "A. ALP\n B. AST\n C. LDH\n D. GGT", + "answer": "B" + }, + { + "question": "In a patient with Hepatitis B infection. Which one of the markers will be increased?\n ", + "options": "A. HbsAg\n B. HbcAg\n C. Anti HbsAg IgG\n D. Anti HbcAg IgG", + "answer": "D" + }, + { + "question": "Urobilinogen levels in obstructed jaundice due to gallstones will be:\n ", + "options": "A. Markedly raised\n B. Slightly increased\n C. Normal\n D. Completely absent", + "answer": "D" + }, + { + "question": "A chronic alcoholic patient came to emergency with severe pain in epigastrium and multiple episodes of vomiting. On examination, guarding was present in upper epigastrium. Chest X-ray was normal. What is the next best step?\n ", + "options": "A. Upper GI endoscopy\n B. Serum lipase\n C. Alcohol breath test\n D. CECT", + "answer": "B" + }, + { + "question": "Investigation of choice to rule out biliary atresia in a 2-month-old child is:\n ", + "options": "A. Hepatic scintigraphy\n B. ERCP\n C. USG\n D. CT scan.", + "answer": "A" + }, + { + "question": "A 48-year old lady presented with bony pain and hepatosplenomegaly. On examination of biopsy speci!men from spleen, crumpled tissue paper appearance is seen. Which of the following product is likely to have accumulated?\n ", + "options": "A. Ganglioside\n B. Sulfatide\n C. Sphingomyelin\n D. Glucocerebroside", + "answer": "D" + }, + { + "question": "A child was brought to the hospital was found to have hypoglycemia, hepatomegaly and accumulation of highly branched glycogen called limit dextrins. He is likely to be suffering from:\n ", + "options": "A. McArdle's disease\n B. Anderson's disease\n C. von Gierke's disease\n D. Cori's disease", + "answer": "D" + }, + { + "question": "Maximum infective stage of hepatitis B is\n ", + "options": "A. HBsAg\n B. HBe Ag\n C. HBc Ag\n D. Anti-HBs", + "answer": "B" + }, + { + "question": "A 60 years old male with alcoholic liver disease presented to emergency with a history of hematemesis. Which of the following is false regarding his management'\n ", + "options": "A. Somatostatin infusion is indicated\n B. Negative nasogastric aspirate does not exclude variceal bleed\n C. Nasogastric tube inseion can provoke variceal bleeding\n D. Upper GI endoscopy is done initially", + "answer": "C" + }, + { + "question": "Liver is divided into eight segments according to Couinaud's classification based upon\n ", + "options": "A. Bile Duct\n B. Poal vein\n C. Hepatic Vein\n D. Hepatic aery", + "answer": "B" + }, + { + "question": "A 27 years old pregnant lady comes with severe jaundice and altered sensorium. On examination, the patient is deeply icteric, not responding to commands and pelvic sonogram reveals intrauterine fetal death. Serum bilirubin levels are 28.8 mg/dL (direct = 18.6 mg/dL), AST levels are 1063 and ALT levels are 1191. The viral markers are as follows. What is the likely diagnosis?Anti-HAV IgGReactiveAnti-HAV IgMNonreactiveHbSAgNon reactiveAnti-HbSAgNonreactiveAnti-HBc IgMNonreactiveAnti-HBc IgGReactiveAnti-HCV IgGNonreactiveAnti-HEV IgMReactiveAnti-HEV IgGNon reactive\n ", + "options": "A. Acute hepatitis E superimposed on chronic liver failure due to hepatitis B\n B. Fulminant hepatitis due to hepatitis B infection\n C. Acute hepatitis E with chronic hepatitis A\n D. Fulminant hepatitis due to hepatitis E infection", + "answer": "D" + }, + { + "question": "In a patient of liver disease, the possible complication during extraction is:\n ", + "options": "A. Dry socket\n B. Fascial space infection\n C. Bleeding\n D. Loss of clot", + "answer": "C" + }, + { + "question": "Asymptomatic hep B is common in 2-3% normal population, but there is increased risk of transmission into hepatocellular carcinoma. Why?\n ", + "options": "A. Inability to induce inflammation to remove the organism\n B. High level of transaminases\n C. High rate of proliferation of virus\n D. Integration of viral DNA with host DNA", + "answer": "D" + }, + { + "question": "Chronic alcoholic comes with pain epigastrium and recurrent vomiting. On examination guarding in upper epigastrium. Chest X-ray normal. What to do next?\n ", + "options": "A. UGI endoscopy\n B. Serum lipase\n C. CECT\n D. Alcohol breath test", + "answer": "B" + }, + { + "question": "A child who was normal at bih develops chronic liver failure and muscle weakness at 3 months of age. On investigations, serum glucose is low, along with ketoacidosis and decreased pH. ALT and AST are raised. Blood lactate and uric acid levels are normal. Intravenous glucagon given after meals raises the blood glucose levels, but does not raise glucose when given after an overnight fast. Liver biopsy shows increased glycogen in liver. Which is the enzyme likely to be defective in this child?\n ", + "options": "A. Glucose-6-phosphatase\n B. Muscle phosphorylase\n C. Branching enzyme\n D. Debranching enzyme", + "answer": "D" + }, + { + "question": "Following hepatitis B infection through blood transfusion, disease manifests in:\n ", + "options": "A. 1 week\n B. 6 weeks\n C. 3 months\n D. 1 year", + "answer": "C" + }, + { + "question": "Serology profile done for a patient is mentioned below. What is the likely cause of the abnormal findings:HbsAg-Non-reactiveHBV DNA-UndetectableHbeAg-Non-reactiveIgG Anti-HbC-Reactive\n ", + "options": "A. Chronic hepatitis inactive state\n B. Chronic hepatitis recovery state\n C. Pre-core mutant infection\n D. Window period", + "answer": "B" + }, + { + "question": "Which of the following marker persists in chronic hepatitis and recurrent hepatitis?\n ", + "options": "A. IgG Anti HbcAg\n B. HBsAg\n C. IgG Anti HBsAG\n D. Anti Hbs", + "answer": "A" + }, + { + "question": "Insulin resistance is seen in liver disease because of-\n ", + "options": "A. Decreased secretion of insulin\n B. Hepatic steatosis\n C. Hepatocytedysfunction\n D. Low 'C'peptide level", + "answer": "B" + }, + { + "question": "Couinaud classified liver into 8 segments,which structure differentiates the segments anatomically\n ", + "options": "A. Poal vein\n B. Hepatic vein\n C. Bile duct\n D. Hepatic aery", + "answer": "B" + }, + { + "question": "In a patient with obstructive jaundice, what is the possible explanation for a bilirubin level of 40 mg/dL?\n ", + "options": "A. Malignant obstruction\n B. Complete obstruction of common bile duct\n C. Renal failure\n D. Liver failure", + "answer": "C" + }, + { + "question": "Morphine should not be used in the treatment of:\n ", + "options": "A. Ischemic pain\n B. Biliary colic\n C. Cancer pain\n D. Post operative pain", + "answer": "B" + }, + { + "question": "Suganti Devi is 30 weeks pregnant with idiopathic cholestasis, is likely to present with following features except:\n ", + "options": "A. Serum bilirubin of 2 mg/dl\n B. Serum alkaline phosphatase slightly elevated\n C. SGPT of 200 units\n D. Prolongation of prothrombin time", + "answer": "D" + }, + { + "question": "In a male after laparoscopic cholecystectomy, the specimen is sent for histopathology which shows carcinoma gallbladder stage T1a. What is the most appropriate management in this patient?\n ", + "options": "A. Conservative and follow up.\n B. Extended cholecystectomy\n C. Simple cholecystectomy\n D. Radiotherapy", + "answer": "C" + }, + { + "question": "Non-visualization of gallbladder in hepatic scintigraphy is suggestive of:\n ", + "options": "A. Chronic cholecystitis\n B. Carcinoma gallbladder\n C. Acute cholecystitis due to gallstones\n D. Gallstones obstructing CBD", + "answer": "C" + }, + { + "question": "VLDL is synthesised in\n ", + "options": "A. GIT\n B. Liver\n C. Liver and GIT\n D. None of the above", + "answer": "B" + }, + { + "question": "A 50 years old patient presented with progressive jaundice. Liver function test was done in which conju!gated serum bilirubin-4.8% and total bilirubin-6.7%, alkaline phosphatase- 550 IU, SGOT-50, SGPT-65. Most probable diagnosis is;\n ", + "options": "A. Jaundice due to choledocholithiasis\n B. Dubin-Johnson syndrome\n C. Viral hepatitis\n D. Malignant obstructive jaundice", + "answer": "A" + }, + { + "question": "If Patient is identified with Hepatitis B positive, after treatment what should be done with instrument\n ", + "options": "A. Clean with water for 2 min\n B. Instruments should be burnt in flame\n C. Instruments should be washed and sent for autoclave\n D. None of the above", + "answer": "C" + }, + { + "question": "A neonate presented with jaundice on first day of life. His mother's blood group is `0' positive. How will you manage this patient?\n ", + "options": "A. Observe only as it is mostly physiological jaundice\n B. Exchange transfusion\n C. Liver function tests and liver biopsy as it is mostly due to cholestasis\n D. Phototherapy", + "answer": "D" + }, + { + "question": "A 14 years old male child presented with abnormal body movements with MRI showing signal changes in corpus striatum, thalami, pons, medulla, centrum semiovale and asymmetric diffuse white matter involvement. Most likely diagnosis is:\n ", + "options": "A. Parkinsonism\n B. Nigrostriatal degeneration\n C. Wilson's disease\n D. Hallervorden-Spatz disease", + "answer": "C" + }, + { + "question": "Hydatid cyst is:\n ", + "options": "A. Parasitic in nature\n B. Fungal\n C. Congenital\n D. Viral", + "answer": "A" + }, + { + "question": "A 3- year old child has hepatosplenomegaly. On examination of the bone marrow, large cells are seen with crumpled paper appearance. Which of the following must have accumulated in these cells?\n ", + "options": "A. Spingomyelins\n B. Gulcocerebrosides\n C. Ceramides\n D. Sulphatides", + "answer": "B" + }, + { + "question": "40 year old female came with fullness in upper right quadrant of abdomen with diabetes type II, hyperlipidemia, biopsy shows\n ", + "options": "A. Biliary cirrhosis\n B. Luminal thrombosis\n C. Non-alcoholic steatohepatitis\n D. Autoimmune hepatitis", + "answer": "C" + }, + { + "question": "A person is HBsAg positive, but Anti- HBc Ab is negative. What should he the next step?\n ", + "options": "A. Repeat test after 6 months\n B. Check HBV DNA load\n C. Check HBeAg, if positive sta interferon\n D. Reassure patient that he does not have any disease", + "answer": "B" + }, + { + "question": "A male child with coarse facial features, macroglossia, thick lips presents with copious mucous discharge from nose at 10 months of age. The child was absolutely normal at bih. On examination he was found to have enlarged Liver and Spleen. Diagnosis is:\n ", + "options": "A. Hurler's syndrome\n B. Beckwith-Weidman syndrome\n C. Hypothyroidism\n D. Proteus syndrome", + "answer": "A" + }, + { + "question": "Biomarker of alcoholic hepatitis:\n ", + "options": "A. ALP\n B. AST\n C. LDH\n D. GGT", + "answer": "D" + }, + { + "question": "4 day old breastfed neonate, otherwise well, term neonate presented with jaundice, on testing the bilirubin level was found to be 18 mg/dl. Which of the following is the best step of management?\n ", + "options": "A. Sta phototherapy and continue breast feeding\n B. Sta iv fluids and given phototherapy\n C. Initiate exchange transfusion\n D. Stop breast feeding and do phototherapy", + "answer": "A" + }, + { + "question": "A neonate presents with jaundice and clay coloured stools. Liver biopsy shows giant cells diagnosis is –\n ", + "options": "A. Neonatal hepatitis with physiological jaundice\n B. Neonatal hepatitis with extrahepatic biliary atresia\n C. Physiological jaundice\n D. Physiological jaundice with extrahepatic biliary atresia", + "answer": "B" + }, + { + "question": "Hepatitis B occurs after an incubation period of:\n ", + "options": "A. 1 week\n B. 3 weeks\n C. 3 months\n D. 6 months", + "answer": "C" + }, + { + "question": "On abdominal ultrasound gallbladder shows diffuse wall thickening with hyperechoic nodules at neck and comet tail aifacts. The most likely diagnosis will be:\n ", + "options": "A. Adenomyomatosis\n B. Adenocarcinoma of gallbladder\n C. Xanthogranulomatous cholecystitis\n D. Cholesterol crystals", + "answer": "A" + }, + { + "question": "Slow growing alveolar like tumor in liver\n ", + "options": "A. E. granulosus\n B. E. multilocularis\n C. Cysticercus cellulosae\n D. Amoebic liver abscess", + "answer": "B" + }, + { + "question": "Most commonly implicated drug for acute liver failure is -\n ", + "options": "A. Paracetamol\n B. Valproate\n C. Warfarin\n D. Tetracyclines", + "answer": "A" + }, + { + "question": "A 59-year-old overweight woman presents to the urgent care clinic with the complaint of severe abdominal pain for the past 2 hours. She also complains of a dull pain in her back with nausea and vomiting several times. Her pain has no relation with food. Her past medical history is significant for recurrent abdominal pain due to cholelithiasis. Her father died at the age of 60 with some form of abdominal cancer. Her temperature is 37°C (98.6°F), respirations are 15/min, pulse is 67/min, and blood pressure is 122/98 mm Hg. Physical exam is unremarkable. However, a CT scan of the abdomen shows a calcified mass near her gallbladder. Which of the following diagnoses should be excluded first in this patient?\n ", + "options": "A. Acute cholecystitis\n B. Gallbladder cancer\n C. Choledocholithiasis\n D. Pancreatitis\n E. Duodenal peptic ulcer", + "answer": "B" + }, + { + "question": "A 42-year-old woman comes to the emergency department because of a 2-day history of right upper abdominal pain and nausea. She is 163 cm (5 ft 4 in) tall and weighs 91 kg (200 lb); her BMI is 34 kg/m2. Her temperature is 38.5°C (101.3°F). Physical examination shows a distended abdomen and right upper quadrant tenderness with normal bowel sounds. Laboratory studies show:\nLeukocyte count 14,000/mm3\nSerum\nTotal bilirubin 1.1 mg/dL\nAST 32 U/L\nALT 40 U/L\nAlkaline phosphatase 68 U/L\nAbdominal ultrasonography is performed, but the results are inconclusive. Cholescintigraphy shows the intrahepatic bile ducts, hepatic ducts, common bile duct, and proximal small bowel. Which of the following is the most likely cause of this patient's symptoms?\"\n ", + "options": "A. Autodigestion of pancreatic parenchyma\n B. Hypomotility of the gallbadder\n C. Fistula between the gallbladder and small intestine\n D. Infection with a hepatotropic virus\n E. Obstruction of the cystic duct", + "answer": "E" + }, + { + "question": "A one-day-old male is evaluated in the hospital nursery for bilious vomiting. The patient has urinated multiple times since birth but has not yet passed meconium. He was born at 38 weeks gestation to a 36-year-old gravida 3 via vaginal delivery. The pregnancy was complicated by gestational diabetes. The patient’s mother received routine prenatal care and declined first trimester screening. She subsequently underwent a quadruple screen at 15 weeks gestation that demonstrated decreased maternal serum alpha-fetoprotein (AFP), increased beta-hCG, decreased unconjugated estriol, and increased inhibin A. Her last ultrasound prior to onset of labor demonstrated an amniotic fluid index (AFI) of 28 cm. The patient’s two older siblings are both healthy. The patient’s temperature is 97.8°F (36.6°C), blood pressure is 58/37 mmHg, pulse is 166/min, and respirations are 38/min. On physical exam, the patient is in moderate distress. His abdomen is firm and distended with hypoactive bowel sounds.\n\nWhich of the following is the most likely etiology of this fetus’s presentation?\n ", + "options": "A. Duodenal atresia\n B. Intestinal malrotation\n C. Meconium ileus\n D. Necrotizing enterocolitis\n E. Pyloric stenosis", + "answer": "A" + }, + { + "question": "A 65-year-old man comes to the physician because of a 1-week history of yellowish discoloration of his skin and generalized pruritus. Examination shows jaundice of the skin and scleral icterus. Urinalysis shows an elevated concentration of bilirubin and a low concentration of urobilinogen. Which of the following is the most likely underlying cause of these findings?\n ", + "options": "A. Absent UDP-glucuronosyltransferase activity\n B. Increased hemoglobin breakdown\n C. Increased intestinal bilirubin reabsorption\n D. Defective hepatic bile excretion\n E. Presence of stones within the gallbladder", + "answer": "D" + }, + { + "question": "A 57-year-old female with a past medical history of alcoholism presents to the emergency room vomiting bright red blood. She is accompanied by her partner, who reports that she had been complaining of black and tarry stools for the past several days. Vital signs are temperature 37 degrees celsius, heart rate 141 beats per minute, blood pressure 90/60, respiratory rate 20, and oxygen saturation 99% on room air. On physical examination, she has splenomegaly and a positive fluid wave. The remainder of her examination is within normal limits. The patient is stabilized with intravenous fluids, and her blood pressure improves. Subsequent emergent upper endoscopy reveals bleeding from the submucosal veins in the lower 1/3 of the esophagus, but no gastric bleed. In the endoscopy suite she also receives IV octreotide. After intervention and resolution of her acute bleed, which of the following pharmacologic agents is indicated?\n ", + "options": "A. Phentolamine\n B. Prazosin\n C. Nifedipine\n D. Nadalol\n E. Doxazosin", + "answer": "D" + }, + { + "question": "A 65-year-old man with a history of hypertension, obesity, and alcoholic cirrhosis is seen in clinic for follow-up. He feels well and currently drinks 5 glasses of wine each night. Medications include atenolol and lisinopril. On physical exam, temperature is 98.1 deg F (36.7 deg C), blood pressure is 151/82 mmHg, pulse is 71/min, and respirations are 14/min. He has spider angiomata on his chest; no asterixis, jaundice, ascites, or peripheral edema is noted. Screening ultrasound reveals a new liver nodule, and follow up CT demonstrates a 2 cm right hepatic lobe lesion with enhancement in the arterial phase. No hypodense attenuation is seen on the venous or delayed phase. What is the next step in management?\n ", + "options": "A. Proceed with liver biopsy\n B. Refer for surgical resection\n C. Refer for radiofrequency ablation\n D. Treat with sorafenib\n E. Observe and get follow-up imaging in 3 months", + "answer": "A" + }, + { + "question": "A 66-year-old man is brought to the emergency room by his wife due to abdominal distension and persistent somnolence for the past 2 weeks. The patient’s wife says that he has been sleeping much more than usual for the past 5 days. His bowel and bladder habit have not changed. His past medical history is significant for alcoholic liver cirrhosis. His vital signs include: pulse 76/min, respiratory rate 15/min, temperature 38.0°C (100.4°F) and blood pressure 122/75 mm Hg. On physical examination, the patient is altered and not responsive to commands. Oriented x 0. The abdomen is significantly distended. Shifting dullness is present and a positive fluid wave can be elicited. Hyperreflexia and asterixis are noted. Laboratory findings are significant for the following:\nLaboratory test\nSodium 140 mEq/L\nPotassium 3.5 mEq/L\nChloride 97 mEq/L\nGlucose 90 mg/dL\nAmmonia 100 µg/dL (ref: 19-60 µg/dL)\nArterial blood gas\npH 7.4\npCO2 40 mm Hg\npO2 90 mm Hg\nHCO3 26 mEq/L\nAn abdominal ultrasound shows surface nodularity compatible with cirrhosis but no other changes aside from ascites. An upper GI endoscopy is performed which shows gastric varices with no signs of active bleeding. An MRI of the brain is insignificant. What is the most likely precipitating factor that led to this patient’s condition?\n ", + "options": "A. Spontaneous bacterial peritonitis\n B. Metabolic alkalosis\n C. Variceal gastrointestinal bleeding\n D. Portal vein thrombosis\n E. Hypoglycemia", + "answer": "A" + }, + { + "question": "A 56-year-old man presents to the emergency department for progressively worsening fatigue, malaise, fever, and abdominal pain. He reports that his symptoms began approximately 1 week ago and he has noticed episodes of diarrhea. He recently started melatonin and magnesium supplementation in hopes of improving his sleep. Medical history is significant for alcohol use disorder that required multiple hospital admissions for management of acute pancreatitis and cirrhosis. He states that he occasionally injects heroin intravenously. Temperature is 100°F (37.8°C), blood pressure is 105/70 mmHg, pulse is 92/min, and respirations are 17/min. Physical examination is significant for scleral icterus, hepatomegaly, ascites, and diffuse abdominal tenderness. Laboratory testing is significant for leukocytosis and metabolic acidosis. A paracentesis is performed and he is admitted into the hospital to receive intravenous cefotaxime and albumin. Ascitic fluid analysis demonstrates a polymorphonuclear cell count of 280 cells/mm^3, serum-ascites albumin gradient of 1.3 g/dL, and a culture positive for Escherichia coli sensitive to cefotaxime and ceftriaxone. On hospital day 2, the nurse reports that the patient is oliguric in the setting of constant fluid intake. Physical examination is unchanged. Laboratory testing is significant for a serum sodium of 131 mEq/L and creatinine of 1.8 mg/dL (it was 0.9 mg/dL on admission). Urine studies are significant for a low urine sodium level, without evidence of blood or protein. Since the hospital admission, he has not been started on any new medications. Which of the following will be the best treatment option for this patient?\n ", + "options": "A. Adding dopamine to his treatment regimen\n B. Adding lisinopril to his treatment regimen\n C. Liver transplantation\n D. Switching cefotaxime to ceftriaxone\n E. Transjugular intrahepatic portosystemic shunting", + "answer": "C" + }, + { + "question": "A 32-year-old woman comes to the physician because of a 3-week history of intermittent loose stools and a 1.2-kg (2.6-lb) weight loss. She immigrated to the US from Uganda 6 weeks ago. Abdominal examination shows diffuse tenderness with no guarding or rebound. The liver is firm and palpable 3 cm below the right costal margin, and the spleen is palpable just below the left costal margin. Her leukocyte count is 12,800/mm3 (12% eosinophils). Stool culture shows several oval-shaped eggs with lateral spines. Microscopic examination of a liver biopsy specimen shows granulomatous inflammation with periportal fibrosis. Exposure to which of the following is most likely to have played a role in the development of this patient's symptoms?\n ", + "options": "A. Tsetse flies\n B. Undercooked pork meat\n C. Undercooked fish meat\n D. Dog feces\n E. Freshwater snails", + "answer": "E" + }, + { + "question": "A 2-day-old male newborn is brought to the physician because of yellowing of the skin and sclerae for 16 hours. He had previously been well. He was born at 38 weeks' gestation via uncomplicated vaginal delivery and weighed 3.1 kg (6 lb 13 oz). The mother has no medical insurance and did not receive prenatal care. The newborn's 4-year-old brother has sickle cell disease. Examination shows jaundice. The abdomen is mildly distended. The liver is palpated 1 cm below the right costal margin and the spleen tip is palpated just below the left costal margin. Laboratory studies show:\nHemoglobin 11 g/dL\nReticulocytes 9%\nLeukocytes 9,100/mm3\nPlatelets 244,000/mm3\nMaternal blood group 0, Rh-negative\nAnti-Rh antibody titer positive\nFetal blood group B, Rh-negative\nSerum\nBilirubin, total 11.3 mg/dL\nDirect 0.3 mg/dL\nWhich of the following is the most likely cause of this patient's condition?\"\n ", + "options": "A. RBC enzyme deficiency\n B. RBC sickling\n C. Anti-D antibodies\n D. Biliary duct malformation\n E. Anti-B antibodies", + "answer": "E" + }, + { + "question": "A 51-year-old man is brought to the emergency department because of a 2-day history of fever, abdominal pain, and confusion. His wife states that he has been unable to recall his birthday or her name. He was diagnosed with hepatitis C 3 years ago but refused treatment. He has been treated twice in the past year for acute pancreatitis. There is no family history of serious illness. His only medication is a calcium supplement. He emigrated from India 15 years ago. He appears ill. His temperature is 38.3°C (100.9°F), pulse is 101/min, and blood pressure is 104/68 mm Hg. He is confused and oriented only to person. Examination shows scleral icterus and spider angiomas. There are fine tremors of the hands bilaterally. The abdomen is distended and shifting dullness is present. There is diffuse tenderness to palpation with no guarding. Bowel sounds are absent. Laboratory studies show:\nHemoglobin 12.6 g/dL\nLeukocyte count 13,900/mm3\nPlatelet count 342,000/mm3\nSerum\nAlbumin 2.6 g/dL\nTotal bilirubin 2.56 mg/dL\nAlkaline phosphatase 54 U/L\nAST 17 U/L\nALT 44 U/L\nParacentesis is performed. Ascitic fluid analysis shows an albumin concentration of 0.8 g/dL, glucose concentration of 62 mg/dL, and a leukocyte count of 1900/mm3 with 60% neutrophils. Which of the following is the most likely explanation for these findings?\"\n ", + "options": "A. Pancreatic fluid leakage\n B. Aseptic peritoneal inflammation\n C. Neoplastic growth\n D. Bacterial translocation\n E. Perforated viscus", + "answer": "D" + }, + { + "question": "A 4-week-old female newborn is brought to the physician because of increasing yellowing of her eyes and skin for 2 weeks. The mother has noticed that the girl's stools have become pale over the past week. She was breastfed since birth but her parents switched her to formula feeds recently after reading on the internet that breastfeeding could be the cause of her current symptoms. The patient was delivered vaginally at 38 weeks' gestation. Pregnancy and delivery were uncomplicated. She appears healthy. Vital signs are within normal limits. She is at the 50th percentile for length and at the 60th percentile for weight. Examination shows scleral icterus and jaundice. The liver is palpated 2 cm below the right costal margin. Cardiopulmonary examination shows no abnormalities. Neurologic examination shows no focal findings. Serum studies show:\nBilirubin\nTotal 15 mg/dL\nDirect 12.3 mg/dL\nAlkaline phosphatase 2007 U/L\nAST 53 U/L\nALT 45 U/L\nγ-glutamyl transferase 154 U/L\nBlood group A positive\nWhich of the following is the most likely diagnosis?\"\n ", + "options": "A. Galactosemia\n B. Biliary atresia\n C. Crigler–Najjar syndrome\n D. Breast milk jaundice\n E. Dubin-Johnson syndrome", + "answer": "B" + }, + { + "question": "A 13-month-old boy is brought to the physician for a well-child examination. Physical examination shows hepatosplenomegaly. A venous blood sample obtained for routine screening tests is milky. After refrigeration, a creamy supernatant layer appears on top of the sample. Genetic analysis shows a mutation in the apolipoprotein C-II gene (APOC2) on chromosome 19. This patient is at greatest risk for developing which of the following complications?\n ", + "options": "A. Acute pancreatitis\n B. Myocardial infarction\n C. Corneal arci\n D. Cholesterol embolization syndrome\n E. Cerebrovascular accident", + "answer": "A" + }, + { + "question": "A 67-year-old woman presents from home hospice with a change in her mental status. She has seemed more confused lately and is unable to verbalize her symptoms. Her temperature is 102°F (38.9°C), blood pressure is 117/65 mmHg, pulse is 110/min, respirations are 19/min, and oxygen saturation is 95% on room air. Physical exam is notable for a right upper quadrant mass that elicits discomfort when palpated. Ultrasound is notable for pericholecystic fluid and gallbladder wall thickening without any gallstones. Which of the following is the most likely diagnosis?\n ", + "options": "A. Acalculous cholecystitis\n B. Calculous cholescystitis\n C. Choledocholithiasis\n D. Emphysematous cholecystitis\n E. Hepatic adenoma", + "answer": "A" + }, + { + "question": "A 47-year-old man presents to the emergency department with fever, fatigue, and loss of appetite for 1 week, followed by right shoulder pain, generalized abdominal pain, and paroxysmal cough. He has had diabetes mellitus for 15 years, for which he takes metformin and gliclazide. His vital signs include a temperature of 38.3°C (101.0°F), pulse of 85/min, and blood pressure of 110/70 mm Hg. On examination, he is ill-appearing, and he has a tender liver edge that is palpable approx. 2 cm below the right costal margin. Percussion and movement worsens the pain. Abdominal ultrasonography is shown. Stool is negative for Entamoeba histolytica antigen. Which of the following is the best initial step in management of this patient condition?\n ", + "options": "A. Metronidazole and paromomycin\n B. Antifungal therapy\n C. Cholecystectomy\n D. Antibiotics and drainage\n E. Endoscopic retrograde cholangiopancreatography (ERCP)", + "answer": "D" + }, + { + "question": "A 32-year-old man comes to the physician for a pre-employment examination. He recently traveled to Guatemala. He feels well but has not seen a physician in several years, and his immunization records are unavailable. Physical examination shows no abnormalities. Serum studies show:\nAnti-HAV IgM Positive\nAnti-HAV IgG Negative\nHBsAg Negative\nAnti-HBs Positive\nHBcAg Negative\nAnti-HBc Negative\nHBeAg Negative\nAnti-HBe Negative\nAnti-HCV Negative\nWhich of the following best explains this patient's laboratory findings?\"\n ", + "options": "A. Active hepatitis B infection\n B. Active hepatitis A infection\n C. Previous hepatitis A infection\n D. Chronic hepatitis B infection\n E. Chronic hepatitis C infection", + "answer": "B" + }, + { + "question": "A 57-year-old man comes to the physician because of a 3-week history of abdominal bloating and increased frequency of stools. He describes the stools as bulky, foul-smelling, and difficult to flush. He also has a 4-month history of recurrent dull upper abdominal pain that usually lasts for a few days, worsens after meals, and is not relieved with antacids. He has had a 10-kg (22-lb) weight loss in the past 4 months. He has no personal or family history of serious illness. He has smoked 1 pack of cigarettes daily for 37 years. He has a 12-year history of drinking 6 to 8 beers daily. He is 160 cm (5 ft 3 in) tall and weighs 52 kg (115 lb); BMI is 20 kg/m2. His vital signs are within normal limits. Abdominal examination shows mild epigastric tenderness without rebound or guarding. Bowel sounds are normal. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in diagnosis?\n ", + "options": "A. Abdominal CT scan\n B. Endoscopic ultrasonography\n C. Abdominal ultrasound\n D. Upper gastrointestinal endoscopy\n E. Abdominal x-ray", + "answer": "A" + }, + { + "question": "A 48-year-old homeless male is brought to the emergency department, by the police, for altered mental status. Past medical records are unavailable. A physical exam on admission reveals scleral icterus and a flapping tremor of the wrists during extension. The patient is admitted to the hospital and his treatment is started after appropriate investigation. The next morning on rounds, he complains of eleven episodes of diarrhea and near-constant flatulence overnight. His mental status has improved and his hand tremor has resolved. Which of the following medications did this patient most likely receive after admission?\n ", + "options": "A. Thiamine\n B. Lactulose\n C. Naloxone\n D. Loperamide\n E. Rifaximin", + "answer": "B" + }, + { + "question": "A 55-year-old man is brought to the emergency department with altered mental status. The patient is in acute distress and cannot provide history due to disorientation. Temperature is 38.7°C (101.6°F), blood pressure is 80/50 mm Hg, pulse is 103/min, respiratory rate is 22/min, and BMI is 20 kg/m2. On examination, his sclera and skin are icteric. On abdominal examination, the patient moans with deep palpation to his right upper quadrant.\nLaboratory test\nComplete blood count\nHemoglobin 14.5 g/dL\nMCV 88 fl\nLeukocytes 16,500/mm3\nPlatelets 170,000/mm3\nBasic metabolic panel\nSerum Na+ 147 mEq/L\nSerum K+ 3.8 mEq/L\nSerum Cl- 106 mEq/L\nSerum HCO3- 25 mEq/L\nBUN 30 mg/dL\nSerum creatinine 1.2 mg/dL\nLiver function test\nTotal bilirubin 2.8 mg/dL\nAST 50 U/L\nALT 65 U/L\nALP 180 U/L\nThe patient is treated urgently with intravenous fluid, dopamine, and broad spectrum antibiotics. The patient’s blood pressure improves to 101/70 mm Hg. On ultrasound of the abdomen, the common bile duct is dilated. What is the best next step in the management of this patient?\n ", + "options": "A. ERCP\n B. Close monitoring\n C. MRCP\n D. Percutaneous transhepatic cholangiogram\n E. CT abdomen", + "answer": "A" + }, + { + "question": "Five days after undergoing an emergency appendectomy under general inhalational anesthesia while on a trip to Haiti, a 43-year-old woman develops low-grade fever, vomiting, and abdominal pain. During the surgery, she received a transfusion of 1 unit of packed red blood cells. Three days after the surgery, she was stable enough to be transported back to the United States. She has no history of serious illness and takes no medications. Her temperature is 38.3°C (100.9°F), pulse is 80/min, and blood pressure is 138/76 mm Hg. Examination shows jaundice of the skin and conjunctivae. Abdominal examination shows moderate tenderness over the liver. The liver is palpated 2 to 3 cm below the right costal margin. Laboratory studies show:\nHemoglobin count 12.0 g/dL\nLeukocyte count 10,400 mm3\nSegmented neutrophils 55%\nBands 1%\nEosinophils 13%\nLymphocytes 28%\nMonocytes 3%\nPlatelet count 160,000 mm3\nSerum\nAlkaline phosphatase 102 U/L\nAspartate aminotransferase 760 U/L\nBilirubin\nTotal 3.8 mg/dL\nDirect 3.1 mg/dL\nAnti-HAV IgG positive\nAnti-HAV IgM negative\nAnti-HBs positive\nHBsAg negative\nAnti-HCV antibodies negative\nAbdominal ultrasonography shows an enlarged liver. A biopsy of the liver shows massive centrilobular necrosis. Which of the following is the most likely underlying cause of this patient's condition?\"\n ", + "options": "A. Adverse effect of anesthetic\n B. Gram negative bacteria in the bloodstream\n C. Trauma to the bile duct\n D. Acalculous inflammation of the gallbladder\n E. Excessive lysis of red blood cells", + "answer": "A" + }, + { + "question": "A 30-year-old primigravid woman at 22 weeks' gestation is brought to the emergency department by her husband for lethargy, nausea, and vomiting for 4 days. This morning she became drowsy. She returned from a business trip to Sudan 3 weeks ago. She denies eating any seafood while traveling. Medications include iron supplements and a multivitamin. Her immunizations are up-to-date and she has never received blood products. Her temperature is 38.9°C (102°F), pulse is 92/min, and blood pressure is 122/76 mm Hg. She is oriented to person and place. Examination shows jaundice and mild asterixis. Pelvic examination shows a uterus consistent in size with a 22-week gestation. Laboratory studies show:\nHemoglobin 11.2 g/dL\nProthrombin time 18 sec (INR=2.0)\nSerum\nTotal bilirubin 4.4 mg/dL\nAlkaline phosphatase 398 U/L\nAST 4,702 U/L\nALT 3,551 U/L\nLactate dehydrogenase 3,412 U/L\nAnti-nuclear antibody negative\nAnti-smooth muscle antibody negative\nAnti-CMV antibody negative\nAnti-EBV nuclear antigen antibody negative\nAn ELISA for HIV is negative. Which of the following is most likely to confirm the diagnosis?\"\n ", + "options": "A. HBsAg\n B. Anti-HAV IgG\n C. HCV RNA\n D. Anti-HCV IgG\n E. Anti-HEV IgM", + "answer": "E" + }, + { + "question": "A 55-year-old man with chronic hepatitis B virus infection comes to the physician because of generalized fatigue and a 5.4 kg (12 lb) weight loss over the past 4 months. Physical examination shows hepatomegaly. Laboratory studies show an α-fetoprotein concentration of 380 ng/ml (N < 10 ng/mL). A CT scan of the abdomen with contrast shows a solitary mass in the left lobe of the liver that enhances in the arterial phase. Which of the following is the most likely underlying pathogenesis of this patient's current condition?\n ", + "options": "A. Overexpression of secretory hepatitis antigen\n B. Intracellular accumulation of misfolded protein\n C. Gain of function mutation of a proto-oncogene\n D. Viral cytotoxin-induced cellular dysplasia\n E. Integration of foreign DNA into host genome\n\"", + "answer": "E" + }, + { + "question": "A 42-year-old man comes to the physician after elevated liver function tests were found after a routine screening. He has had occasional headaches over the past year, but otherwise feels well. The patient reports that he was involved in a severe car accident 30 years ago. He does not smoke or drink alcohol. He has never used illicit intravenous drugs. He takes no medications and has no known allergies. His father had a history of alcoholism and died of liver cancer. The patient appears thin. His temperature is 37.8°C (100°F), pulse is 100/min, and blood pressure is 110/70 mm Hg. Physical examination shows no abnormalities. Laboratory studies show:\nHemoglobin 14 g/dL\nLeukocyte count 10,000/mm3\nPlatelet count 146,000/mm3\nSerum\nGlucose 150 mg/dL\nAlbumin 3.2 g/dL\nTotal bilirubin 1.5 mg/dL\nAlkaline phosphatase 75 U/L\nAST 95 U/L\nALT 73 U/L\nHIV negative\nHepatitis B surface antigen negative\nHepatitis C antibody positive\nHCV RNA positive\nHCV genotype 1\nA liver biopsy is performed and shows mononuclear infiltrates that are limited to portal tracts and periportal hepatocyte necrosis. Which of the following is the most appropriate next step in management?\"\n ", + "options": "A. Sofosbuvir and ledipasvir therapy\n B. Tenofovir and velpatasvir therapy\n C. Interferon and ribavirin therapy\n D. Tenofovir and entecavir therapy\n E. Schedule a follow-up in 6 months", + "answer": "A" + }, + { + "question": "A 56-year-old man with a history of pancreatic cancer presents to the surgical intensive care unit following a pancreaticoduodenectomy. Over the next 3 days, the patient's drainage output is noted to exceed 1 liter per day. In the early morning of postoperative day 4, the nurse states that the patient is difficult to arouse. His temperature is 99.5°F (37.5°C), blood pressure is 107/88 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. His skin and mucous membranes are dry on physical exam. Laboratory values are ordered as seen below.\n\nSerum:\nNa+: 154 mEq/L\nCl-: 100 mEq/L\nK+: 4.3 mEq/L\nHCO3-: 27 mEq/L\nBUN: 20 mg/dL\nGlucose: 99 mg/dL\nCreatinine: 1.1 mg/dL\n\nWhich of the following is the best next step in management?\n ", + "options": "A. 0.45% saline IV\n B. 0.9% saline IV\n C. 5% dextrose IV\n D. 5% dextrose IV with 0.45% saline IV\n E. Oral free water replacement", + "answer": "B" + }, + { + "question": "A 61-year-old man complaining of unexplained bleeding by from the mouth is escorted to the emergency department by corrections officers. Upon examination patient states he feels nauseated as he begins to retch violently and vomit bright red blood. His past medical history is remarkable for cirrhosis secondary to alcohol abuse and untreated hepatitis C. His current blood pressure is 90/50 mm Hg, heart rate is 128/min, and oxygen saturation in room air is 88%. On further questioning, he states that he is scared to die and wants everything done to save his life. IV fluids are initiated and packed RBCs are ordered. You begin to review his labs and notice and he has elevated beta-hydroxybutyrate, ammonia, and lactate. What would be the appropriate response to the patient?\n ", + "options": "A. Consult an ethics committee to determine whether to resuscitate the patient\n B. Do not intubate the patient since he does not have written request to be resuscitated\n C. Accept the patient's wishes and appoint and get a psych evaluation.\n D. Accept the patient's wishes and ensure he receives appropriate care.\n E. Obtain an emergency order from a judge to initiate resuscitation.", + "answer": "D" + }, + { + "question": "Three days after undergoing a laparoscopic Whipple's procedure, a 43-year-old woman has swelling of her right leg. She does not have pain. She has nausea but has not vomited. She was diagnosed with pancreatic cancer 1 month ago. She has been using an incentive spirometer every 6 hours since recovering from her surgery. Prior to admission, her only medications were a multivitamin and an herbal weight-loss preparation. She appears uncomfortable. Her temperature is 38°C (100.4°F), pulse is 90/min, and blood pressure is 118/78 mm Hg. Examination shows mild swelling of the right thigh to the ankle; there is no erythema or pitting edema. Homan's sign is negative. The abdomen is soft and shows diffuse tenderness to palpation. There are five abdominal laparoscopic incisions with no erythema or discharge. The lungs are clear to auscultation. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management?\n ", + "options": "A. CT pulmonary angiography\n B. Compression ultrasonography\n C. Vancomycin therapy\n D. D-dimer level\n E. 2 sets of blood cultures\n\"", + "answer": "B" + }, + { + "question": "A 52-year-old man is brought to the emergency department for recurrent vomiting that began 5 hours ago. He describes the vomitus as bloody and containing black specks. He drinks 10–12 beers daily and has not seen a physician in 15 years. He appears pale. His temperature is 36.7°C (98.1°F), pulse is 122/min, and blood pressure is 85/59 mm Hg. Physical examination shows decreased radial pulses, delayed capillary refill, multiple spider angiomata, and a distended abdomen. He is oriented to person but not to place or time. Which of the following is most likely decreased in this patient in response to his current condition compared to a healthy adult?\n ", + "options": "A. Systemic vascular resistance\n B. Fractional tissue oxygen extraction\n C. Carotid baroreceptor firing activity\n D. Pulmonary vascular resistance\n E. Cardiac inotropy", + "answer": "C" + }, + { + "question": "A 59-year-old man is brought to the emergency department with a history of black, tarry stools but denies vomiting of blood or abdominal pain. His family has noticed progressive confusion. History is significant for liver cirrhosis and alcoholism. His heart rate is 112/min, temperature is 37.1°C (98.7°F), and blood pressure is 110/70 mm Hg. On examination, he is jaundiced, lethargic, is oriented to person and place but not date, and has moderate ascites. Neurological examination reveals asterixis, and his stool is guaiac-positive. Liver function test are shown below:\nTotal albumin 2 g/dL\nProthrombin time 9 seconds\nTotal bilirubin 5 mg/dL\nAlanine aminotransferase (ALT) 100 U/L\nAspartate aminotransferase (AST) 220 U/L\nWhich of the following is a feature of this patient condition?\n ", + "options": "A. It carries a good prognosis\n B. Ammonia level is the best initial test to confirm the diagnosis\n C. It is a diagnosis of exclusion\n D. It only occurs in patients with cirrhosis\n E. Electroencephalography (EEG) usually shows focal localising abnormality", + "answer": "C" + }, + { + "question": "A 14-year-old boy presents with right upper quadrant abdominal pain and is found on ultrasound to have a gallstone. Based on clinical suspicion, a CBC, a Coombs test, and a bilirubin panel are obtained to determine the etiology of the gallstone. These tests reveal a mild normocytic anemia with associated reticulocytosis as well as an increased RDW. In addition there is an indirect hyperbilirubinemia and the Coombs test results are negative. To confirm the diagnosis, an osmotic fragility test is performed which shows increased fragility in hypotonic solution. In this patient, what findings would most likely be anticipated if a blood smear were obtained?\n ", + "options": "A. Hypersegmented neutrophils\n B. Schistocytes\n C. Sideroblasts\n D. Spherocytes\n E. Dacrocytes", + "answer": "D" + }, + { + "question": "A 30-year-old woman presents to your office with decreased appetite, malaise, and fever. Serologic tests reveal positive Anti-HBsAg and Anti-HAV IgM antibodies. Which of the following is most likely responsible for this patient's presentation?\n ", + "options": "A. Needlestick\n B. Unprotected sex\n C. Shellfish\n D. Chronic hepatitis\n E. Acetaminophen overdose", + "answer": "C" + }, + { + "question": "A 40-year-old man presents to the emergency department with altered mental status. He has a history of cirrhosis of the liver secondary to alcoholism. He started becoming more confused a few days ago and it has been getting gradually worse. His temperature is 98.8°F (37.1°C), blood pressure is 134/90 mmHg, pulse is 83/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam reveals a distended abdomen that is non-tender. Neurological exam is notable for a confused patient and asterixis. Laboratory values are ordered as seen below.\n\nSerum:\nNa+: 139 mEq/L\nCl-: 100 mEq/L\nK+: 3.3 mEq/L\nHCO3-: 22 mEq/L\nBUN: 20 mg/dL\nGlucose: 59 mg/dL\nCreatinine: 1.1 mg/dL\nCa2+: 10.2 mg/dL\n\nWhich of the following is the best next treatment for this patient?\n ", + "options": "A. Ceftriaxone\n B. Dextrose\n C. Lactulose\n D. Potassium\n E. Rifaximin", + "answer": "D" + }, + { + "question": "A 67-year-old man comes to the clinic complaining of fatigue and dizziness for the past 2 months. He reports that he gets tired easily compared to his baseline and feels dizzy when he exerts himself (e.g., when he walks long distances). His past medical history is significant for hypertension that is controlled with lisinopril. A physical examination demonstrates moderate hepatomegaly and lymphadenopathy. His laboratory studies are shown below.\n\nLeukocyte count and differential:\nLeukocyte count: 11,500/mm^3\nSegmented neutrophils: 40%\nBands: 3%\nEosinophils: 1%\nBasophils: 0%\nLymphocytes: 50%\nMonocytes: 8%\n\nHemoglobin: 11.2 g/dL\nPlatelet count: 120,000/mm^3\nMean corpuscular hemoglobin concentration: 31%\nMean corpuscular volume: 80 µm^3\nReticulocyte count: 3%\nLactate dehydrogenase: 45 U/L\n\nA subsequent flow cytometry test demonstrates CD20+ cells. What is the most likely finding you would expect in this patient?\n ", + "options": "A. Low levels of erythropoietin\n B. Low levels of leukocyte alkaline phosphatase (LAP)\n C. Myeloperoxidase positive cytoplasmic inclusions\n D. Presence of hairy cells\n E. Presence of smudge cells", + "answer": "E" + }, + { + "question": "A 10-year-old girl is brought to the physician because of high-grade fever, myalgia, and generalized fatigue for 3 days. She returned from a vacation to northern Brazil 4 days ago. She took the appropriate medications and immunizations prior to her visit. There is no family history of serious illness. She appears ill. Her temperature is 39.4°C (103°F), pulse is 110/min and blood pressure is 94/54 mm Hg. Examination shows jaundice of the conjunctivae and skin. The abdomen is soft and nontender; the spleen is palpated 2 to 3 cm below the left costal margin. Laboratory studies show:\nHemoglobin 10.1 g/dL\nLeukocyte count 4,650/mm3\nPlatelet count 200,000/mm3\nSerum\nGlucose 56 mg/dL\nCreatinine 0.8 mg/dL\nBilirubin\nTotal 4.7 mg/dL\nDirect 0.9 mg/dL\nLactate dehydrogenase 212 U/L\nWhich of the following is the most likely to confirm the diagnosis?\"\n ", + "options": "A. Thick and thin blood smear\n B. Direct antiglobulin test\n C. Enzyme testing\n D. Sickle cell test\n E. Ultrasound of the abdomen", + "answer": "A" + }, + { + "question": "A 58-year-old woman presents to the emergency department because of worsening abdominal pain for the past 2 days. She reports nausea and vomiting and is unable to tolerate oral intake. She appears uncomfortable. Her temperature is 38.1°C (100.6°F), the pulse is 92/min, the respirations are 18/min, and the blood pressure is 132/85 mm Hg. Physical examination shows yellowish discoloration of her sclera. Her abdomen is tender in the right upper quadrant. There is no abdominal distention or organomegaly. The laboratory tests show the following results:\nHemoglobin 13 g/dL\nLeukocyte count 16,000/mm3\nUrea nitrogen 25 mg/dL\nCreatinine 2 mg/dL\nAlkaline phosphatase 432 U/L\nAlanine aminotransferase 196 U/L\nAspartate transaminase 207 U/L\nBilirubin \nTotal 3.8 mg/dL\nDirect 2.7 mg/dL\nLipase 82 U/L\nUltrasound of the right upper quadrant shows dilated intrahepatic and extrahepatic bile ducts and multiple hyperechoic spheres within the gallbladder. The pancreas is not well visualized. Intravenous fluid resuscitation and antibiotic therapy with ceftriaxone and metronidazole are initiated. After 12 hours, the patient appears acutely ill and is not oriented to time. Her temperature is 39.1°C (102.4°F), the pulse is 105/min, the respirations are 22/min, and the blood pressure is 112/82 mm Hg. Which of the following is the most appropriate next step in management?\n ", + "options": "A. Abdominal computed tomography (CT) scan\n B. Endoscopic retrograde cholangiopancreatography (ERCP)\n C. Laparoscopic cholecystectomy\n D. Magnetic resonance cholangiopancreatography (MRCP)\n E. Percutaneous cholecystostomy", + "answer": "B" + }, + { + "question": "A 60-year-old man with a long-standing history of chronic hepatitis C infection comes to the emergency department because of abdominal distention and scleral icterus for the past month. His heart rate is 76/min, respiratory rate is 14/min, temperature is 36.0°C (96.8°F), and blood pressure is 110/86 mm Hg. Physical examination show signs suggestive of liver cirrhosis. Which of the following signs is a direct result of hyperestrinism in cirrhotic patients?\n ", + "options": "A. Coagulopathy\n B. Gynecomastia\n C. Jaundice\n D. Lower limb swelling\n E. Caput medusae", + "answer": "B" + }, + { + "question": "A 55-year-old woman presents with severe pruritus and fatigue. She denies any similar symptoms in the past. No significant past medical history. Upon physical examination, scleral icterus is present, and significant hepatosplenomegaly is noted. Mild peripheral edema is also present. Laboratory findings are significant for elevated serum levels of bilirubin, aminotransferases, alkaline phosphatase (ALP), γ-glutamyl transpeptidase (GGTP), immunoglobulins, as well as cholesterol (especially HDL fraction). Antiviral antibodies are not present. The erythrocyte sedimentation rate is also elevated. Anti-mitochondrial antibodies are found. A liver biopsy is performed, and the histopathologic examination shows bile duct injury, cholestasis, and granuloma formation. Which of the following is the most likely diagnosis in this patient?\n ", + "options": "A. Primary biliary cirrhosis\n B. Hemolytic anemia\n C. Hepatitis A\n D. Gilbert syndrome\n E. Crigler–Najjar syndrome type I", + "answer": "A" + }, + { + "question": "Three days after undergoing an open cholecystectomy, an obese 57-year-old woman has fever, chills, and a headache. She has right-sided chest pain that increases on inspiration and has had a productive cough for the last 12 hours. She had an episode of hypotension after the operation that resolved with intravenous fluid therapy. She underwent an abdominal hysterectomy 16 years ago for multiple fibroids of the uterus. She has smoked one pack of cigarettes daily for 17 years. She appears uncomfortable. Her temperature is 39°C (102.2°F), pulse is 98/min, respirations are 18/min, and blood pressure is 128/82 mm Hg. Inspiratory crackles are heard at the right lung base. The abdomen is soft and nontender. There is a healing surgical incision below the right ribcage. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?\n ", + "options": "A. Pulmonary embolism\n B. Subphrenic abscess\n C. Pneumonia\n D. Atelectasis\n E. Pneumothorax", + "answer": "C" + }, + { + "question": "A 44-year-old man comes to the clinic because of a 6-month history of progressive fatigue. He has a history of intravenous heroin use. Physical examination shows scleral icterus. A serum study is positive for hepatitis C RNA. Therapy with interferon-α is initiated in combination with a second drug. The expected beneficial effect of the additional drug is most likely due to inhibition of which of the following enzymes?\n ", + "options": "A. DNA integrase\n B. Inosine monophosphate dehydrogenase\n C. DNA-dependent RNA polymerase\n D. DNA gyrase\n E. Dihydroorotate dehydrogenase", + "answer": "B" + }, + { + "question": "A study is conducted to determine the most effective ways to prevent transmission of various infective agents. One of the agents studied is a picornavirus that preferentially infects hepatocytes. The investigator determines that inactivating this virus can prevent its spread. Which of the following disinfectants is most likely to inactivate this virus?\n ", + "options": "A. Benzalkonium chloride\n B. Chlorhexidine\n C. Sodium hypochlorite\n D. Sulfuric acid\n E. Ethyl alcohol", + "answer": "C" + }, + { + "question": "A 42-year-old man comes to the physician to establish care. He recently moved to the area and has not been to a primary care physician for over 5 years. He has no history of serious illness, but has intermittent bilateral knee pain for which he takes 650 mg acetaminophen every other day. He is married with three children and is sexually active with his wife. During the past 10 years, he has unsuccessfully tried to lose weight. He has smoked one half pack of cigarettes daily for 15 years. About 2–3 times per week he has 1–2 glasses of wine with dinner. He is 160 cm (5 ft 3 in) tall and weighs 93 kg (205 lb); BMI is 36.3 kg/m2. Vital signs are within normal limits. On abdominal examination, the liver is palpated 2 to 3 cm below the right costal margin. Laboratory studies show:\nHemoglobin 12.6 g/dL\nPlatelet count 360,000/mm3\nHemoglobin A1c 6.3%\nSerum\nFerritin 194 ng/mL\nTotal bilirubin 0.7 mg/dL\nAlkaline phosphatase 52 U/L\nAspartate aminotransferase 92 U/L\nAlanine aminotransferase 144 U/L\nHepatitis B surface antigen Negative\nHepatitis B core IgM antibody Negative\nHepatitis B surface antibody Positive\nHepatitis C antibody Negative\nAntinuclear antibody titers 1:20 (N = < 1:60)\nSmooth muscle antibody titers Negative\nAnti-LKM1 antibody titers Negative\nTransabdominal ultrasonography shows a mildly enlarged, diffusely hyperechoic liver. Which of the following is the most likely underlying cause of these liver abnormalities?\"\n ", + "options": "A. Autoimmune liver damage\n B. Congestive hepatopathy\n C. Insulin resistance\n D. Acetaminophen use\n E. Alcohol use", + "answer": "C" + }, + { + "question": "A 45-year-old woman is brought to the emergency department by her husband due to upper abdominal pain, nausea, and vomiting for the past couple of hours. She had similar episodes in the past, which were often precipitated by food but resolved spontaneously. Her temperature is 38.3°C (101.0°F), heart rate is 96/min, blood pressure is 118/76 mm Hg, and respiratory rate is 16/min. Physical examination reveals tenderness over the right upper quadrant that is severe enough to make her stop breathing when deeply palpated in the area. Lab results show:\nLeukocyte count 18,000/mm3 with 79% neutrophils\nAspartate aminotransferase 67 IU/L\nAlanine aminotransferase 71 IU/L\nSerum amylase 46 U/L\nSerum Lipase 55 U/L\nSerum calcium 8.9 mg/dL\nUltrasonography of the abdomen is shown below. During the ultrasound exam, the patient complains of tenderness when the probe presses down on her right upper quadrant. Which of the following is the most likely cause of her pain?\n ", + "options": "A. Acute calculous cholecystitis\n B. Acute acalculous cholecystitis\n C. Biliary colic\n D. Acute pancreatitis\n E. Ascending cholangitis", + "answer": "A" + }, + { + "question": "A 62-year-old woman with a pancreatic insulinoma is being prepared for a laparoscopic enucleation of the tumor. After induction of general anesthesia, preparation of a sterile surgical field, and port placement, the surgeon needs to enter the space posterior to the stomach to access the pancreatic tumor. Which of the following ligaments must be cut in order to access this space?\n ", + "options": "A. Phrenoesophageal ligament\n B. Gastrohepatic ligament\n C. Phrenicocolic ligament\n D. Ligamentum venosum\n E. Falciform ligament\n\"", + "answer": "B" + }, + { + "question": "A 25-year-old man presents to the office because of extreme fatigue for the past 2 days. He is also worried about his skin looking yellow. He does not have any other complaints and denies fever and headache. He admits to using illicit intravenous drugs in the past. He does not have any immunization records because he moved from Africa to the US at the age of 18. His vital signs are as follows: heart rate 72/min, respiratory rate 14/min, temperature 37.9°C (100.2°F), and blood pressure 100/74 mm Hg. Physical examination is not significant except for mild diffuse abdominal tenderness. His blood is drawn for routine tests and shows an alanine aminotransferase level (ALT) of 2,000 IU/L. A hepatitis viral panel is ordered which shows:\nAnti-HAV IgM negative\nHBsAg positive\nAnti-HBs negative\nIgM anti-HBc positive\nAnti-HCV negative\nAnti-HDV negative\nWhat is the most likely diagnosis?\n ", + "options": "A. Past hepatitis B infection\n B. Chronic hepatitis B\n C. Acute hepatitis A\n D. Acute hepatitis D superinfection\n E. Acute hepatitis B", + "answer": "E" + }, + { + "question": "A 55-year-old caucasian male is transferred to a tertiary care hospital from a small county hospital where he presented with jaundice and severe abdominal pain that radiates to the back. While in the county hospital, he did not develop fever, and his vital signs were stable for the 48 hours he spent at there. Initial laboratory tests are given below:\nTotal bilirubin 7 mg/dL\nDirect bilirubin 6.4 mg/dL\nAST 100\nALT 40\nAlkaline phosphatase 480 IU/L\nGlucose 160 mg/dL\nThe patient’s medical history is relevant for hypertension and diabetes mellitus. He admits to smoking cigarettes since his early teenage years. Moderate icterus is evident during physical examination, the abdomen is distended and dull to percussion, and there is periumbilical tenderness. Which of the following markers would you expect to be elevated in this patient?\n ", + "options": "A. CA 125\n B. Alpha-fetoprotein\n C. Desmin\n D. CA 27-29\n E. CA 19-9", + "answer": "E" + }, + { + "question": "A one-week-old boy presents with yellow sclerae, severe lethargy, and decreased muscle tone. His mother notes that the symptoms started shortly after birth and have been progressively worsening. The patient is breast fed and takes no medications. His labs are within normal limits with the exception of his liver function tests as follows:\n\nALT: 8 U/ L\nAST: 10 U/L\nAlkaline phosphatase: 50 U/L\nAlbumin: 3.7 g/dL\nTotal protein: 6.7 g/dL\nBilirubin, total: 29.4 mg/dL\nBilirubin, unconjugated: 29.2 mg/dL\nBilirubin, conjugated: 0.2 mg/dL\n\nThe boy is taken immediately for treatment. What is the most likely underlying cause of his condition?\n ", + "options": "A. Deficiency in glucose-6-phosphate dehydrogenase\n B. Absence of UDP-glucuronosyltransferase-1A1\n C. Alteration in the ankyrin protein\n D. Reduction in UDP-glucuronosyltransferase-1A1 activity\n E. Deficiency in glucocerebrosidase", + "answer": "B" + }, + { + "question": "Public health researchers are reviewing data from an outbreak of hepatitis A that was traced to contaminated produce from a popular restaurant. A case series investigation with prospective and retrospective follow-up found that 500 individuals dined at the restaurant during the week of study. The incidence of hepatitis A infection was found to be 25%, and the total number of deaths recorded among the incident cases was 5 individuals. What was the case-fatality rate for the hepatitis A outbreak?\n ", + "options": "A. 4%\n B. 5%\n C. 10%\n D. 20%\n E. 25%", + "answer": "A" + }, + { + "question": "A 38-year-old woman is brought to the emergency department because of three 1-hour episodes of severe, sharp, penetrating abdominal pain in the right upper quadrant. During these episodes, she has had nausea and vomiting. She has no diarrhea, dysuria, or hematuria and is asymptomatic between episodes. She has hypertension and hyperlipidemia. Seven years ago, she underwent resection of the terminal ileum because of severe Crohn's disease. She is 155 cm (5 ft 2 in) tall and weighs 79 kg (175 lb); BMI is 32 kg/m2. Her temperature is 36.9°C (98.5°F), pulse is 80/min, and blood pressure is 130/95 mm Hg. There is mild scleral icterus. Cardiopulmonary examination shows no abnormalities. The abdomen is soft, and there is tenderness to palpation of the right upper quadrant without guarding or rebound. Bowel sounds are normal. The stool is brown, and test for occult blood is negative. Laboratory studies show:\nHemoglobin 12.5 g/dL\nLeukocyte count 9,500 mm3\nPlatelet count 170,000 mm3\nSerum\nTotal bilirubin 4.1 mg/dL\nAlkaline phosphatase 348 U/L\nAST 187 U/L\nALT 260 U/L\nAbdominal ultrasonography shows a normal liver, a common bile duct caliber of 10 mm (normal < 6 mm) and a gallbladder with multiple gallstones and no wall thickening or pericholecystic fluid. Which of the following is the most likely cause of these findings?\"\n ", + "options": "A. Acute hepatitis A\n B. Choledocholithiasis\n C. Autoimmune hepatitis\n D. Cholecystitis\n E. Pancreatitis\n\"", + "answer": "B" + }, + { + "question": "A 39-year-old woman comes to the physician because of fever, generalized fatigue, and chills for 1 week. She has been having dull right-side abdominal pain during this period. She has nausea. She has no history of travel outside the United States. She has type 1 diabetes mellitus. Current medications include insulin and an oral contraceptive. She appears ill. Her temperature is 40°C (104°F), pulse is 118/min, and blood pressure is 106/70 mm Hg. On examination, the liver is palpated 2–3 cm below the right costal margin and is tender. There are decreased breath sounds over the right lung base. The remainder of the examination shows no abnormalities. Laboratory studies show:\nHemoglobin 14.1 g/dL\nLeukocyte count 17,100/mm3\nSegmented neutrophils 74%\nEosinophils 1%\nLymphocytes 20%\nMonocytes 5%\nSerum\nGlucose 79 mg/dL\nCreatinine 1.1 mg/dL\nTotal bilirubin 0.9 mg/dL\nAlkaline phosphatase 180 U/L\nAST 69 U/L\nALT 100 U/L\nA right upper quadrant ultrasound is shown. Which of the following is the most appropriate next step in management?\"\n ", + "options": "A. Discontinue the oral contraceptive\n B. Obtain hepatoiminodiacetic acid scan\n C. Perform endoscopic retrograde cholangiopancreatography\n D. Administer metronidazole\n E. Perform percutaneous drainage\n\"", + "answer": "E" + }, + { + "question": "An otherwise healthy 49-year-old woman has a routine full blood count complete prior her elective cholecystectomy. The lab test results are as follows:\nLaboratory test\nHemoglobin\n12.1 g/dL\nMean corpuscular volume (MCV)\n85 μm3\nMean corpuscular hemoglobin concentration (MCHC)\n47%\nReticulocyte count\n3.4 %\nWhite blood cell count\n9700/mm3\nPlatelet count\n229,000/mm3\nA peripheral blood smear reveals spherocytes. The Coombs test is negative. The physical examination is remarkable for scleral icterus and moderate splenomegaly. Which of the following is the most appropriate diagnostic test of this patient’s underlying disorder?\n ", + "options": "A. Eosin-5-maleimide binding test\n B. Flow cytometry for CD55/CD59\n C. Anti parvovirus B19 antibodies\n D. Bone marrow biopsy\n E. Liver function tests", + "answer": "A" + }, + { + "question": "A 27-year-old man presents to the emergency department due to a change in his skin color. The patient went on a long hike this morning, and his girlfriend noticed that his skin had changed color when they were driving home. The patient has a past medical history of marijuana use, IV drug use, alcohol use, and asthma. His current medications include albuterol, fluticasone, and ibuprofen. His temperature is 97.5°F (36.4°C), blood pressure is 120/75 mmHg, pulse is 60/min, respirations are 10/min, and oxygen saturation is 98% on room air. Laboratory studies are ordered and are seen below.\n\nHemoglobin: 10 g/dL\nHematocrit: 32%\nLeukocyte count: 5,500 cells/mm^3 with normal differential\nPlatelet count: 207,000/mm^3\n\nSerum:\nNa+: 139 mEq/L\nCl-: 99 mEq/L\nK+: 4.3 mEq/L\nHCO3-: 24 mEq/L\nBUN: 17 mg/dL\nGlucose: 89 mg/dL\nCreatinine: 1.0 mg/dL\nCa2+: 10.1 mg/dL\nBilirubin, total: 11.3 mg/dL\nBilirubin, direct: 7.8 mg/dL\n\nPhysical exam is notable for a patient with skin that appears yellow/orange. Cardiac, pulmonary, abdominal, and neurological exams are within normal limits. Which of the following is associated with this patient's underlying pathology?\n ", + "options": "A. A pathology responsive to sofosbuvir\n B. Decreased UDP-glucuronyl transferase activity\n C. Hyperpigmentation of the liver\n D. Increased consumption of beta-carotene\n E. Increased liver enzymes with AST > ALT", + "answer": "C" + }, + { + "question": "A 57-year-old homeless man is brought to the emergency department because of several episodes of hematemesis in the past 24 hours. His vital signs include a temperature of 37.1°C (98.8°F), pulse of 95/min, and blood pressure of 85/60 mm Hg. On physical examination, he appears confused and unable to give a complete history. He is noted to have jaundice, palpable firm liver, mild splenomegaly, and shifting dullness consistent with the presence of ascites. Liver function tests are as follows:\nSerum aspartate aminotransferase (AST) 97 U/L\nSerum alanine aminotransferase (ALT) 40 U/L\nSerum albumin 2.5 g/dL\nTotal bilirubin 3 mg/dL\nProthrombin time 20 seconds\nWhich of the following is the most likely cause of this patient's illness?\n ", + "options": "A. Metabolic disorder\n B. Autoimmune liver disease\n C. Substance abuse\n D. Obesity\n E. Hepatic venous outflow obstruction", + "answer": "C" + }, + { + "question": "While on a teaching sabbatical in Uruguay, a pathologist examined the excised liver of an 18-year-old otherwise healthy female who passed away due to massive hepatic necrosis 5 days after she underwent general anesthesia to repair a fractured femur. Which of the following is a general anesthetic most likely responsible for her death?\n ", + "options": "A. Bupivacaine\n B. Lidocaine\n C. Midazolam\n D. Halothane\n E. Desflurane", + "answer": "D" + }, + { + "question": "A 56-year-old woman is brought to the emergency department by her husband because of increasing confusion, generalized fatigue, and irritability for the past week. She has been unable to recall her husband's name or their address. She has had insomnia and daytime sleepiness during this period. Her last bowel movement was 3 days ago. One month ago, she underwent a transjugular intrahepatic portal shunt (TIPS) placement. She has alcoholic liver cirrhosis. Current medications include spironolactone and furosemide. She used to drink over a pint of vodka daily but quit 2 months ago. She is oriented to place and person. Her temperature is 37.3°C (99.1°F), pulse is 88/min, and blood pressure is 102/64 mm Hg. Examination shows scleral icterus and jaundice. There are several telangiectasias over the chest and back. Palmar erythema is present. The abdomen is mildly distended and nontender. Shifting dullness is present. There is a flapping tremor of both hands when outstretched and dorsiflexed. Neurologic examination shows no other focal findings. She completes the number connection test slower than the age-normalized standard. Which of the following is the most appropriate next step in management?\n ", + "options": "A. Reversal of TIPS\n B. Paracentesis\n C. Administer IV ceftriaxone\n D. Administer lactulose\n E. Administer vitamin B1", + "answer": "D" + }, + { + "question": "A 48-year-old man presents to the clinic with nausea, vomiting, fever, and pain in the right upper quadrant of his abdomen for the past 18 hours. He mentions that he has been experiencing intermittent episodes of pain at the same location over the last 3 months and that these episodes usually occur after a heavy meal and subside within 1 or 2 hours. On physical examination, his temperature is 38.5°C (101.3°F), pulse is 130/min, respirations are 24/min, and blood pressure is 130/84 mm Hg. On examination of the abdomen, tenderness is present over the right upper quadrant; palpation over the area produces an inspiratory pause. An urgent bedside ultrasonogram shows a dilated common bile duct stone, but no stone in the common bile duct or in the gallbladder. Laboratory results show the following:\nHemoglobin 15.4 g/dL (9.56 mmol/L)\nTotal leukocyte count 14,000/mm3 (17.4 x 10*9/L)\nSegmented neutrophils 70%\nLymphocytes 25%\nMonocytes 4%\nEosinophils 1%\nBasophils 0%\nPlatelet count 32,0000/mm3 (320 x 10*9/L)\nSerum bilirubin (total) 1.8 mg/dL (30.78 μmol/L)\nSerum bilirubin (direct) 1.1 mg/dL (18.81 μmol/L)\nSerum alanine aminotransferase 96 U/L\nSerum aspartate aminotransferase 88 U/L\nSerum alkaline phosphatase\n350 U/L (5.83 μkat/L)\nWhich of the following is the most appropriate next step in management?\n ", + "options": "A. Urgent laparoscopic cholecystectomy\n B. Medical management followed by elective laparoscopic cholecystectomy\n C. Medical management followed by elective open cholecystectomy\n D. Urgent endoscopic retrograde cholangiopancreatography (ECRP)\n E. Cholecystotomy", + "answer": "D" + }, + { + "question": "A 71-year-old woman comes to the physician for evaluation of a pigmented lesion on her left foot. She has had decreased appetite and a 6-kg (13-lb) weight loss in the past 2 months. Physical examination shows that on the left medial ankle there is a 2-cm reddish-black nodule with a verrucous surface. A full-thickness excisional biopsy of the lesion shows S100-protein-positive epithelioid cells. A subsequent CT scan of the chest, abdomen, and pelvis shows metastases to the liver; a diagnosis of metastatic melanoma is made. Chemotherapy with aldesleukin is initiated. Which of the following is the mechanism of action for this drug?\n ", + "options": "A. Stimulating release of acute-phase reactants\n B. Stimulating antigen-processing cells\n C. Inhibiting expression of MHC II and Th1 cytokines\n D. Activating natural killer cells and cytotoxic T cells\n E. Supporting growth of bone marrow stem cells", + "answer": "D" + }, + { + "question": "A 3-year-old boy is brought to the physician because of a 3-day history of fatigue and yellow discoloration of his skin. One week ago, he had an upper respiratory tract infection. Examination shows jaundice of the skin and conjunctivae. The spleen tip is palpated 2 cm below the left costal margin. His hemoglobin concentration is 9.4 g/dl and his mean corpuscular hemoglobin concentration is 39% Hb/cell. A Coombs test is negative. A peripheral blood smear is shown. This patient is at greatest risk for which of the following complications?\n ", + "options": "A. Malaria\n B. Acute myelogenous leukemia\n C. Cholecystitis\n D. Renal papillary necrosis\n E. Splenic sequestration crisis", + "answer": "C" + }, + { + "question": "A 74-year-old man undergoes an open cholecystectomy. Surgery is performed under general anesthesia for which the patient is intubated with an endotracheal tube. Directly following the procedure, his temperature is 37°C (98.6°F), pulse is 80/min, and blood pressure is 110/80 mm Hg. He is extubated as soon as he showed signs of alertness. Five minutes later, he becomes unresponsive. He has type 2 diabetes mellitus, coronary artery disease, and hypertension. He underwent stenting of the right coronary artery 10 years ago. He smoked one pack of cigarettes daily for 40 years but quit 2 weeks ago for surgery. He drinks one to two beers daily. His current medications include metformin, enalapril, aspirin, atorvastatin, and a multivitamin. His temperature is 37°C (98.6°F), pulse is 102/min, respirations are 20/min, and blood pressure is 130/80 mm Hg. Pulse oximetry shows an oxygen saturation of 73%. He is put on a non-rebreather mask with an FiO2 of 100%. Three minutes later, he is still unresponsive. His arterial blood gas analysis shows:\npH 7.32\nPCO2 33 mm Hg\nPO2 73 mm Hg\nHCO3 22 mEq/L\nO2 saturation 73%\nWhich of the following is the best next step in the management of this patient?\"\n ", + "options": "A. Perform tracheostomy\n B. Continue using the non-rebreather mask\n C. Reintubate\n D. Close observation only\n E. Start BiPAP", + "answer": "C" + }, + { + "question": "A 2-hour-old, 3.2 kg (7.0 lb) newborn boy born by cesarean delivery is being evaluated by the resident on-call. The child was born to a gravida 2, para 0 mother with known hepatitis B. The mother made it to all of her prenatal appointments and took the recommended dose of folic acid since conception. She gave up smoking when she discovered she was pregnant. The infant’s heart rate is 150/min, respiratory rate is 48/min, temperature is 37.5°C (99.5°F), and blood pressure is 80/52 mm Hg. APGAR testing exhibits a score of 7 and 8 at 1 and 5 minutes, respectively. The head is normocephalic. No neural tube defects are present on inspection or palpation of the spine. There is strong flexion in all 4 extremities. Cranial nerves 2–12 are intact. Sensory and deep tendon reflexes are without any abnormalities. Which of the following is the best course of action for the newborn child?\nHepatitis B serology\nHBsAg positive\nHBeAg positive\nIgM HBc negative\nTotal anti-HBc positive\nAnti-HBs negative\nAnti-HBc negative\nHBV DNA greater than 1 million IU/mL\nAlanine transferase normal\n ", + "options": "A. Administer hepatitis B vaccine\n B. Administer hepatitis B immunoglobulin (HBIG)\n C. Administer hepatitis B vaccine and HBIG\n D. Check hepatitis B serology\n E. Check liver enzymes", + "answer": "C" + }, + { + "question": "A 3-year-old refugee with increasing pitting edema and abdominal swelling over the past 2 months is brought to the physician. Her family has been displaced several times over the last few years. Nutrition and housing were frequently inadequate. At the physician’s clinic, the boy appears irritated and drowsy. He is difficult to arouse. Physical examination shows pitting edema over the ankles and feet and around his eyes. Abdominal examination is positive for ascites and hepatomegaly. Oral examination shows several missing teeth. Which of the following best explains these findings?\n ", + "options": "A. Kwashiorkor\n B. Marasmus\n C. Beriberi\n D. Rickets\n E. Scurvy", + "answer": "A" + }, + { + "question": "A 24-year-old Asian woman is admitted to the hospital at 30 weeks gestation with nausea, vomiting, and right upper quadrant pain. She is gravida 2 para 0 with a history of the same complaints in her last pregnancy which ended with a stillbirth at the 31st week. Her older sister had preeclampsia in both of her pregnancies. Currently, the patient is responsive but lethargic. The vital signs are as follows: blood pressure 150/90 mm Hg, heart rate 85/min, respiratory rate 15/min, and temperature 36.4°C (97.5°F). The physical examination shows jaundice, right upper quadrant tenderness, and 2+ pitting edema of the lower extremities. The patient’s laboratory findings are as follows:\nErythrocyte count 2.7 million/mm3\nHemoglobin 10.1 g/dL\nHematocrit 0.56\nReticulocyte count 1.1%\nLeukocyte count 8,300/mm3\nThrombocyte count 190,000/mm3\nTotal bilirubin 5.3 mg/dL (91 µmol/L)\nConjugated bilirubin 4.2 mg/dL (72 µmol/L)\nAlanine Transaminase (ALT) 101 U/L\nAspartate Transaminase (AST) 99 U/L\nCreatinine 0.9 mg/dL (80 µmol/L)\nWhich of the following factors is a risk factor for this patient’s condition?\n ", + "options": "A. The patient’s age\n B. The patient’s race\n C. Nulliparity\n D. History in the previous pregnancy\n E. History of preeclampsia in a sibling", + "answer": "D" + }, + { + "question": "A 46-year-old man comes to the physician with a 1-week history of yellowish discoloration of his eyes, generalized fatigue, and pruritus. He was diagnosed with ulcerative colitis 7 years ago. At the time of diagnosis, a pANCA test was also positive. Physical examination shows scleral icterus and multiple scratch marks on the trunk and extremities. Abdominal examination is unremarkable. Serum studies show a total bilirubin concentration of 3.2 mg/dL, direct bilirubin concentration of 2.5 mg/dL, and alkaline phosphatase level of 450 U/L. Magnetic resonance cholangiopancreatography shows focal areas of intrahepatic bile duct strictures alternating with areas of dilation. Histologic examination of a liver biopsy specimen is most likely to show which of the following findings?\n ", + "options": "A. Periductal concentric scarring and fibrosis\n B. Periportal lymphocytic infiltration and piecemeal necrosis\n C. Diffuse fibrosis with PAS-staining globules\n D. Irregular ductal glands lined by atypical and pleomorphic cells\n E. Ductopenia and fibrotic degeneration of periportal hepatocytes", + "answer": "A" + }, + { + "question": "Two hours after undergoing open cholecystectomy for complicated cholecystitis, a 48-year-old woman develops dizziness, lethargy, abdominal pain, and nausea. She has systemic lupus erythematosus and hypertension. Prior to hospitalization, her medications included nifedipine and prednisolone. Her pulse is 112/min and blood pressure is 90/64 mm Hg. Examination shows central obesity. The abdomen is soft and non-tender, and the laparoscopic incisions have no discharge. Her serum cortisol and serum ACTH are decreased. Which of the following additional findings is most likely in this patient?\n ", + "options": "A. Normal anion gap metabolic acidosis\n B. Hyperkalemia\n C. Hyperglycemia\n D. Hypernatremia\n E. Hyponatremia", + "answer": "E" + }, + { + "question": "A 56-year-old man recently diagnosed with cirrhosis secondary to alcohol use presents to the clinic for a follow up evaluation. He states that he has abstained from alcohol and attends a support group regularly. He has not taken any new medications or encountered any sick contacts. The patient's blood pressure is 110/70 mmHg, pulse is 65/min, and respirations are 15/min. His physical exam is grossly unremarkable. He has brought an gastroduodenoscopy report for review, which reveals that the patient has small esophageal varices with red spots. What is the next best step to prevent bleeding?\n ", + "options": "A. Endoscopic sclerotherapy\n B. Ligation\n C. Metoprolol\n D. Nadolol\n E. Repeat endoscopy", + "answer": "D" + }, + { + "question": "A 72-year-old woman with a 40 pack-year history of smoking presents to your office with jaundice. After a thorough workup, you determine that the patient has pancreatic cancer. Which of the following is the most appropriate initial statement to inform the patient of her condition?\n ", + "options": "A. \"Have you ever heard of pancreatic cancer?\"\n B. \"I have bad news I need to share with you. Please sit down so we can discuss.\"\n C. \"Have you designated a healthcare proxy?\"\n D. \"We just received your test results and we have bad news to share with you. The resident will be in to explain the diagnosis to you.\"\n E. \"Your test results are consistent with a pancreatic adenocarcinoma.\"", + "answer": "B" + }, + { + "question": "Two hours following an elective cholecystectomy, a 43-year-old woman has fever and chills. The patient received cephalexin for antibiotic prophylaxis and one unit of packed red blood cells during the procedure. She underwent a hysterectomy 9 years ago for leiomyomata uteri. She has a 5-year history of hypertension treated with lisinopril. Her temperature is 39.5°C (102.3°F), pulse is 90/min, respirations are 18/min, and blood pressure is 125/90 mm Hg. Examination shows a mildly tender abdominal wound without erythema. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. She had a Foley catheter and peripheral line access placed at the time of the procedure. Which of the following is the most likely cause of this patient's symptoms?\n ", + "options": "A. Adverse effect of medication\n B. Malignant hyperthermia\n C. Surgical site infection\n D. Urinary tract infection\n E. Transfusion reaction", + "answer": "E" + }, + { + "question": "A 55-year-old woman is brought to the emergency department because of worsening upper abdominal pain for the past 8 hours. She reports that the pain radiates to her back and is associated with nausea. She has hypertension and hyperlipidemia, for which she takes enalapril, furosemide, and simvastatin. Her temperature is 37.5°C (99.5°F), blood pressure is 84/58 mm Hg, and pulse is 115/min. The lungs are clear to auscultation. Examination shows abdominal distention with epigastric tenderness and guarding. Bowel sounds are decreased. Extremities are warm. Laboratory studies show:\nHematocrit 48%\nLeukocyte count 13,800/mm3\nPlatelet count 175,000/mm3\nSerum \nCalcium 8.0 mg/dL\nUrea nitrogen 32 mg/dL\nAmylase 250 U/L\nAn ECG shows sinus tachycardia. Which of the following is the most likely underlying cause of this patient's vital sign abnormalities?\n ", + "options": "A. Abnormal coagulation and fibrinolysis\n B. Capillary leakage\n C. Decreased cardiac output\n D. Increased excretion of water\n E. Pseudocyst formation", + "answer": "B" + }, + { + "question": "A 57-year-old woman comes to the physician because of a 3-month history of fatigue. She also reports generalized itchiness that started approximately 2 months ago. Two weeks ago, she noticed yellowing of her eyes. She does not smoke or drink alcohol. She uses eyedrops for persistent dryness of the eyes. Her vital signs are within normal limits. Physical examination shows jaundice of the conjunctivae and skin. The mucous membranes of the mouth are dry. The abdomen is soft. The liver edge is palpable 3 cm below the right costal margin. There are generalized skin excoriations. Laboratory studies show:\nHemoglobin 15 g/dL\nLeukocyte count 7,700/mm3\nPlatelet count 332,000/mm3\nSerum\nGlucose 122 mg/dL\nTotal bilirubin 3.1 mg/dL\nDirect 2.5 mg/dL\nAlkaline phosphatase 452 U/L\nAST 155 U/L\nALT 168 U/L\nHepatitis B surface antigen negative\nHepatitis B core IgM antibody negative\nHepatitis B surface antibody positive\nHepatitis C antibody negative\nUltrasonography of the abdomen shows mildly increased echogenicity of the liver. Which of the following additional findings is most likely to be found in this patient?\"\n ", + "options": "A. Inferior vena cava thrombosis\n B. Cutaneous xanthomas\n C. Butterfly-shaped vertebrae\n D. Increased CA 19-9 levels\n E. Kayser-Fleischer rings\n\"", + "answer": "B" + }, + { + "question": "A 78-year-old woman presents to the emergency department with weight loss, abdominal pain, and jaundice. CT demonstrates a mass in the head of the pancreas, and biopsy is planned for the following day. The patient's daughter approaches you outside the room to request that the results of the biopsy not be shared with the patient. She asks that the results instead be shared with her and her brother, who is the patient's documented health care proxy. She explains that she and her brother have discussed the situation and decided that it is best to not inform the patient that she has cancer. Endoscopic ultrasound-guided biopsy the next morning confirms the diagnosis of pancreatic adenocarcinoma. Which of the following is the best response to the patient's daughter's request?\n ", + "options": "A. Ask the patient's son, the documented health care proxy, how he would like to handle the situation\n B. Inquire why the patient's daughter feels her mother should not be informed of the diagnosis\n C. Offer to explain the diagnosis to the patient without using the word \"cancer\"\n D. Order an ethics consult to determine how to address the situation\n E. Tell the patient's daughter that the patient must be informed of the diagnosis", + "answer": "B" + }, + { + "question": "A 48-year-old woman comes to the emergency department because of a 1-day history of fever, vomiting, and abdominal pain. Two weeks ago, while visiting Guatemala, she had an emergency appendectomy under general inhalational anesthesia. During the surgery, she received a transfusion of 1 unit of packed red blood cells. Her temperature is 38.3°C (100.9°F) and blood pressure is 138/76 mm Hg. Examination shows jaundice and tender hepatomegaly. Serum studies show:\nAlkaline phosphatase 102 U/L\nAspartate aminotransferase 760 U/L\nBilirubin\nTotal 3.8 mg/dL\nDirect 3.1 mg/dL\nAnti-HAV IgG positive\nAnti-HAV IgM negative\nAnti-HBs positive\nHBsAg negative\nAnti-HCV antibodies negative\nAbdominal ultrasonography shows an enlarged liver. A biopsy of the liver shows massive centrilobular necrosis. Which of the following is the most likely underlying cause of this patient's condition?\"\n ", + "options": "A. Acalculous inflammation of the gallbladder\n B. Virus-mediated hepatocellular injury\n C. Trauma to the bile duct\n D. Adverse effect of anesthetic\n E. Gram-negative bacteria in the bloodstream", + "answer": "D" + }, + { + "question": "A 23-year-old man comes to the physician because of a 1-week history of anorexia, nausea, upper abdominal pain, and dark-colored urine. He recently returned from a trip to Belize. His temperature is 38.3°C (100.9°F). Physical examination shows scleral icterus and tender hepatomegaly. Serum studies show markedly elevated transaminases and anti-hepatitis A virus antibodies. In this patient, infected cells express more MHC class I molecules on their surfaces. This cellular event is primarily induced by a molecule that is also responsible for which of the following changes?\n ", + "options": "A. Upregulated expression of exogenously synthesized antigens\n B. Enhanced macrophage phagocytic function\n C. Differentiation of T cells into TH1 cells\n D. Activation of eukaryotic initiation factor 2\n E. Increased breakdown of intracellular RNA", + "answer": "E" + }, + { + "question": "A 25-year-old female is brought to the emergency department by her family. They found her somnolent next to her computer and scattered pill bottles over two hours ago. The family cannot recall the types of pill bottles that they found and did not bring them to the ED. The patient's past medical history is notable for anxiety, obesity, hypertension, and polycystic ovarian syndrome. She is currently not on any medications other than an exercise program with which she is non-compliant. A physical exam is performed and is within normal limits. The patient begins communicating with the physician and states that she did take acetaminophen but it was only a few pills. Her temperature is 99.5°F (37.5°C), pulse is 82/min, blood pressure is 125/85 mmHg, respirations are 11/min, and oxygen saturation is 97% on room air. Which of the following is the next best step in management?\n ", + "options": "A. N-acetylcysteine\n B. Blood acetaminophen levels\n C. Charcoal\n D. IV fluids\n E. Syrup of ipecac", + "answer": "A" + }, + { + "question": "A 40-year old man presents to the clinic with vague upper abdominal pain that has been worsening for the last several days. He says that he often gets similar pain but less severe and that it worsens with meals. The pain sometimes radiates to his back. He recently lost 15 kg (33.6 lb) of weight secondary to his lack of appetite since his last visit 2 months ago. He admits to drinking alcohol almost every night since the age of 17. His temperature is 37.0° C (98.6°F), respirations are 15/min, pulse is 67/min, and blood pressure is 122/98 mm Hg. Physical examination reveals moderate epigastric tenderness. An abdominal CT scan reveals calcifications as shown by the white arrows. Which of the following organs is affected in this patient?\n ", + "options": "A. Pancreas\n B. Jejunum\n C. Duodenum\n D. Large intestine\n E. Gall bladder", + "answer": "A" + }, + { + "question": "A 23-year-old man comes to the clinic for yellowing of his eyes. The patient has been relatively healthy and just recently started “intermittent fasting” to try to lose weight. He recalls a similar episode 4 years ago when he was recovering from an emergency appendectomy. The patient denies smoking but endorses an episode of binge drinking 2 days ago. He is sexually active with both men and women. His physical examination is unremarkable besides scleral icterus. What is the most likely explanation for this patient’s symptoms?\n ", + "options": "A. Autoimmune-mediated fibrosis of biliary tract\n B. Chronic viral infection of the liver\n C. Decreased activity of UDP-glucuronosyltransferase\n D. Defective bilirubin excretion\n E. Macrovesicular steatosis", + "answer": "C" + }, + { + "question": "A 31-year-old woman is brought to the emergency department with fever, right upper quadrant pain, and myalgia. Her boyfriend says she recently returned from a trip to Southeast Asia. She appears ill and is lethargic. Her temperature is 39°C (102.2°F). Physical examination shows jaundice and tender hepatomegaly. Laboratory studies show the presence of anti-hepatitis A IgM antibodies. A liver biopsy performed at this time would most likely show which of the following histopathological findings?\n ", + "options": "A. Hepatocytes with shrunken, eosinophilic cytoplasm and pyknotic nuclei\n B. Acellular debris surrounded by lymphocytes and macrophages\n C. Cystic spaces with scattered areas of cellular debris\n D. Basophilic adipocyte remnants, filled with calcifications\n E. Engorged hepatocytes with red blood cell infiltration\n\"", + "answer": "A" + }, + { + "question": "A 66-year-old man with high blood pressure, high cholesterol, and diabetes presents to the clinic with elevated liver function tests from baseline. He has a blood pressure of 136/92 mm Hg and a heart rate of 69/min. On physical examination, his heart sounds are regular and lung sounds are clear. Current medications include simvastatin, metformin, fenofibrate, hydrochlorothiazide, aspirin, glyburide, and lisinopril. Of these medications, which could contribute to the patient’s transaminitis?\n ", + "options": "A. Metformin\n B. Simvastatin\n C. Aspirin\n D. Glyburide\n E. Lisinopril", + "answer": "B" + }, + { + "question": "A 55-year-old woman with no significant past medical history presents to her primary care doctor with fever, fatigue, and bleeding gums for the past 3 days. She denies any sick contacts. Her temperature is 101°F (38.3°C), blood pressure is 110/70 mmHg, pulse is 96/min, and respirations are 15/min. Physical exam reveals several oral mucosal petechiae, bleeding gums, bilateral submandibular lymphadenopathy, and hepatosplenomegaly. Initial laboratory workup shows the following:\n\nLeukocyte count and differential:\nLeukocyte count: 6,600/mm^3\nSegmented neutrophils: 60%\nBands: 20%\nEosinophils: 9%\nBasophils: 1%\nLymphocytes: 0%\nMonocytes: 10%\nPlatelet count: 99,000/mm^3\n\nHemoglobin: 8.1 g/dL\nHematocrit: 25%\n\nProthrombin time: 25 sec\nPartial thromboplastin time: 50 sec\nInternational normalized ratio: 1.6\nD-dimer: 2,000 µg/mL\nFibrinogen: 99 mg/dL\n\nA bone marrow biopsy demonstrates 34% myeloblasts with Auer rods that are myeloperoxidase positive. What is best treatment option?\n ", + "options": "A. Ascorbic acid\n B. Cryoprecipitate\n C. Fresh frozen plasma\n D. Retinoic acid\n E. Zoledronic acid", + "answer": "D" + }, + { + "question": "In humans, the liver is one of the largest and most active organsin the body. Describe its functions.\n ", + "options": "A. The liver only detoxifies harmful substances.\nB. The liver filters out red blood cells, produces urine, and regulates body temperature.\nC. The liver produces insulin and glucagon, regulates carbohydrate metabolism, and stores vitamins.\nD. The liver is mainly responsible for the production of bile.\nE. The liver regulates the level of glucose in the blood, converts glucose into fat, produces bile, detoxifies ammonia, produces cholesterol, plays roles in blood clotting, and is involved in the activation of vitamin D.\nF. The liver synthesizes proteins for muscle development and stores excess glucose as glycogen.\nG. The liver's main function is the regulation of glucose levels.\nH. The liver is involved in the synthesis of growth hormones and the regulation of the body's immune response.\nI. The liver is responsible for the production of digestive enzymes and the absorption of nutrients.\nJ. The liver's primary role is to break down muscle tissue and recycle red blood cells.", + "answer": "E" + }, + { + "question": "A 75-year-old woman comes to the office because she has band-like, burning pain in her right upper abdomen extending from the epigastrium around to the midline of the back. Physical examination discloses no abdominal tenderness to palpation. Findings on ultrasonography of the gallbladder are normal. Serum amylase concentration is within the reference range. Which of the following is the most likely diagnosis?\n ", + "options": "A. Gallstones\nB. Gastric cancer\nC. Peptic Ulcer Disease\nD. Herpes zoster\nE. Irritable Bowel Syndrome\nF. Appendicitis\nG. Acalculous cholecystitis\nH. Diverticulitis of the cecum\nI. Hepatitis C", + "answer": "D" + }, + { + "question": "A 55-year-old male presents to the emergency department with a 2-day history of severe epigastric pain and vomiting. Past medical history is negative for any similar episodes. He does not take any medications. He smokes cigarettes, has a 40 pack-year history, and consumes more than 8 cans of beer per day. Abdominal examination reveals epigastric tenderness. Laboratory studies reveal a serum amylase level of 467 U/L (reference range: 28-100 U/L) and a γ-glutamyltransferase level of 212 U/L (reference range: < 55 U/L). Referred pain in this patient is transmitted to the spinal cord by which of the following nerves?\n ", + "options": "A. anterior rami of C1-C5\nB. anterior rami of T11-T12\nC. anterior rami of L1-L5\nD. posterior rami of T6-T10\nE. posterior rami of L1-L5\nF. posterior rami of T11-T12\nG. anterior rami of T6-T10\nH. anterior rami of T1-T5\nI. anterior rami of C6-C10\nJ. posterior rami of T1-T5", + "answer": "G" + }, + { + "question": "A 55-year-old male presents to the emergency department with a 2-day history of severe epigastric pain and vomiting. Past medical history is negative for any similar episodes. He does not take any medications. He smokes cigarettes, has a 40 pack-year history, and consumes more than 8 cans of beer per day. Abdominal examination reveals epigastric tenderness. Laboratory studies reveal a serum amylase level of 467 U/L (reference range: 28-100 U/L) and a γ-glutamyltransferase level of 212 U/L (reference range: < 55 U/L). Referred pain in this patient is transmitted to the spinal cord by which of the following nerves?\n ", + "options": "A. anterior rami of C1-C5\nB. anterior rami of T11-T12\nC. anterior rami of L1-L5\nD. posterior rami of T6-T10\nE. posterior rami of L1-L5\nF. posterior rami of T11-T12\nG. anterior rami of T6-T10\nH. anterior rami of T1-T5\nI. anterior rami of C6-C10\nJ. posterior rami of T1-T5", + "answer": "G" + }, + { + "question": "A 35-year-old female develops nausea and vomiting after she underwent a cholecystectomy for protracted ileus. Her body mass index was 23 kg/m2 before surgery, and, except for the cholecystitis, she was in good health. The patient remains unable to eat 6 days after surgery. Which of the following forms of nutritional support is most appropriate for this patient?\n ", + "options": "A. oral protein-rich diet\nB. feeding through a nasogastric feeding tube\nC. feeding through a jejunostomy tube\nD. central hyperalimentation\nE. intravenous saline solution\nF. peripheral hyperalimentation\nG. oral carbohydrate-rich diet\nH. feeding through a gastrostomy tube\nI. oral fat-free modular diet\nJ. intravenous dextrose solution", + "answer": "F" + }, + { + "question": "A 35-year-old female develops nausea and vomiting after she underwent a cholecystectomy for protracted ileus. Her body mass index was 23 kg/m2 before surgery, and, except for the cholecystitis, she was in good health. The patient remains unable to eat 6 days after surgery. Which of the following forms of nutritional support is most appropriate for this patient?\n ", + "options": "A. oral protein-rich diet\nB. feeding through a nasogastric feeding tube\nC. feeding through a jejunostomy tube\nD. central hyperalimentation\nE. intravenous saline solution\nF. peripheral hyperalimentation\nG. oral carbohydrate-rich diet\nH. feeding through a gastrostomy tube\nI. oral fat-free modular diet\nJ. intravenous dextrose solution", + "answer": "F" + }, + { + "question": "The replication of hepatitis B includes which of the following stages?\n ", + "options": "A. Movement of intact virus to the cellular cytoplasm for replication\nB. Conversion of relaxed circular viral DNA in to covalently closed circular (CCC) DNA in the nucleus\nC. Virions produced in the cytoplasm by cellular DNA polymerase\nD. Oncogenic activity to transform liver cells.", + "answer": "C" + }, + { + "question": "What is the primary lipoprotein secreted from the liver that is at least partially composed of dietary derived lipids?\n\n ", + "options": "A. Lp(a)\nB. HDL\nC. ApoB-100\nD. IDL\nE. VLDL\nF. Lipoprotein(a)\nG. LDL\nH. ApoA-1\nI. Chylomicrons\nJ. Lipoprotein lipase", + "answer": "E" + }, + { + "question": "The pancreas secretes a large amount of digestive enzymes after a meal. Which statement about this process is correct?\n\n ", + "options": "A. Bile is needed to activate all pancreatic enzymes\nB. All pancreatic enzymes are produced in an active form and can start digestion immediately\nC. Enzymes are produced in the pancreas but released in the stomach for digestion\nD. Pepsinogen is the chief enzyme which digests protein and requires removal of a peptide sequence from the active cleft before it can work\nE. Pancreatic secretion of hydrochloric acid is required to provide the correct pH for maximal pancreatic enzyme in the duodenum\nF. Enteropeptidase converts trypsinogen to trypsin by cleavage of a peptide sequence that blocks the active site of trypsin.\nG. Pancreatic enzymes are needed to break down carbohydrates only.\nH. Pancreatic á-amylase will hydrolyse starch to free glucose", + "answer": "F" + }, + { + "question": "A 42-year-old woman comes to the physician because of an 8-week history of intermittent nausea and abdominal pain that occurs 20 to 30 minutes after eating. The pain extends from the epigastrium to the right upper quadrant and is sometimes felt in the right scapula; it lasts about 30 minutes and is not relieved by antacids. The last episode occurred after she ate a hamburger and french fries. She has not had vomiting. She is currently asymptomatic. She is 165 cm (5 ft 5 in) tall and weighs 104 kg (230 lb); BMI is 38 kg/m2 . Examination shows no other abnormalities. Which of the following is the most appropriate next step in management?\n ", + "options": "A. Abdominal ultrasonography of the right upper quadrant\nB. Upper gastrointestinal series with small bowel follow-through\nC. CT scan of the abdomen\nD. Endoscopic retrograde cholangiopancreatography", + "answer": "A" + }, + { + "question": "Is fear of anaphylactic shock discouraging surgeons from more widely adopting percutaneous and laparoscopic techniques in the treatment of liver hydatid cyst?\n Contexts: Sources of reports about laparoscopic and percutaneous treatment of liver hydatid cysts are limited to just a few countries. To address the reason behind this, we carried out a survey of 30 surgeons in northern Jordan.\nA questionnaire was distributed to collect data regarding the surgical technique preferred by each surgeon. Further information was collected from those not adopting minimal-access techniques to determine their reasons for not doing so.\nOnly 3 surgeons (10%) considered laparoscopy as the first line of treatment. Of the 27 surgeons who did not consider percutaneous or laparoscopic treatment, fear of anaphylaxis and/or dissemination was the main reason given by 21 surgeons (78%) for not using minimal access techniques.\n", + "options": "A. yes \n B. no \n C. maybe", + "answer": "A" + }, + { + "question": "Hepatorenal syndrome: are we missing some prognostic factors?\n Contexts: Hepatorenal syndrome (HRS) is the functional renal failure associated with advanced cirrhosis and has also been described in fulminant hepatic failure. Without liver transplantation its prognosis is dismal. Our study included patients with type 1 HRS associated with cirrhosis, who were not liver transplant candidates.AIM: To identify variables associated with improved survival.\nSixty-eight patients fulfilled the revised Ascites Club Criteria for type 1 HRS. None of them was suitable for liver transplantation. All the patients were treated with combinations of: albumin, midodrine and octreotide, pressors, and hemodialysis.\nMedian survival was 13 days for the whole group. Survival varied with the end-stage liver disease (ESLD) etiology: autoimmune, 49 days, cardiac cirrhosis, 22 days, idiopathic, 15.5 days, viral, 15 days, hepatitis C and alcohol, 14.5 days, alcohol 8 days, and neoplasia 4 days (p = 0.048). Survival of HRS associated with alcoholic liver disease versus other etiologies was not statistically significant (p = 0.1). Increased serum creatinine (p = 0.02) and urinary sodium 6-10 mEq/l (p = 0.027) at the initiation of therapy were prognostic factors for mortality. HRS treatment modalities (p = 0.73), use of dialysis (p = 0.56), dialysis modality (p = 0.35), use of vasopressors (p = 0.26), pre-existing renal disease (p = 0.49), gender (p = 0.90), and age (p = 0.57) were not associated with survival.\n", + "options": "A. yes \n B. no \n C. maybe", + "answer": "A" + }, + { + "question": "Differentiation of nonalcoholic from alcoholic steatohepatitis: are routine laboratory markers useful?\n Contexts: Specific markers for differentiation of nonalcoholic (NASH) from alcoholic steatohepatitis (ASH) are lacking. We investigated the role of routine laboratory parameters in distinguishing NASH from ASH.\nLiver biopsies performed at our hospital over a 10-year period were reviewed, 95 patients with steatohepatitis identified and their data prior to biopsy reevaluated. The diagnosis NASH or ASH was assigned (other liver diseases excluded) on the basis of the biopsy and history of alcohol consumption (<140 g/week). Logistic regression models were used for analysis.\nNASH was diagnosed in 58 patients (61%; 30 f) and ASH in 37 (39%; 9 f). High-grade fibrosis (59% vs. 19%, P<0.0001) and an AST/ALT ratio>1 (54.1% vs 20.7%, P = 0.0008) were more common in ASH. The MCV was elevated in 53% of ASH patients and normal in all NASH patients (P<0.0001). Multivariate analysis identified the MCV (P = 0.0013), the AST/ALT ratio (P = 0.011) and sex (P = 0.0029) as relevant regressors (aROC = 0.92). The AST/ALT ratio (P<0.0001) and age (P = 0.00049) were independent predictors of high-grade fibrosis. Differences in MCV were more marked in high-grade fibrosis.\n", + "options": "A. yes \n B. no \n C. maybe", + "answer": "A" + }, + { + "question": "Do cytokine concentrations in pancreatic juice predict the presence of pancreatic diseases?\n Contexts: Cytokine concentration in pancreatic juice of patients with pancreatic disease is unknown. Secretin stimulation allows endoscopic collection of pancreatic juice secreted into the duodenum. We aimed to evaluate the cytokine concentrations in pancreatic juice of patients with abdominal pain to discriminate presence from absence of pancreatic disease.\nFrom January 2003-December 2004, consecutive patients with abdominal pain compatible with pancreatic origin were enrolled. Patients underwent upper endoscopy. Intravenous secretin (0.2 mug/kg) was given immediately before scope intubation. Pancreatic juice collected from the duodenum was immediately snap-frozen in liquid nitrogen until assays were performed. Pancreatic juice levels of interleukin-8, interleukin-6, intercellular adhesion molecule 1, and transforming growth factor-beta 1 were measured by modified enzyme-linked immunosorbent assays. The final diagnosis was made by the primary gastroenterologist on the basis of medical history; laboratory, endoscopic, and imaging studies; and clinical follow-up. Fisher exact test and Kruskal-Wallis rank sum test were used for statistical analysis.\nOf 130 patients screened, 118 met the inclusion criteria. Multivariate analysis revealed that only interleukin-8 was able to discriminate between normal pancreas and chronic pancreatitis (P = .011), pancreatic cancer (P = .044), and the presence of pancreatic diseases (P = .007). Individual cytokine concentrations were not significantly different in chronic pancreatitis compared with pancreatic cancer.\n", + "options": "A. yes \n B. no \n C. maybe", + "answer": "A" + }, + { + "question": "Does a special interest in laparoscopy affect the treatment of acute cholecystitis?\n Contexts: We tested the hypothesis that the treatment of patients with acute cholecystitis (AC) would be improved under the care of laparoscopic specialists.\nThe records of patients undergoing cholecystectomy for AC from 1 January 1996 to 31 December 1998 were reviewed retrospectively. Of 170 patients, 48 were cared for by three laparoscopic specialists (LS group), whereas 122 were treated by nine general surgeons who perform only laparoscopic cholecystectomy (LC) (GS group). The rates of successful LC, complications, and length of hospital stay were compared. Multivariate analysis was used to control for baseline differences.\nThe patients in the GS group were older (median age, 63 vs 53 years; p = 0.01). In all, 31 LS patients (65%), as compared with 44 GS patients (36%), had successful laparoscopic treatment (p = 0.001). The operating time was the same (median, 70 min). The proportion of patients with postoperative complications was similar in the two groups (37% in the GS vs 31% in the LS group; p = 0.6). The median postoperative hospital stay (3 vs 5 days; p<0.01) was shorter in the LS group. On logistic regression analysis, significant predictors of a successful laparoscopic operation included LS group (p<0.01) and age (p = 0). Predictors of prolonged length of hospital stay were age (p<0.01) and comorbidity score (p<0.01), with LS group status not a significant factor (p = 0.21).\n", + "options": "A. yes \n B. no \n C. maybe", + "answer": "A" + }, + { + "question": "Is non-invasive diagnosis of esophageal varices in patients with compensated hepatic cirrhosis possible by duplex Doppler ultrasonography?\n Contexts: Esophageal varices are present in 30% to 40% of patients in compensated cirrhosis (Child-Pugh class A) and in 60% to 85% of patients in decompensated cirrhosis (Child-Pugh classes B and C). It is important to identify patients with compensated cirrhosis at risk for esophageal varix development. We evaluated the accuracy of a duplex Doppler ultrasonographic index for predicting the presence or absence of esophageal varices in patients with compensated hepatic cirrhosis (Child-Pugh class A) by using endoscopy as the reference standard.\nFifty-six enrolled patients underwent duplex Doppler ultrasonography followed by screening endoscopy. Mean portal vein velocity (PVV), splenic index (SI), splenoportal index (SPI), hepatic and splenic arterial resistive, and pulsatility indices (hepatic artery resistive index [HARI], hepatic artery pulsatility index [HAPI], splenic artery resistive index [SARI], splenic artery pulsatility index [SAPI]) were recorded. Univariate logistic regression analysis was followed by receiver operating characteristic (ROC) curve construction for the indices that were significant.\nThe indices HARI, HAPI, SARI, SAPI were not helpful (p > 0.05). Mean PVV, SI, and SPI were all predictive of the presence of esophageal varices (p < 0.05) and SPI was found to be the most accurate parameter. Of the various cut-off levels of SPI evaluated, a cut-off value of SPI at 5.0, offered the highest diagnostic accuracy (88%). For the 28 patients with SPI<5.0, the absence of esophageal varices in 27 of them could be correctly diagnosed using only SPI without invasive screening endoscopy, with high negative predictive value (96%) and sensitivity (96%). Of the remaining 28 patients with SPI ≥5.0, presence of esophageal varices could be similarly correctly diagnosed in 22 of them by using SPI without screening endoscopy, with high positive predictive value (79%) and specificity (82%).\n", + "options": "A. yes \n B. no \n C. maybe", + "answer": "A" + }, + { + "question": "Should serum pancreatic lipase replace serum amylase as a biomarker of acute pancreatitis?\n Contexts: Serum pancreatic lipase may improve the diagnosis of pancreatitis compared to serum amylase. Both enzymes have been measured simultaneously at our hospital allowing for a comparison of their diagnostic accuracy.\nSeventeen thousand five hundred and thirty-one measurements of either serum amylase and or serum pancreatic lipase were made on 10 931 patients treated at a metropolitan teaching hospital between January 2001 and May 2003. Of these, 8937 were initially treated in the Emergency Department. These results were collected in a database, which was linked by the patients' medical record number to the radiology and medical records. Patients with either an elevated lipase value or a discharge diagnosis of acute pancreatitis had their radiological diagnosis reviewed along with their biochemistry and histology record. The diagnosis of acute pancreatitis was made if there was radiological evidence of peripancreatic inflammation.\nOne thousand eight hundred and twenty-five patients had either elevated serum amylase and or serum pancreatic lipase. The medical records coded for pancreatitis in a further 55 whose enzymes were not elevated. Three hundred and twenty of these had radiological evidence of acute pancreatitis. Receiver operator characteristic analysis of the initial sample from patients received in the Emergency Department showed improved diagnostic accuracy for serum pancreatic lipase (area under the curve (AUC) 0.948) compared with serum amylase (AUC, 0.906, P<0.05). A clinically useful cut-off point would be at the diagnostic threshold; 208 U/L (normal<190 U/L) for serum pancreatic lipase and 114 U/L (normal 27-100 U/L) for serum amylase where the sensitivity was 90.3 cf., 76.8% and the specificity was 93 cf., 92.6%. 18.8% of the acute pancreatitis patients did not have elevated serum amylase while only 2.9% did not have elevated serum pancreatic lipase on the first emergency department measurement.\n", + "options": "A. yes \n B. no \n C. maybe", + "answer": "A" + }, + { + "question": "Hepatic arterial embolization for unresectable hepatocellular carcinomas: do technical factors affect prognosis?\n Contexts: To evaluate retrospectively whether technical factors of hepatic arterial embolization affect the prognosis of patients with hepatocellular carcinoma (HCC).\nInclusion criteria of this study were the following: (1) patients received embolization as the initial treatment during 2003-2004, (2) Child A or B liver profile, (3) five or fewer HCCs with maximum diameter of 7 cm or smaller, and (4) no extrahepatic metastasis. Patient data were gathered from 43 centers. Prognostic factors were evaluated using univariate and multivariate analyses.\nEight hundred fifteen patients were enrolled. The 1-, 3-, 5-, and 7-year overall survival rates were 92.0 % (95 % CI 90.1-93.9), 62.9 % (95 % CI 59.3-66.6), 39.0 % (95 % CI 35.1-43.0), and 26.7 % (95 % CI 22.6-30.8) in all patients. Univariate analysis showed a Child-Pugh class-A, alpha-fetoprotein level lower than 100 ng/ml, tumor size of 3 cm or smaller, tumor number of 3 or fewer, one-lobe tumor distribution, nodular tumor type, within the Milan criteria, stage I or II, no portal venous invasion, use of iodized oil, and selective embolization were significantly better prognostic factors. In the multivariate Cox model, the benefit to survival of selective embolization remained significant (hazard ratio 0.68; 95 % CI 0.48-0.97; p = 0.033).\n", + "options": "A. yes \n B. no \n C. maybe", + "answer": "A" + }, + { + "question": "Is the covering of the resection margin after distal pancreatectomy advantageous?\n Contexts: In recent years, many advances in pancreatic surgery have been achieved. Nevertheless, the rate of pancreatic fistula following pancreatic tail resection does not differ between various techniques, still reaching up to 30% in prospective multicentric studies. Taking into account contradictory results concerning the usefulness of covering resection margins after distal pancreatectomy, we sought to perform a systematic, retrospective analysis of patients that underwent distal pancreatectomy at our center.\nWe retrospectively analysed the data of 74 patients that underwent distal pancreatectomy between 2001 and 2011 at the community hospital in Neuss. Demographic factors, indications, postoperative complications, surgical or interventional revisions, and length of hospital stay were registered to compare the outcome of patients undergoing distal pancreatectomy with coverage of the resection margins vs. patients undergoing distal pancreatectomy without coverage of the resection margins. Differences between groups were calculated using Fisher's exact and Mann-Whitney U test.\nMain indications for pancreatic surgery were insulinoma (n=18, 24%), ductal adenocarcinoma (n=9, 12%), non-single-insulinoma-pancreatogenic-hypoglycemia-syndrome (NSIPHS) (n=8, 11%), and pancreatic cysts with pancreatitis (n=8, 11%). In 39 of 74 (53%) patients no postoperative complications were noted. In detail we found that 23/42 (55%) patients with coverage vs. 16/32 (50%) without coverage of the resection margins had no postoperative complications. The most common complications were pancreatic fistulas in eleven patients (15%), and postoperative bleeding in nine patients (12%). Pancreatic fistulas occurred in patients without coverage of the resection margins in 7/32 (22%) vs. 4/42 (1011%) with coverage are of the resection margins, yet without reaching statistical significance. Postoperative bleeding ensued with equal frequency in both groups (12% with coverage versus 13% without coverage of the resection margins). The reoperation rate was 8%. The hospital stay for patients without coverage was 13 days (5-60) vs. 17 days (8-60) for patients with coverage.\n", + "options": "A. yes \n B. no \n C. maybe", + "answer": "B" + }, + { + "question": "Is diffusion-weighted imaging a significant indicator of the development of vascularization in hypovascular hepatocellular lesions?\n Contexts: The objective was to evaluate the efficacy of diffusion-weighted imaging (DWI) in predicting the development of vascularization in hypovascular hepatocellular lesions (HHLs).\nForty-two HHLs that were diagnosed by computed tomographic (CT) arteriography were evaluated retrospectively. The lesion on DWI was classified as isointense, hypointense, or hyperintense. Follow-up studies that included intravenous dynamic CT or magnetic resonance imaging were performed.\nThe 730-day cumulative developments of vascularization in hypointense, isointense, and hyperintense lesions were 17%, 30%, and 40%, respectively. The differences among these developments were not statistically significant.\n", + "options": "A. yes \n B. no \n C. maybe", + "answer": "B" + }, + { + "question": "Blunt trauma in intoxicated patients: is computed tomography of the abdomen always necessary?\n Contexts: Physical examination to detect abdominal injuries has been considered unreliable in alcohol-intoxicated trauma patients. Computed tomography (CT) plays the primary role in these abdominal evaluations.\nWe reviewed medical records of all blunt trauma patients admitted to our trauma service from January 1, 1992, to March 31, 1998. Study patients had a blood alcohol level>or =80 mg/dL, Glasgow Coma Scale (GCS) score of 15, and unremarkable abdominal examination.\nOf 324 patients studied, 317 (98%) had CT scans negative for abdominal injury. Abdominal injuries were identified in 7 patients (2%), with only 2 (0.6%) requiring abdominal exploration. A significant association was found between major chest injury and abdominal injury.\n", + "options": "A. yes \n B. no \n C. maybe", + "answer": "B" + }, + { + "question": "Can the growth rate of a gallbladder polyp predict a neoplastic polyp?\n Contexts: Cholecystectomy for GB polyps that are larger than 10 mm is generally recommended because of the high probability of neoplasm. In contrast, a follow-up strategy is preferred for GB polyps smaller than 10 mm. However, there are no treatment guidelines for polyps that grow in size during the follow-up period.STUDY: We retrospectively investigated 145 patients with GB polyps who underwent at least 1 ultrasonographic follow-up examination over an interval greater than 6 months, before cholecystectomy at Samsung medical center, South Korea, from 1994 to 2007. The growth rate was determined based on the change in size per time interval between 2 ultrasonographic examinations (mm/mo).\nThe median age of the patients was 48 years (range: 25 to 75). One hundred twenty-five non-neoplastic polyps and 20 neoplastic polyps were found. Neoplastic polyps were more frequently found in patients older than 60 years, those with hypertension, a polyp size greater than 10 mm, and a rapid growth rate greater than 0.6 mm/mo. On multivariate analysis, however, the growth rate was not related to the neoplastic nature of a polyp, but older age (>60 y) and large size (>10 mm) were significantly associated with neoplastic polyps.\n", + "options": "A. yes \n B. no \n C. maybe", + "answer": "B" + }, + { + "question": "Are hepatitis G virus and TT virus involved in cryptogenic chronic liver disease?\n Contexts: Hepatitis G virus can cause chronic infection in man but the role of this agent in chronic liver disease is poorly understood. Little is known about the relation of another newly discovered agent, the TT virus, with chronic liver disease.AIM: To investigate the rate of infection with hepatitis G virus and TT virus in patients with cryptogenic chronic liver disease.\nA total of 23 subjects with chronically raised alanine transaminase and a liver biopsy in whom all known causes of liver disease had been excluded, and 40 subjects with hepatitis C virus-related chronic liver disease.\nEvaluation of anti-hepatitis G virus by enzyme immunoassay. Hepatitis G virus-RNA by polymerase chain reaction with primers from the 5' NC and NS5a regions. TT virus-DNA by nested polymerase chain reaction with primers from the ORF1 region. Results. Hepatitis G virus-RNA was detected in 4 out of 23 patients with cryptogenic chronic hepatitis and in 6 out of 40 with hepatitis C virus chronic hepatitis (17.4% vs 15% p=ns). At least one marker of hepatitis G virus infection (hepatitis G virus-RNA and/or anti-hepatitis G virus, mostly mutually exclusive) was present in 6 out of 23 patients with cryptogenic hepatitis and 16 out of 40 with hepatitis C virus liver disease (26. 1% vs 40% p=ns). T virus-DNA was present in serum in 3 subjects, 1 with cryptogenic and 2 with hepatitis C virus-related chronic liver disease. Demographic and clinical features, including stage and grade of liver histology, were comparable between hepatitis G virus-infected and uninfected subjects. Severe liver damage [chronic hepatitis with fibrosis or cirrhosis) were significantly more frequent in subjects with hepatitis C virus liver disease.\n", + "options": "A. yes \n B. no \n C. maybe", + "answer": "B" + }, + { + "question": "The clinical significance of bile duct sludge: is it different from bile duct stones?\n Contexts: Some patients with suspected common bile duct (CBD) stones are found to have sludge and no stones. Although sludge in the gallbladder is a precursor of gallbladder stones, the significance of bile duct sludge (BDS) is poorly defined. This study aimed to compare BDS with bile duct stones in terms of frequency, associated risk factors, and clinical outcome after endoscopic therapy.\nThe study enrolled 228 patients who underwent therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for suspected choledocholithiasis. The patients were divided into two groups: patients with BDS but no stones on ERCP and patients with CBD stones. The presence of risk factors for bile duct stones (age, periampullary diverticulum, ductal dilation or angulation, previous open cholecystectomy) were assessed at ERCP. Follow-up data (36 +/- 19 months) were obtained from medical records and by patient questioning.\nBile duct sludge occurred in 14% (31/228) of patients and was more common in females. After endoscopic clearance, CBD stones recurred in 17% (33/197) of the patients with CBD stones, and in 16% (5/31) of the patients with BDS (p = 0.99). Common bile duct dilation was less common in the sludge group. The other known risk factors for recurrent CBD stones (age, previous open cholecystectomy, bile duct angulation, and the presence of a peripampullary diverticulum) were not statistically different between the two groups.\n", + "options": "A. yes \n B. no \n C. maybe", + "answer": "B" + }, + { + "question": "Preoperative staging of patients with liver metastases of colorectal carcinoma. Does PET/CT really add something to multidetector CT?\n Contexts: This study was designed to determine prospectively whether the systematic use of PET/CT associated with conventional techniques could improve the accuracy of staging in patients with liver metastases of colorectal carcinoma. We also assessed the impact on the therapeutic strategy.\nBetween 2006 and 2008, 97 patients who were evaluated for resection of LMCRC were prospectively enrolled. Preoperative workup included multidetector-CT (MDCT) and PET/CT. In 11 patients with liver steatosis or iodinated contrast allergy, MR also was performed. Sixty-eight patients underwent laparotomy. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values for hepatic and extrahepatic staging of MDCT and PET-CT were calculated.\nIn a lesion-by-lesion analysis of the hepatic staging, the sensitivity of MDCT/RM was superior to PET/CT (89.2 vs. 55%, p < 0.001). On the extrahepatic staging, PET/CT was superior to MDCT/MR only for the detection of locoregional recurrence (p = 0.03) and recurrence in uncommon sites (p = 0.016). New findings in PET/CT resulted in a change in therapeutic strategy in 17 patients. However, additional information was correct only in eight cases and wrong in nine patients.\n", + "options": "A. yes \n B. no \n C. maybe", + "answer": "B" + }, + { + "question": "Colorectal cancer with synchronous liver metastases: does global management at the same centre improve results?\n Contexts: Synchronous liver metastases (SLM) occur in 20% of colorectal cancers (CRC). Resection of SLM and CLC can be undertaken at different centres (separate management, SM) or at the same centre (global management, GM).\nRetrospective study of SLM and CRC resections carried out during 01/2000 - 12/2006 by SM or GM, using a combined or delayed strategy.\nMorphologic characteristics and type of CRC and SLM resection were similar for the GM (n = 45) or SM (n = 66) groups. In patients with delayed liver resection (62 SM, 17 GM), chemotherapy prior to liver surgery was used in 92% and 38% of SM and GM patients (P<0.0001) and the median delay between procedures was 212 and 182 days, respectively (P = 0.04). First step of liver resection was more often performed during colorectal surgery in the GM group (62 vs. 6% for SM, P<0.0001) and the mean number of procedures (CRC+SLM) was lower (1.6 vs. 2.3, P = 0.003). Three-month mortality was 3% for GM and 0% for SM (n.s.). Overall survival rates were 67% and 51% for SM and GM at 3 years (n.s.), and 35 and 31% at 5 years (n.s.). Disease-free survival to 5 years was higher in SM patients (14% vs. 11%, P = 0.009).\n", + "options": "A. yes \n B. no \n C. maybe", + "answer": "B" + }, + { + "question": "Is There an Additional Value of Using Somatostatin Receptor Subtype 2a Immunohistochemistry Compared to Somatostatin Receptor Scintigraphy Uptake in Predicting Gastroenteropancreatic Neuroendocrine Tumor Response?\n Contexts: It is unknown whether tumoral somatostatin receptor subtype 2a (sst2a) immunohistochemistry (IHC) has additional value compared to somatostatin receptor scintigraphy (SRS) uptake using OctreoScan® in predicting response to peptide receptor radiotherapy using 177Lu-octreotate (PRRT) in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs). The aims of this study were: (1) to establish the percentage of sst2a immunopositivity in GEP-NET samples of PRRT-treated patients, (2) to determine the relationship between best GEP-NET response using RECIST 1.0 criteria 1 year after PRRT and tumoral sst2a IHC, and (3) to compare characteristics of patients with sst2a IHC-negative and -positive tumors.\nAll 73 consecutive patients were selected for PRRT based on a positive SRS. Radiological response was scored according to RECIST 1.0 criteria. sst2a status was detected on tumor samples by IHC.\nIn total, 93% of GEP-NET samples showed sst2a IHC positivity. No statistically significant relationship was observed between in vitro sst2a expression and in vivo best GEP-NET response 1 year after PRRT (p = 0.47). Sex, primary tumor site, disease stage, ENETS TNM classification, Ki-67 index, highest serum chromogranin-A level, and highest neuron-specific enolase level were not significantly different between patients with negative and positive sst2a tumoral IHC with the exception of age at diagnosis (p = 0.007).\n", + "options": "A. yes \n B. no \n C. maybe", + "answer": "B" + }, + { + "question": "Does patient position during liver surgery influence the risk of venous air embolism?\n Contexts: It is generally believed that positioning of the patient in a head-down tilt (Trendelenberg position) decreases the likelihood of a venous air embolism during liver resection.\nThe physiological effect of variation in horizontal attitude on central and hepatic venous pressure was measured in 10 patients during liver surgery. Hemodynamic indices were recorded with the operating table in the horizontal, 20 degrees head-up and 20 degrees head-down positions.\nThere was no demonstrable pressure gradient between the hepatic and central venous levels in any of the positions. The absolute pressures did, however, vary in a predictable way, being highest in the head-down and lowest during head-up tilt. However, on no occasion was a negative intraluminal pressure recorded.\n", + "options": "A. yes \n B. no \n C. maybe", + "answer": "B" + }, + { + "question": "Prognosis of well differentiated small hepatocellular carcinoma--is well differentiated hepatocellular carcinoma clinically early cancer?\n Contexts: The purpose of this study is to examine whether or not well differentiated (w-d) hepatocellular carcinoma (HCC) is indeed clinically early cancer.\nSeventy six patients with solitary small HCCs up to 3 cm in diameter, who underwent hepatectomy, were observed for at least 2 years for possible recurrence. These patients were divided into two groups: 10 patients with w-d HCCs (Edmondson and Steiner's grade I) and 66 patients with less differentiated (l-d) HCCs (Edmondson and Steiner's grade I-II, II-III, and III).\nThe histological analysis revealed that w-d HCCs had lower incidences of fibrous capsule formation (P<0.01), when compared to l-d HCCs. There were no significant differences in the incidence of intrahepatic metastasis, or portal vein invasion. In a resected specimen of w-d HCC, barium sulfate and gelatin were injected into portal vein and a transparent specimen was made. The transparent specimen showed that the portal vein in the tumor seemed to be intact. Microscopically, cancer cell infiltration into the fibrous frame of the portal tract was present. There were no significant differences in the disease free survival between the two groups. An analysis of tumor volume doubling time in recurrent foci suggested that minute cancerous foci had been present at the time of operation.\n", + "options": "A. yes \n B. no \n C. maybe", + "answer": "B" + }, + { + "question": "Is it necessary to insert a nasobiliary drainage tube routinely after endoscopic clearance of the common bile duct in patients with choledocholithiasis-induced cholangitis?\n Contexts: Little is known about whether a routinely inserted endoscopic nasobiliary drainage (ENBD) tube improves the clinical course in patients with choledocholithiasis-induced acute cholangitis after clearance of choledocholithiasis.\nThe aim of this study was to investigate the need for ENBD on the clinical outcomes of patients with acute cholangitis undergoing endoscopic clearance of common bile duct (CBD) stones.\nProspective, randomized study.\nTertiary referral center.\nA total of 104 patients with choledocholithiasis-induced acute cholangitis who underwent primary endoscopic treatment were compared according to insertion of an ENBD tube (51 in the ENBD group and 53 in the no-ENBD group).\nInsertion of an ENBD tube after clearance of CBD stones.\nRecurrence of cholangitis and length of hospital stay after clearance of CBD stones.\nBaseline clinical characteristics were similar between both groups. There were no significant differences in the recurrence rate of cholangitis at 24 weeks (3.9% for the ENBD group vs 3.8% for the no-ENBD group at 24 weeks; P = .99) and length of hospital stay (7.9 days [standard error = 1.2] for the ENBD group vs 7.9 days [standard error = 0.7]for the no-ENBD group; P = .98). However, procedure time was longer (26.2 [SE = 1.8] minutes vs 22.7 [SE = 1.0]minutes, respectively; P = .01) and the discomfort score was higher (4.9 [SE = 0.4] vs 2.8 [SE = 0.3], respectively; P = .02) in the ENBD group than in the no-ENBD group.\nSingle-center study.\n", + "options": "A. yes \n B. no \n C. maybe", + "answer": "B" + }, + { + "question": "Xanthogranulomatous cholecystitis: a premalignant condition?\n Contexts: Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic cholecystitis, characterized by marked thickening of the gallbladder wall and dense local adhesions. It often mimics a gallbladder carcinoma (GBC), and may coexist with GBC, leading to a diagnostic dilemma. Furthermore, the premalignant nature of this entity is not known. This study was undertaken to assess the p53, PCNA and beta-catenin expression in XGC in comparison to GBC and chronic inflammation.\nSections from paraffin-embedded blocks of surgically resected specimens of GBC (69 cases), XGC (65), chronic cholecystitis (18) and control gallbladder (10) were stained with the monoclonal antibodies to p53 and PCNA, and a polyclonal antibody to beta-catenin. p53 expression was scored as the percentage of nuclei stained. PCNA expression was scored as the product of the percentage of nuclei stained and the intensity of the staining (1-3). A cut-off value of 80 for this score was taken as a positive result. Beta-catenin expression was scored as type of expression-membranous, cytoplasmic or nuclear staining.\np53 mutation was positive in 52% of GBC cases and 3% of XGC, but was not expressed in chronic cholecystitis and control gallbladders. p53 expression was lower in XGC than in GBC (P<0.0001). PCNA expression was seen in 65% of GBC cases and 11% of XGC, but not in chronic cholecystitis and control gallbladders. PCNA expression was higher in GBC than XGC (P=0.0001), but there was no significant difference between the XGC, chronic cholecystitis and control gallbladder groups. Beta-catenin expression was positive in the GBC, XGC, chronic cholecystitis and control gallbladder groups. But the expression pattern in XGC, chronic cholecystitis and control gallbladders was homogenously membranous, whereas in GBC the membranous expression pattern was altered to cytoplasmic and nuclear.\n", + "options": "A. yes \n B. no \n C. maybe", + "answer": "B" + }, + { + "question": "Expression of c-kit protooncogen in hepatitis B virus-induced chronic hepatitis, cirrhosis and hepatocellular carcinoma: has it a diagnostic role?\n Contexts: Paraffin-embedded tissues in Cukurova University Faculty of Medicine Department of Pathology between January 2002 and February 2006 were searched restrospectively to investigate this issue. We performed immunohistochemistry on biopsies of 125 patients with HBV infection, grouped as: mild, moderate and severe hepatitis, cirrhosis and HCC, 25 patients in each of them, using anti c-kit monoclonal antibody. The severity of parenchymal inflammation and of interface hepatitis was semiquantitatively graded on a haematoxylin and eosin stained paraffin sections. Additionally, 50 more HCC, formed on HBV basis, were studied to determine the prevalence of c-kit overexpression.\nIn cirrhotic liver, lower intensity of staining and rarely c-kit positivity were present. The greatest number of the c-kit positivity and higher intensity of staining was found in the livers of patients with severe hepatitis and HCC. In chronic hepatitis B infection, the staining intensity was parallel with the grade and stage of the disease. In the areas where fibrosis was seen, c-kit positivity was rare or absent. In the HCC specimens, c-kit positivity appeared both inside and around the cancerous nodes. C-kit expression was observed in 62 of 75 HCC tissue specimens (82%) (p<0.001).\n", + "options": "A. yes \n B. no \n C. maybe", + "answer": "C" + }, + { + "question": "What is the primary causative agent of an amebic liver abscess?", + "options": "A. *Entamoeba coli* B. *Entamoeba histolytica* C. *Giardia lamblia* D. *Cryptosporidium parvum*", + "answer": "B" + }, + { + "question": "Which of the following symptoms is most commonly associated with an amebic liver abscess?", + "options": "A. Left upper quadrant pain B. Right upper quadrant pain C. Epigastric pain D. Diffuse abdominal pain", + "answer": "B" + }, + { + "question": "A male presents with fever, right upper quadrant pain, and a history of recent travel to an endemic area. Ultrasound reveals a solitary liver abscess with no evidence of rupture. What is the first-line treatment for this suspected amebic liver abscess?", + "options": "A. Broad-spectrum antibiotics (e.g., ceftriaxone) B. Antiparasitic drugs (e.g., metronidazole) C. Surgical drainage D. Antifungal therapy (e.g., fluconazole) E. Percutaneous drainage", + "answer": "B" + }, + { + "question": "Which diagnostic tool is most commonly used to confirm an amebic liver abscess?", + "options": "A. MRI B. Ultrasound or CT C. X-ray D. Endoscopy", + "answer": "B" + }, + { + "question": "After successful antiparasitic therapy for an amebic liver abscess, what additional treatment is often required to eliminate residual luminal cysts?", + "options": "A. Antiviral drugs B. Luminal agents C. Antibiotics D. Corticosteroids", + "answer": "B" + }, + { + "question": "A male with a known amebic liver abscess presents with new-onset hemoptysis. Which of the following symptoms would most strongly suggest hematogenous spread of the abscess to the lungs?", + "options": "A. Pleuritic chest pain B. Productive cough with foul-smelling sputum C. Dysuria D. Flank pain", + "answer": "A" + }, + { + "question": "A male returning from a tropical region presents with fever, right upper quadrant pain, and cough. Imaging reveals an amebic liver abscess with extension into the lung. In the management of amebiasis, what is a key difference in treatment between an isolated amebic liver abscess and a liver-lung abscess?", + "options": "A. Longer antiparasitic course B. Immediate surgical intervention C. Use of corticosteroids in addition to antiparasitic therapy D. Use of antifungal drugs", + "answer": "A" + }, + { + "question": "A patient with amebiasis presents with a liver and kidney cyst and concurrent pneumonia. What additional intervention is most appropriate for managing the cysts?", + "options": "A. Antiparasitic drugs B. Cyst aspiration C. Antibiotics for pneumonia D. Surgical drainage", + "answer": "B" + }, + { + "question": "Given the involvement of multiple organs (liver, kidney) and concurrent pneumonia, which of the following best describes the complexity of treatment for an amebic liver and kidney cyst with pneumonia compared to an isolated liver abscess?", + "options": "A. Less complex due to localized treatment options B. Equally complex as both require similar interventions C. More complex due to multi-organ involvement and concurrent infections D. No difference in complexity", + "answer": "C" + }, + { + "question": "A patient presents with hilar lymphadenopathy and a history of exposure to tuberculosis. What is the most likely causative agent of this condition?", + "options": "A. Viral infection\nB. Bacterial infection with *Mycobacterium tuberculosis*\nC. Fungal infection\nD. Parasitic infection", + "answer": "B" + }, + { + "question": "Which of the following is a common symptom of pulmonary tuberculosis affecting the hilar lymph nodes?", + "options": "A. High-grade fever B. Persistent low-grade fever C. Night sweats D. Chest pain", + "answer": "B" + }, + { + "question": "A male with disseminated tuberculosis presents with fever, weight loss, and hepatomegaly. Liver biopsy reveals caseating granulomas. How did Mycobacterium tuberculosis most likely reach the liver in this patient?", + "options": "A. Direct extension from adjacent organs B. Hematogenous spread or lymphatic drainage C. Ascending infection from the gastrointestinal tract D. Inhalation of spores", + "answer": "B" + }, + { + "question": "An immigrant from a TB-endemic region presents with fever, weight loss, and right upper quadrant pain. Imaging is required to evaluate suspected tuberculosis involving the hilar lymph nodes and liver. Which of the following is the most appropriate initial imaging modality?", + "options": "A. Chest X-ray B. Ultrasound, CT, or MRI C. Nuclear medicine scan D. Contrast-enhanced ultrasound", + "answer": "B" + }, + { + "question": "What histopathological feature is characteristic of tuberculosis of the hilar lymph nodes of the liver?", + "options": "A. Non-caseating granulomas B. Caseating granulomas with acid-fast bacilli C. Fibrotic tissue D. Necrotic abscesses", + "answer": "B" + }, + { + "question": "A patient presents with fever, night sweats, and weight loss. Imaging reveals enlarged hilar lymph nodes with caseating granulomas on biopsy, consistent with tuberculosis. What is the standard treatment for this condition?", + "options": "A. Antibiotics for 6 weeks B. Antifungal therapy for 6 months C. Standard anti-tubercular therapy for 6–9 months D. Surgical resection of affected lymph nodes", + "answer": "C" + }, + { + "question": "A patient with untreated tuberculosis of the hilar lymph nodes of the liver develops biliary obstruction. What is the most likely mechanism of this complication?", + "options": "A. Direct compression of the bile ducts by enlarged lymph nodes B. Formation of a hepatic abscess C. Development of portal hypertension D. Autoimmune destruction of bile ducts", + "answer": "A" + }, + { + "question": "A patient with tuberculosis is started on anti-tubercular therapy. Which of the following additional supports is most appropriate to initiate alongside the treatment?", + "options": "A. Physical therapy B. Nutritional support and liver-protective agents C. Psychological counseling D. Antifungal therapy", + "answer": "B" + }, + { + "question": "Which of the following histopathological features distinguishes tuberculosis of the hilar lymph nodes from other causes of hilar lymphadenopathy?", + "options": "A. Presence of caseating granulomas B. Distinct histopathological features C. Absence of granulomas D. Response to anti-tuberculous therapy over several months", + "answer": "A" + }, + { + "question": "An immigrant from a high TB-endemic region presents with hepatomegaly, fever, and night sweats. Liver biopsy reveals caseating granulomas. What is the most likely primary cause of hepatic tuberculosis in this patient?", + "options": "A. Mycobacterium tuberculosis infection B. Hepatitis B virus infection C. Candida albicans infection D. Schistosoma mansoni infection", + "answer": "A" + }, + { + "question": "A patient from a tuberculosis-endemic region presents with fatigue, weight loss, and abdominal discomfort. Which of the following is a common symptom of hepatic tuberculosis?", + "options": "A. Left upper quadrant pain B. Fever C. Jaundice D. Hepatomegaly", + "answer": "B", + "explanation": "Fever is a common systemic symptom of hepatic tuberculosis, often accompanied by night sweats and weight loss. While jaundice and hepatomegaly may occur, fever is more consistently present due to the systemic nature of tuberculosis infection." + }, + { + "question": "A patient with a history of tuberculosis presents with right upper quadrant pain and hepatomegaly. What imaging technique is most commonly used to diagnose hepatic tuberculosis? (CT is preferred due to its ability to detect granulomas and assess the extent of liver involvement.)", + "options": "A. MRI B. Ultrasound C. CT D. X-ray E. PET scan", + "answer": "C" + }, + { + "question": "Which of the following is a key diagnostic feature of hepatic tuberculosis on biopsy?", + "options": "A. Non-caseating granulomas B. Caseating granulomas C. Fibrosis D. Necrosis", + "answer": "B" + }, + { + "question": "A patient with a history of tuberculosis presents with right upper quadrant pain and abnormal liver function tests. Imaging shows liver lesions. Which of the following findings on imaging or pathology would most strongly suggest hepatic tuberculosis rather than tuberculosis of the bile ducts?", + "options": "A. Presence of jaundice B. Dilated intrahepatic bile ducts on imaging C. Parenchymal involvement with granulomas D. Cholecystitis-like symptoms", + "answer": "C" + }, + { + "question": "A patient from a TB-endemic region presents with a pancreatic mass. Pancreatic tuberculosis is a rare extrapulmonary manifestation of TB. Which of the following features would most strongly suggest pancreatic tuberculosis over pancreatic cancer?", + "options": "A. Mass lesions on imaging B. Presence of caseating granulomas on biopsy C. Response to anti-TB therapy D. Elevated serum CA 19-9 levels", + "answer": "C" + }, + { + "question": "An immigrant from a tuberculosis-endemic region presents with chronic right upper quadrant pain, low-grade fever, and unintentional weight loss. Imaging reveals gallbladder wall thickening. Which of the following findings is most suggestive of gallbladder tuberculosis as the underlying diagnosis?", + "options": "A. Obstructive jaundice with dilated bile ducts B. Episodic biliary colic and postprandial pain C. Caseating granulomas on histopathology D. Asymptomatic gallbladder calcifications E. Elevated CA 19-9 with pancreatic mass", + "answer": "C" + }, + { + "question": "A patient with tuberculosis of the bile ducts presents with obstructive jaundice and strictures. Given the anatomical and functional differences between bile duct and hepatic tuberculosis, which additional interventions might be required compared to hepatic tuberculosis due to the need for biliary drainage or stricture management?", + "options": "A. Endoscopic interventions only B. Surgical interventions only C. A combination of endoscopic and surgical interventions D. No additional interventions are required", + "answer": "C" + }, + { + "question": "A patient presents with jaundice, confusion, and coagulopathy, progressing to hepatic coma. The patient recently returned from a region with poor sanitation. What is the most likely underlying cause of this presentation?", + "options": "A. Hepatitis B virus (HBV) infection B. Hepatitis A virus (HAV) exposure C. Co-infection with Hepatitis E virus (HEV) D. Severe dehydration complicating acute infection", + "answer": "B" + }, + { + "question": "A patient with acute severe viral hepatitis A develops hepatic coma (Grade III). What is the most critical treatment approach in this scenario?", + "options": "A. Oral lactulose therapy B. Artificial liver support systems C. Intravenous N-acetylcysteine D. Antiviral trials", + "answer": "B" + }, + { + "question": "A patient presents with jaundice, ascites, and altered mental status. Laboratory tests confirm subacute severe viral hepatitis A with hepatic coma. How does the progression of this condition differ from that of typical acute hepatitis A?", + "options": "A. It progresses rapidly within days B. It progresses gradually over weeks to months C. It progresses with minimal hepatic inflammation D. It resolves spontaneously without liver damage", + "answer": "B" + }, + { + "question": "A patient with acute Hepatitis A presents with hepatic coma. Which of the following is the most likely underlying cause?", + "options": "A. Multi-organ dysfunction unrelated to liver failure B. HAV-induced liver failure C. Chronic kidney disease D. Pulmonary fibrosis", + "answer": "B" + }, + { + "question": "A male with acute Hepatitis A presents with jaundice, ascites, and altered mental status. Over the next 48 hours, he becomes progressively confused and eventually unresponsive. Which of the following neurological symptoms is most commonly associated with hepatic coma in this condition?", + "options": "A. Tremors B. Progressive confusion leading to coma C. Asterixis D. Seizures without coma", + "answer": "B" + }, + { + "question": "A patient with Subacute severe viral hepatitis A develops hepatic coma. The patient has jaundice, coagulopathy, and asterixis. Which of the following is the most appropriate therapeutic measure?", + "options": "A. Immediate liver transplantation B. Antiviral therapy trials C. Supportive care with lactulose D. High-dose corticosteroids E. Long-term dialysis", + "answer": "B" + }, + { + "question": "A patient presents with jaundice, confusion, and rapid deterioration of liver function. Which of the following best explains the underlying pathophysiology of acute severe viral hepatitis A with hepatic coma?", + "options": "A. Slow progression over months B. Liver necrosis within days C. Absence of jaundice D. Elevated serum ammonia levels", + "answer": "B" + }, + { + "question": "Which of the following is a supportive care measure for Hepatitis A with hepatic coma?", + "options": "A. Chemotherapy B. Lactulose for encephalopathy C. Antihypertensive drugs D. Antidepressants", + "answer": "B" + }, + { + "question": "What is the primary mode of transmission for hepatitis A virus (HAV)?", + "options": "A. Airborne droplets B. Contaminated food or water C. Blood transfusion D. Sexual contact", + "answer": "B" + }, + { + "question": "Which of the following symptoms is NOT typically associated with acute hepatitis A without hepatic coma?", + "options": "A. Fatigue B. Jaundice C. Confusion D. Nausea", + "answer": "C" + }, + { + "question": "What is the mainstay of treatment for acute hepatitis A without hepatic coma?", + "options": "A. Antiviral therapy B. Supportive care C. Liver transplantation D. Antibiotics", + "answer": "B" + }, + { + "question": "A patient with acute hepatitis A presents with altered mental status. Which of the following findings is most specific for hepatic coma?", + "options": "A. Hypoglycemia B. Confusion and asterixis C. Elevated liver enzymes D. Ascites", + "answer": "B" + }, + { + "question": "A patient with acute cholestatic viral hepatitis A presents with severe pruritus. What is the most appropriate treatment to relieve this symptom?", + "options": "A. Antiviral therapy B. Ursodeoxycholic acid C. Cholestyramine D. Rifampicin", + "answer": "B" + }, + { + "question": "Which of the following is a key public health measure for preventing hepatitis A?", + "options": "A. Antiviral therapy B. Vaccination C. Liver transplantation D. Antibiotics", + "answer": "B" + }, + { + "question": "What is the most critical intervention for acute hepatitis A with hepatic coma?", + "options": "A. Supportive care B. Immediate hospitalization and intensive care C. Antiviral therapy D. Vaccination", + "answer": "B" + }, + { + "question": "A patient presents with fatigue and jaundice two weeks after a trip to a region with poor sanitation. Which of the following symptoms is most characteristic of acute cholestatic viral hepatitis A in the initial weeks of infection?", + "options": "A. Fever B. Prolonged jaundice C. Confusion D. Itching", + "answer": "B" + }, + { + "question": "What is the primary cause of hepatic coma in acute hepatitis A?", + "options": "A. Elevated liver enzymes B. Toxin accumulation due to liver failure C. Prolonged jaundice D. Pruritus", + "answer": "B" + }, + { + "question": "What is the primary cause of hepatic coma in acute hepatitis B with delta-agent coinfection?", + "options": "A. Accumulation of bilirubin B. Inability of the liver to detoxify ammonia C. Overproduction of bile acids D. Excessive iron deposition in the liver", + "answer": "B" + }, + { + "question": "A patient with acute hepatitis B presents with worsening jaundice and fatigue. Serologic testing confirms hepatitis D virus (HDV) coinfection. Which of the following treatments is specifically recommended for HDV in this setting, and what is the primary rationale for its use?", + "options": "A. Tenofovir (reduces HBV DNA replication) B. Entecavir (potent HBV suppression) C. Pegylated interferon-alpha (direct antiviral activity against HDV) D. Ribavirin (adjunctive therapy for HCV) E. Sofosbuvir (NS5B inhibitor for HCV) F. Lamivudine (older HBV nucleoside analog)", + "answer": "C" + }, + { + "question": "What is the definitive intervention for irreversible liver failure in acute hepatitis B with delta-agent coinfection?", + "options": "A. Antiviral therapy B. Liver transplantation C. Nutritional support D. Hydration therapy", + "answer": "B" + }, + { + "question": "In acute hepatitis B with delta-agent, which of the following is a key difference between coinfection (simultaneous infection with HBV and HDV) and superinfection (HDV infection in a chronic HBV carrier)? Note: Hepatitis B with delta-agent is a rare but clinically significant condition.", + "options": "A. Coinfection has a higher chronicity risk than superinfection. B. Superinfection typically presents with a biphasic clinical course. C. Coinfection often leads to rapid cirrhosis. D. Superinfection is associated with worse baseline liver dysfunction due to pre-existing HBV-related damage.", + "answer": "D" + }, + { + "question": "In a cohort of patients with chronic HBV infection, what is the observed likelihood that HDV superinfection will progress to chronic HDV infection?", + "options": "A. Less than 10% B. 10-30% C. 70-90% D. More than 90%", + "answer": "C" + }, + { + "question": "Which of the following symptoms is most indicative of hepatic coma in acute hepatitis B with delta-agent coinfection?", + "options": "A. Jaundice B. Fatigue C. Neurological impairment D. Abdominal pain", + "answer": "C" + }, + { + "question": "What is the primary role of HBV in HDV infection?", + "options": "A. HDV can replicate independently of HBV B. HBV provides the necessary proteins for HDV replication C. HBV and HDV are unrelated viruses D. HDV enhances the replication of HBV", + "answer": "B" + }, + { + "question": "Which of the following is a critical preventive measure against HDV infection?", + "options": "A. Early antiviral therapy B. HBV vaccination C. Regular liver function tests D. Use of pegylated interferon-alpha", + "answer": "B" + }, + { + "question": "What is the typical clinical course of HDV superinfection in patients with chronic HBV?", + "options": "A. Biphasic B. Mild and self-limiting C. Rapid progression to cirrhosis or fulminant hepatitis D. Gradual improvement over time", + "answer": "C" + }, + { + "question": "What is the primary cause of Acute hepatitis B with delta-agent (coinfection) without hepatic coma?", + "options": "A. Hepatitis B virus (HBV) alone B. Hepatitis D virus (HDV) alone C. Simultaneous exposure to HBV and HDV D. Hepatitis C virus (HCV)", + "answer": "C" + }, + { + "question": "Which of the following viruses requires hepatitis B virus (HBV) for replication in the context of Acute hepatitis B with delta-agent?", + "options": "A. Hepatitis A virus (HAV) B. Hepatitis C virus (HCV) C. Hepatitis D virus (HDV) D. Hepatitis E virus (HEV)", + "answer": "C" + }, + { + "question": "A patient presents with fatigue, abdominal pain, and dark urine. What is the most likely physical finding in this patient with acute hepatitis B and delta-agent coinfection (without hepatic coma)?", + "options": "A. Jaundice B. Abdominal distension C. Spider angiomas D. Peripheral edema", + "answer": "A" + }, + { + "question": "A patient presents with acute hepatitis B and delta-agent (HDV) coinfection. Laboratory tests reveal elevated liver enzymes and bilirubin, but there is no evidence of hepatic coma. Which of the following treatments is specifically recommended for this condition?", + "options": "A. Nucleos(t)ide analogues for HBV B. Pegylated interferon-alpha C. Direct-acting antivirals for HCV D. Corticosteroids", + "answer": "B" + }, + { + "question": "What is the primary method of prevention for Acute hepatitis B with delta-agent (coinfection) without hepatic coma?", + "options": "A. Antiviral medication B. HBV vaccination C. Regular exercise D. Dietary changes", + "answer": "B" + }, + { + "question": "A patient with Acute hepatitis B with delta-agent presents with confusion, asterixis, and markedly elevated liver enzymes. What is the primary clinical distinction between this patient's condition and Acute hepatitis B with delta-agent without hepatic coma?", + "options": "A. Duration of symptoms B. Severity of liver failure C. Mode of transmission D. Response to antiviral therapy", + "answer": "B" + }, + { + "question": "An intravenous drug user presents with acute hepatitis B and delta-agent coinfection (without hepatic coma). Which of the following symptoms is LEAST likely to be associated with this condition?", + "options": "A. Fatigue and malaise B. Right upper quadrant abdominal pain C. High-grade fever (≥39°C) D. Clay-colored stools", + "answer": "C" + }, + { + "question": "What is the main focus of treatment for Acute hepatitis B with delta-agent (coinfection) without hepatic coma?", + "options": "A. Antiviral therapy B. Supportive care C. Surgical intervention D. Radiation therapy", + "answer": "B" + }, + { + "question": "In a patient with acute hepatitis B with delta-agent (without hepatic coma), which of the following complications is most critical to monitor?", + "options": "A. Hepatocellular carcinoma B. Fulminant hepatitis C. Portal hypertension D. Cholestasis", + "answer": "B", + "explanation": "Fulminant hepatitis is a severe complication of acute hepatitis B with delta-agent, leading to rapid liver failure and high mortality." + }, + { + "question": "A patient presents with acute hepatitis B coinfection with delta-agent (HDV) but no signs of hepatic coma. Which of the following is the most critical initial step in managing this condition?", + "options": "A. Early confirmation of HBV diagnosis and HDV testing B. Initiation of antiviral therapy C. Administration of corticosteroids D. Immediate liver biopsy", + "answer": "A" + }, + { + "question": "In a rare and severe presentation of acute hepatitis B without delta-agent (coinfection) but with hepatic coma, which of the following is a key distinguishing feature?", + "options": "A. Coinfection with hepatitis D virus (HDV) B. Presence of hepatic encephalopathy C. Exclusion of hepatitis D virus (HDV) D. Chronic liver inflammation", + "answer": "C" + }, + { + "question": "What is the primary treatment approach for 'Acute viral hepatitis B with hepatic coma'?", + "options": "A. Antibiotic therapy B. Antiviral therapy and liver transplant evaluation C. Surgical intervention D. Radiation therapy", + "answer": "B" + }, + { + "question": "A male with a history of chronic hepatitis B presents with worsening fatigue, jaundice, and confusion over the past month. Laboratory tests confirm subacute severe viral hepatitis B with impending hepatic coma. Which of the following best describes the typical temporal progression from the onset of symptoms to hepatic coma in this condition?", + "options": "A. 1-2 weeks B. 3-6 weeks C. Less than 1 week D. More than 6 weeks", + "answer": "B" + }, + { + "question": "Which of the following is a hallmark symptom of hepatic coma in patients with acute hepatitis B?", + "options": "A. Jaundice B. Encephalopathy C. Ascites D. Hyperglycemia", + "answer": "B" + }, + { + "question": "A patient presents with acute severe viral hepatitis B, hepatic encephalopathy, and coagulopathy. Which of the following is the most critical intervention?", + "options": "A. Antiviral therapy (e.g., entecavir) B. Immediate liver transplant evaluation C. Supportive care with lactulose D. High-dose corticosteroids", + "answer": "B" + }, + { + "question": "In a patient with acute hepatitis B without delta-agent (coinfection) but with hepatic coma, what is the primary cause of the hepatic coma?", + "options": "A. Hepatitis D virus (HDV) B. Hepatitis B virus (HBV) C. Hepatitis C virus (HCV) D. Hepatitis A virus (HAV) E. Hyperammonemia due to liver failure F. Drug-induced liver injury", + "answer": "B" + }, + { + "question": "A patient presents with jaundice, confusion, and coagulopathy, diagnosed with acute hepatitis B and hepatic coma. What is the key distinguishing feature between this condition and acute hepatitis B with hepatic coma accompanied by hepatitis D virus (HDV) coinfection?", + "options": "A. Presence of hepatitis D virus (HDV) B. Severity of hepatic coma C. Duration of symptoms D. Presence of liver fibrosis", + "answer": "A" + }, + { + "question": "What is the most urgent clinical consideration for 'Acute severe viral hepatitis B with hepatic coma'?", + "options": "A. Long-term outpatient follow-up B. Immediate ICU support and transplant evaluation C. Routine blood tests D. Dietary modifications", + "answer": "B" + }, + { + "question": "Which of the following is a potential treatment for 'Subacute severe viral hepatitis B with hepatic coma'?", + "options": "A. Antiviral therapy and albumin infusions B. Surgical removal of the liver C. Radiation therapy D. Physical therapy", + "answer": "A" + }, + { + "question": "A patient presents with jaundice, dark urine, and right upper quadrant tenderness. Which of the following findings is most consistent with acute icteric viral hepatitis B?", + "options": "A. Elevated alkaline phosphatase B. Severe itching C. Elevated ALT levels D. Prolonged PT/INR", + "answer": "C" + }, + { + "question": "What is the primary treatment approach for acute hepatitis B without delta-agent and without hepatic coma?", + "options": "A. Antiviral therapy B. Supportive care C. Surgical intervention D. Immunosuppressants", + "answer": "B" + }, + { + "question": "Which variant of acute hepatitis B is characterized by bile flow obstruction?", + "options": "A. Acute icteric viral hepatitis B B. Acute cholestatic viral hepatitis B C. Post-transfusion viral hepatitis B D. Acute non-icteric viral hepatitis B", + "answer": "B" + }, + { + "question": "What distinguishes the etiology of post-transfusion viral hepatitis B from other forms of acute hepatitis B?", + "options": "A. Presence of jaundice B. Transmission via contaminated blood products C. Severe itching D. Elevated liver enzymes E. Recent travel to endemic regions F. Ingestion of contaminated food or water G. Close contact with an infected individual", + "answer": "B" + }, + { + "question": "Which of the following is a common symptom of acute non-icteric viral hepatitis B, where jaundice is absent?", + "options": "A. Jaundice B. Dark urine C. Fatigue D. Loss of appetite", + "answer": "C" + }, + { + "question": "A male presents with jaundice, pruritus, and right upper quadrant discomfort for 1 week. Laboratory workup is ordered to evaluate for acute cholestatic viral hepatitis B. Which of the following findings is most characteristic of this condition?", + "options": "A. Markedly elevated total bilirubin (12 mg/dL) B. Tea-colored urine on urinalysis C. Alkaline phosphatase 3x upper limit of normal D. Palpable hepatomegaly on physical exam", + "answer": "C" + }, + { + "question": "Which of the following is NOT a typical symptom of acute hepatitis B without delta-agent and without hepatic coma?", + "options": "A. Fatigue B. Nausea C. Hepatic coma D. Abdominal pain", + "answer": "C" + }, + { + "question": "What is the primary method of prevention for all variants of acute hepatitis B?", + "options": "A. Antiviral therapy B. HBV vaccination C. Blood screening D. Supportive care", + "answer": "B" + }, + { + "question": "Which of the following is a feature unique to acute icteric viral hepatitis B and not seen in acute non-icteric viral hepatitis B?", + "options": "A. Presence of jaundice B. Dark urine C. Elevated liver enzymes D. Asymptomatic presentation", + "answer": "A" + }, + { + "question": "A patient with acute cholestatic viral hepatitis B presents with jaundice, pruritus, and elevated liver enzymes. What is the primary focus of treatment in this case?", + "options": "A. Antiviral therapy B. Alleviating cholestasis C. Surgical intervention D. Immunosuppressants", + "answer": "B" + }, + { + "question": "What is the primary mode of transmission for acute hepatitis C?", + "options": "A. Fecal-oral route B. Blood exposure C. Respiratory droplets D. Sexual contact", + "answer": "B" + }, + { + "question": "Which virus requires coinfection with hepatitis B virus (HBV) for replication?", + "options": "A. Hepatitis A virus (HAV) B. Hepatitis C virus (HCV) C. Hepatitis D virus (HDV) D. Hepatitis E virus (HEV)", + "answer": "C" + }, + { + "question": "What is the most effective treatment for acute hepatitis C?", + "options": "A. Pegylated interferon-alpha B. Direct-acting antivirals (DAAs) C. Nucleos(t)ide analogs D. Corticosteroids", + "answer": "B" + }, + { + "question": "A male with a history of intravenous drug use presents with rapid-onset jaundice, confusion, and bleeding tendencies. Laboratory tests reveal markedly elevated transaminases and coagulopathy. Which of the following conditions, a rare but severe complication of hepatitis C, is most likely responsible for this clinical picture?", + "options": "A. Acute delta (super) infection of chronic hepatitis B B. Acute hepatitis C C. Fulminant hepatitis C D. Chronic hepatitis C with subacute progression", + "answer": "C" + }, + { + "question": "In a patient presenting with acute icteric hepatitis C, a rare condition, which of the following is a distinguishing feature and is most likely to prompt specific diagnostic testing?", + "options": "A. Elevated ALT (>10x ULN) B. Prominent jaundice C. Fever D. Right upper quadrant pain", + "answer": "B" + }, + { + "question": "Which of the following is a key difference in the replication mechanisms of HBV/HDV and HCV infections?", + "options": "A. HCV requires HBV for replication B. HBV acute infections frequently become chronic C. HCV does not require a helper virus for replication D. HDV can only replicate in the presence of HBV", + "answer": "C" + }, + { + "question": "What is the primary preventive measure for acute delta (super) infection of chronic hepatitis B?", + "options": "A. Direct-acting antivirals (DAAs) B. HBV vaccination C. Pegylated interferon-alpha D. Nucleos(t)ide analogs", + "answer": "B" + }, + { + "question": "Which condition represents the transition phase between acute and chronic hepatitis C, characterized by persistent jaundice and ascites?", + "options": "A. Acute hepatitis C B. Acute severe viral hepatitis C C. Subacute severe hepatitis C D. Chronic hepatitis C with acute flare", + "answer": "C" + }, + { + "question": "Acute icteric hepatitis C is rare but clinically significant. What is the prognosis for acute icteric hepatitis C in patients who receive timely and appropriate antiviral treatment?", + "options": "A. Poor, with high mortality despite treatment B. Generally favorable with complete recovery in most cases C. Rapid progression to cirrhosis despite treatment D. High risk of chronic infection despite treatment", + "answer": "B" + }, + { + "question": "A male with known chronic hepatitis B presents with sudden onset of jaundice, fatigue, and abdominal distension. Which of the following symptoms is most consistent with acute delta superinfection?", + "options": "A. Fatigue B. Jaundice C. Ascites D. Hepatic encephalopathy", + "answer": "B" + }, + { + "question": "What is the primary mode of transmission for Acute Hepatitis E?", + "options": "A. Airborne droplets B. Contaminated water or food C. Blood transfusion D. Sexual contact", + "answer": "B" + }, + { + "question": "Which of the following is a hallmark symptom of Acute Icteric Hepatitis E?", + "options": "A. Severe itching B. Prominent jaundice C. Coagulopathy D. Encephalopathy", + "answer": "B" + }, + { + "question": "What is the main treatment approach for Acute Hepatitis E?", + "options": "A. Antiviral therapy B. Liver transplantation C. Supportive care (hydration and rest) D. Antibiotics", + "answer": "C" + }, + { + "question": "Which form of Hepatitis E is characterized by cholestasis, leading to bile flow obstruction?", + "options": "A. Acute Hepatitis E B. Icteric Hepatitis E C. Cholestatic Hepatitis E D. Severe Hepatitis E", + "answer": "C" + }, + { + "question": "What is a common symptom of Acute Cholestatic Viral Hepatitis E?", + "options": "A. Fever B. Severe itching C. Coagulopathy D. Encephalopathy", + "answer": "B" + }, + { + "question": "In rare cases of Hepatitis E, which form is most likely to require liver transplantation due to fulminant liver failure?", + "options": "A. Acute Hepatitis E without liver failure B. Acute Icteric Hepatitis E without liver failure C. Acute Severe Viral Hepatitis E with fulminant liver failure D. Subacute Severe Hepatitis E with progressive liver failure", + "answer": "C" + }, + { + "question": "A patient presents with hepatitis E infection. What is the key clinical feature that distinguishes Subacute Severe Hepatitis E from Acute Severe Viral Hepatitis E in terms of disease progression?", + "options": "A. Presence of jaundice B. Slower progression to liver failure C. Bile flow obstruction D. Severe itching E. Presence of extrahepatic manifestations F. Duration of symptoms before liver failure", + "answer": "B" + }, + { + "question": "A patient presents with jaundice, fatigue, and elevated liver enzymes due to mild to moderate Acute Cholestatic Viral Hepatitis E. Which of the following is the most appropriate initial management option?", + "options": "A. Antiviral therapy B. Ursodeoxycholic acid C. Liver transplantation D. Supportive care with hydration and monitoring", + "answer": "D" + }, + { + "question": "A male presents with jaundice, fatigue, and elevated liver enzymes after recent travel to an endemic region. Which of the following best distinguishes Acute Hepatitis E with jaundice from Fulminant Hepatitis E?", + "options": "A. Duration of symptoms B. Severity of liver damage C. Risk factors for severe disease D. Underlying viral genotype", + "answer": "B" + }, + { + "question": "Which of the following is the most likely route of transmission for acute viral hepatitis with mixed infections involving hepatitis B and C viruses?", + "options": "A. Exposure to contaminated food B. Exposure to contaminated blood or bodily fluids C. Consumption of contaminated water D. Occupational exposure to chemicals", + "answer": "B" + }, + { + "question": "A patient presents with acute liver injury and is suspected to have either acute viral hepatitis with mixed infections or acute overlapping icteric viral hepatitis. Which of the following clinical findings is most likely to be present in both conditions?", + "options": "A. Jaundice B. High fever (>39°C) with rigors C. Diffuse maculopapular rash D. Right upper quadrant abdominal pain with guarding", + "answer": "A" + }, + { + "question": "What is the main focus of treatment for acute viral hepatitis with mixed infections?", + "options": "A. Antibiotics B. Supportive care and antiviral therapy C. Surgical intervention D. Immunosuppressants", + "answer": "B" + }, + { + "question": "Which of the following is a key difference between mixed infections (simultaneous infection with multiple hepatitis viruses) and overlapping hepatitis (sequential infection with different hepatitis viruses)?", + "options": "A. Mixed infections involve sequential viral attacks B. Overlapping hepatitis involves sequential infections with different hepatitis viruses C. Mixed infections demand broader antiviral strategies D. The prognosis of overlapping hepatitis depends on the timing and severity of the sequential infections", + "answer": "C" + }, + { + "question": "What is a significant risk associated with acute overlapping icteric viral hepatitis?", + "options": "A. Complete recovery without complications B. Higher risk of fulminant hepatitis C. Development of autoimmune diseases D. Increased risk of kidney failure", + "answer": "B" + }, + { + "question": "Acute overlapping icteric viral hepatitis is a rare condition characterized by the simultaneous occurrence of two or more viral hepatitis infections. A patient with this condition is most likely to present with which of the following symptoms?", + "options": "A. Fatigue B. Sudden worsening of jaundice C. Nausea D. Dark urine", + "answer": "B" + }, + { + "question": "A patient presents with jaundice, fatigue, and elevated liver enzymes, suggestive of acute overlapping icteric viral hepatitis (a rare but severe condition involving simultaneous infection with multiple hepatitis viruses). What is the most critical initial step in management?", + "options": "A. Immediate antiviral therapy B. Urgent liver function monitoring C. Initiation of corticosteroids D. Referral for liver biopsy", + "answer": "B" + }, + { + "question": "Which of the following viruses can be involved in mixed infections of acute viral hepatitis?", + "options": "A. HBV, HCV, HDV B. HIV, HPV, HSV C. Influenza, RSV, Adenovirus D. Rotavirus, Norovirus, Enterovirus", + "answer": "A" + }, + { + "question": "A patient presents with jaundice, fatigue, and elevated liver enzymes due to acute overlapping icteric viral hepatitis. Which of the following complications is most likely to occur as a result of impaired hepatic synthesis of clotting factors?", + "options": "A. Coagulopathy B. Diabetes mellitus C. Portal hypertension D. Hyperbilirubinemia E. Ascites", + "answer": "A" + }, + { + "question": "In patients with severe acute overlapping icteric viral hepatitis, a condition characterized by simultaneous infection with multiple hepatitis viruses, which of the following statements is true regarding prognosis?", + "options": "A. It has a better prognosis than mixed infections B. It poses higher risks of fulminant hepatitis C. It rarely leads to liver failure D. It is less likely to progress to chronic liver disease compared to single viral infections", + "answer": "B" + }, + { + "question": "Which of the following viruses is primarily transmitted through contaminated food or water?", + "options": "A. Hepatitis B virus (HBV) B. Hepatitis C virus (HCV) C. Hepatitis A virus (HAV) D. Hepatitis D virus (HDV)", + "answer": "C" + }, + { + "question": "What is the primary mode of transmission for Hepatitis B virus (HBV)?", + "options": "A. Contaminated food or water B. Blood or bodily fluids C. Airborne droplets D. Direct skin contact", + "answer": "B" + }, + { + "question": "Which of the following symptoms is characteristic of Acute Icteric Viral Hepatitis but not necessarily present in non-icteric forms?", + "options": "A. Fatigue B. Nausea C. Jaundice D. Abdominal pain", + "answer": "C" + }, + { + "question": "What is the primary treatment approach for Acute Viral Hepatitis?", + "options": "A. Antiviral therapy B. Supportive care (hydration, rest) C. Surgical intervention D. Antibiotic therapy", + "answer": "B" + }, + { + "question": "Which of the following viruses can progress to chronic disease in immunocompetent individuals if not properly managed?", + "options": "A. Hepatitis A virus (HAV) B. Hepatitis E virus (HEV) C. Hepatitis B virus (HBV) D. Hepatitis C virus (HCV)", + "answer": "C" + }, + { + "question": "A patient presents with fatigue, nausea, and elevated liver enzymes. On further evaluation, jaundice is noted. Which of the following signs is most specific to Acute Icteric Viral Hepatitis compared to non-icteric forms?", + "options": "A. Dark urine and pale stools B. Elevated liver enzymes C. Fatigue and nausea D. Abdominal pain and vomiting E. Jaundice and pruritus F. Hepatomegaly and splenomegaly", + "answer": "A" + }, + { + "question": "A patient presents with fatigue and elevated liver enzymes. Which finding would most strongly suggest Acute Icteric Viral Hepatitis over a non-icteric form?", + "options": "A. Presence of jaundice and dark urine \nB. Mild elevation of alanine aminotransferase (ALT) \nC. Recent exposure to contaminated food \nD. Impaired bilirubin metabolism leading to conjugated hyperbilirubinemia", + "answer": "A" + }, + { + "question": "In an otherwise healthy adult, what is the typical prognosis for Acute Icteric Viral Hepatitis caused by non-chronic viruses, and what is the primary reason for this outcome?", + "options": "A. Poor, due to a high risk of fulminant liver failure B. Favorable, as it is usually self-limiting with complete resolution C. Variable, depending on the presence of complications such as coagulopathy D. Chronic, because of persistent viral replication requiring lifelong antiviral therapy", + "answer": "B" + }, + { + "question": "Which of the following complications is a potential risk in Acute Viral Hepatitis?", + "options": "A. Liver failure B. Kidney failure C. Heart failure D. Lung failure", + "answer": "A" + }, + { + "question": "Which of the following viruses does NOT typically require antiviral therapy unless chronicity is suspected?", + "options": "A. Hepatitis B virus (HBV) B. Hepatitis C virus (HCV) C. Hepatitis A virus (HAV) D. Hepatitis D virus (HDV)", + "answer": "C" + }, + { + "question": "What is the primary cause of Chronic Viral Hepatitis B with Delta-Agent?", + "options": "A. Hepatitis B virus (HBV) alone B. Hepatitis D virus (HDV) alone C. Coinfection or superinfection of HBV and HDV D. Hepatitis C virus (HCV)", + "answer": "C" + }, + { + "question": "Which of the following treatments is used to suppress HBV in Chronic Viral Hepatitis B with Delta-Agent?", + "options": "A. Pegylated interferon-alpha B. Nucleos(t)ide analogs (e.g., tenofovir, entecavir) C. Lactulose D. Rifaximin", + "answer": "B" + }, + { + "question": "A patient with Chronic Viral Hepatitis B and D presents with hepatic coma, a severe manifestation of acute-on-chronic liver failure. Which of the following is a distinguishing feature of this condition?", + "options": "A. Isolated elevation of transaminases without clinical symptoms B. Persistent jaundice C. Acute-on-chronic liver failure and encephalopathy D. Occasional fatigue", + "answer": "C" + }, + { + "question": "A patient with a history of Chronic Viral Hepatitis B with Delta-Agent presents with which of the following symptoms?", + "options": "A. Jaundice B. Fatigue C. Right upper quadrant abdominal pain D. Dark urine E. All of the above", + "answer": "E", + "rationale": "Chronic Viral Hepatitis B with Delta-Agent often presents with fatigue (due to liver dysfunction and systemic inflammation), jaundice (from impaired bilirubin metabolism), right upper quadrant pain (due to liver capsule stretching), and dark urine (from bilirubinuria). These are hallmark systemic and hepatic manifestations of the disease." + }, + { + "question": "A patient with chronic hepatitis B and confirmed HDV coinfection presents for management. Which of the following treatments is most likely to achieve sustained virologic response in this patient?", + "options": "A. Nucleos(t)ide analogs B. Pegylated interferon-alpha C. Direct-acting antivirals D. Corticosteroids", + "answer": "B" + }, + { + "question": "A patient presents with mild fatigue and no jaundice. Liver biopsy shows minimal inflammation and normal ALT levels. Which of the following conditions is most consistent with this presentation?", + "options": "A. Chronic Viral Hepatitis B with Delta-Agent, moderate inflammation and elevated ALT; B. Chronic Viral Hepatitis B and D, minimal inflammation and normal ALT; C. Chronic Viral Hepatitis B and D with hepatic coma and severe inflammation; D. Chronic Viral Hepatitis B with Delta-Agent, moderate inflammation and mild symptoms", + "answer": "B" + }, + { + "question": "What is a significant risk associated with Chronic Viral Hepatitis B with Delta-Agent compared to HBV monoinfection?", + "options": "A. Lower risk of cirrhosis B. Increased risk of cirrhosis and hepatocellular carcinoma C. Reduced liver damage D. Minimal fibrosis progression", + "answer": "B" + }, + { + "question": "A patient with Chronic Viral Hepatitis B and D presents with confusion, asterixis, and elevated ammonia levels. Which of the following is the most appropriate initial treatment for managing hepatic encephalopathy?", + "options": "A. Pegylated interferon-alpha B. Nucleos(t)ide analogs C. Lactulose and rifaximin D. Liver transplantation", + "answer": "C" + }, + { + "question": "What is the prognosis for Chronic Viral Hepatitis B with Delta-Agent as the disease progresses?", + "options": "A. Improves with advancing stages B. Remains stable C. Worsens due to HDV’s synergistic hepatotoxicity D. Becomes less complex to manage", + "answer": "C" + }, + { + "question": "A patient with a history of elevated liver enzymes for over 6 months presents with fatigue and mild hepatomegaly. Serologic testing rules out Hepatitis D virus (HDV) coinfection. What is the most likely causative agent of this chronic hepatitis?", + "options": "A. Hepatitis C virus (HCV) B. Hepatitis B virus (HBV) C. Autoimmune hepatitis D. Non-alcoholic steatohepatitis (NASH) E. Hepatitis A virus (HAV)", + "answer": "B" + }, + { + "question": "A patient with chronic Hepatitis B presents with renal dysfunction. Which of the following findings is most characteristic of HBV-associated nephritis?", + "options": "A. Hematuria B. Proteinuria C. Hypertension D. Oliguria", + "answer": "B" + }, + { + "question": "What histological feature distinguishes Chronic Viral Hepatitis B without Delta-Agent, Mild from more severe forms (e.g., those characterized by significant fibrosis, inflammation, or liver dysfunction)?", + "options": "A. Presence of HDV coinfection B. Minimal liver inflammation C. Severe fibrosis D. Elevated ALT levels >5× upper limit with severe symptoms", + "answer": "B" + }, + { + "question": "Which treatment is specifically required for Chronic Viral Hepatitis B with Delta-Agent without Hepatic Coma?", + "options": "A. Tenofovir B. Entecavir C. Pegylated interferon-alpha D. Corticosteroids", + "answer": "C" + }, + { + "question": "What is a key histological feature of Chronic Viral Hepatitis B, Moderate Activity?", + "options": "A. No significant fibrosis B. Minimal liver inflammation C. Necroinflammation on biopsy D. Severe cirrhosis", + "answer": "C" + }, + { + "question": "Which organ is primarily affected in Hepatitis B Virus-Associated Nephritis?", + "options": "A. Liver B. Kidneys C. Spleen D. Pancreas", + "answer": "B" + }, + { + "question": "What is the primary goal of antiviral therapy in Chronic Viral Hepatitis B without Delta-Agent?", + "options": "A. Cure the infection B. Suppress viral replication C. Eliminate HDV D. Reduce renal inflammation", + "answer": "B" + }, + { + "question": "A patient with chronic hepatitis B infection is found to have coinfection with the delta-agent (hepatitis D virus) but no evidence of hepatic coma. Which of the following is a key distinguishing feature of this condition compared to chronic hepatitis B without delta-agent coinfection?", + "options": "A. Slower disease progression B. Higher rates of fulminant hepatitis C. Lower risk of cirrhosis D. Less frequent need for liver transplantation", + "answer": "B" + }, + { + "question": "A male with Chronic Viral Hepatitis B presents with moderate disease activity (persistent inflammation but no cirrhosis). What is the expected alanine aminotransferase (ALT) level range in this condition?", + "options": "A. <2× upper limit of normal (minimal elevation) B. 2–5× upper limit of normal (consistent with moderate inflammation) C. >5× upper limit of normal (suggesting severe activity) D. Within normal range (unlikely in active disease)", + "answer": "B" + }, + { + "question": "Hepatitis B Virus-Associated Nephritis is a rare condition characterized by renal involvement in patients with chronic Hepatitis B infection. Which of the following treatments is NOT commonly used in the chronic management of Hepatitis B Virus-Associated Nephritis?", + "options": "A. Antiviral drugs B. Corticosteroids C. Pegylated interferon-alpha D. Immunosuppressants", + "answer": "C" + }, + { + "question": "What is the primary mode of transmission for chronic viral hepatitis C?", + "options": "A. Airborne droplets B. Blood-to-blood contact C. Fecal-oral route D. Sexual contact", + "answer": "B" + }, + { + "question": "Which of the following is a common symptom of advanced chronic viral hepatitis C?", + "options": "A. Headache B. Jaundice C. Rash D. Cough", + "answer": "B" + }, + { + "question": "What is the first-line treatment for chronic viral hepatitis C?", + "options": "A. Antibiotics B. Direct-acting antivirals (DAAs) C. Corticosteroids D. Chemotherapy", + "answer": "B" + }, + { + "question": "Which condition is a rare extrahepatic manifestation of chronic viral hepatitis C?", + "options": "A. Hepatitis C-associated glomerulonephritis B. Chronic obstructive pulmonary disease C. Rheumatoid arthritis D. Type 2 diabetes", + "answer": "A" + }, + { + "question": "An asymptomatic patient with chronic hepatitis C infection has persistently normal liver function tests. Which of the following histological findings is most likely to be seen on liver biopsy?", + "options": "A. Severe necroinflammation with interface hepatitis B. Minimal inflammatory activity with no fibrosis C. Mild portal fibrosis without necrosis D. Bridging fibrosis with architectural distortion", + "answer": "B" + }, + { + "question": "A patient with chronic hepatitis C presents with elevated liver enzymes and imaging findings suggestive of advanced fibrosis. Which of the following METAVIR fibrosis classifications best describes their condition?", + "options": "A. F0 (No fibrosis) B. F1 (Mild fibrosis) C. F3 (Advanced fibrosis) D. F4 (Cirrhosis)", + "answer": "C" + }, + { + "question": "What is a key symptom of hepatitis C-associated glomerulonephritis?", + "options": "A. Hypertension B. Proteinuria C. Hyperglycemia D. Anemia", + "answer": "B" + }, + { + "question": "A patient with chronic viral hepatitis C presents with jaundice. This finding is most indicative of which systemic complication?", + "options": "A. Early stage liver inflammation B. Advanced liver damage C. Hepatic steatosis D. Portal hypertension", + "answer": "B" + }, + { + "question": "What is the primary goal of treatment for chronic viral hepatitis C?", + "options": "A. Symptom management B. Cure the infection C. Prevent transmission D. Reduce inflammation", + "answer": "B" + }, + { + "question": "In patients diagnosed with Chronic Mild Overlapping Viral Hepatitis, which histological feature is most commonly observed on liver biopsy, and how does it influence treatment decisions?", + "options": "A. Severe fibrosis (typically seen in advanced disease, not mild forms) B. Minimal fibrosis (consistent with mild disease and often does not require aggressive therapy) C. Bridging necrosis (suggests more severe inflammation, not typical of mild cases) D. Hepatic decompensation (indicates end-stage disease, not a histological feature of mild hepatitis)", + "answer": "B" + }, + { + "question": "Chronic Mild Overlapping Viral Hepatitis is a rare condition characterized by persistent liver inflammation due to concurrent viral infections. Which of the following symptoms is most commonly associated with this condition?", + "options": "A. Ascites B. Fatigue C. Coagulopathy D. Encephalopathy", + "answer": "B" + }, + { + "question": "A patient with Chronic Viral Hepatitis, Overlapping, presents with elevated liver enzymes (ALT 120 U/L, AST 95 U/L) and no evidence of cirrhosis on imaging. What is the most appropriate initial treatment approach?", + "options": "A. Symptomatic management only B. Tailored antiviral therapy C. Broad-spectrum antibiotics D. Immediate surgical consultation", + "answer": "B" + }, + { + "question": "In a patient diagnosed with Chronic Severe Overlapping Viral Hepatitis, a rare and aggressive form of viral hepatitis, which of the following histological features is most indicative of the disease?", + "options": "A. Mild inflammation B. Minimal fibrosis C. Bridging necrosis D. Lymphocytic infiltration", + "answer": "C" + }, + { + "question": "Chronic Viral Hepatitis, Mixed is characterized by involvement of multiple etiologies. What feature best distinguishes it from pure viral forms?", + "options": "A. Presence of both viral and autoimmune markers B. Elevated liver enzymes C. Multifactorial etiology D. Minimal fibrosis", + "answer": "C. The correct answer is C because mixed chronic viral hepatitis involves multiple etiologies, such as viral and non-viral factors, unlike pure viral forms." + }, + { + "question": "A patient with Chronic Severe Mixed Viral Hepatitis presents with ascites and confusion. Which of the following clinical manifestations is most consistent with this condition?", + "options": "A. Mild jaundice B. Hepatic decompensation C. Extensive fibrosis D. Portal hypertension", + "answer": "B" + }, + { + "question": "A patient with chronic mild overlapping viral hepatitis (due to concurrent HBV and HCV infection) presents with persistent fatigue and mildly elevated liver enzymes. Which of the following is the most appropriate initial treatment focus, and why?", + "options": "A. Liver transplant (reserved for decompensated cirrhosis) B. Antiviral therapy (targets underlying viral replication) C. Immunosuppressants (risk of exacerbating viral infection) D. Lifestyle modifications (insufficient as monotherapy)", + "answer": "B", + "rationale": "Antiviral therapy is prioritized in overlapping viral hepatitis to suppress viral replication, which drives disease progression. While lifestyle changes are adjunctive, immunosuppressants are contraindicated, and transplant is only considered in advanced disease." + }, + { + "question": "A patient with a history of alcohol use and hepatitis B infection presents with elevated liver enzymes. Chronic Viral Hepatitis, Mixed is characterized by which of the following features?", + "options": "A. Exclusive viral replication B. Multifactorial liver insults C. Early-stage fibrosis D. Preserved liver function", + "answer": "B" + }, + { + "question": "What is the primary cause of Chronic Viral Hepatitis?", + "options": "A. Bacterial infection B. Hepatitis viruses (B, C, or D) C. Autoimmune disorders D. Alcohol consumption", + "answer": "B" + }, + { + "question": "Which of the following is a common symptom of Chronic Viral Hepatitis?", + "options": "A. Persistent cough B. Fatigue C. Skin rash D. Joint pain", + "answer": "B" + }, + { + "question": "Which of the following antiviral medications is first-line therapy for Chronic Hepatitis B?", + "options": "A. Acyclovir B. Tenofovir disoproxil fumarate C. Ribavirin D. Immunosuppressive therapy E. Supportive care only", + "answer": "B" + }, + { + "question": "A patient with chronic mild viral hepatitis undergoes a liver biopsy for disease staging. The histopathology report notes portal inflammation with minimal interface activity. According to the modified Histological Activity Index (HAI) grading system, which of the following grades of inflammation is most likely associated with this patient's condition, and what is its clinical significance?", + "options": "A. Grade 1-2 (mild inflammation; typically managed with monitoring and lifestyle modifications) B. Grade 3 (moderate inflammation; may require antiviral therapy) C. Grade 4 (severe inflammation; indicates high risk of fibrosis progression) D. Grade 5 (fulminant inflammation; urgent intervention needed)", + "answer": "A" + }, + { + "question": "An asymptomatic patient is diagnosed with Chronic Mild Hepatitis B Virus (HBV) infection during routine screening. What is the key management strategy in this case?", + "options": "A. Observation without treatment B. Antiviral therapy (if indicated by viral load) C. Iron supplementation D. Surgical intervention", + "answer": "B" + }, + { + "question": "In a patient with moderate chronic Hepatitis B, which of the following symptoms is most likely to be present?", + "options": "A. Mild abdominal discomfort B. Persistent fatigue C. Severe jaundice D. Spider angiomas", + "answer": "B" + }, + { + "question": "A patient with severe chronic viral hepatitis presents with decompensated cirrhosis, including ascites and hepatic encephalopathy. What is the most critical immediate treatment goal in this clinical scenario?", + "options": "A. Lifestyle modifications to reduce liver inflammation | B. Urgent antiviral therapy to prevent progression to liver failure | C. Dietary sodium restriction to manage ascites | D. Serial monitoring of ammonia levels for encephalopathy", + "answer": "B" + }, + { + "question": "Which organ is primarily affected in Viral Hepatitis-Associated Nephropathy?", + "options": "A. Liver B. Kidneys C. Heart D. Lungs", + "answer": "B" + }, + { + "question": "A patient with chronic hepatitis B infection presents with renal dysfunction. Which of the following findings is most characteristic of Viral Hepatitis-Associated Nephropathy?", + "options": "A. Jaundice B. Proteinuria C. Ascites D. Coagulopathy E. Hematuria F. Hypertension", + "answer": "B" + }, + { + "question": "A patient with Hepatitis B Virus-Associated Nephropathy presents with worsening renal function. Which treatment strategy is most appropriate and why?", + "options": "A. Antiviral medications only B. Immunosuppressants only C. Combination of antivirals and immunosuppressants D. Supportive care only", + "answer": "C" + }, + { + "question": "What is the primary cause of Fascioliasis?", + "options": "A. Bacterial infection B. Viral infection C. Liver flukes D. Fungal infection", + "answer": "C" + }, + { + "question": "Which of the following is the most common mode of transmission for Fascioliasis?", + "options": "A. Mosquito bites B. Ingestion of contaminated water or raw aquatic plants C. Direct contact with infected individuals D. Airborne transmission", + "answer": "B" + }, + { + "question": "What is the drug of choice for treating Fascioliasis?", + "options": "A. Ivermectin B. Triclabendazole C. Metronidazole D. Albendazole", + "answer": "B" + }, + { + "question": "Which phase of Fascioliasis is characterized by fever, abdominal pain, and hepatomegaly?", + "options": "A. Latent phase B. Acute phase C. Subacute phase D. Chronic phase", + "answer": "B" + }, + { + "question": "What is a unique feature of Fascioliasis compared to other liver fluke infections in terms of its pathophysiology?", + "options": "A. It causes biliary obstruction as the primary manifestation B. It causes hepatic parenchymal damage during larval migration C. It is transmitted through direct person-to-person contact D. It is primarily diagnosed through serological testing", + "answer": "B" + }, + { + "question": "Which diagnostic method is commonly used to detect Fascioliasis eggs?", + "options": "A. Blood culture B. Stool microscopy C. Chest X-ray D. MRI scan", + "answer": "B" + }, + { + "question": "A farmer presents with intermittent right upper quadrant abdominal pain and hepatomegaly for several months after initially experiencing fever and eosinophilia. Which of the following symptoms is most characteristic of the chronic phase of Fascioliasis, as opposed to the acute phase?", + "options": "A. Fever B. Jaundice C. Right upper quadrant abdominal pain D. Urticarial rash", + "answer": "C" + }, + { + "question": "Which of the following is an intermediate host for Fascioliasis?", + "options": "A. Dogs B. Freshwater snails C. Mosquitoes D. Birds", + "answer": "B" + }, + { + "question": "What is a key preventive measure for Fascioliasis in endemic regions?", + "options": "A. Avoiding mosquito bites B. Avoiding raw watercress and contaminated water C. Wearing masks D. Regular hand washing", + "answer": "B" + }, + { + "question": "What is the primary cause of Clonorchiasis?", + "options": "A. Ingestion of contaminated water B. Consumption of raw or undercooked freshwater fish C. Direct contact with infected individuals D. Inhalation of airborne parasites", + "answer": "B" + }, + { + "question": "Which part of the human body does *Clonorchis sinensis* primarily affect?", + "options": "A. Liver parenchyma B. Bile ducts C. Small intestine D. Pancreas", + "answer": "B" + }, + { + "question": "A patient from Southeast Asia presents with chronic gastrointestinal symptoms. What is the most likely symptom associated with Clonorchiasis?", + "options": "A. Jaundice and hepatomegaly B. Abdominal pain and diarrhea C. Hematuria and dysuria D. Joint pain and swelling", + "answer": "B" + }, + { + "question": "A patient presents with abdominal pain, jaundice, and a history of consuming raw freshwater fish. Which diagnostic method is most appropriate to confirm Clonorchiasis?", + "options": "A. Blood culture B. Stool microscopy for ova C. Serology for Clonorchis sinensis D. Liver ultrasound", + "answer": "B" + }, + { + "question": "What is the recommended treatment for Clonorchiasis?", + "options": "A. Antibiotics like amoxicillin B. Antiparasitic drugs such as praziquantel C. Antifungal medications like fluconazole D. Antiviral drugs such as acyclovir", + "answer": "B" + }, + { + "question": "Which region is most endemic for Clonorchiasis?", + "options": "A. South America B. East Asia C. Sub-Saharan Africa D. Western Europe", + "answer": "B" + }, + { + "question": "What is a potential complication of untreated Clonorchiasis?", + "options": "A. Hepatitis B. Cholangiocarcinoma C. Pancreatitis D. Gastric ulcer", + "answer": "B" + }, + { + "question": "Clonorchiasis is a parasitic infection caused by the liver fluke Clonorchis sinensis, primarily transmitted through the consumption of undercooked freshwater fish. How can Clonorchiasis be prevented?", + "options": "A. Avoiding consumption of raw or undercooked shellfish B. Thoroughly cooking freshwater fish C. Drinking only boiled water D. Properly disposing of human feces to prevent contamination of water sources", + "answer": "B" + }, + { + "question": "Which stage of *Clonorchis sinensis* is infective to humans?", + "options": "A. Adult fluke B. Egg C. Metacercaria D. Miracidium", + "answer": "C" + }, + { + "question": "What is a distinguishing feature of Clonorchiasis compared to other liver parasitic diseases?", + "options": "A. It primarily affects the liver parenchyma B. It is transmitted through contaminated water C. It specifically targets the biliary system D. It is caused by a bacterial infection", + "answer": "C" + }, + { + "question": "What is the primary cause of hepatic echinococcosis?", + "options": "A. Bacterial infection B. Viral infection C. Parasitic infection D. Fungal infection", + "answer": "C" + }, + { + "question": "Which species of *Echinococcus* is responsible for cystic echinococcosis?", + "options": "A. *E. multilocularis* B. *E. granulosus* C. *E. vogeli* D. *E. oligarthrus*", + "answer": "B" + }, + { + "question": "How is hepatic echinococcosis primarily transmitted to humans?", + "options": "A. Mosquito bites B. Ingestion of eggs shed in feces of infected canines C. Direct skin contact with infected individuals D. Inhalation of fungal spores", + "answer": "B" + }, + { + "question": "What is the typical presentation of cystic echinococcosis?", + "options": "A. Rapidly growing multilocular cysts B. Slow-growing unilocular cysts C. Infiltrative tumor-like lesions D. Abscess formation with pus", + "answer": "B" + }, + { + "question": "Which imaging modality is commonly used for diagnosing hepatic echinococcosis?", + "options": "A. X-ray B. Ultrasound C. PET scan D. Angiography", + "answer": "B" + }, + { + "question": "What is the primary treatment for accessible cysts in hepatic echinococcosis?", + "options": "A. Antibiotic therapy B. Surgical resection C. Radiation therapy D. Chemotherapy", + "answer": "B" + }, + { + "question": "Which medication is used in combination with surgery to prevent recurrence of hepatic echinococcosis?", + "options": "A. Penicillin B. Albendazole C. Metronidazole D. Fluconazole", + "answer": "B" + }, + { + "question": "What is a key preventive measure for hepatic echinococcosis in endemic regions?", + "options": "A. Vaccination B. Deworming dogs C. Avoiding mosquito bites D. Using insect repellent", + "answer": "B" + }, + { + "question": "Which form of hepatic echinococcosis is more aggressive and resembles malignancy?", + "options": "A. Cystic echinococcosis B. Alveolar echinococcosis C. Polycystic echinococcosis D. Unicystic echinococcosis", + "answer": "B" + }, + { + "question": "A shepherd from a rural area presents with abdominal discomfort and an ultrasound reveals multiple cystic lesions in the liver. Which of the following is a potential complication of cystic echinococcosis in this patient?", + "options": "A. Liver failure B. Rupture of cysts C. Metastasis to the lungs", + "answer": "B" + }, + { + "question": "Which of the following is a primary cause of Hepatocellular carcinoma (HCC)?", + "options": "A. Primary sclerosing cholangitis B. Hepatitis B/C infection C. Liver fluke infections D. Lynch syndrome", + "answer": "B" + }, + { + "question": "Intrahepatic cholangiocarcinoma (ICC), a rare liver malignancy, shares some symptoms with hepatocellular carcinoma (HCC). Which of the following is the most common symptom shared by both HCC and ICC?", + "options": "A. Obstructive jaundice B. Abdominal pain C. Hepatomegaly D. Weight loss", + "answer": "B" + }, + { + "question": "A patient with unresectable Intrahepatic cholangiocarcinoma (ICC) presents with no significant comorbidities. Which treatment is specifically recommended as first-line therapy?", + "options": "A. Radiofrequency ablation B. Sorafenib C. Gemcitabine-cisplatin D. Liver transplantation", + "answer": "C" + }, + { + "question": "Which of the following best distinguishes malignant neoplasm of the liver from hepatocellular carcinoma (HCC) in terms of their origin?", + "options": "A. It is always primary to the liver (False) B. It includes metastatic liver cancers C. It is caused by viral hepatitis D. It is associated with cirrhosis in the majority of cases", + "answer": "B" + }, + { + "question": "Which imaging technique is most specialized for the early detection and characterization of Intrahepatic cholangiocarcinoma (ICC) due to its ability to visualize bile duct structures non-invasively?", + "options": "A. CT scan B. Ultrasound C. MRCP D. ERCP", + "answer": "C" + }, + { + "question": "What is a key procedural difference in the management of perihilar/distal cholangiocarcinoma compared to intrahepatic cholangiocarcinoma (ICC)? (Note: ERCP [Endoscopic Retrograde Cholangiopancreatography] is used for biliary drainage, while a Whipple procedure [pancreaticoduodenectomy] involves surgical resection of the pancreatic head, duodenum, and bile duct.)", + "options": "A. Use of chemotherapy B. Need for surgical resection C. Requirement of ERCP or Whipple procedure for biliary drainage D. Use of tyrosine kinase inhibitors", + "answer": "C" + }, + { + "question": "Which of the following is a risk factor for Intrahepatic cholangiocarcinoma (ICC)?", + "options": "A. Non-alcoholic fatty liver disease B. Primary sclerosing cholangitis C. Hepatitis B infection D. Lynch syndrome", + "answer": "B" + }, + { + "question": "A male with advanced Hepatocellular carcinoma (HCC) and portal vein thrombosis is being evaluated for systemic therapy. Which of the following is a first-line systemic treatment option for this patient?", + "options": "A. Gemcitabine-cisplatin B. Sorafenib C. Pembrolizumab D. Transarterial chemoembolization (TACE)", + "answer": "B" + }, + { + "question": "A male presents with progressive jaundice, pale stools, and pruritus. Imaging reveals a biliary stricture. Which of the following symptoms is most specifically associated with Cholangiocarcinoma?", + "options": "A. Ascites B. Obstructive jaundice C. Weight loss D. Abdominal pain E. Hemoptysis", + "answer": "B" + }, + { + "question": "A male with a history of chronic right upper quadrant pain and intermittent jaundice is diagnosed with cholangiocarcinoma. Which of the following is the most significant risk factor for the development of this malignancy?", + "options": "A. Chronic liver cirrhosis due to hepatitis B/C infection B. Primary sclerosing cholangitis C. Non-alcoholic steatohepatitis (NASH) D. Recurrent gallstone disease", + "answer": "B" + }, + { + "question": "What is the most common primary malignant liver tumor in children?", + "options": "A. Hepatocellular carcinoma B. Hepatoblastoma C. Cholangiocarcinoma D. Angiosarcoma", + "answer": "B" + }, + { + "question": "Which age group is most commonly affected by hepatoblastoma?", + "options": "A. Adolescents (10-18 years) B. Infants and toddlers under 5 years old C. Adults over 50 years old D. School-aged children (6-12 years)", + "answer": "B" + }, + { + "question": "What is a common clinical presentation of hepatoblastoma?", + "options": "A. Severe abdominal pain B. Painless right upper abdominal mass C. Chronic diarrhea D. Persistent cough", + "answer": "B" + }, + { + "question": "A child presents with an abdominal mass and is diagnosed with hepatoblastoma. Hepatoblastoma is often linked to a specific chromosomal abnormality. Which of the following genetic alterations is most commonly associated with this condition?", + "options": "A. 11p chromosome deletion B. TP53 mutation (17p) C. 22q11.2 deletion syndrome D. RB1 gene deletion (13q) E. Trisomy 21", + "answer": "A" + }, + { + "question": "What is a key diagnostic marker for hepatoblastoma?", + "options": "A. Elevated lactate dehydrogenase (LDH) B. Elevated alpha-fetoprotein (AFP) C. Elevated C-reactive protein (CRP) D. Elevated creatinine", + "answer": "B" + }, + { + "question": "Which imaging technique is commonly used to diagnose hepatoblastoma?", + "options": "A. X-ray B. Ultrasound C. CT/MRI D. PET scan", + "answer": "C" + }, + { + "question": "What is the primary treatment approach for localized hepatoblastoma?", + "options": "A. Radiation therapy B. Neoadjuvant chemotherapy followed by surgical resection C. Liver transplantation D. Targeted therapy alone", + "answer": "B" + }, + { + "question": "A patient presents with a liver mass. Biopsy confirms hepatoblastoma. Which of the following histologic subtypes is most strongly associated with a favorable prognosis?", + "options": "A. Mesenchymal B. Epithelial (fetal subtype) C. Embryonic subtype D. Mixed epithelial-mesenchymal", + "answer": "B" + }, + { + "question": "Hepatoblastoma is associated with mutations in the Wnt pathway, leading to aberrant activation of β-catenin. In patients with hepatoblastoma harboring Wnt pathway mutations, what is a potential novel therapeutic target?", + "options": "A. β-catenin inhibitors B. Immunotherapy C. Radiation therapy D. Surgical resection", + "answer": "A" + }, + { + "question": "Which of the following environmental or genetic factors is NOT associated with the etiology of hepatoblastoma in children?", + "options": "A. Low birth weight B. Familial syndromes (e.g., Beckwith-Wiedemann syndrome) C. Maternal smoking during pregnancy D. Fetal alcohol exposure", + "answer": "C. Maternal smoking is not directly linked to hepatoblastoma, whereas low birth weight, familial syndromes, and fetal alcohol exposure are known risk factors." + }, + { + "question": "What is the primary cell of origin for hepatic angiosarcoma?", + "options": "A. Hepatocytes B. Endothelial cells C. Macrophages D. Dendritic cells", + "answer": "B" + }, + { + "question": "Which of the following environmental carcinogens is associated with hepatic angiosarcoma?", + "options": "A. Asbestos B. Vinyl chloride C. Benzene D. Radon", + "answer": "B" + }, + { + "question": "A male with a history of vinyl chloride exposure presents with progressive abdominal distension, right upper quadrant pain, and unexplained weight loss. Physical examination reveals hepatomegaly. Which of the following is the most likely underlying diagnosis given these findings?", + "options": "A. Hepatic angiosarcoma B. Alcoholic cirrhosis C. Hepatitis B infection D. Metastatic colon cancer", + "answer": "A" + }, + { + "question": "Which diagnostic method is essential for confirming hepatic macrophage sarcoma?", + "options": "A. MRI B. Immunohistochemical staining C. Ultrasound D. Blood culture", + "answer": "B" + }, + { + "question": "A patient with unresectable hepatic angiosarcoma presents for treatment. Which of the following is the most appropriate first-line systemic therapy?", + "options": "A. Liver transplantation B. CHOP regimen (cyclophosphamide/doxorubicin/vincristine/prednisone) C. Doxorubicin D. Pazopanib (VEGFR inhibitor) E. Immunomodulatory therapy (e.g., checkpoint inhibitors)", + "answer": "C" + }, + { + "question": "Understanding the differences between these rare hepatic tumors is critical for accurate diagnosis and management. Which of the following is a key difference between hepatic angiosarcoma and hepatic macrophage sarcoma?", + "options": "A. Angiosarcoma originates from endothelial cells B. Macrophage sarcoma is linked to environmental toxins C. Angiosarcoma exhibits rapid vascular invasion D. Macrophage sarcoma is less likely to present with systemic symptoms compared to angiosarcoma", + "answer": "C" + }, + { + "question": "In hepatic macrophage sarcoma, systemic manifestations due to cytokine release syndrome may include which of the following?", + "options": "A. Jaundice B. Fever C. Ascites D. Hepatomegaly", + "answer": "B" + }, + { + "question": "Which of the following is a known risk factor for hepatic angiosarcoma?", + "options": "A. Genetic mutations B. Immune dysregulation C. Arsenic exposure D. Viral hepatitis", + "answer": "C" + }, + { + "question": "Hepatic angiosarcoma is a rare and aggressive malignancy. What is its typical prognosis?", + "options": "A. Generally favorable with routine treatment B. Poor due to diagnostic delays and rapid progression C. Excellent if surgically resected early D. Favorable only in patients under 40 years old", + "answer": "B" + }, + { + "question": "A patient with newly diagnosed hepatic macrophage sarcoma presents with localized disease. Which treatment regimen is most appropriate for this condition?", + "options": "A. Doxorubicin monotherapy B. CHOP regimen (cyclophosphamide, doxorubicin, vincristine, prednisone) C. Anti-angiogenic therapy (e.g., bevacizumab) D. Palliative care only", + "answer": "B (The CHOP regimen is the most evidence-based systemic therapy for hepatic macrophage sarcoma, despite its rarity, due to its efficacy in aggressive sarcomas. While doxorubicin is a component of CHOP, combination chemotherapy provides superior outcomes.)" + }, + { + "question": "Other sarcomas of the liver, distinct from hepatocellular carcinoma, primarily originate from which tissue type?", + "options": "A. Hepatocytes B. Mesenchymal tissues C. Biliary epithelial cells D. Kupffer cells", + "answer": "B" + }, + { + "question": "A patient with a history of chronic hepatitis B presents with a liver mass. Which of the following is NOT a potential cause of their suspected rare sarcoma of the liver?", + "options": "A. Genetic mutations (e.g., TP53) B. Chronic liver diseases (e.g., hepatitis B/C-induced cirrhosis) C. Exposure to carcinogens (e.g., vinyl chloride, arsenic) D. Prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs)", + "answer": "D" + }, + { + "question": "A patient presents with a newly diagnosed sarcoma of the liver. Which of the following symptoms is most commonly associated with this condition?", + "options": "A. Early jaundice B. Abdominal pain C. Unexplained weight loss D. Fatigue", + "answer": "B" + }, + { + "question": "What is the primary diagnostic tool for other sarcomas of the liver?", + "options": "A. Blood tests B. Imaging (CT/MRI) and biopsy C. Urine analysis D. Physical examination", + "answer": "B" + }, + { + "question": "A patient presents with a 5 cm localized sarcoma in the left lobe of the liver. Imaging shows no evidence of metastasis. Which treatment is most appropriate for this resectable sarcoma?", + "options": "A. Chemotherapy alone B. Surgical resection C. Combination of chemotherapy and radiation therapy D. Targeted therapy", + "answer": "B" + }, + { + "question": "A patient presents with a large hepatic mass confirmed to be a primary sarcoma. What is the most likely general prognosis for this condition?", + "options": "A. Excellent due to early detection B. Poor due to aggressive growth and late detection C. Moderate with proper treatment D. Variable depending on tumor size and stage at diagnosis", + "answer": "B" + }, + { + "question": "Which of the following is a distinct feature of primary liver sarcomas compared to hepatocellular carcinoma?", + "options": "A. Strong association with viral hepatitis B. Commonly associated with cirrhosis C. Lack of strong associations with viral hepatitis D. Often presents with biliary obstruction", + "answer": "C" + }, + { + "question": "A patient with a family history of vascular malformations presents with a liver mass. Which inherited condition, due to its vascular abnormalities, is most likely associated with the development of liver sarcomas?", + "options": "A. Cystic fibrosis B. Hereditary hemorrhagic telangiectasia C. Von Hippel-Lindau disease D. Alpha-1 antitrypsin deficiency", + "answer": "B" + }, + { + "question": "A patient with advanced other sarcoma of the liver presents with progressive disease despite prior surgical resection. Imaging shows multifocal lesions unsuitable for repeat surgery. Which of the following is the most appropriate next step in management?", + "options": "A. Chemotherapy (e.g., doxorubicin) B. Radiation therapy C. Targeted therapy (e.g., tyrosine kinase inhibitors) D. Palliative care focused on symptom management", + "answer": "A" + }, + { + "question": "Which of the following is a primary cause of hepatocellular carcinoma (HCC)?", + "options": "A. Chronic hepatitis B/C infections B. Excessive alcohol consumption C. Autoimmune hepatitis D. Wilson's disease", + "answer": "A" + }, + { + "question": "What is a common symptom of advanced liver cancer?", + "options": "A. Persistent right upper quadrant pain B. Frequent urination C. Skin rash D. Nasal congestion", + "answer": "A" + }, + { + "question": "Which serum biomarker is indicative of liver cancer when elevated to ≥400 μg/L?", + "options": "A. Alanine aminotransferase (ALT) B. Aspartate aminotransferase (AST) C. Alpha-fetoprotein (AFP) D. C-reactive protein (CRP)", + "answer": "C" + }, + { + "question": "What imaging technique is commonly used for diagnosing liver cancer?", + "options": "A. X-ray B. Ultrasound C. CT/MRI with contrast D. PET scan", + "answer": "C" + }, + { + "question": "Which of the following is a curative treatment option for early-stage liver tumors?", + "options": "A. Targeted agents like sorafenib B. Immunotherapy C. Surgical resection D. Transarterial chemoembolization (TACE)", + "answer": "C" + }, + { + "question": "A male with chronic hepatitis B presents with weight loss, abdominal pain, and a palpable right upper quadrant mass. What is the most distinctive imaging feature of liver cancer that differentiates it from other liver pathologies?", + "options": "A. Presence of a liver mass with arterial hyperenhancement B. Elevated ALT levels C. Gallstones on ultrasound D. Diffuse hepatic steatosis", + "answer": "A" + }, + { + "question": "A patient with liver cancer presents with hematemesis. Which of the following is the most likely complication due to portal hypertension?", + "options": "A. Hepatic encephalopathy B. Hypoglycemia C. Ascites D. Variceal bleeding", + "answer": "D" + }, + { + "question": "A patient with metastatic liver cancer asks about their prognosis. Understanding survival rates helps guide treatment decisions and patient counseling. What is the most accurate 5-year survival rate to share with them?", + "options": "A. >70% B. 50-70% C. 30-50% D. <10%", + "answer": "D" + }, + { + "question": "A patient with advanced liver cancer presents with recurrent episodes of low blood sugar. Which of the following paraneoplastic syndromes is most commonly associated with liver cancer?", + "options": "A. Hyperglycemia (due to insulin resistance) B. Hypoglycemia (due to insulin-like growth factors) C. Hypertension (secondary to renal artery compression) D. Hypercalcemia (due to PTH-related peptide secretion)", + "answer": "B", + "explanation": "Hypoglycemia in liver cancer is often caused by tumor production of insulin-like growth factors (IGF-2), leading to a paraneoplastic syndrome. Other options, such as hypercalcemia, are more typical of squamous cell carcinoma or hematologic malignancies." + }, + { + "question": "What is a key diagnostic feature of liver cancer on imaging?", + "options": "A. Hypovascular masses B. Hypervascular masses C. Cystic lesions D. Calcifications", + "answer": "B" + }, + { + "question": "Which of the following is a common symptom of malignant neoplasm of extrahepatic bile ducts?", + "options": "A. Hematuria B. Jaundice C. Chest pain D. Headache", + "answer": "B" + }, + { + "question": "What is the standard palliative chemotherapy for malignant neoplasm of hepatic duct?", + "options": "A. Doxorubicin B. Gemcitabine-cisplatin C. Paclitaxel D. Methotrexate", + "answer": "B" + }, + { + "question": "A patient presents with jaundice, weight loss, and right upper quadrant pain. Which diagnostic method is most appropriate for evaluating a suspected malignant neoplasm of the extrahepatic bile ducts?", + "options": "A. Abdominal ultrasound B. MRI/CT C. Chest X-ray D. Serum bilirubin levels", + "answer": "B" + }, + { + "question": "A patient with a history of abdominal pain and jaundice is diagnosed with malignant neoplasm of the common bile duct. Which of the following conditions increases the risk of this malignancy due to chronic inflammation?", + "options": "A. Primary sclerosing cholangitis B. Choledochal cysts C. Liver fluke infection D. Hypertension", + "answer": "A" + }, + { + "question": "Which of the following is a treatment option for malignant neoplasm of cystic duct?", + "options": "A. Radical cholecystectomy with lymph node dissection B. Appendectomy C. Coronary artery bypass grafting D. Total knee replacement", + "answer": "A" + }, + { + "question": "What is a distinguishing radiological feature of malignant neoplasm of the hepatic duct compared to extrahepatic bile duct tumors?", + "options": "A. It is less likely to cause biliary obstruction B. It may mimic liver metastases radiologically C. It has a higher association with cirrhosis D. It is more likely to present with intrahepatic ductal dilation", + "answer": "B" + }, + { + "question": "A patient with a history of recurrent right upper quadrant pain is found to have a mass in the cystic duct on imaging. Which of the following is a well-established modifiable risk factor for malignant neoplasm of the cystic duct?", + "options": "A. Gallstone disease B. Primary sclerosing cholangitis C. Chronic cholecystitis D. Diabetes mellitus", + "answer": "A" + }, + { + "question": "What is a common symptom of malignant neoplasm of common bile duct?", + "options": "A. Early obstructive jaundice B. Hemoptysis C. Syncope D. Peripheral edema", + "answer": "A" + }, + { + "question": "A patient presents with jaundice, and imaging reveals a biliary tumor. Which of the following best distinguishes proximal from distal biliary tumors in terms of resectability?", + "options": "A. Proximal tumors are always resectable B. Distal tumors are often unresectable C. Proximal tumors are often unresectable D. Distal tumors are less likely to cause early jaundice compared to proximal tumors", + "answer": "C" + }, + { + "question": "A patient presents with obstructive jaundice, and imaging confirms a malignant neoplasm of the common bile duct. What is the most appropriate initial treatment approach?", + "options": "A. Endoscopic stenting followed by bile duct excision with hepaticojejunostomy B. Chemotherapy alone C. Radiation therapy without surgery D. Percutaneous transhepatic biliary drainage without surgical intervention", + "answer": "A" + }, + { + "question": "A patient presents with jaundice and weight loss. Imaging reveals a mass at the ampulla of Vater. What is the primary anatomical location of this malignant neoplasm?", + "options": "A. Junction of the bile duct, pancreatic duct, and duodenum B. Junction of the stomach and duodenum C. Junction of the liver and gallbladder D. Junction of the pancreas and duodenum", + "answer": "A" + }, + { + "question": "Which of the following is NOT a typical symptom of ampullary cancer?", + "options": "A. Obstructive jaundice B. Upper abdominal pain C. Unintentional weight gain D. Gastrointestinal bleeding", + "answer": "C" + }, + { + "question": "A patient presents with jaundice and weight loss. Imaging reveals a mass in the ampulla of Vater. What is the most common diagnostic tool used to confirm ampullary cancer?", + "options": "A. X-ray B. CT/MRI C. Endoscopic ultrasound D. Biopsy E. Blood tests F. Physical examination", + "answer": "D" + }, + { + "question": "Which procedure is considered curative for ampullary cancer?", + "options": "A. Chemotherapy B. Radiotherapy C. Whipple procedure D. Endoscopic ultrasound", + "answer": "C" + }, + { + "question": "Ampullary cancer is a rare malignancy with a complex etiology. Which of the following is a significant factor contributing to its development?", + "options": "A. Chronic pancreatitis B. Biliary tract infections C. Genetic mutations D. Physical trauma", + "answer": "C", + "explanation": "Genetic mutations, particularly in the KRAS and TP53 genes, are known to play a significant role in the development of ampullary cancer." + }, + { + "question": "Ampullary cancer is a rare malignancy of the ampulla of Vater. Which of the following lifestyle factors is most strongly associated with an increased risk of developing this condition?", + "options": "A. Regular exercise B. Smoking C. High alcohol consumption D. Chronic exposure to industrial chemicals E. Vegetarian diet", + "answer": "B" + }, + { + "question": "A patient is diagnosed with ampullary cancer. Compared to other pancreaticobiliary cancers (e.g., pancreatic adenocarcinoma or cholangiocarcinoma), what is the typical prognosis of ampullary cancer in terms of 5-year survival rates?", + "options": "A. Significantly worse B. Slightly worse C. Similar D. Significantly better", + "answer": "D" + }, + { + "question": "Which of the following procedures is used to obtain tissue samples for histopathological diagnosis of ampullary cancer?", + "options": "A. CT scan B. MRI C. ERCP with biopsy D. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA)", + "answer": "C" + }, + { + "question": "What is the primary cause of obstructive jaundice in ampullary cancer?", + "options": "A. Liver failure B. Bile duct compression C. Pancreatic duct obstruction D. Duodenal obstruction", + "answer": "B" + }, + { + "question": "Which of the following is a treatment option for advanced cases of ampullary cancer?", + "options": "A. Surgery alone B. Adjuvant chemotherapy/radiotherapy C. Endoscopic ultrasound D. Physical therapy", + "answer": "B" + }, + { + "question": "A patient presents with a malignant neoplasm involving overlapping sites of the biliary tract. Which of the following is the most common underlying cause of this condition, and by what mechanism does it contribute to malignancy?", + "options": "A. Viral hepatitis (via direct oncogenic effects) B. Chronic biliary inflammation (via persistent tissue damage and cellular regeneration) C. Autoimmune disorders (via immune-mediated destruction) D. Genetic mutations associated with familial syndromes (e.g., Lynch syndrome)", + "answer": "B" + }, + { + "question": "Which parasitic infection is associated with the development of malignant neoplasm of overlapping sites of biliary tract?", + "options": "A. *Plasmodium falciparum* B. *Clonorchis sinensis* C. *Schistosoma mansoni* D. *Entamoeba histolytica*", + "answer": "B" + }, + { + "question": "A male with a history of chronic biliary disease presents for evaluation. Which of the following conditions is NOT a recognized risk factor for malignant neoplasm of overlapping sites of the biliary tract?", + "options": "A. Primary sclerosing cholangitis B. Choledocholithiasis C. Congenital biliary cysts D. Chronic pancreatitis E. Acute pancreatitis", + "answer": "E", + "explanation": "Acute pancreatitis is not a known risk factor for biliary tract malignancies, whereas primary sclerosing cholangitis, choledocholithiasis, congenital biliary cysts, and chronic pancreatitis are associated with an increased risk." + }, + { + "question": "A patient with a history of malignant neoplasm of overlapping sites of biliary tract presents with yellowing of the skin and dark urine. Which of the following is the most likely mechanism underlying these symptoms?", + "options": "A. Abdominal pain due to tumor invasion B. Obstructive jaundice from biliary tract compression C. Ascites secondary to portal hypertension D. Weight loss from cancer cachexia", + "answer": "B" + }, + { + "question": "Which imaging modality is primarily used for diagnosing malignant neoplasm of overlapping sites of biliary tract?", + "options": "A. X-ray B. Ultrasound C. MRI/MRCP D. PET scan", + "answer": "C" + }, + { + "question": "What is the primary treatment for resectable malignant neoplasm of overlapping sites of biliary tract?", + "options": "A. Chemotherapy B. Radiation therapy C. Surgical resection D. Immunotherapy", + "answer": "C" + }, + { + "question": "A patient presents with a distal tumor in malignant neoplasm of overlapping sites of the biliary tract. Which procedure is most appropriate for definitive treatment?", + "options": "A. Hepatectomy\nB. Whipple procedure\nC. Biliary drainage\nD. Palliative stenting", + "answer": "B. The Whipple procedure is the definitive surgical treatment for distal biliary tract tumors, while biliary drainage and palliative stenting are palliative measures, and hepatectomy is not indicated for distal tumors." + }, + { + "question": "What is a significant challenge in surgical treatment of malignant neoplasm of overlapping sites of biliary tract?", + "options": "A. Early detection B. Ambiguous tumor margins C. High recurrence rate D. Limited efficacy of systemic therapies", + "answer": "B" + }, + { + "question": "A patient with advanced malignant neoplasm of overlapping sites of biliary tract presents with obstructive jaundice and is not a candidate for curative treatment. Which of the following is the most appropriate palliative intervention to relieve biliary obstruction?", + "options": "A. Surgical resection B. Endoscopic stenting C. Pain management with opioids D. Immunotherapy", + "answer": "B" + }, + { + "question": "A patient presents with painless jaundice, weight loss, and imaging revealing a tumor involving overlapping sites of the biliary tract. Biopsy confirms malignant neoplasm. Why is the 5-year survival rate for this condition generally poor?", + "options": "A. High recurrence rate B. Aggressive tumor biology C. Effective treatment options D. Limited surgical resectability", + "answer": "A" + }, + { + "question": "What is the primary origin of cholangiocarcinoma?", + "options": "A. Hepatocytes B. Epithelial cells of the bile ducts C. Kupffer cells D. Pancreatic acinar cells", + "answer": "B" + }, + { + "question": "A male with a history of primary sclerosing cholangitis presents with jaundice and weight loss. Imaging reveals a biliary stricture. Which of the following is NOT a key risk factor for his suspected cholangiocarcinoma?", + "options": "A. Chronic biliary diseases B. Hepatobiliary parasites C. Chronic pancreatitis D. Exposure to thorotrast", + "answer": "C", + "explanation": "While chronic pancreatitis can cause biliary obstruction, it is not a recognized risk factor for cholangiocarcinoma. The other options (chronic biliary diseases, hepatobiliary parasites, and thorotrast exposure) are well-established risk factors." + }, + { + "question": "Which genetic mutations are commonly associated with cholangiocarcinoma?", + "options": "A. BRCA1 and BRCA2 B. KRAS and TP53 C. EGFR and ALK D. HER2 and BRAF", + "answer": "B" + }, + { + "question": "A patient with a history of primary sclerosing cholangitis presents with progressive symptoms including weight loss, abdominal pain, and pruritus. Which of the following is a typical late manifestation of cholangiocarcinoma?", + "options": "A. Hypertension B. Obstructive jaundice C. Hyperglycemia D. Polyuria", + "answer": "B" + }, + { + "question": "Which imaging technique is commonly used for diagnosing cholangiocarcinoma?", + "options": "A. CT scan B. X-ray C. MRI/MRCP D. Ultrasound", + "answer": "C" + }, + { + "question": "What is the only curative treatment option for cholangiocarcinoma?", + "options": "A. Chemotherapy B. Radiotherapy C. Surgical resection D. Biliary stenting", + "answer": "C" + }, + { + "question": "Which tumor marker is commonly elevated in cholangiocarcinoma?", + "options": "A. PSA B. CA19-9 C. AFP D. CEA", + "answer": "B" + }, + { + "question": "For patients with early-stage resectable cholangiocarcinoma undergoing complete surgical resection with negative margins, what is the 5-year survival rate?", + "options": "A. 10-20% B. 25-35% C. 40-50% D. Above 55%", + "answer": "A" + }, + { + "question": "What is the primary goal of palliative approaches in cholangiocarcinoma?", + "options": "A. Cure the disease B. Relieve symptoms and improve quality of life C. Prevent recurrence D. Enhance immune response", + "answer": "B" + }, + { + "question": "Which of the following is a strong risk factor for malignant neoplasm of the head of the pancreas?", + "options": "A. Chronic exposure to tobacco smoke B. High-fiber diet C. Regular exercise D. Vitamin D deficiency", + "answer": "A" + }, + { + "question": "Which of the following is the most common early-stage symptom of pancreatic head cancer?", + "options": "A. Obstructive jaundice B. Epigastric discomfort C. Severe back pain D. Unexplained weight loss", + "answer": "A" + }, + { + "question": "Which of the following is a distinctive feature associated with advanced pancreatic head cancer?", + "options": "A. Migratory thrombophlebitis (Trousseau’s sign) B. Elevated blood sugar levels C. Increased appetite D. Weight gain", + "answer": "A" + }, + { + "question": "What is the primary surgical treatment for localized tumors of the pancreatic head?", + "options": "A. Biliary stenting B. Whipple procedure C. Palliative care D. Radiation therapy", + "answer": "B" + }, + { + "question": "Which of the following is a common adjuvant chemotherapy regimen for pancreatic head cancer?", + "options": "A. FOLFIRINOX B. Insulin therapy C. Antibiotic therapy D. Antiviral therapy", + "answer": "A" + }, + { + "question": "In a patient with advanced pancreatic head cancer presenting with obstructive jaundice, what is the primary focus of palliative care?", + "options": "A. Pain management with opioids B. Biliary stenting for jaundice relief C. Weight gain strategies D. Nutritional support via enteral feeding", + "answer": "B" + }, + { + "question": "Which of the following is NOT a risk factor for pancreatic head cancer?", + "options": "A. Chronic pancreatitis B. Diabetes mellitus C. Occupational exposure to asbestos D. Regular physical activity", + "answer": "D" + }, + { + "question": "What is a common manifestation of advanced pancreatic head cancer?", + "options": "A. Increased appetite B. Obstructive jaundice C. Weight gain D. Improved energy levels", + "answer": "B" + }, + { + "question": "Why is early detection of pancreatic head cancer particularly important?", + "options": "A. The disease is easily treatable in late stages B. The disease has a slow progression C. The disease’s rapid progression and resistance to therapy D. The disease is asymptomatic in early stages", + "answer": "C" + }, + { + "question": "Which of the following is a modifiable risk factor for malignant neoplasm of the body of the pancreas?", + "options": "A. BRCA1/2 mutations B. Chronic tobacco use C. Advancing age D. Genetic predisposition", + "answer": "B" + }, + { + "question": "A male presents with vague abdominal complaints. Imaging reveals a malignant neoplasm in the body of the pancreas. Which of the following is the most common early symptom in this condition?", + "options": "A. Obstructive jaundice B. Unintentional weight loss C. Epigastric pain radiating to the back D. New-onset diabetes mellitus", + "answer": "C" + }, + { + "question": "Which diagnostic tool is prioritized for tumor localization and staging in malignant neoplasm of the body of the pancreas?", + "options": "A. EUS-guided biopsy B. Contrast-enhanced CT C. MRI D. PET scan", + "answer": "B" + }, + { + "question": "What is the 5-year survival rate for malignant neoplasm of the body of the pancreas?", + "options": "A. <10% B. 20-30% C. 40-50% D. >60%", + "answer": "A" + }, + { + "question": "Which of the following treatments is used for resectable tumors of the body of the pancreas?", + "options": "A. FOLFIRINOX B. Gemcitabine/nab-paclitaxel C. Distal pancreatectomy with splenectomy D. Celiac plexus block", + "answer": "C" + }, + { + "question": "In terms of pathological behavior, what is the primary difference between pancreatic body tumors and pancreatic head tumors? Understanding this difference is crucial for surgical planning and prognosis.", + "options": "A. Higher propensity for retroperitoneal invasion B. More frequent jaundice onset C. Better prognosis D. Higher likelihood of early symptoms", + "answer": "A" + }, + { + "question": "A patient presents for a risk assessment of pancreatic cancer. According to recent meta-analyses, which of the following conditions is associated with a 50% increased risk of developing malignant neoplasm of the body of the pancreas?", + "options": "A. Chronic tobacco use\nB. Obesity (BMI >35 kg/m²)\nC. Chronic alcohol consumption\nD. Long-standing diabetes (duration ≥10 years)", + "answer": "D" + }, + { + "question": "What is the primary systemic therapy used for advanced cases of malignant neoplasm of the body of the pancreas?", + "options": "A. Distal pancreatectomy B. FOLFIRINOX C. Celiac plexus block D. EUS-guided biopsy", + "answer": "B" + }, + { + "question": "Which of the following is a non-modifiable risk factor for malignant neoplasm of the body of the pancreas?", + "options": "A. Chronic tobacco use B. Obesity C. Advancing age D. Chronic alcohol consumption", + "answer": "C" + }, + { + "question": "A patient with a history of chronic smoking presents with epigastric pain radiating to the back and unexplained weight loss. Imaging reveals a mass in the tail of the pancreas. Which of the following is the most significant risk factor for this condition?", + "options": "A. Chronic smoking B. Chronic pancreatitis C. Family history of pancreatic cancer D. High-fat diet", + "answer": "A" + }, + { + "question": "In a patient with a rare malignant neoplasm of the tail of the pancreas, which of the following best explains why pain worsens in the supine position?", + "options": "A. Tumor compression of the bile duct leading to jaundice B. Direct invasion of retroperitoneal nerves causing positional pain C. Exocrine insufficiency resulting in steatorrhea D. Insulin resistance due to tumor-induced metabolic changes E. Nausea and vomiting from gastric compression F. Weight loss due to cancer cachexia", + "answer": "B" + }, + { + "question": "A male presents with epigastric pain radiating to the back and unexplained weight loss. Imaging is ordered to evaluate a suspected malignant neoplasm of the tail of the pancreas. Which diagnostic tool is most appropriate?", + "options": "A. Endoscopic ultrasound B. CT/MRI C. PET scan D. Abdominal X-ray", + "answer": "B" + }, + { + "question": "A patient presents with abdominal pain, weight loss, and new-onset diabetes mellitus. Imaging reveals a malignant neoplasm of the tail of the pancreas. What is the 5-year survival rate for this condition?", + "options": "A. Below 5% B. 5-10% C. 15-20% D. Above 25%", + "answer": "A", + "rationale": "The 5-year survival rate for pancreatic tail malignancies is typically below 5% due to late presentation, aggressive biology, and limited treatment options (reference: AJCC Cancer Staging Manual, 8th edition)." + }, + { + "question": "Which of the following treatments is feasible for early-stage localized malignant neoplasm of the tail of pancreas?", + "options": "A. Palliative chemotherapy B. Radiation therapy C. Distal pancreatectomy D. Nutritional support only", + "answer": "C" + }, + { + "question": "A male presents with epigastric pain and weight loss. Imaging reveals a mass in the tail of the pancreas. Which tumor marker is most likely elevated in this condition?", + "options": "A. CA 125 B. CA19-9 C. CA 72-4 D. CEA", + "answer": "B. CA19-9 is the most commonly elevated tumor marker in pancreatic adenocarcinoma, including tumors of the tail." + }, + { + "question": "Which of the following is less common in malignant neoplasm of the tail of pancreas compared to pancreatic head tumors?", + "options": "A. Obstructive jaundice B. Weight loss C. Steatorrhea D. New-onset diabetes", + "answer": "A" + }, + { + "question": "In a patient with a family history of breast and ovarian cancer, which of the following genetic mutations is most likely associated with malignant neoplasm of the tail of the pancreas and may influence targeted treatment decisions?", + "options": "A. BRCA2 B. TP53 C. EGFR D. KRAS", + "answer": "A", + "rationale": "While KRAS is the most common mutation in pancreatic adenocarcinoma, BRCA2 is specifically tested here due to its association with hereditary breast-ovarian cancer syndrome and potential implications for PARP inhibitor therapy." + }, + { + "question": "Due to its anatomical proximity to the splenic vessels and retroperitoneum, which of the following is the most common complication of malignant neoplasm of the tail of the pancreas?", + "options": "A. Splenic infarction B. Invasion of splenic vessels and retroperitoneum C. Gastric outlet obstruction D. Pancreatic duct obstruction", + "answer": "B" + }, + { + "question": "In the palliative care setting for a patient with malignant neoplasm of the tail of the pancreas, which of the following is the primary focus of multidisciplinary management?", + "options": "A. Surgical resection B. Symptom control, nutritional support, and palliative care C. Radiation therapy D. Chemotherapy only E. Early detection and screening", + "answer": "B" + }, + { + "question": "What is the primary origin of pancreatic ductal adenocarcinoma (PDAC)?", + "options": "A. Pancreatic acinar cells B. Epithelial cells lining the pancreatic ducts C. Pancreatic neuroendocrine cells D. Stromal cells of the pancreas", + "answer": "B" + }, + { + "question": "Which of the following is NOT a recognized risk factor for pancreatic ductal adenocarcinoma?", + "options": "A. Smoking B. Chronic pancreatitis C. Obesity D. Hypertension", + "answer": "D" + }, + { + "question": "A male with a 20-pack-year smoking history presents with persistent but nonspecific gastrointestinal complaints. In the early stages of pancreatic ductal adenocarcinoma, which of the following symptoms is most commonly reported by patients?", + "options": "A. Severe upper abdominal pain radiating to the back B. Obstructive jaundice with dark urine and pale stools C. Mild, vague abdominal discomfort or indigestion D. Significant weight loss and muscle wasting (cachexia)", + "answer": "C" + }, + { + "question": "Which diagnostic modality is commonly used for pancreatic ductal adenocarcinoma?", + "options": "A. X-ray B. CT scan C. Electrocardiogram D. Pulmonary function test", + "answer": "B" + }, + { + "question": "A patient is diagnosed with pancreatic ductal adenocarcinoma. Which of the following factors most significantly contributes to the 5-year survival rate of <10% in this disease?", + "options": "A. Late-stage diagnosis due to nonspecific symptoms B. High prevalence of surgical resectability at diagnosis C. Rapid response to first-line chemotherapy D. Low metastatic potential of the tumor", + "answer": "A" + }, + { + "question": "Which treatment offers the only curative potential for pancreatic ductal adenocarcinoma?", + "options": "A. Chemotherapy B. Radiotherapy C. Surgical resection D. Palliative care", + "answer": "C" + }, + { + "question": "What is a common site of metastasis for pancreatic ductal adenocarcinoma?", + "options": "A. Brain B. Bones C. Liver D. Skin", + "answer": "C" + }, + { + "question": "Which tumor marker is often elevated in pancreatic ductal adenocarcinoma?", + "options": "A. PSA B. CA19-9 C. CEA D. AFP", + "answer": "B" + }, + { + "question": "What is a key focus of palliative care for pancreatic ductal adenocarcinoma?", + "options": "A. Curative surgery B. Symptom management C. Preventive vaccination D. Physical therapy", + "answer": "B" + }, + { + "question": "Malignant neoplasms of the endocrine pancreas are rare but clinically significant. Which of the following is the primary underlying molecular mechanism responsible for the development of these neoplasms?", + "options": "A. Chronic inflammation leading to cellular damage B. Germline or somatic mutations disrupting cell cycle regulation C. Environmental toxin-induced DNA adduct formation D. Autoimmune destruction of pancreatic islet cells", + "answer": "B" + }, + { + "question": "Which symptom is most commonly associated with insulinomas?", + "options": "A. Peptic ulcers B. Hypoglycemia C. Flushing and diarrhea D. Hyperglycemia", + "answer": "B" + }, + { + "question": "Given the rarity of malignant neoplasms of the endocrine pancreas, what is the first-line diagnostic tool for initial evaluation in a patient with suspected disease?", + "options": "A. Blood tests for hormone levels B. Endoscopic ultrasound-guided biopsy C. Imaging (CT/MRI) D. Physical examination", + "answer": "C" + }, + { + "question": "Which treatment is typically used to control hormone secretion in malignant neoplasms of the endocrine pancreas?", + "options": "A. Surgical resection B. Somatostatin analogs C. Chemotherapy D. Radiation therapy", + "answer": "B" + }, + { + "question": "A patient is diagnosed with a rare pancreatic islet cell neoplasm. When comparing malignant neoplasms of pancreatic islet cells to other endocrine tumors of the pancreas (e.g., non-functional neuroendocrine tumors), which feature is most specific to islet cell neoplasms?", + "options": "A. Their origin in the islets of Langerhans B. Their hormone-secreting capabilities C. Their metastatic potential D. Their association with chronic pancreatitis", + "answer": "A" + }, + { + "question": "Which syndrome is most frequently associated with gastrinomas?", + "options": "A. Zollinger-Ellison syndrome B. Cushing's syndrome C. Addison's disease D. Graves' disease", + "answer": "A" + }, + { + "question": "What is a key factor in determining the prognosis of malignant neoplasms of pancreatic islet cells?", + "options": "A. Patient age B. Tumor grade and metastasis C. Blood pressure levels D. Dietary habits", + "answer": "B" + }, + { + "question": "A patient presents with a 6-month history of weight loss, migratory necrolytic erythema, and new-onset diabetes mellitus. Imaging reveals a pancreatic neuroendocrine tumor. Which of the following symptoms, if present, would be LEAST consistent with a diagnosis of glucagonoma?", + "options": "A. Flushing B. Diarrhea C. Hypoglycemia D. Peptic ulcers E. Migratory necrolytic erythema F. Deep vein thrombosis", + "answer": "C" + }, + { + "question": "What is the primary treatment for localized malignant neoplasms of the endocrine pancreas?", + "options": "A. Chemotherapy B. Radiation therapy C. Surgical resection D. Hormone replacement therapy", + "answer": "C" + }, + { + "question": "Which of the following best describes the relationship between malignant neoplasms of the endocrine pancreas and pancreatic islet cells?", + "options": "A. They are completely unrelated conditions B. Islet cell tumors are a subset of endocrine pancreas tumors C. Endocrine pancreas tumors are a subset of islet cell tumors D. They have entirely different treatment strategies", + "answer": "B" + }, + { + "question": "A male with a 20-pack-year smoking history presents with unexplained weight loss, epigastric pain radiating to the back, and new-onset diabetes. Which of the following is a well-established non-modifiable risk factor for malignant neoplasms of the pancreas in this patient?", + "options": "A. Genetic mutations (e.g., BRCA2) B. Chronic pancreatitis C. Smoking D. Obesity", + "answer": "A" + }, + { + "question": "Which symptom is most commonly associated with malignant neoplasms of the pancreas?", + "options": "A. Headache B. Abdominal pain radiating to the back C. Joint pain D. Skin rash", + "answer": "B" + }, + { + "question": "What is a primary treatment option for localized malignant neoplasms of the pancreas?", + "options": "A. Physical therapy B. Surgical resection C. Antibiotics D. Herbal supplements", + "answer": "B" + }, + { + "question": "Which of the following is a unique challenge in treating malignant neoplasms of the pancreatic neck?", + "options": "A. Easy surgical access B. Proximity to critical structures C. High response to chemotherapy D. Early-stage diagnosis", + "answer": "B" + }, + { + "question": "What is the most common adjuvant therapy following surgical resection for pancreatic neck adenocarcinoma?", + "options": "A. Chemoradiation therapy B. Chemotherapy alone C. Targeted therapy with EGFR inhibitors D. Immunotherapy with checkpoint inhibitors", + "answer": "A" + }, + { + "question": "A patient presents with a neoplasm in the pancreatic neck. Which of the following is a key clinical difference compared to neoplasms in other parts of the pancreas?", + "options": "A. Neck tumors are less likely to metastasize B. Neck tumors require broader surgical resection margins C. Neck tumors may obstruct the biliary system earlier D. Neck tumors are more responsive to chemotherapy", + "answer": "C", + "rationale": "Due to their proximity to the common bile duct, pancreatic neck tumors are more likely to cause early biliary obstruction compared to neoplasms in other pancreatic regions." + }, + { + "question": "A male presents with vague epigastric pain, weight loss, and jaundice. Imaging reveals a pancreatic mass. Which of the following is the most significant diagnostic challenge in identifying malignant neoplasms of the pancreas in clinical practice?", + "options": "A. Early detection due to nonspecific symptoms B. High specificity of blood tests for malignancy C. Overlapping symptoms with benign pancreatic conditions D. Frequent early-stage diagnosis by routine screening", + "answer": "A" + }, + { + "question": "Pancreatic neck neoplasms can present with symptoms earlier than other pancreatic tumors due to their proximity to the common bile duct, which may lead to biliary obstruction. Which of the following is a symptom that may manifest earlier in pancreatic neck neoplasms compared to other pancreatic tumors?", + "options": "A. Jaundice B. Abdominal pain C. Nausea D. Fatigue", + "answer": "A" + }, + { + "question": "What is a common chemotherapy agent used for treating pancreatic neoplasms?", + "options": "A. Aspirin B. Gemcitabine C. Paracetamol D. Ibuprofen", + "answer": "B" + }, + { + "question": "Why is the prognosis for pancreatic neck neoplasms generally poor?", + "options": "A. High response to treatment B. Frequent late-stage diagnosis C. Easy surgical access D. Low recurrence rate", + "answer": "B" + }, + { + "question": "A male presents with jaundice and unintentional weight loss. Imaging reveals a mass in the head of the pancreas, consistent with malignant neoplasm. Which of the following is the most common symptom associated with this condition?", + "options": "A. Early satiety B. Jaundice C. Venous thrombosis D. Epigastric pain radiating to the back", + "answer": "B" + }, + { + "question": "What is the primary surgical treatment for malignant neoplasm of the head and neck of the pancreas?", + "options": "A. Distal pancreatectomy B. Whipple procedure C. Radiation therapy D. Chemotherapy", + "answer": "B" + }, + { + "question": "Malignant neoplasms of overlapping sites of the pancreas are rare but associated with specific risk factors. Which of the following is the most significant risk factor for the development of this condition?", + "options": "A. Chronic pancreatitis B. Smoking C. Family history of pancreatic cancer D. Diabetes mellitus", + "answer": "B" + }, + { + "question": "In patients with malignant neoplasm of the body and tail of the pancreas, which of the following is a distinguishing clinical feature compared to tumors located in the head of the pancreas? (Hint: Body and tail tumors often compress adjacent structures like the stomach.)", + "options": "A. Early jaundice B. Early satiety due to gastric compression C. Abdominal pain radiating to the back D. Weight loss", + "answer": "B", + "rationale": "Early satiety is more characteristic of body and tail tumors due to their propensity to compress the stomach, whereas head tumors typically present with jaundice or biliary obstruction due to proximity to the common bile duct." + }, + { + "question": "Malignant neoplasm of overlapping sites of the pancreas is a rare condition. Which of the following treatments is typically used for its management in the advanced stage?", + "options": "A. Surgical resection B. Radiation therapy C. Chemotherapy D. Combination of surgical resection and chemotherapy", + "answer": "D" + }, + { + "question": "What is the most common clinical manifestation of malignant neoplasm of the pancreatic neck and body, particularly when it involves adjacent structures?", + "options": "A. Early satiety B. Biliary obstruction C. Venous thrombosis D. Epigastric pain radiating to the back", + "answer": "D" + }, + { + "question": "A patient presents with obstructive jaundice and is diagnosed with pancreatic cancer. In this disease, which of the following is a reason for the marginally better prognosis of head tumors compared to body/tail tumors?", + "options": "A. Earlier symptomatic detection leading to timely intervention B. Higher likelihood of surgical resection due to anatomical location C. Lower incidence of distant metastasis at diagnosis D. Better response to targeted therapy", + "answer": "A" + }, + { + "question": "A patient with a malignant neoplasm of the body and tail of the pancreas presents with abdominal pain and splenomegaly. What is a potential complication of this condition?", + "options": "A. Biliary obstruction B. Splenic vein thrombosis C. Early jaundice D. Gastric varices", + "answer": "B" + }, + { + "question": "Malignant neoplasms involving overlapping sites of the pancreas (e.g., tumors spanning the head and body) are rare but clinically significant. Which of the following is a characteristic feature of such tumors?", + "options": "A. Early jaundice B. Frequent metastasis to distant sites C. Involvement of multiple contiguous regions D. Better prognosis than head tumors", + "answer": "C" + }, + { + "question": "What is a common treatment approach for malignant neoplasm of the pancreatic neck and body?", + "options": "A. Surgical resection alone B. Chemotherapy alone C. Multimodal therapy D. Radiation therapy alone", + "answer": "C" + }, + { + "question": "A male presents with painless jaundice, weight loss, and a palpable gallbladder. Imaging reveals a mass in the head of the pancreas. Which of the following cell types is most likely the origin of this patient's pancreatic cancer?", + "options": "A. Endocrine islet cells B. Acinar cells of the exocrine pancreas C. Hepatic progenitor cells D. Common bile duct epithelium E. Pancreatic ductal cells F. Tumor-associated stromal cells", + "answer": "E" + }, + { + "question": "Which of the following is NOT a known cause of pancreatic cancer?", + "options": "A. Chronic pancreatitis B. Smoking C. Obesity D. Hypertension", + "answer": "D" + }, + { + "question": "What is a common symptom of pancreatic cancer due to bile duct obstruction?", + "options": "A. Fever B. Jaundice C. Cough D. Headache", + "answer": "B" + }, + { + "question": "Which imaging technique is commonly used in the diagnosis of pancreatic cancer?", + "options": "A. X-ray B. Ultrasound C. CT/MRI D. PET scan", + "answer": "C" + }, + { + "question": "A patient with a localized pancreatic adenocarcinoma in the head of the pancreas presents for surgical management. What is the most appropriate procedure?", + "options": "A. Laparoscopy B. Whipple procedure C. Biopsy D. Distal pancreatectomy", + "answer": "B" + }, + { + "question": "A patient is diagnosed with advanced pancreatic cancer. Which chemotherapy regimen is most commonly recommended as first-line treatment?", + "options": "A. Cisplatin B. Gemcitabine C. Paclitaxel D. Doxorubicin E. Oxaliplatin", + "answer": "B" + }, + { + "question": "A patient is diagnosed with pancreatic adenocarcinoma. Compared to other gastrointestinal malignancies (e.g., colorectal or gastric cancer), what is the approximate 5-year survival rate for pancreatic cancer?", + "options": "A. Below 10% B. 10-15% C. 15-20% D. Above 20%", + "answer": "A" + }, + { + "question": "What is a major challenge in the timely intervention of pancreatic cancer?", + "options": "A. Early detection B. Lack of specific early symptoms C. High cost of treatment D. Limited surgical options", + "answer": "B" + }, + { + "question": "What is a focus of palliative care in pancreatic cancer patients?", + "options": "A. Chemotherapy B. Radiation therapy C. Symptom relief D. Surgical resection", + "answer": "C" + }, + { + "question": "A patient with a history of smoking presents with jaundice and weight loss. Genetic testing reveals a mutation associated with pancreatic cancer. Which of the following mutations is most likely responsible?", + "options": "A. BRCA1 B. KRAS C. EGFR D. SMAD4", + "answer": "B" + }, + { + "question": "What is the primary cause of secondary malignant neoplasm of the liver?", + "options": "A. Chronic bile duct inflammation B. Spread of cancer cells from other primary tumors C. Hepatitis B/C infection D. Genetic predispositions", + "answer": "B" + }, + { + "question": "Which of the following is a common symptom of both metastatic liver cancer and intrahepatic bile duct cancer?", + "options": "A. Itching B. Pale stools C. Jaundice D. Elevated CA19-9 levels", + "answer": "C" + }, + { + "question": "What is the primary diagnostic tool for secondary malignant neoplasm of the liver?", + "options": "A. Tumor markers (CA19-9) B. Biopsy C. Imaging (CT/MRI) D. Blood tests for liver enzymes", + "answer": "C" + }, + { + "question": "Which treatment is considered curative for early-stage intrahepatic bile duct cancer?", + "options": "A. Chemotherapy B. Radiation therapy C. Surgical resection D. Palliative stenting", + "answer": "C" + }, + { + "question": "What is a key risk factor for intrahepatic bile duct cancer?", + "options": "A. Colorectal cancer B. Chronic bile duct inflammation C. Lung cancer D. Breast cancer", + "answer": "B" + }, + { + "question": "Systemic therapies are treatments that affect the entire body. Which of the following is a systemic therapy used for metastatic hepatocellular carcinoma?", + "options": "A. Targeted therapy B. Immunotherapy C. Chemotherapy D. Radiation therapy", + "answer": "C" + }, + { + "question": "A patient with a history of chronic liver disease presents with jaundice and weight loss. Imaging reveals a liver mass. How does the origin of intrahepatic bile duct cancer influence its diagnostic approach compared to metastatic liver cancer?", + "options": "A. It is associated with chronic viral hepatitis B. It originates within the bile ducts of the liver C. It typically presents with multifocal lesions on imaging D. It is more responsive to localized therapies", + "answer": "B" + }, + { + "question": "A patient with a history of weight loss and hematochezia is found to have multiple liver lesions on imaging. Which of the following is the most likely primary source of these metastases?", + "options": "A. Primary sclerosing cholangitis B. Colorectal cancer C. Pancreatic cancer D. Breast cancer", + "answer": "B" + }, + { + "question": "A patient presents with jaundice and abdominal pain. What is the most appropriate initial imaging modality to evaluate for intrahepatic bile duct cancer?", + "options": "A. CT scan B. MRI with contrast C. CA19-9 levels D. Liver biopsy", + "answer": "A" + }, + { + "question": "In patients with intrahepatic bile duct cancer, a rare malignancy, which of the following symptoms is specifically caused by bile flow obstruction?", + "options": "A. Unexplained weight loss B. Nausea C. Itching D. Elevated liver enzymes", + "answer": "C" + }, + { + "question": "What is the most likely primary site of a secondary malignant neoplasm of the gallbladder?", + "options": "A. Originates in the gallbladder B. Spreads from a primary tumor elsewhere in the body C. Commonly presents with jaundice D. Is typically diagnosed at an early stage", + "answer": "B" + }, + { + "question": "A patient presents with a secondary malignant neoplasm of the gallbladder. Which of the following symptoms is most likely to be the dominant clinical feature at initial presentation due to biliary obstruction?", + "options": "A. Epigastric abdominal pain B. Jaundice C. Unintentional weight loss D. Early satiety", + "answer": "B" + }, + { + "question": "What is the primary diagnostic method for confirming secondary malignant neoplasm of the gallbladder?", + "options": "A. Blood test B. Imaging (CT/MRI) and biopsy C. Physical examination D. Urine test", + "answer": "B" + }, + { + "question": "A patient with metastatic colon cancer presents with secondary malignant neoplasm of the gallbladder. Which treatment is most commonly used in this setting?", + "options": "A. Surgical resection B. Systemic therapies like chemotherapy or immunotherapy C. Radiation therapy D. Palliative care", + "answer": "B" + }, + { + "question": "A patient with a history of colorectal cancer presents with jaundice and abdominal pain. Imaging reveals a mass in the biliary tract. What is the most likely explanation for this finding?", + "options": "A. Originates in the bile ducts B. Spreads from a primary tumor elsewhere in the body C. Is often associated with a poor prognosis despite treatment D. Does not cause any symptoms E. Is more common than primary biliary tract malignancies", + "answer": "B" + }, + { + "question": "Which of the following symptoms is most commonly associated with secondary malignant neoplasm of the biliary tract?", + "options": "A. Obstructive jaundice B. Chest pain C. Headache D. Shortness of breath", + "answer": "A" + }, + { + "question": "What is the primary diagnostic method for confirming secondary malignant neoplasm of the biliary tract?", + "options": "A. Blood test B. ERCP, MRCP, or biopsy C. Physical examination D. Urine test", + "answer": "B" + }, + { + "question": "A patient with metastatic colorectal cancer presents with jaundice and imaging confirms secondary malignant neoplasm of the biliary tract. Which intervention is most appropriate as the initial management?", + "options": "A. Surgical resection B. Relieving biliary obstruction via stents or drains C. Radiation therapy D. Systemic chemotherapy", + "answer": "B" + }, + { + "question": "A patient presents with jaundice and abdominal pain. Imaging reveals a mass. What is the key anatomical difference between secondary malignant neoplasm of the gallbladder and secondary malignant neoplasm of the biliary tract that would guide further diagnostic workup?", + "options": "A. The gallbladder neoplasm targets the bile ducts B. The biliary tract neoplasm primarily affects the gallbladder wall C. The gallbladder neoplasm primarily affects the gallbladder wall, while the biliary tract neoplasm targets the bile ducts D. Both conditions primarily affect the bile ducts but differ in their metastatic origins", + "answer": "C" + }, + { + "question": "What is the defining characteristic of carcinoma in situ of the liver, gallbladder, and bile ducts?", + "options": "A. Invasion into deeper tissues B. Presence of malignant cells confined to the epithelium C. Metastasis to distant organs D. Formation of gallstones", + "answer": "B" + }, + { + "question": "A female presents with right upper quadrant abdominal pain and is diagnosed with carcinoma in situ of the gallbladder. Which of the following is the most common risk factor for this condition in the general population?", + "options": "A. Hepatitis B/C infection B. Gallstones C. Primary sclerosing cholangitis D. Liver fluke infestation", + "answer": "B" + }, + { + "question": "What is the primary treatment for carcinoma in situ of the gallbladder?", + "options": "A. Chemotherapy B. Radiation therapy C. Cholecystectomy D. Liver transplantation", + "answer": "C" + }, + { + "question": "Carcinoma in situ of the biliary tract is a rare condition. Which symptom is most commonly associated with its early stage?", + "options": "A. Asymptomatic B. Obstructive jaundice C. Abdominal pain D. Pancreatitis", + "answer": "A" + }, + { + "question": "What is the standard surgical treatment for carcinoma in situ of the ampulla of Vater?", + "options": "A. Partial hepatectomy B. Endoscopic ampullectomy C. Cholecystectomy D. Whipple procedure", + "answer": "B" + }, + { + "question": "A female with a history of gallstones undergoes cholecystectomy, and pathology reveals carcinoma in situ (CIS) of the gallbladder. A 58-year-old male with primary sclerosing cholangitis is found to have biliary tract CIS on biopsy. Which of the following best explains the key pathophysiological difference between these two conditions?", + "options": "A. Gallbladder CIS is strongly associated with gallstone-related chronic inflammation, while biliary CIS arises from inflammatory conditions like primary sclerosing cholangitis B. Biliary CIS requires immediate liver transplantation for cure C. Gallbladder CIS demonstrates deeper submucosal invasion compared to biliary CIS D. Biliary CIS is typically asymptomatic until metastatic spread occurs", + "answer": "A" + }, + { + "question": "A patient is diagnosed with carcinoma in situ of the liver during a routine screening. What is the most likely prognosis if the condition is detected at this early stage (e.g., before metastasis)?", + "options": "A. Poor, with a high likelihood of progression to invasive cancer B. Moderate, with a significant risk of recurrence C. High curability, with a low risk of progression D. Variable, depending on the specific organ and treatment approach", + "answer": "C" + }, + { + "question": "A patient with a long-standing history of chronic biliary tract disease presents with worsening jaundice and weight loss. During diagnostic evaluation, carcinoma in situ of the biliary tract is suspected. Which of the following is the most significant risk factor for this condition?", + "options": "A. Hepatitis B/C infection B. Gallstones C. Biliary stasis D. Familial adenomatous polyposis", + "answer": "C" + }, + { + "question": "Which of the following is a common risk factor for carcinoma in situ of the liver?", + "options": "A. Gallstones B. Hepatitis B/C C. Biliary stasis D. Familial adenomatous polyposis", + "answer": "B" + }, + { + "question": "What is the defining characteristic of carcinoma in situ of the pancreas?", + "options": "A. Invasion of surrounding tissues B. Confinement of malignant cells to the pancreatic ductal epithelium C. Presence of distant metastases D. Formation of large tumors in the pancreas", + "answer": "B" + }, + { + "question": "Which of the following is NOT a known risk factor for carcinoma in situ of the pancreas?", + "options": "A. Genetic predisposition (e.g., BRCA2 mutations) B. Chronic pancreatitis C. High-fat diets D. Regular exercise", + "answer": "D" + }, + { + "question": "What is the most common symptom associated with carcinoma in situ of the pancreas?", + "options": "A. Severe abdominal pain B. Weight loss C. Jaundice D. Absence of symptoms due to its localized nature", + "answer": "D" + }, + { + "question": "Which diagnostic method is primarily used to confirm carcinoma in situ of the pancreas?", + "options": "A. Blood tests B. Imaging (e.g., endoscopic ultrasound) C. Physical examination D. Histopathological confirmation via biopsy", + "answer": "D" + }, + { + "question": "A patient is diagnosed with carcinoma in situ of the pancreas. Imaging shows no evidence of metastasis. What is the most appropriate primary treatment?", + "options": "A. Neoadjuvant chemotherapy B. Palliative care C. Surgical resection (e.g., Whipple procedure) D. Targeted therapy", + "answer": "C" + }, + { + "question": "Why does carcinoma in situ of the pancreas have a significantly better prognosis compared to invasive pancreatic cancer?", + "options": "A. It responds better to chemotherapy B. It is less aggressive C. It is in a pre-invasive state D. It is more easily detected", + "answer": "C" + }, + { + "question": "A patient presents with suspected carcinoma in situ of the pancreas. Which imaging technique is most appropriate for initial diagnosis due to its high resolution and ability to guide biopsies?", + "options": "A. X-ray B. Endoscopic ultrasound C. MRI D. CT scan", + "answer": "B" + }, + { + "question": "What is a critical component of managing carcinoma in situ of the pancreas after treatment?", + "options": "A. Regular chemotherapy sessions B. Surveillance for detecting recurrence C. Continuous radiation therapy D. Long-term hospitalization", + "answer": "B" + }, + { + "question": "Which of the following is a common type of benign neoplasm of the liver?", + "options": "A. Cholangiocarcinoma B. Hepatic hemangioma C. Biliary adenoma D. Cystadenoma", + "answer": "B" + }, + { + "question": "A patient presents with right upper quadrant pain and a palpable liver mass. What is the primary diagnostic tool to evaluate for benign neoplasms of the liver?", + "options": "A. Serum alpha-fetoprotein (AFP) B. Ultrasound C. CT scan D. Liver biopsy", + "answer": "B" + }, + { + "question": "A woman presents with a palpable right upper quadrant mass. Which of the following symptoms is most likely associated with a large hepatic adenoma?", + "options": "A. Jaundice B. Abdominal discomfort C. Fatigue D. Nausea", + "answer": "B" + }, + { + "question": "A patient presents with an incidentally discovered intrahepatic bile duct mass. Biopsy reveals a biliary adenoma. Which of the following is the most likely underlying cause?", + "options": "A. Hormonal influences B. Chronic bile duct inflammation C. Congenital liver anomalies D. Viral hepatitis", + "answer": "B" + }, + { + "question": "Which of the following is a treatment option for symptomatic benign liver neoplasms?", + "options": "A. Chemotherapy B. Radiation therapy C. Surgical resection D. Antibiotics", + "answer": "C" + }, + { + "question": "In a patient presenting with an incidentally discovered liver mass, what is a key histological difference between benign liver neoplasms and benign bile duct neoplasms? Although both conditions are rare, understanding their differences is crucial for accurate diagnosis and management.", + "options": "A. Liver neoplasms are always symptomatic B. Bile duct neoplasms are hormone-related C. Liver neoplasms primarily affect hepatocytes D. Bile duct neoplasms often present with obstructive jaundice", + "answer": "C" + }, + { + "question": "Which of the following imaging techniques is critical for diagnosing benign bile duct neoplasms?", + "options": "A. CT scan B. MRI C. MRCP D. X-ray", + "answer": "C" + }, + { + "question": "A woman on long-term oral contraceptive therapy presents with a liver mass. Biopsy confirms a hepatic adenoma, a type of benign liver neoplasm. What is the unique hormonal association most likely related to this condition?", + "options": "A. Estrogen B. Insulin C. Thyroid hormone D. Cortisol", + "answer": "A" + }, + { + "question": "A patient is diagnosed with a rare benign neoplasm of the intrahepatic bile ducts. Which of the following symptoms is most likely to be observed in this condition?", + "options": "A. Abdominal bloating B. Jaundice C. Palpable mass D. Pruritus E. Dark urine", + "answer": "B" + }, + { + "question": "What is the primary goal of treatment for benign bile duct neoplasms?", + "options": "A. Monitoring B. Relieving obstruction C. Hormonal therapy D. Chemotherapy", + "answer": "B" + }, + { + "question": "A patient with a history of recurrent cholangitis presents with jaundice and pruritus. Imaging reveals a benign neoplasm of the extrahepatic bile ducts. What is the most likely primary symptom associated with this condition?", + "options": "A. Nausea B. Jaundice C. Fever D. Diarrhea E. Abdominal pain F. Weight loss", + "answer": "B" + }, + { + "question": "A female presents with right upper quadrant pain. Imaging reveals a lesion in the gallbladder. Which diagnostic tool is most commonly used to confirm a benign neoplasm of the gallbladder?", + "options": "A. MRI B. Endoscopic ultrasound C. Ultrasound D. Biopsy", + "answer": "C. Ultrasound is commonly used due to its non-invasive nature, cost-effectiveness, and high sensitivity for gallbladder lesions." + }, + { + "question": "Although benign gallbladder neoplasms are rare, they can present with specific management challenges. In a patient with larger or symptomatic benign neoplasms of the gallbladder and no contraindications to surgery, what is the typical treatment?", + "options": "A. Radiofrequency ablation B. Cholecystectomy C. Monitoring D. Percutaneous drainage", + "answer": "B" + }, + { + "question": "A female presents with incidental findings of a gallbladder polyp on abdominal ultrasound. Given the rarity of benign gallbladder neoplasms, which of the following is the most likely risk factor for the development of a gallbladder adenoma?", + "options": "A. Chronic inflammation B. Gallstones C. Bile duct abnormalities D. Liver cirrhosis", + "answer": "B" + }, + { + "question": "A patient presents with a benign neoplasm in the biliary system. What is the main difference in symptoms between benign neoplasms of the extrahepatic bile ducts and benign neoplasms of the gallbladder?", + "options": "A. Extrahepatic bile duct neoplasms cause nausea, while gallbladder tumors cause jaundice B. Extrahepatic bile duct neoplasms cause jaundice, while gallbladder tumors often remain silent C. Both can cause abdominal pain, but severity varies D. Both are asymptomatic", + "answer": "B" + }, + { + "question": "A patient presents with obstructive jaundice due to a 3 cm benign neoplasm of the common bile duct. Which surgical approach is most appropriate?", + "options": "A. Cholecystectomy B. Complex resection with biliary reconstruction C. Endoscopic stenting D. Laparoscopic cholecystectomy", + "answer": "B" + }, + { + "question": "An asymptomatic patient is found to have a 0.8 cm polyp in the gallbladder during routine abdominal ultrasound. What is the most appropriate management approach?", + "options": "A. Surgical resection B. Cholecystectomy C. Monitoring D. Antibiotic therapy", + "answer": "C" + }, + { + "question": "A patient presents with a benign neoplasm of the extrahepatic bile ducts. Which of the following is the most likely underlying pathophysiological mechanism?", + "options": "A. Gallstone obstruction leading to epithelial hyperplasia B. Chronic inflammation causing reactive cellular proliferation C. Liver cirrhosis inducing ductal metaplasia D. Viral infection triggering dysplastic changes E. Genetic predisposition to biliary neoplasia F. Autoimmune-mediated ductal injury", + "answer": "B" + }, + { + "question": "A patient presents with jaundice and abdominal pain. Imaging reveals a mass in the extrahepatic bile ducts. Which of the following is the most accurate diagnostic method to confirm a benign neoplasm, given its superior soft-tissue characterization and absence of radiation exposure?", + "options": "A. Ultrasound B. CT scan C. MRI D. Biopsy", + "answer": "C" + }, + { + "question": "Which of the following is a common symptom of larger benign neoplasms of the gallbladder?", + "options": "A. Jaundice B. Right upper quadrant pain C. Itching D. Fever", + "answer": "B" + }, + { + "question": "What is the primary characteristic of a benign neoplasm of the pancreas?", + "options": "A. Invasive potential B. Non-cancerous growth C. High malignant transformation risk D. Rapid metastasis", + "answer": "B" + }, + { + "question": "A patient presents with episodic abdominal pain and early satiety. Imaging reveals a 4 cm serous cystadenoma in the pancreatic tail. Which of the following is the most likely symptom associated with this benign pancreatic tumor?", + "options": "A. Hypoglycemia B. Abdominal pain C. Jaundice D. Nausea", + "answer": "B" + }, + { + "question": "What is a typical treatment for symptomatic or enlarging benign pancreatic tumors?", + "options": "A. Chemotherapy B. Radiation therapy C. Surgical resection D. Hormonal therapy", + "answer": "C" + }, + { + "question": "Which subtype of benign pancreatic tumor is associated with excessive insulin secretion?", + "options": "A. Pancreatic cysts B. Insulinomas C. Lipomas D. Fibromas", + "answer": "B" + }, + { + "question": "A woman is found to have an incidental pancreatic mass on imaging. Biopsy reveals a serous cystadenoma, a benign pancreatic neoplasm. What is the most likely underlying etiology of this lesion?", + "options": "A. Chronic pancreatitis B. Genetic mutations in the VHL gene C. Autoimmune pancreatitis D. Alcohol abuse", + "answer": "B" + }, + { + "question": "A patient presents with recurrent episodes of sweating, palpitations, and confusion. Laboratory tests reveal hypoglycemia. Which of the following is NOT a typical symptom of functional benign pancreatic tumors like insulinomas?", + "options": "A. Sweating B. Palpitations C. Confusion D. Hyperglycemia E. Weight loss", + "answer": "D. Hyperglycemia is not typical because insulinomas cause hypoglycemia due to excessive insulin secretion." + }, + { + "question": "What is the prognosis for most benign pancreatic neoplasms post-resection?", + "options": "A. Poor B. Favorable C. Uncertain D. High recurrence risk", + "answer": "B" + }, + { + "question": "A patient is diagnosed with a pancreatic serous cystadenoma. Which of the following is the most accurate characteristic of this benign pancreatic neoplasm?", + "options": "A. High invasive potential B. Low malignant transformation risk C. Rapid growth D. Frequent metastasis E. Association with von Hippel-Lindau syndrome", + "answer": "B" + }, + { + "question": "A patient is incidentally found to have a 2 cm asymptomatic serous cystadenoma on abdominal imaging. What is the most appropriate next step?", + "options": "A. Immediate surgical resection B. Endoscopic ultrasound surveillance C. Chemotherapy D. Radiation therapy E. Surgical resection if growth is observed on serial imaging", + "answer": "B" + }, + { + "question": "A patient presents with episodic hypoglycemia. Imaging reveals a pancreatic mass. Which of the following is the most defining feature of a benign neoplasm of the endocrine pancreas in this context?", + "options": "A. Localized growth without metastasis B. Hormone production by islet cells C. Association with chronic pancreatitis D. Potential for malignant transformation over time", + "answer": "B" + }, + { + "question": "Which genetic syndrome is commonly associated with benign neoplasms of the endocrine pancreas?", + "options": "A. Down syndrome B. MEN1 syndrome C. Turner syndrome D. Marfan syndrome", + "answer": "B" + }, + { + "question": "What is a common symptom of an insulinoma?", + "options": "A. Hyperglycemia B. Hypoglycemia C. Peptic ulcers D. Watery diarrhea", + "answer": "B" + }, + { + "question": "Which diagnostic method is used to identify benign neoplasms of the endocrine pancreas?", + "options": "A. Blood culture B. CT/MRI imaging C. Urine analysis D. Electrocardiogram", + "answer": "B" + }, + { + "question": "What is the primary treatment for symptomatic benign neoplasms of the endocrine pancreas?", + "options": "A. Chemotherapy B. Surgical resection C. Radiation therapy D. Antibiotic therapy", + "answer": "B" + }, + { + "question": "A patient is diagnosed with a pancreatic mass. Which of the following best distinguishes benign neoplasms from islet cell tumors in terms of their clinical behavior?", + "options": "A. Benign neoplasms are typically non-invasive B. Islet cell tumors can be malignant C. Benign neoplasms do not secrete hormones D. Islet cell tumors are often asymptomatic but can present with hormonal syndromes", + "answer": "B" + }, + { + "question": "What is a common symptom of a VIPoma?", + "options": "A. Hypoglycemia B. Peptic ulcers C. Watery diarrhea D. Skin rashes", + "answer": "C" + }, + { + "question": "A patient presents with recurrent hypoglycemia and elevated insulin levels. Which diagnostic tool is most appropriate for localizing an islet cell tumor?", + "options": "A. Endoscopic ultrasound B. Abdominal CT scan C. Lumbar puncture D. Serum chromogranin A test", + "answer": "A" + }, + { + "question": "Benign neoplasms of the endocrine pancreas are rare. What is the typical long-term prognosis for these tumors following complete surgical removal?", + "options": "A. Poor, with frequent recurrence B. Excellent, with minimal risk of recurrence C. Variable, depending on tumor size and location D. Unpredictable, with high risk of complications", + "answer": "B" + }, + { + "question": "A patient with metastatic islet cell tumors presents with symptoms of hormone hypersecretion. Which of the following is a first-line treatment option?", + "options": "A. Surgical resection only B. Somatostatin analogs C. Antibiotic therapy D. Physical therapy E. Chemotherapy F. Targeted therapy", + "answer": "B", + "rationale": "Somatostatin analogs (e.g., octreotide) are first-line for symptom control in metastatic islet cell tumors due to their ability to inhibit hormone secretion. While chemotherapy (E) and targeted therapy (F) may be used in advanced cases, they are not first-line. Surgical resection (A) is rarely curative in metastatic disease." + }, + { + "question": "A woman undergoes abdominal ultrasound for unrelated symptoms, and an incidental liver mass is identified. Biopsy confirms a liver hemangioma. What is the most likely underlying cause of this finding?", + "options": "A. Chronic alcohol use B. Congenital vascular malformations C. Hepatitis C infection D. Metastatic carcinoma", + "answer": "B" + }, + { + "question": "A patient with a known large liver hemangioma presents for evaluation. Which of the following symptoms is most commonly associated with this condition?", + "options": "A. Left lower quadrant pain B. Right upper quadrant pain C. Epigastric pain D. Jaundice", + "answer": "B" + }, + { + "question": "What is the recommended management for asymptomatic liver hemangiomas smaller than 4 cm?", + "options": "A. Surgical resection B. Arterial embolization C. Monitoring D. Chemotherapy", + "answer": "C" + }, + { + "question": "Which of the following is a rare complication of liver hemangioma?", + "options": "A. Jaundice B. Kasabach-Merritt syndrome C. Dysphagia D. Nausea", + "answer": "B" + }, + { + "question": "An asymptomatic patient undergoes abdominal imaging for unrelated reasons, and incidental hemangiomas are noted. In the general population, what is the primary difference between liver and pancreatic hemangiomas in terms of prevalence and clinical significance?", + "options": "A. Liver hemangiomas are more common and typically asymptomatic\nB. Pancreatic hemangiomas are more common but rarely symptomatic\nC. Both are equally prevalent, though pancreatic hemangiomas have higher malignant potential\nD. Neither is common, but liver hemangiomas are more likely to require intervention", + "answer": "A" + }, + { + "question": "A patient presents with a rare vascular tumor of the pancreas (pancreatic hemangioma) identified on abdominal CT. Which of the following symptoms is most likely associated with this condition?", + "options": "A. Epigastric pain radiating to the back B. Jaundice with clay-colored stools C. Unintentional weight loss and nausea D. Right upper quadrant tenderness", + "answer": "A" + }, + { + "question": "A patient presents with a symptomatic pancreatic hemangioma causing abdominal pain and obstructive jaundice. What is the most appropriate treatment approach?", + "options": "A. Endoscopic intervention B. Surgical excision C. Chemotherapy D. Embolization", + "answer": "B", + "rationale": "Surgical excision is the definitive treatment for symptomatic pancreatic hemangiomas, particularly when they cause complications such as obstruction or bleeding. While endoscopic intervention or embolization may provide temporary relief, they are not curative. Chemotherapy and radiation therapy are not standard treatments for this benign vascular lesion." + }, + { + "question": "What is the primary reason pancreatic hemangiomas are more likely to cause obstructive symptoms compared to liver hemangiomas?", + "options": "A. Hormonal influences B. Anatomical proximity to critical structures C. Larger size D. Higher prevalence", + "answer": "B" + }, + { + "question": "A patient with obesity and a family history of type 2 diabetes presents with elevated fasting glucose levels. What is the most likely primary contributor to their insulin resistance?", + "options": "A. Genetic predisposition B. Obesity C. Chronic inflammation D. Sedentary lifestyle", + "answer": "B" + }, + { + "question": "Which of the following is a typical symptom of insulin resistance?", + "options": "A. Steatorrhea B. Hyperglycemia C. Gallstones D. Fasting hypoglycemia", + "answer": "B" + }, + { + "question": "A patient presents with diabetes, steatorrhea, and gallstones. Imaging reveals a pancreatic mass, and biochemical testing confirms elevated somatostatin levels, consistent with a somatostatinoma. What is the most appropriate treatment for this condition?", + "options": "A. Somatostatin analogs B. Surgical resection C. Chemotherapy D. Radiation therapy", + "answer": "B" + }, + { + "question": "Which condition is characterized by a cluster of conditions such as hypertension and dyslipidemia?", + "options": "A. Insulin resistance B. Increased somatostatin in the pancreas C. Metabolic syndrome D. Autoimmune insulin receptor disease", + "answer": "C" + }, + { + "question": "What is the primary driver of metabolic syndrome?", + "options": "A. Excessive somatostatin secretion B. Insulin resistance and inflammation C. Autoantibodies targeting insulin receptors D. Genetic predisposition", + "answer": "B" + }, + { + "question": "Which of the following treatments is used for autoimmune insulin receptor disease?", + "options": "A. Metformin B. Surgical resection C. Immunosuppressants D. Somatostatin analogs", + "answer": "C" + }, + { + "question": "A patient with a pancreatic neuroendocrine tumor secreting excessive somatostatin is most likely to present with which of the following conditions as a consequence of somatostatin's inhibition of insulin and glucagon secretion?", + "options": "A. Hypoglycemia B. Steatorrhea C. Diabetes mellitus D. Hyperinsulinemia", + "answer": "C" + }, + { + "question": "Which of the following is a key difference between insulin resistance and autoimmune insulin receptor disease?", + "options": "A. Insulin resistance is multifactorial, while autoimmune insulin receptor disease stems from immune dysregulation B. Both conditions are caused by genetic predisposition C. Both conditions are treated with lifestyle modifications D. Insulin resistance is treated with immunosuppressants", + "answer": "A" + }, + { + "question": "A patient presents with obesity, hypertension, and elevated fasting glucose. What is the primary treatment approach for this patient with metabolic syndrome?", + "options": "A. High-dose statins B. Bariatric surgery C. Lifestyle interventions D. Continuous glucose monitoring", + "answer": "C" + }, + { + "question": "Which of the following is a symptom of autoimmune insulin receptor disease?", + "options": "A. Steatorrhea B. Hyperglycemia C. Gallstones D. Fasting hypoglycemia", + "answer": "D" + }, + { + "question": "In this rare condition, what is the primary functional pathological feature of islet cell hyperplasia?", + "options": "A. Excessive insulin secretion B. Pancreatic β-cell atrophy C. Elevated blood glucose levels D. Pancreatic ductal obstruction", + "answer": "A" + }, + { + "question": "A patient with recurrent hypoglycemia is found to have islet cell hyperplasia on biopsy. Which of the following is the most likely etiological factor?", + "options": "A. Type 1 diabetes mellitus B. Genetic mutations (e.g., MEN1 gene variants) C. Excessive glucagon production D. Autoimmune destruction of β-cells E. Chronic use of sulfonylureas", + "answer": "B" + }, + { + "question": "Which diagnostic method is essential for confirming islet cell hyperplasia?", + "options": "A. Blood glucose monitoring B. Histopathological examination C. MRI of the pancreas D. Serum glucagon levels", + "answer": "B" + }, + { + "question": "A patient presents with recurrent hypoglycemia due to islet cell hyperplasia. Which pharmacological treatment works by inhibiting insulin secretion in this condition?", + "options": "A. Diazoxide B. Octreotide C. Metformin D. Glyburide", + "answer": "A" + }, + { + "question": "A patient with untreated islet cell hyperplasia presents with recurrent episodes of confusion and seizures. Which of the following is the most likely underlying mechanism?", + "options": "A. Hyperglycemia B. Hypoglycemia C. Gastrointestinal obstruction D. Neurological sequelae", + "answer": "B" + }, + { + "question": "A patient presents with recurrent episodes of hypoglycemia. Imaging reveals a pancreatic mass. Which of the following features most reliably distinguishes islet cell hyperplasia from pancreatic cancer?", + "options": "A. Malignant cellular proliferation B. Benign hyperplastic islet cells C. Presence of insulin hypersecretion D. Association with MEN1 syndrome", + "answer": "B" + }, + { + "question": "A patient with islet cell hyperplasia exhibits excessive insulin secretion and pancreatic β-cell proliferation. Which cellular signaling pathway, when dysregulated, is most directly implicated in the pathogenesis of this condition?", + "options": "A. MAPK/ERK pathway B. PI3K/Akt/mTOR pathway C. JAK/STAT pathway D. Wnt/β-catenin pathway", + "answer": "B" + }, + { + "question": "A patient with persistent hypoglycemia due to focal lesions in islet cell hyperplasia is being evaluated for surgical management. Which of the following is the most appropriate surgical treatment option?", + "options": "A. Pancreatic transplantation B. Surgical resection C. Radiofrequency ablation D. Chemotherapy", + "answer": "B" + }, + { + "question": "A patient with a history of chronic pancreatitis presents with recurrent hypoglycemia. Which of the following is the most likely underlying cause of their islet cell hyperplasia?", + "options": "A. Type 2 diabetes mellitus B. Chronic pancreatitis C. Insulinoma D. Zollinger-Ellison syndrome", + "answer": "B" + }, + { + "question": "What is the primary genetic cause of Wilson's disease?", + "options": "A. Mutation in the *ATP7A* gene B. Mutation in the *ATP7B* gene C. Mutation in the *CFTR* gene D. Mutation in the *HFE* gene", + "answer": "B" + }, + { + "question": "Which organ is primarily affected by the toxic accumulation of copper in Wilson's disease?", + "options": "A. Heart B. Liver C. Lungs D. Pancreas", + "answer": "B" + }, + { + "question": "What is a characteristic ocular finding in Wilson's disease?", + "options": "A. Cataracts B. Kayser-Fleischer rings C. Retinal detachment D. Glaucoma", + "answer": "B" + }, + { + "question": "Which of the following is a hallmark neurological symptom of Wilson's disease?", + "options": "A. Dystonia B. Parkinsonism C. Optic neuritis D. Myasthenia gravis", + "answer": "B" + }, + { + "question": "What is the typical age range for the manifestation of Wilson's disease?", + "options": "A. 1-5 years B. 5-35 years C. 40-60 years D. 60-80 years", + "answer": "B" + }, + { + "question": "Which diagnostic test is used to measure copper excretion in Wilson's disease?", + "options": "A. Serum ceruloplasmin B. 24-hour urinary copper C. Liver biopsy D. Genetic testing", + "answer": "B" + }, + { + "question": "What is the primary treatment for Wilson's disease?", + "options": "A. Iron chelation therapy B. Copper chelation therapy C. Vitamin C supplementation D. High-copper diet", + "answer": "B" + }, + { + "question": "A patient presents with unexplained liver dysfunction and neurological symptoms. As part of your differential diagnosis, you consider Wilson's disease. Given the global prevalence of this condition, which of the following populations is most likely to benefit from routine screening?", + "options": "A. Neonates in intensive care units B. Siblings of affected individuals C. Adults over 50 years with hypertension D. Patients with type 2 diabetes mellitus", + "answer": "B" + }, + { + "question": "Which of the following is a potential complication of untreated Wilson's disease?", + "options": "A. Diabetes mellitus B. Acute liver failure C. Chronic kidney disease D. Pulmonary fibrosis", + "answer": "B" + }, + { + "question": "Wilson's disease is caused by autosomal recessive mutations in the *ATP7B* gene. If the carrier frequency of the *ATP7B* mutation is 1 in 90 in the general population, what is the probability that a sibling of an affected patient is a carrier?", + "options": "A. 1 in 30 B. 1 in 90 C. 1 in 180 D. 2 in 3", + "answer": "D" + }, + { + "question": "What is the primary cause of Alcoholic Fatty Liver?", + "options": "A. Viral infection B. Excessive alcohol consumption C. Genetic predisposition D. Autoimmune disorder", + "answer": "B" + }, + { + "question": "A male with a history of heavy alcohol use presents for evaluation. He reports feeling unwell but has no severe symptoms. Which of the following is the most common early symptom of Alcoholic Fatty Liver Disease?", + "options": "A. Mild jaundice B. Fatigue C. Right upper quadrant abdominal discomfort D. Hepatomegaly", + "answer": "B" + }, + { + "question": "What is the cornerstone of treatment for Alcoholic Fatty Liver?", + "options": "A. Antibiotic therapy B. Complete alcohol abstinence C. Surgical intervention D. Chemotherapy", + "answer": "B" + }, + { + "question": "Which condition is characterized by the triad of hemolytic anemia, hyperlipidemia, and jaundice?", + "options": "A. Alcoholic Fatty Liver B. Zieve Syndrome C. Non-alcoholic fatty liver disease (NAFLD) D. Cirrhosis", + "answer": "B" + }, + { + "question": "A male with a history of chronic alcohol use presents with abdominal pain, fatigue, and recent onset of yellowish discoloration of the skin. Laboratory studies reveal hemolytic anemia and hyperlipidemia. Which of the following is a key clinical feature of Zieve Syndrome?", + "options": "A. Hyperglycemia B. Jaundice C. Peripheral edema D. Hemoptysis", + "answer": "B" + }, + { + "question": "A male with a history of chronic alcohol use presents with jaundice, hemolytic anemia, and hyperlipidemia. Which of the following is the most appropriate treatment focus for this patient?", + "options": "A. Antiviral medication for hepatitis C B. Blood transfusions for severe anemia C. Lipid-lowering therapy for hyperlipidemia D. Corticosteroids for autoimmune hemolysis", + "answer": "B", + "rationale": "Blood transfusions are indicated for severe anemia in Zieve Syndrome to stabilize the patient while addressing the underlying alcohol-related liver damage." + }, + { + "question": "In patients with a history of alcohol abuse, how does the progression of Alcoholic Fatty Liver (characterized by fat accumulation in the liver due to chronic alcohol use) differ from that of Zieve Syndrome (a rare acute condition associated with hemolytic anemia, hyperlipidemia, and jaundice)?", + "options": "A. Alcoholic Fatty Liver progresses abruptly with acute symptoms, while Zieve Syndrome develops slowly over years B. Alcoholic Fatty Liver progresses slowly over years, while Zieve Syndrome presents abruptly with acute symptoms C. Both conditions develop gradually over years D. Both conditions present with sudden onset of symptoms", + "answer": "B" + }, + { + "question": "A male with a history of chronic alcohol use presents with jaundice, abdominal pain, and fatigue. Laboratory findings reveal hemolytic anemia and hyperlipidemia. Which of the following is NOT a typical feature of Zieve Syndrome?", + "options": "A. Hemolytic anemia B. Hyperlipidemia C. Jaundice D. Thrombocytopenia E. Hepatic encephalopathy", + "answer": "E" + }, + { + "question": "What is a critical intervention for both Alcoholic Fatty Liver and Zieve Syndrome?", + "options": "A. Alcohol cessation B. Anticoagulant therapy C. Immunosuppressive drugs D. Dialysis", + "answer": "A" + }, + { + "question": "What is the primary cause of alcoholic hepatitis?", + "options": "A. Viral infection B. Prolonged excessive alcohol consumption C. Metabolic syndrome D. Autoimmune disorder", + "answer": "B" + }, + { + "question": "A male with a history of heavy alcohol use presents with jaundice, ascites, and elevated liver enzymes. Genetic testing reveals HLA-B8/B40 variants. Which of the following best explains the role of these variants in his increased susceptibility to alcoholic hepatitis?", + "options": "A. Enhanced pro-inflammatory cytokine production via Th1 cell activation B. Impaired alcohol metabolism due to ADH1B polymorphism C. Defective bile acid transport from CFTR mutation D. Accelerated hepatic fibrosis mediated by APOE4 allele", + "answer": "A" + }, + { + "question": "Alcoholic hepatitis is a condition associated with chronic alcohol use. Which gender is more susceptible to developing alcoholic hepatitis?", + "options": "A. Men B. Women C. Both equally D. No gender difference", + "answer": "B" + }, + { + "question": "What is a common laboratory finding in patients with alcoholic hepatitis?", + "options": "A. AST:ALT ratio >2 B. Decreased bilirubin C. Normal INR D. Low serum creatinine", + "answer": "A" + }, + { + "question": "Which of the following is a key component of treatment for alcoholic hepatitis?", + "options": "A. Antiviral therapy B. Absolute alcohol cessation C. Insulin therapy D. Chemotherapy", + "answer": "B" + }, + { + "question": "In patients with severe alcoholic hepatitis (Maddrey Discriminant Function ≥32), what is the 90-day mortality rate?", + "options": "A. 15% B. 30% C. 45% D. 60%", + "answer": "C" + }, + { + "question": "Which of the following treatments may be required for severe cases of alcoholic hepatitis?", + "options": "A. Antiviral agents B. Corticosteroids C. Antibiotics D. Antifungal drugs", + "answer": "B" + }, + { + "question": "What is a common clinical manifestation of acute alcoholic hepatitis?", + "options": "A. Hypertension B. Nausea and abdominal pain C. Hyperglycemia D. Hypothyroidism", + "answer": "B" + }, + { + "question": "A male with a history of chronic alcohol use presents with jaundice and elevated liver enzymes. Which of the following nutritional deficiencies is most commonly associated with alcoholic hepatitis?", + "options": "A. Vitamin C B. Vitamin A C. Vitamin B1 (Thiamine) D. Vitamin D E. Vitamin K", + "answer": "C" + }, + { + "question": "A male with a history of heavy alcohol use presents with jaundice and hepatomegaly. Which of the following pathological features is most likely to be observed on liver biopsy?", + "options": "A. Viral hepatitis B. Non-alcoholic fatty liver disease (NAFLD) C. Mallory-Denk bodies with steatosis D. Iron overload consistent with hemochromatosis", + "answer": "C" + }, + { + "question": "What is the primary cause of alcoholic fibrosis and sclerosis of the liver?", + "options": "A. Viral infection B. Prolonged ethanol toxicity C. Autoimmune disease D. Genetic mutation", + "answer": "B" + }, + { + "question": "In advanced alcoholic cirrhosis of the liver, which of the following is a characteristic feature?", + "options": "A. Reversible fibrosis B. Progressive nodular regeneration and fibrosis C. Portal hypertension D. Steatosis without inflammation", + "answer": "B" + }, + { + "question": "What is the main treatment focus for alcoholic liver fibrosis?", + "options": "A. Liver transplantation B. Complete alcohol cessation C. Antibiotic therapy D. Surgical intervention", + "answer": "B" + }, + { + "question": "A male with a history of heavy alcohol use presents with fatigue, abdominal discomfort, and jaundice. Which of the following symptoms is most consistent with alcoholic fibrosis and sclerosis of the liver?", + "options": "A. Headache B. Fatigue C. Abdominal swelling D. Joint pain", + "answer": "B" + }, + { + "question": "What is the role of hepatic stellate cells in alcoholic liver disease?", + "options": "A. Detoxification of ethanol B. Activation leading to collagen accumulation C. Production of bile D. Regulation of blood sugar", + "answer": "B" + }, + { + "question": "A patient with severe alcoholic liver disease presents with hepatorenal syndrome and acute-on-chronic liver failure. Which of the following treatments is most appropriate for this condition?", + "options": "A. N-acetylcysteine B. Pentoxifylline C. Corticosteroids D. Antiviral therapy", + "answer": "B" + }, + { + "question": "In the context of alcoholic liver disease, what is the critical difference between fibrosis and sclerosis?", + "options": "A. Fibrosis is irreversible, while sclerosis is reversible B. Fibrosis is dynamic and potentially reversible, while sclerosis is irreversible C. Fibrosis involves extracellular matrix deposition, while sclerosis involves tissue hardening D. Fibrosis can occur in both early and advanced stages, while sclerosis is a late-stage complication", + "answer": "B" + }, + { + "question": "Which of the following complications is associated with alcoholic fibrosis and sclerosis of the liver?", + "options": "A. Hypoglycemia B. Portal hypertension C. Pulmonary embolism D. Renal failure", + "answer": "B" + }, + { + "question": "What is the primary goal of managing alcoholic liver fibrosis?", + "options": "A. Immediate liver transplantation B. Halting progression of fibrosis C. Treating viral infections D. Managing diabetes", + "answer": "B" + }, + { + "question": "Which of the following cytokines is implicated in the progression of alcoholic liver fibrosis?", + "options": "A. Interleukin-6 (IL-6) B. Transforming growth factor-beta (TGF-β) C. Tumor necrosis factor-alpha (TNF-α) D. Interferon-gamma (IFN-γ)", + "answer": "B" + }, + { + "question": "What is the primary cause of alcoholic cirrhosis of the liver?", + "options": "A. Viral infection B. Prolonged excessive alcohol consumption C. Autoimmune disease D. Genetic mutation", + "answer": "B" + }, + { + "question": "Which of the following is a common symptom of alcoholic cirrhosis of the liver?", + "options": "A. Hypertension B. Fatigue C. Hyperglycemia D. Hypothyroidism", + "answer": "B" + }, + { + "question": "What is the main treatment focus for alcoholic cirrhosis of the liver?", + "options": "A. Antiviral therapy B. Alcohol abstinence C. Chemotherapy D. Radiation therapy", + "answer": "B" + }, + { + "question": "What complication arises in alcoholic cirrhosis with esophageal varices?", + "options": "A. Pulmonary embolism B. Enlarged veins in the esophagus C. Kidney failure D. Myocardial infarction", + "answer": "B" + }, + { + "question": "Which of the following is a symptom of bleeding esophageal varices?", + "options": "A. Hematemesis B. Diarrhea C. Constipation D. Urinary retention", + "answer": "A" + }, + { + "question": "A male with alcoholic cirrhosis presents with hematemesis and hemodynamic instability. What is the immediate medical intervention for suspected bleeding esophageal varices?", + "options": "A. Endoscopic hemostasis B. Vasopressor therapy C. Transjugular intrahepatic portosystemic shunt (TIPS) D. Antibiotic therapy", + "answer": "A" + }, + { + "question": "Which treatment is used to reduce portal pressure in alcoholic cirrhosis with esophageal varices?", + "options": "A. Anticoagulants B. Beta-blockers C. Antidepressants D. Antihistamines", + "answer": "B" + }, + { + "question": "What is the primary anatomical distinction between alcoholic cirrhosis with esophageal varices and alcoholic cirrhosis with both esophageal and gastric varices, and why is this clinically significant?", + "options": "A. Presence of jaundice B. Location of varices C. Risk of variceal bleeding D. Severity of portal hypertension", + "answer": "B" + }, + { + "question": "A male with alcoholic cirrhosis presents with recurrent esophageal variceal bleeding despite initial endoscopic therapy. He has no contraindications to further interventions. What is the most appropriate long-term management strategy to prevent rebleeding?", + "options": "A. Repeated endoscopic variceal ligation B. Transjugular intrahepatic portosystemic shunt (TIPS) C. Non-selective beta-blocker therapy (e.g., propranolol) D. Surgical portocaval shunt E. Long-term antibiotic prophylaxis", + "answer": "B" + }, + { + "question": "Which of the following is a critical intervention for alcoholic cirrhosis with esophageal and gastric varices with bleeding?", + "options": "A. Urgent endoscopy B. Antiviral therapy C. Physical therapy D. Dietary changes", + "answer": "A" + }, + { + "question": "A male with a history of heavy alcohol consumption presents with jaundice, ascites, and elevated liver enzymes. Which of the following mechanisms primarily contributes to liver damage in his condition?", + "options": "A. Direct viral cytopathic effect B. Chronic ethanol toxicity leading to oxidative stress and inflammation C. Acute acetaminophen overdose causing glutathione depletion D. Autoimmune-mediated hepatocyte destruction E. Genetic mutation impairing bile acid transport", + "answer": "B" + }, + { + "question": "Which of the following is a common symptom of Alcoholic Liver Failure (ALF)?", + "options": "A. Hypertension B. Jaundice C. Hyperglycemia D. Hypokalemia", + "answer": "B" + }, + { + "question": "What is the cornerstone of therapy for all forms of Alcoholic Liver Failure (ALF)?", + "options": "A. Corticosteroids B. Alcohol cessation C. Liver transplantation D. Diuretics", + "answer": "B" + }, + { + "question": "A male presents with jaundice and abdominal pain after a weekend of heavy drinking. Which condition is most likely responsible for his symptoms?", + "options": "A. Alcoholic Hepatitis B. Acute Alcoholic Liver Failure (AALF) C. Alcoholic Cirrhosis D. Wernicke's Encephalopathy", + "answer": "B" + }, + { + "question": "What is a distinguishing feature of Acute Alcoholic Liver Failure (AALF) compared to Chronic Alcoholic Liver Failure (CALF)?", + "options": "A. Gradual symptom development B. Presence of cirrhosis C. Rapid progression without prior cirrhosis D. Long-term management with diuretics", + "answer": "C" + }, + { + "question": "A male with a history of chronic alcoholism presents with jaundice and ascites. Which of the following is a hallmark symptom of Chronic Alcoholic Liver Failure (CALF)?", + "options": "A. Hypoglycemia B. Portal hypertension C. Lactic acidosis D. Hypercalcemia", + "answer": "B" + }, + { + "question": "A male with a history of chronic alcohol use presents with jaundice, ascites, and progressive confusion progressing to stupor. Which of the following best describes the critical stage of Alcoholic Liver Failure (ALF) characterized by these findings of advanced encephalopathy?", + "options": "A. Acute Alcoholic Liver Failure (AALF) B. Chronic Alcoholic Liver Failure (CALF) C. Alcoholic Hepatic Failure with Hepatic Coma D. Alcoholic Hepatitis without Encephalopathy", + "answer": "C" + }, + { + "question": "Which of the following treatments is used for Alcoholic Hepatic Failure with Hepatic Coma?", + "options": "A. Corticosteroids B. Lactulose C. N-acetylcysteine D. Diuretics", + "answer": "B" + }, + { + "question": "Which of the following best distinguishes Acute Alcoholic Liver Failure (AALF) from Chronic Alcoholic Liver Failure (CALF) in terms of progression and underlying pathology?", + "options": "A. AALF involves acute inflammation without prior fibrosis B. CALF develops in the context of prior cirrhosis C. AALF progresses rapidly without prior cirrhosis D. CALF is caused by long-term chronic alcohol use", + "answer": "C" + }, + { + "question": "A male with a history of heavy alcohol use presents with jaundice, fever, and abdominal pain. Laboratory findings reveal elevated bilirubin and AST/ALT ratio >2. Imaging shows no biliary obstruction. Which of the following is a first-line treatment option for severe inflammation in Alcoholic Liver Failure (ALF) with acute alcoholic hepatitis?", + "options": "A. N-acetylcysteine B. Corticosteroids C. Pentoxifylline D. Albumin", + "answer": "B" + }, + { + "question": "What is the primary cause of Alcoholic Liver Disease (ALD)?", + "options": "A. Viral infection B. Chronic excessive alcohol consumption C. Autoimmune response D. Genetic mutation", + "answer": "B" + }, + { + "question": "Which of the following is a toxic byproduct generated during ethanol metabolism that contributes to ALD?", + "options": "A. Methanol B. Acetaldehyde C. Formaldehyde D. Ethylene glycol", + "answer": "B" + }, + { + "question": "What is a common symptom of advanced Alcoholic Liver Disease (ALD)?", + "options": "A. Headache B. Ascites C. Rash D. Cough", + "answer": "B" + }, + { + "question": "A male with a history of chronic alcohol use presents with jaundice and elevated liver enzymes. Which diagnostic method is most appropriate to confirm the diagnosis of Alcoholic Liver Disease (ALD)?", + "options": "A. Serum ferritin level B. Liver biopsy C. Abdominal ultrasound D. Serum ammonia level", + "answer": "B" + }, + { + "question": "What is the cornerstone of treatment for Alcoholic Liver Disease (ALD)?", + "options": "A. Antibiotics B. Alcohol abstinence C. Chemotherapy D. Radiation therapy", + "answer": "B" + }, + { + "question": "In the context of chronic liver disease progression, which of the following best distinguishes Alcoholic Liver Disease (ALD) from isolated alcoholic liver damage in terms of clinical management implications?", + "options": "A. ALD can be reversible with early abstinence and intervention B. Alcoholic liver damage consistently leads to portal hypertension C. ALD requires histologic confirmation of fibrosis/cirrhosis for diagnosis D. Alcoholic liver damage necessitates lifelong immunosuppressive therapy", + "answer": "C" + }, + { + "question": "Which of the following is the most appropriate initial management strategy for a patient with alcoholic liver damage who presents with jaundice and ascites?", + "options": "A. Immediate alcohol cessation B. Long-term corticosteroid use C. Liver transplantation D. Initiation of antiviral therapy", + "answer": "A" + }, + { + "question": "A male with a 20-year history of heavy alcohol use presents with jaundice, ascites, and fatigue. Laboratory tests reveal elevated liver enzymes and hypoalbuminemia. Which of the following is the most likely long-term consequence if his Alcoholic Liver Disease (ALD) remains untreated?", + "options": "A. Spontaneous resolution of symptoms B. Liver transplantation C. Development of hepatocellular carcinoma D. Stabilization of liver function with dietary changes", + "answer": "B" + }, + { + "question": "In the early stages of alcoholic liver damage, what is a common symptom?", + "options": "A. Hepatomegaly B. Transient elevation of liver enzymes C. Persistent jaundice D. Chronic fatigue", + "answer": "D" + }, + { + "question": "Which of the following is a treatment option for severe alcoholic hepatitis in ALD?", + "options": "A. Antiviral drugs B. Corticosteroids C. Antihistamines D. Antidepressants", + "answer": "B" + }, + { + "question": "What is the primary cause of Toxic liver disease with cholestasis?", + "options": "A. Genetic mutations B. Exposure to hepatotoxic substances C. Bacterial infection D. Viral hepatitis", + "answer": "B" + }, + { + "question": "What is the genetic basis of Progressive familial intrahepatic cholestasis (PFIC)?", + "options": "A. Mutations in bile transport genes B. Exposure to industrial chemicals C. Adverse drug reactions D. Viral infections", + "answer": "A" + }, + { + "question": "A patient presents with jaundice, pruritus, and elevated liver enzymes. Liver biopsy confirms toxic liver disease with cholestasis. Which treatment is specifically recommended for this condition?", + "options": "A. Corticosteroids B. Ursodeoxycholic acid C. Bile acid supplements D. Liver transplantation", + "answer": "B", + "rationale": "Ursodeoxycholic acid is specifically recommended due to its ability to improve bile flow and reduce cholestasis in toxic liver disease." + }, + { + "question": "What is a distinguishing feature of Progressive familial intrahepatic cholestasis (PFIC) compared to Toxic and Drug-induced cholestasis?", + "options": "A. It is acquired from environmental toxins B. It is caused by specific drugs C. It is a hereditary disorder D. It is associated with bacterial infection", + "answer": "C" + }, + { + "question": "A patient presents with Drug-induced hepatitis with cholestasis. Which of the following is the first-line management strategy?", + "options": "A. Discontinuation of the toxic agent B. Corticosteroids for immune-mediated cases C. Ursodeoxycholic acid D. Bile acid supplements", + "answer": "A" + }, + { + "question": "What is a common symptom shared by both Toxic liver disease with cholestasis and Drug-induced hepatitis with cholestasis?", + "options": "A. Jaundice B. Fever and rash C. Failure to thrive D. Liver fibrosis", + "answer": "A" + }, + { + "question": "Which of the following treatments directly addresses the underlying bile acid deficiency in early-stage Progressive familial intrahepatic cholestasis (PFIC)?", + "options": "A. Discontinuation of the toxic agent \nB. Corticosteroids \nC. Bile acid supplements \nD. Supportive care with ursodeoxycholic acid", + "answer": "C" + }, + { + "question": "A patient presents with jaundice, pruritus, and elevated liver enzymes after prolonged exposure to industrial solvents. Liver biopsy reveals cholestasis with hepatocellular injury. Which of the following findings would most strongly support a diagnosis of toxic liver disease with cholestasis over drug-induced hepatitis with cholestasis?", + "options": "A. Family history of autoimmune liver disease B. Detection of specific drug-metabolizing enzyme mutations C. Documented exposure to known hepatotoxic environmental toxins D. Presence of anti-mitochondrial antibodies", + "answer": "C" + }, + { + "question": "A patient with a history of prolonged exposure to industrial solvents presents with fatigue, pruritus, and jaundice. Liver biopsy confirms toxic liver disease with cholestasis. Which of the following is a chronic complication of this condition?", + "options": "A. Portal hypertension B. Hepatic encephalopathy C. Rash D. Fever", + "answer": "A" + }, + { + "question": "What is the primary cause of toxic liver disease with hepatic necrosis?", + "options": "A. Viral infection B. Exposure to hepatotoxic substances C. Autoimmune reaction D. Genetic mutation", + "answer": "B" + }, + { + "question": "Which of the following is a common symptom of drug-induced hepatitis with hepatic failure?", + "options": "A. Hypertension B. Dark urine C. Hyperglycemia D. Tachycardia", + "answer": "B" + }, + { + "question": "What is a key distinguishing feature of acute drug-induced liver failure compared to subacute forms?", + "options": "A. Gradual onset over months B. Rapid progression within days to weeks C. Mild symptoms D. No need for urgent intervention", + "answer": "B" + }, + { + "question": "Which treatment is specifically mentioned for toxic liver disease caused by acetaminophen?", + "options": "A. Corticosteroids B. N-acetylcysteine C. Activated charcoal D. Liver transplantation", + "answer": "B" + }, + { + "question": "Which of the following is a characteristic of subacute drug-induced liver failure, as opposed to acute liver failure?", + "options": "A. Gradual onset B. Severe encephalopathy C. Development over weeks to months D. Variable mortality over weeks to months", + "answer": "C" + }, + { + "question": "A patient presents with elevated liver enzymes after exposure to industrial solvents. What is a primary difference in the mechanism of liver injury between toxic liver disease and drug-induced hepatitis?", + "options": "A. Toxic liver disease can be immune-mediated in some cases B. Drug-induced hepatitis involves direct toxin-induced necrosis C. Toxic liver disease involves direct toxin-induced necrosis D. Drug-induced hepatitis is often dose-dependent", + "answer": "C" + }, + { + "question": "Which of the following is a potential complication of toxic liver failure?", + "options": "A. Hypoglycemia B. Cerebral edema C. Hyperkalemia D. Hypotension", + "answer": "B" + }, + { + "question": "A patient presents with acute liver failure secondary to acetaminophen overdose. What is the most appropriate initial treatment approach?", + "options": "A. Long-term medication B. Detoxification and specific antidotes C. No specific treatment D. Immediate liver transplantation", + "answer": "B" + }, + { + "question": "Which of the following is a key difference in treatment strategies between toxic liver disease (caused by environmental toxins) and drug-induced hepatitis (caused by medication-related liver injury, often involving immune-mediated mechanisms)?", + "options": "A. Use of antidotes for toxins B. Use of immunosuppressants for immune-mediated injury C. Use of corticosteroids for inflammation D. No specific treatment for either", + "answer": "B" + }, + { + "question": "A male with a history of heavy alcohol use presents with jaundice, fatigue, and markedly elevated AST/ALT (AST > ALT). What is the most likely etiology of his acute hepatitis?", + "options": "A. Hepatitis B virus infection B. Autoimmune hepatitis C. Alcohol-induced liver injury D. Drug-induced liver injury (e.g., acetaminophen) E. Wilson’s disease", + "answer": "C" + }, + { + "question": "Which of the following substances is NOT mentioned as a cause of toxic liver disease with acute hepatitis?", + "options": "A. Acetaminophen B. Carbon tetrachloride C. Amanita phalloides D. Hepatitis B virus", + "answer": "D" + }, + { + "question": "What is a common clinical manifestation of toxic liver disease with acute hepatitis?", + "options": "A. Fever B. Jaundice C. Rash D. Joint pain", + "answer": "B" + }, + { + "question": "Which of the following is a key diagnostic marker for toxic liver disease with acute hepatitis?", + "options": "A. Elevated white blood cell count B. Elevated liver enzymes (AST/ALT) C. Decreased serum creatinine D. Increased hemoglobin levels", + "answer": "B" + }, + { + "question": "What is the first step in the treatment of toxic liver disease with acute hepatitis?", + "options": "A. Administration of antibiotics B. Immediate cessation of toxin exposure C. Liver transplantation D. Use of antiviral medications", + "answer": "B" + }, + { + "question": "Which specific antidote is mentioned for the treatment of acetaminophen toxicity?", + "options": "A. Vitamin K B. N-acetylcysteine C. Activated charcoal D. Penicillin", + "answer": "B" + }, + { + "question": "What is a potential severe complication of toxic liver disease with acute hepatitis?", + "options": "A. Chronic kidney disease B. Acute liver failure C. Pulmonary embolism D. Myocardial infarction", + "answer": "B" + }, + { + "question": "How does toxic hepatitis differ from viral hepatitis in terms of their underlying causes (etiology)?", + "options": "A. Toxic hepatitis is caused by exposure to chemicals or drugs B. Toxic hepatitis lacks infectious etiology C. Viral hepatitis is caused by viral infections D. Viral hepatitis can be triggered by autoimmune processes", + "answer": "B" + }, + { + "question": "What is a critical factor in determining the prognosis of toxic liver disease with acute hepatitis?", + "options": "A. Patient's age B. Type of toxin and exposure duration C. Presence of fever D. Blood pressure levels", + "answer": "B" + }, + { + "question": "Which of the following is a potential treatment option for severe cases of toxic liver disease with acute hepatitis?", + "options": "A. Dialysis B. Liver transplantation C. Chemotherapy D. Radiation therapy", + "answer": "B" + }, + { + "question": "A factory worker with chronic persistent hepatitis presents with elevated liver enzymes. He reports frequent exposure to industrial solvents. What is the most likely cause of his toxic liver disease?", + "options": "A. Acute viral hepatitis B. Repeated exposure to hepatotoxic substances C. Autoimmune dysfunction D. Genetic mutations", + "answer": "B" + }, + { + "question": "A patient with a history of long-term acetaminophen use presents with suspected toxic liver disease and chronic persistent hepatitis. Which of the following is the most common symptom in this condition?", + "options": "A. Severe abdominal pain B. Fatigue C. Mild jaundice D. Loss of appetite", + "answer": "B" + }, + { + "question": "A patient with a history of chronic hepatitis presents with mild symptoms. Liver biopsy reveals persistent but non-progressive inflammation. What feature distinguishes this condition (chronic persistent hepatitis) from chronic active hepatitis?", + "options": "A. Presence of bridging fibrosis B. Extensive lobular necrosis C. Persistent but non-progressive inflammation D. Elevated viral load", + "answer": "C", + "explanation": "Chronic persistent hepatitis is characterized by mild, non-progressive inflammation without significant necrosis or fibrosis, unlike chronic active hepatitis, which features aggressive necrosis (option B) and bridging fibrosis (option A). The absence of disease progression is key to the diagnosis." + }, + { + "question": "A patient with a history of long-term acetaminophen use presents with fatigue and mild hepatomegaly. Liver biopsy reveals chronic persistent hepatitis due to toxic liver disease. Which laboratory finding is most likely to be observed in this patient?", + "options": "A. Decreased ALT/AST levels B. Elevated ALT/AST levels C. Normal bilirubin levels D. Elevated alkaline phosphatase levels", + "answer": "B" + }, + { + "question": "A patient with chronic persistent hepatitis due to long-term exposure to industrial toxins presents for management. Laboratory results show elevated liver enzymes but no evidence of viral infection. What is the primary focus of treatment?", + "options": "A. Antiviral therapy B. Toxin elimination C. Immunosuppressive therapy D. Nutritional support", + "answer": "B" + }, + { + "question": "A patient with a history of long-term acetaminophen use presents with fatigue, mild jaundice, and elevated liver enzymes consistent with toxic liver disease and chronic persistent hepatitis. Which of the following interventions is least likely to be effective in managing this condition?", + "options": "A. N-acetylcysteine B. Ursodeoxycholic acid C. Antiviral therapy D. Alcohol cessation E. High-dose vitamin C F. Regular exercise", + "answer": "C" + }, + { + "question": "A patient with chronic hepatitis due to toxic liver injury receives prompt cessation of the toxic agent and supportive care (early intervention). What is the most likely prognosis?", + "options": "A. Poor B. Moderate improvement C. Significant improvement D. Unpredictable", + "answer": "C" + }, + { + "question": "Which of the following substances is NOT typically associated with causing toxic liver disease?", + "options": "A. Alcohol B. Acetaminophen C. Environmental toxins D. Vitamin A", + "answer": "D" + }, + { + "question": "What is a key histopathological feature of toxic liver disease with chronic persistent hepatitis?", + "options": "A. Significant fibrosis B. Aggressive necrosis C. Persistent but non-progressive inflammation D. Viral inclusion bodies", + "answer": "C" + }, + { + "question": "Which of the following is a hepatoprotective agent that may be used adjunctively in toxic liver disease with chronic persistent hepatitis?", + "options": "A. N-acetylcysteine B. Ursodeoxycholic acid C. Interferon D. Ribavirin", + "answer": "B" + }, + { + "question": "What is the primary cause of toxic liver disease with chronic lobular hepatitis?", + "options": "A. Genetic mutations B. Prolonged exposure to hepatotoxic agents C. Autoimmune disorders D. Bacterial infections", + "answer": "B" + }, + { + "question": "A patient with a history of chronic alcohol use presents with symptoms of liver disease. Which of the following symptoms is NOT typically associated with toxic liver disease manifesting as chronic lobular hepatitis?", + "options": "A. Fatigue B. Jaundice C. Left lower quadrant pain D. Nausea and vomiting", + "answer": "C" + }, + { + "question": "A patient with a history of chronic alcohol use presents with fatigue and jaundice. What laboratory findings are most consistent with toxic liver disease and chronic lobular hepatitis?", + "options": "A. Elevated ALT and AST B. Elevated alkaline phosphatase C. Decreased albumin D. Prolonged prothrombin time", + "answer": "A" + }, + { + "question": "Which diagnostic method may be required to confirm toxic liver disease with chronic lobular hepatitis?", + "options": "A. Blood glucose test B. Liver biopsy C. Electrocardiogram D. Pulmonary function test", + "answer": "B" + }, + { + "question": "What is a key component of treatment for toxic liver disease with chronic lobular hepatitis?", + "options": "A. Antibiotic therapy B. Eliminating the causative agent C. Radiation therapy D. Surgical intervention", + "answer": "B" + }, + { + "question": "Which hepatoprotective medication is specifically mentioned for acetaminophen toxicity in toxic liver disease?", + "options": "A. Metformin B. N-acetylcysteine C. Ibuprofen D. Prednisone", + "answer": "B" + }, + { + "question": "What is a potential long-term complication of untreated toxic liver disease with chronic lobular hepatitis?", + "options": "A. Pulmonary fibrosis B. Cirrhosis C. Renal failure D. Osteoporosis", + "answer": "B" + }, + { + "question": "What is a critical factor in the prognosis of toxic liver disease with chronic lobular hepatitis?", + "options": "A. Age of the patient B. Early intervention and avoidance of re-exposure to toxins C. Presence of diabetes mellitus D. Family history of liver disease", + "answer": "B" + }, + { + "question": "A patient with a history of chronic alcohol use presents with elevated liver enzymes and suspected toxic liver disease. Which imaging technique is most appropriate for the initial assessment of chronic lobular hepatitis?", + "options": "A. X-ray B. Ultrasound C. CT scan D. MRI", + "answer": "B" + }, + { + "question": "What is a possible consequence of chronic toxic liver disease if left untreated?", + "options": "A. Portal hypertension B. Hypothyroidism C. Cardiomyopathy D. Peripheral neuropathy", + "answer": "A" + }, + { + "question": "A patient with a history of chronic active hepatitis presents with fatigue, jaundice, and elevated liver enzymes. Toxic liver disease is suspected. Given this rare disease presentation, what is the most likely primary cause?", + "options": "A. Viral infection B. Prolonged exposure to hepatotoxic agents C. Autoimmune response D. Genetic predisposition", + "answer": "B" + }, + { + "question": "Which of the following is a common symptom of chronic active hepatitis, a form of toxic liver disease?", + "options": "A. Jaundice B. Fatigue C. Abdominal pain D. Headache", + "answer": "B" + }, + { + "question": "What laboratory finding is typically elevated in toxic liver disease with chronic active hepatitis?", + "options": "A. Serum creatinine B. Liver enzymes (ALT, AST) C. Blood glucose D. Hemoglobin", + "answer": "B" + }, + { + "question": "Which of the following is a key management strategy for toxic liver disease with chronic active hepatitis?", + "options": "A. Antiviral therapy B. Eliminating the causative toxin C. High-fat diet D. Regular exercise", + "answer": "B" + }, + { + "question": "What is a potential complication of untreated toxic liver disease with chronic active hepatitis?", + "options": "A. Myocardial infarction B. Cirrhosis or liver failure C. Pulmonary embolism D. Stroke", + "answer": "B" + }, + { + "question": "In patients with cirrhosis, which of the following is NOT a typical sign of portal hypertension?", + "options": "A. Ascites B. Spider angiomas C. Hepatic encephalopathy D. Variceal bleeding", + "answer": "C" + }, + { + "question": "A patient with toxic liver disease secondary to chronic active hepatitis (a rare condition) presents for dietary counseling. Which dietary modification is most critical for this patient, and why?", + "options": "A. High-fat, low-protein diet (to reduce hepatic workload) B. Low-fat, high-protein diet (to support liver regeneration and minimize fat accumulation) C. High-carbohydrate, low-protein diet (to prioritize energy intake) D. Low-carbohydrate, high-fat diet (to promote ketosis)", + "answer": "B" + }, + { + "question": "Which of the following treatments is specifically mentioned for acetaminophen toxicity in this condition?", + "options": "A. Antibiotics B. N-acetylcysteine C. Antiviral therapy D. Corticosteroids", + "answer": "B" + }, + { + "question": "Although rare, toxic liver disease with chronic active hepatitis can lead to severe outcomes if untreated. What is the long-term prognosis of drug-induced toxic liver disease with chronic active hepatitis if untreated?", + "options": "A. Complete recovery B. Progression to cirrhosis or liver failure C. Development of autoimmune disease D. Development of hepatocellular carcinoma", + "answer": "B" + }, + { + "question": "Which of the following is NOT a mechanism involved in toxic liver disease with chronic active hepatitis?", + "options": "A. Direct cytotoxicity B. Immune-mediated injury C. Metabolic disturbances D. Viral replication", + "answer": "D" + }, + { + "question": "What is the primary cause of toxic liver disease with hepatitis?", + "options": "A. Viral infection B. Exposure to toxic substances C. Genetic predisposition D. Autoimmune reaction", + "answer": "B" + }, + { + "question": "Which of the following is a common symptom of toxic liver disease with hepatitis?", + "options": "A. Headache B. Jaundice C. Chest pain D. Shortness of breath", + "answer": "B" + }, + { + "question": "A patient presents with acute hepatitis due to toxic liver disease. What is the first step in treatment?", + "options": "A. Immediate cessation of the toxic agent B. Initiation of N-acetylcysteine therapy C. Liver transplantation D. Supportive care with hydration", + "answer": "A", + "explanation": "The most critical initial step in toxic liver disease is stopping exposure to the causative agent to prevent further liver injury. While N-acetylcysteine (B) and supportive care (D) may be part of management, they are secondary to eliminating the toxin. Liver transplantation (C) is reserved for irreversible liver failure." + }, + { + "question": "Which medication is specifically mentioned as a treatment for acetaminophen toxicity in toxic liver disease?", + "options": "A. Prednisone B. N-acetylcysteine C. Ibuprofen D. Metformin", + "answer": "B" + }, + { + "question": "A patient presents with elevated liver enzymes after starting a new medication. Which of the following best distinguishes drug-induced hepatitis from toxic liver disease?", + "options": "A. It is associated with systemic viral symptoms such as fever and fatigue B. It is specifically triggered by medications C. It involves genetic mutations in drug-metabolizing enzymes D. It is characterized by autoimmune markers like anti-nuclear antibodies", + "answer": "B" + }, + { + "question": "A patient on long-term acetaminophen therapy presents with fatigue, jaundice, and elevated liver enzymes. Which of the following is the most likely underlying mechanism of their condition?", + "options": "A. Direct hepatocyte necrosis due to toxic metabolite accumulation B. Autoimmune-mediated destruction of bile ducts C. Viral replication within hepatocytes D. Ischemic injury from hepatic artery occlusion", + "answer": "A" + }, + { + "question": "What is a key management strategy for drug-induced hepatitis?", + "options": "A. Immediate use of antivirals B. Discontinuation of the offending drug C. Administration of chemotherapy D. Surgical intervention", + "answer": "B" + }, + { + "question": "A patient with drug-induced hepatitis presents with signs of immune-mediated reactions. Which of the following therapies is most appropriate for managing these reactions?", + "options": "A. Antihistamines B. Corticosteroids C. Immunosuppressants D. Plasmapheresis", + "answer": "B" + }, + { + "question": "Drug-induced hepatitis, such as that caused by isoniazid, differs from toxic liver disease in what critical mechanism?", + "options": "A. It involves direct chemical toxicity without immune involvement B. It often involves immune-mediated mechanisms C. It is caused by bacterial infections D. It is always genetic", + "answer": "B" + }, + { + "question": "What is a potential severe outcome if toxic liver disease or drug-induced hepatitis is not treated early?", + "options": "A. Kidney failure B. Liver failure C. Heart attack D. Stroke", + "answer": "B" + }, + { + "question": "What is the primary cause of toxic liver disease with fibrosis and cirrhosis of the liver?", + "options": "A. Viral infections B. Prolonged exposure to hepatotoxic substances C. Genetic mutations D. Autoimmune disorders", + "answer": "B" + }, + { + "question": "Which of the following is a characteristic symptom of cirrhosis in toxic liver disease?", + "options": "A. Hypertension B. Jaundice C. Hyperglycemia D. Hypothyroidism", + "answer": "B" + }, + { + "question": "What is the main treatment focus for toxic liver disease with cirrhosis?", + "options": "A. Antiviral therapy B. Removal of the toxic agent C. Chemotherapy D. Radiation therapy", + "answer": "B" + }, + { + "question": "Drug-induced cirrhosis is a specific type of toxic liver disease caused by pharmacologic agents. Which of the following best distinguishes drug-induced cirrhosis from cirrhosis caused by non-drug-related environmental toxins?", + "options": "A. History of long-term medication use B. Evidence of drug-specific liver injury patterns C. Exposure to industrial chemicals D. Presence of steatosis on liver biopsy", + "answer": "B" + }, + { + "question": "What is a key management strategy for drug-induced cirrhosis?", + "options": "A. Initiating antiviral therapy B. Discontinuation of the offending drug C. Environmental toxin avoidance D. Surgical intervention", + "answer": "B" + }, + { + "question": "Which of the following is a common complication of cirrhosis in both toxic liver disease and drug-induced cirrhosis?", + "options": "A. Hyperthyroidism B. Coagulopathy C. Hypoglycemia D. Pulmonary fibrosis", + "answer": "B" + }, + { + "question": "A factory worker presents with cirrhosis. He has no history of medication use but reports long-term exposure to industrial chemicals. What is the key etiological factor distinguishing toxic liver disease with cirrhosis from drug-induced cirrhosis in this case?", + "options": "A. Medication-specific immune reactions B. Broader exposure to environmental/occupational toxins C. Short and predictable latency periods D. Isolated genetic polymorphisms", + "answer": "B" + }, + { + "question": "Which of the following is a potential treatment option for advanced cases of toxic liver disease with cirrhosis?", + "options": "A. Chemotherapy B. Liver transplantation C. Radiation therapy D. Antiviral therapy", + "answer": "B" + }, + { + "question": "What is a primary difference in the progression of drug-induced cirrhosis compared to acute toxic liver injury?", + "options": "A. Drug-induced cases may have identifiable latency periods B. Acute toxic liver injury progresses more rapidly C. Drug-induced cirrhosis typically has a longer latency period than toxic liver disease D. Acute toxic liver injury is often reversible if the offending agent is removed early", + "answer": "A" + }, + { + "question": "A male presents with jaundice and elevated liver enzymes after taking high doses of acetaminophen for a week. What is the most likely cause of his liver injury?", + "options": "A. Hepatitis B infection B. Exposure to acetaminophen C. Alpha-1 antitrypsin deficiency D. Primary biliary cholangitis", + "answer": "B" + }, + { + "question": "Which of the following is a typical symptom of toxic liver disease?", + "options": "A. Headache B. Jaundice C. Chest pain D. Shortness of breath", + "answer": "B" + }, + { + "question": "What is the first step in treating drug-induced liver injury (DILI)?", + "options": "A. Administering corticosteroids B. Discontinuing the offending drug C. Starting liver transplantation D. Providing hydration and nutrition", + "answer": "B" + }, + { + "question": "A patient presents with elevated liver enzymes and jaundice after starting a new medication for a bacterial infection. Which of the following antibiotics is most commonly associated with drug-induced liver injury (DILI)?", + "options": "A. Amoxicillin B. Ciprofloxacin C. Azithromycin D. Amoxicillin-clavulanate", + "answer": "D" + }, + { + "question": "What is a critical complication of toxic liver disease with esophageal varices?", + "options": "A. Kidney failure B. Variceal bleeding C. Pulmonary embolism D. Myocardial infarction", + "answer": "B" + }, + { + "question": "Which treatment is used to reduce the risk of variceal bleeding in toxic liver disease with esophageal varices?", + "options": "A. Antibiotics B. Beta-blockers C. Anticoagulants D. Diuretics", + "answer": "B" + }, + { + "question": "A patient with toxic liver disease presents with hematemesis and hemodynamic instability. What is the most appropriate emergency treatment for esophageal varices with bleeding?", + "options": "A. Endoscopic band ligation B. Liver transplantation C. Corticosteroids D. Octreotide infusion", + "answer": "A" + }, + { + "question": "A patient presents with elevated liver enzymes after starting a new medication. Which of the following features most strongly suggests drug-induced liver injury (DILI)?", + "options": "A. It is never dose-dependent B. It is associated with autoimmune markers C. It is specifically triggered by medications D. It is linked to genetic mutations", + "answer": "C" + }, + { + "question": "In a patient with cirrhosis due to toxic liver disease and a history of esophageal varices with bleeding, what is the most appropriate long-term management strategy?", + "options": "A. Regular exercise B. Addressing the underlying liver disease C. High-protein diet (unless contraindicated by hepatic encephalopathy) D. Vitamin supplements (unless deficiency is present)", + "answer": "B", + "explanation": "Addressing the underlying liver disease is crucial to prevent further complications, including recurrent variceal bleeding." + }, + { + "question": "A male with a history of chronic alcohol use presents with vomiting of bright red blood. Which of the following is the most characteristic symptom of toxic liver disease complicated by esophageal varices with bleeding?", + "options": "A. Hematemesis B. Melena C. Jaundice D. Abdominal distension", + "answer": "A" + }, + { + "question": "What is the primary distinguishing feature between Acute Hepatic Failure (AHF) and Subacute Hepatic Failure (SAHF)?", + "options": "A. Presence of encephalopathy B. Duration of onset (AHF <8 weeks, SAHF 8–26 weeks) C. Elevated INR levels D. Association with viral hepatitis", + "answer": "B" + }, + { + "question": "A woman presents with jaundice, coagulopathy, and encephalopathy. Which of the following is the most likely cause of her Acute Liver Failure (ALF)?", + "options": "A. Chronic alcohol use B. Drug toxicity (e.g., acetaminophen) C. Autoimmune hepatitis D. Viral hepatitis (e.g., hepatitis E)", + "answer": "B" + }, + { + "question": "A patient presents with prolonged jaundice and mild ascites. Which symptom is most consistently observed in Subacute Hepatic Failure (SAHF)?", + "options": "A. Gradual onset of fatigue B. Prolonged jaundice C. Cerebral edema D. Hypoglycemia", + "answer": "B" + }, + { + "question": "What is the primary management strategy for Acute Nonviral Hepatitis caused by drug toxicity?", + "options": "A. Liver transplantation B. Discontinuing the causative agent C. Immunosuppressants D. Albumin infusions", + "answer": "B" + }, + { + "question": "Late-Onset Hepatic Failure (LOHF) is a rare condition characterized by chronic liver dysfunction. Which of the following is a key feature of LOHF?", + "options": "A. Presence of autoimmune hepatitis markers B. Insidious development of ascites and encephalopathy C. High urgency for liver transplantation D. Association with chronic liver disease rather than acute viral hepatitis", + "answer": "B" + }, + { + "question": "What is the most urgent intervention for a patient with Acute Hepatic Failure (AHF) due to acetaminophen toxicity?", + "options": "A. Liver transplantation B. N-acetylcysteine C. Mannitol for cerebral edema D. Albumin infusions", + "answer": "B" + }, + { + "question": "Which of the following is a recognized cause of Subacute Hepatic Failure (SAHF)?", + "options": "A. Acetaminophen toxicity B. Autoimmune hepatitis C. Viral hepatitis D. Chronic alcohol use E. Drug-induced liver injury", + "answer": "C" + }, + { + "question": "What is the primary treatment for cerebral edema in patients with Acute Liver Failure (ALF)?", + "options": "A. N-acetylcysteine B. Mannitol C. Activated charcoal D. Albumin infusions", + "answer": "B" + }, + { + "question": "A patient presents with acute liver failure characterized by rapid clinical deterioration. Which of the following findings is most specific for Acute Yellow Atrophy of the Liver?", + "options": "A. Gradual onset of jaundice over weeks B. Marked reduction in liver size (shrinkage) on imaging C. Moderately prolonged INR (1.5-2.5) D. Transient mild confusion without coma", + "answer": "B" + }, + { + "question": "What is the primary cause of chronic liver failure in China and similar regions?", + "options": "A. Chronic alcohol abuse B. Hepatitis B and C viral infections C. Drug-induced toxicity D. Autoimmune diseases", + "answer": "B" + }, + { + "question": "Which of the following is a leading cause of chronic liver failure in Western countries?", + "options": "A. Hepatitis B and C viral infections B. Chronic alcohol abuse C. Parasitic infections D. Metabolic disorders", + "answer": "B" + }, + { + "question": "Which symptom is commonly associated with hepatic decompensation in chronic liver failure?", + "options": "A. Hypertension B. Jaundice C. Hyperglycemia D. Tachycardia", + "answer": "B" + }, + { + "question": "What is a common treatment approach for chronic liver failure caused by viral hepatitis?", + "options": "A. Alcohol cessation B. Antiviral therapy C. Immunosuppressants D. Diuretics", + "answer": "B" + }, + { + "question": "Which of the following is a supportive measure for managing ascites in chronic liver failure?", + "options": "A. Lactulose B. Diuretics C. Antiviral therapy D. Immunosuppressants", + "answer": "B" + }, + { + "question": "What is the only curative option for advanced stages of chronic liver failure?", + "options": "A. Nutritional management B. Liver transplantation C. Antiviral therapy D. Alcohol cessation", + "answer": "B" + }, + { + "question": "Which of the following is a symptom of hepatic encephalopathy in chronic liver failure?", + "options": "A. Easy bruising B. Fatigue C. Confusion D. Ascites", + "answer": "C" + }, + { + "question": "What is a common cause of chronic liver failure related to chronic environmental exposure to heavy metals? (Focus on rare diseases linked to environmental exposure)", + "options": "A. Hepatitis B B. Chronic exposure to heavy metals like lead or mercury C. Autoimmune diseases D. Metabolic disorders", + "answer": "B" + }, + { + "question": "A patient with chronic hepatitis B and cirrhosis presents with fatigue and mild jaundice. Which of the following interventions is most likely to slow the progression of liver failure?", + "options": "A. Delaying antiviral therapy in hepatitis B patients B. Early initiation of disease-modifying treatments C. Avoiding regular monitoring of liver function D. Limiting fluid intake in ascites patients", + "answer": "B" + }, + { + "question": "A male presents with jaundice, fatigue, and markedly elevated liver enzymes. Which of the following is the most common infectious cause of his acute liver failure?", + "options": "A. Viral hepatitis B. Acetaminophen overdose C. Autoimmune hepatitis D. Ischemic cholangiopathy", + "answer": "A" + }, + { + "question": "What is the primary treatment for hepatic encephalopathy?", + "options": "A. Insulin therapy B. Lactulose C. Antihypertensives D. Antidepressants", + "answer": "B" + }, + { + "question": "A patient with a history of chronic alcohol use presents with a shrunken liver on imaging. Which condition is most likely responsible for this finding?", + "options": "A. Hepatomegaly B. Hepatic encephalopathy C. Atrophy of the liver D. Cirrhosis", + "answer": "C" + }, + { + "question": "What is a key symptom of hepatic encephalopathy?", + "options": "A. Jaundice B. Confusion C. Hypertension D. Hyperglycemia", + "answer": "B" + }, + { + "question": "Which of the following is a potential treatment for liver necrosis caused by acetaminophen toxicity?", + "options": "A. Rifaximin B. N-acetylcysteine C. Lactulose D. Antivirals", + "answer": "B" + }, + { + "question": "A patient with a history of chronic alcohol use presents with fatigue, jaundice, and easy bruising. Which of the following findings is most consistent with liver failure?", + "options": "A. Hyperglycemia B. Coagulopathy C. Hypertension D. Osteoporosis", + "answer": "B" + }, + { + "question": "A patient with cirrhosis presents with confusion and asterixis. In this context of chronic liver disease, which condition is specifically driven by the accumulation of metabolic toxins such as ammonia?", + "options": "A. Atrophy of the liver B. Hepatic encephalopathy C. Liver failure D. Portal hypertension", + "answer": "B" + }, + { + "question": "A patient with chronic liver disease presents with signs of liver atrophy, including reduced liver size on imaging and worsening synthetic function. What is the primary management strategy in this case?", + "options": "A. Antiviral therapy B. Nutritional support C. Insulin therapy D. Liver transplantation E. Antioxidant therapy", + "answer": "B" + }, + { + "question": "Which of the following is a potential acute cause of liver necrosis?", + "options": "A. Severe acute malnutrition B. Ischemia C. Acetaminophen overdose D. Diabetes mellitus", + "answer": "B" + }, + { + "question": "A patient presents with jaundice and ascites. What is a key functional difference between liver failure and atrophy of the liver in this context?", + "options": "A. Liver failure involves structural shrinkage B. Atrophy of the liver involves localized dysfunction C. Liver failure encompasses global dysfunction D. Atrophy of the liver can be chronic or acute", + "answer": "C" + }, + { + "question": "What is the primary cause of chronic persistent hepatitis?", + "options": "A. Bacterial infections B. Hepatitis B or C viral infections C. Fungal infections D. Parasitic infections", + "answer": "B" + }, + { + "question": "Which of the following is a typical symptom of chronic persistent hepatitis?", + "options": "A. Severe abdominal pain B. Frequent headaches C. Fatigue D. Persistent fever", + "answer": "C" + }, + { + "question": "In the early stages of chronic persistent hepatitis, what does histopathology typically reveal?", + "options": "A. Significant fibrosis with architectural distortion B. Preserved liver architecture with minimal fibrosis C. Complete liver necrosis D. Extensive portal tract involvement", + "answer": "B" + }, + { + "question": "What is the main focus of treatment for chronic persistent hepatitis?", + "options": "A. Surgical intervention B. Addressing the underlying cause C. Radiation therapy D. Chemotherapy", + "answer": "B" + }, + { + "question": "A male with a history of recurrent hepatitis presents for follow-up. Liver biopsy reveals persistent inflammation confined to the liver lobules without significant fibrosis. Which of the following conditions best matches this histological description?", + "options": "A. Chronic persistent hepatitis B. Chronic lobular hepatitis (focal inflammation limited to lobules) C. Acute hepatitis D. Fulminant hepatitis", + "answer": "B" + }, + { + "question": "A patient with a history of chronic lobular hepatitis reports episodic yellowing of the skin and eyes. Which of the following symptoms is most consistent with this condition?", + "options": "A. Persistent fever B. Episodic jaundice C. Recurrent abdominal pain D. Fatigue and malaise", + "answer": "B" + }, + { + "question": "A patient presents with mild elevation of liver enzymes and no evidence of cirrhosis on imaging. Which of the following histological features is most characteristic of chronic lobular hepatitis in its early stages?", + "options": "A. Significant portal tract involvement B. Lobular necrosis and inflammatory infiltrates C. Minimal portal inflammation D. Preserved liver architecture", + "answer": "B" + }, + { + "question": "This question focuses on rare forms of chronic hepatitis. In terms of histopathology, how does chronic lobular hepatitis differ from chronic persistent hepatitis?", + "options": "A. Chronic lobular hepatitis shows diffuse portal inflammation B. Chronic persistent hepatitis maintains intact lobular architecture C. Chronic lobular hepatitis features focal lobular inflammation and necrosis D. Chronic persistent hepatitis involves minimal portal tract inflammation", + "answer": "C" + }, + { + "question": "A patient with a history of chronic persistent viral hepatitis and a 50-year-old patient with chronic lobular viral hepatitis both present for management. Which of the following therapeutic approaches is most likely to be effective for both conditions?", + "options": "A. Immunosuppressive therapy B. Antiviral therapy C. Lifestyle modifications (e.g., alcohol avoidance) D. Liver transplantation", + "answer": "B" + }, + { + "question": "A patient with persistent fatigue and elevated liver enzymes has been monitored for 5 months. Liver biopsy reveals ongoing inflammation. Based on the duration of symptoms and histologic findings, which of the following management steps is most appropriate to classify and address this condition?", + "options": "A. Reassure the patient and repeat testing in 3 months (acute hepatitis) B. Initiate antiviral therapy for chronic active hepatitis C. Perform an abdominal ultrasound to rule out biliary obstruction D. Discontinue alcohol consumption and reassess in 6 months (alcoholic hepatitis)", + "answer": "B" + }, + { + "question": "A patient presents with fatigue, jaundice, and elevated liver enzymes persisting for 8 months. Which of the following is LEAST likely to be the underlying cause of their chronic active hepatitis, a condition characterized by persistent liver inflammation lasting more than six months?", + "options": "A. Hepatitis B virus infection B. Autoimmune hepatitis C. Non-alcoholic fatty liver disease D. Chronic alcohol use", + "answer": "C" + }, + { + "question": "A patient with a history of chronic active hepatitis presents to the clinic. Which of the following clinical manifestations is most specifically associated with this condition?", + "options": "A. Fatigue B. Jaundice C. Abdominal discomfort D. Generalized pruritus", + "answer": "B" + }, + { + "question": "Which of the following is a severe long-term complication of untreated chronic active hepatitis that is most likely to result in portal hypertension?", + "options": "A. Kidney failure B. Cirrhosis C. Hepatocellular carcinoma D. Stroke", + "answer": "B" + }, + { + "question": "Which treatment is typically used for chronic active hepatitis caused by viral infections?", + "options": "A. Immunosuppressants B. Antiviral medications C. Antibiotics D. Pain relievers", + "answer": "B" + }, + { + "question": "What is the primary focus of managing chronic active hepatitis?", + "options": "A. Curing the disease completely B. Reducing inflammation and preventing further liver damage C. Immediate liver transplantation D. Treating only the symptoms", + "answer": "B" + }, + { + "question": "A patient presents with elevated liver enzymes for 6 months. Which of the following findings would most likely differentiate acute from chronic active viral hepatitis?", + "options": "A. Resolution of symptoms and liver enzyme normalization within 6 months suggests acute hepatitis, while persistence beyond 6 months suggests chronic hepatitis B. Chronic hepatitis resolves within months, while acute hepatitis requires long-term monitoring C. Acute hepatitis is most commonly caused by viral infections D. Chronic hepatitis can be caused by autoimmune disorders, among other factors", + "answer": "A" + }, + { + "question": "What lifestyle change is recommended for patients with toxin-related chronic active hepatitis?", + "options": "A. Increasing alcohol consumption B. Avoiding alcohol C. Reducing physical activity D. Increasing salt intake", + "answer": "B" + }, + { + "question": "What is the primary characteristic of chronic hepatitis, not elsewhere classified?", + "options": "A. Persistent liver inflammation lasting more than six months B. Specific classification as viral hepatitis C. Exclusive autoimmune origin D. Immediate progression to cirrhosis", + "answer": "A" + }, + { + "question": "Which of the following is a common symptom of chronic hepatitis, not elsewhere classified?", + "options": "A. Severe joint pain B. Fatigue and jaundice C. Persistent cough D. Frequent urination", + "answer": "B" + }, + { + "question": "A patient with chronic hepatitis due to long-term use of acetaminophen presents for management. What is the most appropriate initial treatment?", + "options": "A. Antibiotics B. Discontinuing acetaminophen and other hepatotoxic drugs C. Chemotherapy D. Radiation therapy E. Antiviral therapy F. Liver transplantation", + "answer": "B" + }, + { + "question": "A patient presents with chronic liver disease. Histopathological examination reveals inflammation primarily in the liver's connective tissue. What is the most likely diagnosis?", + "options": "A. It primarily affects hepatocytes in the early stages B. It is always caused by viral infections C. It targets the liver's connective tissue D. It is associated with autoimmune markers", + "answer": "C" + }, + { + "question": "A patient with a history of chronic interstitial hepatitis presents with which of the following symptoms?", + "options": "A. Severe abdominal pain B. Mild fatigue and vague abdominal discomfort C. Persistent high-grade fever D. Joint stiffness", + "answer": "B" + }, + { + "question": "A patient with a confirmed diagnosis of chronic interstitial hepatitis presents with persistent fatigue, elevated liver enzymes, and mild hepatomegaly despite conservative management. What is the most appropriate next step in treatment?", + "options": "A. Antiviral medications B. Immunosuppressive therapies C. Surgical liver resection D. Lifestyle modifications (diet and exercise)", + "answer": "B" + }, + { + "question": "What histological feature is characteristic of chronic interstitial hepatitis?", + "options": "A. Extensive hepatocellular necrosis B. Prominent fibrous tissue involvement C. Absence of inflammation D. Normal liver architecture", + "answer": "B" + }, + { + "question": "In a patient with chronic hepatitis, not elsewhere classified, who develops cirrhosis, what is the most likely long-term outcome?", + "options": "A. Complete recovery B. Liver transplantation may be necessary C. Spontaneous resolution D. Development of hepatic encephalopathy", + "answer": "B" + }, + { + "question": "A factory worker with a history of prolonged exposure to industrial chemicals presents with fatigue, mild hepatomegaly, and persistently elevated liver enzymes for over 6 months. Liver biopsy reveals chronic interstitial hepatitis. Which of the following is the most likely etiology of his condition?", + "options": "A. Viral hepatitis B B. Prolonged exposure to toxins C. Autoimmune hepatitis D. Wilson's disease", + "answer": "B" + }, + { + "question": "Which of the following is a common symptom of chronic hepatitis?", + "options": "A. Jaundice B. Fatigue C. Coagulopathy D. Hepatic encephalopathy", + "answer": "B" + }, + { + "question": "What is the main goal of treatment for chronic hepatitis?", + "options": "A. Managing life-threatening complications B. Viral suppression and fibrosis prevention C. Liver transplantation D. Supportive care", + "answer": "B" + }, + { + "question": "What is a critical symptom of chronic severe hepatitis that indicates liver dysfunction?", + "options": "A. Fatigue B. Abdominal discomfort C. Jaundice D. Hepatic encephalopathy", + "answer": "D" + }, + { + "question": "Which treatment is essential for chronic severe hepatitis if HBV is the underlying cause?", + "options": "A. Antiviral therapy B. Albumin infusion C. Lactulose D. Liver transplantation", + "answer": "A" + }, + { + "question": "In the context of liver disease, chronic severe hepatitis is characterized by liver decompensation, while chronic hepatitis may not be. What is a key clinical difference between these two conditions?", + "options": "A. Chronic hepatitis can be asymptomatic in some cases B. Chronic severe hepatitis is a manageable condition C. Chronic severe hepatitis denotes a critical, decompensated state D. Chronic hepatitis may require long-term management but not always urgent intervention", + "answer": "C" + }, + { + "question": "A patient with untreated chronic hepatitis B for 10 years presents with fatigue and mild abdominal discomfort. Which of the following is the most common long-term complication of this condition?", + "options": "A. Cirrhosis B. Coagulopathy C. Ascites D. Hepatic encephalopathy", + "answer": "A" + }, + { + "question": "A patient with chronic severe hepatitis has not received any treatment due to lack of access to healthcare. What is the most likely prognosis if this condition remains untreated?", + "options": "A. Excellent (full recovery likely) B. Good (mild long-term complications) C. Poor (severe complications or death likely) D. Unpredictable (outcome varies widely)", + "answer": "C" + }, + { + "question": "What is the primary characteristic of liver fibrosis?", + "options": "A. Excessive deposition of extracellular matrix proteins B. Increased production of red blood cells C. Rapid degradation of liver cells D. Accumulation of fat in the liver", + "answer": "A" + }, + { + "question": "Which cells are primarily responsible for the development of liver fibrosis?", + "options": "A. Hepatocytes B. Kupffer cells C. Hepatic stellate cells D. Endothelial cells", + "answer": "C" + }, + { + "question": "A patient with a history of chronic hepatitis B presents with elevated liver enzymes and signs of portal hypertension. What is the most likely underlying etiology of their liver fibrosis?", + "options": "A. Acute viral infections B. Chronic viral hepatitis C. Short-term alcohol use D. Non-alcoholic fatty liver disease (NAFLD)", + "answer": "B" + }, + { + "question": "A patient with chronic hepatitis C presents with signs of advanced liver fibrosis. Which of the following symptoms is most likely attributable to this condition?", + "options": "A. Jaundice B. Fatigue C. Abdominal distension D. Muscle cramps", + "answer": "B" + }, + { + "question": "What is a diagnostic tool used for liver fibrosis?", + "options": "A. Blood glucose test B. Transient elastography C. Chest X-ray D. Urine analysis", + "answer": "B" + }, + { + "question": "A patient with chronic hepatitis C presents with signs of liver fibrosis. What is the most appropriate treatment strategy to address the underlying cause?", + "options": "A. Increased alcohol consumption B. Antiviral therapy for hepatitis C C. High-dose corticosteroids D. Regular aerobic exercise E. Iron supplementation", + "answer": "B" + }, + { + "question": "Which cytokine is involved in the activation of hepatic stellate cells?", + "options": "A. Interleukin-6 B. Tumor necrosis factor-alpha C. Transforming growth factor-beta 1 D. Interferon-alpha", + "answer": "C" + }, + { + "question": "A patient with chronic hepatitis B presents with progressive liver fibrosis confirmed by biopsy. Based on current research, which of the following therapeutic strategies is most promising to halt disease progression?", + "options": "A. Inhibition of TGF-β signaling pathways B. Stimulation of hepatic stellate cell activation C. Inhibition of collagen degradation pathways D. Systemic corticosteroid administration", + "answer": "A" + }, + { + "question": "Which of the following is a potential outcome of early intervention in liver fibrosis?", + "options": "A. Progression to cirrhosis B. Reversal of fibrosis C. Development of cancer D. Permanent liver damage", + "answer": "B" + }, + { + "question": "What is the primary pathological feature of liver cirrhosis?", + "options": "A. Diffuse fibrosis B. Acute inflammation C. Hepatocyte necrosis D. Biliary obstruction", + "answer": "A" + }, + { + "question": "Which of the following is the leading cause of liver cirrhosis in Western countries?", + "options": "A. Chronic viral hepatitis B. Non-alcoholic fatty liver disease C. Chronic alcohol abuse D. Autoimmune disorders", + "answer": "C" + }, + { + "question": "A male with a history of chronic alcohol use presents with worsening abdominal distension, confusion, and scleral icterus. Which of the following is the most characteristic symptom of decompensated liver cirrhosis in this patient?", + "options": "A. Fatigue B. Jaundice C. Hepatic encephalopathy D. Asymptomatic findings", + "answer": "C" + }, + { + "question": "Which diagnostic test is commonly used to detect nodular liver in cirrhosis?", + "options": "A. Blood tests B. Liver biopsy C. Ultrasound/CT D. Endoscopy", + "answer": "C" + }, + { + "question": "What is a key treatment strategy for liver cirrhosis caused by chronic alcohol abuse?", + "options": "A. Antivirals B. Diuretics C. Abstinence D. Beta-blockers", + "answer": "C" + }, + { + "question": "Which of the following complications is most specific to decompensated liver cirrhosis?", + "options": "A. Hepatic encephalopathy B. Elevated bilirubin C. Low albumin D. Prolonged PT E. Hypertension", + "answer": "A" + }, + { + "question": "What is the prognosis of decompensated liver cirrhosis compared to compensated cases?", + "options": "A. Better prognosis B. Similar prognosis C. Worse prognosis D. Unpredictable prognosis", + "answer": "C" + }, + { + "question": "Which of the following is a primary cause of liver cirrhosis in Asia?", + "options": "A. Chronic alcohol abuse B. Non-alcoholic fatty liver disease C. Chronic viral hepatitis D. Autoimmune disorders", + "answer": "C" + }, + { + "question": "What is the irreversible architectural damage in liver cirrhosis primarily due to?", + "options": "A. Acute inflammation B. Persistent liver injury C. Biliary obstruction D. Hepatocyte necrosis", + "answer": "B" + }, + { + "question": "Which of the following is a common treatment for managing ascites in liver cirrhosis?", + "options": "A. Antivirals B. Diuretics C. Beta-blockers D. Liver transplantation", + "answer": "B" + }, + { + "question": "What is the primary pathological feature of liver fibrosis with cirrhosis?", + "options": "A. Excessive deposition of extracellular matrix (ECM) B. Destruction of hepatic lobules C. Formation of regenerative nodules D. Accumulation of fat in hepatocytes", + "answer": "A" + }, + { + "question": "Which of the following is NOT a primary cause of liver fibrosis with cirrhosis?", + "options": "A. Chronic viral hepatitis (HBV, HCV) B. Alcohol abuse C. Genetic conditions like hemochromatosis D. Acute bacterial infections", + "answer": "D" + }, + { + "question": "What is a key complication of advanced cirrhosis?", + "options": "A. Fatigue B. Abdominal discomfort C. Hepatic encephalopathy D. Jaundice", + "answer": "C" + }, + { + "question": "Which of the following treatments is specific for managing ascites in patients with cirrhosis?", + "options": "A. Antivirals for viral hepatitis B. Non-selective beta-blockers for variceal bleeding C. Diuretics for ascites D. Lactulose for hepatic encephalopathy", + "answer": "C" + }, + { + "question": "What distinguishes liver fibrosis from cirrhosis in terms of reversibility?", + "options": "A. Fibrosis is irreversible, while cirrhosis is reversible B. Fibrosis is reversible, while cirrhosis is irreversible C. Both fibrosis and cirrhosis are reversible D. Both fibrosis and cirrhosis are irreversible", + "answer": "B" + }, + { + "question": "Which of the following is a typical early-stage symptom of liver fibrosis with cirrhosis?", + "options": "A. Hepatic encephalopathy B. Hepatocellular carcinoma C. Fatigue D. Variceal bleeding", + "answer": "C" + }, + { + "question": "What is the primary treatment goal for early-stage liver fibrosis?", + "options": "A. Managing complications B. Etiology-specific interventions C. Liver transplantation D. Symptomatic relief", + "answer": "B" + }, + { + "question": "A patient with obesity and type 2 diabetes presents with elevated liver enzymes and evidence of liver fibrosis on imaging. Which of the following conditions is most likely contributing to the fibrosis due to underlying metabolic dysfunction?", + "options": "A. Non-alcoholic fatty liver disease (NAFLD)/Non-alcoholic steatohepatitis (NASH) B. Hereditary hemochromatosis C. Autoimmune hepatitis D. Chronic hepatitis B infection", + "answer": "A" + }, + { + "question": "What is the most critical intervention for survival in established cirrhosis?", + "options": "A. Antiviral therapy B. Alcohol cessation C. Liver transplantation D. Weight loss", + "answer": "C" + }, + { + "question": "What is the primary characteristic of Primary Biliary Cirrhosis (PBC)?", + "options": "A. Destruction of intrahepatic bile ducts B. Formation of esophageal varices C. Acute hematemesis D. Gram-negative bacterial infection", + "answer": "A" + }, + { + "question": "Which antibody is often associated with Primary Biliary Cirrhosis (PBC)?", + "options": "A. Antinuclear antibody (ANA) B. Antimitochondrial antibody (AMA) C. Anti-smooth muscle antibody (ASMA) D. Anti-liver-kidney microsomal antibody (LKM)", + "answer": "B" + }, + { + "question": "What is the first-line treatment for slowing disease progression in Primary Biliary Cirrhosis (PBC)?", + "options": "A. Propranolol B. Ursodeoxycholic acid (UDCA) C. Terlipressin D. Cholestyramine", + "answer": "B" + }, + { + "question": "Which symptom is indicative of advanced Primary Biliary Cirrhosis with esophageal varices?", + "options": "A. Fatigue B. Pruritus C. Hematemesis D. Jaundice", + "answer": "C" + }, + { + "question": "What is the primary cause of esophageal varices in Primary Biliary Cirrhosis?", + "options": "A. Cholestasis B. Portal hypertension C. Autoimmune bile duct injury D. Hypovolemia", + "answer": "B" + }, + { + "question": "A woman with Primary Biliary Cirrhosis is found to have large esophageal varices on endoscopy. Which intervention is most appropriate for the prophylactic prevention of esophageal variceal rupture in this patient?", + "options": "A. Ursodeoxycholic acid (UDCA) B. Endoscopic variceal ligation C. Non-selective beta-blockers (e.g., propranolol) D. Liver transplantation", + "answer": "B" + }, + { + "question": "A patient with Primary Biliary Cirrhosis presents with acute hematemesis, tachycardia, and hypotension. Esophagogastroduodenoscopy reveals actively bleeding esophageal varices. What is the most appropriate immediate intervention to control the hemorrhage?", + "options": "A. Octreotide infusion B. Endoscopic band ligation or sclerotherapy C. Balloon tamponade D. Ursodeoxycholic acid (UDCA) administration", + "answer": "B" + }, + { + "question": "Which drug is used as a vasoactive agent in the management of esophageal varices bleeding?", + "options": "A. Ursodeoxycholic acid (UDCA) B. Terlipressin C. Propranolol D. Cholestyramine", + "answer": "B" + }, + { + "question": "A woman with Primary Biliary Cirrhosis (PBC) presents with compensated cirrhosis and small esophageal varices on endoscopy. She is currently on ursodeoxycholic acid (UDCA) but is not yet a candidate for liver transplantation. What is the recommended long-term strategy to prevent esophageal varices bleeding in this patient?", + "options": "A. Ursodeoxycholic acid (UDCA) monotherapy B. Endoscopic variceal ligation and non-selective beta-blockers C. Antibiotic prophylaxis D. Vitamin K supplementation", + "answer": "B" + }, + { + "question": "Which condition represents a decompensated state of Primary Biliary Cirrhosis requiring urgent intervention?", + "options": "A. Primary Biliary Cirrhosis with esophageal varices B. Primary Biliary Cirrhosis with esophageal varices bleeding C. Uncomplicated Primary Biliary Cirrhosis D. Primary Biliary Cirrhosis with portal hypertension", + "answer": "B" + }, + { + "question": "What is the primary cause of secondary biliary cirrhosis?", + "options": "A. Autoimmune destruction of bile ducts B. Prolonged obstruction of extrahepatic bile ducts C. Viral hepatitis infection D. Excessive alcohol consumption", + "answer": "B" + }, + { + "question": "Which of the following is a common etiology of secondary biliary cirrhosis?", + "options": "A. Primary biliary cholangitis B. Gallstones C. Chronic hepatitis B infection D. Non-alcoholic fatty liver disease", + "answer": "B" + }, + { + "question": "In secondary biliary cirrhosis, bile pigment accumulation leads to which characteristic pathological feature? (Feathery degeneration refers to swollen, pale hepatocytes with a 'feathery' appearance due to retained bile.)", + "options": "A. Bridging fibrosis B. Feathery degeneration C. Mallory bodies D. Steatosis", + "answer": "B" + }, + { + "question": "A patient with a history of chronic bile duct obstruction presents with fatigue and gastrointestinal complaints. Which of the following clinical manifestations is most characteristic of secondary biliary cirrhosis during early disease progression?", + "options": "A. Abdominal pain B. Jaundice C. Pruritus D. Dark urine E. Weight loss", + "answer": "B" + }, + { + "question": "A patient with long-standing secondary biliary cirrhosis due to chronic bile duct obstruction presents with worsening fatigue and abdominal distension. Which of the following is most likely to represent a late-stage complication of this condition?", + "options": "A. Hepatic encephalopathy B. Variceal bleeding C. Hepatorenal syndrome D. Spontaneous bacterial peritonitis", + "answer": "B" + }, + { + "question": "Which diagnostic finding is typically elevated in secondary biliary cirrhosis?", + "options": "A. Alanine aminotransferase (ALT) B. Aspartate aminotransferase (AST) C. Alkaline phosphatase D. Gamma-glutamyl transferase (GGT)", + "answer": "C" + }, + { + "question": "What is the primary treatment goal for secondary biliary cirrhosis?", + "options": "A. Immunosuppressive therapy B. Relieving bile duct obstruction C. Antiviral therapy D. Lifestyle modifications", + "answer": "B" + }, + { + "question": "Which intervention is commonly used to relieve obstruction in secondary biliary cirrhosis?", + "options": "A. Liver transplantation B. Endoscopic retrograde cholangiopancreatography (ERCP) C. Antifibrotic therapy D. Corticosteroid treatment", + "answer": "B" + }, + { + "question": "A patient with a history of chronic bile duct obstruction presents with jaundice and pruritus. Which of the following best describes the primary cause of secondary biliary cirrhosis compared to primary biliary cholangitis?", + "options": "A. It is autoimmune in origin B. It is strictly obstructive in origin C. It primarily affects intrahepatic bile ducts D. It is associated with chronic bile duct obstruction", + "answer": "B" + }, + { + "question": "In patients with secondary biliary cirrhosis, which is characterized by bile duct obstruction leading to cholestasis and liver injury, what is the primary goal of early intervention?", + "options": "A. To improve bile flow and reduce cholestasis B. To avoid irreversible liver damage C. To prevent the progression to hepatocellular carcinoma D. To manage metabolic complications", + "answer": "B" + }, + { + "question": "What is the primary characteristic of biliary cirrhosis?", + "options": "A. Destruction of hepatocytes B. Progressive destruction of bile ducts C. Accumulation of fat in the liver D. Viral infection of liver cells", + "answer": "B" + }, + { + "question": "Which of the following is a typical symptom of biliary cirrhosis?", + "options": "A. Hypertension B. Pruritus C. Hyperglycemia D. Muscle weakness", + "answer": "B" + }, + { + "question": "What is the primary cause of Primary Biliary Cholangitis (PBC)?", + "options": "A. Viral infection B. Autoimmune attack on intrahepatic bile ducts C. Prolonged alcohol consumption D. Genetic mutation", + "answer": "B" + }, + { + "question": "Which diagnostic marker is elevated in biliary cirrhosis?", + "options": "A. Serum creatinine B. Alkaline phosphatase C. Hemoglobin D. Platelet count", + "answer": "B" + }, + { + "question": "What is the definitive therapy for end-stage biliary cirrhosis?", + "options": "A. Ursodeoxycholic acid (UDCA) B. Liver transplantation C. Cholestyramine D. Obeticholic acid", + "answer": "B" + }, + { + "question": "Which of the following treatments is used to slow the progression of biliary cirrhosis?", + "options": "A. Antibiotics B. Ursodeoxycholic acid (UDCA) C. Antiviral therapy D. Chemotherapy", + "answer": "B" + }, + { + "question": "What is a common complication of advanced biliary cirrhosis?", + "options": "A. Hypoglycemia B. Portal hypertension C. Renal failure D. Pulmonary embolism", + "answer": "B" + }, + { + "question": "Which antibody is associated with Primary Biliary Cholangitis (PBC)?", + "options": "A. Anti-nuclear antibody (ANA) B. Anti-mitochondrial antibody (AMA) C. Anti-smooth muscle antibody (ASMA) D. Anti-liver-kidney microsomal antibody (LKM)", + "answer": "B" + }, + { + "question": "What is the primary pathological feature that distinguishes biliary cirrhosis from other types of cirrhosis?", + "options": "A. It is primarily caused by autoimmune destruction of bile ducts B. It specifically targets bile duct integrity C. It is predominantly a result of chronic viral hepatitis D. It leads to rapid progression to hepatic encephalopathy E. It is associated with elevated serum iron levels", + "answer": "B" + }, + { + "question": "Which medication is used to manage pruritus in biliary cirrhosis?", + "options": "A. Ursodeoxycholic acid (UDCA) B. Cholestyramine C. Obeticholic acid D. Antibiotics", + "answer": "B" + }, + { + "question": "Which of the following is a primary cause of liver cirrhosis?", + "options": "A. Chronic alcohol abuse B. Hypertension C. Diabetes mellitus D. Hyperthyroidism", + "answer": "A" + }, + { + "question": "What is a distinctive laboratory marker of decompensated cirrhosis following hepatitis B?", + "options": "A. Elevated alpha-fetoprotein levels B. HBsAg positivity C. HBV DNA levels D. Alkaline phosphatase elevation", + "answer": "B" + }, + { + "question": "A patient with decompensated cirrhosis due to hepatitis C requires management addressing both liver dysfunction and the underlying viral infection. Which treatment is specifically targeted at the hepatitis C virus in this context?", + "options": "A. Nucleos(t)ide analogs B. Immunosuppressants C. Genotype-specific antiviral therapy D. Liver transplantation", + "answer": "C" + }, + { + "question": "A woman with a history of autoimmune hepatitis presents with ascites, hepatic encephalopathy, and jaundice. Which of the following laboratory findings is most characteristic of decompensated cirrhosis due to autoimmune hepatitis?", + "options": "A. Elevated serum ferritin B. Elevated IgG and autoantibodies C. Low ceruloplasmin levels D. Alkaline phosphatase elevation", + "answer": "B" + }, + { + "question": "A patient with a history of chronic hepatitis B and posthepatic cirrhosis presents with persistent itching. Which of the following is the most likely explanation for this symptom?", + "options": "A. Fatigue due to hepatic encephalopathy B. Pruritus from bile salt accumulation C. Coagulopathy from vitamin K deficiency D. Hepatorenal syndrome from advanced cirrhosis", + "answer": "B" + }, + { + "question": "What histological feature is characteristic of nodular cirrhosis?", + "options": "A. Fibrous bands surrounding regenerative nodules B. Elevated HBV DNA levels C. Presence of autoantibodies D. Alkaline phosphatase elevation", + "answer": "A" + }, + { + "question": "Which of the following is a key difference in therapy between viral and autoimmune hepatitis-induced cirrhosis?", + "options": "A. Antivirals for both B. Immunosuppressants for both C. Antivirals for viral and immunosuppressants for autoimmune D. Bile acid therapy for both", + "answer": "C" + }, + { + "question": "What is a common complication of decompensated cirrhosis following hepatitis B?", + "options": "A. Refractory ascites B. Pruritus C. Elevated alkaline phosphatase D. Presence of autoantibodies", + "answer": "A" + }, + { + "question": "A patient with early-stage posthepatic cirrhosis due to biliary obstruction presents with pruritus and steatorrhea. Which of the following is the most appropriate primary treatment to address the underlying pathophysiology?", + "options": "A. Nucleos(t)ide analogs (for viral hepatitis) B. Immunosuppressants (for autoimmune liver disease) C. Bile acid therapy (e.g., ursodeoxycholic acid) D. Genotype-specific antiviral therapy (for HCV)", + "answer": "C" + }, + { + "question": "A woman presents with jaundice, ascites, and hepatic encephalopathy, consistent with decompensated cirrhosis. What is the key initial diagnostic tool for confirming autoimmune hepatitis as the underlying etiology?", + "options": "A. Liver biopsy B. Autoantibodies (ANA, ASMA, or anti-LKM1) C. Serum immunoglobulin levels D. Abdominal ultrasound", + "answer": "B" + }, + { + "question": "Which of the following is a common symptom of portal cirrhosis?", + "options": "A. Joint pain B. Ascites C. Hyperbilirubinemia D. Extrahepatic autoimmune manifestations", + "answer": "B" + }, + { + "question": "A female with fatigue, pruritus, and elevated alkaline phosphatase (ALP) is diagnosed with autoimmune cirrhosis based on liver biopsy showing interface hepatitis and positive anti-mitochondrial antibodies (AMA). What is the mainstay treatment for her condition?", + "options": "A. Ursodeoxycholic acid B. Antivirals C. Immunosuppressants D. Liver transplantation", + "answer": "C" + }, + { + "question": "Which complication of cirrhosis requires emergency endoscopy?", + "options": "A. Non-bleeding esophageal varices B. Bleeding esophageal varices C. Splenomegaly D. Ascites", + "answer": "B" + }, + { + "question": "What is the primary treatment for non-bleeding esophageal varices in cirrhosis?", + "options": "A. Immunosuppressants B. Prophylactic beta-blockers C. TIPS D. Antivirals", + "answer": "B" + }, + { + "question": "Which type of cirrhosis is diagnosed when no clear cause is identified?", + "options": "A. Portal cirrhosis B. Mixed cirrhosis C. Cryptogenic cirrhosis D. Autoimmune cirrhosis", + "answer": "C" + }, + { + "question": "Which treatment is specifically used for bleeding gastric varices in cirrhosis?", + "options": "A. Beta-blockers B. Glue injection C. Immunosuppressants D. Antivirals", + "answer": "B" + }, + { + "question": "What is the primary goal of treatment in cirrhosis with non-bleeding esophageal and gastric varices?", + "options": "A. Emergency intervention B. Symptom relief C. Prevention of rupture D. Management of autoimmune dysfunction", + "answer": "C" + }, + { + "question": "A woman presents with fatigue and elevated liver enzymes. Autoimmune cirrhosis is suspected. Which of the following is the most likely underlying mechanism that distinguishes it from other types of cirrhosis?", + "options": "A. Viral hepatitis B. Immune dysfunction C. Cryptogenic factors D. Alcohol-induced liver damage", + "answer": "B" + }, + { + "question": "What is the primary cause of a liver abscess?", + "options": "A. Viral infection B. Bacterial, parasitic, or fungal infections C. Autoimmune disease D. Trauma to the liver", + "answer": "B" + }, + { + "question": "Which of the following is a typical symptom of a liver abscess?", + "options": "A. Left lower quadrant pain B. Fever, right upper quadrant pain, nausea, and weight loss C. Chest pain and shortness of breath D. Headache and dizziness", + "answer": "B" + }, + { + "question": "A male with a history of diabetes mellitus presents with fever, right upper quadrant pain, and leukocytosis. Imaging reveals a 5 cm liver abscess. What is the most appropriate initial treatment?", + "options": "A. Antiviral medications (for viral hepatitis) B. Antibiotics and percutaneous drainage C. Antifungal therapy (for suspected fungal infection) D. Observation alone (for small, asymptomatic abscesses)", + "answer": "B" + }, + { + "question": "A male with a history of gallstones presents with fever, jaundice, and right upper quadrant pain. Imaging reveals a liver abscess. What is the most likely specific cause of this biliary liver abscess?", + "options": "A. Systemic infection spread via the bloodstream (unlikely without a primary source) B. Biliary tract infection secondary to obstruction or cholangitis C. Parasitic infection (rare in non-endemic areas) D. Fungal infection (typically seen in immunocompromised patients)", + "answer": "B" + }, + { + "question": "Which pathogen is commonly associated with hematogenous liver abscess in Asia?", + "options": "A. Escherichia coli B. Streptococcus spp. C. Klebsiella pneumoniae D. Staphylococcus aureus", + "answer": "C" + }, + { + "question": "What is a key difference between biliary liver abscess and hematogenous liver abscess?", + "options": "A. Biliary liver abscess lacks biliary symptoms B. Hematogenous liver abscess stems from biliary pathology C. Biliary liver abscess results from distant infections D. Hematogenous liver abscess results from systemic infection spread via the bloodstream", + "answer": "D" + }, + { + "question": "What is critical for the treatment of large liver abscesses (>5 cm)?", + "options": "A. Antibiotics alone B. Drainage C. Chemotherapy D. Radiation therapy", + "answer": "B" + }, + { + "question": "Which of the following is a common symptom of biliary liver abscess?", + "options": "A. Sepsis B. Jaundice and fever C. Nausea and vomiting D. Right upper quadrant pain", + "answer": "B" + }, + { + "question": "A male with poorly controlled diabetes mellitus presents with fever, right upper quadrant pain, and elevated inflammatory markers. Imaging reveals a solitary liver abscess. Which of the following pathogens is most commonly implicated in this clinical scenario?", + "options": "A. Klebsiella pneumoniae B. Escherichia coli C. Streptococcus spp. D. Staphylococcus aureus", + "answer": "A" + }, + { + "question": "A patient with a history of recent abdominal surgery presents with fever, abdominal pain, and imaging findings consistent with portal vein phlebitis. Portal vein phlebitis is a rare condition often associated with intra-abdominal infections or surgical complications. What is the most likely primary cause of this condition?", + "options": "A. Viral infection B. Bacterial infection C. Fungal infection D. Parasitic infection E. Thrombosis", + "answer": "B" + }, + { + "question": "A patient with a history of portal vein phlebitis presents with fever and right upper quadrant pain. Which of the following is the most likely complication?", + "options": "A. Portal hypertension B. Liver abscesses C. Splenic vein thrombosis D. Ascites", + "answer": "B" + }, + { + "question": "A patient presents with fever, abdominal pain, and elevated inflammatory markers. Which diagnostic tool is most commonly used to identify portal vein phlebitis?", + "options": "A. Doppler ultrasound B. Contrast-enhanced CT/MRI C. Liver function tests D. Abdominal X-ray", + "answer": "B" + }, + { + "question": "What is the mainstay of treatment for portal vein phlebitis?", + "options": "A. Antiviral therapy B. Broad-spectrum antibiotics C. Antifungal therapy D. Antiparasitic therapy", + "answer": "B" + }, + { + "question": "A patient with a history of abdominal surgery presents with fever, abdominal pain, and signs of sepsis. Imaging reveals portal vein phlebitis, a rare but serious complication that can lead to life-threatening sepsis if not promptly treated. Which of the following bacteria is most commonly associated with this condition?", + "options": "A. Streptococcus pneumoniae B. Escherichia coli C. Mycobacterium tuberculosis D. Helicobacter pylori", + "answer": "B" + }, + { + "question": "In patients with portal vein phlebitis, what additional treatment is often combined with antibiotics to prevent thrombotic complications?", + "options": "A. Chemotherapy B. Anticoagulation C. Radiation therapy D. Immunotherapy E. Antiplatelet therapy F. Thrombolysis", + "answer": "B" + }, + { + "question": "A patient with a history of recurrent abdominal infections presents with fever and abdominal pain. Imaging reveals portal vein phlebitis, an inflammation of the portal vein typically associated with intra-abdominal infections. Which of the following conditions is least likely to be associated with this finding?", + "options": "A. Appendicitis B. Diverticulitis C. Liver abscesses D. Pneumonia", + "answer": "D" + }, + { + "question": "Why is early recognition of portal vein phlebitis critical?", + "options": "A. To prevent viral spread B. To avoid surgical intervention C. To reduce the risk of life-threatening complications D. To minimize antibiotic use", + "answer": "C" + }, + { + "question": "A patient with a history of abdominal surgery presents with fever, abdominal pain, and jaundice. Imaging reveals thrombosis in the portal vein. What distinguishes portal vein phlebitis (pylephlebitis), a rare but serious condition, from superficial thrombophlebitis in this case?", + "options": "A. Its association with bacterial infections B. Its systemic infectious nature C. Its presentation with localized erythema D. Its lack of systemic symptoms", + "answer": "B" + }, + { + "question": "What is the primary characteristic of nonspecific reactive hepatitis?", + "options": "A. Primary liver pathology B. Inflammatory changes due to systemic triggers C. Chronic liver damage D. Presence of specific autoantibodies", + "answer": "B" + }, + { + "question": "A patient presents with mild transaminitis (ALT 120 U/L, AST 98 U/L) and nonspecific fatigue. Liver biopsy reveals nonspecific reactive hepatitis. Which of the following is the most common underlying cause of this condition?", + "options": "A. Autoimmune disorders B. Viral hepatitis C. Systemic bacterial infections D. Chronic alcohol use", + "answer": "B" + }, + { + "question": "Which of the following are the most typical symptoms of nonspecific reactive hepatitis?", + "options": "A. Mild jaundice and nausea B. Fatigue and right upper quadrant discomfort C. Abdominal distension and mild edema D. Intermittent fever and muscle aches", + "answer": "B" + }, + { + "question": "A patient presents with fatigue and mild jaundice. Laboratory tests are ordered to evaluate possible liver disease. Which of the following findings would most strongly suggest nonspecific reactive hepatitis?", + "options": "A. Elevated ALT and AST B. Elevated alkaline phosphatase C. Elevated bilirubin D. Elevated gamma-glutamyl transferase (GGT)", + "answer": "A" + }, + { + "question": "A woman presents with fatigue and mild transaminitis. Liver biopsy shows nonspecific reactive hepatitis. Which of the following laboratory findings would most reliably distinguish this condition from autoimmune hepatitis?", + "options": "A. Presence of anti-nuclear antibodies (ANA) or anti-smooth muscle antibodies (ASMA) \nB. Elevated serum IgG levels (hypergammaglobulinemia) \nC. Mildly elevated ALT/AST without autoantibodies \nD. Histologic findings of interface hepatitis on biopsy", + "answer": "B" + }, + { + "question": "What is the primary focus of treatment for nonspecific reactive hepatitis?", + "options": "A. Liver transplantation B. Addressing the underlying cause C. Long-term antiviral therapy D. Immediate surgical intervention", + "answer": "B" + }, + { + "question": "Nonspecific reactive hepatitis is a rare condition characterized by mild hepatic inflammation without a specific etiology. Which of the following factors contributes to the generally favorable prognosis of nonspecific reactive hepatitis when treated promptly with supportive care?", + "options": "A. Poor with chronic sequelae B. Generally favorable due to reversible histologic changes C. Requires lifelong monitoring D. High risk of progression to liver failure", + "answer": "B" + }, + { + "question": "A patient with elevated liver enzymes undergoes a liver biopsy. The histopathology report describes nonspecific reactive hepatitis. Which of the following histological features is NOT typically observed in this condition?", + "options": "A. Portal inflammation B. Lobular inflammation C. Viral inclusion bodies D. Presence of granulomas", + "answer": "C" + }, + { + "question": "A patient presents with fatigue and mildly elevated liver enzymes. Liver biopsy shows nonspecific reactive hepatitis. Which feature most distinguishes this condition from viral hepatitis?", + "options": "A. Presence of chronic liver damage B. Resolution without chronic sequelae C. Histological evidence of viral inclusion bodies D. Requires antiviral therapy", + "answer": "B" + }, + { + "question": "What is the hallmark histological feature of granulomatous hepatitis?", + "options": "A. Fibrosis B. Granulomas C. Necrosis D. Steatosis", + "answer": "B" + }, + { + "question": "A patient presents with fever, hepatomegaly, and elevated liver enzymes. Which of the following is least likely to explain these findings?", + "options": "A. Tuberculosis B. Viral hepatitis C. Sarcoidosis D. Drug reactions E. Primary biliary cholangitis", + "answer": "B" + }, + { + "question": "What is the primary diagnostic method for confirming granulomatous hepatitis?", + "options": "A. Blood tests B. Liver biopsy C. Imaging studies D. Urine analysis", + "answer": "B" + }, + { + "question": "Granulomatous hepatitis is a rare condition characterized by hepatic inflammation with granuloma formation. Which of the following symptoms is least likely to be associated with granulomatous hepatitis?", + "options": "A. Fatigue B. Jaundice C. Chest pain D. Right upper quadrant pain", + "answer": "C" + }, + { + "question": "What is the main focus of treatment for granulomatous hepatitis?", + "options": "A. Symptom management B. Addressing the underlying cause C. Liver transplantation D. Antiviral therapy", + "answer": "B" + }, + { + "question": "A woman presents with fatigue, hepatomegaly, and elevated liver enzymes. Liver biopsy reveals granulomatous hepatitis. Which of the following is the most likely autoimmune cause of her condition?", + "options": "A. Tuberculosis B. Brucellosis C. Sarcoidosis D. Fungal infection E. Primary biliary cholangitis", + "answer": "C" + }, + { + "question": "A woman with a history of sarcoidosis presents with fatigue and elevated liver enzymes. Which of the following imaging findings is most consistent with granulomatous hepatitis?", + "options": "A. Liver cysts B. Hepatomegaly C. Periportal fibrosis D. Hepatic abscesses", + "answer": "B" + }, + { + "question": "In a patient with autoimmune granulomatous hepatitis, what is the primary role of immunosuppressants?", + "options": "A. Treat infections B. Manage autoimmune triggers C. Directly reduce liver inflammation D. Prevent fibrosis", + "answer": "B" + }, + { + "question": "What is the primary cause of Autoimmune Hepatitis (AIH)?", + "options": "A. Viral infection B. Immune system attacking hepatocytes C. Bacterial infection D. Genetic mutation", + "answer": "B" + }, + { + "question": "A female presents with fatigue, joint pain, and elevated liver enzymes. Autoimmune Hepatitis (AIH) is a rare chronic liver disease. Which of the following symptoms is most commonly associated with AIH?", + "options": "A. Joint pain B. Fatigue C. Jaundice D. Headache", + "answer": "B" + }, + { + "question": "What is the main diagnostic tool for confirming Autoimmune Hepatitis (AIH)?", + "options": "A. Blood culture B. Liver biopsy C. Urine analysis D. Chest X-ray", + "answer": "B" + }, + { + "question": "Which of the following treatments is commonly used for Autoimmune Hepatitis (AIH)?", + "options": "A. Antiviral drugs B. Immunosuppressants C. Antibiotics D. Antifungal drugs", + "answer": "B" + }, + { + "question": "A female with a known history of systemic lupus erythematosus (SLE) presents with fatigue, jaundice, and elevated liver enzymes (AST 250 U/L, ALT 300 U/L). Which of the following features most reliably distinguishes Lupus Hepatitis from Autoimmune Hepatitis (AIH) in this patient?", + "options": "A. Presence of anti-smooth muscle antibodies (ASMA) B. Association with systemic lupus erythematosus (SLE) C. Rapid normalization of liver enzymes with corticosteroids D. Detection of hepatitis B surface antigen (HBsAg)", + "answer": "B" + }, + { + "question": "A female with systemic lupus erythematosus presents with elevated liver enzymes and biopsy findings consistent with Lupus Hepatitis. Which of the following is the most appropriate initial treatment?", + "options": "A. Hydroxychloroquine B. Corticosteroids C. Methotrexate D. Ursodeoxycholic acid", + "answer": "B" + }, + { + "question": "What is a key histological feature of Autoimmune Hepatitis (AIH)?", + "options": "A. Vascular changes B. Interface hepatitis C. Nonspecific changes D. Fibrosis", + "answer": "B" + }, + { + "question": "Which of the following is a potential complication of untreated Autoimmune Hepatitis (AIH)?", + "options": "A. Diabetes B. Cirrhosis C. Hypertension D. Osteoporosis", + "answer": "B" + }, + { + "question": "Which of the following symptoms is commonly seen in both Lupus Hepatitis and systemic lupus erythematosus (SLE) due to shared autoimmune pathophysiology?", + "options": "A. Jaundice B. Joint pain C. Abdominal discomfort D. Fatigue", + "answer": "B" + }, + { + "question": "Which of the following best distinguishes the underlying pathology of Autoimmune Hepatitis (AIH) from Lupus Hepatitis?", + "options": "A. AIH is associated with anti-smooth muscle antibodies B. Lupus Hepatitis is a manifestation of SLE C. AIH has a liver-specific pathology D. Lupus Hepatitis requires aggressive immunosuppression", + "answer": "C" + }, + { + "question": "A patient presents with fever, right upper quadrant pain, and an inflammatory mass adjacent to the liver on imaging. Which of the following is the most likely primary cause of this finding?", + "options": "A. Systemic viral hepatitis B. Abscess due to bacterial infection C. Chronic alcohol-induced inflammation D. Fatty infiltration from metabolic syndrome", + "answer": "B" + }, + { + "question": "In a patient with suspected nutritional hepatitis, which of the following is a key symptom that directly reflects the underlying hepatocellular injury?", + "options": "A. Pruritus B. Hepatomegaly C. Joint pain D. Biliary strictures", + "answer": "B" + }, + { + "question": "A patient presents with jaundice, pruritus, and elevated liver enzymes. Liver biopsy confirms cholestatic hepatitis. What is the most appropriate initial treatment?", + "options": "A. Corticosteroids B. Ursodeoxycholic acid C. Antiviral therapy D. Cholestyramine", + "answer": "B" + }, + { + "question": "Which condition is characterized by inflammation of both bile ducts and liver parenchyma?", + "options": "A. Nutritional hepatitis B. Cholestatic hepatitis C. Cholangiohepatitis D. Non-alcoholic steatohepatitis", + "answer": "C" + }, + { + "question": "What is the primary driver of non-alcoholic steatohepatitis (NASH)?", + "options": "A. Protein deficiency B. Biliary pathology C. Metabolic syndrome D. Post-infectious etiology", + "answer": "C" + }, + { + "question": "A patient presents with abdominal pain and a liver mass on imaging. Which diagnostic method confirms an inflammatory pseudotumor of the liver?", + "options": "A. Serum markers B. Imaging C. Biopsy D. Endoscopic ultrasound", + "answer": "C" + }, + { + "question": "A female presents with fatigue, pruritus, and elevated liver enzymes. Liver biopsy confirms autoimmune cholangiohepatitis. Which treatment is most specific for this condition?", + "options": "A. Ursodeoxycholic acid B. Biliary drainage C. Immunosuppression D. Antiviral therapy", + "answer": "C" + }, + { + "question": "A patient with cholangiohepatitis undergoes magnetic resonance cholangiopancreatography (MRCP). Which of the following findings would most likely support the diagnosis?", + "options": "A. Hepatomegaly B. Biliary strictures C. Dilated bile ducts D. Periductal fibrosis", + "answer": "B" + }, + { + "question": "A patient undergoes abdominal imaging for unexplained weight loss, revealing a solitary liver mass with features suspicious for malignancy. Which of the following benign lesions is most likely to mimic hepatocellular carcinoma on imaging?", + "options": "A. Focal nodular hyperplasia B. Hepatic adenoma C. Inflammatory pseudotumor of the liver D. Non-alcoholic steatohepatitis", + "answer": "C" + }, + { + "question": "A male presents with fatigue and elevated liver enzymes. Which of the following is the most common cause of chronic inflammatory liver disease in this patient?", + "options": "A. Viral infections B. Alcohol abuse C. Autoimmune reactions D. Metabolic abnormalities", + "answer": "A" + }, + { + "question": "A patient presents with acute viral hepatitis. Which of the following findings is most directly attributed to impaired bilirubin metabolism?", + "options": "A. Fatigue B. Dark urine C. Right upper quadrant pain D. Elevated serum ALT levels", + "answer": "B" + }, + { + "question": "Which treatment is typically used for autoimmune hepatitis?", + "options": "A. Antivirals B. Corticosteroids C. Hepatoprotective agents D. Weight management", + "answer": "B" + }, + { + "question": "Which of the following is NOT a common cause of chronic inflammatory liver disease? (Focus on long-term etiologies rather than acute conditions.)", + "options": "A. Alcohol abuse B. Non-alcoholic fatty liver disease (NAFLD) C. Autoimmune hepatitis D. Exposure to hepatotoxic substances", + "answer": "C" + }, + { + "question": "A patient presents with fatigue and abdominal discomfort. Which of the following symptoms would be most indicative of both chronic inflammatory liver disease and hepatitis?", + "options": "A. Fever B. Jaundice C. Nausea D. Dark urine", + "answer": "B" + }, + { + "question": "A patient with chronic hepatitis B and elevated viral load presents for treatment. Which of the following is the most appropriate antiviral therapy?", + "options": "A. Corticosteroids B. Tenofovir C. Interferon-alpha D. Hepatoprotective agents", + "answer": "B" + }, + { + "question": "A patient with a 10-year history of untreated chronic hepatitis B presents with fatigue, ascites, and splenomegaly. Which of the following complications of chronic hepatitis B is most likely responsible for these findings, and what is the underlying pathophysiology?", + "options": "A. Cirrhosis due to progressive fibrosis and nodular regeneration B. Autoimmune reactions triggering hepatic inflammation C. Metabolic abnormalities leading to steatosis D. Hepatocellular carcinoma causing vascular obstruction", + "answer": "A" + }, + { + "question": "Which of the following is a prophylactic measure for hepatitis A?", + "options": "A. Antivirals B. Corticosteroids C. Vaccine D. Hepatoprotective agents", + "answer": "C" + }, + { + "question": "A woman presents with fatigue, jaundice, and elevated liver enzymes. Laboratory testing reveals positive anti-smooth muscle antibodies (ASMA) and hypergammaglobulinemia. A liver biopsy confirms the diagnosis of autoimmune hepatitis. What is the primary focus of treatment for this patient?", + "options": "A. Antivirals (for viral hepatitis) B. Addressing the underlying cause (e.g., immunosuppression for autoimmune hepatitis) C. Corticosteroids (first-line therapy for autoimmune hepatitis) D. Hepatoprotective agents (supportive therapy)", + "answer": "C" + }, + { + "question": "A male with a history of heavy alcohol use presents with elevated liver enzymes and hepatomegaly. What is the most likely primary cause of his Fatty Liver Disease?", + "options": "A. Viral infection B. Alcohol abuse C. Insulin resistance D. Autoimmune disorder", + "answer": "B" + }, + { + "question": "A patient with obesity and elevated liver enzymes presents with which of the following symptoms commonly associated with Fatty Liver Disease?", + "options": "A. Abdominal pain B. Fatigue C. Jaundice D. Nausea", + "answer": "B" + }, + { + "question": "Which of the following is the most appropriate initial treatment for a patient with non-alcoholic fatty liver disease (NAFLD) and obesity?", + "options": "A. Weight loss through diet and exercise B. Addressing underlying causes such as insulin resistance C. Liver transplantation D. Use of statins to reduce cholesterol", + "answer": "A" + }, + { + "question": "Which condition is characterized by hepatic fat deposition without significant alcohol consumption?", + "options": "A. Alcoholic Fatty Liver Disease B. Non-Alcoholic Fatty Liver Disease (NAFLD) C. Hepatitis C D. Cirrhosis", + "answer": "B" + }, + { + "question": "What is a common cause of Non-Alcoholic Fatty Liver Disease (NAFLD)?", + "options": "A. Alcohol abuse B. Obesity C. Viral infection D. Genetic mutation", + "answer": "B" + }, + { + "question": "Which of the following symptoms is most indicative of progression to cirrhosis in a patient with Non-Alcoholic Fatty Liver Disease (NAFLD)?", + "options": "A. Right upper quadrant pain B. Jaundice C. Ascites D. Hepatic encephalopathy", + "answer": "D" + }, + { + "question": "What is the primary management strategy for Non-Alcoholic Fatty Liver Disease (NAFLD)?", + "options": "A. Alcohol cessation B. Lifestyle modifications C. Surgery D. Chemotherapy", + "answer": "B" + }, + { + "question": "Which of the following is a key difference between Alcoholic Fatty Liver Disease and Non-Alcoholic Fatty Liver Disease (NAFLD)?", + "options": "A. NAFLD is caused by alcohol abuse B. Alcoholic Fatty Liver Disease is associated with metabolic syndrome C. NAFLD excludes alcohol as a causative factor D. Alcoholic Fatty Liver Disease requires long-term metabolic management", + "answer": "C" + }, + { + "question": "What is a potential severe outcome of non-alcoholic fatty liver disease (NAFLD)?", + "options": "A. Diabetes B. Cirrhosis C. Hepatocellular carcinoma D. Liver failure", + "answer": "B" + }, + { + "question": "A patient with biopsy-proven nonalcoholic steatohepatitis (NASH) and advanced fibrosis is being evaluated for treatment. Which of the following medications is most appropriate for this high-risk case of Non-Alcoholic Fatty Liver Disease (NAFLD)?", + "options": "A. Vitamin E B. Pioglitazone C. Statins D. Antihistamines", + "answer": "A" + }, + { + "question": "What is the primary cause of chronic passive congestion of the liver?", + "options": "A. Left-sided heart failure B. Right-sided heart failure C. Viral hepatitis D. Alcoholic liver disease", + "answer": "B" + }, + { + "question": "Which of the following is a typical symptom of chronic passive congestion of the liver?", + "options": "A. Ascites B. Hepatomegaly with a tender, smooth-edged liver C. Splenomegaly D. Severe jaundice", + "answer": "B" + }, + { + "question": "What is the main focus of management for chronic passive congestion of the liver?", + "options": "A. Antiviral therapy B. Treating the underlying cardiac pathology C. Liver transplantation D. Chemotherapy", + "answer": "B" + }, + { + "question": "A patient with long-standing heart failure presents with hepatomegaly, ascites, and signs of portal hypertension. Liver biopsy reveals irreversible architectural disruption with fibrosis. Which of the following is the most likely underlying condition?", + "options": "A. Chronic passive congestion of the liver (due to right-sided heart failure) B. Cardiac cirrhosis (due to chronic hepatic congestion) C. Acute liver failure D. Alcoholic liver disease", + "answer": "B" + }, + { + "question": "A patient with long-standing heart failure presents with signs of liver dysfunction. Which histological feature is most characteristic of cardiac cirrhosis and helps distinguish it from other types of cirrhosis?", + "options": "A. Centrilobular hepatocyte atrophy B. Bridging fibrosis and nodular regeneration C. Sinusoidal dilation D. Centrilobular necrosis", + "answer": "B" + }, + { + "question": "Chronic congestive liver damage, often due to chronic right-sided heart failure, is characterized by hepatic congestion and fibrosis, while cardiac cirrhosis results from long-standing severe congestion leading to irreversible architectural disruption. While both conditions are rare, understanding their distinguishing features is crucial for accurate diagnosis. Which of the following pathological features is most characteristic of chronic congestive liver damage but not cardiac cirrhosis?", + "options": "A. Centrilobular necrosis with fibrosis B. Bridging fibrosis with nodular regeneration C. Severe portal hypertension with varices D. Diffuse architectural distortion with regenerative nodules", + "answer": "A" + }, + { + "question": "What is a common laboratory finding in chronic passive congestion of the liver?", + "options": "A. Markedly increased aspartate aminotransferase (AST) B. Mild transaminase elevation C. Prolonged prothrombin time (PT) D. Hyperammonemia", + "answer": "B" + }, + { + "question": "A patient with heart failure presents with hepatomegaly and elevated liver enzymes. Which of the following liver conditions is reversible if venous congestion is alleviated early?", + "options": "A. Cardiac cirrhosis B. Chronic congestive liver damage C. Acute passive congestion of the liver D. Budd-Chiari syndrome", + "answer": "C" + }, + { + "question": "A patient with a history of heart failure presents with hepatomegaly and mild jaundice. What is a key difference between chronic passive congestion of the liver and cardiac cirrhosis in this patient?", + "options": "A. Presence of centrilobular necrosis B. Reversibility of the condition C. Association with portal hypertension D. Presence of viral hepatitis markers", + "answer": "B" + }, + { + "question": "A patient with a history of chronic congestive heart failure presents with signs of liver damage. Which of the following is most likely to be observed on physical examination?", + "options": "A. Severe portal hypertension B. Persistent hepatomegaly C. Ascites D. Severe jaundice", + "answer": "B" + }, + { + "question": "What is the primary pathological feature of central hemorrhagic necrosis of the liver?", + "options": "A. Fibrosis of liver tissue B. Hemorrhage and necrosis in the central zones of liver lobules C. Accumulation of fat in hepatocytes D. Inflammation of the bile ducts", + "answer": "B" + }, + { + "question": "Central hemorrhagic necrosis of the liver is a rare but severe condition characterized by ischemic injury and bleeding in the centrilobular region. Which of the following is NOT a primary cause of this condition?", + "options": "A. Viral infections (e.g., hepatitis B or C) B. Prolonged alcohol abuse C. Autoimmune hepatitis D. Excessive consumption of dietary fats leading to non-alcoholic fatty liver disease (NAFLD)", + "answer": "D" + }, + { + "question": "A patient with a history of chronic liver disease presents with sudden onset of severe abdominal pain. Which symptom is most characteristic of central hemorrhagic necrosis of the liver?", + "options": "A. Jaundice B. Intense and persistent abdominal pain radiating to the back C. Nausea and vomiting D. Swelling of the lower extremities", + "answer": "B", + "explanation": "Central hemorrhagic necrosis of the liver typically presents with intense and persistent abdominal pain radiating to the back due to the rapid destruction of liver tissue and associated bleeding. This symptom is more specific to this condition compared to jaundice, nausea/vomiting, or lower extremity swelling, which are nonspecific and can occur in many other liver disorders." + }, + { + "question": "What laboratory finding is commonly associated with central hemorrhagic necrosis of the liver?", + "options": "A. Elevated liver enzymes (AST/ALT) B. Decreased serum creatinine C. Hypoglycemia D. Increased serum calcium", + "answer": "A" + }, + { + "question": "Which of the following is a key treatment approach for central hemorrhagic necrosis of the liver caused by viral infections?", + "options": "A. Antiviral drugs B. Antibiotics C. Antifungal medications D. Antihistamines", + "answer": "A" + }, + { + "question": "What is a potential complication of delayed treatment in central hemorrhagic necrosis of the liver?", + "options": "A. Pulmonary embolism B. Hepatic failure or multi-organ dysfunction C. Osteoporosis D. Chronic kidney disease", + "answer": "B" + }, + { + "question": "In patients at risk for liver disease, why is vaccination against hepatitis viruses emphasized to reduce the risk of central hemorrhagic necrosis of the liver?", + "options": "A. Hepatitis viruses directly cause vascular occlusion leading to necrosis B. Vaccination prevents viral-induced inflammation and hepatocellular damage C. Herbal supplements exacerbate liver injury in hepatitis infections D. High-fat diets accelerate progression to hemorrhagic necrosis", + "answer": "B" + }, + { + "question": "A patient presents with jaundice and abdominal pain. Imaging reveals liver abnormalities. Central hemorrhagic necrosis, characterized by vascular disruption and parenchymal cell death, is suspected. Which finding would most strongly differentiate this condition from a cholestatic disorder?", + "options": "A. Presence of vascular disruption and cellular death B. Elevated serum bilirubin levels C. Bile duct obstruction on imaging D. Gallbladder wall thickening", + "answer": "A" + }, + { + "question": "A patient with a history of chronic liver disease presents with severe abdominal pain and shock. Which of the following systemic signs is most indicative of central hemorrhagic necrosis of the liver?", + "options": "A. Hypotension and tachycardia B. Jaundice C. Hepatic encephalopathy D. Hyperglycemia E. Peripheral neuropathy", + "answer": "A" + }, + { + "question": "What surgical intervention may be required in severe cases of central hemorrhagic necrosis of the liver?", + "options": "A. Hepatic artery embolization or partial hepatectomy B. Cholecystectomy C. Appendectomy D. Gastric bypass surgery", + "answer": "A" + }, + { + "question": "What is the primary cause of hepatic infarction?", + "options": "A. Chronic hepatitis B. Occlusion of the hepatic artery or portal vein C. Excessive alcohol consumption D. Autoimmune liver disease", + "answer": "B" + }, + { + "question": "Which of the following is NOT a predisposing factor for hepatic infarction?", + "options": "A. Arterial thrombosis B. Systemic hypotension C. Chronic hepatitis D. Iatrogenic causes such as liver transplantation", + "answer": "C" + }, + { + "question": "What is a common clinical presentation of hepatic infarction?", + "options": "A. Gradual weight loss B. Sudden right upper quadrant pain C. Persistent cough D. Generalized rash", + "answer": "B" + }, + { + "question": "Which imaging modality is most likely to show wedge-shaped hypodense areas in hepatic infarction?", + "options": "A. Ultrasound B. X-ray C. CT or MRI D. PET scan", + "answer": "C" + }, + { + "question": "What is a key treatment approach for hepatic infarction caused by thrombosis?", + "options": "A. Anticoagulation B. Antibiotics C. Chemotherapy D. Radiation therapy", + "answer": "A" + }, + { + "question": "Which of the following laboratory findings is most indicative of hepatic infarction?", + "options": "A. Elevated serum bilirubin B. Sharply elevated serum transaminases C. Decreased white blood cell count D. Low serum albumin", + "answer": "B" + }, + { + "question": "What is a distinguishing feature of hepatic infarction compared to other liver pathologies?", + "options": "A. Chronic inflammatory pattern B. Acute ischemic etiology and focal necrotic pattern C. Diffuse fibrosis D. Steatosis", + "answer": "B" + }, + { + "question": "A patient with hepatic artery thrombosis develops hepatic infarction and presents with fever, severe right upper quadrant pain, and elevated liver enzymes. Which of the following is the most likely life-threatening complication of this condition?", + "options": "A. Secondary liver abscess formation B. Acute liver failure C. Portal hypertension D. Septic shock", + "answer": "D" + }, + { + "question": "What is a critical factor affecting the prognosis of hepatic infarction?", + "options": "A. Age of the patient B. Extent of necrosis and prompt intervention C. Presence of diabetes mellitus D. Family history of liver disease", + "answer": "B" + }, + { + "question": "Purpura-like liver disease is a rare condition characterized by specific vascular changes in the liver. What is the primary pathological feature of this disease?", + "options": "A. Benign vascular tumors in the liver (e.g., hemangiomas) B. Immune-mediated vascular damage leading to inflammation C. Endothelial cell proliferation causing vascular occlusion D. Systemic bacterial infection with liver involvement", + "answer": "B" + }, + { + "question": "A patient with a history of chronic liver disease presents with cutaneous purpura. Which of the following symptoms is the most distinguishing feature of Purpura-like liver disease compared to other liver conditions?", + "options": "A. Jaundice B. Cutaneous purpura C. Coagulopathy D. Fever E. Muscle weakness F. Visual disturbances", + "answer": "B" + }, + { + "question": "A patient presents with liver dysfunction and purpura-like skin lesions, diagnosed with autoimmune hepatitis with purpura-like manifestations. What is the main treatment approach?", + "options": "A. Surgical resection B. Immunosuppressants C. Antiviral therapy D. Corticosteroids", + "answer": "B" + }, + { + "question": "A woman undergoes abdominal imaging for unrelated symptoms, and multiple benign vascular tumors are incidentally found in the liver. Which condition is most likely responsible for these findings?", + "options": "A. Focal nodular hyperplasia B. Hemangiomatosis of the liver C. Hepatitis D. Hepatic adenoma", + "answer": "B" + }, + { + "question": "A patient with Hemangiomatosis of the liver presents with sudden-onset abdominal pain and hypotension. What is the most likely life-threatening complication in this scenario?", + "options": "A. Systemic purpura B. Rupture of hepatic lesions C. Pancreatic insufficiency D. Autoimmune vasculitis", + "answer": "B" + }, + { + "question": "How is Hemangiomatosis of the liver typically managed if asymptomatic?", + "options": "A. Surgical resection B. Immunomodulatory therapy C. Monitoring D. Antibiotics", + "answer": "C" + }, + { + "question": "A patient with Purpura-like liver disease presents with systemic bleeding tendencies. Which of the following best explains this finding in contrast to Hemangiomatosis of the liver?", + "options": "A. Presence of systemic bleeding tendencies due to platelet dysfunction B. Involvement of vascular malformations C. Requirement for surgical resection D. Association with thrombocytopenia secondary to splenic sequestration", + "answer": "A" + }, + { + "question": "A patient presents with multiple liver lesions on imaging. Biopsy reveals endothelial cell proliferation. Which of the following is the most likely underlying mechanism for the development of hepatic hemangiomatosis?", + "options": "A. Genetic mutations B. Endothelial cell proliferation C. Vascular malformations D. Chronic inflammation", + "answer": "B" + }, + { + "question": "A woman presents with abdominal pain, hepatomegaly, and ascites. Imaging reveals hepatic vein obstruction. What is the most likely primary cause of this condition?", + "options": "A. Tumor compression (e.g., hepatocellular carcinoma) B. Thrombosis (e.g., Budd-Chiari syndrome) C. Congenital vascular anomalies (e.g., membranous webs) D. Infections (e.g., hepatic abscess)", + "answer": "B", + "follow_up": "What is the most appropriate initial diagnostic test for this condition?" + }, + { + "question": "Which of the following is NOT a typical symptom of hepatic vein obstruction?", + "options": "A. Severe abdominal pain B. Hepatomegaly C. Ascites D. Hypertension", + "answer": "D" + }, + { + "question": "What imaging technique is commonly used to diagnose hepatic vein obstruction?", + "options": "A. X-ray B. Doppler ultrasound C. PET scan D. Echocardiography", + "answer": "B" + }, + { + "question": "Which treatment is typically used for acute cases of hepatic vein obstruction?", + "options": "A. Liver transplantation B. Anticoagulation C. Angioplasty D. Radiation therapy", + "answer": "B" + }, + { + "question": "What is a common cause of hepatic vein obstruction related to hypercoagulable states?", + "options": "A. Viral hepatitis B. Myeloproliferative disorders C. Congenital vascular anomalies D. Tumor compression", + "answer": "B" + }, + { + "question": "Which of the following is a potential complication of chronic hepatic vein obstruction?", + "options": "A. Acute liver failure B. Portal hypertension C. Pulmonary embolism D. Myocardial infarction", + "answer": "B" + }, + { + "question": "A woman presents with abdominal pain, hepatomegaly, and ascites. Imaging reveals hepatic vein obstruction. Which of the following anatomical features would help differentiate Budd-Chiari syndrome from hepatic veno-occlusive disease (VOD)?", + "options": "A. Involvement of larger hepatic veins B. Presence of sinusoidal congestion C. Affects terminal hepatic venules D. Involvement of portal veins", + "answer": "A" + }, + { + "question": "A woman presents with abdominal pain and ascites. She has been taking oral contraceptives for 10 years. Which of the following is the most likely external factor contributing to hepatic vein obstruction in this patient?", + "options": "A. Viral hepatitis B. Oral contraceptives C. Autoimmune diseases D. Long-term use of anabolic steroids", + "answer": "B" + }, + { + "question": "What is a critical step in managing hepatic vein obstruction to prevent progressive liver damage?", + "options": "A. Delayed intervention B. Early intervention C. Radiation therapy D. Chemotherapy", + "answer": "B" + }, + { + "question": "What is the primary cause of portal hypertension?", + "options": "A. Pancreatic tumors B. Liver cirrhosis C. Chronic infections D. Idiopathic factors", + "answer": "B" + }, + { + "question": "Which of the following is a common symptom of portal hypertension?", + "options": "A. Isolated gastric varices B. Ascites C. Hypersplenism D. Pancytopenia", + "answer": "B" + }, + { + "question": "A male with a history of chronic pancreatitis presents with upper gastrointestinal bleeding. Imaging reveals isolated gastric varices without evidence of liver disease. Which of the following findings is most characteristic of pancreatic portal hypertension and distinguishes it from generalized portal hypertension?", + "options": "A. Presence of cirrhosis B. Isolated gastric varices without esophageal varices C. Splenomegaly with normal liver function D. Esophageal varices with ascites", + "answer": "B" + }, + { + "question": "A woman presents with splenomegaly and signs of portal hypertension, but liver biopsy shows no evidence of cirrhosis or thrombosis. Which of the following is the most likely diagnosis?", + "options": "A. Non-cirrhotic portal fibrosis B. Banti syndrome C. Idiopathic portal hypertension D. Splenic vein thrombosis", + "answer": "C" + }, + { + "question": "A patient with Banti syndrome is being evaluated for liver transplantation. Which of the following findings is most consistent with the diagnosis?", + "options": "A. Isolated gastric varices B. Preserved hepatic synthetic function C. Chronic pancreatitis D. Thrombosis of the portal vein", + "answer": "B" + }, + { + "question": "A male with cirrhosis presents with hematemesis and hemodynamic instability. Endoscopy reveals actively bleeding esophageal varices. Which intervention is most appropriate for the acute management of variceal bleeding in this patient with portal hypertension?", + "options": "A. Endoscopic band ligation B. Propranolol (non-selective beta-blocker) C. Liver transplantation D. Vasopressin analog (e.g., terlipressin)", + "answer": "A" + }, + { + "question": "What is the primary focus of treatment for idiopathic portal hypertension?", + "options": "A. Liver transplantation B. Variceal bleeding prevention C. Pancreatic surgery D. Splenectomy", + "answer": "B" + }, + { + "question": "A patient presents with progressive splenomegaly, pancytopenia, and no evidence of liver dysfunction. Which of the following conditions is most likely associated with these findings?", + "options": "A. Pancreatic portal hypertension B. Idiopathic portal hypertension C. Banti syndrome D. Myelofibrosis", + "answer": "C" + }, + { + "question": "A patient with chronic pancreatitis presents with upper gastrointestinal bleeding. Imaging reveals isolated gastric varices without evidence of cirrhosis. What is the most likely cause of this presentation?", + "options": "A. Splenic vein thrombosis B. Isolated gastric varices C. Cirrhosis D. Esophageal varices", + "answer": "B" + }, + { + "question": "A patient with Banti syndrome presents with severe cytopenias (anemia, thrombocytopenia, and leukopenia). Which of the following is the most appropriate initial treatment?", + "options": "A. Blood transfusions B. Splenectomy C. Immunosuppressive therapy D. Corticosteroids", + "answer": "B" + }, + { + "question": "What is the primary cause of hepatorenal syndrome (HRS)?", + "options": "A. Structural damage to the kidneys B. Systemic circulatory dysfunction due to portal hypertension C. Excessive diuretic use D. Intrinsic renal disease", + "answer": "B" + }, + { + "question": "Which of the following is a typical symptom of hepatorenal syndrome (HRS)?", + "options": "A. Polyuria B. Spontaneous oliguria or anuria C. Hypernatremia D. Increased urinary sodium", + "answer": "B" + }, + { + "question": "What is the first-line therapy for hepatorenal syndrome (HRS)?", + "options": "A. Liver transplantation B. Vasoconstrictors combined with albumin C. Diuretics alone D. Antibiotics for infection", + "answer": "B" + }, + { + "question": "Which of the following is a precipitating factor for hepatorenal syndrome (HRS)?", + "options": "A. Hypertension B. Spontaneous bacterial peritonitis C. Hyperkalemia D. Increased glomerular filtration rate", + "answer": "B" + }, + { + "question": "What is the definitive treatment for hepatorenal syndrome (HRS)?", + "options": "A. Vasoconstrictors B. Albumin infusion C. Liver transplantation D. Diuretic therapy", + "answer": "C" + }, + { + "question": "Which of the following is NOT a characteristic of hepatorenal syndrome (HRS)?", + "options": "A. Impaired kidney function without structural damage B. Pathological changes in kidney tissue C. Reduced effective arterial blood volume D. Renal vasoconstriction", + "answer": "B" + }, + { + "question": "What is a critical factor in the progression of hepatorenal syndrome (HRS)?", + "options": "A. Hypernatremia B. Hepatic dysfunction C. Increased urinary sodium D. Polyuria", + "answer": "B" + }, + { + "question": "Hepatorenal syndrome is a rare but severe complication of advanced liver disease. Which of the following laboratory findings is most characteristic of type 1 hepatorenal syndrome?", + "options": "A. Elevated urinary sodium B. Dilutional hyponatremia C. Elevated serum creatinine D. Low urinary osmolality", + "answer": "B" + }, + { + "question": "In the management of Type 1 hepatorenal syndrome (HRS), albumin is administered primarily to address which of the following pathophysiological mechanisms?", + "options": "A. To improve renal perfusion B. To counteract splanchnic vasodilation C. To increase urinary sodium excretion D. To reduce systemic inflammation", + "answer": "B" + }, + { + "question": "Why is early diagnosis and management of hepatorenal syndrome (HRS) critical?", + "options": "A. To prevent hypernatremia B. To avoid the use of vasoconstrictors C. To prevent irreversible organ damage D. To reduce the need for liver transplantation", + "answer": "C" + }, + { + "question": "Which of the following conditions is characterized by sudden liver rupture without trauma, often associated with preeclampsia or HELLP syndrome in pregnant women?", + "options": "A. Hepatic Adenoma B. Spontaneous Hepatic Rupture with Hemorrhage C. Liver Nodule D. Budd-Chiari Syndrome", + "answer": "B" + }, + { + "question": "A male with a history of chronic liver disease presents with dyspnea and hypoxemia. Hepatopulmonary Syndrome (HPS) is characterized by intrapulmonary vascular dilatations in the setting of liver disease. What is the primary underlying cause of his condition?", + "options": "A. Chronic liver disease leading to vascular changes B. Genetic predisposition C. Acute liver trauma D. Primary pulmonary vascular disease", + "answer": "A" + }, + { + "question": "Which condition involves multiple liver cysts due to genetic mutations?", + "options": "A. Liver Cyst B. Polycystic Liver Disease (PLD) C. Focal Nodular Hyperplasia (FNH) D. Hepatoptosis", + "answer": "B" + }, + { + "question": "What is the hallmark feature of Focal Nodular Hyperplasia (FNH)?", + "options": "A. Malignant growth B. Central scar on imaging C. Genetic origin D. Pulmonary symptoms", + "answer": "B" + }, + { + "question": "A woman presents with episodic right upper quadrant pain exacerbated by standing and relieved by lying down. Physical examination reveals a palpable liver edge that shifts with positional changes. Which of the following is the most likely diagnosis, and what is the preferred imaging modality for confirmation?", + "options": "A. Hepatopulmonary Syndrome (HPS) - Chest X-ray B. Hepatoptosis - Ultrasound with positional maneuvers C. Hepatomegaly - CT abdomen D. Liver Herniation - MRI abdomen", + "answer": "B" + }, + { + "question": "A patient with cirrhosis and severe hypoxemia (PaO2 <60 mmHg on room air) is diagnosed with Hepatopulmonary Syndrome (HPS). Which of the following interventions is the only definitive treatment for this condition?", + "options": "A. Long-term oxygen therapy B. Pulmonary vasodilators (e.g., sildenafil) C. Liver transplantation D. Transjugular intrahepatic portosystemic shunt (TIPS) E. Systemic corticosteroids", + "answer": "C" + }, + { + "question": "A woman is found to have a liver lesion on imaging. Which of the following benign liver lesions is typically asymptomatic and managed conservatively unless symptomatic?", + "options": "A. Focal Nodular Hyperplasia (FNH) B. Polycystic Liver Disease (PLD) C. Hepatic Hemangioma D. Hepatocellular Adenoma", + "answer": "A" + }, + { + "question": "A patient is found to have multiple liver cysts on imaging. Which of the following best distinguishes Polycystic Liver Disease (PLD) from simple liver cysts in terms of etiology and morphology?", + "options": "A. PLD is genetic and multifocal B. Simple cysts are genetic C. PLD is solitary D. Simple cysts are typically solitary and fluid-filled", + "answer": "A" + }, + { + "question": "Which of the following is a key difference between liver nodules and liver cysts?", + "options": "A. Nodules are fluid-filled; cysts are solid B. Nodules are solid; cysts are fluid-filled C. Nodules are genetic; cysts are not D. Nodules are always malignant; cysts are benign", + "answer": "B" + }, + { + "question": "A patient presents with abdominal discomfort and is found to have a 6 cm symptomatic simple liver cyst on imaging. What is the primary management strategy?", + "options": "A. Observation with serial imaging B. Aspiration or surgical removal C. Percutaneous sclerotherapy D. Resection or ablation", + "answer": "B" + }, + { + "question": "A patient with a history of liver transplantation presents with acute abdominal pain and elevated liver enzymes. Imaging reveals hepatic artery thrombosis. What is the primary cause of ischemic liver disease in this patient?", + "options": "A. Hepatic artery thrombosis B. Portal vein thrombosis C. Congestive heart failure D. Autoimmune hepatitis", + "answer": "A" + }, + { + "question": "A male presents with acute abdominal pain and a history of recent blunt trauma. Which of the following is a key symptom of hepatic hematoma?", + "options": "A. Jaundice B. Hypotension C. Abdominal distension D. Fever", + "answer": "B" + }, + { + "question": "A patient with a history of chronic hepatitis B infection undergoes abdominal imaging, which reveals multiple intrahepatic calcifications. Which of the following is the most likely underlying cause of these calcifications?", + "options": "A. Granulomatous inflammation (e.g., tuberculosis) B. Hepatocellular carcinoma C. Primary sclerosing cholangitis D. Hereditary hemochromatosis", + "answer": "A" + }, + { + "question": "A patient with advanced liver cancer presents with sudden abdominal distension and hypotension. Which of the following is the most immediately life-threatening complication?", + "options": "A. Biliary obstruction B. Hemoperitoneum C. Hepatic encephalopathy D. Portal hypertension", + "answer": "B" + }, + { + "question": "A patient presents with jaundice and episodic right upper quadrant pain. Imaging reveals multiple benign symptomatic bile duct polyps. What is the primary treatment?", + "options": "A. Transarterial embolization B. Surgical resection C. Oral synthetic bile acids D. Percutaneous aspiration E. Endoscopic surveillance F. Broad-spectrum antibiotic therapy", + "answer": "B" + }, + { + "question": "A male with a history of chronic alcohol use presents with jaundice, fatigue, and right upper quadrant tenderness. Laboratory evaluation is most likely to reveal which of the following findings characteristic of hepatocellular jaundice?", + "options": "A. Biliary dilation on imaging B. Conjugated hyperbilirubinemia C. Elevated transaminases (AST/ALT) D. Hemoperitoneum", + "answer": "B" + }, + { + "question": "A male with a history of recurrent abdominal trauma presents with signs of portal hypertension (ascites, splenomegaly). Imaging reveals intrahepatic vascular shunts. Given the rarity of this condition, which of the following is the most likely acquired cause of these shunts and the underlying mechanism?", + "options": "A. Genetic defect (congenital malformation of hepatic vasculature) B. Trauma (mechanical disruption of hepatic parenchyma and vasculature) C. Parasitic infection (Schistosoma-induced granulomatous inflammation) D. Chronic inflammation (cirrhosis-induced sinusoidal remodeling)", + "answer": "B" + }, + { + "question": "Which of the following is true about simple hepatic cysts?", + "options": "A. They are usually symptomatic B. They require surgical resection C. They are fluid-filled benign lesions D. They are associated with parasitic infections", + "answer": "C" + }, + { + "question": "A 3-month-old infant presents with persistent jaundice, failure to thrive, and elevated liver enzymes. Genetic testing confirms a congenital disorder of bile acid synthesis. What is the primary treatment for this condition?", + "options": "A. Ursodeoxycholic acid B. Liver transplantation C. Synthetic bile acids D. Cholestyramine", + "answer": "C" + }, + { + "question": "A male with chronic hepatitis B presents with a liver mass. Which of the following is the most likely diagnosis?", + "options": "A. Hemangioma B. Hepatic adenoma C. Hepatocellular carcinoma D. Hepatic steatosis", + "answer": "C" + }, + { + "question": "A patient presents with a large liver mass on imaging. Which of the following is a common systemic symptom associated with malignant liver masses?", + "options": "A. Asymptomatic presentation B. Right upper quadrant pain C. Weight loss D. Jaundice", + "answer": "C" + }, + { + "question": "A patient presents with right upper quadrant pain and elevated liver enzymes. Which imaging technique is most appropriate for the initial evaluation of a suspected liver mass?", + "options": "A. X-ray B. Ultrasound C. CT scan D. MRI", + "answer": "B" + }, + { + "question": "What biomarker is often tested for hepatocellular carcinoma?", + "options": "A. C-reactive protein B. Alpha-fetoprotein C. Prostate-specific antigen D. Hemoglobin A1c", + "answer": "B" + }, + { + "question": "A woman presents with right upper quadrant discomfort and is found to have a 6 cm hepatic hemangioma on imaging. She reports intermittent pain exacerbated by movement. Which of the following is the most appropriate management for this symptomatic benign liver mass?", + "options": "A. Chemotherapy B. Radiation therapy C. Surgical resection D. Targeted therapy E. Observation F. Transarterial embolization", + "answer": "C" + }, + { + "question": "A patient presents with vague abdominal discomfort and weight loss. Imaging reveals a suspicious liver mass. What is the most critical factor for improving survival outcomes in this patient?", + "options": "A. Delayed detection B. Early detection C. Use of non-specific treatments D. Reliance on symptomatic management only", + "answer": "B" + }, + { + "question": "Which of the following is a benign liver mass?", + "options": "A. Hepatocellular carcinoma B. Hemangioma C. Metastatic cancer D. Lymphoma", + "answer": "B" + }, + { + "question": "An asymptomatic patient undergoes abdominal imaging for an unrelated issue, and a benign liver mass is incidentally discovered. Which of the following is the most likely cause of this finding?", + "options": "A. Chronic hepatitis C B. Cirrhosis C. Hepatic hemangioma D. Aflatoxin exposure", + "answer": "C" + }, + { + "question": "A patient with advanced hepatocellular carcinoma presents with abdominal pain and weight loss. Which of the following is the most appropriate treatment option?", + "options": "A. Active surveillance in early-stage disease B. Surgical resection in resectable cases C. Tyrosine kinase inhibitors in advanced disease D. Palliative care in end-stage disease", + "answer": "C" + }, + { + "question": "What is the primary cause of Cholelithiasis with Acute Cholecystitis?", + "options": "A. Viral infection B. Gallstone obstruction of the cystic duct C. Autoimmune inflammation D. Trauma to the gallbladder", + "answer": "B" + }, + { + "question": "Which of the following is a common symptom of Cholelithiasis with Acute Cholecystitis?", + "options": "A. Left lower quadrant pain B. Severe right upper quadrant pain radiating to the back C. Chest pain D. Headache", + "answer": "B" + }, + { + "question": "What is the treatment for Cholelithiasis with Acute Cholecystitis?", + "options": "A. Immediate open cholecystectomy B. Analgesia, antibiotics, and laparoscopic cholecystectomy post-acute phase C. Radiation therapy D. Chemotherapy", + "answer": "B" + }, + { + "question": "Which condition is characterized by gallbladder wall necrosis due to prolonged ischemia?", + "options": "A. Cholelithiasis with Acute Cholecystitis B. Cholelithiasis with Gangrenous Cholecystitis C. Cholelithiasis with Acute Suppurative Cholecystitis D. Chronic cholecystitis", + "answer": "B" + }, + { + "question": "Which of the following is a direct risk factor for developing Cholelithiasis with Gangrenous Cholecystitis?", + "options": "A. Obesity B. Rapid weight loss C. Female gender D. Diabetes mellitus", + "answer": "D" + }, + { + "question": "A patient with cholelithiasis develops gangrenous cholecystitis, a rare and severe complication. Which of the following is the most likely life-threatening symptom?", + "options": "A. Septic shock B. Peritoneal signs C. Hypotension D. High fever", + "answer": "A" + }, + { + "question": "What is the treatment for Cholelithiasis with Gangrenous Cholecystitis?", + "options": "A. Observation and follow-up B. Emergent cholecystectomy and broad-spectrum antibiotics C. Oral antibiotics only D. Radiation therapy", + "answer": "B" + }, + { + "question": "Which condition involves pus accumulation in the gallbladder due to bacterial proliferation?", + "options": "A. Cholelithiasis with Acute Cholecystitis B. Cholelithiasis with Gangrenous Cholecystitis C. Cholelithiasis with Acute Suppurative Cholecystitis D. Chronic cholecystitis", + "answer": "C" + }, + { + "question": "A female with a history of cholelithiasis presents with fever, leukocytosis, and abdominal tenderness. Which of the following is the most characteristic symptom of Acute Suppurative Cholecystitis in this patient?", + "options": "A. Low-grade fever B. Intense right upper quadrant pain C. Persistent vomiting D. Severe jaundice with dark urine", + "answer": "B" + }, + { + "question": "What is the treatment for Cholelithiasis with Acute Suppurative Cholecystitis in high surgical risk patients?", + "options": "A. Immediate open cholecystectomy B. Percutaneous cholecystostomy followed by interval cholecystectomy C. Oral antibiotics only D. Radiation therapy", + "answer": "B" + }, + { + "question": "What is the primary cause of both acute and chronic cholecystitis?", + "options": "A. Bacterial infection B. Gallstones C. Viral infection D. Autoimmune disease", + "answer": "B" + }, + { + "question": "Which symptom is most characteristic of acute cholecystitis?", + "options": "A. Recurrent dull abdominal pain B. Severe right upper quadrant pain C. Bloating D. Intolerance to fatty foods", + "answer": "B" + }, + { + "question": "What is the definitive treatment for acute cholecystitis?", + "options": "A. Intravenous antibiotics B. Pain management C. Cholecystectomy D. Dietary changes", + "answer": "C" + }, + { + "question": "Which of the following is a potential complication of untreated acute cholecystitis?", + "options": "A. Gallbladder wall thickening B. Abscess or perforation C. Chronic inflammation D. Increased cancer risk", + "answer": "B" + }, + { + "question": "In patients with suspected gallbladder disease, understanding the differences between acute and chronic cholecystitis is critical for appropriate management. What is a key difference in the clinical presentation of acute versus chronic cholecystitis?", + "options": "A. Acute cholecystitis is associated with gallstones in 90% of cases B. Chronic cholecystitis typically presents with mild, intermittent symptoms C. Acute cholecystitis is episodic and severe D. Chronic cholecystitis is caused by bacterial infection", + "answer": "C" + }, + { + "question": "A patient with a history of gallstones reports persistent symptoms over several months. Which symptom is most characteristic of chronic cholecystitis in this stable, non-acute presentation?", + "options": "A. Fever and chills B. Mild, intermittent right upper quadrant discomfort C. Recurrent dull abdominal pain after meals D. Persistent nausea with vomiting", + "answer": "C" + }, + { + "question": "A patient with recurrent episodes of right upper quadrant pain, postprandial bloating, and ultrasound findings consistent with chronic cholecystitis is referred for definitive management to prevent future complications. Which of the following is the most appropriate long-term treatment strategy?", + "options": "A. Long-term oral antibiotics B. Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) C. Elective cholecystectomy D. Low-fat dietary modifications alone", + "answer": "C" + }, + { + "question": "Which of the following is a structural change associated with chronic cholecystitis?", + "options": "A. Gallbladder wall thickening B. Abscess formation C. Perforation D. Rapid inflammation", + "answer": "A" + }, + { + "question": "What is Murphy’s sign indicative of in the context of cholecystitis?", + "options": "A. Chronic inflammation B. Acute inflammation C. Gallbladder wall thickening D. Increased cancer risk", + "answer": "B" + }, + { + "question": "Which of the following is a risk factor for chronic cholecystitis?", + "options": "A. Bacterial infection B. Viral infection C. Long-term gallstone irritation D. Autoimmune disease", + "answer": "C" + }, + { + "question": "What is the primary cause of cholelithiasis without cholecystitis?", + "options": "A. Bacterial infection B. Imbalances in bile composition C. Trauma to the gallbladder D. Autoimmune inflammation", + "answer": "B" + }, + { + "question": "Which of the following is a typical symptom of cholelithiasis without cholecystitis?", + "options": "A. Persistent fever B. Intermittent right upper quadrant pain C. Severe jaundice D. Continuous vomiting", + "answer": "B" + }, + { + "question": "What is the recommended treatment for persistent symptoms of cholelithiasis without cholecystitis?", + "options": "A. Antibiotic therapy B. Dietary modifications C. Surgical removal of the gallbladder D. Pain management with NSAIDs", + "answer": "C" + }, + { + "question": "A patient presents with right upper quadrant pain and ultrasound findings of gallstones in the cystic duct. Which condition best describes this finding?", + "options": "A. Cholelithiasis without obstruction B. Biliary colic due to gallbladder stones C. Cholelithiasis of the cystic duct D. Common bile duct obstruction", + "answer": "C" + }, + { + "question": "What is a common symptom of cholelithiasis of the cystic duct?", + "options": "A. Mild abdominal discomfort B. Severe, cramping pain in the upper abdomen C. Persistent diarrhea D. Low-grade fever", + "answer": "B" + }, + { + "question": "A woman presents with severe right upper quadrant pain 30 minutes after eating a large, greasy meal. What is the most likely trigger for her symptoms?", + "options": "A. Alcohol consumption B. Fatty meals C. Prolonged fasting D. Viral infection", + "answer": "B" + }, + { + "question": "A patient presents with recurrent episodes of severe right upper quadrant pain lasting 30 minutes, associated with nausea. Imaging confirms gallstones without evidence of acute cholecystitis. How should this patient be managed?", + "options": "A. Immediate surgery for acute cholecystitis B. Pain relief with NSAIDs and elective cholecystectomy C. Long-term dietary restrictions D. Observation and follow-up without intervention", + "answer": "B" + }, + { + "question": "A patient presents with right upper quadrant pain and imaging confirms an impacted gallstone. Which of the following is a key clinical feature of this condition?", + "options": "A. Transient pain B. Persistent obstruction C. Mild symptoms D. Rarely associated with fever", + "answer": "B" + }, + { + "question": "Which of the following is a potential complication of an impacted gallstone?", + "options": "A. Mild indigestion B. Jaundice and risk of infection C. Temporary bloating D. Asymptomatic course", + "answer": "B" + }, + { + "question": "What is the primary cause of Choledocholithiasis with cholangitis?", + "options": "A. Viral infection B. Bile duct obstruction due to stones C. Autoimmune response D. Parasitic infection", + "answer": "B" + }, + { + "question": "A patient presents with right upper quadrant pain, fever, and jaundice. Imaging confirms choledocholithiasis with acute suppurative cholangitis. Which of the following is a characteristic systemic symptom of this condition?", + "options": "A. Right upper quadrant pain B. Hypotension C. Fever D. Jaundice", + "answer": "B" + }, + { + "question": "What is the definitive treatment for Cholelithiasis of extrahepatic bile duct with cholangitis?", + "options": "A. Oral antibiotics B. ERCP with sphincterotomy C. Liver transplantation D. Chemotherapy", + "answer": "B" + }, + { + "question": "A patient presents with recurrent episodes of jaundice and right upper quadrant pain. Imaging reveals stones within the intrahepatic ducts. Which condition is most likely?", + "options": "A. Choledocholithiasis B. Hepatolithiasis C. Cholelithiasis D. Biliary atresia", + "answer": "B" + }, + { + "question": "What is the primary difference between Choledocholithiasis with acute cholangitis and Choledocholithiasis with acute suppurative cholangitis?", + "options": "A. Presence of pus B. Location of stones C. Type of bacteria involved D. Duration of symptoms", + "answer": "A" + }, + { + "question": "Which of the following is a common bacterial cause of cholangitis secondary to choledocholithiasis?", + "options": "A. Streptococcus pneumoniae B. Escherichia coli C. Klebsiella pneumoniae D. Enterococcus species", + "answer": "B" + }, + { + "question": "What is the recommended initial treatment for Choledocholithiasis with cholangitis?", + "options": "A. Surgery B. Antibiotics followed by ERCP C. Radiation therapy D. Physical therapy", + "answer": "B" + }, + { + "question": "A patient presents with fever, jaundice, right upper quadrant pain, hypotension, and altered mental status (Reynold’s pentad). Which condition is most likely associated with this presentation?", + "options": "A. Acute pancreatitis B. Choledocholithiasis with acute suppurative cholangitis C. Hepatitis D. Gallstone ileus", + "answer": "B" + }, + { + "question": "A patient presents with fever, jaundice, and right upper quadrant pain. Imaging reveals stones confined to the intrahepatic ducts. Which of the following is the most distinguishing feature of this condition compared to other forms of cholangitis?", + "options": "A. Stones in the common bile duct B. Stones confined to intrahepatic ducts C. Systemic sepsis D. Elevated serum bilirubin", + "answer": "B" + }, + { + "question": "A male presents with fever, jaundice, and right upper quadrant pain. Imaging reveals biliary duct dilation. Which of the following distinctions between intrahepatic and extrahepatic cholangitis is most critical for determining the appropriate treatment approach?", + "options": "A. Anatomical involvement of proximal vs. distal bile ducts B. Presence of leukocytosis and elevated C-reactive protein C. Type of antibiotic coverage required D. Duration of symptoms prior to presentation", + "answer": "A" + }, + { + "question": "What is the primary cause of Cholelithiasis with cholecystitis?", + "options": "A. Bacterial infection B. Gallstones obstructing the cystic duct C. Autoimmune inflammation D. Viral infection", + "answer": "B" + }, + { + "question": "Which of the following is a hallmark symptom of Choledocholithiasis with acute cholecystitis?", + "options": "A. Epigastric pain B. Jaundice C. Nausea and vomiting D. Headache", + "answer": "B" + }, + { + "question": "A patient presents with severe right upper quadrant pain, fever, and jaundice. Imaging confirms choledocholithiasis with acute cholecystitis. What is the first-line treatment?", + "options": "A. Antibiotics B. Elective cholecystectomy C. Emergency ERCP D. Supportive care with IV fluids and pain management", + "answer": "C" + }, + { + "question": "Which of the following is a key difference between Cholelithiasis and Choledocholithiasis?", + "options": "A. Cholelithiasis affects the gallbladder, while Choledocholithiasis affects the common bile duct B. Cholelithiasis primarily involves the gallbladder, while Choledocholithiasis affects the common bile duct C. Cholelithiasis can present acutely or chronically, while Choledocholithiasis often presents with obstructive symptoms D. Cholelithiasis is often managed with cholecystectomy, while Choledocholithiasis may require ERCP for stone removal", + "answer": "B" + }, + { + "question": "What is a common symptom of Choledocholithiasis with chronic cholecystitis?", + "options": "A. Severe fever B. Episodic right upper quadrant pain C. Persistent diarrhea D. Severe jaundice", + "answer": "B" + }, + { + "question": "A patient presents with recurrent right upper quadrant pain, fever, and jaundice. Imaging confirms cholelithiasis with chronic cholecystitis of the bile duct. Which of the following is the most appropriate treatment?", + "options": "A. Oral bile acid dissolution therapy B. Endoscopic stone removal C. Percutaneous cholecystostomy D. Surgical cholecystectomy", + "answer": "B" + }, + { + "question": "What is a potential complication of Choledocholithiasis?", + "options": "A. Localized inflammation B. Pancreatitis C. Gastritis D. Hepatitis", + "answer": "B" + }, + { + "question": "Which of the following is a characteristic feature of acute cholecystitis?", + "options": "A. Mild, persistent pain B. Severe pain and fever C. Intermittent jaundice D. Indigestion", + "answer": "B" + }, + { + "question": "Which of the following is a diagnostic sign for Cholelithiasis with cholecystitis?", + "options": "A. Murphy's sign B. McBurney's point tenderness C. Cullen's sign D. Grey Turner's sign", + "answer": "A" + }, + { + "question": "What is the primary treatment for Choledocholithiasis without cholangitis or cholecystitis?", + "options": "A. Antibiotic therapy B. Endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction C. Liver transplantation D. Pain management only", + "answer": "B" + }, + { + "question": "A patient presents with recurrent episodes of jaundice and right upper quadrant pain. Imaging reveals stones within the intrahepatic ducts. Which of the following conditions is most likely responsible for these findings?", + "options": "A. Choledocholithiasis B. Biliary colic C. Intrahepatic bile duct calculus D. Hepatolithiasis", + "answer": "D", + "explanation": "Hepatolithiasis refers to the presence of stones within the intrahepatic bile ducts, which aligns with the clinical and imaging findings described. While intrahepatic bile duct calculus (Option C) is technically correct, hepatolithiasis is the more precise and clinically recognized term for this condition." + }, + { + "question": "What is a key symptom of Biliary colic?", + "options": "A. Fever B. Jaundice C. Intense, episodic right upper quadrant pain D. Pale stools", + "answer": "C" + }, + { + "question": "Which condition is most commonly associated with bile stasis and infections, particularly in East Asia?", + "options": "A. Choledocholithiasis B. Hepatolithiasis C. Residual stone of common bile duct D. Choledochoenterostomy calculus", + "answer": "B" + }, + { + "question": "A patient presents with recurrent biliary colic after a cholecystectomy. Imaging reveals a residual stone in the common bile duct. What is the most likely cause of this residual stone?", + "options": "A. Primary formation in the duct B. Incomplete clearance or overlooked stones C. Migration of gallstones from the gallbladder D. Bile stasis and infections", + "answer": "B" + }, + { + "question": "Which diagnostic imaging is commonly used for biliary diseases?", + "options": "A. CT scan B. Ultrasound and MRCP C. X-ray D. PET scan", + "answer": "B" + }, + { + "question": "A patient with a history of choledochojejunostomy presents with recurrent abdominal pain and jaundice. Imaging reveals stones at the anastomotic site. What is the most likely diagnosis?", + "options": "A. Choledocholithiasis B. Hepatolithiasis C. Anastomotic stone formation D. Intrahepatic bile duct calculus", + "answer": "C" + }, + { + "question": "A patient with a history of recurrent biliary infections presents with jaundice and right upper quadrant pain. Imaging confirms Hepatolithiasis, a condition characterized by intrahepatic bile duct stones. Which of the following is a common long-term complication of this condition?", + "options": "A. Pancreatitis B. Cirrhosis and cholangiocarcinoma C. Biliary strictures D. Acute liver failure", + "answer": "B" + }, + { + "question": "Which of the following is NOT a typical symptom of Choledocholithiasis without cholangitis or cholecystitis?", + "options": "A. Intermittent right upper quadrant pain B. Jaundice C. Fever D. Pale stools", + "answer": "C" + }, + { + "question": "What is the primary cause of Mirizzi Syndrome?", + "options": "A. Intraductal stones in the common hepatic duct B. Extrinsic compression of the common hepatic duct by an impacted gallstone C. Bacterial infection of the gallbladder D. Autoimmune inflammation of the bile ducts", + "answer": "B" + }, + { + "question": "Which anatomical variation is most commonly associated with Mirizzi Syndrome?", + "options": "A. Divergent course of the cystic duct and common hepatic duct B. Parallel course of the cystic duct and common hepatic duct with shared fibrous membranes C. Absence of the cystic duct D. Duplication of the common hepatic duct", + "answer": "B" + }, + { + "question": "A patient presents with recurrent right upper quadrant pain and jaundice. Which of the following symptoms would NOT typically be associated with Mirizzi Syndrome?", + "options": "A. Recurrent right upper quadrant pain B. Jaundice C. Fever D. Severe, localized lower abdominal cramping unrelated to biliary pathology", + "answer": "D" + }, + { + "question": "A patient presents with jaundice and right upper quadrant pain. Imaging reveals extrinsic compression of the common hepatic duct. What is the most appropriate initial imaging modality to confirm Mirizzi Syndrome?", + "options": "A. Plain X-ray B. Ultrasound C. Magnetic resonance cholangiopancreatography (MRCP) D. Computed tomography (CT) scan", + "answer": "B" + }, + { + "question": "A patient with Mirizzi Syndrome presents with worsening jaundice and right upper quadrant abdominal pain. Which of the following complications is most likely responsible for these symptoms?", + "options": "A. Secondary biliary cirrhosis B. Acute cholangitis C. Biliary fistula D. Gastric ulcer", + "answer": "B" + }, + { + "question": "What is the primary treatment for Mirizzi Syndrome?", + "options": "A. Antibiotic therapy B. Surgical intervention C. Radiation therapy D. Chemotherapy", + "answer": "B" + }, + { + "question": "Which of the following is a distinguishing feature of Mirizzi Syndrome compared to simple choledocholithiasis?", + "options": "A. Presence of intraductal stones B. Mechanical duct compression C. Absence of biliary dilation D. Lower risk of iatrogenic bile duct injury", + "answer": "B" + }, + { + "question": "In Mirizzi Syndrome, gallstones typically cause obstruction by lodging in the cystic duct or common hepatic duct. What is the typical size range of these gallstones?", + "options": "A. <5 mm B. 5–15 mm C. 15–25 mm D. >25 mm", + "answer": "B" + }, + { + "question": "A patient presents with jaundice, fever, and right upper quadrant pain due to Mirizzi Syndrome. In the acute management of this condition, what is the primary goal of endoscopic or percutaneous drainage?", + "options": "A. Stone removal B. Sepsis control C. Bile duct reconstruction D. Gallbladder preservation E. Symptom relief F. Prevention of biliary stricture", + "answer": "B" + }, + { + "question": "What is the primary cause of Acute Cholecystitis?", + "options": "A. Bacterial infection B. Gallstones obstructing the cystic duct C. Trauma to the gallbladder D. Autoimmune inflammation", + "answer": "B" + }, + { + "question": "A patient presents with severe right upper quadrant pain, fever, and leukocytosis. Acute Suppurative Cholecystitis is a rare but life-threatening complication of gallbladder inflammation. Which of the following is a key symptom indicating severe progression of this condition?", + "options": "A. Jaundice B. Septic shock C. Mild abdominal discomfort D. Hypotension", + "answer": "B" + }, + { + "question": "What is the most urgent treatment for Acute Gangrenous Cholecystitis?", + "options": "A. Antibiotics alone B. Percutaneous drainage C. Urgent surgical intervention D. Observation and pain management", + "answer": "C" + }, + { + "question": "Which condition is characterized by pus accumulation around the gallbladder?", + "options": "A. Acute Cholecystitis B. Pericholecystic Abscess C. Necrosis of Gallbladder D. Acute Exacerbation of Chronic Cholecystitis", + "answer": "B" + }, + { + "question": "Which clinical features are most specific to Acute Obstructive Suppurative Cholecystitis (AOSC) compared to other forms of cholecystitis?", + "options": "A. Severe right upper quadrant pain radiating to the back B. Jaundice and mental status changes C. Mild fever and nausea D. Elevated liver enzymes without jaundice", + "answer": "B" + }, + { + "question": "A patient with untreated gangrenous cholecystitis presents with worsening symptoms. Which of the following is a likely complication?", + "options": "A. Sepsis B. Gallbladder perforation C. Liver abscess formation D. Necrosis of the gallbladder", + "answer": "D" + }, + { + "question": "A patient with known chronic cholecystitis presents with moderate right upper quadrant pain, low-grade fever, and mild leukocytosis but is hemodynamically stable. What is the most appropriate initial management for this acute exacerbation?", + "options": "A. Immediate cholecystectomy B. Elective cholecystectomy after resolution of acute symptoms with antibiotics C. Antibiotics alone without surgical intervention D. Percutaneous cholecystostomy for high-risk surgical candidates", + "answer": "B" + }, + { + "question": "A patient presents with severe right upper quadrant pain, fever, and leukocytosis. Imaging reveals gas in the gallbladder wall. Which condition is most consistent with these findings?", + "options": "A. Acute Cholecystitis B. Gangrenous Cholecystitis C. Emphysematous Cholecystitis D. Chronic Cholecystitis", + "answer": "B" + }, + { + "question": "What is a critical diagnostic feature of Pericholecystic Abscess?", + "options": "A. Elevated liver enzymes B. Fluid collections adjacent to the gallbladder on imaging C. Chronic inflammation D. Mild fever", + "answer": "B" + }, + { + "question": "Which of the following conditions requires immediate biliary decompression?", + "options": "A. Acute Cholecystitis B. Acute Obstructive Suppurative Cholecystitis (AOSC) C. Acute Exacerbation of Chronic Cholecystitis D. Pericholecystic Abscess", + "answer": "B" + }, + { + "question": "What is the primary cause of chronic cholecystitis?", + "options": "A. Bacterial infection B. Recurrent gallstones obstructing the cystic duct C. Autoimmune inflammation D. Viral infection", + "answer": "B" + }, + { + "question": "Which of the following is a typical symptom of chronic cholecystitis?", + "options": "A. Left lower quadrant pain B. Recurrent right upper quadrant pain C. Chest pain D. Lower back pain", + "answer": "B" + }, + { + "question": "What is the definitive treatment for chronic cholecystitis?", + "options": "A. Antibiotic therapy B. Cholecystectomy C. Dietary modifications alone D. Pain management alone", + "answer": "B" + }, + { + "question": "A patient presents with persistent right upper quadrant pain 6 months after cholecystectomy. Imaging reveals a retained gallstone in the bile duct. What is the most likely cause of their symptoms?", + "options": "A. Incomplete removal of gallbladder tissue B. Retained gallstones in the bile duct C. Viral hepatitis D. Pancreatic inflammation", + "answer": "B" + }, + { + "question": "A patient with a history of chronic cholecystitis presents with persistent right upper quadrant pain and intermittent jaundice. Which diagnostic procedure is most appropriate to evaluate for residual pathology, particularly bile duct abnormalities?", + "options": "A. Ultrasound B. HIDA scan C. MRCP D. CT scan", + "answer": "C" + }, + { + "question": "A patient with a history of chronic residual cholecystitis presents with jaundice, pale stools, and dark urine. Which of the following is the most likely underlying cause of these findings?", + "options": "A. Bile duct obstruction B. Acute pancreatitis C. Hepatitis D. Peptic ulcer disease", + "answer": "A" + }, + { + "question": "A patient presents with chronic right upper quadrant pain and recurrent episodes of cholangitis. Imaging reveals retained gallstones in the cystic duct stump following a previous cholecystectomy. Which intervention is most appropriate for definitive management of this condition?", + "options": "A. Open cholecystectomy B. Endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction C. Long-term antibiotic prophylaxis D. Percutaneous drainage of the cystic duct stump", + "answer": "B" + }, + { + "question": "Which imaging modality is commonly used to confirm chronic cholecystitis?", + "options": "A. MRI B. Ultrasound C. X-ray D. PET scan", + "answer": "B" + }, + { + "question": "A patient with a history of cholecystectomy presents with recurrent biliary pain. Imaging reveals inflammation in the gallbladder fossa, suggesting chronic residual cholecystitis (persistent inflammation due to retained gallbladder remnants post-surgery). What is the key difference between chronic cholecystitis and chronic residual cholecystitis?", + "options": "A. Chronic cholecystitis involves a diseased but intact gallbladder, while residual cholecystitis occurs after incomplete gallbladder removal\nB. Chronic residual cholecystitis is caused by new gallstone formation in the common bile duct\nC. Chronic cholecystitis is exclusively seen in patients with prior biliary surgery\nD. Chronic residual cholecystitis results from autoimmune inflammation of the gallbladder", + "answer": "A" + }, + { + "question": "Which of the following is NOT a typical symptom of chronic cholecystitis?", + "options": "A. Nausea B. Bloating C. Intolerance to fatty foods D. Severe headache", + "answer": "D" + }, + { + "question": "A patient presents with fever, right upper quadrant pain, and leukocytosis. Imaging reveals gallbladder wall thickening and pericholecystic fluid. What is the primary cause of acute pericholecystitis in this patient?", + "options": "A. Ischemic injury to the gallbladder B. Bacterial infection spreading from the gallbladder C. Autoimmune response D. Trauma to the gallbladder", + "answer": "B" + }, + { + "question": "Which of the following is a common symptom of pericholecystitis?", + "options": "A. Left lower quadrant pain B. Persistent right upper quadrant pain radiating to the back C. Chest pain D. Headache", + "answer": "B" + }, + { + "question": "What imaging findings are typical for pericholecystitis?", + "options": "A. Normal gallbladder wall B. Gallbladder wall thickening with pericholecystic fluid C. Enlarged liver D. Pancreatic calcifications", + "answer": "B" + }, + { + "question": "Which of the following bacteria is commonly associated with pericholecystitis?", + "options": "A. Streptococcus pneumoniae B. Escherichia coli C. Mycobacterium tuberculosis D. Helicobacter pylori", + "answer": "B" + }, + { + "question": "What is the mainstay of treatment for pericholecystitis?", + "options": "A. Oral antivirals B. Intravenous antibiotics followed by cholecystectomy C. Radiation therapy D. Chemotherapy", + "answer": "B" + }, + { + "question": "Which of the following complications may require percutaneous drainage in pericholecystitis?", + "options": "A. Gallstones B. Abscess formation C. Pancreatitis D. Hepatitis", + "answer": "B" + }, + { + "question": "How does pericholecystitis differ from isolated cholecystitis in terms of management?", + "options": "A. Requires shorter antibiotic therapy B. May require extended antibiotic therapy C. Does not require imaging D. Can be managed with oral antibiotics alone", + "answer": "B" + }, + { + "question": "Which of the following is a key diagnostic feature of pericholecystitis?", + "options": "A. Elevated serum amylase B. Gallbladder wall thickening with pericholecystic fluid C. Normal white blood cell count D. Absence of fever", + "answer": "B" + }, + { + "question": "A patient presents with fever, right upper quadrant pain, and leukocytosis. Imaging reveals inflammation around the gallbladder. What is the most likely source of infection in this case?", + "options": "A. The liver B. The pancreas C. The gallbladder D. The stomach E. The bile ducts F. The duodenum", + "answer": "C" + }, + { + "question": "A patient with acute pericholecystitis develops worsening right upper quadrant pain and fever. Which of the following is the most likely complication in this scenario?", + "options": "A. Appendicitis B. Abscess formation C. Biliary fistula D. Gallbladder perforation", + "answer": "B" + }, + { + "question": "What is the primary cause of acute cholecystitis in 90% of cases?", + "options": "A. Bacterial infections B. Gallstones obstructing the cystic duct C. Ischemia D. Systemic conditions like vasculitis", + "answer": "B" + }, + { + "question": "Which of the following is a typical symptom of acute cholecystitis?", + "options": "A. Vague dyspepsia B. Persistent right upper quadrant pain radiating to the back or shoulder C. Bloating D. Intolerance to fatty foods", + "answer": "B" + }, + { + "question": "What imaging finding is indicative of cholecystitis on ultrasound?", + "options": "A. Gallbladder wall thickening >3mm B. Presence of gallstones C. Increased bile duct diameter D. Absence of gallbladder", + "answer": "A" + }, + { + "question": "What is a key distinction between acute and chronic cholecystitis?", + "options": "A. Presence of gallstones B. Duration and severity of symptoms C. Elevated white blood cell counts D. Need for surgical intervention", + "answer": "B" + }, + { + "question": "A patient with untreated acute cholecystitis for 5 days presents with fever and severe abdominal pain. Which of the following complications is most likely to develop due to disease progression?", + "options": "A. Gallbladder perforation B. Hypertension C. Diabetic ketoacidosis D. Hyperthyroidism", + "answer": "A" + }, + { + "question": "A patient presents with severe cholecystitis, fever, and leukocytosis. Imaging confirms gallbladder perforation. What is the most appropriate surgical intervention?", + "options": "A. Elective laparoscopic cholecystectomy B. Emergency open cholecystectomy C. Percutaneous cholecystostomy D. Endoscopic retrograde cholangiopancreatography (ERCP)", + "answer": "B" + }, + { + "question": "A woman presents with right upper quadrant pain, fever, and leukocytosis. Imaging confirms acute cholecystitis with biliary obstruction. Which of the following pathogens is most likely responsible for the infection and why?", + "options": "A. Streptococcus pneumoniae (rarely involved in biliary infections) B. Escherichia coli (most common gram-negative pathogen in cholecystitis due to ascending infection from the gut) C. Staphylococcus aureus (more typical of skin/soft tissue infections) D. Klebsiella pneumoniae (gram-negative pathogen seen in biliary infections, but less common than E. coli)", + "answer": "B" + }, + { + "question": "What dietary modification is often recommended for chronic cholecystitis?", + "options": "A. High-fat diet B. Low-fat diet C. High-protein diet D. Low-carbohydrate diet", + "answer": "B" + }, + { + "question": "In patients with non-obstructive cholecystitis (inflammation of the gallbladder without gallstone obstruction), what is a potential consequence of delayed diagnosis?", + "options": "A. Increased risk of gallbladder perforation B. Higher morbidity C. Development of obstructive cholecystitis D. Reduced need for antibiotics", + "answer": "B" + }, + { + "question": "What is the most common cause of gallbladder obstruction?", + "options": "A. Tumors B. Gallstones C. Strictures D. Fibrosis", + "answer": "B" + }, + { + "question": "Which symptom is most characteristic of gallbladder obstruction?", + "options": "A. Left upper quadrant pain B. Severe right upper quadrant pain radiating to the back or shoulder C. Lower abdominal cramping D. Chest pain", + "answer": "B" + }, + { + "question": "What is the primary diagnostic tool for gallbladder obstruction?", + "options": "A. CT scan B. Ultrasound C. MRI D. X-ray", + "answer": "B" + }, + { + "question": "A patient presents with acute right upper quadrant pain, fever, and jaundice. Imaging confirms gallbladder and cystic duct obstruction. Which treatment is definitive in this case?", + "options": "A. Antibiotics (for initial management) B. Analgesics (for symptom control) C. Cholecystectomy D. ERCP (for bile duct obstruction)", + "answer": "C" + }, + { + "question": "A female presents with right upper quadrant pain and nausea. Ultrasound reveals an enlarged gallbladder without bile duct dilation. What is the most likely imaging finding in this patient with cystic duct obstruction, given that the obstruction prevents bile outflow from the gallbladder but does not affect the common bile duct?", + "options": "A. Common bile duct dilation B. Isolated gallbladder dilation (due to trapped bile) C. Pericholecystic fluid D. Gallbladder wall thickening", + "answer": "B" + }, + { + "question": "A patient with untreated, prolonged gallbladder obstruction due to a large impacted stone presents with worsening right upper quadrant pain and fever. Which of the following complications is most likely to develop in this setting?", + "options": "A. Mirizzi syndrome (chronic complication from extrinsic bile duct compression) B. Empyema or gangrene of the gallbladder (acute infective/septic complications) C. Ascending cholangitis (biliary tree infection) D. Acute pancreatitis (gallstone migration)", + "answer": "B" + }, + { + "question": "In patients presenting with right upper quadrant pain, distinguishing between cystic duct obstruction and gallbladder obstruction is critical for appropriate management. What is the key difference in biliary involvement between these two conditions?", + "options": "A. Cystic duct obstruction typically causes localized gallbladder inflammation B. Gallbladder obstruction may involve broader biliary implications C. Cystic duct obstruction leads to systemic biliary involvement D. Gallbladder obstruction often results in bile duct compression", + "answer": "B" + }, + { + "question": "A patient with a history of gallstones presents with persistent right upper quadrant pain and imaging confirms prolonged cystic duct obstruction. Which of the following conditions is most likely to develop as a direct complication of this obstruction?", + "options": "A. Acute cholecystitis (early inflammatory complication) B. Mirizzi syndrome (chronic compression of the common hepatic duct) C. Ascending cholangitis (biliary infection) D. Acute pancreatitis (gallstone migration)", + "answer": "B" + }, + { + "question": "What is a common symptom shared by both gallbladder and cystic duct obstruction?", + "options": "A. Jaundice B. Severe right upper quadrant pain C. Chest pain D. Diarrhea", + "answer": "B" + }, + { + "question": "Which imaging modality is used to diagnose cystic duct obstruction?", + "options": "A. CT scan B. Ultrasound or MRI C. X-ray D. Endoscopy", + "answer": "B" + }, + { + "question": "Hydrops of the gallbladder is a rare condition characterized by distension of the gallbladder without inflammation or infection, often caused by cystic duct obstruction. What is its primary pathological feature?", + "options": "A. Accumulation of bile B. Accumulation of serous fluid C. Necrosis of the gallbladder wall D. Bacterial colonization of the lumen", + "answer": "B" + }, + { + "question": "A patient presents with a distended, non-tender gallbladder on ultrasound, consistent with hydrops (gallbladder distension without inflammation). Which of the following is the most likely underlying cause?", + "options": "A. Bacterial infection B. Chronic cystic duct obstruction C. Autoimmune disease D. Viral infection E. Prolonged fasting F. Gallbladder polyps", + "answer": "B" + }, + { + "question": "What is the typical treatment for mucocele of the gallbladder?", + "options": "A. Antibiotic therapy B. Endoscopic drainage C. Cholecystectomy D. Observation", + "answer": "C" + }, + { + "question": "A female presents with right upper quadrant pain and ultrasound findings of gallbladder distension. Which of the following gallbladder conditions carries the highest risk of complications such as rupture or infection?", + "options": "A. Hydrops of the gallbladder B. Mucocele of the gallbladder C. Biliary colic D. Gallstone pancreatitis", + "answer": "B" + }, + { + "question": "What is the key difference in the fluid content between hydrops and mucocele of the gallbladder?", + "options": "A. Hydrops contains mucinous fluid, while mucocele contains serous fluid B. Hydrops contains serous fluid, while mucocele contains mucinous fluid C. Both contain serous fluid D. Both contain mucinous fluid", + "answer": "B" + }, + { + "question": "A patient presents with right upper quadrant pain and fever. Which imaging modality is most important for differentiating hydrops from mucocele of the gallbladder based on anatomical detail?", + "options": "A. MRI B. X-ray C. Ultrasound D. CT E. PET scan", + "answer": "C" + }, + { + "question": "A patient presents with a palpable mass in the right upper quadrant and reports dull pain. Ultrasound reveals a distended gallbladder without evidence of stones. What is the most likely diagnosis?", + "options": "A. Acute cholecystitis (sharp, stabbing pain) B. Mucocele of the gallbladder (palpable mass and dull pain) C. Cholangitis (fever and chills) D. Biliary obstruction (jaundice)", + "answer": "B" + }, + { + "question": "A patient presents with acute abdominal pain and imaging reveals a dilated gallbladder with an obstructing stone. Which of the following conditions may resolve if the obstruction is relieved?", + "options": "A. Acute cholecystitis B. Hydrops of the gallbladder C. Gallbladder perforation D. Gallstone ileus", + "answer": "B" + }, + { + "question": "What is a potential complication of mucocele of the gallbladder?", + "options": "A. Resolution of symptoms B. Rupture or infection C. Spontaneous drainage D. Complete obstruction of the bile duct", + "answer": "B" + }, + { + "question": "What is the most common cause of gallbladder perforation?", + "options": "A. Abdominal trauma B. Gallstones C. Vasculitis D. Iatrogenic procedures", + "answer": "B" + }, + { + "question": "Which of the following is a typical symptom of gallbladder perforation?", + "options": "A. Mild abdominal discomfort B. Sudden, severe right upper quadrant pain C. Persistent cough D. Headache", + "answer": "B" + }, + { + "question": "What is a systemic complication that may arise from untreated gallbladder perforation?", + "options": "A. Hypertension B. Septic shock C. Diabetes mellitus D. Asthma", + "answer": "B" + }, + { + "question": "Which treatment is considered urgent for gallbladder perforation?", + "options": "A. Oral antibiotics B. Surgical intervention C. Physical therapy D. Dietary changes", + "answer": "B" + }, + { + "question": "What is a key distinction between uncomplicated cholecystitis and gallbladder perforation?", + "options": "A. Presence of gallstones B. Structural wall breach with peritoneal contamination C. Mild symptoms D. No need for surgical intervention", + "answer": "B" + }, + { + "question": "A male presents with severe right upper quadrant abdominal pain, fever, and leukocytosis. Imaging reveals gallbladder perforation. Which of the following is the least likely cause of his condition?", + "options": "A. Obstructing gallstones B. Acute calculous cholecystitis C. Blunt abdominal trauma D. Advanced gallbladder cancer", + "answer": "C" + }, + { + "question": "A patient with multiple comorbidities (including severe sepsis and cardiovascular instability) presents with gallbladder perforation. What is the most appropriate initial treatment option?", + "options": "A. Laparoscopic cholecystectomy B. Percutaneous drainage C. Endoscopic retrograde cholangiopancreatography (ERCP) D. Antibiotic therapy alone", + "answer": "B" + }, + { + "question": "Which of the following is a sign of peritonitis due to gallbladder perforation?", + "options": "A. Rebound tenderness B. Rash C. Joint pain D. Dizziness", + "answer": "A" + }, + { + "question": "What is a primary goal of early diagnosis and management in gallbladder perforation?", + "options": "A. Prevent hypertension B. Prevent life-threatening bile peritonitis C. Reduce cholesterol levels D. Improve lung function", + "answer": "B" + }, + { + "question": "Which of the following conditions often underlies gallbladder perforation?", + "options": "A. Asthma B. Chronic gallstones C. Diabetes mellitus D. Hypertension", + "answer": "B" + }, + { + "question": "A woman with a history of recurrent biliary colic presents with fever, right upper quadrant pain, and signs of bowel obstruction. Imaging reveals a cholecystoenteric fistula. What is the most likely underlying cause of this complication in patients with gallstone disease?", + "options": "A. Peptic ulcer disease B. Chronic cholecystitis C. Gallstone perforation D. Post-traumatic injury", + "answer": "C" + }, + { + "question": "A patient with a history of recurrent gallstones presents with severe abdominal pain, vomiting, and signs of intestinal obstruction. Which of the following is the most pathognomonic finding for a Cholecystoenteric Fistula?", + "options": "A. Biliary colic B. Passage of gallstones in stool C. Bilious vomiting D. Air in the biliary tree on imaging", + "answer": "D" + }, + { + "question": "A patient presents with recurrent biliary symptoms and is diagnosed with a Cholecystogastric Fistula. What is the primary treatment?", + "options": "A. Endoscopic stenting B. Gastric resection and cholecystectomy C. Antibiotic therapy D. Percutaneous drainage", + "answer": "B" + }, + { + "question": "Which type of fistula is most commonly associated with gallstone erosion into the duodenum?", + "options": "A. Cholecystic Fistula B. Cholecystoenteric Fistula C. Cholecystoduodenal Fistula D. Cholecystocolic Fistula", + "answer": "C" + }, + { + "question": "A patient with a history of chronic cholecystitis presents with persistent diarrhea. Imaging reveals a Cholecystocolic Fistula. What is the most likely complication in this case?", + "options": "A. Gallstone ileus B. Chronic diarrhea C. Pneumobilia D. Biliary colic", + "answer": "A" + }, + { + "question": "A patient develops a fistula of the gallbladder following a laparoscopic cholecystectomy. What is the most likely cause of this complication? (Note: This question focuses on a rare but clinically significant complication of gallbladder surgery.)", + "options": "A. Chronic cholecystitis B. Iatrogenic injury C. Peptic ulcer disease", + "answer": "B" + }, + { + "question": "A patient presents with abdominal pain, jaundice, and bilious drainage from a surgical wound. Which imaging modality is most commonly used to diagnose biliary fistulas?", + "options": "A. Ultrasound B. CT/MRCP C. X-ray D. Endoscopy", + "answer": "B", + "rationale": "CT/MRCP is the preferred modality for diagnosing biliary fistulas due to its high-resolution visualization of the biliary tract and ability to identify the fistula's origin and complications (e.g., abscesses). Ultrasound may miss small fistulas due to limited sensitivity, and X-ray lacks specificity for biliary pathology. Endoscopy is invasive and typically reserved for therapeutic intervention rather than diagnosis." + }, + { + "question": "A patient presents with a chronic draining sinus in the abdominal wall, diagnosed as a Cholecystocutaneous Fistula. Which of the following is the most appropriate primary treatment and why?", + "options": "A. Antibiotic therapy alone (to manage infection) B. Percutaneous drainage (to relieve symptoms) C. Surgical excision and drainage control (to address the fistula definitively) D. Endoscopic retrograde cholangiopancreatography (ERCP) (to evaluate biliary anatomy)", + "answer": "C" + }, + { + "question": "In the management of biliary fistulas, which of the following is a key difference between internal and external fistulas?", + "options": "A. Internal fistulas primarily require surgical intervention for bowel repair B. External fistulas primarily require surgical intervention for wound management C. Internal fistulas are managed conservatively with antibiotics D. External fistulas are managed conservatively with drainage", + "answer": "B" + }, + { + "question": "A patient with a history of gallstones presents with abdominal pain, fever, and jaundice. Imaging reveals a biliary fistula. Which of the following is the most likely life-threatening complication if this condition remains untreated?", + "options": "A. Cholangitis B. Bile leakage with peritonitis C. Portal hypertension D. Hepatic steatosis", + "answer": "B" + }, + { + "question": "What is the primary pathological feature of cholesterolosis of the gallbladder?", + "options": "A. Inflammation of the gallbladder wall B. Abnormal deposition of cholesterol esters in macrophages C. Formation of gallstones in the bile ducts D. Fibrosis of the gallbladder mucosa", + "answer": "B" + }, + { + "question": "Cholesterolosis is characterized by the accumulation of cholesterol esters in the gallbladder mucosa. Which of the following is a hypothesized mechanism for this accumulation? (Note: Acyl-CoA cholesterol acyltransferase [ACAT] catalyzes the formation of cholesterol esters from free cholesterol.)", + "options": "A. Impaired cholesterol ester hydrolase activity B. Enhanced activity of acyl-CoA cholesterol acyltransferase (ACAT) C. Decreased macrophage phagocytosis D. Increased LDL receptor expression", + "answer": "B" + }, + { + "question": "What is the characteristic appearance of diffuse cholesterolosis of the gallbladder?", + "options": "A. Smooth, pale mucosa B. Widespread speckled yellow deposits resembling a 'strawberry gallbladder' C. Thickened, fibrotic wall D. Multiple large polypoid lesions", + "answer": "B" + }, + { + "question": "Which imaging modality is most commonly used to diagnose cholesterolosis of the gallbladder?", + "options": "A. X-ray B. Ultrasound C. Endoscopy D. PET scan", + "answer": "B" + }, + { + "question": "What is the typical treatment approach for asymptomatic cholesterolosis of the gallbladder?", + "options": "A. Immediate cholecystectomy B. Conservative management with surveillance C. Antibiotic therapy D. Radiation therapy", + "answer": "B" + }, + { + "question": "A female with a history of cholesterolosis of the gallbladder presents with severe epigastric pain radiating to the back. Which of the following complications is most likely associated with her condition?", + "options": "A. Biliary colic B. Acute pancreatitis C. Chronic cholecystitis D. Gallbladder perforation", + "answer": "B" + }, + { + "question": "A patient with cholesterolosis presents with recurrent postprandial right upper quadrant pain. Which dietary modification would most likely alleviate their gallbladder symptoms?", + "options": "A. High-fat, irregular meals (to stimulate bile flow) B. Low-fat, regular meals (to reduce gallbladder stimulation) C. High-protein, low-carbohydrate diet (to promote weight loss) D. Intermittent fasting (to reduce gallbladder workload)", + "answer": "B" + }, + { + "question": "Which of the following is a clinical feature of cholesterolosis of the gallbladder?", + "options": "A. Severe jaundice B. Mild right upper quadrant discomfort C. Persistent fever D. Hematemesis", + "answer": "B" + }, + { + "question": "What is the malignant potential of cholesterolosis of the gallbladder?", + "options": "A. High risk of transformation into cancer B. Moderate risk of malignancy C. No malignant potential D. Variable depending on polyp size", + "answer": "C" + }, + { + "question": "In a patient with cholesterolosis (a rare condition characterized by cholesterol deposits in the gallbladder wall), which of the following findings would be a reason to consider cholecystectomy?", + "options": "A. Asymptomatic small polyps B. Large (>1 cm) or growing polyps C. Persistent severe biliary colic D. Spontaneous regression of polyps", + "answer": "B" + }, + { + "question": "A patient presents with right upper quadrant abdominal pain, nausea, and a palpable mass. Imaging reveals an enlarged gallbladder (Cholecystomegaly). What is the most likely primary underlying cause of this finding?", + "options": "A. Chronic inflammation B. Biliary obstruction C. Muscular wall thickening D. Epithelial proliferation", + "answer": "B" + }, + { + "question": "Which of the following is the most common subtype of gallbladder polyps?", + "options": "A. Adenomatous polyps B. Cholesterol polyps C. Inflammatory polyps D. Hyperplastic polyps", + "answer": "B" + }, + { + "question": "What is the characteristic feature of Adenomyomatosis of the gallbladder?", + "options": "A. Focal mucosal growths B. Diffuse wall thickening with intramural diverticula C. Lumen dilation D. Muscular wall thickening without sinus formation", + "answer": "B" + }, + { + "question": "Which condition is associated with a heightened malignancy risk due to wall calcification?", + "options": "A. Gallbladder hypertrophy B. Calcified gallbladder (Porcelain gallbladder) C. Gallbladder atrophy D. Cystic duct dilation", + "answer": "B" + }, + { + "question": "A female presents with right upper quadrant pain, fever, and ultrasound findings of gallbladder wall thickening. What is the most appropriate treatment?", + "options": "A. Antibiotics B. Percutaneous cholecystostomy C. Cholecystectomy D. Surveillance", + "answer": "C" + }, + { + "question": "Which condition is characterized by a shrunken, nonfunctional gallbladder due to chronic cholecystitis?", + "options": "A. Gallbladder torsion B. Gallbladder atrophy C. Cholecystomegaly D. Adenomyomatosis", + "answer": "B" + }, + { + "question": "A female presents with sudden onset of severe right upper quadrant pain and vomiting. Imaging reveals gallbladder torsion. What is the most likely primary symptom?", + "options": "A. Fever and jaundice B. Severe RUQ pain with vomiting C. Epigastric burning pain D. Asymptomatic", + "answer": "B" + }, + { + "question": "Which imaging modality is commonly used for diagnosing gallbladder conditions?", + "options": "A. X-ray B. Ultrasound C. PET scan D. Angiography", + "answer": "B" + }, + { + "question": "What is the key difference between gallbladder polyps and adenomyomatosis?", + "options": "A. Polyps involve diffuse wall changes; adenomyomatosis involves focal growths B. Polyps are focal growths; adenomyomatosis involves diffuse wall changes with sinuses C. Polyps are always malignant; adenomyomatosis is benign D. Polyps require emergency surgery; adenomyomatosis does not", + "answer": "B" + }, + { + "question": "A female presents with sudden onset of severe right upper quadrant pain radiating to the back, nausea, and fever. Imaging reveals a twisted gallbladder. Which of the following gallbladder conditions is most likely responsible for her presentation?", + "options": "A. Gallbladder polyps B. Gallbladder torsion C. Acute cholecystitis D. Cystic duct dilation", + "answer": "B" + }, + { + "question": "Which of the following is a hallmark symptom triad for cholangitis?", + "options": "A. Fever, jaundice, right upper quadrant pain B. Hypotension, altered mental status, fever C. Pruritus, dark urine, fatigue D. Nausea, vomiting, diarrhea", + "answer": "A" + }, + { + "question": "What is the primary treatment for acute cholangitis?", + "options": "A. Long-term immunosuppressants B. Urgent ERCP and IV antibiotics C. Proton pump inhibitors D. Surgical revision", + "answer": "B" + }, + { + "question": "Which of the following is a key distinction between acute and chronic cholangitis?", + "options": "A. Acute cholangitis requires long-term anti-inflammatory therapy B. Chronic cholangitis demands urgent intervention C. Acute cholangitis requires emergent intervention to prevent sepsis D. Chronic cholangitis is caused by complete biliary obstruction", + "answer": "C" + }, + { + "question": "What is the primary cause of obstructive cholangitis?", + "options": "A. Autoimmune conditions B. Bacterial infection C. Physical blockage (e.g., tumors, stones) D. Drug-induced cholestasis", + "answer": "C" + }, + { + "question": "Which of the following is a characteristic feature of cholestatic cholangitis?", + "options": "A. High fever and septic shock B. Pruritus and dark urine C. Recurrent episodes of infection D. Hypotension and altered mental status", + "answer": "B" + }, + { + "question": "A patient with recurrent episodes of right upper quadrant abdominal pain, jaundice, and fever is diagnosed with reflux cholangitis due to biliary-enteric anastomotic stricture. Which of the following is the most appropriate definitive treatment approach?", + "options": "A. ERCP-guided stenting with biliary sphincterotomy B. Proton pump inhibitors with surgical revision of the anastomosis C. Long-term broad-spectrum antibiotics D. Ursodeoxycholic acid (UDCA) therapy", + "answer": "B" + }, + { + "question": "Which of the following is a common cause of recurrent cholangitis?", + "options": "A. Complete biliary obstruction B. Autoimmune conditions C. Incomplete obstruction (e.g., post-surgical strictures) D. Drug-induced cholestasis", + "answer": "C" + }, + { + "question": "What is the primary diagnostic tool for cholangitis?", + "options": "A. Blood culture B. MRI/CT cholangiography C. Stool analysis D. Urinalysis", + "answer": "B" + }, + { + "question": "In the context of rare biliary diseases, which of the following best describes the primary treatment approach distinguishing obstructive from cholestatic cholangitis?", + "options": "A. Obstructive cholangitis is managed primarily with antibiotics B. Cholestatic cholangitis is treated with bile acid sequestrants C. Obstructive cholangitis necessitates mechanical relief D. Cholestatic cholangitis is caused by bacterial infection", + "answer": "C" + }, + { + "question": "Which of the following is a hallmark symptom of Suppurative Cholangitis?", + "options": "A. Fatigue B. Charcot’s triad C. Pruritus D. Weight loss", + "answer": "B" + }, + { + "question": "What is the primary treatment for Acute Suppurative Cholangitis?", + "options": "A. Ursodeoxycholic acid B. Emergent ERCP and IV antibiotics C. Liver transplantation D. Corticosteroids", + "answer": "B" + }, + { + "question": "Which condition is most commonly associated with Primary Sclerosing Cholangitis (PSC)?", + "options": "A. Sarcoidosis B. Ulcerative colitis C. Gallstones D. Liver transplantation", + "answer": "B" + }, + { + "question": "What is the main cause of Ischemic Cholangitis?", + "options": "A. Bacterial infection B. Bile duct ischemia C. Autoimmune response D. Biliary obstruction", + "answer": "B" + }, + { + "question": "Which of the following treatments is used for Primary Cholangitis (formerly PBC)?", + "options": "A. Broad-spectrum antibiotics B. Ursodeoxycholic acid C. ERCP D. Corticosteroids", + "answer": "B" + }, + { + "question": "A patient presents with cholestatic liver disease. Which of the following features is most likely to distinguish Pericholangitis from Primary Cholangitis?", + "options": "A. Association with systemic diseases such as inflammatory bowel disease B. Autoimmune markers such as anti-mitochondrial antibodies C. Predominance in middle-aged women with fatigue and pruritus D. Improvement with antibiotic therapy targeting bacterial overgrowth", + "answer": "A" + }, + { + "question": "Which of the following is a key feature of Secondary Cholangitis?", + "options": "A. Autoimmune markers B. Biliary obstruction C. Chronic cholestasis D. Response to immunosuppression", + "answer": "B" + }, + { + "question": "What is the definitive treatment for advanced Primary Sclerosing Cholangitis (PSC)?", + "options": "A. Ursodeoxycholic acid B. Liver transplantation C. Broad-spectrum antibiotics D. Corticosteroids", + "answer": "B" + }, + { + "question": "Which of the following is a common bacterial cause of Suppurative Cholangitis?", + "options": "A. Streptococcus pneumoniae B. Escherichia coli C. Mycobacterium tuberculosis D. Helicobacter pylori", + "answer": "B" + }, + { + "question": "What is the primary management strategy for Ischemic Cholangitis?", + "options": "A. Antibiotics B. Revascularization or stenting C. Immunosuppression D. Liver transplantation", + "answer": "B" + }, + { + "question": "A female presents with jaundice, dark urine, and right upper quadrant pain. Imaging reveals dilation of the common bile duct. What is the most likely cause of her bile duct obstruction?", + "options": "A. Hepatitis B. Gallstones C. Dysmotility D. Pancreatic cancer", + "answer": "B" + }, + { + "question": "Which symptom is most commonly associated with obstruction of the bile duct?", + "options": "A. Pruritus B. Jaundice C. Fat malabsorption D. Confusion", + "answer": "B" + }, + { + "question": "What is the primary treatment for obstruction of the bile duct caused by gallstones?", + "options": "A. Ursodeoxycholic acid B. ERCP C. Cholecystectomy D. Antibiotics", + "answer": "B" + }, + { + "question": "A female presents with right upper quadrant pain and ultrasound findings suggestive of cholecystic bile stasis. What is the most likely primary cause of this condition?", + "options": "A. Hepatitis B. Gallstones C. Genetic disorders D. Dysmotility", + "answer": "B" + }, + { + "question": "Which symptom is most commonly associated with cholecystic bile stasis?", + "options": "A. Jaundice B. Right upper quadrant pain C. Fat malabsorption D. Confusion", + "answer": "B" + }, + { + "question": "A patient with a history of recurrent cholecystic bile stasis, unresponsive to ursodeoxycholic acid therapy, presents with persistent right upper quadrant pain and postprandial nausea. Imaging confirms sludge in the gallbladder without evidence of obstruction. What is the most appropriate definitive treatment?", + "options": "A. Ursodeoxycholic acid B. ERCP C. Cholecystectomy D. Antibiotics", + "answer": "C", + "explanation": "Cholecystectomy (C) is the definitive treatment for recurrent cholecystic bile stasis unresponsive to medical management. Ursodeoxycholic acid (A) is used for medical dissolution but is ineffective in recurrent cases. ERCP (B) is indicated for biliary obstruction, which is not present here. Antibiotics (D) are used for acute cholecystitis but do not address the underlying stasis." + }, + { + "question": "Which symptom is most commonly associated with cholestasis?", + "options": "A. Jaundice B. Right upper quadrant pain C. Pruritus D. Confusion", + "answer": "C" + }, + { + "question": "A pregnant woman presents with pruritus and elevated liver enzymes. What is the primary treatment for her intrahepatic cholestasis of pregnancy?", + "options": "A. Ursodeoxycholic acid B. Rifampin C. Cholestyramine D. Vitamin K supplementation", + "answer": "A" + }, + { + "question": "A patient presents with jaundice and abdominal pain. Imaging reveals a stricture of the bile duct. What is the most likely primary cause of this condition?", + "options": "A. Gallstones B. Chronic pancreatitis C. Scarring from prior surgery D. Primary sclerosing cholangitis", + "answer": "D" + }, + { + "question": "In a patient with suspected benign bile duct stricture, which diagnostic method is preferred for initial non-invasive evaluation, and why?", + "options": "A. ERCP (allows direct visualization and intervention) | B. MRCP (non-invasive with high accuracy for structural assessment) | C. Ultrasound (first-line for detecting duct dilation but limited in stricture characterization) | D. CT scan (provides cross-sectional imaging but inferior to MRCP for biliary detail)", + "answer": "B", + "rationale": "MRCP is the preferred initial non-invasive method due to its high sensitivity for visualizing bile duct strictures without the risks of ERCP (e.g., pancreatitis). ERCP is typically reserved for therapeutic intervention after diagnosis." + }, + { + "question": "What is the primary treatment for stricture of the bile duct?", + "options": "A. Ursodeoxycholic acid B. Balloon dilation C. Cholecystectomy D. Antibiotics", + "answer": "B" + }, + { + "question": "What is the primary treatment for Biliary Atresia in infants?", + "options": "A. Endoscopic dilation with stenting B. Kasai procedure (hepatoportoenterostomy) C. Surgical bypass (e.g., choledochojejunostomy) D. Liver transplantation", + "answer": "B" + }, + { + "question": "A patient presents with right upper quadrant abdominal pain and jaundice. Imaging reveals a narrowed bile duct. Which of the following findings is most pathognomonic for Biliary Stricture?", + "options": "A. Dark urine (urobilinogen) B. Clay-colored stools (acholia) C. Conjugated hyperbilirubinemia D. Elevated serum amylase", + "answer": "B" + }, + { + "question": "What is the most likely cause of Obstruction of the Common Bile Duct in adults?", + "options": "A. Congenital malformation B. Chronic pancreatitis C. Gallstones D. Primary sclerosing cholangitis", + "answer": "C" + }, + { + "question": "Which diagnostic imaging technique is commonly used to guide treatment for Obstructive Jaundice?", + "options": "A. CT scan B. Ultrasound C. MRCP D. X-ray", + "answer": "C" + }, + { + "question": "A patient presents with jaundice, dark urine, and pale stools. Which of the following is a key feature of Obstructive Jaundice in this patient?", + "options": "A. Unconjugated hyperbilirubinemia B. Pruritus C. Elevated ALT levels D. Elevated alkaline phosphatase levels", + "answer": "B" + }, + { + "question": "A 2-month-old infant presents with jaundice and pale stools. Which of the following conditions is most likely congenital and pediatric-specific?", + "options": "A. Choledochal Cyst B. Biliary Atresia C. Stricture of the Common Bile Duct D. Obstruction of the Common Bile Duct", + "answer": "B" + }, + { + "question": "What is a common treatment for Stricture of the Common Bile Duct?", + "options": "A. Kasai procedure B. ERCP with stenting C. Liver transplantation D. Antibiotic therapy", + "answer": "B" + }, + { + "question": "Which of the following is least likely to be a symptom of Biliary Atresia?", + "options": "A. Jaundice B. Dark urine C. Pale stools D. Hepatomegaly", + "answer": "D" + }, + { + "question": "What is the primary goal of early intervention in conditions causing bile flow obstruction?", + "options": "A. Prevent liver damage B. Reduce pruritus C. Lower ALT levels D. Treat Gram-negative bacteremia", + "answer": "A" + }, + { + "question": "A male with a history of recurrent cholangitis presents with jaundice and pruritus. Imaging reveals a focal, fibrotic narrowing of the common bile duct. Which condition is most likely responsible for these findings?", + "options": "A. Biliary Atresia B. Choledocholithiasis C. Stricture of the Common Bile Duct D. Primary Sclerosing Cholangitis", + "answer": "C" + }, + { + "question": "A woman presents with acute abdominal pain and jaundice. Imaging reveals bile duct perforation. What is the most likely cause?", + "options": "A. Gallstones B. Trauma C. Iatrogenic injury during surgery D. Infections like cholangitis", + "answer": "A (Gallstones are the most common cause due to obstruction and increased pressure in the biliary system.)" + }, + { + "question": "A patient presents with suspected bile duct perforation, a rare but serious condition often caused by trauma or obstruction. Which of the following is NOT a typical clinical manifestation of this condition?", + "options": "A. Sudden severe right upper quadrant abdominal pain B. Fever and jaundice C. Referred pain to the right shoulder D. Pleuritic chest pain", + "answer": "D" + }, + { + "question": "A patient presents with acute abdominal pain and jaundice. What imaging technique is NOT typically used as an initial diagnostic tool for bile duct perforation?", + "options": "A. Ultrasound B. CT scan C. MRCP D. X-ray E. Endoscopic retrograde cholangiopancreatography (ERCP)", + "answer": "D" + }, + { + "question": "In a patient with suspected bile duct perforation, which laboratory finding is most indicative of this condition?", + "options": "A. Elevated bilirubin B. Elevated alkaline phosphatase C. Elevated amylase D. Elevated creatinine", + "answer": "A" + }, + { + "question": "A male presents with severe abdominal pain, fever, and jaundice. Imaging confirms bile duct perforation. What is the primary goal of immediate emergency treatment? (Rationale: Surgical repair is critical to prevent further bile leakage and complications such as peritonitis.)", + "options": "A. Pain management B. Surgical repair C. Antibiotic therapy D. Supportive care", + "answer": "B" + }, + { + "question": "Which of the following is a potential complication of untreated bile duct perforation?", + "options": "A. Biliary strictures B. Cholangitis C. Bile peritonitis D. Hepatitis", + "answer": "C" + }, + { + "question": "What is the most critical aspect of managing bile duct perforation?", + "options": "A. Immediate intervention B. Long-term antibiotic therapy C. Pain relief D. Dietary changes", + "answer": "A" + }, + { + "question": "A patient presents with bile duct perforation following laparoscopic cholecystectomy. Which of the following is the most appropriate initial surgical intervention for this condition?", + "options": "A. Primary closure B. T-tube drainage C. Biliary-enteric anastomosis D. Percutaneous transhepatic cholangiography", + "answer": "B" + }, + { + "question": "A patient presents with jaundice, fever, and acute-onset right upper quadrant pain. Imaging reveals biliary dilation. Which of the following findings would most strongly suggest bile duct perforation rather than a biliary stricture?", + "options": "A. Presence of acute peritoneal signs B. Presence of bile in the peritoneal cavity C. Response to endoscopic stenting D. History of chronic cholangitis", + "answer": "A" + }, + { + "question": "Which of the following is NOT a component of supportive care for bile duct perforation?", + "options": "A. Antibiotics B. Pain management C. Fluid resuscitation D. Chemotherapy", + "answer": "D" + }, + { + "question": "A male develops a biliary fistula 2 weeks after undergoing a laparoscopic cholecystectomy. What is the most likely etiology of this complication?", + "options": "A. Congenital anomalies B. Trauma or surgical injury C. Gallstone erosion D. Infectious cholangitis", + "answer": "B" + }, + { + "question": "A patient with a history of gallstones presents with symptoms suggestive of a choledochoduodenal fistula. Which of the following symptoms is most commonly associated with this condition? (Jaundice occurs due to bile duct obstruction or leakage, a hallmark of choledochoduodenal fistula.)", + "options": "A. Bilious vomiting B. Jaundice C. Weight loss D. Abdominal pain", + "answer": "B" + }, + { + "question": "A patient presents with recurrent cholangitis and imaging reveals a choledochogastric fistula. What is the primary treatment for this condition?", + "options": "A. Endoscopic stenting B. Surgical resection C. Conservative management with antibiotics and drainage D. Endoscopic sphincterotomy", + "answer": "B" + }, + { + "question": "A patient with recurrent cholangitis and a history of biliary obstruction is found to have a fistula between the bile duct and gastrointestinal tract. Which of the following is the key anatomical difference between choledochoduodenal and choledochogastric fistulas?", + "options": "A. Etiology: biliary obstruction (choledochoduodenal) vs. peptic ulcer disease (choledochogastric) B. Severity: life-threatening hemorrhage (choledochogastric) vs. chronic inflammation (choledochoduodenal) C. Location: connection to duodenum (choledochoduodenal) vs. stomach (choledochogastric) D. Diagnostic imaging: endoscopic retrograde cholangiopancreatography (ERCP) required for choledochogastric only", + "answer": "C" + }, + { + "question": "A patient develops a choledochoenteric fistula (an abnormal connection between the bile duct and intestine) postoperatively, presenting with signs of peritonitis and hemodynamic instability. What is the most urgent intervention required?", + "options": "A. Endoscopic stenting B. Surgical revision C. Broad-spectrum antibiotics D. Percutaneous drainage", + "answer": "B" + }, + { + "question": "A patient presents with persistent bile leakage after cholecystectomy. Which diagnostic imaging is most appropriate for confirming a biliary fistula?", + "options": "A. CT scan B. Ultrasound C. MRCP/ERCP D. HIDA scan", + "answer": "C" + }, + { + "question": "A patient with a history of biliary disease presents with recurrent episodes of vomiting. On examination, the vomitus appears bilious. What is the primary symptom of a choledochogastric fistula in this patient? What additional diagnostic finding would most strongly support this diagnosis?", + "options": "A. Jaundice B. Bilious vomiting C. Abdominal pain D. Weight loss E. Presence of bile in gastric aspirate", + "answer": "B" + }, + { + "question": "A patient develops a hepatic duct-intestinal fistula (an abnormal connection between the hepatic duct and intestine, often due to surgical trauma) following abdominal surgery. What is the most likely immediate complication?", + "options": "A. Bile peritonitis B. Sepsis C. Hemorrhage D. Intestinal obstruction", + "answer": "A" + }, + { + "question": "A patient presents with a biliary fistula secondary to gallstone erosion, confirmed by imaging. The patient is hemodynamically stable. Which of the following treatments is most appropriate?", + "options": "A. Endoscopic stenting B. Surgical repair C. Percutaneous drainage D. Endoscopic sphincterotomy", + "answer": "B. Surgical repair is the definitive treatment for biliary fistulas caused by gallstone erosion, as it addresses the underlying pathology and prevents recurrence." + }, + { + "question": "A female presents with episodic right upper quadrant pain after cholecystectomy. What is the primary cause of Sphincter of Oddi spasm in this patient?", + "options": "A. Gallstone obstruction of the bile duct B. Dysregulation of sphincter contractions C. Chronic pancreatitis D. Autoimmune inflammation of the bile ducts", + "answer": "B" + }, + { + "question": "Which of the following is a typical symptom of Sphincter of Oddi spasm?", + "options": "A. Chronic diarrhea B. Episodic severe epigastric pain lasting >30 minutes C. Persistent fever D. Lower abdominal cramping", + "answer": "B" + }, + { + "question": "A female presents with recurrent episodes of postprandial right upper quadrant pain and nausea. What is the gold standard diagnostic test for Sphincter of Oddi spasm in this patient?", + "options": "A. Abdominal ultrasound B. Sphincter manometry C. CT scan of the abdomen D. Endoscopic retrograde cholangiopancreatography (ERCP)", + "answer": "B" + }, + { + "question": "Which of the following treatments is used for smooth muscle relaxation in Sphincter of Oddi spasm?", + "options": "A. Antibiotics B. Nitrates or calcium channel blockers C. Surgical removal of the gallbladder D. Antiviral medications", + "answer": "B" + }, + { + "question": "A female presents with episodic right upper quadrant pain after cholecystectomy. What imaging technique is most appropriate to evaluate biliary anatomy and exclude structural pathology in suspected Sphincter of Oddi spasm?", + "options": "A. Abdominal ultrasound B. MRCP C. CT scan D. Endoscopic ultrasound", + "answer": "B" + }, + { + "question": "A female presents with episodic right upper quadrant pain following cholecystectomy. Which of the following conditions is NOT associated with Sphincter of Oddi spasm?", + "options": "A. Gallstone disease B. Post-cholecystectomy syndrome C. Appendicitis D. Chronic pancreatitis", + "answer": "C" + }, + { + "question": "What distinguishes Sphincter of Oddi spasm from structural obstructions like stones?", + "options": "A. Presence of anatomical abnormalities B. Functional pathophysiology C. Persistent fever D. Elevated white blood cell count", + "answer": "B" + }, + { + "question": "Which of the following is a treatment option for refractory cases of Sphincter of Oddi spasm?", + "options": "A. Endoscopic sphincterotomy B. Liver transplant C. Chemotherapy D. Radiation therapy", + "answer": "A" + }, + { + "question": "What is the primary function of the Sphincter of Oddi?", + "options": "A. Regulating blood flow to the liver B. Controlling bile and pancreatic juice flow into the duodenum C. Filtering toxins from the blood D. Producing digestive enzymes", + "answer": "B" + }, + { + "question": "What is the primary organ affected by cholecystopathy?", + "options": "A. Liver B. Gallbladder C. Pancreas D. Bile ducts", + "answer": "B" + }, + { + "question": "Which of the following is a common symptom of cholecystopathy?", + "options": "A. Left lower quadrant pain B. Right upper quadrant pain C. Chest pain D. Lower back pain", + "answer": "B" + }, + { + "question": "In the absence of contraindications, what is the definitive treatment for severe or recurrent symptomatic cholelithiasis or cholecystitis?", + "options": "A. Antibiotic therapy B. Laparoscopic cholecystectomy C. Dietary modifications D. Pain management E. Endoscopic retrograde cholangiopancreatography (ERCP) F. Percutaneous cholecystostomy", + "answer": "B" + }, + { + "question": "What is the congenital anomaly characterized by abnormal dilatation of the bile ducts?", + "options": "A. Cholecystitis B. Choledochal cyst C. Biliary dyskinesia D. Gallstones", + "answer": "B" + }, + { + "question": "A 3-month-old infant presents with jaundice and a palpable right upper quadrant mass. Which of the following is the most likely presenting symptom of choledochal cysts due to bile duct obstruction?", + "options": "A. Abdominal pain B. Jaundice C. Dark urine D. Pale stools", + "answer": "B" + }, + { + "question": "What is the surgical treatment for choledochal cysts?", + "options": "A. Laparoscopic cholecystectomy B. Roux-en-Y hepaticojejunostomy C. Antibiotic therapy D. Pain management", + "answer": "B" + }, + { + "question": "A child presents with jaundice and abdominal pain. Imaging reveals a choledochal cyst. If left untreated, which of the following complications is most likely to develop over time?", + "options": "A. Pancreatitis B. Cirrhosis C. Biliary dyskinesia D. Cholangiocarcinoma", + "answer": "B" + }, + { + "question": "Which of the following is a key difference in the etiology of cholecystopathy and choledochal cysts?", + "options": "A. Cholecystopathy is congenital, while choledochal cysts are acquired B. Cholecystopathy affects the gallbladder, while choledochal cysts affect the bile ducts C. Cholecystopathy is acquired, while choledochal cysts are congenital D. Cholecystopathy is associated with gallstones, while choledochal cysts are associated with biliary malformations", + "answer": "C" + }, + { + "question": "A patient presents with recurrent episodes of biliary colic and elevated liver enzymes. Imaging reveals abnormal narrowing of the sphincter of Oddi. Which condition is most likely responsible for these findings?", + "options": "A. Stenosing papillitis of the duodenum B. Stenosis of the sphincter of Oddi C. Choledocholithiasis D. Pancreatic pseudocyst", + "answer": "B" + }, + { + "question": "A patient presents with obstructive jaundice and biopsy-confirmed atypical hyperplasia of the ampulla of Vater. The patient is referred for definitive management. What is the primary treatment, and why is it preferred over other options?", + "options": "A. Endoscopic resection with close surveillance B. Pancreaticoduodenectomy (Whipple procedure) C. Chemoradiation therapy D. Observation with serial imaging", + "answer": "B" + }, + { + "question": "A patient with a history of recurrent biliary colic presents with jaundice and epigastric pain. Imaging reveals inflammation-induced stricture of the duodenal papilla. Which condition is most likely responsible?", + "options": "A. Stenosis of sphincter of Oddi B. Stenosing papillitis of the duodenum C. Pancreatic pseudocyst D. Biliary atresia", + "answer": "B" + }, + { + "question": "A patient with a congenital choledochal cyst presents for follow-up. Which of the following is the most common long-term complication of this condition?", + "options": "A. Hemobilia B. Cholangiocarcinoma C. Biliary stricture D. Pancreatitis", + "answer": "B" + }, + { + "question": "A patient presents with Quincke’s triad (pain, jaundice, and gastrointestinal bleeding). Which condition is most likely responsible for this presentation?", + "options": "A. Hemobilia B. Ulcer of bile duct C. Choledochal cyst D. Stenosis of sphincter of Oddi E. Pancreatic pseudocyst F. Gallbladder carcinoma", + "answer": "A" + }, + { + "question": "A patient presents with jaundice and abdominal pain. Imaging reveals a biliary abnormality. What is the main anatomical difference between choledochal cysts and choledochal hypertrophy?", + "options": "A. Cysts are dilated structures; hypertrophy denotes wall thickening B. Cysts are more commonly associated with pancreatitis C. Cysts are congenital; hypertrophy is acquired D. Cysts require surgical intervention; hypertrophy may resolve with conservative management", + "answer": "A" + }, + { + "question": "A female presents with recurrent episodes of biliary-type pain and elevated liver enzymes. Which diagnostic method is most appropriate to confirm stenosis of the sphincter of Oddi?", + "options": "A. Abdominal ultrasound B. MRCP C. ERCP with manometry D. CT scan of the abdomen", + "answer": "C" + }, + { + "question": "A male presents with upper gastrointestinal bleeding and biliary colic following a motor vehicle accident. Which of the following is the most likely cause of his hemobilia?", + "options": "A. Gallbladder polyps B. Hepatic trauma C. Hepatic artery aneurysm D. Chronic cholangitis", + "answer": "B" + }, + { + "question": "A patient presents with recurrent biliary colic and episodic jaundice. Imaging reveals narrowing at the level of the duodenal papilla. What is the key anatomical and pathological distinction between stenosis of the sphincter of Oddi and stenosing papillitis of the duodenum?", + "options": "A. Stenosis involves fibrosis of the sphincter of Oddi; stenosing papillitis involves inflammation of the duodenal papilla. B. Stenosis is associated with biliary dyskinesia; stenosing papillitis is linked to chronic pancreatitis. C. Stenosis affects the sphincter of Oddi; stenosing papillitis affects the duodenal papilla. D. Stenosis requires surgical sphincteroplasty; stenosing papillitis responds to endoscopic papillectomy.", + "answer": "C" + }, + { + "question": "A patient presents with obstructive jaundice six months after undergoing cholecystectomy. Imaging reveals narrowing and adhesion of the bile duct. What is the most likely etiology of this finding?", + "options": "A. Congenital malformation B. Post-surgical scarring C. Chronic pancreatitis D. Autoimmune cholangitis", + "answer": "B" + }, + { + "question": "A child presents with jaundice and abdominal distension. Imaging reveals a cystic dilatation of the bile ducts. Which of the following conditions is most likely responsible?", + "options": "A. Biliary atresia B. Choledochal dilatation C. Atrophy of bile duct D. Primary sclerosing cholangitis", + "answer": "B" + }, + { + "question": "What is the hallmark symptom of Vanishing Bile Duct Syndrome (VBDS)?", + "options": "A. Abdominal pain B. Pruritus C. Arrhythmias D. Dark urine", + "answer": "B" + }, + { + "question": "Which treatment is most appropriate for spasm of the bile duct?", + "options": "A. Liver transplant B. Antispasmodics C. Surgical resection D. Immunosuppressants", + "answer": "B" + }, + { + "question": "A 6-month-old infant presents with cholestatic jaundice, congenital heart defects, and butterfly vertebrae. Which of the following is the most distinguishing feature of Alagille syndrome compared to Vanishing Bile Duct Syndrome (VBDS)?", + "options": "A. Presence of congenital anomalies (e.g., heart defects, butterfly vertebrae) B. History of drug-induced liver injury C. Reversible bile duct damage on imaging D. Absence of JAG1 or NOTCH2 mutations", + "answer": "A" + }, + { + "question": "A patient presents with epigastric pain radiating to the chest and transient tachycardia. For advanced medical students or residents, which condition is most likely associated with these reflex cardiovascular symptoms?", + "options": "A. Myocardial infarction B. Cholecysto-cardiac syndrome C. Gastroesophageal reflux disease D. Pancreatitis", + "answer": "B" + }, + { + "question": "A patient with a history of prior biliary surgery presents with obstructive jaundice and right upper quadrant pain. Imaging reveals a stricture in the bile duct consistent with a fibrotic scar. What is the first-line treatment for this condition?", + "options": "A. Surgical adhesiolysis B. Endoscopic retrograde cholangiopancreatography (ERCP) with stenting C. Percutaneous transhepatic cholangiography (PTC) D. Antispasmodics", + "answer": "B" + }, + { + "question": "A patient with progressive jaundice and imaging findings consistent with bile duct atrophy presents for management. What is the primary treatment approach?", + "options": "A. Immunosuppressants B. Stenting or liver transplant C. Antispasmodics D. Bile acid sequestrants", + "answer": "B" + }, + { + "question": "A patient presents with abdominal pain and jaundice. Which of the following symptoms is most commonly associated with bile duct neoplasms?", + "options": "A. Abdominal pain B. Jaundice C. Weight loss D. Hematuria", + "answer": "A" + }, + { + "question": "Which imaging modality is typically used to delineate the extent of common bile duct neoplasms?", + "options": "A. CT scan B. Ultrasound C. MRCP D. X-ray", + "answer": "C" + }, + { + "question": "What is the primary treatment for localized bile duct neoplasms?", + "options": "A. Chemotherapy B. Radiation therapy C. Radical surgical resection D. Palliative care", + "answer": "C" + }, + { + "question": "Which condition is NOT associated with the etiology of bile duct neoplasms?", + "options": "A. Hepatolithiasis B. Clonorchis sinensis infection C. Primary sclerosing cholangitis D. Hypertension", + "answer": "D" + }, + { + "question": "A male presents with painless jaundice, weight loss, and clay-colored stools. Imaging reveals a mass in the bile duct. What is a distinguishing feature of malignant common bile duct neoplasms compared to intrahepatic bile duct neoplasms?", + "options": "A. Subtle symptoms until advanced B. Early obstructive jaundice C. Weight loss D. Abdominal pain", + "answer": "B" + }, + { + "question": "A patient with jaundice and biliary duct dilation on imaging undergoes biopsy, revealing an intraductal papillary neoplasm of the bile duct. Which histological subtype is most characteristic of this condition?", + "options": "A. Tubular adenocarcinoma B. Mucinous C. Hepatoid carcinoma D. Intrahepatic cholangiocarcinoma", + "answer": "B" + }, + { + "question": "What is a critical factor in the prognosis of common bile duct neoplasms?", + "options": "A. Age of the patient B. Resection margins and nodal involvement C. Presence of hypertension D. History of smoking", + "answer": "B" + }, + { + "question": "Which of the following is a characteristic MRI finding of bile duct neoplasms?", + "options": "A. T1 hyperintensity B. T2 hypointensity C. T1 iso-/hypointensity and T2 hyperintensity D. No contrast enhancement", + "answer": "C" + }, + { + "question": "What is the primary surgical procedure for distal common bile duct lesions?", + "options": "A. Hepatectomy B. Whipple procedure C. Cholecystectomy D. Appendectomy", + "answer": "B" + }, + { + "question": "Which of the following surgical management strategies is most specific to intrahepatic bile duct tumors compared to common bile duct tumors?", + "options": "A. Intrahepatic tumors require extensive biliary reconstruction B. Common bile duct lesions are typically managed with biliary stenting or resection without hepatectomy C. Intrahepatic tumors may necessitate hepatectomy", + "answer": "C" + }, + { + "question": "What is the hallmark symptom of idiopathic acute pancreatitis?", + "options": "A. Severe epigastric pain radiating to the back B. Persistent headache C. Chest tightness D. Joint swelling", + "answer": "A" + }, + { + "question": "A male presents with severe epigastric pain radiating to the back, nausea, and vomiting. Which diagnostic marker is most indicative of idiopathic acute pancreatitis?", + "options": "A. Elevated serum amylase/lipase (≥3x normal) B. Elevated serum creatinine C. Normal serum calcium levels D. Decreased serum albumin", + "answer": "A" + }, + { + "question": "What is the primary treatment approach for mild acute idiopathic pancreatitis?", + "options": "A. Surgical intervention B. Aggressive fluid resuscitation and fasting C. Long-term antibiotic therapy D. Immediate oral refeeding with solid foods", + "answer": "B" + }, + { + "question": "Which of the following is a characteristic feature of severe acute idiopathic pancreatitis?", + "options": "A. Mild abdominal pain B. Persistent organ failure C. Absence of fever D. Normal inflammatory markers", + "answer": "B" + }, + { + "question": "A male presents with severe epigastric pain radiating to the back, nausea, and elevated serum lipase levels. What is the most appropriate initial imaging modality to confirm idiopathic acute pancreatitis?", + "options": "A. Abdominal X-ray B. Magnetic resonance imaging (MRI) C. Contrast-enhanced computed tomography (CT) D. Endoscopic ultrasound E. Transabdominal ultrasound", + "answer": "C" + }, + { + "question": "Which of the following is a common complication of severe acute idiopathic pancreatitis requiring intensive care?", + "options": "A. Pancreatic necrosis B. Pseudocyst formation C. Hyperglycemia D. Ascites", + "answer": "A" + }, + { + "question": "What is the recommended initial nutritional support for patients with mild acute idiopathic pancreatitis within the first 24 hours after symptoms subside?", + "options": "A. High-fat diet B. Clear liquids C. Gradual reintroduction of low-fat solid foods D. Parenteral nutrition", + "answer": "B" + }, + { + "question": "A male presents with acute idiopathic pancreatitis. Which of the following is a key difference in clinical outcomes between mild and severe forms of this condition?", + "options": "A. Presence of transient organ failure in mild cases B. Need for early enteral feeding in mild cases C. Higher mortality rates in severe cases D. Absence of pancreatic necrosis in severe cases", + "answer": "C" + }, + { + "question": "A male presents with severe epigastric pain, vomiting, and systemic inflammatory response syndrome (SIRS). CT imaging reveals pancreatic necrosis. In this patient with severe acute idiopathic pancreatitis complicated by pancreatic necrosis, what is the primary role of prophylactic antibiotics?", + "options": "A. To treat systemic inflammatory response syndrome (SIRS) B. To prevent infection in pancreatic necrosis C. To reduce pancreatic enzyme secretion D. To prevent gastrointestinal bleeding", + "answer": "B" + }, + { + "question": "A patient presents with sudden onset of abdominal pain. Which of the following is most consistent with mild acute idiopathic pancreatitis?", + "options": "A. High fever B. Hemodynamic instability C. Moderate abdominal pain D. Nausea and vomiting", + "answer": "C" + }, + { + "question": "What is the primary cause of acute pancreatitis of biliary origin?", + "options": "A. Alcohol consumption B. Gallstones obstructing the pancreatic or bile duct C. Viral infection D. Autoimmune disease", + "answer": "B" + }, + { + "question": "Which of the following is a typical symptom of acute pancreatitis of biliary origin?", + "options": "A. Severe epigastric pain radiating to the back B. Chest pain C. Diarrhea D. Headache", + "answer": "A" + }, + { + "question": "What laboratory findings are commonly associated with acute pancreatitis of biliary origin?", + "options": "A. Elevated serum amylase and lipase B. Decreased white blood cell count C. Low serum bilirubin D. Normal liver enzymes", + "answer": "A" + }, + { + "question": "What is the primary treatment for acute pancreatitis of biliary origin?", + "options": "A. Antibiotics B. Fluid resuscitation and pain management C. Chemotherapy D. Radiation therapy", + "answer": "B" + }, + { + "question": "Which procedure is typically used to address biliary obstruction in acute pancreatitis of biliary origin?", + "options": "A. Laparotomy B. Endoscopic retrograde cholangiopancreatography (ERCP) C. Colonoscopy D. Bronchoscopy", + "answer": "B" + }, + { + "question": "A female presents with epigastric pain radiating to the back, nausea, and elevated serum lipase. Imaging is performed to assess the severity of acute biliary pancreatitis. Which of the following findings best distinguishes mild acute biliary pancreatitis from severe acute biliary pancreatitis?", + "options": "A. Presence of organ failure (e.g., hypotension or respiratory distress) B. Localized pancreatic inflammation vs. extensive pancreatic necrosis C. Extent of peripancreatic fluid collections on imaging D. Severity of systemic inflammatory response (e.g., leukocytosis or fever)", + "answer": "B" + }, + { + "question": "What is a key feature of severe acute biliary pancreatitis?", + "options": "A. Mild epigastric pain B. Multi-organ dysfunction C. Absence of systemic complications D. Rapid recovery without intervention", + "answer": "B" + }, + { + "question": "Which of the following is a management strategy for mild acute biliary pancreatitis?", + "options": "A. Surgical debridement B. Fasting and intravenous fluids C. Parenteral nutrition D. Chemotherapy", + "answer": "B" + }, + { + "question": "What is a common complication of severe acute biliary pancreatitis?", + "options": "A. Localized inflammation B. Respiratory or renal failure C. Mild pain D. Rapid recovery", + "answer": "B" + }, + { + "question": "A patient presents with severe epigastric pain radiating to the back, vomiting, and jaundice. Imaging confirms severe acute biliary pancreatitis with signs of systemic inflammatory response syndrome (SIRS). What is the most likely short-term prognosis for this patient?", + "options": "A. High likelihood of recovery with early biliary decompression and supportive care B. Poor due to high risk of multiorgan failure and systemic complications C. Moderate risk of mortality if treatment is delayed beyond 72 hours D. Complete resolution without long-term pancreatic dysfunction", + "answer": "B" + }, + { + "question": "What is the primary cause of Alcoholic Acute Pancreatitis?", + "options": "A. Bacterial infection B. Alcohol-induced toxicity C. Autoimmune response D. Viral infection", + "answer": "B" + }, + { + "question": "Which of the following is a typical symptom of Alcoholic Acute Pancreatitis?", + "options": "A. Chest pain B. Severe epigastric pain radiating to the back C. Headache D. Joint pain", + "answer": "B" + }, + { + "question": "What is a critical component of treatment for all forms of Alcoholic Acute Pancreatitis?", + "options": "A. Antibiotic therapy B. Long-term abstinence from alcohol C. Surgical intervention D. Chemotherapy", + "answer": "B" + }, + { + "question": "A male with a history of heavy alcohol use presents with sudden-onset epigastric pain radiating to the back, nausea, and vomiting. Laboratory tests reveal mildly elevated serum amylase and lipase. Imaging shows pancreatic edema without necrosis or systemic complications. Which of the following best characterizes this presentation of Acute Alcoholic Pancreatitis, Mild, defined by minimal organ dysfunction and absence of systemic complications?", + "options": "A. Multi-organ failure B. Transient abdominal pain with minimal pancreatic enzyme elevation C. Hemodynamic instability requiring vasopressors D. Respiratory distress necessitating mechanical ventilation", + "answer": "B" + }, + { + "question": "In terms of clinical management, what is a key difference between mild and severe Acute Alcoholic Pancreatitis?", + "options": "A. Mild cases may resolve with oral hydration and pain management B. Severe cases resolve with basic supportive care alone C. Severe cases often require advanced interventions such as ICU admission or invasive procedures D. Mild cases typically present with persistent multi-organ failure", + "answer": "C" + }, + { + "question": "Which of the following is the most appropriate initial management step for a patient with pancreatic necrosis due to severe Acute Alcoholic Pancreatitis?", + "options": "A. Immediate surgical debridement B. Aggressive fluid resuscitation and ICU monitoring C. Short-term fasting and pain control D. Oral pancreatic enzyme replacement E. Empiric broad-spectrum antibiotics alone", + "answer": "B" + }, + { + "question": "What is the primary goal of treatment for Acute Alcoholic Pancreatitis, Mild?", + "options": "A. Surgical intervention B. Supportive measures including hydration and analgesics C. Prolonged nutritional support D. Intensive care management", + "answer": "B" + }, + { + "question": "A male with a history of chronic alcohol use presents with severe abdominal pain, nausea, and vomiting. Which of the following findings is most consistent with severe acute alcoholic pancreatitis?", + "options": "A. Jaundice B. Hemodynamic instability C. Cullen's sign D. Grey Turner's sign", + "answer": "B" + }, + { + "question": "A male with severe Acute Alcoholic Pancreatitis presents to the emergency department. Which of the following interventions is most critical to improving his prognosis?", + "options": "A. Long-term antibiotic use B. Early aggressive treatment and strict alcohol avoidance C. Delayed initiation of treatment D. Intermittent alcohol use", + "answer": "B" + }, + { + "question": "What is the primary cause of drug-induced acute pancreatitis?", + "options": "A. Bacterial infection B. Toxic or hypersensitivity reaction to drugs C. Viral infection D. Autoimmune response", + "answer": "B" + }, + { + "question": "Which of the following is a typical symptom of drug-induced acute pancreatitis?", + "options": "A. Severe epigastric pain radiating to the back B. High fever C. Chest pain D. Diarrhea", + "answer": "A" + }, + { + "question": "What is the first step in the treatment of drug-induced acute pancreatitis?", + "options": "A. Administration of antibiotics B. Discontinuation of the offending drug C. Surgical intervention D. Immediate oral feeding", + "answer": "B" + }, + { + "question": "Which of the following is a characteristic of mild acute drug-induced pancreatitis?", + "options": "A. Persistent organ failure B. Severe systemic complications C. Minimal systemic involvement D. High mortality rate", + "answer": "C" + }, + { + "question": "Although rare, drug-induced pancreatitis can present with varying severity. What is a key clinical feature that distinguishes mild from severe acute drug-induced pancreatitis?", + "options": "A. Mild cases involve organ failure B. Severe cases are associated with persistent organ failure C. Mild cases lack organ failure D. Severe cases are characterized by significant systemic inflammation", + "answer": "C" + }, + { + "question": "Which of the following is required in the management of acute severe drug-induced pancreatitis?", + "options": "A. Oral nutrition B. Intensive care and fluid resuscitation C. Immediate surgical intervention D. Minimal hydration", + "answer": "B" + }, + { + "question": "A patient presents with acute severe drug-induced pancreatitis. Which of the following is a potential systemic complication?", + "options": "A. Transient hypotension B. Shock C. Mild fever D. Localized abdominal tenderness", + "answer": "B" + }, + { + "question": "Which of the following is a common diagnostic marker for drug-induced acute pancreatitis?", + "options": "A. Elevated serum amylase/lipase B. Low blood pressure C. High white blood cell count D. Elevated liver enzymes", + "answer": "A" + }, + { + "question": "What is the initial nutritional approach for a patient with drug-induced acute pancreatitis?", + "options": "A. Immediate oral intake B. Enteral nutrition C. NPO (nothing by mouth) D. High-fat diet", + "answer": "C" + }, + { + "question": "A patient presents with acute severe drug-induced pancreatitis (a rare etiology accounting for <5% of cases) and evidence of infected pancreatic necrosis. Which of the following interventions is most appropriate?", + "options": "A. Symptomatic relief only B. Drainage for infected necrosis C. Aggressive intravenous hydration D. Immediate oral feeding E. Early initiation of enteral nutrition", + "answer": "B" + }, + { + "question": "A patient develops mild pancreatitis (characterized by transient abdominal pain and minimal pancreatic enzyme elevation) immediately following an endoscopic retrograde cholangiopancreatography (ERCP). What is the most likely primary cause of this acute postprocedural condition?", + "options": "A. Alcohol consumption B. Mechanical trauma to the pancreatic duct C. Genetic mutations D. Hypertriglyceridemia", + "answer": "B" + }, + { + "question": "A male presents with acute epigastric pain and nausea following blunt abdominal trauma. Imaging reveals mild pancreatic inflammation without necrosis. Which of the following is the most distinguishing feature of Acute Traumatic Pancreatitis, Mild?", + "options": "A. Presence of pancreatic pseudocysts B. History of abdominal trauma C. Elevated serum amylase levels D. History of chronic alcohol use", + "answer": "B" + }, + { + "question": "What is the main focus of long-term management for Acute Recurrent Pancreatitis, Mild?", + "options": "A. Bowel rest and IV fluids B. Pain control and hydration C. Targeting underlying causes D. Use of immunosuppressants", + "answer": "C" + }, + { + "question": "Which of the following is a characteristic of Acute Edematous Pancreatitis, Mild?", + "options": "A. Presence of tissue necrosis B. Self-limiting symptoms C. Persistent organ failure D. Severe abdominal pain", + "answer": "B" + }, + { + "question": "A patient presents with mild abdominal pain, elevated IgG4 levels, and imaging findings consistent with Acute Autoimmune Pancreatitis. What is the first-line therapy?", + "options": "A. Pancreatic enzyme replacement B. Immunosuppressants other than steroids C. Steroids D. Antibiotics", + "answer": "C" + }, + { + "question": "According to the Atlanta classification, what is the key feature that distinguishes Acute Postprocedural Pancreatitis, Severe (defined by persistent organ failure lasting >48 hours) from its mild form?", + "options": "A. Transient organ dysfunction B. Persistent organ failure C. Self-limiting symptoms D. Elevated serum amylase/lipase", + "answer": "B" + }, + { + "question": "Mild acute pancreatitis accounts for 80% of cases and typically follows a self-limiting course. Which of the following is a common symptom across all mild forms of acute pancreatitis?", + "options": "A. Jaundice B. Mild epigastric discomfort C. Nausea and vomiting D. Low-grade fever", + "answer": "C" + }, + { + "question": "What is a key diagnostic marker for Acute Autoimmune Pancreatitis, Mild?", + "options": "A. Elevated serum amylase B. Elevated IgG4 levels C. Presence of gallstones D. Hypertriglyceridemia", + "answer": "B" + }, + { + "question": "A male presents with epigastric pain radiating to the back, nausea, and vomiting. Imaging reveals mild pancreatic edema without necrosis. Which of the following is NOT a recognized cause of Acute Edematous Pancreatitis, Mild?", + "options": "A. Gallstones B. Alcohol C. Hypertriglyceridemia D. Blunt abdominal trauma", + "answer": "D" + }, + { + "question": "What is the primary treatment approach for Acute Postprocedural Pancreatitis, Mild?", + "options": "A. Steroids B. Bowel rest and IV fluids C. Antibiotics D. Endoscopic drainage", + "answer": "B" + }, + { + "question": "A male presents with severe epigastric pain radiating to the back, vomiting, and abdominal tenderness. Imaging reveals pancreatic necrosis with hemorrhage. Which of the following is the most common cause of this condition (Acute Hemorrhagic Pancreatitis)?", + "options": "A. Gallstone-related bacterial infection B. Chronic alcohol abuse C. Autoimmune pancreatitis D. Hereditary PRSS1 gene mutation", + "answer": "B" + }, + { + "question": "What is a distinguishing feature of Acute Necrotizing Pancreatitis, Severe on contrast-enhanced CT imaging?", + "options": "A. Hemorrhage into pancreatic tissue B. Pus formation within the pancreas C. Non-enhancing pancreatic parenchyma D. Air within the pancreas", + "answer": "C" + }, + { + "question": "A male presents with severe abdominal pain, jaundice, and elevated pancreatic enzymes. Imaging reveals diffuse pancreatic enlargement. Which treatment is first-line for Acute Severe Autoimmune Pancreatitis in this patient?", + "options": "A. Broad-spectrum antibiotics B. High-dose corticosteroids C. Pancreatic resection D. Supportive care with fluid resuscitation", + "answer": "B" + }, + { + "question": "A male presents with severe abdominal pain and vomiting. Which of the following symptoms is most indicative of Acute Severe Suppurative Pancreatitis?", + "options": "A. Jaundice B. Fever C. Hypotension D. Severe abdominal pain", + "answer": "B" + }, + { + "question": "A male presents with severe abdominal pain following a motor vehicle accident. Imaging reveals pancreatic injury. Which of the following is the most likely cause of his acute traumatic pancreatitis?", + "options": "A. Gallstones B. Blunt abdominal trauma C. Alcohol abuse D. Hypertriglyceridemia", + "answer": "B" + }, + { + "question": "A patient develops acute severe pancreatitis with persistent abdominal pain, vomiting, and hypotension following an endoscopic retrograde cholangiopancreatography (ERCP). What is the most critical step in their immediate management?", + "options": "A. Aggressive intravenous fluid resuscitation B. Early initiation of enteral nutrition C. Procedural risk mitigation for future interventions D. Empiric broad-spectrum antibiotics", + "answer": "A" + }, + { + "question": "Which of the following is a characteristic feature of Acute Recurrent Severe Pancreatitis, a condition marked by repeated episodes of pancreatic inflammation leading to chronic damage?", + "options": "A. Episodes of mild abdominal pain without long-term damage B. Cumulative organ damage C. Pancreatic pseudocyst formation D. Elevated serum amylase and lipase levels", + "answer": "B" + }, + { + "question": "What is a primary diagnostic marker for Acute Severe Autoimmune Pancreatitis?", + "options": "A. Elevated serum amylase B. Increased serum IgG4 C. Leukocytosis D. Prolonged prothrombin time", + "answer": "B" + }, + { + "question": "Which of the following is a key difference in the management of Acute Severe Suppurative Pancreatitis compared to non-suppurative acute pancreatitis?", + "options": "A. Use of steroids B. Surgical intervention C. Culture-directed antibiotics D. Early enteral nutrition", + "answer": "C" + }, + { + "question": "A male presents with acute abdominal pain and vomiting. Which symptom is most suggestive of severe acute pancreatitis compared to mild cases?", + "options": "A. Jaundice B. Severe epigastric pain C. Organ failure D. Hypotension", + "answer": "C" + }, + { + "question": "What is the most common cause of acute pancreatitis?", + "options": "A. Viral infection B. Gallstones C. Autoimmune disease D. Trauma", + "answer": "B" + }, + { + "question": "Which of the following symptoms is most characteristic of acute pancreatitis?", + "options": "A. Chest pain B. Severe epigastric pain radiating to the back C. Diarrhea D. Headache", + "answer": "B" + }, + { + "question": "What is the primary treatment approach for acute pancreatitis?", + "options": "A. Immediate surgery B. Hospitalization, fasting, and intravenous fluids C. Oral antibiotics D. Radiation therapy", + "answer": "B" + }, + { + "question": "In rare cases of acute pancreatitis, which condition is characterized by pancreatic necrosis, systemic inflammatory response syndrome, and multi-organ dysfunction?", + "options": "A. Mild acute pancreatitis B. Moderate acute pancreatitis C. Acute severe pancreatitis D. Chronic pancreatitis", + "answer": "C" + }, + { + "question": "Which of the following best describes the clinical presentation that distinguishes subacute pancreatitis from acute pancreatitis?", + "options": "A. Presence of chronic abdominal pain B. Milder symptoms and slower progression C. Gradual onset requiring conservative management D. Higher risk of developing chronic pancreatitis", + "answer": "B" + }, + { + "question": "A male presents with severe epigastric pain, fever, and tachycardia. Which of the following findings is most consistent with acute severe pancreatitis?", + "options": "A. Self-limiting symptoms B. Systemic inflammatory response syndrome (SIRS) C. Mild pain D. Elevated serum amylase levels", + "answer": "B" + }, + { + "question": "What is a critical intervention for acute severe pancreatitis?", + "options": "A. Dietary adjustments B. Aggressive fluid resuscitation C. Oral painkillers D. Outpatient monitoring", + "answer": "B" + }, + { + "question": "Which of the following is NOT a typical symptom of acute pancreatitis?", + "options": "A. Nausea B. Vomiting C. Fever D. Joint pain", + "answer": "D" + }, + { + "question": "What is the primary goal of treatment in subacute pancreatitis?", + "options": "A. Immediate surgery B. Supportive care and monitoring C. Aggressive fluid resuscitation D. Radiation therapy", + "answer": "B" + }, + { + "question": "Acute severe pancreatitis, though rare, requires prompt recognition due to its high morbidity. Which of the following is a distinguishing feature of acute severe pancreatitis, as opposed to mild acute pancreatitis?", + "options": "A. Resolution within 48 hours with conservative management B. Pancreatic necrosis C. Mild symptoms D. No need for hospitalization", + "answer": "B" + }, + { + "question": "What is the primary cause of alcoholic chronic pancreatitis?", + "options": "A. Genetic predisposition B. Prolonged excessive alcohol consumption C. Viral infection D. Autoimmune disease", + "answer": "B" + }, + { + "question": "Which of the following mechanisms is NOT involved in the pathogenesis of alcoholic chronic pancreatitis?", + "options": "A. Ethanol-induced hypertriglyceridemia B. Direct cytotoxic effects on pancreatic cells C. Increased intraductal pressure due to ductal obstruction D. Enhanced insulin secretion", + "answer": "D" + }, + { + "question": "What is a typical symptom of alcoholic chronic pancreatitis?", + "options": "A. Persistent epigastric pain radiating to the back B. Sudden onset of jaundice C. Severe headache D. Chest pain", + "answer": "A" + }, + { + "question": "Which of the following is a common complication of alcoholic chronic pancreatitis?", + "options": "A. Hypertension B. Diabetes mellitus C. Hyperthyroidism D. Osteoporosis", + "answer": "B" + }, + { + "question": "What is a key component of the management of alcoholic chronic pancreatitis?", + "options": "A. Regular exercise B. Abstinence from alcohol C. High-fat diet D. Increased caffeine intake", + "answer": "B" + }, + { + "question": "Which treatment is used to address malabsorption in alcoholic chronic pancreatitis?", + "options": "A. Insulin therapy B. Pancreatic enzyme replacement C. Antihypertensive drugs D. Antidepressants", + "answer": "B" + }, + { + "question": "A male with a history of alcohol use presents with recurrent abdominal pain and steatorrhea. Which feature most distinguishes chronic pancreatitis from acute pancreatitis?", + "options": "A. Presence of pancreatic calcifications on imaging B. Progressive functional decline C. Sudden onset of symptoms D. Episodic pain with symptom-free intervals", + "answer": "B" + }, + { + "question": "Which intervention may be required in severe cases of alcoholic chronic pancreatitis?", + "options": "A. Chemotherapy B. Endoscopic or surgical interventions C. Radiation therapy D. Physical therapy", + "answer": "B" + }, + { + "question": "A male with a history of chronic alcoholic pancreatitis presents with persistent abdominal pain. What is the role of pancreatic enzyme supplements in his management?", + "options": "A. To reduce pancreatic exocrine function B. To reduce feedback stimulation and pain C. To enhance alcohol metabolism D. To prevent fat malabsorption", + "answer": "B" + }, + { + "question": "A male with a 15-year history of heavy alcohol use presents with recurrent epigastric pain, steatorrhea, and weight loss. Imaging reveals pancreatic calcifications and ductal dilation. Which of the following underlying pathophysiological mechanisms is most likely responsible for his chronic pancreatitis?", + "options": "A. Recurrent acute pancreatitis leading to glandular fibrosis B. Autoimmune destruction of pancreatic acinar cells C. Alcohol-induced activation of pancreatic stellate cells and oxidative stress D. Gallstone obstruction causing ductal hypertension E. Genetic mutations (e.g., SPINK1, CFTR) impairing enzyme regulation", + "answer": "C" + }, + { + "question": "What is the first-line treatment for Chronic Autoimmune Pancreatitis (AIP)?", + "options": "A. Enzyme replacement therapy B. Steroids (e.g., prednisone) C. Surgical resection D. Endoscopic stenting", + "answer": "B" + }, + { + "question": "Which subtype of Chronic Pancreatitis is characterized by repeated episodes of acute pancreatitis occurring in the setting of pre-existing chronic pancreatic damage?", + "options": "A. Chronic Obstructive Pancreatitis B. Chronic Recurrent Pancreatitis C. Chronic Autoimmune Pancreatitis D. Chronic Fibrosing Pancreatitis", + "answer": "B" + }, + { + "question": "A female with a history of recurrent gallstones presents with episodic upper abdominal discomfort and digestive symptoms. Which of the following is the most common symptom of Chronic Cholelithiasis Pancreatitis?", + "options": "A. Painless jaundice B. Biliary colic C. Severe epigastric pain D. Nausea and vomiting", + "answer": "B" + }, + { + "question": "Accurate classification of Chronic Pancreatitis subtypes is critical for determining treatment strategies, as it guides management decisions such as endoscopic intervention or surgery. Which imaging modality is most commonly used for this purpose?", + "options": "A. Abdominal Ultrasound B. CT/MRCP C. Endoscopic Ultrasound D. PET scan", + "answer": "B" + }, + { + "question": "Which subtype of Chronic Pancreatitis is marked by extensive collagen deposition and often secondary to alcohol or genetic causes?", + "options": "A. Chronic Interstitial Pancreatitis B. Chronic Cystic Pancreatitis C. Chronic Fibrosing Pancreatitis D. Chronic Autoimmune Pancreatitis", + "answer": "C" + }, + { + "question": "What is a key distinction in the symptoms of Chronic Autoimmune Pancreatitis (AIP) compared to other subtypes?", + "options": "A. Presence of severe pain B. Painless jaundice C. Rapid exocrine insufficiency D. Biliary colic", + "answer": "B" + }, + { + "question": "A male with chronic traumatic pancreatitis and imaging-confirmed pancreatic duct disruption presents with persistent abdominal pain. Which treatment is most appropriate?", + "options": "A. Enzyme replacement therapy B. Endoscopic stenting C. Steroids D. Surgical drainage", + "answer": "B", + "rationale": "Endoscopic stenting is preferred for duct disruption as it allows for drainage and reduces pressure in the pancreatic duct." + }, + { + "question": "A patient with a history of chronic cystic pancreatitis presents with severe abdominal pain and fever. What is the most likely complication in this scenario?", + "options": "A. Diabetes mellitus B. Pancreatic pseudocyst C. Painless jaundice D. Rapid exocrine insufficiency", + "answer": "B" + }, + { + "question": "Which biomarker is analyzed for accurate classification of Chronic Autoimmune Pancreatitis (AIP)?", + "options": "A. SPINK1 B. CFTR C. IgG4 D. ALT", + "answer": "C" + }, + { + "question": "What is the primary cause of pseudocyst formation in the pancreas?", + "options": "A. Neoplastic growth B. Parasitic infections C. Inflammatory conditions D. Genetic disorders", + "answer": "C" + }, + { + "question": "A male with a history of chronic pancreatitis presents with abdominal pain and a cystic lesion on imaging. Which of the following is a characteristic feature of pancreatic pseudocysts?", + "options": "A. Presence of infection B. Fibrotic encapsulation of inflammatory fluid C. Association with trauma D. Mucin-lined walls", + "answer": "B" + }, + { + "question": "What is the most common symptom in patients with symptomatic larger benign pancreatic cysts?", + "options": "A. Jaundice B. Epigastric pain C. Weight loss D. Back pain", + "answer": "B" + }, + { + "question": "In a patient with suspected pancreatic pseudocysts, which imaging technique is most appropriate to differentiate pseudocysts from true cysts due to its ability to assess cyst wall characteristics and fluid content?", + "options": "A. X-ray B. Ultrasound C. PET scan D. Angiography E. CT scan with contrast F. MRI", + "answer": "B" + }, + { + "question": "A patient is diagnosed with a mucinous cystic neoplasm of the pancreas, which carries a risk of malignant transformation. What is the most appropriate management approach?", + "options": "A. Surveillance with imaging B. Endoscopic drainage C. Surgical resection D. Endoscopic ultrasound-guided ablation", + "answer": "C" + }, + { + "question": "A patient presents with pancreatic cysts. Which of the following is least likely to be associated with this condition?", + "options": "A. Chronic pancreatitis B. Parasitic infections C. Viral infections D. Autoimmune diseases", + "answer": "C" + }, + { + "question": "A patient with a family history of pancreatic cysts asks about lifestyle changes to reduce their risk. What is the most strongly recommended preventive measure?", + "options": "A. Regular exercise B. Alcohol moderation C. Increased caffeine intake D. Smoking cessation", + "answer": "B" + }, + { + "question": "A patient is found to have a pancreatic cyst on imaging. Which of the following is a benign neoplastic origin of pancreatic cysts?", + "options": "A. Serous cystadenoma B. Mucinous cystic neoplasm C. Intraductal papillary mucinous neoplasm (IPMN) D. Acute pancreatitis", + "answer": "A" + }, + { + "question": "What is the recommended waiting period before draining a pancreatic pseudocyst that has been stable in size and symptoms for at least 4 weeks (indicating maturity)? This waiting period allows the pseudocyst wall to mature and reduces the risk of complications during drainage.", + "options": "A. 1–2 weeks (early intervention) B. 2–3 weeks (moderate waiting) C. 4–6 weeks (standard waiting period) D. 6–8 weeks (extended waiting period)", + "answer": "C" + }, + { + "question": "What is the primary cause of a pancreatic pseudocyst?", + "options": "A. Bacterial infection B. Leakage of pancreatic enzymes due to ductal disruption C. Genetic mutation D. Autoimmune response", + "answer": "B" + }, + { + "question": "Which of the following imaging techniques is used to diagnose a pancreatic pseudocyst?", + "options": "A. X-ray B. CT, MRI, or ultrasound C. PET scan D. Angiography", + "answer": "B" + }, + { + "question": "What is a common symptom of a pancreatic pseudocyst?", + "options": "A. Persistent epigastric pain radiating to the back B. High fever C. Severe headache D. Chest pain", + "answer": "A" + }, + { + "question": "Which of the following is a potential complication of a pancreatic pseudocyst?", + "options": "A. Hypertension B. Infection, hemorrhage, or rupture C. Diabetes mellitus D. Chronic kidney disease", + "answer": "B" + }, + { + "question": "What is the recommended management for a small asymptomatic pancreatic pseudocyst?", + "options": "A. Immediate surgical drainage B. Percutaneous drainage C. Endoscopic transmural stenting D. Spontaneous resolution", + "answer": "D" + }, + { + "question": "On histopathological examination, what feature differentiates a pancreatic pseudocyst from a true cystic neoplasm?", + "options": "A. Presence of an epithelial lining B. Wall composed of fibrous or granulation tissue C. Presence of mucin-producing epithelium D. Association with chronic pancreatitis", + "answer": "B" + }, + { + "question": "Which of the following interventions is NOT typically used for larger or symptomatic pancreatic pseudocysts?", + "options": "A. Percutaneous drainage B. Endoscopic transmural stenting C. Surgical drainage D. Chemotherapy", + "answer": "D" + }, + { + "question": "What is a key diagnostic feature of a pancreatic pseudocyst on imaging?", + "options": "A. Solid mass with irregular borders B. Well-defined fluid collections with enhancing walls C. Calcifications within the cyst D. Multiple small nodules", + "answer": "B" + }, + { + "question": "Why is early intervention critical for infected or rapidly enlarging pancreatic pseudocysts in a patient presenting with fever and abdominal pain?", + "options": "A. To minimize the risk of infection spreading to adjacent organs B. To avoid unnecessary imaging C. To prevent life-threatening sequelae D. To reduce the likelihood of developing chronic pancreatitis", + "answer": "C" + }, + { + "question": "Which of the following is a characteristic feature of pancreatic necrosis?", + "options": "A. Chronic fibrotic tissue replacement B. Irreversible cellular death due to autodigestion C. Hardening of pancreatic islets D. Abnormal cell proliferation", + "answer": "B" + }, + { + "question": "In the context of chronic pancreatitis, what is the primary cause of fibrosis of the pancreas?", + "options": "A. Acute pancreatitis B. Recurrent inflammation C. Genetic mutations (e.g., CFTR) D. Autoimmune destruction", + "answer": "B" + }, + { + "question": "Which condition is most likely to cause hyperglycemia due to direct damage to the insulin-producing beta cells in the islets of Langerhans?", + "options": "A. Pancreatic necrosis involving exocrine tissue only B. Fibrosis sparing the pancreatic islets C. Islet sclerosis with beta-cell destruction D. Chronic pancreatitis with preserved islet function", + "answer": "C" + }, + { + "question": "A patient presents with recurrent episodes of abdominal discomfort and difficulty digesting fatty foods. Imaging reveals a stricture of the pancreatic duct. What is the most characteristic clinical manifestation of this condition?", + "options": "A. Severe epigastric pain radiating to the back B. Jaundice C. Steatorrhea D. Obstructive symptoms (e.g., postprandial bloating and nausea)", + "answer": "D" + }, + { + "question": "A patient presents with recurrent epigastric pain, steatorrhea, and weight loss. Imaging and biopsy confirm diffuse hyperplasia of the pancreas. Which treatment is most appropriate?", + "options": "A. Observation and monitoring B. Partial pancreatectomy C. Enzyme replacement therapy D. Somatostatin analogs", + "answer": "B" + }, + { + "question": "A male with a history of recurrent abdominal pain and chronic alcohol use presents with pancreatic calcification on imaging. What is the most likely underlying cause?", + "options": "A. Acute pancreatitis B. Chronic pancreatitis C. Amyloid deposition D. Pancreatic adenocarcinoma E. Transient ductal muscle contraction", + "answer": "B" + }, + { + "question": "In patients with a rare pancreatic disorder, which condition of the pancreatic duct is characterized by transient muscle contraction causing episodic pain?", + "options": "A. Spasm of pancreatic duct B. Dilation of pancreatic duct C. Calculus of pancreatic duct D. Hyperplasia of pancreas E. Sphincter of Oddi dysfunction", + "answer": "A" + }, + { + "question": "What is the primary treatment for dilation of the pancreatic duct?", + "options": "A. Antibiotics B. Stenting or surgery C. Enzyme replacement D. Antispasmodics", + "answer": "B" + }, + { + "question": "Which condition involves stone formation obstructing the pancreatic duct?", + "options": "A. Pancreatic necrosis B. Fibrosis of pancreas C. Calculus of pancreatic duct D. Islet sclerosis", + "answer": "C" + }, + { + "question": "What is the primary cause of a pancreatic fistula?", + "options": "A. Obesity B. Surgery, trauma, or pancreatitis C. Metabolic syndrome D. Chronic inflammation", + "answer": "B" + }, + { + "question": "A patient presents with recurrent episodes of abdominal pain and elevated serum amylase. Which of the following is the most likely underlying cause of these symptoms?", + "options": "A. Steatorrhea B. Recurrent pancreatitis C. Abdominal distension D. Jaundice", + "answer": "B" + }, + { + "question": "A patient with obesity and fatty infiltration of the pancreas presents for management. What is the most appropriate initial treatment approach?", + "options": "A. Statin therapy B. Lifestyle changes C. Antibiotic therapy D. Pancreatic enzyme replacement", + "answer": "B" + }, + { + "question": "A patient presents with chronic epigastric pain and weight loss. Imaging reveals multiple inflammatory nodules in the pancreas. Which of the following is the most likely diagnosis?", + "options": "A. Chronic pancreatitis B. Pancreatic granuloma C. Pancreatic adenocarcinoma D. Autoimmune pancreatitis", + "answer": "B" + }, + { + "question": "What is the primary management strategy for pancreatic insufficiency?", + "options": "A. Drainage and antibiotics B. ERCP with stenting C. Pancreatic enzyme replacement D. Percutaneous drainage", + "answer": "C" + }, + { + "question": "Which condition is specifically associated with iatrogenic duct leakage following pancreatic surgery?", + "options": "A. Pancreatic fistula B. Postprocedural pancreatic fistula C. Pancreatic pseudocyst D. Pancreatic necrosis", + "answer": "B" + }, + { + "question": "A patient with a history of chronic pancreatitis presents with persistent abdominal discomfort and imaging reveals pancreatic effusion (a rare complication involving fluid accumulation due to pancreatic duct disruption). Which of the following is the most common clinical manifestation of this condition?", + "options": "A. Fever B. Abdominal distension C. Steatorrhea D. Weight loss", + "answer": "B" + }, + { + "question": "A patient with a history of chronic alcohol use presents with steatorrhea and weight loss. Imaging reveals a reduction in pancreatic size. Which condition is most consistent with these findings?", + "options": "A. Fatty infiltration of pancreas B. Atrophy of pancreas C. Granuloma of pancreas D. Chronic pancreatitis", + "answer": "B" + }, + { + "question": "A patient with chronic pancreatitis presents with new-onset heart failure. What is the most likely mechanism linking these conditions in pancreatic-cardiac syndrome?", + "options": "A. Direct pancreatic enzyme damage to cardiac tissue B. Autoantibody-mediated myocardial injury C. Cardiac dysfunction triggered by systemic inflammation D. Recurrent pancreatitis-induced coronary vasospasm", + "answer": "C" + }, + { + "question": "Which of the following is the most prevalent and aggressive type of pancreatic neoplasm?", + "options": "A. Pancreatic neuroendocrine tumor B. Pancreatic adenocarcinoma C. Insulinoma D. Somatostatinoma", + "answer": "B" + }, + { + "question": "A patient is evaluated for risk factors of pancreatic adenocarcinoma. Which of the following is NOT a well-established risk factor for this malignancy?", + "options": "A. Smoking B. Chronic pancreatitis C. New-onset diabetes in individuals ≥50 years D. Family history of breast cancer", + "answer": "D" + }, + { + "question": "A male presents with painless jaundice, unintentional weight loss, and clay-colored stools. Which of the following is the most likely underlying cause of his symptoms?", + "options": "A. Epigastric pain radiating to the back (chronic pancreatitis) B. Obstructive jaundice (pancreatic head neoplasm) C. Hematemesis (gastric ulcer) D. Dysuria (urinary tract infection)", + "answer": "B", + "explanation": "Painless jaundice with weight loss and acholic stools is a classic triad for pancreatic head neoplasms, which often obstruct the common bile duct. Option A suggests chronic pancreatitis (typically painful), C suggests upper GI bleeding, and D is unrelated to biliary pathology." + }, + { + "question": "Which genetic mutations are associated with an increased risk of pancreatic neoplasms?", + "options": "A. BRCA1/2 and CDKN2A B. TP53 and KRAS C. EGFR and ALK D. BRAF and NRAS", + "answer": "A" + }, + { + "question": "What is the primary curative treatment for localized pancreatic adenocarcinoma?", + "options": "A. Chemotherapy B. Radiation therapy C. Surgical resection D. Targeted therapy", + "answer": "C" + }, + { + "question": "Which of the following treatments is specifically used for BRCA-mutated pancreatic adenocarcinomas?", + "options": "A. Gemcitabine B. FOLFIRINOX C. PARP inhibitors D. Somatostatin analogs", + "answer": "C" + }, + { + "question": "What is a common digestive disturbance associated with pancreatic neoplasms?", + "options": "A. Diarrhea B. Constipation C. Steatorrhea D. Dysphagia", + "answer": "C" + }, + { + "question": "Which of the following is a treatment option for pancreatic neuroendocrine tumors?", + "options": "A. Gemcitabine B. FOLFIRINOX C. Somatostatin analogs D. PARP inhibitors", + "answer": "C" + }, + { + "question": "Pancreatic adenocarcinoma and low-grade neuroendocrine tumors are both rare but have distinct prognostic profiles. In terms of overall survival, how does the prognosis for pancreatic adenocarcinoma compare to that of low-grade neuroendocrine tumors?", + "options": "A. Better for adenocarcinoma B. Better for neuroendocrine tumors C. Similar for both D. Depends on the stage at diagnosis", + "answer": "B" + }, + { + "question": "A patient presents with recurrent episodes of confusion and diaphoresis. Laboratory tests reveal low blood glucose levels. This question focuses on a rare but clinically significant syndrome. Which of the following hormone-related syndromes is most commonly associated with insulin-secreting functional neuroendocrine tumors?", + "options": "A. Hyperglycemia B. Hypoglycemia C. Hyperthyroidism D. Hypothyroidism", + "answer": "B" + }, + { + "question": "What is hepatomegaly primarily considered in clinical practice?", + "options": "A. A disease B. A clinical sign C. A genetic disorder D. A bacterial infection", + "answer": "B" + }, + { + "question": "A patient presents with fatigue and abdominal distension. Which of the following is NOT a primary cause of their chronic hepatomegaly?", + "options": "A. Viral hepatitis B. Congestive heart failure C. Hypertension D. Fatty liver due to obesity", + "answer": "C (Hypertension is not a primary cause of hepatomegaly as it does not directly lead to liver enlargement. While it may contribute to vascular changes, hepatomegaly typically results from conditions like viral hepatitis, congestion, or metabolic disorders.)" + }, + { + "question": "Which symptom is commonly associated with hepatomegaly?", + "options": "A. Left lower quadrant pain B. Right upper quadrant pain C. Chest pain D. Headache", + "answer": "B" + }, + { + "question": "A patient presents with right upper quadrant pain and a palpable liver edge on physical examination. Which imaging modality is the most appropriate initial choice to confirm hepatomegaly due to its cost-effectiveness, lack of radiation, and real-time assessment capability?", + "options": "A. CT scan B. Ultrasound C. MRI D. PET scan", + "answer": "B" + }, + { + "question": "A patient presents with hepatomegaly and elevated liver enzymes due to chronic hepatitis B infection. Which of the following treatments directly targets viral replication in this condition?", + "options": "A. Lifestyle modifications B. Antivirals C. Corticosteroids D. Immunosuppressants", + "answer": "B" + }, + { + "question": "A patient presents with jaundice, fatigue, and right upper quadrant tenderness. On palpation, what is a critical distinction in the liver's texture in cases of acute hepatitis?", + "options": "A. Hard and irregular B. Enlarged and smooth C. Soft and tender D. Normal texture", + "answer": "C" + }, + { + "question": "Which of the following conditions can lead to hepatomegaly due to circulatory issues?", + "options": "A. Viral hepatitis B. Congestive heart failure C. Fatty liver D. Bile duct obstruction", + "answer": "B" + }, + { + "question": "What is a potential complication of untreated hepatomegaly?", + "options": "A. Hypertension B. Liver failure C. Diabetes D. Osteoporosis", + "answer": "B" + }, + { + "question": "A patient presents with abdominal distension and right upper quadrant tenderness. Physical examination reveals hepatomegaly. Which of the following lab tests is most relevant for initial diagnostic evaluation?", + "options": "A. Complete blood count (CBC) B. Liver function panels C. Serum alpha-fetoprotein D. Ammonia levels", + "answer": "B" + }, + { + "question": "What is the texture of the liver typically described as in cases of cirrhosis?", + "options": "A. Soft and tender B. Nodular and firm C. Hard and irregular D. Fibrotic and rigid", + "answer": "B" + }, + { + "question": "Which of the following is a common infectious cause of hepatomegaly with splenomegaly?", + "options": "A. Diabetes mellitus B. Hepatitis viruses C. Hypertension D. Osteoporosis", + "answer": "B" + }, + { + "question": "What is a primary diagnostic tool for hepatomegaly with splenomegaly?", + "options": "A. Electrocardiogram (ECG) B. Ultrasound/CT imaging C. Pulmonary function test D. Skin biopsy", + "answer": "B" + }, + { + "question": "A patient presents with hepatomegaly and splenomegaly. Which of the following hematologic diseases is most likely responsible?", + "options": "A. Hemochromatosis B. Leukemia C. Polycythemia vera D. Thalassemia", + "answer": "B" + }, + { + "question": "What is a potential circulatory cause of hepatomegaly with splenomegaly?", + "options": "A. Portal hypertension B. Hyperthyroidism C. Chronic obstructive pulmonary disease (COPD) D. Migraine", + "answer": "A" + }, + { + "question": "Which of the following is the most common clinical presentation of hepatomegaly with splenomegaly?", + "options": "A. Chest pain B. Abdominal distension C. Jaundice D. Fatigue E. Joint swelling", + "answer": "B" + }, + { + "question": "What is a treatment option for hepatomegaly with splenomegaly caused by portal hypertension secondary to cirrhosis?", + "options": "A. Beta-blockers B. Anticoagulants C. Diuretics D. Vasopressin analogs", + "answer": "C" + }, + { + "question": "Which of the following is a metabolic disorder that can lead to hepatomegaly with splenomegaly?", + "options": "A. Glycogen storage diseases B. Hypertension C. Diabetes insipidus D. Hyperlipidemia", + "answer": "A" + }, + { + "question": "A patient presents with hepatomegaly and splenomegaly accompanied by fatigue and early satiety. What is the most critical step in their initial management?", + "options": "A. Monitoring without intervention for 6 months B. Early intervention with diagnostic workup (e.g., imaging, labs) C. Immediate referral to a hepatologist D. Symptomatic treatment only (e.g., pain relief)", + "answer": "B" + }, + { + "question": "A male presents with hepatomegaly and splenomegaly. Which of the following is a neoplastic cause of these findings?", + "options": "A. Hepatocellular carcinoma B. Hemochromatosis C. Budd-Chiari syndrome D. Amyloidosis", + "answer": "A" + }, + { + "question": "In a patient with untreated hepatomegaly and splenomegaly due to chronic liver disease, which of the following complications is most likely to arise from portal hypertension?", + "options": "A. Liver failure B. Hypersplenism C. Osteoporosis D. Asthma", + "answer": "B" + }, + { + "question": "Which of the following is a common symptom of injury to the liver or gallbladder?", + "options": "A. Left lower quadrant pain B. Right upper quadrant pain C. Chest pain D. Lower back pain", + "answer": "B" + }, + { + "question": "What is a key symptom of traumatic rupture of the liver?", + "options": "A. Left shoulder pain B. Right shoulder pain (Kehr’s sign) C. Neck stiffness D. Leg weakness", + "answer": "B" + }, + { + "question": "Which treatment is most appropriate for a traumatic rupture of the common bile duct?", + "options": "A. Conservative management B. Cholecystectomy C. Roux-en-Y hepaticojejunostomy D. Antibiotics alone", + "answer": "C" + }, + { + "question": "A male presents with an open laceration of the liver following a motor vehicle accident. Which of the following is the most immediate life-threatening complication in this scenario?", + "options": "A. Infection B. Hemorrhage C. Bile leakage D. Thrombosis", + "answer": "B" + }, + { + "question": "A male presents with right upper quadrant pain and tenderness following a motor vehicle accident. Imaging reveals a gallbladder injury. Which of the following mechanisms is most commonly associated with this finding?", + "options": "A. Blunt abdominal trauma B. Viral infection C. Autoimmune-mediated inflammation D. Gallstone obstruction E. Chronic cholecystitis F. Genetic predisposition", + "answer": "A" + }, + { + "question": "In the acute management of traumatic or iatrogenic injuries, what is a critical difference in treatment priorities between liver injuries and bile duct injuries?", + "options": "A. Liver injuries focus on preventing strictures B. Bile duct injuries prioritize hemorrhage control C. Liver injuries prioritize hemorrhage control D. Bile duct injuries often require surgical repair or stenting", + "answer": "C" + }, + { + "question": "Which of the following is a severe complication of an open injury to the common bile duct in a patient presenting with abdominal pain and jaundice?", + "options": "A. Biliary peritonitis B. Cholangitis C. Biliary stricture D. Sepsis", + "answer": "A" + }, + { + "question": "What is a common treatment for a perforated or necrotic gallbladder?", + "options": "A. Antibiotics alone B. Cholecystectomy C. Conservative management D. Radiation therapy", + "answer": "B" + }, + { + "question": "A male presents with abdominal trauma following a motor vehicle accident. In the management of hepatobiliary injuries, which of the following is a key distinction between open injuries and blunt trauma?", + "options": "A. Open injuries carry lower infection risks B. Blunt trauma carries higher infection risks C. Open injuries carry higher infection risks D. Blunt trauma may require delayed surgical intervention", + "answer": "C" + }, + { + "question": "Which of the following is a common symptom of injury to the pancreas?", + "options": "A. Severe abdominal pain B. Persistent cough C. Joint stiffness D. Visual disturbances", + "answer": "A" + }, + { + "question": "What is the primary cause of traumatic rupture of the pancreas?", + "options": "A. Chronic pancreatitis B. High-impact trauma C. Viral infection D. Dietary factors", + "answer": "B" + }, + { + "question": "A male presents with abdominal pain following blunt trauma. Imaging reveals pancreatic injury. Which of the following is a potential complication of this condition?", + "options": "A. Pseudocysts B. Pancreatic fistula C. Hemorrhage D. Sepsis", + "answer": "A" + }, + { + "question": "A patient presents with blunt abdominal trauma. Imaging reveals a minor laceration of the pancreatic capsule without ductal injury. What is the most appropriate management approach?", + "options": "A. Immediate surgery B. Conservative management C. Endoscopic intervention D. Percutaneous drainage", + "answer": "B" + }, + { + "question": "Which imaging technique is commonly used to assess the depth of a pancreatic laceration?", + "options": "A. X-ray B. Ultrasound C. CT/MRI D. PET scan", + "answer": "C" + }, + { + "question": "What is the most likely treatment for an open injury of the pancreas?", + "options": "A. Antibiotics alone B. Emergency laparotomy C. Physical therapy D. Dietary changes", + "answer": "B" + }, + { + "question": "Which of the following conditions is considered an emergency requiring immediate surgical intervention?", + "options": "A. Laceration of the pancreatic capsule B. Traumatic rupture of the pancreas C. Chronic pancreatitis D. Pancreatic pseudocyst", + "answer": "B" + }, + { + "question": "A male presents with blunt abdominal trauma. Imaging reveals injury to the pancreatic capsule. What is a key difference in management between traumatic rupture and laceration of the pancreatic capsule?", + "options": "A. Traumatic rupture is less severe and can be managed conservatively. B. Laceration may not always require surgery depending on the extent of injury. C. Traumatic rupture is an emergency requiring immediate surgical intervention. D. Laceration is typically caused by acute trauma rather than chronic conditions.", + "answer": "C. Correct answer: C. Traumatic rupture of the pancreatic capsule is a surgical emergency due to the risk of severe complications such as peritonitis and sepsis." + }, + { + "question": "A male presents with severe epigastric pain and vomiting after a high-impact motor vehicle collision. CT reveals a pancreatic injury. Which of the following is the most significant risk factor for developing severe complications (e.g., pancreatic fistula or sepsis) in this patient?", + "options": "A. Presence of comorbidities B. Conservative management C. Delayed treatment D. High-grade injury", + "answer": "D" + }, + { + "question": "What is the primary goal of surgical intervention in open injuries of the pancreas?", + "options": "A. Control bleeding and repair ducts B. Remove the entire pancreas C. Administer chemotherapy D. Perform a biopsy", + "answer": "A" + } +] \ No newline at end of file