Multiple Choice Questions

• 1.
  Regarding drug induced liver injury (DILI) the following are TRUE EXCEPT:

  • 1.
    Most common cause of drug induced acute liver failure in India is paracetamol.
  • 2.
    Most common cause of drug induced liver injury in India is antitubercular drugs.
  • 3.
    Degree of liver enzyme elevation correlates with severity of liver disease.
  • 4.
    Clinical jaundice is a predictor of mortality.
  • 5.
    Cholestatic pattern of DILI can be prolonged even on stopping the offending drug.
• 2.
  Regarding surgery in patients with liver disease the following are TRUE:

  • 1.
    Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) scores can reliably predict operative mortality in chronic liver disease.
  • 2.
    Acute viral hepatitis is not a contraindication for surgery.
  • 3.
    Laparoscopic cholecystectomy can be safely performed in compensated cirrhotics.
  • 4.
    Umbilical hernias have low risk of complications in cirrhotics and elective repair should not be attempted.
  • 5.
    Preferred anaesthetic agents include sevoflurane, desflurane and isoflurane.
• 3.
  Regarding peri-operative monitoring after liver transplantation the following are TRUE:

  • 1.
    Cardiovascular events are the most common cause of readmission to intensive care and non-graft related deaths after liver transplantation.
  • 2.
    Conventional tests of coagulation like prothrombin time, activated partial thromboplastin time, platelet count and plasma fibrinogen levels are sufficient measure of coagulation intra-operatively.
  • 3.
    Hyperglycemia is an ominous sign of poor graft function.
  • 4.
    Serum potassium levels are independent predictors of death after liver transplantation.
  • 5.
    Commonest acid-base disorder in the immediate post-operative period is metabolic acidosis.
• 4.
  Regarding tuberculosis (TB) in chronic liver disease the following are TRUE EXCEPT:

  • 1.
    Cirrhotic patients have a higher chance of developing extra-pulmonary tuberculosis than those without cirrhosis.
  • 2.
    Adenosine deaminase for diagnosis of TB in cirrhosis with ascites has high sensitivity.
  • 3.
    Tuberculin skin testing is sensitive for the diagnosis of TB in cirrhotic patients.
  • 4.
    Likelihood of anti-tubercular drug induced hepatotoxicity is higher in pre-existing liver disease patients.
  • 5.
    Isoniazid induced hepatotoxicity is more common in slow acetylators.
• 5.
  Regarding hepatotoxicity of anti-tubercular therapy (ATT) the following are TRUE:

  • 1.
    Rechallenge with isoniazid is contraindicated if patient has history of isoniazid induced hepatotoxicity.
  • 2.
    Isoniazid induced transaminitis is self limited and asymptomatic in majority of patients.
  • 3.
    Isolated conjugated hyperbilirubinemia is seen with rifampicin.
  • 4.
    Pyrazinamide mainly causes idiosyncratic hepatotoxicity.
  • 5.
    Inactive carriers of hepatitis B do not have increased risk of ATT induced hepatotoxicity.
• 6.
  Regarding Budd-Chiari syndrome (BCS) the following are TRUE EXCEPT:

  • 1.
    Most common cause of BCS in India is membranous obstruction of inferior vena cava.
  • 2.
    Ascites with high protein and high serum ascitic albumin gradient is suggestive of BCS.
  • 3.
    Initial imaging modality of choice to diagnose BCS is magnetic resonance venogram.
  • 4.
    Failure to visualize the hepatic veins on Doppler is diagnostic of BCS.
  • 5.
    Direct intrahepatic portosystemic shunt can be done even if all hepatic vein ostia are blocked.
• 7.
  Regarding the role of gut microbiota in hepatic encephalopathy (HE) the following are TRUE:

  • 1.
    Markers of systemic inflammation are better correlated with HE than the severity of liver disease.
  • 2.
    Pathogen associated molecular patterns (PAMPs) are microbial components that initiate inflammatory cascade.
  • 3.
    Gut microbiota of patients with cirrhosis and normal controls is similar.
  • 4.
    Lactulose exerts its actions in HE predominantly by altering the composition of gut microbiota.
  • 5.
    Stool microbiota is an accurate estimate of intestinal microbiota.
• 8.
  Regarding primary sclerosing cholangitis (PSC) the following are TRUE:

  • 1.
    Majority of patients with PSC have isolated extrahepatic disease.
  • 2.
    Magnetic resonance cholangiography is the diagnostic modality of choice.
  • 3.
    Dominant stricture is a stenosis with a diameter of <1.5 mm in the hepatic duct or of <1 mm in the common bile duct.
  • 4.
    Inflammatory bowel disease is usually diagnosed after diagnosis of PSC.
  • 5.
    Cholecystectomy is recommended in a patient with PSC with a gallbladder mass lesion, irrespective of its size.
• 9.
  Regarding primary biliary cirrhosis (PBC) the following are TRUE EXCEPT:

  • 1.
    Antimitochondrial antibodies (AMA) are highly sensitive and specific for the diagnosis of PBC.
  • 2.
    AMA negative cases of PBC have less aggressive disease and better prognosis.
  • 3.
    Ursodeoxycholic acid improves symptoms but does not alter natural course of PBC.
  • 4.
    Modafinil may improve fatigue in patients with PBC.
  • 5.
    Sjogren's syndrome occurs more frequently in PBC than matched controls.
• 10.
  Regarding overlap syndromes the following are TRUE:

  • 1.
    Overlap of autoimmune hepatitis (AIH) and PBC is the most common variant.
  • 2.
    Overlap of PSC and PBC is common.
  • 3.
    Autoimmune sclerosing cholangitis refers to features of PSC in children with AIH.
  • 4.
    The components of the overlap syndrome may develop sequentially with one appearing years after the first.
  • 5.
    UDCA does not have a beneficial role in overlap syndromes.