EMQs in Clinical Medicine.pdf - Peshawar Medical College

Liver diseases 145
57 Liver diseases
A
B
C
D
E
F
hepatocellular carcinoma
hepatic encephalopathy
liver metastasis
1 -antitrypsin deficiency
alcoholic cirrhosis
acute viral hepatitis E
G
H
I
J
K
L
fulminant liver failure
Wilson’s disease
hepatic haemangioma
primary biliary cirrhosis
haemochromatosis
acute viral hepatitis B
For each clinical scenario below, give the most likely cause for the clinical findings.
Each option may be used once only.
1 A 69-year-old retired bricklayer presents with weight loss, fever and right upper
quadrant pain. On examination, a hard, irregular liver can be felt on palpation.
Serum AFP is grossly elevated.
2 A 45-year-old man presents with arthralgia, tiredness and development of
diabetes. On examination his skin is pigmented and blood tests show increased
serum ferritin.
3 A 60-year-old publican presents with signs of spider naevi, gynaecomastia and
testicular atrophy. His hands show clubbing and leukonychia.
4 A 20-year-old man with a history of liver problems in the past presents with
tremor and dysarthria with developing dyskinesias. Slit-lamp examination
reveals a greenish-brown ring at the corneoscleral junction.
5 A 50-year-old man presents with signs of chronic liver disease with a history of
early onset pulmonary emphysema. He is a non-smoker and is teetotal. His
father had a similar history.
Answers: see page 169.