NMS Q&A Family Medicine

chap ter 16Problems of the LiverExamination questions: Unless instructed otherwise, choosethe ONE lettered answer or completion that is BEST ineach case.1 A 33-year-old woman has a diagnosis of post-inflammatorycirrhosis after suffering a bout of hepatitis B.Recently, on upper endoscopy, she demonstratedpresence of esophageal varices, and a decision wasmade to utilize nonselective beta-adrenergic blockadeto prevent bleeding of the varices. Which of thefollowing is the parameter that in follow-up indicatesthe therapeutic endpoint has been reached?(A) Hemoglobin increases by 2 g/dL(B) Pulse rate drops by about 25%(C) Rise in blood pressure by 10%(D) Normalization of AST and ALT(E) Normalization of serum bilirubin2 A man who weighs 220 pounds at a height of 5 ft10 in. undergoes a routine physical examination.The physician finds the liver to be palpable at 6 cm(2 in.) below the right costal margin. A chemicalprofile shows AST elevated threefold above normaland the ALT twice normal. A needle biopsy showsfatty infiltration (steatohepatosis). Each of the followingconditions is in the top four most likely causesexcept for which one?(A) Iatrogenic of pathophysiologic glucocorticoideffects(B) Alcoholic liver disease(C) Obesity(D) Diabetes(E) Hypertriglyceridemia3 The list of drugs that can idiosyncratically causesevere liver toxicity, that is, not dose related and relativelyunpredictable, is large. However, the commonlyused antipyretic analgesic drug acetaminophen (e.g.,Tylenol) causes drug-induced hepatitis in a dose-relatedfashion. Which of the following is the toxic singledose of acetaminophen in an average sizeperson?(A) 4 g(B) 6 g(C) 10 g(D) 16 g(E) 20 g4 A 28-year-old woman who admits to a history of intravenousdrug abuse is planning a serious new relationshipand is concerned about the possibility of passinghepatitis to her new sex partner. A screening test foranti-hepatitis C antibody was negative. You obtain ahepatitis B panel. Which of the following sets of laboratoryfindings make the diagnosis of hepatitis B carrier?(A) HBsAg negative, anti-HBc negative, anti-HBsnegative unexposed(B) HBsAg negative, anti-HBc positive, anti-HBsnegative(C) HBsAg negative, anti-HBc negative/positive,anti-HBs positive(D) HBsAg positive, anti-HBc positive,immunoglobulin M (IgM) anti-HBc positive,anti-HBs negative(E) HBsAg positive, anti-HBc positive, IgM anti-HBc negative, anti-HBs negative5 Which of the following is the best indicator of a highdegree of hepatitis B virus (HBV) replication, hencemarker of infectivity?(A) HBsAg(B) HBcAg(C) HBeAg(D) Anti-HBs(E) Anti-HBc6 The woman seeking testing for hepatitis B before startinga serious relationship exhibits the following results:HBeAg negative, HBc antibody positive, HBs antibodypositive, ALT, and AST levels normal. What is youradvice to the patient vis-a-vis her prospective fiancée’?(A) He should take the three injection series ofhepatitis vaccine.(B) He should have hepatitis B immune globulininjection.(C) The couple should be advised to use a barriermethod of contraception for protection of theman from hepatitis B.101