Internal Medicine Chronic Liver Disease Complications Questions and Answers

Question 1

A 64-year-old man with cirrhosis due to non-alcoholic steatohepatitis presents with increasing confusion, lethargy, and asterixis.
His family notes he has been more forgetful over the past week.
He has no fever or abdominal pain.
What is the most appropriate initial pharmacologic therapy for this patient's condition?

Accepted Answer

Lactulose

Answer

Rifaximin

Answer

Intravenous albumin

Answer

Propranolol

Question 2

A 59-year-old female with decompensated alcoholic cirrhosis and ascites is admitted with fever and diffuse abdominal tenderness. A diagnostic paracentesis is performed. Which of the following ascitic fluid findings is the most critical for diagnosing spontaneous bacterial peritonitis (SBP)?

Accepted Answer

Polymorphonuclear (PMN) leukocyte count ≥ 250 cells/mm³

Answer

Serum-ascites albumin gradient (SAAG) > 1.1 g/dL

Answer

Total protein < 1.0 g/dL

Answer

Positive bacterial culture

Question 3

A 62-year-old male with cirrhosis, portal hypertension, and medium-sized esophageal varices noted on a screening endoscopy has no history of gastrointestinal bleeding. He is hemodynamically stable. Which of the following medications is the most appropriate choice for primary prophylaxis against variceal hemorrhage?

Accepted Answer

Nadolol

Answer

Octreotide

Answer

Furosemide

Answer

Omeprazole

Question 4

According to the American Association for the Study of Liver Diseases (AASLD) guidelines, which of the following is the recommended surveillance strategy for hepatocellular carcinoma (HCC) in an adult patient with compensated cirrhosis?

Accepted Answer

Abdominal ultrasound with or without AFP every 6 months

Answer

Annual contrast-enhanced abdominal MRI

Answer

Serum alpha-fetoprotein (AFP) level every 3 months

Answer

Flexible sigmoidoscopy every 5 years

Question 5

A 60-year-old male with alcoholic cirrhosis and ascites is admitted with a serum creatinine of 2.8 mg/dL, which has risen from a baseline of 1.0 mg/dL over three days. He is hypotensive with a urine sodium of 5 mEq/L. A renal ultrasound is unremarkable. After withholding diuretics and administering a 2-day trial of intravenous albumin (1 g/kg/day), his creatinine fails to improve. Which of the following is the most likely diagnosis?

Accepted Answer

Hepatorenal syndrome-acute kidney injury (HRS-AKI)

Answer

Acute tubular necrosis (ATN)

Answer

Pre-renal azotemia due to dehydration

Answer

Post-renal obstruction

Question 6

A patient with advanced cirrhosis has a prolonged INR of 2.5. Despite this, he develops a spontaneous portal vein thrombosis. Which of the following pathophysiologic changes best explains this prothrombotic tendency?

Accepted Answer

Markedly elevated levels of Factor VIII and von Willebrand factor

Answer

A severe deficiency of anticoagulant proteins C and S

Answer

Thrombocytopenia secondary to splenomegaly

Answer

Decreased clearance of activated clotting factors