Internal Medicine Exam Chronic Liver Disease Complications 2

Question 1

A cirrhotic patient develops confusion and asterixis after a high-protein meal. Serum ammonia is elevated. Which neurotransmitter system is most implicated in hepatic encephalopathy?

Accepted Answer

GABAergic system

Answer

Elevated ammonia enhances GABAergic neurotransmission, promoting inhibitory tone and causing hepatic encephalopathy.

Question 2

A patient with cirrhosis has ascites refractory to diuretics. Diagnostic paracentesis shows SAAG of 1.8 g/dL. What is the most appropriate next management step?

Accepted Answer

Large-volume paracentesis with albumin infusion

Answer

Refractory ascites is managed with large-volume paracentesis (LVP) plus IV albumin (6–8 g per liter removed) to prevent paracentesis-induced circulatory dysfunction.

Question 3

Which Child-Pugh score component best correlates with the severity of synthetic liver dysfunction?

Accepted Answer

Prothrombin time/INR

Answer

Prothrombin time/INR reflects hepatic synthesis of clotting factors and is the most direct measure of synthetic dysfunction in the Child-Pugh score.

Question 4

A cirrhotic patient with esophageal varices is started on non-selective beta-blocker therapy. Which parameter best confirms adequate pharmacologic response?

Accepted Answer

Hepatic venous pressure gradient (HVPG) <12 mmHg or ≥20% reduction

Answer

Adequate beta-blocker response is confirmed by HVPG reduction to <12 mmHg or ≥20% from baseline, which significantly reduces variceal bleeding risk.

Question 5

A patient with decompensated cirrhosis develops oliguria, rising creatinine, and a FENa <0.01% despite adequate volume status. Urine microscopy is bland. What is the most likely diagnosis?

Accepted Answer

Hepatorenal syndrome type 1

Answer

HRS type 1 presents with rapidly progressive renal failure, FENa <0.01%, bland urine sediment, and normal renal parenchyma in a cirrhotic patient without alternative cause.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Chronic Liver Disease Complications 2