Internal Medicine Exam Chronic Liver Disease Complications 3

Question 1

A patient with alcoholic cirrhosis presents with acute upper GI bleeding. Endoscopy shows actively bleeding esophageal varices treated with band ligation. Which medication should be started immediately upon admission?

Accepted Answer

Octreotide IV infusion

Answer

Octreotide (or terlipressin) reduces splanchnic blood flow and portal pressure; it should be started at admission and continued for 3–5 days during acute variceal hemorrhage.

Question 2

Which of the following is the strongest independent risk factor for spontaneous bacterial peritonitis (SBP) in cirrhotic patients with ascites?

Accepted Answer

Ascitic fluid protein <1.5 g/dL

Answer

Low ascitic fluid protein (<1.5 g/dL) reflects reduced opsonic activity and is the strongest independent risk factor for SBP in cirrhotic ascites.

Question 3

A cirrhotic patient with known varices has not bled. What is the recommended primary prophylaxis approach for large varices?

Accepted Answer

Non-selective beta-blockers or endoscopic band ligation

Answer

Non-selective beta-blockers (propranolol, nadolol, carvedilol) or endoscopic band ligation are equally effective first-line primary prophylaxis for large esophageal varices.

Question 4

A patient with cirrhosis and hepatic encephalopathy is found to have hyponatremia (Na 121 mEq/L). Which treatment is most appropriate?

Accepted Answer

Fluid restriction and consideration of vaptans

Answer

Dilutional hyponatremia in cirrhosis is managed with fluid restriction; vasopressin receptor antagonists (vaptans) may be used in resistant cases.

Question 5

Which complication of cirrhosis is characterized by intrapulmonary vascular dilatations leading to hypoxemia that improves with 100% oxygen administration?

Accepted Answer

Hepatopulmonary syndrome

Answer

Hepatopulmonary syndrome results from intrapulmonary vasodilation causing V/Q mismatch and right-to-left shunting, with PaO2 improving on 100% O2.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Chronic Liver Disease Complications 3