1. The following statements are true except :

1. chronic ethanol ingestion

2. glucocorticoids

3. Grisofulvin

4.  carbamazepin

5. Cimetidin

2. The following statements are true except

1.     low blood urea is seen in many acute and chronic liver diseases

2.       high blood urea in the context of severe liver damage may indicates gastrointestinal hemorrhage or hepatorenal syndrome

3.     hyponatremia is very common in severe liver disease and usually multifactorial

4.  raised gamma GT enzyme level may occur during treatment with carbamazepin

5. large increase in serum aminotrnsferases activity with a small rise in alkaline phsophatase activity is in favor of biliary obstruction

3. Imaging in liver diseases, all are true except:

1.      ultrasound of the liver is a rapid, cheap and easy method and usually the first imaging to be done, yet its main limitation is that small focal lesions less than 2 cm will be missed

2.      color Doppler studies are very useful and used to investigate hepatic veins, portal vein and hepatic artery diseases

3.      MRI is usually used for pancreaticobiliary diseases rather than parenchymal liver diseases

4.      outlining the biliary tree can be done by injecting a contrast medium into the biliary tree through the skin or by an endoscopic approach

5.       plain abdominal radiographs are very helpful in liver diseases

4. Regarding liver biopsy, all are true except

1. the patient should be cooperative

2. the PT prolongation if present, should be less than 4 seconds above the upper normal control value

3.  severe COPD is a contraindication

4.  marked ascites will make the procedure easier

5.  local skin infection should not be present

5. Spontaneous bacterial peritonitis in the context of cirrhosis, all are true except

1. unfortunaterly, up to one third of cases the abdominal signs are mild or absent

2. almost always a mono-microbial infection state

3.  recurrence is common but unfortunately there is no way to prevent it

4.  The commonest organisms are enteric gram negatives, but no source of infection is usually present

5.   the ascitic fluid is cloudy with more than 250 neutrophils / mm3

6. Precipitating factors for hepatic encephalopathy in a patient with cirrhosis, all are true except

1. occult infection

2.  aggressive diuresis

3.  diarrhea or constipation

4.  treamtent with oral neomycin

5.  excesss dietary proteins

7. The hepatitis viruses, all are true except

1.   hepatitis A is an RNA enterovirus which does not lead to a carrier state

2.   hepatitis B is a DNA virus that 42 nm in diameter and leads to chronic infection up to 10% of adults versus 90% of neonatal hepatitis B infection

3.   hepatitis C is an RNA flavivirus that is the commonest cause of chronic liver disease in USA and of those infected ,up to 20 % of them will develop cirrhosis after 20 years

4.   hepatitis D is a defective RNA virus that can be prevented by preventing hepatitis B infection in high risk groups by using hepatitis B vaccine and immunoglobulin

5.  hepatitis E is a RNA calicivirus that carries a mortality of 2% if the infection occurs in pregnancy

8. Hepatocelluar carcinoma (HCC ), all are true except

1.   occurs in the background of cirrhosis in up to 80% of cases

2.   chronic hepatitis B infection is the commonest cause world-wide

3.   may be treated by liver transplantation

4.  any patient with cirrhosis should be screened for the development of HCC by serial serum alpha fetoprotein and liver ultrasound

5.   the fibrolammellar variant has a very poor prognosis

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