QUESTION#01
A 10-year-old child with severe acute liver failure is being cared for in the intensive care unit.
Which of the following laboratory findings best reflects worsening liver function in this patient?
A. Uptrending AST
B. Uptrending ALT
C. Hyperglycemia
D. Uptrending total bilirubin
E. Uptrending factor VII
B. Uptrending ALT
C. Hyperglycemia
D. Uptrending total bilirubin
E. Uptrending factor VII
QUESTION#02
A 7-year-old girl is admitted with new-onset elevated serum aminotransferases and jaundice; gallstones within the gallbladder and dilation of the common bile duct are visualized on initial right upper quadrant ultrasound, as well as single stone within the common bile duct.
Which is the next most appropriate evaluation of the hepatobiliary system to pursue?
A. Computed tomography (CT)
B. Liver biopsy
C. Percutaneous transhepatic cholangiography (PTC)
D. Hepatobiliary iminodiacetate (HIDA) scan
E. Endoscopic retrograde cholangiopancreatography (ERCP)
QUESTION#03
A 7-year-old female is admitted to the pediatric general care floor with jaundice and fatigue. Laboratory evaluation reveals elevated AST, ALT, bilirubin, prolonged INR, IgA deficiency, and a positive anti–liver kidney microsomal type 1 (LKM-1) antibody titer.
Which of the following is the most likely diagnosis?
A. Primary sclerosing cholangitis
B. Lupus
C. Type I autoimmune hepatitis (AIH)
D. Type II AIH
E. Intrahepatic cystic biliary dilation (Caroli disease)
QUESTION#04
Treatment options are considered for a 14-year-old female with newly diagnosed type I autoimmune hepatitis who has not yet started on any therapy.
Which of the following is the best choice for initial treatment in this patient?
A. Prednisone
B. Cyclosporine
C. Mycophenolate
D. Tacrolimus
E. Azathioprine
QUESTION#05
A 3-year-old girl presents to the emergency room after her mother discovered her on the bathroom floor with an open, mostly empty bottle of acetaminophen tablets. N -Acetylcysteine is administered and she is admitted to the intensive care unit for observation.
Although each of the following might be considered appropriate investigations during the course of her illness, which is most useful for monitoring the synthetic function of this patient’s liver?
A. Serum alanine aminotransferase
B. Prothrombin time (PT)
C. Ultrasound of the abdomen
D. Serum alkaline phosphatase
E. Acetaminophen level
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