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Clinical Review Quiz

  Nonalcoholic Fatty Liver Disease: Review Questions

Mark W. Russo, MD, MPH, and Ira M. Jacobson, MD

Dr. Russo is an Assistant Professor of Medicine, Weill Medical College of Cornell University; and an Attending Physician, New York-Presbyterian Hospital, New York, NY. Dr. Jacobson is the Vincent Astor Professor of Clinical Medicine and Chief, Division of Gastroenterology and Hepatology, Weill Medical College of Cornell University; and an Attending Physician, New York-Presbyterian Hospital, New York, NY.

The questions below are based on the November 2002 cover article, “Nonalcoholic Fatty Liver Disease.”

Choose the single best answer for each question.


1. Which of the following is NOT a risk factor for nonalcoholic fatty liver disease (NAFLD)
  1. Alcohol consumption
  2. Cigarette smoking
  3. Diabetes mellitus
  4. Hypertriglyceridemia
  5. Obesity
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2. Which of the following statements regarding NAFLD is NOT true?

  1. Alkaline phosphatase level is often normal in patients with NAFLD
  2. Hyperbilirubinemia occurs in 60% of patients with NAFLD
  3. In mild cases of NAFLD, serum alanine aminotransferase (ALT) level is usually greater than serum aspartate aminotransferase level
  4. Patients with elevated serum enzyme levels on liver function tests and suspected NAFLD should also be checked for markers of viral hepatitis and iron levels
  5. Some studies suggest a role for heterozygosity of the hemochromatosis gene in mediating progressive liver disease
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3. Which of the following statements about the role of liver biopsy in patients with suspected NAFLD is NOT true?

  1. ALT levels have been shown to correlate directly with extent of fibrosis found on liver biopsy
  2. Liver biopsy may yield diagnostic information but nothing relevant to therapy
  3. Liver biopsy results can distinguish steatosis from steatohepatitis
  4. There are differences of opinion among hepatologists about the role of liver biopsy
  5. Ultrasonography without liver biopsy is unable to distinguish steatosis from steatohepatitis
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4. Which of the following statements does NOT accurately describe the natural history of NAFLD?
  1. The characteristic histologic changes of NAFLD may be less apparent when cirrhosis is present than in earlier stages of the disease
  2. Cirrhosis associated with NAFLD may lead to liver cancer
  3. Regular alcohol use may exacerbate the course of NAFLD
  4. Steatosis transitions to steatohepatitis in roughly 80% of patients within 10 years
  5. Steatosis and steatohepatitis have different rates of progression to cirrhosis
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5. Which of the following is NOT a histologic feature of NAFLD?

  1. Ballooning degeneration
  2. Centrilobular fibrosis
  3. Mallory bodies
  4. Neutrophilic infiltrates
  5. Portal lymphoid aggregates
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6. Which of the following statements about therapy for NAFLD is NOT accurate?

  1. The Food and Drug Administration has yet to approve pharmacologic therapy for NAFLD
  2. Improvement in ALT level may occur with ursodeoxycholic acid therapy
  3. Patients with steatohepatitis and extensive fibrosis should refrain from alcohol consumption
  4. Rapid weight loss is safer than gradual weight loss in patients with NAFLD
  5. Statins may be used to treat hyperlipidemia patients with NAFLD
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