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Self-Assessment Questions


Tumors of the Liver and Biliary Tree: Review Questions

Douglas G. Adler, MD, and John J. Poterucha, MD

Dr. Adler is a fellow in Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN; and Dr. Poterucha is an Associate Professor of Medicine, Mayo Medical School, Rochester, MN.

Choose the single best answer for each question.

1. A 49-year-old man with cirrhosis from hepatitis C is seen for evaluation. The patient contracted hepatitis C approximately 30 years ago from a blood transfusion but had never been treated. He reports a 15-lb weight loss over 1 year. Physical examination reveals tenderness in the right upper quadrant and stigmata of chronic liver disease. Ultrasonography shows cirrhosis and a 2-cm lesion in the left hepatic lobe, indicating possible hepatocellular carcinoma (HCC). Serum alpha-fetoprotein (AFP) level is normal. Which of the following is the best management option?
  1. Check the patient’s serum carbohydrate antigen 19-9 level
  2. Obtain a computed tomography (CT) scan
  3. Perform a left hepatectomy
  4. Perform surgical resection of the tumor alone
  5. Repeat the test for AFP in 3 to 6 months
Click here to compare your answer.

2. A 22-year-old woman develops fullness of the right upper quadrant but otherwise feels well. Results on physical examination are normal. She has no history of liver disease. She takes a proton pump inhibitor for gastroesophageal reflux disease and an oral contraceptive. A CT scan reveals a 6-cm lesion in the right hepatic lobe that is initially hypodense but becomes irregularly enhancing after contrast administration. Which of the following is the lesion most likely to be?

  1. Ampullary cancer
  2. Cholangiocarcinoma
  3. Gallbladder cancer
  4. Hepatic adenoma
  5. Hepatocellular carcinoma
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3. A 55-year-old man is evaluated because of painless jaundice and a 15-lb weight loss. He has had intermittent bloody diarrhea for several years. A magnetic resonance study suggests a mass within the common bile duct. Endoscopic biopsy indicates cholangiocarcinoma. Which of the following is the most likely cause of the patient’s bloody diarrhea?

  1. Chronic duodenal ulcer
  2. Hemorrhoids
  3. Shigella enteritis
  4. Tumor bleeding into the gastrointestinal tract
  5. Ulcerative colitis
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  4. A 48-year-old woman undergoes abdominal and pelvic CT scanning during a gynecologic evaluation. The scan detects a 3.5-cm lesion in the right hepatic lobe. The lesion is hypodense on precontrast images and shows early peripheral enhancement and then complete opacification with intravenous contrast, consistent with a cavernous hemangioma. The patient has normal liver chemistries and has no other symptoms. Which of the following is the most appropriate next step in management?
  1. Measure the patient’s serum AFP level
  2. Perform a right hepatectomy
  3. Perform chemoembolization of the tumor
  4. Perform surgical enucleation of the tumor, preserving the right hepatic lobe
  5. Perform no further evaluation or therapy
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5. A 65-year-old Chinese man who immigrated to the United States 25 years ago sees his physician because of a 2-month history of fatigue, 20-lb weight loss, and upper abdominal pain. Ultrasonography shows a 2-cm lesion in the left hepatic lobe and parenchymal changes consistent with cirrhosis. He denies consuming alcohol. His AFP level is elevated to 10 times the normal range; a diagnosis of HCC is made. Which of the following is most likely the underlying cause of his disease?

  1. Alpha1-antitrypsin deficiency
  2. Chronic hepatitis A infection
  3. Chronic hepatitis B infection
  4. Hereditary hemochromatosis
  5. Wilson’s disease
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