hepatitis C

Practice targeted AMC-style multiple-choice questions on hepatitis C.

Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma

Image by R. Badea, Simona Ioanitescu — CC BY 3.0 · Source

A 62-year-old male with a history of hepatitis C presents with new onset jaundice and ascites. His AFP is markedly elevated. A contrast-enhanced ultrasound is performed, as shown. What is the MOST appropriate next step in management?

A. Initiate systemic chemotherapy

B. Referral for liver transplant evaluation

C. Order a triple-phase CT scan of the abdomen

D. Perform a percutaneous liver biopsy

E. Start sorafenib therapy

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CT scan of hepatocellular carcinoma, without and with IV contrast

Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong — CC BY 4.0 · Source

A 68-year-old male with a long history of alcohol-related cirrhosis and previous treatment for hepatitis C presents with increasing abdominal distension, fatigue, and a dull ache in the right upper quadrant. He denies acute pain or fever. On examination, he has mild jaundice, shifting dullness, and spider naevi. His vital signs are stable. Recent blood tests show albumin 28 g/L, INR 1.4, total bilirubin 45 µmol/L, ALT 65 U/L, AST 88 U/L, creatinine 90 µmol/L. Alpha-fetoprotein (AFP) is 850 µg/L (normal <10). An abdominal CT scan with contrast is performed, axial views of which are shown. Considering the patient's clinical presentation, laboratory results, and the findings on the provided imaging, what is the MOST appropriate immediate next step in the management of this patient?

A. Proceed directly to surgical resection of the lesion.

B. Schedule a follow-up CT scan in 3 months to monitor for growth.

C. Discuss the case at a multidisciplinary liver tumour board meeting to determine staging and treatment options.

D. Initiate systemic chemotherapy with sorafenib.

E. Obtain a percutaneous biopsy of the lesion for histological confirmation.

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Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong — CC BY 4.0 · Source

A 62-year-old male with a history of chronic hepatitis C presents with right upper quadrant pain, weight loss, and jaundice. Vital signs are stable. Physical examination reveals hepatomegaly and mild ascites. Laboratory investigations include elevated alpha-fetoprotein (AFP). Imaging is performed as shown. Considering the clinical context and the findings demonstrated in the imaging, which of the following assessments is MOST crucial for determining the feasibility and type of definitive treatment for the identified lesion?

A. Confirmation of hepatitis C viral load

B. Assessment of underlying liver synthetic function (e.g., Child-Pugh score)

C. Evaluation for extrahepatic metastatic disease

D. Assessment of portal vein patency

E. Measurement of the lesion's maximum diameter

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Image by R. Badea, Simona Ioanitescu — CC BY 3.0 · Source

A 62-year-old male with a history of hepatitis C presents with new onset ascites and right upper quadrant pain. His AFP is markedly elevated. A contrast-enhanced ultrasound is performed, as shown. What is the MOST appropriate next step in management?

A. Order a CT scan of the abdomen with IV contrast

B. Referral for liver transplant evaluation

C. Initiate systemic chemotherapy

D. Begin palliative care

E. Perform a percutaneous liver biopsy

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Image by R. Badea, Simona Ioanitescu — CC BY 3.0 · Source

A 62-year-old male with a history of chronic hepatitis C presents to his general practitioner for a routine check-up. He reports no new symptoms. His liver function tests from 6 months ago were within normal limits. However, recent blood work reveals an elevated alpha-fetoprotein (AFP) level of 600 ng/mL (normal <10 ng/mL). The GP orders a contrast-enhanced ultrasound of the liver, the images from which are shown. Based on the ultrasound findings and the patient's history, what is the MOST appropriate next step in management?

A. Order a triple-phase CT scan of the abdomen

B. Initiate antiviral therapy for hepatitis C and repeat AFP in 3 months

C. Repeat the contrast-enhanced ultrasound in 3 months to monitor for growth

D. Referral to a hepatobiliary surgeon for consideration of resection or transplantation

E. Perform a percutaneous liver biopsy under ultrasound guidance

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Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong — CC BY 4.0 · Source

A 62-year-old male presents to the emergency department with right upper quadrant abdominal pain, weight loss, and increasing jaundice over the past month. He has a history of chronic hepatitis C infection and heavy alcohol use. His vital signs are stable. Physical examination reveals hepatomegaly and mild ascites. Laboratory investigations show elevated bilirubin, alkaline phosphatase, and gamma-glutamyl transferase (GGT). Alpha-fetoprotein (AFP) is significantly elevated. A CT scan of the abdomen with and without contrast is performed, as shown. Based on the clinical presentation and imaging findings, what is the MOST appropriate next step in management?

A. Administration of intravenous antibiotics for suspected cholangitis

B. Percutaneous liver biopsy for histological confirmation

C. Initiation of antiviral therapy for hepatitis C

D. Surgical resection of the identified lesion

E. Referral to a hepatologist for consideration of liver transplantation

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Image by R. Badea, Simona Ioanitescu — CC BY 3.0 · Source

A. Surveillance with serial AFP measurements and ultrasound

B. Referral for liver transplant evaluation

C. Percutaneous ethanol ablation

D. Surgical resection

E. Initiation of systemic chemotherapy

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Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong — CC BY 4.0 · Source

A 65-year-old man with chronic hepatitis C and compensated cirrhosis (Child-Pugh A) presents for routine surveillance. His alpha-fetoprotein is 250 ng/mL. He feels well. The provided images are obtained. Considering the clinical context and the findings demonstrated in the images, which of the following management strategies is most likely to be the initial approach for this patient?

A. Liver transplantation

B. Radiofrequency ablation (RFA)

C. Palliative care

D. Systemic chemotherapy

E. Transarterial chemoembolisation (TACE)

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Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong — CC BY 4.0 · Source

A 62-year-old male presents to the emergency department with right upper quadrant abdominal pain, weight loss, and jaundice. He has a known history of chronic hepatitis C infection. His vital signs are stable. Physical examination reveals hepatomegaly and mild ascites. The patient denies any alcohol consumption. Laboratory investigations reveal elevated alpha-fetoprotein (AFP) levels. A CT scan of the abdomen with and without contrast is performed, as shown. Based on the imaging and clinical findings, what is the MOST appropriate next step in management?

A. Referral to a hepatologist for consideration of liver transplantation

B. Percutaneous liver biopsy for histological confirmation

C. Observation with serial AFP measurements every 3 months

D. Administration of intravenous antibiotics for suspected cholangitis

E. Initiation of antiviral therapy for hepatitis C

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Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong — CC BY 4.0 · Source

A 62-year-old male with a history of chronic hepatitis C presents with right upper quadrant pain, weight loss, and jaundice. Physical examination reveals hepatomegaly and mild ascites. Laboratory investigations include elevated alpha-fetoprotein (AFP) levels. Imaging is performed as shown. Considering the clinical context and the findings demonstrated in the imaging, which of the following factors is MOST critical in determining this patient's eligibility for potentially curative surgical resection?

A. Absolute value of serum alpha-fetoprotein

B. Genotype of hepatitis C virus

C. Tumour size and number

D. Patient's chronological age

E. Presence of clinically significant portal hypertension

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Image by R. Badea, Simona Ioanitescu — CC BY 3.0 · Source

A 62-year-old male with cirrhosis presents for routine surveillance. AFP is elevated. The provided image was obtained. What is the MOST appropriate next step in management?

A. Schedule a follow-up ultrasound in 6 months

B. Initiate sorafenib therapy

C. Repeat AFP in 3 months

D. Referral for liver transplant evaluation

E. Order a CT scan of the abdomen with contrast

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Image by R. Badea, Simona Ioanitescu — CC BY 3.0 · Source

A 68-year-old male with a history of chronic hepatitis C presents to the clinic complaining of right upper quadrant abdominal pain and unintentional weight loss of 10 kg over the past 6 months. His past medical history is significant for well-controlled hypertension and hyperlipidemia. Physical examination reveals mild hepatomegaly. Laboratory investigations show elevated alpha-fetoprotein (AFP) levels. A contrast-enhanced ultrasound of the liver is performed, and representative images are shown. Based on the imaging and clinical context, which of the following is the MOST appropriate next step in management?

A. Radiofrequency ablation of the lesion

B. Surveillance with serial AFP measurements and ultrasound every 3 months

C. Surgical resection of the lesion

D. Initiation of systemic chemotherapy with sorafenib

E. Referral for liver biopsy to confirm diagnosis and assess grade

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Image by R. Badea, Simona Ioanitescu — CC BY 3.0 · Source

A 65-year-old male with Hepatitis C cirrhosis is undergoing routine surveillance. A liver lesion was identified on initial ultrasound, prompting a contrast-enhanced ultrasound study. Considering the findings demonstrated in the provided images, what is the most appropriate next step in the management of this patient?

A. Repeat ultrasound in 3 months

B. Refer for urgent liver transplant assessment

C. Prescribe antibiotics for suspected abscess

D. Liver biopsy for histological confirmation

E. Initiate palliative care

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Image by R. Badea, Simona Ioanitescu — CC BY 3.0 · Source

A 62-year-old male with a history of hepatitis C presents with new onset jaundice and abdominal distension. Ascites is confirmed on examination. The patient denies alcohol use. An ultrasound with contrast is performed, as shown. What is the MOST appropriate next step in management?

A. Referral for liver transplant evaluation

B. Order a triple-phase CT scan of the abdomen

C. Initiate empiric antibiotic therapy for spontaneous bacterial peritonitis

D. Administer intravenous albumin and diuretics

E. Paracentesis for diagnostic and therapeutic purposes

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Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong — CC BY 4.0 · Source

A 62-year-old male with a history of hepatitis C presents with new onset ascites and right upper quadrant pain. His AFP is elevated. A CT scan of the abdomen with and without contrast is performed, as shown. What is the MOST appropriate next step in management?

A. Start sorafenib therapy

B. Referral for liver transplant evaluation

C. Initiate systemic chemotherapy

D. Perform a percutaneous liver biopsy

E. Order a triple phase MRI of the liver

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Image by R. Badea, Simona Ioanitescu — CC BY 3.0 · Source

A. Referral for liver transplant evaluation

B. Initiate sorafenib therapy

C. Perform a percutaneous liver biopsy

D. Schedule a follow-up ultrasound in 3 months

E. Order a CT scan of the abdomen with IV contrast

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Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong — CC BY 4.0 · Source

A 65-year-old male with chronic hepatitis C cirrhosis undergoes routine surveillance imaging. He has no new symptoms. Liver function tests are stable. Alpha-fetoprotein is mildly elevated. The provided images are obtained. What is the most appropriate next step in management?

A. Referral for liver transplant assessment

B. Percutaneous biopsy of the lesion

C. Initiation of systemic therapy

D. Transarterial chemoembolisation

E. Repeat imaging in 3 months

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Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong — CC BY 4.0 · Source

A 62-year-old male with a history of hepatitis C presents with new-onset right upper quadrant pain and a 5kg weight loss over the past 3 months. His liver function tests show elevated ALT and AST. An abdominal CT scan with and without contrast is performed (image attached). What is the MOST appropriate next step in management?

A. Order serum alpha-fetoprotein (AFP) levels and monitor for elevation

B. Recommend lifestyle modifications, including alcohol cessation and weight loss

C. Referral to hepatology for consideration of liver biopsy and further management

D. Initiate empiric antibiotic therapy for suspected cholangitis

E. Schedule a follow-up ultrasound in 3 months to monitor the lesion

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Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong — CC BY 4.0 · Source

A 62-year-old male with cirrhosis presents for routine surveillance. His AFP is elevated at 450 ng/mL. The provided image was obtained. What is the MOST appropriate next step in management?

A. Repeat AFP in 3 months

B. Initiate sorafenib therapy

C. Schedule a follow-up CT scan in 6 months

D. Referral for liver transplant evaluation

E. Order a liver biopsy

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Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong — CC BY 4.0 · Source

A 62-year-old male with chronic hepatitis C presents with right upper quadrant pain, weight loss, and mild ascites. Laboratory tests show elevated alpha-fetoprotein. Imaging is performed. Based on the clinical context and the findings depicted in the provided imaging, which of the following factors is MOST important in assessing this patient's suitability for potentially curative surgical management?

A. Evidence of portal venous thrombosis or invasion.

B. Absolute level of serum alpha-fetoprotein.

C. Patient's body mass index.

D. Maximum diameter of the hepatic lesion.

E. Specific viral load of hepatitis C RNA.

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hepatitis C

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