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Old 10-08-2012
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Arrow Billy Step 1 Questions # 17

Seven years ago, a 30-year-old man saw a physician because he had experienced malaise, fever, and jaundice for 2
weeks. On physical examination, there were needle tracks in the left antecubital fossa and a murmur of mitral
regurgitation. Serologic test results were positive for HBsAg, HBV DNA, and IgG anti-HBc. He did not return for follow-up.
Two years later, he was seen in the emergency department because of hematemesis and ascites. Serologic test results
were similar to those reported earlier. Sclerotherapy to treat esophageal varices was performed, and he was discharged.
He again failed to return for follow-up. Five years after this episode, he now sees a physician because of a 5-kg weight
loss, worsening abdominal pain, and rapid enlargement of the abdomen over the past month. Physical examination shows
an increased liver span. Which of the following laboratory tests is most likely to be diagnostic of this last phase of his
disease?


□ (A) Prolonged prothrombin time
□ (B) Elevated serum α-fetoprotein level
□ (C) Elevated serum ALT level
□ (D) Elevated serum alkaline phosphatase level
□ (E) Elevated serum ferritin level
□ (F) Increased blood ammonia level
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Old 10-08-2012
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B............................HCC
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Old 10-08-2012
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B... Elevated AFP due to HCC
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Old 10-08-2012
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My answer B) Elevated serum alpha fetoprotein
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Old 10-08-2012
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answer??
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Old 10-08-2012
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Default □ (B) Elevated serum α-fetoprotein level

Patient got HCC
So, □ (B) Elevated serum α-fetoprotein level
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Old 10-08-2012
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□ (B) Elevated serum α-fetoprotein level
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Old 10-08-2012
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b) elevated serum AFP-----coz already pt. reached to cirrhosis and now to ca.
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Old 10-09-2012
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Correct Answer Yes B is correct

This intravenous drug user developed chronic HBV infection, as evidenced by the persistence of HBsAg, HBV
DNA, and IgG anti-HBc antibodies. Of individuals with a history of intravenous drug use, 80% to 90% are found to have
serologic evidence of HBV or HCV infection. Ruptured varices and ascites suggest that this patient subsequently
developed cirrhosis and portal hypertension. His final presentation of weight loss and rapid enlargement of the abdomen
suggests that a hepatocellular carcinoma has developed. In most cases, hepatocellular carcinoma can be confirmed by an
elevated α-fetoprotein level. The other test findings, including a prolonged prothrombin time, increased ALT level, and
increased ferritin level, all indicate chronic liver disease. Any mass lesion in the liver is associated with an elevated
alkaline phosphatase level. An increasing blood ammonia level indicates liver failure
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Old 10-09-2012
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Elevated alpha fp due to hcc
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