Alcoholic liver disease MCQs With Answer

Alcoholic liver disease MCQs With Answer is a focused resource designed for B. Pharm students to master the pharmacology, pathophysiology, diagnosis, and management of alcohol-related liver disorders. This introduction covers key concepts such as stages of alcoholic liver disease (steatosis, alcoholic hepatitis, cirrhosis), ethanol metabolism (ADH, ALDH, CYP2E1), diagnostic markers (AST/ALT ratio, GGT, MCV), scoring systems (Maddrey’s discriminant function, MELD, Child‑Pugh), and evidence-based drug therapies. Student-friendly keywords like Alcoholic liver disease MCQs With Answer, ALD, B. Pharm, pharmacotherapy, and diagnostics are integrated to help you revise effectively. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. What is the earliest reversible stage of alcoholic liver disease?

• Alcoholic hepatitis
• Alcoholic cirrhosis
• Hepatocellular carcinoma
• Alcoholic fatty liver (steatosis)

Correct Answer: Alcoholic fatty liver (steatosis)

Q2. Which enzyme system is primarily induced by chronic alcohol use and contributes to oxidative stress?

• Alcohol dehydrogenase (ADH)
• CYP2E1 (microsomal ethanol-oxidizing system)
• Aldehyde dehydrogenase (ALDH)
• Glutathione peroxidase

Correct Answer: CYP2E1 (microsomal ethanol-oxidizing system)

Q3. A classical laboratory finding in alcoholic liver disease is an AST to ALT ratio typically:

• Less than 1
• Approximately 1:1
• Greater than 2
• Exactly 0.5

Correct Answer: Greater than 2

Q4. Mallory-Denk bodies seen on liver biopsy in alcoholic liver disease represent accumulation of:

• Lipofuscin
• Aggregated intermediate filaments (keratin)
• Glycogen
• Iron

Correct Answer: Aggregated intermediate filaments (keratin)

Q5. Which scoring system specifically helps assess severity in alcoholic hepatitis for steroid treatment decisions?

• Child-Pugh score
• Maddrey’s discriminant function
• MELD score
• APGAR score

Correct Answer: Maddrey’s discriminant function

Q6. The most appropriate initial non-pharmacologic management for a patient with alcoholic liver disease is:

• Immediate liver transplant
• Complete abstinence from alcohol and nutritional support
• High-dose acetaminophen for pain
• Daily corticosteroids for all patients

Correct Answer: Complete abstinence from alcohol and nutritional support

Q7. In severe alcoholic hepatitis (Maddrey’s DF ≥ 32), which drug is commonly used as first-line pharmacotherapy?

• Prednisolone
• Interferon alpha
• Metformin
• Simvastatin

Correct Answer: Prednisolone

Q8. Which laboratory marker is classically elevated in chronic alcohol use and indicates biliary or alcohol-related liver induction?

• Alkaline phosphatase only
• Gamma-glutamyl transferase (GGT)
• Creatine kinase
• Amylase

Correct Answer: Gamma-glutamyl transferase (GGT)

Q9. Which of the following best describes the metabolism pathway that produces acetaldehyde?

• ALDH converts ethanol to acetaldehyde
• CYP2E1 converts acetaldehyde to acetate
• ADH converts ethanol to acetaldehyde
• Alcohol is excreted unchanged

Correct Answer: ADH converts ethanol to acetaldehyde

Q10. Chronic alcohol use affects lipid metabolism primarily by:

• Decreasing hepatic triglyceride synthesis
• Increasing NADH/NAD+ ratio leading to fatty acid synthesis and steatosis
• Blocking lipoprotein secretion in the intestine only
• Increasing fatty acid oxidation exclusively

Correct Answer: Increasing NADH/NAD+ ratio leading to fatty acid synthesis and steatosis

Q11. Which histological feature is most characteristic of alcoholic hepatitis?

• Lobular eosinophilic infiltrate without ballooning
• Neutrophilic infiltrate with hepatocyte ballooning
• Portal tract fibrosis only
• Fatty change without inflammation

Correct Answer: Neutrophilic infiltrate with hepatocyte ballooning

Q12. Which measurement is most useful to assess synthetic liver function in ALD?

• Serum AST level
• Serum albumin and INR
• Serum GGT
• Serum amylase

Correct Answer: Serum albumin and INR

Q13. Which of the following is a reliable biomarker used to detect heavy alcohol consumption over weeks?

• Carbohydrate-deficient transferrin (CDT)
• Serum creatinine
• Serum calcium
• Serum troponin

Correct Answer: Carbohydrate-deficient transferrin (CDT)

Q14. Pentoxifylline’s proposed benefit in alcoholic hepatitis is primarily due to:

• Antiviral action
• TNF-alpha inhibition and improved microcirculation
• Direct hepatocyte regeneration
• Increasing alcohol metabolism

Correct Answer: TNF-alpha inhibition and improved microcirculation

Q15. Which therapy is first-line for hepatic encephalopathy secondary to ALD?

• Lactulose and rifaximin
• High-protein diet only
• IV corticosteroids
• Blood transfusion

Correct Answer: Lactulose and rifaximin

Q16. An important contraindication or caution when prescribing disulfiram is:

• Active cardiac arrhythmia only
• Severe liver disease due to hepatotoxicity risk
• No contraindications in liver disease
• Use in pregnancy is safe

Correct Answer: Severe liver disease due to hepatotoxicity risk

Q17. In ALD, which imaging modality is most useful to estimate liver fibrosis noninvasively?

• Plain abdominal X-ray
• Transient elastography (FibroScan)
• Upper GI endoscopy
• Electrocardiogram

Correct Answer: Transient elastography (FibroScan)

Q18. Which complication of cirrhosis contributes most to mortality and requires prophylactic management?

• Hepatic steatosis
• Variceal bleeding due to portal hypertension
• Simple ascites without infection
• Fatty pancreas

Correct Answer: Variceal bleeding due to portal hypertension

Q19. The primary toxic metabolite of ethanol implicated in hepatocellular injury is:

• Acetate
• Acetaldehyde
• Ethylene glycol
• Formaldehyde

Correct Answer: Acetaldehyde

Q20. Which statement about corticosteroid use in alcoholic hepatitis is correct?

• Corticosteroids are universally recommended for all ALD stages
• They may improve short-term survival in severe alcoholic hepatitis but require infection exclusion
• They are contraindicated in all patients with ALD
• They cure alcoholic cirrhosis

Correct Answer: They may improve short-term survival in severe alcoholic hepatitis but require infection exclusion

Q21. A B. Pharm student should note that chronic alcohol induces which pharmacokinetic change in the liver?

• Reduced CYP enzyme activity uniformly
• Induction of certain CYP enzymes (e.g., CYP2E1), altering drug metabolism
• Elimination of first-pass metabolism completely
• No change in drug metabolism

Correct Answer: Induction of certain CYP enzymes (e.g., CYP2E1), altering drug metabolism

Q22. Which nutritional deficiency is commonly seen in chronic alcoholic liver disease and contributes to neuropathy?

• Vitamin C deficiency
• Thiamine (vitamin B1) deficiency
• Vitamin D excess
• Folic acid excess

Correct Answer: Thiamine (vitamin B1) deficiency

Q23. What is the role of N-acetylcysteine (NAC) in alcoholic hepatitis management?

• Antiviral agent for hepatitis B co-infection
• Antioxidant adjunct that may improve outcomes when combined with corticosteroids
• Primary monotherapy for all cases
• Renal replacement therapy alternative

Correct Answer: Antioxidant adjunct that may improve outcomes when combined with corticosteroids

Q24. Which laboratory abnormality is most indicative of portal-systemic shunting and impaired liver function?

• Low serum bilirubin
• Prolonged INR
• Elevated hemoglobin
• Low serum potassium only

Correct Answer: Prolonged INR

Q25. Which antiviral therapy is specifically indicated to treat alcoholic liver disease?

• Interferon for alcoholic liver disease
• No antiviral is indicated for ALD unless viral hepatitis coexists
• Oseltamivir
• Acyclovir

Correct Answer: No antiviral is indicated for ALD unless viral hepatitis coexists

Q26. Hepatocellular carcinoma risk in ALD is increased primarily in patients with:

• Simple steatosis only
• Established cirrhosis
• Short-term binge drinking without fibrosis
• Isolated elevated GGT only

Correct Answer: Established cirrhosis

Q27. Which medication is used to prevent spontaneous bacterial peritonitis in patients with cirrhotic ascites?

• Long-term prophylactic antibiotics such as norfloxacin or rifaximin
• Daily insulin
• High-dose loop diuretics only
• Intravenous albumin exclusively

Correct Answer: Long-term prophylactic antibiotics such as norfloxacin or rifaximin

Q28. In the context of ALD, which statement about liver transplantation is true?

• Active heavy drinking is typically required for transplant eligibility
• Many centers require a period of documented abstinence (commonly 6 months) before listing
• Transplant is contraindicated for all ALD patients
• Immunosuppression is not needed post-transplant

Correct Answer: Many centers require a period of documented abstinence (commonly 6 months) before listing

Q29. Which electrolyte disturbance commonly occurs in advanced ALD and contributes to hepatic encephalopathy?

• Hypernatremia only
• Hyponatremia
• Hypercalcemia
• Hypoglycemia exclusively

Correct Answer: Hyponatremia

Q30. Which of the following is a common feature of alcoholic cirrhosis on physical examination?

• Exophthalmos
• Spider angiomata and palmar erythema
• Hyperreflexia only
• Rash limited to lower limbs exclusively

Correct Answer: Spider angiomata and palmar erythema

Q31. Which test helps estimate short-term mortality and transplant priority in chronic liver disease?

• Glucose tolerance test
• MELD score
• DEXA scan
• Electroencephalogram

Correct Answer: MELD score

Q32. In pharmacotherapy of ALD-related complications, rifaximin is used primarily to:

• Treat portal hypertension
• Reduce intestinal ammonia-producing bacteria in hepatic encephalopathy
• Directly reverse fibrosis
• Stimulate appetite

Correct Answer: Reduce intestinal ammonia-producing bacteria in hepatic encephalopathy

Q33. Which lipid-related change is typical in alcoholic liver disease?

• Decreased hepatic triglyceride accumulation
• Hepatic steatosis due to increased triglyceride accumulation
• Decreased VLDL production always
• No change in hepatic lipid metabolism

Correct Answer: Hepatic steatosis due to increased triglyceride accumulation

Q34. Which of the following best describes Mallory-Denk bodies composition relevant to pathogenesis?

• Aggregates of ubiquitin and cytokeratin intermediate filaments indicating hepatocellular injury
• Calcium deposits in bile ducts
• Pure lipid droplets in hepatocytes
• Clusters of lymphocytes in portal tracts

Correct Answer: Aggregates of ubiquitin and cytokeratin intermediate filaments indicating hepatocellular injury

Q35. Which of these drugs requires caution or dose adjustment in patients with advanced ALD due to hepatic metabolism?

• Drugs with renal elimination only
• Warfarin, benzodiazepines, and statins
• Oral contraceptives only
• Topical emollients

Correct Answer: Warfarin, benzodiazepines, and statins

Q36. The presence of jaundice, coagulopathy, and encephalopathy indicates which stage of liver disease?

• Mild steatosis
• Decompensated liver disease (decompensated cirrhosis)
• Asymptomatic carrier state
• Acute pancreatitis

Correct Answer: Decompensated liver disease (decompensated cirrhosis)

Q37. Which preventive strategy is most effective at population level to reduce ALD burden?

• Mass antibiotic prophylaxis
• Public health measures to reduce harmful alcohol use (policy, taxation, screening and brief intervention)
• Universal liver biopsy
• Routine corticosteroid prescription

Correct Answer: Public health measures to reduce harmful alcohol use (policy, taxation, screening and brief intervention)

Q38. In alcoholic hepatitis, the presence of infection affects corticosteroid therapy how?

• Infection is not relevant to steroid decisions
• Active infection is a relative contraindication and should be treated before or alongside steroids
• Infection mandates immediate high-dose steroids
• Steroids cure infections

Correct Answer: Active infection is a relative contraindication and should be treated before or alongside steroids

Q39. Which test can help distinguish alcoholic liver disease from nonalcoholic fatty liver disease (NAFLD)?

• History of alcohol intake and CDT levels
• Serum creatinine only
• Skin biopsy
• Pulmonary function test

Correct Answer: History of alcohol intake and CDT levels

Q40. The mechanism by which acetaldehyde contributes to liver fibrosis includes:

• Inhibition of stellate cell activation
• Formation of protein adducts and activation of hepatic stellate cells leading to collagen deposition
• Direct stimulation of bile production
• Neutralization of ROS exclusively

Correct Answer: Formation of protein adducts and activation of hepatic stellate cells leading to collagen deposition

Q41. Which dietary recommendation is generally advised for patients with alcoholic liver disease?

• High calorie, high protein diet with vitamin supplementation unless contraindicated
• Starvation for several days
• Low-protein diet universally
• High alcohol intake with meals

Correct Answer: High calorie, high protein diet with vitamin supplementation unless contraindicated

Q42. Which of the following is a direct consequence of chronic CYP2E1 induction by alcohol?

• Reduced generation of reactive oxygen species
• Increased production of reactive oxygen species and enhanced toxicity of certain drugs (e.g., acetaminophen)
• Complete protection from hepatotoxins
• Reduced drug interactions

Correct Answer: Increased production of reactive oxygen species and enhanced toxicity of certain drugs (e.g., acetaminophen)

Q43. Which clinical feature differentiates acute alcoholic hepatitis from simple alcoholic steatosis?

• Asymptomatic presentation
• Jaundice, fever, and tender hepatomegaly are more suggestive of alcoholic hepatitis
• Pure elevation of HDL cholesterol
• Exclusive elevation of alkaline phosphatase

Correct Answer: Jaundice, fever, and tender hepatomegaly are more suggestive of alcoholic hepatitis

Q44. What role does mitochondrial dysfunction play in ALD pathogenesis?

• Mitochondrial dysfunction decreases oxidative stress
• Mitochondrial dysfunction leads to impaired ATP production, increased ROS, and hepatocyte injury
• Mitochondria are unaffected by alcohol
• Mitochondrial changes only occur in muscles

Correct Answer: Mitochondrial dysfunction leads to impaired ATP production, increased ROS, and hepatocyte injury

Q45. In managing ascites due to cirrhosis, which of the following is a standard pharmacologic approach?

• ACE inhibitors alone
• Sodium restriction and diuretics such as spironolactone ± furosemide
• High-sodium diet and fluid loading
• Immediate intravenous corticosteroids

Correct Answer: Sodium restriction and diuretics such as spironolactone ± furosemide

Q46. Which of the following is considered a hepatoprotective agent with limited clinical evidence in ALD?

• Silymarin (milk thistle)
• Digoxin
• Insulin
• Metoprolol

Correct Answer: Silymarin (milk thistle)

Q47. Which parameter is included in the Child-Pugh score used to assess cirrhosis severity?

• Fasting glucose level
• Bilirubin, albumin, INR, ascites, and encephalopathy
• Serum amylase
• Serum potassium only

Correct Answer: Bilirubin, albumin, INR, ascites, and encephalopathy

Q48. Which is the best counseling point a B. Pharm student should give about medication use in patients with ALD?

• All over-the-counter drugs are safe
• Avoid hepatotoxic drugs (e.g., high-dose acetaminophen), consult physician for dosing adjustments
• Increase alcohol intake to tolerance
• Never take any prescribed medications

Correct Answer: Avoid hepatotoxic drugs (e.g., high-dose acetaminophen), consult physician for dosing adjustments

Q49. Which factor most strongly predicts progression from steatosis to cirrhosis in alcohol users?

• Quantity and duration of alcohol consumption
• Daily caffeine intake
• Use of topical medications
• Short-term abstinence

Correct Answer: Quantity and duration of alcohol consumption

Q50. For B. Pharm students, understanding pharmacotherapy in ALD includes knowing that drug clearance in cirrhosis is often:

• Unchanged for all drugs
• Reduced for drugs with high hepatic extraction, requiring dose adjustments
• Increased for drugs eliminated by the liver
• Predictable solely by body weight

Correct Answer: Reduced for drugs with high hepatic extraction, requiring dose adjustments

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