QUESTION 1

Your Answer is Incorrect

Answer with Detailed explanation

The correct answer is This patient has cirrhosis secondary to the use of methotrexate and metabolic-associated fatty liver disease

Liver stiffness measurement by transient elastography is a non-invasive test of liver fibrosis. A liver stiffness of 15 kPa or above strongly suggests advanced liver fibrosis, and a liver stiffness over 20-25 kPa raises the suspicion of cirrhosis with portal hypertension (thus options B and C are wrong).
The diagnosis of non-alcoholic fatty liver disease requires the exclusion of other liver diseases and secondary causes of fatty liver. This patient has been treated with methotrexate, which can cause both hepatic steatosis and fibrosis. Thus, by definition, we cannot call this non-alcoholic fatty liver disease (options A and C are wrong).
A transient elastography involves 10 measurements. We take the median liver stiffness and controlled attenuation parameter results as reflective of the degree of liver fibrosis and steatosis, respectively. With 10 measurements, we can also understand the variability and therefore the reliability of the measurements. For liver stiffness measurement, an interquartile range-to-median ratio over 0.30 indicates high measurement variability and unreliable results. In this case, the interquartile range-to-median ratio was 0.20, and the results are considered reliable (option E is wrong).
By Prof Vincent Wong, Mok Hing You Professor of Medicine, Head of the Division of Gastroenterology and Hepatology, The Chinese University of Hong Kong

Your Answer is Correct

Answer with Detailed explanation

The correct answer is D. This patient has cirrhosis secondary to the use of methotrexate and metabolic-associated fatty liver disease

Liver stiffness measurement by transient elastography is a non-invasive test of liver fibrosis. A liver stiffness of 15 kPa or above strongly suggests advanced liver fibrosis, and a liver stiffness over 20-25 kPa raises the suspicion of cirrhosis with portal hypertension (thus options B and C are wrong).
The diagnosis of non-alcoholic fatty liver disease requires the exclusion of other liver diseases and secondary causes of fatty liver. This patient has been treated with methotrexate, which can cause both hepatic steatosis and fibrosis. Thus, by definition, we cannot call this non-alcoholic fatty liver disease (options A and C are wrong).
A transient elastography involves 10 measurements. We take the median liver stiffness and controlled attenuation parameter results as reflective of the degree of liver fibrosis and steatosis, respectively. With 10 measurements, we can also understand the variability and therefore the reliability of the measurements. For liver stiffness measurement, an interquartile range-to-median ratio over 0.30 indicates high measurement variability and unreliable results. In this case, the interquartile range-to-median ratio was 0.20, and the results are considered reliable (option E is wrong).
By Prof Vincent Wong, Mok Hing You Professor of Medicine, Head of the Division of Gastroenterology and Hepatology, The Chinese University of Hong Kong

QUESTION 2

The patient underwent a liver biopsy, which confirmed the presence of steatohepatitis and cirrhosis. Apart from the cessation of methotrexate, which of the following treatments is the MOST