- 1. What are the two main macroscopic appearances of hepatocellular carcinoma?
A) Nodular and infiltrative
B) Cystic and solid
C) Encapsulated and diffused
D) Fibrous and vascular
- 2. What color might liver tumor nodules appear if they produce bile?
A) Green
B) Red
C) Yellow
D) Blue
- 3. Which statement accurately describes the nodular type of hepatocellular carcinoma?
A) Completely encapsulated
B) Poorly circumscribed and infiltrative
C) Exclusively solitary
D) Well circumscribed but not encapsulated
- 4. What structure is commonly infiltrated by the diffuse type of hepatocellular carcinoma?
A) Pancreatic duct
B) Bile ducts
C) Gallbladder
D) Portal veins
- 5. How many architectural and cytological types of hepatocellular carcinoma are listed in the text?
A) Six
B) Two
C) Four
D) Five
- 6. Which of the following is an architectural type of hepatocellular carcinoma?
A) Fibrolamellar
B) Small cell
C) Papillary
D) Squamous
- 7. What do tumor cells resemble in well-differentiated forms of hepatocellular carcinoma?
A) Hepatocytes
B) Bile duct cells
C) Kupffer cells
D) Endothelial cells
- 8. What patterns can tumor cells form in well-differentiated hepatocellular carcinoma?
A) Papillae and follicles
B) Trabeculae, cords, and nests
C) Sheets and clusters
D) Acini and tubules
- 9. Why do poorly differentiated hepatocellular carcinomas often show central necrosis?
A) High lipid content
B) Poor vascularization
C) Rapid cell division
D) Bile accumulation
- 10. What is the name of the fifth, less common form of hepatocellular carcinoma?
A) Sarcomatoid hepatocellular carcinoma
B) Hepatoblastoma-like carcinoma
C) Cholangiocarcinoma-like carcinoma
D) Lymphoepithelioma-like hepatocellular carcinoma
- 11. How are malignant epithelial cells described in poorly differentiated forms?
A) Columnar, glandular, and well-defined
B) Uniform, cohesive, and small
C) Discohesive, pleomorphic, anaplastic, and giant
D) Cuboidal, organized, and encapsulated
- 12. Which of the following describes the stroma of hepatocellular carcinoma?
A) Fibrotic
B) Abundant
C) Scant
D) Calcified
- 13. When does the nodular type of hepatocellular carcinoma often appear as multiple masses?
A) As a complication of cirrhosis
B) After chemotherapy treatment
C) In the early stages of development
D) When the tumor is encapsulated
- 14. Which of the following is a cytological type of hepatocellular carcinoma mentioned in the text?
A) Large cell
B) Clear cell
C) Fatty cell
D) Spindle cell
- 15. What is the main characteristic of the diffuse type of hepatocellular carcinoma?
A) Poorly circumscribed
B) Encapsulated
C) Well circumscribed
D) Solitary nodule
- 16. Which imaging modality is listed as having the potential to deliver high-resolution images without using ionizing radiation?
A) X-ray
B) CT scan
C) MRI
D) Ultrasound
- 17. How many growth patterns of HCC are identified on CT and MRI?
A) Four
B) Two
C) Three
D) Five
- 18. What is the sensitivity of CT diagnosis for HCC according to the systematic review mentioned?
A) 81%
B) 85%
C) 68%
D) 90%
- 19. How does HCC typically appear on T1-weighted MRI images?
A) High-intensity pattern
B) Iso-intense pattern
C) Heterogeneous pattern
D) Low-intensity pattern
- 20. What is the specific appearance of HCC on T2-weighted MRI images?
A) Variable intensity pattern
B) Iso-intense pattern
C) High-intensity pattern
D) Low-intensity pattern
- 21. What is the acronym for the classification system used for reporting liver lesions?
A) LI-RADS
B) HCC-RADS
C) LIVER-CAT
D) LI-SCORE
- 22. What happens to MRI sensitivity when gadolinium contrast-enhanced and diffusion-weighted imaging are combined?
A) It becomes unreliable
B) It remains the same
C) It decreases
D) It increases
- 23. In which patient group does MRI offer an advantage in differentiating HCC from regenerative nodules?
A) Patients with fatty liver disease
B) Patients with liver trauma
C) Cirrhotic patients
D) Pediatric patients
- 24. According to the text, what is the highest LI-RADS category mentioned?
A) 3
B) 4
C) 5
D) 6
- 25. Is a biopsy always required to confirm the diagnosis of HCC?
A) No, if imaging criteria are met
B) Only in late stages
C) Only for small lesions
D) Yes, always
- 26. What was the specificity of MRI for HCC based on the systematic review cited?
A) 93%
B) 85%
C) 90%
D) 68%
- 27. What is the five-year survival rate for individuals diagnosed with HCC?
A) 5%
B) 50%
C) 35%
D) 18%
- 28. Which population group has a higher incidence of HCC, being more than three times as common as the other?
A) Elderly individuals
B) Children
C) Females
D) Males
- 29. What is currently the fastest growing cause of HCC?
A) Hepatitis B
B) Alcohol use
C) Hemochromatosis
D) NASH
- 30. In the United States, the rising incidence of HCC is primarily linked to an increase in which virus?
A) Hepatitis B
B) Hepatitis D
C) Hepatitis A
D) Hepatitis C
- 31. Globally, what is the estimated percentage of HCC cases caused by chronic viral hepatitis?
A) 50%
B) 25%
C) 10%
D) 80%
- 32. Which type of hepatitis is responsible for about 50% of HCC cases globally?
A) Hepatitis E
B) Hepatitis B
C) Hepatitis A
D) Hepatitis C
- 33. Which toxin is specifically mentioned as a risk factor for HCC?
A) Lead
B) Aflatoxin
C) Mercury
D) Arsenic
- 34. What is the most common cause of cirrhosis?
A) Hepatitis C
B) Hemochromatosis
C) Diabetes
D) Alcohol use disorder
- 35. What congenital disorder is known to markedly increase the risk of HCC?
A) Alpha 1-antitrypsin deficiency
B) Cystic fibrosis
C) Turner syndrome
D) Down syndrome
- 36. HCC ranks as the leading cause of cancer-related deaths worldwide at which position?
A) Fifth
B) First
C) Third
D) Second
- 37. What is the primary reason HCC is statistically associated with hemophilia?
A) Side effects of blood clotting medication
B) Genetic predisposition to liver tumors
C) Coincident chronic viral hepatitis infection
D) High levels of iron in blood products
- 38. Which subtype of hepatic adenoma is particularly associated with an increased risk of HCC?
A) Fibrolamellar variant
B) Alpha-fetoprotein dominant
C) Hepatocyte-only adenoma
D) Beta-catenin activation mutation
- 39. Which factor is suspected to contribute significantly to the increased risk of hepatocellular carcinoma in diabetics?
A) Type of carbohydrate consumption
B) Circulating insulin concentration
C) Physical activity level
D) Blood glucose stability
- 40. What is a characteristic of diabetics who show risk levels for HCC indistinguishable from the general population?
A) Chronic high blood sugar
B) High insulin output
C) Exclusive use of anabolic steroids
D) Tight insulin control
- 41. Besides type 2 diabetes, which condition is mentioned as having poor insulin regulation and increased HCC risk?
A) Type 1 diabetes
B) Metabolic syndrome
C) Chronic kidney disease
D) Hypertension
- 42. What are the two main ways that cancer cells develop?
A) Higher replication rate or avoiding apoptosis
B) Viral integration or bile salt accumulation
C) Increased oxygen uptake or reduced liver size
D) High glucose consumption or reduced bile flow
- 43. How do hepatitis B and C contribute to HCC pathogenesis?
A) By increasing insulin production in the liver
B) By directly converting benign adenomas
C) By blocking the bile salt export pump
D) By causing immune cells to attack liver cells
- 44. What substances are released by activated immune-system inflammatory cells that cause DNA damage?
A) Steroid hormones
B) Bile salts
C) Free radicals
D) Insulin-like growth factors
- 45. What percentage of HCC cases involve mutations in the TERT promoter?
A) 47–60%
B) 30–40%
C) 10–20%
D) 70–85%
- 46. What is the result of TERT promoter mutations in HCC cells?
A) Reduced bile salt export
B) Constitutively active telomerase
C) Increased apoptotic rate
D) Decreased cell division
- 47. What is the approximate prevalence of TP53 gene mutations in HCC cases?
A) 30%
B) 60%
C) 10%
D) 5%
- 48. Which signaling pathway, commonly mutated in HCC, is responsible for embryogenesis and cell homeostasis?
A) Wnt
B) TP53
C) ABCB11
D) TERT
- 49. A deficiency in which gene leads to the toxic accumulation of bile salts?
A) CTNNB1
B) ABCB11
C) TP53
D) AXIN1
- 50. What was historically required to prove an HCC diagnosis?
A) Physical examination
B) Blood testing
C) Biopsy
D) Genetic screening
- 51. Which mutations are seen in 10% of HCC cases regarding chromatin remodeling?
A) ARID1A
B) CTNNB1
C) AXIN1
D) ABCB11
- 52. What is the recommended interval for ultrasound screening for HCC in patients with cirrhosis according to the AASLD?
A) Every three months
B) Every eighteen months
C) Every six months
D) Every twelve months
- 53. What is the sensitivity of AFP at levels greater than 20?
A) 41–65%
B) 31%
C) 99%
D) 80–94%
- 54. What is the specificity of AFP at levels greater than 200?
A) 31%
B) 41–65%
C) 80–94%
D) 99%
- 55. When combined with AFP correlation, what does the sensitivity of ultrasound for HCC detection increase to?
A) 97%
B) 60%
C) 41%
D) 79%
- 56. What primary imaging modality is recommended for routine HCC screening in high-risk populations?
A) CT scan
B) PET scan
C) MRI
D) Ultrasound
- 57. What is the specificity of ultrasound for HCC based on a systematic review compared to pathologic examination?
A) 60%
B) 97%
C) 79%
D) 31%
- 58. What technique is used during CT or MRI to improve detection and classification of liver lesions?
A) Sedation-free imaging
B) Low-dose radiation scanning
C) Intravenous contrast in multiple phases
D) Oral contrast agents
- 59. What is the stated reason for the high mortality rate of HCC?
A) Lack of available treatment
B) Poor patient compliance
C) Rapid resistance to chemotherapy
D) Diagnosis occurs at an advanced stage
- 60. Besides AFP, what other blood test marker is mentioned for the evaluation of HCC?
A) C-reactive protein
B) Alkaline phosphatase
C) Des-gamma carboxyprothrombin
D) Liver transaminases
- 61. What is the AASLD's position on screening for cirrhosis secondary to fatty liver disease?
A) It is not recommended under any circumstances
B) There is some controversy surrounding whether surveillance reduces mortality
C) It is standard of care worldwide
D) It is definitively proven to reduce mortality
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