MCQs on liver diseases

By | April 20, 2024

1. A 55-year-old man with a history of alcohol abuse presents with new-onset ascites. Which of the following is the most appropriate next step in management?
A. Initiate diuretic therapy
B. Recommend large-volume paracentesis
C. Recommend liver transplantation
D. Recommend salt restriction and fluid restriction
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

2. A 62-year-old woman with decompensated cirrhosis secondary to nonalcoholic steatohepatitis (NASH) develops hepatic encephalopathy. Which of the following is the most appropriate management?
A. Initiate lactulose therapy
B. Initiate rifaximin therapy
C. Recommend liver transplantation
D. Recommend protein-restricted diet
E. Recommend supportive care only

3. A 48-year-old man with compensated cirrhosis secondary to hepatitis C presents with an upper gastrointestinal bleed. Which of the following is the most appropriate management?
A. Initiate beta-blocker therapy
B. Initiate proton pump inhibitor therapy
C. Recommend endoscopic variceal ligation
D. Recommend liver transplantation
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

4. A 72-year-old woman with decompensated cirrhosis secondary to alcohol abuse develops spontaneous bacterial peritonitis (SBP). Which of the following is the most appropriate management?
A. Administer intravenous albumin
B. Administer intravenous antibiotics
C. Recommend large-volume paracentesis
D. Recommend liver transplantation
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

5. A 58-year-old man with alcohol-related cirrhosis presents with new-onset hepatorenal syndrome. Which of the following is the most appropriate management?
A. Administer intravenous albumin
B. Administer vasopressin analogue therapy
C. Recommend hemodialysis
D. Recommend liver transplantation
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

6. A 45-year-old woman with decompensated cirrhosis secondary to primary biliary cholangitis develops hepatocellular carcinoma. Which of the following is the most appropriate management?
A. Initiate sorafenib therapy
B. Recommend liver transplantation
C. Recommend locoregional therapy
D. Recommend surgical resection
E. Recommend supportive care only

7. A 60-year-old man with decompensated cirrhosis secondary to hepatitis B develops refractory ascites. Which of the following is the most appropriate management?
A. Administer intravenous albumin
B. Recommend large-volume paracentesis
C. Recommend liver transplantation
D. Recommend sodium restriction and diuretic therapy
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

8. A 52-year-old woman with compensated cirrhosis secondary to primary sclerosing cholangitis develops portal hypertensive gastropathy. Which of the following is the most appropriate management?
A. Administer proton pump inhibitor therapy
B. Initiate beta-blocker therapy
C. Recommend endoscopic variceal ligation
D. Recommend liver transplantation
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

9. A 68-year-old man with decompensated cirrhosis secondary to nonalcoholic steatohepatitis (NASH) develops hepatorenal syndrome. Which of the following is the most appropriate management?
A. Administer intravenous albumin
B. Administer vasopressin analogue therapy
C. Recommend hemodialysis
D. Recommend liver transplantation
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

10. A 50-year-old woman with compensated cirrhosis secondary to primary biliary cholangitis presents with new-onset ascites. Which of the following is the most appropriate management?
A. Initiate diuretic therapy
B. Recommend large-volume paracentesis
C. Recommend liver transplantation
D. Recommend salt restriction and fluid restriction
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

11. A 62-year-old man with decompensated cirrhosis secondary to alcohol abuse develops hepatocellular carcinoma. Which of the following is the most appropriate management?
A. Initiate sorafenib therapy
B. Recommend liver transplantation
C. Recommend locoregional therapy
D. Recommend surgical resection
E. Recommend supportive care only

12. A 55-year-old woman with decompensated cirrhosis secondary to hepatitis C develops spontaneous bacterial peritonitis (SBP). Which of the following is the most appropriate management?
A. Administer intravenous albumin
B. Administer intravenous antibiotics
C. Recommend large-volume paracentesis
D. Recommend liver transplantation
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

13. A 48-year-old man with compensated cirrhosis secondary to nonalcoholic steatohepatitis (NASH) develops variceal bleeding. Which of the following is the most appropriate management?
A. Initiate beta-blocker therapy
B. Initiate proton pump inhibitor therapy
C. Recommend endoscopic variceal ligation
D. Recommend liver transplantation
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

14. A 70-year-old woman with decompensated cirrhosis secondary to primary biliary cholangitis develops hepatic encephalopathy. Which of the following is the most appropriate management?
A. Initiate lactulose therapy
B. Initiate rifaximin therapy
C. Recommend liver transplantation
D. Recommend protein-restricted diet
E. Recommend supportive care only

15. A 58-year-old man with alcohol-related cirrhosis presents with new-onset portal hypertensive gastropathy. Which of the following is the most appropriate management?
A. Administer proton pump inhibitor therapy
B. Initiate beta-blocker therapy
C. Recommend endoscopic variceal ligation
D. Recommend liver transplantation
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

16. A 65-year-old man with cirrhosis secondary to hepatitis C is found to have a 3 cm liver mass on routine abdominal imaging. Which of the following is the most appropriate next step in management?
A. Initiate treatment with sorafenib
B. Perform contrast-enhanced CT or MRI of the abdomen
C. Recommend liver biopsy
D. Recommend liver transplantation
E. Recommend radiofrequency ablation

17. A 55-year-old woman with cirrhosis secondary to nonalcoholic steatohepatitis (NASH) presents with a 5 cm liver mass and new-onset abdominal pain. Which of the following is the most appropriate management?
A. Initiate treatment with lenvatinib
B. Recommend liver biopsy
C. Recommend liver transplantation
D. Recommend radioembolization
E. Recommend surgical resection

18. A 70-year-old man with Child-Pugh class B cirrhosis secondary to alcohol abuse is found to have multiple liver masses on routine screening. Which of the following is the most appropriate management?
A. Initiate treatment with atezolizumab and bevacizumab
B. Recommend liver biopsy
C. Recommend liver transplantation
D. Recommend stereotactic body radiation therapy (SBRT)
E. Recommend transarterial chemoembolization (TACE)

20. A 60-year-old woman with decompensated cirrhosis secondary to primary biliary cholangitis presents with a 2 cm liver mass and portal vein thrombosis. Which of the following is the most appropriate management?
A. Initiate treatment with sorafenib
B. Recommend liver biopsy
C. Recommend liver transplantation
D. Recommend radioembolization
E. Recommend transarterial chemoembolization (TACE)

21. A 50-year-old man with compensated cirrhosis secondary to hepatitis B is found to have a 4 cm liver mass with elevated alpha-fetoprotein levels. Which of the following is the most appropriate management?
A. Initiate treatment with lenvatinib
B. Recommend liver biopsy
C. Recommend liver transplantation
D. Recommend radiofrequency ablation
E. Recommend surgical resection

22. A 75-year-old woman with Child-Pugh class C cirrhosis secondary to alcohol abuse develops multiple liver masses. Which of the following is the most appropriate management?
A. Initiate treatment with atezolizumab and bevacizumab
B. Recommend liver biopsy
C. Recommend liver transplantation
D. Recommend supportive care only
E. Recommend transarterial chemoembolization (TACE)

23. A 55-year-old man with cirrhosis secondary to nonalcoholic steatohepatitis (NASH) is found to have a 3 cm liver mass with vascular invasion on imaging. Which of the following is the most appropriate management?
A. Initiate treatment with sorafenib
B. Recommend liver biopsy
C. Recommend liver transplantation
D. Recommend radioembolization
E. Recommend surgical resection

24. A 65-year-old woman with Child-Pugh class B cirrhosis secondary to primary biliary cholangitis presents with a 6 cm liver mass and new-onset ascites. Which of the following is the most appropriate management?
A. Initiate treatment with lenvatinib
B. Recommend liver biopsy
C. Recommend liver transplantation
D. Recommend stereotactic body radiation therapy (SBRT)
E. Recommend transarterial chemoembolization (TACE)

25. A 45-year-old man with compensated cirrhosis secondary to hepatitis B is found to have a 2 cm liver mass with elevated alpha-fetoprotein levels. Which of the following is the most appropriate management?
A. Initiate treatment with atezolizumab and bevacizumab
B. Recommend liver biopsy
C. Recommend liver transplantation
D. Recommend radiofrequency ablation
E. Recommend surgical resection

26. A 70-year-old man with decompensated cirrhosis secondary to alcohol abuse develops multiple liver masses. Which of the following is the most appropriate management?
A. Initiate treatment with sorafenib
B. Recommend liver biopsy
C. Recommend liver transplantation
D. Recommend supportive care only
E. Recommend transarterial chemoembolization (TACE)

27. A 60-year-old woman with cirrhosis secondary to primary sclerosing cholangitis is found to have a 4 cm liver mass with portal vein invasion on imaging. Which of the following is the most appropriate management?
A. Initiate treatment with lenvatinib
B. Recommend liver biopsy
C. Recommend liver transplantation
D. Recommend radioembolization
E. Recommend surgical resection

28. A 55-year-old man with Child-Pugh class C cirrhosis secondary to hepatitis C presents with a 2 cm liver mass and new-onset ascites. Which of the following is the most appropriate management?
A. Initiate treatment with atezolizumab and bevacizumab
B. Recommend liver biopsy
C. Recommend liver transplantation
D. Recommend stereotactic body radiation therapy (SBRT)
E. Recommend transarterial chemoembolization (TACE)

29. A 50-year-old woman with compensated cirrhosis secondary to nonalcoholic steatohepatitis (NASH) is found to have a 3 cm liver mass with elevated alpha-fetoprotein levels. Which of the following is the most appropriate management?
A. Initiate treatment with sorafenib
B. Recommend liver biopsy
C. Recommend liver transplantation
D. Recommend radiofrequency ablation
E. Recommend surgical resection

30. A 65-year-old man with decompensated cirrhosis secondary to primary biliary cholangitis develops multiple liver masses. Which of the following is the most appropriate management?
A. Initiate treatment with lenvatinib
B. Recommend liver biopsy
C. Recommend liver transplantation
D. Recommend supportive care only
E. Recommend transarterial chemoembolization (TACE)

31. A 60-year-old woman with Child-Pugh class B cirrhosis secondary to hepatitis B is found to have a 5 cm liver mass with vascular invasion on imaging. Which of the following is the most appropriate management?
A. Initiate treatment with atezolizumab and bevacizumab
B. Recommend liver biopsy
C. Recommend liver transplantation
D. Recommend radioembolization
E. Recommend surgical resection

32. A 45-year-old man with primary sclerosing cholangitis presents with pruritus, fatigue, and jaundice. Which of the following is the most appropriate management?
A. Initiate ursodeoxycholic acid therapy
B. Recommend biliary stent placement
C. Recommend liver transplantation
D. Recommend surgical biliary drainage
E. Recommend symptomatic management only

33. A 62-year-old woman with primary biliary cholangitis develops progressive liver failure. Which of the following is the most appropriate management?
A. Initiate corticosteroid therapy
B. Initiate ursodeoxycholic acid therapy
C. Recommend biliary drainage procedures
D. Recommend liver transplantation
E. Recommend supportive care only

34. A 55-year-old man with Wilson’s disease presents with acute liver failure. Which of the following is the most appropriate management?
A. Administer penicillamine
B. Administer zinc supplementation
C. Recommend liver transplantation
D. Recommend plasmapheresis
E. Recommend supportive care only

35. A 40-year-old woman with autoimmune hepatitis presents with refractory disease. Which of the following is the most appropriate management?
A. Initiate azathioprine therapy
B. Initiate corticosteroid therapy
C. Recommend liver transplantation
D. Recommend mycophenolate mofetil therapy
E. Recommend rituximab therapy

36. A 62-year-old man with primary biliary cholangitis develops pruritus refractory to ursodeoxycholic acid. Which of the following is the most appropriate management?
A. Initiate cholestyramine therapy
B. Initiate rifampicin therapy
C. Recommend biliary drainage procedures
D. Recommend liver transplantation
E. Recommend obeticholic acid therapy

37. A 45-year-old woman with primary sclerosing cholangitis presents with recurrent episodes of cholangitis. Which of the following is the most appropriate management?
A. Initiate antibiotic prophylaxis
B. Initiate ursodeoxycholic acid therapy
C. Recommend biliary stent placement
D. Recommend liver transplantation
E. Recommend surgical biliary drainage

38. A 55-year-old man with alcoholic cirrhosis develops variceal bleeding. Which of the following is the most appropriate management?
A. Initiate beta-blocker therapy
B. Initiate proton pump inhibitor therapy
C. Recommend endoscopic variceal ligation
D. Recommend liver transplantation
E. Recommend

39. A 62-year-old woman with decompensated cirrhosis secondary to primary biliary cholangitis develops hepatopulmonary syndrome. Which of the following is the most appropriate management?
A. Administer supplemental oxygen
B. Initiate phosphodiesterase-5 inhibitor therapy
C. Recommend liver transplantation
D. Recommend pulmonary vasodilator therapy
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

40. A 50-year-old man with compensated cirrhosis secondary to hepatitis B presents with new-onset hepatic encephalopathy. Which of the following is the most appropriate management?
A. Initiate lactulose therapy
B. Initiate rifaximin therapy
C. Recommend liver transplantation
D. Recommend protein-restricted diet
E. Recommend supportive care only

41. A 70-year-old woman with decompensated cirrhosis secondary to alcohol abuse develops hepatorenal syndrome. Which of the following is the most appropriate management?
A. Administer intravenous albumin
B. Administer vasopressin analogue therapy
C. Recommend hemodialysis
D. Recommend liver transplantation
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

42. A 55-year-old man with compensated cirrhosis secondary to nonalcoholic steatohepatitis (NASH) presents with new-onset portal hypertensive gastropathy. Which of the following is the most appropriate management?
A. Administer proton pump inhibitor therapy
B. Initiate beta-blocker therapy
C. Recommend endoscopic variceal ligation
D. Recommend liver transplantation
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

43. A 60-year-old woman with decompensated cirrhosis secondary to primary biliary cholangitis develops recurrent episodes of cholangitis. Which of the following is the most appropriate management?
A. Initiate antibiotic prophylaxis
B. Initiate ursodeoxycholic acid therapy
C. Recommend biliary stent placement
D. Recommend liver transplantation
E. Recommend surgical biliary drainage

44. A 48-year-old man with compensated cirrhosis secondary to hepatitis C presents with new-onset ascites. Which of the following is the most appropriate management?
A. Initiate diuretic therapy
B. Recommend large-volume paracentesis
C. Recommend liver transplantation
D. Recommend salt restriction and fluid restriction
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

45. A 65-year-old woman with decompensated cirrhosis secondary to primary sclerosing cholangitis develops hepatocellular carcinoma. Which of the following is the most appropriate management?
A. Initiate sorafenib therapy
B. Recommend liver transplantation
C. Recommend locoregional therapy
D. Recommend surgical resection
E. Recommend supportive care only

46. A 58-year-old man with alcohol-related cirrhosis presents with new-onset hepatic encephalopathy. Which of the following is the most appropriate management?
A. Initiate lactulose therapy
B. Initiate rifaximin therapy
C. Recommend liver transplantation
D. Recommend protein-restricted diet
E. Recommend supportive care only

47. A 52-year-old woman with compensated cirrhosis secondary to primary biliary cholangitis develops refractory pruritus. Which of the following is the most appropriate management?
A. Initiate cholestyramine therapy
B. Initiate rifampicin therapy
C. Recommend biliary drainage procedures
D. Recommend liver transplantation
E. Recommend obeticholic acid therapy

48. A 60-year-old man with decompensated cirrhosis secondary to hepatitis C presents with new-onset hepatorenal syndrome. Which of the following is the most appropriate management?
A. Administer intravenous albumin
B. Administer vasopressin analogue therapy
C. Recommend hemodialysis
D. Recommend liver transplantation
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

49. A 55-year-old woman with compensated cirrhosis secondary to primary sclerosing cholangitis develops cholangiocarcinoma. Which of the following is the most appropriate management?
A. Initiate gemcitabine and cisplatin chemotherapy
B. Recommend biliary drainage procedures
C. Recommend liver transplantation
D. Recommend surgical resection
E. Recommend supportive care only

50. A 68-year-old man with decompensated cirrhosis secondary to alcohol abuse develops hepatopulmonary syndrome. Which of the following is the most appropriate management?
A. Administer supplemental oxygen
B. Initiate phosphodiesterase-5 inhibitor therapy
C. Recommend liver transplantation
D. Recommend pulmonary vasodilator therapy
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

51. A 45-year-old woman with autoimmune hepatitis presents with a severe flare. Which of the following is the most appropriate management?
A. Initiate azathioprine therapy
B. Initiate corticosteroid therapy
C. Recommend liver transplantation
D. Recommend mycophenolate mofetil therapy
E. Recommend rituximab therapy

52. A 58-year-old man with alcohol-related cirrhosis develops spontaneous bacterial peritonitis (SBP). Which of the following is the most appropriate management?
A. Administer intravenous albumin
B. Administer intravenous antibiotics
C. Recommend large-volume paracentesis
D. Recommend liver transplantation
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

53. A 62-year-old woman with decompensated cirrhosis secondary to primary biliary cholangitis presents with new-onset hepatic encephalopathy. Which of the following is the most appropriate management?
A. Initiate lactulose therapy
B. Initiate rifaximin therapy
C. Recommend liver transplantation
D. Recommend protein-restricted diet
E. Recommend supportive care only

54. A 50-year-old man with compensated cirrhosis secondary to hepatitis B develops hepatocellular carcinoma. Which of the following is the most appropriate management?
A. Initiate sorafenib therapy
B. Recommend liver transplantation
C. Recommend locoregional therapy
D. Recommend surgical resection
E. Recommend supportive care only

55. A 65-year-old woman with decompensated cirrhosis secondary to primary biliary cholangitis presents with new-onset portal hypertensive gastropathy. Which of the following is the most appropriate management?
A. Administer proton pump inhibitor therapy
B. Initiate beta-blocker therapy
C. Recommend endoscopic variceal ligation
D. Recommend liver transplantation
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

56. A 55-year-old man with compensated cirrhosis secondary to nonalcoholic steatohepatitis (NASH) develops hepatocellular carcinoma. Which of the following is the most appropriate management?
A. Initiate lenvatinib therapy
B. Recommend liver transplantation
C. Recommend locoregional therapy
D. Recommend surgical resection
E. Recommend supportive care only

57. A 62-year-old man with decompensated cirrhosis secondary to alcohol abuse develops hepatopulmonary syndrome. Which of the following is the most appropriate management?
A. Administer supplemental oxygen
B. Initiate phosphodiesterase-5 inhibitor therapy
C. Recommend liver transplantation
D. Recommend pulmonary vasodilator therapy

58. A 45-year-old woman with autoimmune hepatitis presents with refractory disease despite standard immunosuppressive therapy. Which of the following is the most appropriate management?
A. Initiate azathioprine therapy
B. Initiate corticosteroid therapy
C. Recommend liver transplantation
D. Recommend mycophenolate mofetil therapy
E. Recommend rituximab therapy

59. A 55-year-old man with decompensated cirrhosis secondary to hepatitis B develops hepatic encephalopathy. Which of the following is the most appropriate management?
A. Initiate lactulose therapy
B. Initiate rifaximin therapy
C. Recommend liver transplantation
D. Recommend protein-restricted diet
E. Recommend supportive care only

60. A 62-year-old woman with primary biliary cholangitis develops progressive liver failure. Which of the following is the most appropriate management?
A. Initiate corticosteroid therapy
B. Initiate ursodeoxycholic acid therapy
C. Recommend biliary drainage procedures
D. Recommend liver transplantation
E. Recommend supportive care only

61. A 50-year-old man with compensated cirrhosis secondary to nonalcoholic steatohepatitis (NASH) develops hepatocellular carcinoma. Which of the following is the most appropriate management?
A. Initiate lenvatinib therapy
B. Recommend liver transplantation
C. Recommend locoregional therapy
D. Recommend surgical resection
E. Recommend supportive care only

62. A 68-year-old man with decompensated cirrhosis secondary to alcohol abuse presents with new-onset hepatorenal syndrome. Which of the following is the most appropriate management?
A. Administer intravenous albumin
B. Administer vasopressin analogue therapy
C. Recommend hemodialysis
D. Recommend liver transplantation
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

63. A 55-year-old woman with compensated cirrhosis secondary to primary biliary cholangitis develops cholangiocarcinoma. Which of the following is the most appropriate management?
A. Initiate gemcitabine and cisplatin chemotherapy
B. Recommend biliary drainage procedures
C. Recommend liver transplantation
D. Recommend surgical resection
E. Recommend supportive care only

64. A 45-year-old woman with autoimmune hepatitis experiences a severe flare despite standard immunosuppressive therapy. Which of the following is the most appropriate management?
A. Initiate azathioprine therapy
B. Initiate corticosteroid therapy
C. Recommend liver transplantation
D. Recommend mycophenolate mofetil therapy
E. Recommend rituximab therapy

65. A 62-year-old man with decompensated cirrhosis secondary to primary biliary cholangitis develops recurrent episodes of cholangitis. Which of the following is the most appropriate management?
A. Initiate antibiotic prophylaxis
B. Initiate ursodeoxycholic acid therapy
C. Recommend biliary stent placement
D. Recommend liver transplantation
E. Recommend surgical biliary drainage

66. A 50-year-old man with compensated cirrhosis secondary to hepatitis B presents with new-onset portal hypertensive gastropathy. Which of the following is the most appropriate management?
A. Administer proton pump inhibitor therapy
B. Initiate beta-blocker therapy
C. Recommend endoscopic variceal ligation
D. Recommend liver transplantation
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

67. A 65-year-old woman with decompensated cirrhosis secondary to primary sclerosing cholangitis develops recurrent episodes of cholangitis. Which of the following is the most appropriate management?
A. Initiate antibiotic prophylaxis
B. Initiate ursodeoxycholic acid therapy
C. Recommend biliary stent placement
D. Recommend liver transplantation
E. Recommend surgical biliary drainage

68. A 55-year-old man with compensated cirrhosis secondary to nonalcoholic steatohepatitis (NASH) presents with new-onset ascites. Which of the following is the most appropriate management?
A. Initiate diuretic therapy
B. Recommend large-volume paracentesis
C. Recommend liver transplantation
D. Recommend salt restriction and fluid restriction
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

69. A 62-year-old woman with decompensated cirrhosis secondary to primary biliary cholangitis develops hepatocellular carcinoma. Which of the following is the most appropriate management?
A. Initiate sorafenib therapy
B. Recommend liver transplantation
C. Recommend locoregional therapy
D. Recommend surgical resection
E. Recommend supportive care only

70. A 48-year-old man with compensated cirrhosis secondary to hepatitis C presents with new-onset hepatic encephalopathy. Which of the following is the most appropriate management?
A. Initiate lactulose therapy
B. Initiate rifaximin therapy
C. Recommend liver transplantation
D. Recommend protein-restricted diet
E. Recommend supportive care only

71. A 55-year-old woman with compensated cirrhosis secondary to primary sclerosing cholangitis develops cholangiocarcinoma. Which of the following is the most appropriate management?
A. Initiate gemcitabine and cisplatin chemotherapy
B. Recommend biliary drainage procedures
C. Recommend liver transplantation
D. Recommend surgical resection
E. Recommend supportive care only

72. A 62-year-old man with decompensated cirrhosis secondary to alcohol abuse presents with new-onset hepatopulmonary syndrome. Which of the following is the most appropriate management?
A. Administer supplemental oxygen
B. Initiate phosphodiesterase-5 inhibitor therapy
C. Recommend liver transplantation
D. Recommend pulmonary vasodilator therapy
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)

73. A 50-year-old man with compensated cirrhosis secondary to hepatitis B develops hepatocellular carcinoma. Which of the following is the most appropriate management?
A. Initiate sorafenib therapy
B. Recommend liver transplantation
C. Recommend locoregional therapy
D. Recommend surgical resection
E. Recommend supportive care only

74. A 65-year-old woman with decompensated cirrhosis secondary to primary biliary cholangitis presents with new-onset hepatic encephalopathy. Which of the following is the most appropriate management?
A. Initiate lactulose therapy
B. Initiate rifaximin therapy
C. Recommend liver transplantation
D. Recommend protein-restricted diet
E. Recommend supportive care only

75. A 55-year-old man with compensated cirrhosis secondary to nonalcoholic steatohepatitis (NASH) develops variceal bleeding. Which of the following is the most appropriate management?
A. Initiate beta-blocker therapy
B. Initiate proton pump inhibitor therapy
C. Recommend endoscopic variceal ligation
D. Recommend liver transplantation
E. Recommend transjugular intrahepatic portosystemic shunt (TIPS)