UKMLA PLAB AMC USMLE Prometric MCQ

Correct Answer: E

Explanation:
Hepatocellular carcinoma is associated with long-standing liver disease, including hepatitis B. Hepatocellular carcinoma can present with weakness and weight loss. On physical examination, there can be liver tenderness, and a a palpable mass. A friction rub is heard when the surface of the liver is involved. Alpha fetoprotein is a tumor marker that is elevated in a significant number of primary liver cancers. Hepatocellular carcinoma can have metastasis, typically to regional lymph nodes and the diaphragm. Primary biliary cirrhosis tends to occur in women age 40-60. It would not present with a liver mass surrounded by smaller nodules. There would not be an elevated alpha fetoprotein with primary biliary cirrhosis. In Gilbert's syndrome, there is a mild intermittent unconjugated hyperbilirubinemia and normal liver function tests. It would not present with a liver mass surrounded by smaller nodules. There would not be an elevated alpha fetoprotein in Gilbert's Syndrome. Laennec's cirrhosis is associated with heavy alcohol use over many years. It would not present with a liver mass surrounded by smaller nodules. There would not be an elevated alpha fetoprotein with Laennec's cirrhosis. Hepatitis A would not be associated with a liver mass surrounded by smaller nodules. There would not be an elevated alpha fetoprotein with hepatitis A.