{"id":4115,"date":"2024-07-24T16:50:00","date_gmt":"2024-07-24T16:50:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=4115"},"modified":"2025-10-01T11:38:22","modified_gmt":"2025-10-01T19:38:22","slug":"usmle-step-2-question-of-the-day-hepatocellular-carcinoma","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-hepatocellular-carcinoma","title":{"rendered":"USMLE\u00ae Step 2 Question of the Day: Hepatocellular carcinoma"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-hepatocellular-carcinoma\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-hepatocellular-carcinoma\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-hepatocellular-carcinoma\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-hepatocellular-carcinoma\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-hepatocellular-carcinoma\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>Test your knowledge with this USMLE Step 2 Question of the Day! A 65-year-old woman is diagnosed with hepatocellular carcinoma and is scheduled for a laparoscopic liver resection. Which measure is best for managing intraoperative bleeding?<br><\/strong><\/em><br>A 65-year-old woman is diagnosed with hepatocellular carcinoma. The patient\u2019s tumor is located in segment V of the liver, with imminent obstruction of biliary structures. Laparoscopic liver resection is planned. Which of the following is the best measure to manage intraoperative bleeding in this patient?&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A.&nbsp;Blood transfusion<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B.&nbsp;Adequate postoperative oral hydration<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C.&nbsp;Preoperative intravenous fluids&nbsp;<br><\/strong><br><strong>D.&nbsp;Clamping of the hepatoduodenal ligament&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E.&nbsp;Clamping of the cystoduodenal ligament&nbsp;&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D.\u00a0Clamping of the hepatoduodenal ligament\u00a0<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the&nbsp;<strong>Main Explanation<\/strong>, let&#8217;s see why the answer wasn&#8217;t A, B, C, or E. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Today&#8217;s incorrect answers are&#8230;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A.\u00a0Blood transfusion\u00a0<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Blood transfusions, while an essential part of intraoperative hemostasis, have not been shown to mitigate morbidity and mortality in liver resections, and are negatively associated with post-operative complications.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B.&nbsp;Adequate postoperative oral hydration&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Postoperative oral hydration has minimal effect on fluid hemostasis post-surgically and has no role in intraoperative hemostasis.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C.&nbsp;Preoperative intravenous fluids&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Careful preoperative IV fluid management is critical for surgical candidates and, in particular, patients with underlying cardiopulmonary conditions. However, hemostasis during liver surgery can be better achieved by directly arresting blood flow to the majority of the liver via surgical clamping.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E.&nbsp;Clamping of the cystoduodenal ligament&nbsp;&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Commonly mistaken for the hepatoduodenal ligament, clamping of the cystoduodenal ligament would not provide hemostatic control during resection of the liver. Blood flow to the liver is from the hepatic artery and hepatic portal vein.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The liver is a richly vascularized organ, thus acute&nbsp;life-threatening hemorrhage&nbsp;is a feared complication of liver resection. Management of intraoperative hemorrhage and strictly maintaining hemostatic control remains one of the most challenging aspects of hepatic surgery. Currently, the best way to achieve this goal is to clamp the&nbsp;hepatoduodenal ligament.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The hepatoduodenal ligament contains the&nbsp;hepatic artery,&nbsp;portal vein, and&nbsp;common bile duct. Manual compression of this structure is known as the&nbsp;Pringle maneuver. The Pringle maneuver should be used only immediately before hepatic manipulation or resection, as prolonged use of the Pringle maneuver can lead to reperfusion injury of the liver.&nbsp;&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" height=\"486\" width=\"1024\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/pringle-maneuver.png?w=1024\" alt=\"Pringle Maneuver\nLiver\nGallbladder\nHepatoduodenal Ligament\nLesser Omentum\nStomach\nDuodenum\" class=\"wp-image-4117\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/pringle-maneuver.png 1244w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/pringle-maneuver.png?resize=300,142 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/pringle-maneuver.png?resize=768,364 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/pringle-maneuver.png?resize=1024,486 1024w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The Pringle maneuver involves manually compressing the hepatoduodenal ligament to minimize blood loss l during hepatic surgery. The hepatoduodenal ligament is composed of the hepatic artery, portal vein, and common bile duct.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Piardi, T., Lhuaire, M., Memeo, R., et al. (2016) Laparoscopic Pringle maneuver: How we do it?.&nbsp;Hepatobiliary Surgery and Nutrition. 5(4), 345-349. Doi:10.21037\/hbsn.2015.11.01.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/clinical-sciences\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?w=700\" alt=\"\" class=\"wp-image-5904\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more \u00a0USMLE\u00ae Step 2 CK practice questions?\u00a0Try Osmosis by Elsevier today! Access your\u00a0<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>\u00a0and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Test your knowledge with this USMLE Step 2 Question of the Day! A 65-year-old woman is diagnosed with hepatocellular carcinoma and is scheduled for a laparoscopic liver resection. Which measure is best for managing intraoperative bleeding?A 65-year-old woman is diagnosed with hepatocellular carcinoma. The patient\u2019s tumor is located in segment V of the liver, with [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":4116,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[20,29,32,1370],"tags":[],"class_list":["post-4115","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-exam-prep","category-nclex","category-nursing","category-step-2-questions"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 2 Question of the Day: Hepatocellular carcinoma - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-hepatocellular-carcinoma\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 2 Question of the Day: Hepatocellular carcinoma - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Test your knowledge with this USMLE Step 2 Question of the Day! A 65-year-old woman is diagnosed with hepatocellular carcinoma and is scheduled for a laparoscopic liver resection. Which measure is best for managing intraoperative bleeding?A 65-year-old woman is diagnosed with hepatocellular carcinoma. 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