In which ONE of the following conditions is fatty change of the liver not a feature? A. Alcohol abuse. B. Kwashiorkor. C. Obesity. D. Pernicious anaemia. E. Viral hepatitis. The answer is E. Fatty change is not a feature in acute viral hepatitis. All of the others involve nutritional deficiency and toxic damage to hepatocytes which result in fatty change.
Which ONE of the following is not usually a feature of acute viral hepatitis in a liver biopsy? A. Acidophilic degeneration of hepatocytes. B. Ballooning degeneration of hepatocytes. C. Intact reticulin framework. D. Lymphocytic infiltrates in parenchyma and portal tracts. E. Mallory bodies. The answer is E. Mallory bodies are usually found in alcoholic hepatitis, but occur in other conditions, i.e., Indian childhood cirrhosis. The others are the histological hallmarks of acute hepatitis; acidophilic degeneration of hepatocytes (A) with extrusion of the pyknotic nucleus produces the Councilman body.
For each outcome of infection by hepatitis B (HB) virus on the left select the most appropriate association from the list on the right. 46 a. Asymptomatic HB carrier with low infectivity. b. HB positive chronic active hepatitis. c. Recovery from acute hepatitis B. A. Anti-mitochondrial antibody develops. B. HBcAb and HbsAb produced. C. HBcAg and HbsAg both expressed in hepatocyte. D. Predominant HBcAg expression. E. Predominant HBsAg expression in serum and hepatocytes. The answer is E, C, B. If virus is not completely eliminated a carrier state may develop with continued expression of HBsAg; this is viral envelope and is of low infectivity. In some cases chronic liver disease develops with continued expression of HBcAg and HBs Ag. Successful elimination of virus with resolution of the hepatitis results from adequate humoral responses. Antimitochondrial Ab (A) is present in primary biliary cirrhosis. Predominant HBcAg (D) expression occurs in carriers who remain highly infective.
For each of the features of alcoholic liver disease listed on the left select the most appropriate association from the list on the right. a. Fatty liver. b. Alcoholic hepatitis. c. Micronodular cirrhosis. A. Evidence of hepatocyte regeneration. B. Ground glass hepatocytes present. C. Hepatitis predominantly around hepatic vein branches. D. Portal areas severely affected initially. E. Recovery occurs if alcohol withdrawn. The answer is E, C, A. The metabolic effects of alcohol on hepatocytes responsible for fatty change are reversible if alcohol is stopped. This is the earliest feature of alcoholic liver damage. The site of earliest damage in alcoholic liver disease is around the terminal hepatic vein (centrilobular); hepatocyte necrosis in this area is very suggestive of alcohol damage. Before cirrhosis can be present hepatocyte regeneration has to occur, along with fibrosis; fibrosis on its own is not cirrhosis. Ground glass hepatocytes (B) are a feature of hepatitis B infection. The portal areas (D) are affected later in alcoholic hepatitis when extensive damage has occurred and when cirrhosis is present.
Oesophageal varices are caused by which ONE of the following? 47 A. Enlarged liver pressing on the portal vein. B. Portal hypertension. C. Pulmonary hypertension. D. Systemic hypertension. E. Tumour metastases in the porta hepatis. The answer is B. Portal hypertension (usually caused by cirrhosis) results from interference with the hepatic micro-circulation such that vessels in the portal-systemic anastomotic system become engorged and develop varicosities. This occurs most spectacularly in the oesophagus, and rupture of these veins is a common cause of death in alcoholics.
For each of the types of liver tumour listed on the left select the most appropriate association from the list on the right. a. Cholangiocarcinoma. b. Haemangiosarcoma. c. Liver cell adenoma. A. Commonest primary liver tumour. B. Exposure to vinyl chloride monomer. C. Sex hormone therapy. D. Tumour of childhood. E. Ulcerative colitis. The answer is E, B, C. Patients with ulcerative colitis may develop sclerosing cholangitis which is associated with the development of cholangiocarcinoma. In the Far East infection by river fluke causes cholangiocarcinoma. Exposure to vinyl chloride monomer is implicated in the development of haemangiosarcoma. Oral contraceptive and sex hormone therapy have been associated with the development of liver cell adenomas which are benign liver cell tumours. The commonest primary liver cell tumour (A) is the hepatocellular carcinoma. The hepatoblastoma is a liver tumour of childhood (D).
With which ONE of the following do gallstones and/or chronic cholecystitis not have a recognized association? A. Acute pancreatitis. B. Haemolytic anaemia. C. Hepatitis B infection. D. Intestinal obstruction. E. Typhoid fever. The answer is C. There is no association with viral hepatitis. 48 Haemolytic anaemia (B) is associated with the formation of pigment stones. The presence of gallstones is associated with pancreatitis (A) and rarely with small intestinal obstruction (D). Typhoid fever may result in a carrier state in which organisms survive in the gallbladder (E).
For each of the pancreatic lesions listed on the left select the most appropriate association from the list on the right. a. Acute pancreatitis. b. Cystic fibrosis. c. Pancreatic adenocarcinoma. A. Autosomal dominant inheritance. B. Increased sodium chloride content of sweat. C. Raised serum amylase. D. Recurrent peptic ulceration. E. Thrombophlebitis migrans. The answer is C, B, E. This is a diagnostic test for acute pancreatitis; the release of amylase is also responsible for the clinicopathological features of pancreatitis. This autosomal recessive condition is caused by abnormal exocrine gland secretions; the abnormal sweat is a diagnostic test. Thrombophlebitis migrans is one of the bizarre clinical effects seen in patients with pancreatic cancer. Recurrent peptic ulceration (D) is a feature of the endocrine pancreatic tumours which secrete gastrin. 1
