Deck 15: Liver, Gallbladder, and Biliary Tract

Question 1

Antibodies to mitochondrial dihydrolipoamide acetyltransferase are typically found in 90% of patients who have

A) autoimmune hepatitis
B) lupoid hepatitis
C) primary sclerosing cholangitis
D) primary biliary cirrhosis
E) hepatocellular carcinoma

Answer 1

primary biliary cirrhosis

Question 2

Which of the following types of hepatocellular carcinoma occurs in young adults, is unrelated to cirrhosis, and has a much better prognosis (i.e., a 60% 5-year survival rate)?

A) Tumor developing in hemochromatosis
B) Tumor in Wilson disease
C) Diffusely infiltrative hepatocellular carcinoma
D) Fibrolamellar hepatocellular carcinoma
E) Cholangio-hepatocellular carcinoma

Answer 2

Fibrolamellar hepatocellular carcinoma

Question 3

An obese 50-year-old woman, whose height is 5 ft 4 in (160 cm) and weight is 220 lb (100 kg), decided to lose weight. She lost 45 lb (approximately 20 kg) over a period of 6 months, and then had an attack of biliary colic and required a cholecystectomy. The gallbladder stones identified by the pathologist were most likely

A) pigmented stones
B) calcium oxalate stones
C) cholesterol stones
D) bilirubin carbonate stones
E) lithocholate stones

Answer 3

cholesterol stones

Question 4

The most common cause of cirrhosis unrelated to alcohol, viral hepatitis, or metabolic diseases (i.e., the so-called "cryptogenic cirrhosis") is

A) latent bacterial infection
B) amyloidosis
C) circulatory disorders
D) steatohepatitis
E) autoimmune diseases

Question 5

This liver tumor nodule, measuring 6 cm in diameter, was seen on a computerized tomography (CT) scan of a 40-year-old man. Initially, the nodule was considered to be benign, but when it became painful, the patient decided to have it removed. Histologically, it was composed of well-differentiated hepatocytes, whereas the central scar and the fibrous septa contained proliferating bile ducts. This nodule is most likely

A) a hepatocellular adenoma
B) a hamartoma
C) an adenomyoma
D) a focal nodular hyperplasia
E) a hepatocellular carcinoma

Question 6

Copper accumulates in the liver in Wilson disease but stainable copper also can be seen in liver biopsies of patients who have

A) fatty liver of alcoholism
B) chronic obstructive cholestasis
C) acute viral hepatitis
D) drug-induced liver cell necrosis
E) centrolobular congestion

Question 7

Centrolobular necrosis is typical of intoxication with

A) hydralazine
B) acetaminophen
C) methyldopa
D) methotrexate
E) chlorpromazine

Question 8

These gallstones surgically removed along with the gallbladder of a 50-year-old obese woman are composed predominantly of

A) calcium carbonate
B) cholesterol
C) bilirubin
D) biliverdin
E) calcium hydroxyapatite

Question 9

HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) occurs typically in

A) autoimmune hepatitis
B) Budd-Chiari syndrome
C) primary sclerosing cholangitis
D) primary biliary cirrhosis
E) preeclampsia

Question 10

A 55-year-old man known to have drunk a half liter of gin daily for the past 15 years died due to ruptured esophageal varices and massive bleeding. At autopsy, the liver was nodular and

A) dark brown
B) green
C) red
D) yellow
E) bluish

Question 11

Which of the following drugs causes microvesicular fatty change of the liver?

A) Tetracycline
B) Acetaminophen
C) Methyldopa
D) Methotrexate
E) Chlorpromazine

Question 12

Cryoglobulinemia is found in chronic hepatitis caused by which hepatotropic virus?

A) Hepatitis A virus (HAV)
B) HBV
C) HCV
D) HDV
E) HEV

Question 13

Transplacental infection of the fetus will most often occur in women who have been infected with which hepatotropic virus?

A) Hepatitis A virus (HAV)
B) HBV
C) HCV
D) HDV
E) HEV

Question 14

Which genetic liver disease results from the mutation of multidrug resistance protein 2 (MRP2) and is characterized by massive accumulation of pigmentary granules in hepatocytes and dark discoloration of the liver?

A) Crigler-Najjar syndrome type I
B) Gilbert disease
C) Dubin-Johnson disease
D) Rotor syndrome
E) Galactosemia

Question 15

What is the most common cause of neonatal cholestasis?

A) a1-antitrypsin deficiency
B) Biliary atresia
C) Cytomegalovirus infection
D) Galactosemia
E) Unknown

Question 16

A mutation of the gene encoding the hepatic enzyme bilirubin uridine diphosphate-glucuronyltransferase (UGT1A1) associated with congenital jaundice and a complete absence of UGT1A1 is called

A) Crigler-Najjar syndrome type I
B) Gilbert disease
C) Dubin-Johnson disease
D) Rotor syndrome
E) Galactosemia

Question 17

Peliosis hepatis is a form of primary hepatic sinusoidal dilatation and intrasinusoidal blood stagnation most often caused by

A) tetracycline
B) anabolic steroids
C) acetaminophen
D) methotrexate
E) Escherichia coli infection

Question 18

Ascending cholangitis is most often caused by

A) Staphylococcus aureus
B) Streptococcus pneumoniae
C) Escherichia coli
D) Salmonella typhi
E) Ascaris lumbricoides