Liver and Biliary Pathology Practice Questions

Q: A liver biopsy in a patient with malaria will show which of the following histological findings?

Kupffer cell hyperplasia. **Explanation:** In malaria, the liver is a primary site of involvement during the exo-erythrocytic phase. The characteristic histological finding is **Kupffer cell hyperplasia** [1]. As the malaria parasite (Plasmodium) infects and ruptures red blood cells, it releases hemoglobin breakdown products and **hemozoin pigment** (malarial pigment). The Kupffer cells, which are the resident macrophages of the liver, proliferate and become heavily engorged as they phagocytose these pigments and cellular debris [1]. This often gives the liver a slate-gray or "dusky" macroscopic appearance [1]. **Analysis of Incorrect Options:** * **A. Microabscesses:** These are typically seen in pyogenic liver abscesses or systemic bacterial infections (e.g., *Staphylococcus aureus* or *E. coli*), not protozoal infections like malaria. * **C. Piecemeal necrosis (Interface Hepatitis):** This is the hallmark of Chronic Active Hepatitis (especially Hepatitis B and C), where inflammation spills over from the portal tracts into the adjacent parenchyma. * **D. Non-caseating granuloma:** These are characteristic of Sarcoidosis, Tuberculosis (though TB is usually caseating), or drug-induced liver injury. **High-Yield NEET-PG Pearls:** * **Malarial Pigment:** Hemozoin is an iron-containing pigment but is **Prussian Blue negative** (unlike hemosiderin), as the iron is sequestered in a crystalline form. * **Liver Involvement:** While the liver is enlarged (hepatomegaly), true "hepatitis" with significant transaminase elevation is rare in malaria; the pathology is primarily reticuloendothelial [1]. * **Other Organs:** Similar pigment deposition and macrophage hyperplasia are seen in the **spleen** (leading to "Big Spleen Disease" or Tropical Splenomegaly Syndrome) and bone marrow [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, p. 400.

Question 1

Which of the following statements about hepatic adenoma is false?

Accepted Answer

Most cases are asymptomatic

Answer

More common in females

Answer

Rupture risk is increased in pregnancy

Answer

Low risk for transforming into malignancy

Question 2

Ingestion of arsenic causes which of the following?

Accepted Answer

Noncirrhotic portal fibrosis

Answer

Hepatic carcinoma

Answer

Hepatic adenoma

Answer

Hepatic cirrhosis

Question 3

Which of the following is NOT a predisposing factor for cholangiocarcinoma?

Accepted Answer

Cholelithiasis

Answer

Asiatic cholangiohepatitis

Answer

Ulcerative colitis

Answer

Choledochal cyst

Question 4

A liver biopsy in a patient with malaria will show which of the following histological findings?

Accepted Answer

Kupffer cell hyperplasia

Answer

Microabscesses

Answer

Piecemeal necrosis

Answer

Non-caseating granuloma

Question 5

A 45-year-old chronic alcoholic patient developed ascites and decreased libido. Physical examination revealed mild enlargement of the breasts and atrophy of testes. A liver biopsy was done. All of the following are probable findings seen in histopathologic examination, EXCEPT?

Accepted Answer

Necrosis and infiltration of neutrophils within hepatic lobules

Answer

Complete disruption of hepatic lobular architecture

Answer

Bands of fibrosis

Answer

Regenerating lobules

Question 6

Anti-mitochondrial antibody is typically seen in which of the following conditions?

Accepted Answer

Primary biliary cirrhosis

Answer

Hepatic cirrhosis

Answer

Cardiac cirrhosis

Answer

Primary sclerosing cholangitis

Question 7

Councilman bodies are seen in which of the following conditions?

Accepted Answer

Viral hepatitis

Answer

Molluscum contagiosum

Answer

Rabies

Answer

Granuloma inguinale

Question 8

All of the following conditions may show Mallory Hyaline changes except?

Accepted Answer

Hepatitis E

Answer

Wilson disease

Answer

Indian childhood cirrhosis

Answer

Primary biliary cirrhosis

Question 9

Which of the following diseases is not a cause of indirect hyperbilirubinemia?

Accepted Answer

Rotor syndrome

Answer

Crigler-Najjar syndrome

Answer

Gilbert syndrome

Answer

Hereditary spherocytosis

Question 10

Which of the following are histopathologic features of bile duct obstruction?

Accepted Answer

All of the above

Answer

Proliferation of bile duct

Answer

Bile lakes

Answer

Portal fibrosis

Liver and Biliary Pathology — MCQs

Liver and Biliary Pathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?