Liver and Biliary Pathology Practice Questions

Q: Intake of which of the following causes vascular lesions in the liver?

Steroids. **Explanation:** The correct answer is **Steroids (C)**. Specifically, anabolic steroids and oral contraceptives are well-known causes of **Peliosis hepatis**. This is a vascular lesion characterized by the presence of blood-filled cystic spaces in the liver, which are not lined by endothelium. These cysts can rupture, leading to potentially fatal intra-abdominal hemorrhage. **Analysis of Options:** * **A. Halothanes:** Primarily cause **massive hepatic necrosis** (fulminant hepatitis). This is an immune-mediated idiosyncratic reaction leading to acute liver failure rather than a vascular lesion. * **B. Isoniazid (INH):** Causes drug-induced hepatitis ranging from asymptomatic elevation of liver enzymes to **bridging necrosis** or chronic hepatitis. It does not typically cause vascular pathology. * **D. Chlorpromazine (CPZ):** A classic cause of **intrahepatic cholestasis**. It leads to "bland cholestasis" where bile plugs are seen in canaliculi without significant inflammation or vascular damage. **High-Yield Clinical Pearls for NEET-PG:** * **Peliosis Hepatis:** Associated with **Anabolic Steroids**, Oral Contraceptive Pills (OCPs), and infections like *Bartonella henselae* (Bacillary peliosis). * **Budd-Chiari Syndrome:** Often linked to OCP use [1], leading to hepatic vein thrombosis (a different type of vascular lesion) [1]. * **Vinyl Chloride & Thorotrast:** High-yield triggers for **Angiosarcoma**, a malignant vascular tumor of the liver. * **Aflatoxin B1:** Strongly associated with **Hepatocellular Carcinoma (HCC)** via TP53 mutations. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 869-870.

Q: Which of the following is the primary tumor marker for hepatocellular carcinoma?

Alpha-fetoprotein (AFP). **Explanation:** **Alpha-fetoprotein (AFP)** is the primary and most widely used tumor marker for **Hepatocellular Carcinoma (HCC)** [1], [2]. AFP is a glycoprotein normally synthesized by the fetal liver and yolk sac. In adults, levels are typically negligible; however, they rise significantly in HCC due to the dedifferentiation of hepatocytes into a fetal-like state. For NEET-PG, remember that while AFP is sensitive, it can also be elevated in non-seminomatous germ cell tumors (Yolk sac tumors) and benign conditions like cirrhosis or chronic hepatitis [1], [2]. **Analysis of Incorrect Options:** * **Carcinoembryonic Antigen (CEA):** Primarily used for monitoring **Colorectal Carcinoma** [2]. It is also elevated in pancreatic, gastric, and breast cancers, but is not specific for HCC [2]. * **Human Chorionic Gonadotropin (HCG):** The hallmark marker for **Choriocarcinoma** and hydatidiform moles. It is also elevated in certain germ cell tumors (e.g., seminoma, dysgerminoma). * **CA 19-9:** The primary marker for **Pancreatic Adenocarcinoma** and cholangiocarcinoma (bile duct cancer). **High-Yield Clinical Pearls for NEET-PG:** * **Diagnostic Threshold:** In a patient with cirrhosis, an AFP level **>400 ng/mL** combined with characteristic imaging (e.g., arterial enhancement and venous wash-out on CT/MRI) is highly suggestive of HCC. * **Fibrolamellar Variant:** A rare subtype of HCC occurring in young adults without cirrhosis; notably, **AFP levels are usually normal** in these patients. * **Other HCC Markers:** DCP (Des-gamma-carboxy prothrombin) and Glypican-3 are emerging markers for HCC. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 399-400. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 346.

Question 1

Intake of which of the following causes vascular lesions in the liver?

Accepted Answer

Steroids

Answer

Halothanes

Answer

Isoniazid (INH)

Answer

Chlorpromazine (CPZ)

Question 2

Which of the following is the primary tumor marker for hepatocellular carcinoma?

Accepted Answer

Alpha-fetoprotein (AFP)

Answer

Carcinoembryonic antigen (CEA)

Answer

Human chorionic gonadotropin (HCG)

Answer

Carbohydrate antigen 19-9 (CA-19)

Question 3

A patient with cirrhosis of the liver has the following coagulation parameters: Platelet count 2,00,000, Prothrombin time 25s/12s, Activated partial thromboplastin time 60s/35s, Thrombin time 15s/15s. In this patient:

Accepted Answer

D-dimer will be normal

Answer

Fibrinogen will be <100 mg

Answer

ATIII will be high

Answer

Protein C will be elevated

Question 4

Budd-Chiari syndrome is characterized by all except?

Accepted Answer

Fatty liver

Answer

Hepatomegaly

Answer

Inferior Vena Cava obstruction

Answer

Hepatic vein obstruction

Question 5

Micro-vesicular fatty liver in Reye's syndrome is due to what underlying defect?

Accepted Answer

Defect in beta oxidation of fatty acids

Answer

Defect in oxidative phosphorylation

Answer

Defect in fatty acid synthesis

Answer

Defective acyl CoA synthesis

Question 6

Cholesterol stones are primarily made up of which form of cholesterol?

Accepted Answer

Crystalline cholesterol monohydrate

Answer

Amorphous cholesterol monohydrate

Answer

Cholesterol polyhydrate

Answer

Cholesterol with calcium palmitate

Question 7

In alcoholic liver disease, which of the following pigments is deposited in the hepatocytes?

Accepted Answer

Hemosiderin

Answer

Hemoglobin

Answer

Lipofuscin

Answer

Melanin

Question 8

Mallory bodies are seen in all of the following conditions except?

Accepted Answer

Secondary biliary cirrhosis

Answer

Alcoholism

Answer

Primary biliary cirrhosis

Answer

Wilson's disease

Question 9

A 40-year-old obese female presents with fullness of the right upper quadrant of the abdomen. Her medical history is significant for Type 2 diabetes mellitus and hyperlipidemia. A liver biopsy is most likely suggestive of which of the following diagnoses?

Accepted Answer

Non-alcoholic steatohepatitis

Answer

Peliosis hepatis

Answer

Autoimmune hepatitis

Answer

Primary biliary sclerosis

Question 10

Which of the following is not a feature of Alcoholic liver disease?

Accepted Answer

Lymphocytic infiltration of portal tracts

Answer

Macrovesicular fat within hepatocytes

Answer

Lipogranuloma

Answer

Portal and sinusoidal collagen deposits

Liver and Biliary Pathology — MCQs

Liver and Biliary Pathology — MCQs

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