Question 1

Which of the following cells found within the liver is the major source of the excess collagen deposited in cirrhosis?
●	Hepatocytes 
●	Kupffer Cells
●	Ito Cells
●	Endothelial Cells
●	Bile duct epithelial Cells

Accepted Answer

Ito Cells

Question 2

All  of the ff produced  a predominantly unconjugated hyperbilirubinemia  EXCEPT:
●	Hemolytic anemias 
●	Physiologic jaundice of the newborn
●	Crigler-Najjar syndrome, type 1
●	Gilbert's syndrome
●	Dubin-Johnson syndrome

Accepted Answer

Dubin-Johnson syndrome

Question 3

Dilated sinusoids and irregular cystic spaces filled with blood within the liver, which may rupture leading to massive intra-abdominal hemorrhage, are most common associated with:
●	Salicylates
●	Estrogen
●	Anabolic steroids
●	Acetaminophen

Accepted Answer

Anabolic steroids

Question 4

Refers to a severe clinical consequence of liver disease and develops only with loss of >80-90% of hepatic function

Accepted Answer

Hepatic failure

Question 5

Which viral hepatitis does not cause chronic disease or the carrier state?

Accepted Answer

Hepatitis A

Question 6

All of the following viral hepatitis infections cause hepatocellular carcinoma EXCEPT:
●	Hepatitis A infection 
●	 Hepatitis B infection 
●	 Hepatitis C infection 
●	 Hepatitis D infection 
●	 Hepatitis G infection

Accepted Answer

Hepatitis A

Question 7

All of the following are inherited anomalies of the biliary tree EXCEPT:
●	 von-Meyenburg complex 
●	 Polycystic liver disease 
●	 Congenital hepatic fibrosis 
●	 Budd-Chiari syndrome 
●	 Caroli disease

Accepted Answer

Budd-Chiari syndrome

Question 8

The most common hepatic malignancy

Accepted Answer

Hepatocellular carcinoma

Question 9

All of the following are risk factors for cholesterol gallstone formation EXCEPT:
●	 Americans 
●	 Gallbladder stasis 
●	 Biliary tract infections 
●	 Hypercholesterolemic syndromes 
●	 Oral contraceptive use

Accepted Answer

Biliary tract infections

Question 10

Antibodies to which of the following forms of viral hepatitis do not confer immunity from reinfection?

Accepted Answer

Hepatitis C

Question 11

Chronic hepatitis is most likely to occur after acute infection with which of the following viruses?
●	 Hepatitis A virus 
●	 Hepatitis B virus 
●	 Hepatitis C virus 
●	 Hepatitis E virus 
●	 Coinfection with Hepatitis B & D virus

Accepted Answer

Hepatitis C

Question 12

Which of the following conditions is least likely to be seen in association with cholelithiasis in a 38-year-old female?
●	 Adenocarcinoma of the gallbladder 
●	 Obesity 
●	 Hemolytic anemia 
●	 Crohn disease 
●	 Chronic hepatitis B

Accepted Answer

Chronic hepatitis B

Question 13

Hepatic circulatory disorders characterized by impaired intrahepatic blood flow.

Accepted Answer

Cirrhosis

Question 14

This type of intrahepatic biliary tract disease is associated with Inflammatory Bowel Disease ( particularly ulcerative colitis.

Accepted Answer

Primary sclerosing cholangitis

Question 15

Carcinoma of the gallbladder is associated with all of the following statements. EXCEPT:
●	The most important risk factor for gallbladder carcinoma is gallstones
●	It is the most common malignancy of the extrahepatic biliary tract
[flip other options]

Accepted Answer

●	Most common gallbladder carcinomas are adenocarcinoma
●	Carries an excellent prognosis because gallbladder carcinoma is typically detected
early
●	Gallbladder carcinoma is at least twice as common in women than in men
[options done]

Question 16

All of the following statements are true of Hepatitis B Virus Infection. EXCEPT:
● A characteristic feature is the high mortality rate among pregnant women.
approaching 20%
● It can produce progressive chronic disease ending in cirrhosis 
[flip next]

Accepted Answer

● HBx protein has been implicated in the pathogenesis of hepatocellular carcinoma 
● HBe antigen, HBV-DNA and DNA polymerase signify active viral replication 
● Age at the time of infection is the best predictor of chronicity
[options done]

Question 17

Alcoholic liver disease is characterized by the following EXCEPT:
●	Consumption of 80 grams/day of alcohol is considered to be the threshold for the development of ALD
●	Fatty change is completely reversible if there is abstinence from alcohol intake

Accepted Answer

●	Alcoholic hepatitis is characterized by hepatocyte swelling and necrosis, Mallory
bodies, and neutrophilic reaction 
●	50% of alcoholics develop cirrhosis
●	The development of severity of ALD are also influence by other factors

Question 18

Diagnosis of this Hepatitis Virus is by third-generation ELISA for antibody detection and PCR for Hepatitis Virus RNA.

Accepted Answer

Hepatitis C Virus

Question 19

The most common hepatotoxin causing acute liver failure is:

Accepted Answer

Acetaminophen

Question 20

This inherited metabolic liver disease is characterized by a mutation in metal ion transporter ATP7B gene.

Accepted Answer

Wilson disease

Question 21

A 49-year-old male experiences increasing ascites, and a liver biopsy demonstrates diffuse portal tract bridging fibrosis and nodular regeneration of liver cells. There is no hepatocyte necrosis and no cholestasis.

Accepted Answer

Within the areas of fibrosis, bile duct proliferation and mononuclear cell inflammatory infiltrates can be seen. These findings are most characteristic for:

Question 22

The finding of multiple, pale yellow, hard, round stones within the gallbladder is associated with all of the following EXCEPT:
[flip for options]

Accepted Answer

●	Oral contraceptives 
●	Obesity
●	 Biliary infection population 
●	 Hyperlipidemia syndromes 
●	Prevalence within the Native-American
[flip for answer]

Question 23

Which of the following modes of transmission of HBV is most likely to give rise to a carrier state?

Accepted Answer

Vertical transmission during childbirth

Question 24

A 38-year-old woman complains of fatigue and pruritus. She is found to have high serum alkaline phosphatase and slightly elevated serum bilirubin levels, and serum antimitochondrial antibodies are present.
The most likely diagnosis is:

Accepted Answer

Primary biliary cirrhosis

Question 25

A 59-year old male, chronic alcoholic was brought to the emergency room due to vomiting of blood. The patient is jaundiced with elevated liver enzymes. A liver biopsy was performed, the microscopic findings are [cont question]

Accepted Answer

Delicate bands or broad septa accompanied by reorganization of the vascular architecture, with formations of abnormal interconnections between inflow and outflow
What is your diagnosis?

Question 26

All of the following conditions are major clinical consequences of portal hypertension in the setting of the above condition. EXCEPT:
●	 Hepatic encephalopathy 
●	 Hepatomegaly 
●	 Splenomegaly 
●	 Esophageal varices 
●	 Ascites

Accepted Answer

Hepatomegaly

Question 27

A 58-year old woman consulted a private clinic due to jaundice, skin xanthomas, diarrhea, and pruritus of prolonged duration. Alkaline phosphatase and gamma glutamyl transferase are elevated. Liver biopsy was performed

Accepted Answer

Hepatocytes are enlarged with dilated canalicular spaces. Apoptotic cells may be seen, and Kupffer cells frequently contained regurgitated bile pigments.

Question 28

All are morphologic features of the above liver biopsy, EXCEPT:
●	 Enlarged hepatocytes 
●	 Absence of neutrophilic inflammation 
●	 Presence of apoptotic cells 
●	 Kupffer cells containing regurgitated bile 
●	 Bile duct proliferation

Accepted Answer

Absence of neutrophilic inflammation

Question 29

A 48-year old male, chronic alcoholic consulted at the OPD due to an ill- defined upper abdominal mass, abdominal pain, malaise, fatigue, and weight loss. Liver enzymes, direct bilirubin and a-feto protein are all elevated. What is your diagnosis.

Accepted Answer

Hepatocellular carcinoma

Question 30

All of the following statements are true of Hepatocellular Carcinoma (HCC) EXCEPT:
A. Precursor lesions in HCC are biliary intraepithelial neoplasia, mucinous cystic
neoplasms, and papillary biliary neoplasia

Accepted Answer

B. HCC is the most common primary liver cancer
C. Chronic liver diseases are the most common setting for the emergence of HCC

Question 31

A 48-year-old female presents w/ colicky RUQ pain. He has had nausea for the past 2 days. His temp is now 38.8C. His WBC count is 11.200/uL. with a differential count of 71 segmented neutrophils, 9 band cells. 13 lymphocytes, and 7 monocytes per 100 WBCs.

Accepted Answer

●	 Acute cholecystitis with cholecystolithiasis
●	 Acute cholecystitis with choledocholithiasis 
●	 Chronic cholecystitis with cholecystolithiasis 
●	 Chronic cholecystitis with choledocholithiasis 
●	 Cholesterolosis

Question 32

Major risk factors for the development of the above lesion include all of the following, EXCEPT: [pigmented gallstones]
●	 Ileal diseases 
●	Oral contraceptives 
●	 Biliary infections 
●	Chronic hemolytic syndromes 
●	 Rural more than urban

Accepted Answer

Oral contraceptives

Question 33

COLUMN A
Cholangiocarcinoma
Chronic Cholecystitis
Wilson disease

COLUMN B
Porcelain gallbladder		
Mutation ATP7B gene
Bile duct adenocarcinoma

Accepted Answer

1. Cholangiocarcinoma- Bile duct adenocarcinoma
2. Chronic Cholecystitis- Porcelain gallbladder
3. Wilson disease- Mutation ATP7B gene

Question 34

COLUMN A
Alcoholic hepatitis
Chronic congestion liver
Chronic HBV infection

COLUMN B
Mallory-Denk bodies
Ground-glass hepatocyte
Centrilobular necrosis

Accepted Answer

Alcoholic hepatitis - Mallory-Denk bodies
Chronic congestion liver - Centrilobular necrosis
Chronic HBV infection - Ground-glass hepatocyte

Question 35

COLUMN A
Hereditary hemochromatosis
a1-antitrypsin deficiency
Criggler-Najjar syndrome
Dubin-Johnson syndrome- J

COLUMN B
Protein misfolding, impaired secretion
Decreased UGT1A1 activity
Mutation MRP2 gene
Mutation hepcidin

Accepted Answer

Hereditary hemochromatosis - Mutation hepcidin

a1-antitrypsin deficiency - Protein misfolding, impaired secretion

Criggler-Najjar syndrome - Decreased UGT1A1 activity

Dubin-Johnson syndrome - Mutation MRP2 gene

LIVER

Pathology REYES OT

Question	Answer
Which of the following cells found within the liver is the major source of the excess collagen deposited in cirrhosis? ● Hepatocytes ● Kupffer Cells ● Ito Cells ● Endothelial Cells ● Bile duct epithelial Cells	Ito Cells	Hepatic stellate cells (HSC), also known as perisinusoidal cells or Ito cells (earlier lipocytes or fat-storing cells), are pericytes found in the perisinusoidal space of the liver, also known as the space of Disse.
All of the ff produced a predominantly unconjugated hyperbilirubinemia EXCEPT: ● Hemolytic anemias ● Physiologic jaundice of the newborn ● Crigler-Najjar syndrome, type 1 ● Gilbert's syndrome ● Dubin-Johnson syndrome	Dubin-Johnson syndrome	Predominantly Conjugated Hyperbilirubinemia -Decreased hepatic excretion of bilirubin glucuronides -Deficiency in canalicular membrane transporters (Dubin-Johnson syndrome, Rotor syndrome)
Dilated sinusoids and irregular cystic spaces filled with blood within the liver, which may rupture leading to massive intra-abdominal hemorrhage, are most common associated with: ● Salicylates ● Estrogen ● Anabolic steroids ● Acetaminophen	Anabolic steroids	Peliosis Hepatis  primary dilation of hepatic sinusoids associated with exposure to anabolic steroids, oral contraceptives, and danazol  liver is mottled and blotchy  irregular blood-filled cystic spaces, with or without lining endothelium
Refers to a severe clinical consequence of liver disease and develops only with loss of >80-90% of hepatic function	Hepatic failure	 a severe clinical consequence of liver disease and develops only with loss of >80-90% of hepatic function  overall mortality is 70-95%
Which viral hepatitis does not cause chronic disease or the carrier state?	Hepatitis A	 does not cause chronic disease or the carrier state  acute infection is marked by anti-HAV IgM in serum, IgG can persist for years conferring immunity
All of the following viral hepatitis infections cause hepatocellular carcinoma EXCEPT: ● Hepatitis A infection ● Hepatitis B infection ● Hepatitis C infection ● Hepatitis D infection ● Hepatitis G infection	Hepatitis A	Of the primary hepatitis viruses, only hepatitis B and C viruses cause HCC. Hepatitis A and E viruses do not produce long-term pathological sequelae. Although HDV always occurs as co-infection with HBV and leads to severe acute or chronic hepatic disease.
All of the following are inherited anomalies of the biliary tree EXCEPT: ● von-Meyenburg complex ● Polycystic liver disease ● Congenital hepatic fibrosis ● Budd-Chiari syndrome ● Caroli disease	Budd-Chiari syndrome	Budd-Chiari syndrome [Hepatic vein thrombosis] - HEPATIC VEIN OUTFLOW OBSTRUCTION
The most common hepatic malignancy	Hepatocellular carcinoma
All of the following are risk factors for cholesterol gallstone formation EXCEPT: ● Americans ● Gallbladder stasis ● Biliary tract infections ● Hypercholesterolemic syndromes ● Oral contraceptive use	Biliary tract infections	Native Americans, adults in industrialized countries Increasing age, with male:female ratio of 1:2 Estrogenic influences, clofibrate, obesity, or rapid weight loss Gallbladder stasis (e.g.spinal cord injury or pregnancy) Hypercholesterolemic syndromes
Antibodies to which of the following forms of viral hepatitis do not confer immunity from reinfection?	Hepatitis C	elevated titers of anti-HCV IgG do not confer effective immunity, either against reactivation of endogenous HCV or by infection with a new HCV strain
Chronic hepatitis is most likely to occur after acute infection with which of the following viruses? ● Hepatitis A virus ● Hepatitis B virus ● Hepatitis C virus ● Hepatitis E virus ● Coinfection with Hepatitis B & D virus	Hepatitis C	 high rate of progression to chronic disease and cirrhosis (>50%)  high risk of developing hepatocellular carcinoma  persistent infection and chronic hepatitis are the hallmarks of HCV infection
Which of the following conditions is least likely to be seen in association with cholelithiasis in a 38-year-old female? ● Adenocarcinoma of the gallbladder ● Obesity ● Hemolytic anemia ● Crohn disease ● Chronic hepatitis B	Chronic hepatitis B
Hepatic circulatory disorders characterized by impaired intrahepatic blood flow.	Cirrhosis	IMPAIRED INTRAHEPATIC BLOOD FLOW  cirrhosis is the most important cause  sinusoidal occlusion leading to parenchymal necrosis include DIC, sickle cell disease, and sarcoidosis
This type of intrahepatic biliary tract disease is associated with Inflammatory Bowel Disease ( particularly ulcerative colitis.	Primary sclerosing cholangitis	Etiology Unknown, possibly autoimmune; 50%-70% associated with inflammatory bowel disease
Carcinoma of the gallbladder is associated with all of the following statements. EXCEPT: ● The most important risk factor for gallbladder carcinoma is gallstones ● It is the most common malignancy of the extrahepatic biliary tract [flip other options]	● Most common gallbladder carcinomas are adenocarcinoma ● Carries an excellent prognosis because gallbladder carcinoma is typically detected early ● Gallbladder carcinoma is at least twice as common in women than in men [options done]	● Carries an excellent prognosis because gallbladder carcinoma is typically detected early
All of the following statements are true of Hepatitis B Virus Infection. EXCEPT: ● A characteristic feature is the high mortality rate among pregnant women. approaching 20% ● It can produce progressive chronic disease ending in cirrhosis [flip next]	● HBx protein has been implicated in the pathogenesis of hepatocellular carcinoma ● HBe antigen, HBV-DNA and DNA polymerase signify active viral replication ● Age at the time of infection is the best predictor of chronicity [options done]
Alcoholic liver disease is characterized by the following EXCEPT: ● Consumption of 80 grams/day of alcohol is considered to be the threshold for the development of ALD ● Fatty change is completely reversible if there is abstinence from alcohol intake	● Alcoholic hepatitis is characterized by hepatocyte swelling and necrosis, Mallory bodies, and neutrophilic reaction ● 50% of alcoholics develop cirrhosis ● The development of severity of ALD are also influence by other factors	● Alcoholic hepatitis is characterized by hepatocyte swelling and necrosis, Mallory bodies, and neutrophilic reaction (hepatocyte swelling and apoptosis dapat)
Diagnosis of this Hepatitis Virus is by third-generation ELISA for antibody detection and PCR for Hepatitis Virus RNA.	Hepatitis C Virus	Diagnosis for HCV ELISA for HCV antibodies; PCR for HCV RNA
The most common hepatotoxin causing acute liver failure is:	Acetaminophen	A classic, predictable hepatotoxin is acetaminophen, now the most common cause of acute liver failure necessitating transplantation in the United States.
This inherited metabolic liver disease is characterized by a mutation in metal ion transporter ATP7B gene.	Wilson disease	Wilson disease is caused by loss-of-function mutations in the metal ion transporter ATP7B, which results in accumulation of copper in the liver, brain (particularly basal ganglia), and eyes (Kayser-Fleischer rings).
A 49-year-old male experiences increasing ascites, and a liver biopsy demonstrates diffuse portal tract bridging fibrosis and nodular regeneration of liver cells. There is no hepatocyte necrosis and no cholestasis.	Within the areas of fibrosis, bile duct proliferation and mononuclear cell inflammatory infiltrates can be seen. These findings are most characteristic for:	Cirrhosis
The finding of multiple, pale yellow, hard, round stones within the gallbladder is associated with all of the following EXCEPT: [flip for options]	● Oral contraceptives ● Obesity ● Biliary infection population ● Hyperlipidemia syndromes ● Prevalence within the Native-American [flip for answer]	Biliary infection population
Which of the following modes of transmission of HBV is most likely to give rise to a carrier state?	Vertical transmission during childbirth
A 38-year-old woman complains of fatigue and pruritus. She is found to have high serum alkaline phosphatase and slightly elevated serum bilirubin levels, and serum antimitochondrial antibodies are present. The most likely diagnosis is:	Primary biliary cirrhosis	LABORATORY FINDINGS Same as secondary biliary cirrhosis, plus elevated serum IgM autoantibodies (especially M2 form of anti-mitochondrial antibody)
A 59-year old male, chronic alcoholic was brought to the emergency room due to vomiting of blood. The patient is jaundiced with elevated liver enzymes. A liver biopsy was performed, the microscopic findings are [cont question]	Delicate bands or broad septa accompanied by reorganization of the vascular architecture, with formations of abnormal interconnections between inflow and outflow What is your diagnosis?	Liver cirrhosis
All of the following conditions are major clinical consequences of portal hypertension in the setting of the above condition. EXCEPT: ● Hepatic encephalopathy ● Hepatomegaly ● Splenomegaly ● Esophageal varices ● Ascites	Hepatomegaly	The four major consequences of portal hypertension are (1) hepatic encephalopathy (described under liver failure), (2) ascites, (3) the formation of portosystemic venous shunts, and (4) congestive splenomegaly.
A 58-year old woman consulted a private clinic due to jaundice, skin xanthomas, diarrhea, and pruritus of prolonged duration. Alkaline phosphatase and gamma glutamyl transferase are elevated. Liver biopsy was performed	Hepatocytes are enlarged with dilated canalicular spaces. Apoptotic cells may be seen, and Kupffer cells frequently contained regurgitated bile pigments.	Cholestasis
All are morphologic features of the above liver biopsy, EXCEPT: ● Enlarged hepatocytes ● Absence of neutrophilic inflammation ● Presence of apoptotic cells ● Kupffer cells containing regurgitated bile ● Bile duct proliferation	Absence of neutrophilic inflammation	All of the following are morphologic features of the above liver biopsy, EXCEPT:
A 48-year old male, chronic alcoholic consulted at the OPD due to an ill- defined upper abdominal mass, abdominal pain, malaise, fatigue, and weight loss. Liver enzymes, direct bilirubin and a-feto protein are all elevated. What is your diagnosis.	Hepatocellular carcinoma
All of the following statements are true of Hepatocellular Carcinoma (HCC) EXCEPT: A. Precursor lesions in HCC are biliary intraepithelial neoplasia, mucinous cystic neoplasms, and papillary biliary neoplasia	B. HCC is the most common primary liver cancer C. Chronic liver diseases are the most common setting for the emergence of HCC	D. The most important underlying factors in hepatocarcinogenesis are viral infections and toxic injuries E. Activation of ß-catenin and inactivation of p53 are the 2 most common mutations in HCC A ang sagot [EXCEPT ha}
A 48-year-old female presents w/ colicky RUQ pain. He has had nausea for the past 2 days. His temp is now 38.8C. His WBC count is 11.200/uL. with a differential count of 71 segmented neutrophils, 9 band cells. 13 lymphocytes, and 7 monocytes per 100 WBCs.	● Acute cholecystitis with cholecystolithiasis ● Acute cholecystitis with choledocholithiasis ● Chronic cholecystitis with cholecystolithiasis ● Chronic cholecystitis with choledocholithiasis ● Cholesterolosis	Acute cholecystitis with cholecystolithiasis
Major risk factors for the development of the above lesion include all of the following, EXCEPT: [pigmented gallstones] ● Ileal diseases ● Oral contraceptives ● Biliary infections ● Chronic hemolytic syndromes ● Rural more than urban	Oral contraceptives	 Asian more than Western, rural more than urban  chronic hemolytic syndromes or biliary tract infections  ileal disease (resection or bypass) or cystic fibrosis with pancreatic insufficiency
COLUMN A Cholangiocarcinoma Chronic Cholecystitis Wilson disease COLUMN B Porcelain gallbladder Mutation ATP7B gene Bile duct adenocarcinoma	1. Cholangiocarcinoma- Bile duct adenocarcinoma 2. Chronic Cholecystitis- Porcelain gallbladder 3. Wilson disease- Mutation ATP7B gene	-Bile duct adenocarcinoma is also called cholangiocarcinoma -CHRONIC CHOLECYSTITIS - In rare instances, there is extensive dystrophic calcification of the gallbladder wall (porcelain gallbladder). -Mutation ATP7B gene - Copper excretion
COLUMN A Alcoholic hepatitis Chronic congestion liver Chronic HBV infection COLUMN B Mallory-Denk bodies Ground-glass hepatocyte Centrilobular necrosis	Alcoholic hepatitis - Mallory-Denk bodies Chronic congestion liver - Centrilobular necrosis Chronic HBV infection - Ground-glass hepatocyte	-ALCOHOLIC HEPA - Mallory body formation (eosinophilic clumps of intermediate filaments) -In chronic passive hepatic congestion, the centrilobular regions are grossly redbrown and slightly depressed (because of cell death)
COLUMN A Hereditary hemochromatosis a1-antitrypsin deficiency Criggler-Najjar syndrome Dubin-Johnson syndrome- J COLUMN B Protein misfolding, impaired secretion Decreased UGT1A1 activity Mutation MRP2 gene Mutation hepcidin	Hereditary hemochromatosis - Mutation hepcidin a1-antitrypsin deficiency - Protein misfolding, impaired secretion Criggler-Najjar syndrome - Decreased UGT1A1 activity Dubin-Johnson syndrome - Mutation MRP2 gene	HH -Mutations of genes encoding HFE, transferrin receptor 2 (TfR2), or hepcidin -Mutations of genes encoding HJV (hemojuvelin: juvenile hemochromatosis) Genetic deficiency of UGT1A1 act. (Crigler-Najjar types I and II, some cases Gilbert syndrome)

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