Question & Answers quiz session for Pathology of Hepatitis, lecture for medical students.

1. "It's not the will to win, but the will to
prepare to win that makes the
difference."
Bear Bryant
1913-1983, Football Coach

2. 2
Pathology of
Common Liver Disorders
Dr. Venkatesh M. Shashidhar.
Assoc.Prof & Head of Pathology

3. 3
Viral serology interpretation:
HBsAg Positive,
Anti HBcAg Positive
Anti HBcAg IGM Negative
Anti HBsAg Negative
1 2 3 4 5
41%
7%
0%
26%26%
A. Acute Viral Hepatitis
B. Immunised against Hep. B
C. Chronic Hepatitis B
D. Hepatitis B carrier stage
E. Fulminant hepatitis B
IgM anti-HAV
antibody
Acute Hepatitis A
HBsAg Hepatitis B or
carrier – exp./inf.
HBeAg Active hepatitis B
infection
Anti-HCV antibody Hepatitis C virus
exposure
HCV RNA Active hepatitis C
infection

4. 4
?
A. B. C. D. E.
20% 20% 20%20%20%
A. Chronic Passive Hepatitis B
B. Chronic Viral Hepatitis A
C. Hepatitis C
D. Alcoholic Hepatitis.
E. Transfusion Haemochromatosis.

5. 5
51y M, Alcoholic: Look at Arrow ? Pathogenesis.
1 2 3 4 5
0% 0% 0%
13%
88%
A. Porta-systemic shunt
B. Hyper-oestrogenemia
C. Portal hypertension
D. Hypo-albuminemia
E. Decreased vit-K

6. 6
?
1 2 3 4 5
18%
29%
12%
29%
12%
1. Acute Alcoholic hepatitis.
2. Drug induced Hepatitis.
3. Fulminant Hepatitis.
4. Nutmeg liver (venous congestion)
5. Budd Chiari Syndrome.

7. 42y M, alcoholic, recurrent fatigue 3 years.
Liver biopsy. ? Diagnosis
1 2 3 4 5
0% 0%
6%
0%
94%
A. Acute Hepatitis
B. Chronic Active hepatitis.
C. Chronic Persistant hepatitis.
D. Fulminant Hepatitis.
E. Cirrhosis.

8. 8
?
1 2 3 4 5
65%
0% 0%
29%
6%
1. Acute Alcoholic hepatitis.
2. Drug induced Hepatitis.
3. Fulminant Hepatitis.
4. Acute Viral hepatitis
5. Budd Chiari Syndrome.

9. Pathogenesis - typical of which virus?
1 2 3 4 5
100%
0% 0%0%0%
1. HAV
2. HBV
3. HCV
4. HDV
5. Non Specific

10. 10
?
1 2 3 4 5
59%
6%
0%0%
35%
1. Hepatic failure – cirrhosis.
2. Hepatic encephalopathy.
3. Hepatorenal syndrome.
4. Chronic renal failure.
5. Budd Chiari Syndrome.

11. A 42year travelling salesperson has routine medical test for
insurance. Following initial testing he was advised liver
biopsy. This is a image of his Liver Biopsy. What is the
most likely diagnosis?
A. B. C. D. E.
31%
0% 0%
19%
50%
A. Acute Viral Hepatitis
B. Alcoholic hepatitis.
C. Chronic viral Hepatitis.
D. Post viral cirrhosis.
E. Alcoholic Cirrhosis.

12. 69y Female, Chronic bronchitis. Died following
chronic Cardiac failure. Liver specimen. Likely
diagnosis?
1 2 3 4 5
0%
7%
14%
79%
0%
A. Alcoholic Hepatitis
B. Dubin-Johnson Syndrome
C. Alcoholic cirrhosis
D. Nutmeg liver
E. Metastatic deposits

13. 13
Viral serology interpretation:
HBsAg Negative,
Anti HBcAg Ab Negative
Anti HBcAg IGM Negative
Anti HBsAg Ab PositiveA. Acute Viral Hepatitis
B. Immunised against Hep. B
C. Past Hepatitis B
D. Hepatitis B carrier stage
E. Fulminant hepatitis B

14. 28y M, alcoholic, homosexual icterus and fever.
Liver biopsy. ? diagnosis
A. B. C. D. E.
80%
0%
10%
0%
10%
A. Acute viral hepatitis
B. Hemolytic anemia
C. Chronic persistent hepatitis
D. Alcoholic fatty liver.
E. Alcoholic Hepatits.

15. 15
Viral serology interpretation:
1 2 3 4 5
0% 0% 0%
50%50%
HBsAg Negative,
Anti HBsAg Ab Positive
Anti HBcAg Ab Positive
Anti HBcAg IGM NegativeA. Acute Viral Hepatitis B
B. Immunised against Hep. B
C. Past Hepatitis B
D. Hepatitis B carrier stage
E. Carrier state of Hepatitis B

16. 58y M, alcoholic, distended abdomen & icterus.
Liver biopsy. ? diagnosis
1 2 3 4 5
0% 0%
50%
0%
50%
A. Chronic active hepatitis.
B. Chronic Persistant hepatitis.
C. Hepatocellular carcinoma.
D. Cirrhosis
E. Chronic alcoholic hepatitis.

17. 17
Lab Investigations interpretation:
A. B. C. D. E.
57%
14%
0%
14%14%
Protein (Total) 59 g/L
Albumin 30 g/L
Globulin 29 g/L
Bilirubin (Total) 27 μmol/L
ALP 71 U/L
GGT 523 U/L
ALT 79 U/L
AST 151 U/L
A. Alcoholic Liver disease
B. Acute Viral Hepatitis.
C. Past Hepatitis B
D. Hepatitis B carrier stage
E. Carrier state of Hepatitis B

18. 18
51y M, Alcoholic: Look at Arrow ? Pathogenesis.
1 2 3 4 5
0%
81%
0%
13%
6%
A. Porta-systemic shunt
B. Hyper-oestrogenemia
C. Portal hypertension
D. Hypo-albuminemia
E. Decreased vit-K

19. 19
Lab Investigations interpretation:
A. B. C. D. E.
33% 33% 33%
0%0%
Urea 5.8 mmol/L
Creatinine 80 μmol/L
Protein (Total) 66 g/L
Albumin 35 g/L
Globulin 31 g/L
Bilirubin (Total) 192 μmol/L
Bilirubin (Conj.) 130 μmol/L
ALP 203 U/L
GGT 470 U/L
ALT 6055 U/L
AST 4860 U/L
A. Alcoholic Fatty liver
B. Past Hepatitis B
C. Acute Viral Hepatitis.
D. Hepatitis B carrier stage
E. Chronic Hepatitis

20. 62 year Male, malaise, lethargy since 2 years. Liver mildly enlarged. No
jaundice. Liver function tests normal. Image from liver biopsy. Most likely
diagnosis?
A. B. C. D. E.
33%
67%
0%0%0%
A. Alcoholic fatty liver.
B. Acute viral hepatitis.
C. Fulminant hepatitis.
D. Chronic viral hepatitis.
E. Alcoholic Cirrhosis.

21. MG, 29 year old man presents with arthritis, darkening of skin and fatigue
since 3 years. He has also recently developed congestive cardiac failure.
His Hb A1c is 11.2%. Image shows his liver biopsy stained with Prussian
blue stain for iron. Most likely diagnosis?
A. B. C. D. E.
0% 0% 0%0%0%
A. Cirrhosis of liver.
B. Hemosiderosis.
C. Hemochromatosis.
D. Wilson’s disease.
E. Chronic pancreatitis.

22. 22y M, alcoholic, 3wk fatigue, icterus & fever. Liver
biopsy. ? Identify the structure
1 2 3 4 5
0%
33% 33%33%
0%
A. Mallory hyaline
B. Apoptotic cell
C. Viral inclusion
D. Hepatocyte necrosis
E. Inflammatory cell

23. 34y M, icterus and fever.
Liver biopsy. ? diagnosis
1 2 3 4 5
0%
100%
0%0%0%
A. Acute Hepatitis
B. Chronic Persistent Hepatitis.
C. Chronic active Hepatitis
D. Fulminant Hepatitis
E. Cirrhosis

24. 56y chronic alcoholic, 2 days fever, abdomen
distended, tender, tap yielded cloudy yellow fluid
with 98% neutrophils, Blood culture E.coli. Patient
dies 3 days later. Image shows his liver.
1 2 3 4 5
0% 0% 0%0%0%
A. A1 antitrypsin deficiency
B. HEV infection
C. Hereditary hemochromatosis
D. Primary sclerosing cholangitis
E. Alcoholic cirrhosis

25. 22y M, alcoholic, 3wk fatigue, icterus & fever. Liver biopsy.
? Identify the structure
1 2 3 4 5
0% 0% 0%0%0%
A. Mallory hyaline
B. Apoptotic cell
C. Viral inclusion
D. Hepatocyte necrosis
E. Inflammatory cell

26. 26
Learn from the mistakes
of others. You can't live
long enough to make
them all yourself…!
61% of 5th year students exceeded ‘sensible’ limits
Drugs and alcohol were taken mainly for pleasure and were
perceived as a normal part of life for many students…
Capability of advising patients…?
http://www.lycaeum.org/research/researchpdfs/1996_webb_1.pdf

27. 51y M, Alcoholic, surgery for pigmented skin
lesion: Liver specimen. Likely diagnosis?
1 2 3 4 5
0% 0% 0%0%0%
A. Amoebic Liver abscesses
B. Multiple Liver Infarcts
C. Alcoholic Hepatitis
D. Macronodular cirrhosis
E. Metastatic deposits

28. 59y Male, Alcoholic, presents with
fatigue, anorexia. Normal liver function tests. Liver
specimen. Likely diagnosis?
1 2 3 4 5
0% 0% 0%0%0%
A. Dubin-Johnson Syndrome
B. Alcoholic cirrhosis
C. Alcoholic Hepatitis
D. Fatty Liver
E. Metastatic deposits

29. 28y Male, 3 weeks after visiting east Timor, presents
with malaise, fatigue, loss of appetite. Mild icterus.
AST & ALT mild elevation. Total bil 3.9mg/dl (Direct
2.8). Which of the following would be positive?
1 2 3 4 5
0% 0% 0%0%0%
1. Anti HBs
2. IgM anti-HDV
3. Anti HCV
4. IgM anti HAV
5. Anti HBc

30. 28y Male, 3 weeks after visiting east Timor, presents
with malaise, fatigue, loss of appetite. Mild icterus.
AST & ALT mild elevation. Total bil 3.9mg/dl (Direct
2.8). Which of the following would be positive?
1 2 3 4 5
0% 0% 0%0%0%
1. Anti HBs
2. IgM anti-HDV
3. Anti HCV
4. IgM anti HAV
5. Anti HBc

31. 41y Female, increasing malaise, 10kg weight loss
since last year. Developed coma and died.
Specimen of her Liver. Most likely etiologic agent?
1 2 3 4 5
0% 0% 0%0%0%
1. Aspirin abuse
2. Ferrous sulphate
3. Acetaminophen
4. Aflatoxins
5. Raw Oysters.

32. A 48y man referred following high ALT in health screening.
HCV immunoassay +ve. Past h/o appendectomy 10 years
ago. Examination is normal. Which of the following tests
would determine if he has Chronic HCV infection?
1 2 3 4 5
0% 0% 0%0%0%
1. Repeat EIA for anti HCV Ab.
2. Recombinant immunoblot assay (RIBA)
3. Alpha-fetoprotein levels.
4. HCV RNA test.
5. Direct, indirect & total bilirubin assay.

33. 33
Alcohol Metabolism: