Pathology of Biliary & Pancreatic Disorders - Quiz

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Pathology of Biliary & Pancreatic Disorders - Quiz

  1. 1. Great wars & Great creationsstart first in human mind…!-- Thoughts are seeds with potential.
  2. 2. 54y man with chornic intermittend right upper quadrant painnow presents with severe abdominal pain. Raised Bilirubin(direct), ALP, Amylase. Image abdominal CT. Diagnosis ?.1 2 3 4 57% 7%14%0%71%1. Acute Cholecystitis.2. Chronic Pancreatitis.3. Acute pancreatitis.4. Acute Hepatitis.5. Pancreatic carcinoma.1. Explain the clinical features? – acute, sudden over chronic.2. Explain the laboratory data? – Bil, ALP, Amylase (pancreatitis).3. What are possible risk factors? – smoking, alcoholism, diabetes, cholelithiasis.4. What is the pathogenesis? – activation of enzymes, inflammation, fat necrosis.
  3. 3. 38y F, Obese, abdominal colicky pain, Gallbladder:? Type of stones1 2 3 4 575%19%0%0%6%A. Pure cholesterolB. Mixed cholesterol.C. PigmentD. CalciumE. Triple phosphate.
  4. 4. 38y F, Obese, abdominal colicky pain, Gallbladder:? Type of stones1 2 3 4 50%71%0%0%29%A. Pure cholesterolB. Mixed cholesterol.C. PigmentD. CalciumE. Triple phosphate.
  5. 5. A 45y mildly obese woman, 1-week history of upperabdominal pain, fever, shaking chills, and vomiting. P/Esevere right upper quadrant tenderness. Lab: serumbilirubin of 1.0 mg/dL, AST of 25 U/L, ALT of 35 U/L, ALP220 U/L (high), WBC of 14,000/µL, and amylase of 95 U/L(normal).Most likely diagnosis?1 2 3 4 587%0%13%0%0%1. Acute Cholecystitis2. Acute Pancreatitis3. Carcinoma pancreas4. Carcinoma Gall bladder5. Primary biliary cirrhosis.
  6. 6. 40y Black woman, indigestion, abdominal pain,Gallbladder: Most likely associated disease?1 2 3 4 517%0%72%6%6%1. Chronic Pancreatitis2. Diabetes mellitus3. Familial hypercholesterolemia4. Hyperparathyroidism5. Sickle cell disease
  7. 7. 69y M, Massive GI bleeding, jaundice.Section of liver ? Pathogenesis1 2 3 4 525%19%0%6%50%1. Cholangiocarcinoma2. Hepatocellular carcinoma3. Metastatic carcinoma4. Liver abscesses5. Tuberculosis.
  8. 8. 38y F, Obese, intermittent abdominal colicky painsince 2y, Gallbladder: ? DiagnosisA. B. C. D. E.14%43%0%0%43%A. AdenocarcinomaB. CholelithiasisC. CholecystitisD. CholesterosisE. Primary Biliary Cirrhosis.
  9. 9. A 21 year old man, abdominal pain, rigidity since 3 days.Serum Lipase raised but calcium normal. Image showsappearance of his pancreas. He had 4 similar attacks since8 years. ? Most likely Etiology.1 2 3 4 538%8% 8%38%8%1. Explain the clinical features? – acute, sudden recurrent.2. Explain the laboratory data? – Lipase, Calcium.3. What are possible risk factors? – Genetic AD Trypsin mutation (PRSS1),4. What is the pathogenesis? – uncontrolled activation of enzyme trypsin,1. Chronic Acoholism.2. Chronic Cholecystitis.3. Type 1 Diabetes.4. Genetic disorder.5. Unknown.
  10. 10. 69y Female, Chronic bronchitis. Died followingchronic pulmonary failure. Liver specimen.Likely diagnosis?1. Alcoholic Hepatitis2. Dubin-Johnson Syndrome3. Liver cirrhosis4. Passive congestion liver5. Primary Biliary cirrhosis
  11. 11. A 46 year old man, 8 year history of intermittent abdominalpain now presents with steatorrhoea. Image showsabdominal CT. ? Most likely Diagnosis.1 2 3 4 50% 0%47%37%16%1. Explain the clinical features? – chronic steatorrhoea - pancreas.2. What are possible risk factors? – alcohol, diabetes, cholelithiasis,3. What is the pathogenesis? pancreatitis  fat storage  steatorrhoea  fatty liver1. Fatty liver.2. Chronic Cholecystitis.3. Chronic pancreatitis4. Cholelithiasis & fatty liver.5. Both 1 & 3
  12. 12. 38y F, Obese, abdominal colicky pain, Gallbladder:Most likely metabolic abnormality?1 2 3 4 511%0%89%0%0%1.Decreased bilirubin conjugation.2.Decreased serum albumin.3.Increased bilirubin uptake4.Increased hepatic calcium secretion.5.Increased hepatic cholesterol secretion.
  13. 13. Complications of Cholelithiasis include all thefollowing EXCEPT:1 2 3 4 513%0%60%7%20%A. Secondary Biliary CirrhosisB. Recurrent CholangitisC. Liver AbscessD. Chronic PancreatitisE. Primary Biliary cirrhosis.
  14. 14. 62y F, Abd. Pain & jaundice. Gall bladder biopsy ? Diag1 2 3 4 50% 0% 0%7%93%A. CholecystitisB. CholesterosisC. AdenocarcinomaD. Aschoff-RokitanskysinusesE. Primary Biliary Cirrhosis.
  15. 15. 38y F, jaundice. Gall bladder ? Pathogenesis1 2 3 4 535%0% 0%65%0%A. Excess BilirubinB. Low cholesterolC. Low Bile SaltsD. Infection.E. Cholestasis.
  16. 16. 34y M, alcholic, fever, abdominal pain, mild icterusand malaise 6 months. Liver biopsy. ? diagnosis1 2 3 4 520%0% 0%73%7%1. Alcoholic Hepatitis2. Chronic Persistent Hepatitis.3. Hepatitis C infection4. Fatty Liver5. Alcoholic Cirrhosis
  17. 17. 78y woman, epigrastric pain & 4 kg weight loss since 6m.Bilirubin raised, AST & ALT normal, but ALP 216 u/l (<125).Image shows her abd. CT & Microscopy. Likely diagnosis ?.1 2 3 4 514%5%71%0%10%1. Explain the clinical features? – Chronic, weight loss, pain, jaundice – Ca Pan.2. Explain the laboratory data? – AST/ALT Hepatocytes normal, ALP –bile obstr.3. What are possible risk factors? – smoking, chronic pancreatitis, ca. syndromes.4. What is the pathogenesis? – PanIN -1A, PanIN -1B, K-RAS, PanIN -2, 3, Ca.1. Cholecystitis.2. Cholelithiasis.3. Chronic pancreatitis.4. Chronic Hepatitis.5. Pancreatic carcinoma.
  18. 18. 26y female, medical student, day before pathology exam presents withmild scleral jaundice. Physical Examination normal, Liver functiontests: Protein total-7.9, Albumin 4.8 g/dl, AST-36 U.L, ALT 16 U/L, ALP-36 U/L, Total Bilirubin 4.9, direct 0.7 mg/dl. Jaundice resolves weeklater after exams. Most likely diagnosis?1 2 3 4 55%0%29%5%62%1. Alcoholic hepatitis.2. Primary biliary cirrhosis.3. Gilbert Syndrome.4. Acute HAV infection.5. Acetaminophen poisoning.
  19. 19. Viral serology interpretation:HBsAg Positive,Anti HBc Ab PositiveAnti HBc IGM NegativeAnti HBs Ab NegativeA. Acute Viral HepatitisB. Immunised against Hep. BC. Chronic Hepatitis BD. Hepatitis B carrier stageE. Fulminant hepatitis B
  20. 20. 52y F, multiple red-brown, tender subcutaneous nodules with15kg wt. Loss since 3m. Microscopy of nodule inflammation, fat necrosis, no malignant cells. ? Diagnosis.1 2 3 4 50%25%35%20%20%1. Acute Pancreatitis2. Chronic Pancreatitis3. Adenocarcinoma4. Pancreatic Pseudocyst5. MEN I Syndrome
  21. 21. “The ancestor of every action is athought.”--Ralph Waldo Emerson
  22. 22. 34y M, alcoholic, homosexual- icterus andfever 6 months. Liver biopsy. ? diagnosisA. Acute HepatitisB. Chronic active Hepatitis.C. Cirrhosis  CarcinomaD. Fulminant HepatitisE. Hepatitis  Cirrhosis
  23. 23. 34y M, icterus and fever.Liver biopsy. ? diagnosis1. Acute Hepatitis2. Chronic Persistent Hepatitis.3. Chronic active Hepatitis4. Fulminant Hepatitis5. Cirrhosis
  24. 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 dayslater. Image shows his liver. Most Likely diagnosis?1 2 3 4 50% 0% 0%0%0%1. A1 antitrypsin deficiency2. HEV infection3. Hereditary hemochromatosis4. Primary sclerosing cholangitis5. Alcoholic cirrhosis
  25. 25. 58y M, alcoholic, distended abdomen & icterus.Liver biopsy. ? diagnosis1 2 3 4 50% 0% 0%0%0%1. Chronic active hepatitis.2. Chronic Persistant hepatitis.3. Hepatocellular carcinoma.4. Cirrhosis5. Chronic alcoholic hepatitis.
  26. 26. Viral serology interpretation:A. B. C. D. E.0% 0% 0%0%0%HBsAg Negative,Anti HBc Ab NegativeAnti HBcAg IGM NegativeAnti HBs Ag PositiveA. Acute Viral HepatitisB. Immunised against Hep. BC. Past Hepatitis B infection.D. Hepatitis B carrier stageE. Chronic hepatits B
  27. 27. 59y Male, Alcoholic, presents with fatigue, anorexia.Normal liver function tests. Liver specimen.Likely diagnosis?1 2 3 4 50% 0% 0%0%0%A. Dubin-Johnson SyndromeB. Alcoholic cirrhosisC. Alcoholic HepatitisD. Fatty LiverE. Nutmeg liver
  28. 28. 42y male smoker presented with recurrent cough& dyspnoea. Image shows cut section of hislung. What is the most likely diagnosis?1 2 3 4 50% 0% 0%0%0%1. Emphysematous bullae2. Panlobular emphysema3. Centrilobular emphysema4. Chronic Bronchitis + Emphysema.5. Smokers lung with Silicosis
  29. 29. 46 year male on treatment for lymphoma presentswith pallor, shortness of breath and mild jaundice.Image shows his blood film appearance. What isthe most likely type of anemia?1 2 3 4 50% 0% 0%0%0%1. Anemia of chronic disorder2. Megaloblastic anemia3. Hemolytic anemia4. Aplastic anemia5. Iron deficiency Anemia
  30. 30. 42y M, alcoholic, recurrent fatigue.Liver biopsy. ? Diagnosis1 2 3 4 50% 0% 0%0%0%1. Acute Hepatitis2. Chronic Active hepatitis.3. Chronic Persistant hepatitis.4. Fulminant Hepatitis.5. Cirrhosis.
  31. 31. 78year female presents with prolonged weakness,fatigue and anemia. She has palpable spleen & fewenlarged cervical Lymphnodes. Image shows herblood film. What is the most likely diagnosis?1 2 3 4 50% 0% 0%0%0%1. Acute myeloid leukaemia2. Acute lymphatic leukaemia3. Chronic myeloid leukaemia4. Chronic lymphatic leukaemia5. Non-hodgkins lymphoma
  32. 32. Health is the greatestpossession. Contentment is thegreatest treasure. Confidence isthe greatest friend. Non-being(selfless) is the greatest joyLao Tzu
  33. 33. Do you have Problems learningPathology ?Need a personal coach….?email/call me for an appointmentvenkatesh.shashidhar@jcu.edu.auTel: 47814566Remember…100% pass…!
  34. 34. CPC-2.7– GIT–Ca Pan+dep• Pathology - Core Learning Issues:– Pathology of exocrine Pancreas – Acute & ChronicPancreatitis & complications.– Neoplasms – Endocrine-adenoma, exocrinemalignancy – Adeno-carcinoma. & complications.– Paraneoplastic syndromes and common tumourmarkers. – MEN, Insulinoma, Gastrinoma,• Basic science - Core Learning Issues:– Structure & Function of Pancreas.– Pancreatic enzymes.– Neoplasia – Carcinogenesis, biology of neoplasms.
  35. 35. Uncommon risk factor for Acute Pancreatitis ?1 2 3 4 50% 0% 0%0%0%1. Alcohol abuse2. Gallstones3. Hyperlipidemia4. Genetic5. Hyperparathyroidism
  36. 36. Histopathology Image is from lung biopsy of a 61 yearmale chronic smoker. What is the most likely type ofcarcinoma?1 2 3 4 50% 0% 0%0%0%1. Small cell carcinoma2. Adenocarcinoma3. Metastatic deposits4. Squamous carcinoma5. Lung abscesses
  37. 37. The gross image of lung specimen from a 59yearold male heavy smoker presented with high fever,shortness of breath. Likely type of pneumonia?1 2 3 4 50% 0% 0%0%0%1. Lobar pneumonia2. Interstitial pneumonia3. Broncho pneumonia4. Fungal pneumonia5. Carcinomatous pneumonia
  38. 38. 42y obese female. Acute abdomen.Elevated serum amylase, Normal Lipase & AST.? Diagnosis1 2 3 4 50% 0% 0%0%0%A. Acute cholecystitisB. Acute PancreatitisC. Acute alcoholic hepatitisD. Chronic pancreatitisE. Recurrent Pancreatitis
  39. 39. Mary, 58y, 6m h/o epigastric pain, weight loss, foul smellingdiarrhoea. Lab Results:Serum Amylase-P – 56 U/L (Range 30-110)Serum Lipase – 460 U/L (Range 30-300)Serum Calcium – 1.92 (Range 2.1-2.55)What is the most likely diagnosis?1 2 3 4 50% 0% 0%0%0%A. Acute AppendicitisB. Chronic CholecystitisC. Acute PancreatitisD. Chronic PancreatitisE. Ulcerative colitis
  40. 40. Which of the following findings is most likely to beencountered in Mary?1 2 3 4 50% 0% 0%0%0%1. Alcoholic hepatitis2. Melena3. Pernicious anemia4. Steatorrhea5. Hypoglycemia
  41. 41. Mary presents again after 3 years. Physicalexamination shows jaundice. A CT scan of theabdomen shows a large fluid-filled cyst in the lessersac. What is the most likely diagnosis?1 2 3 4 50% 0% 0%0%0%1. Adenocarcinoma2. Carcinoid tumor3. True Pancreatic cyst4. Abscess in Pancreas5. Pancreatic Pseudocyst
  42. 42. 1y male, bilious vomiting. Mid duodenal narrowing.? Diagnosis1 2 3 4 50% 0% 0%0%0%1. Annular pancreas2. Duodenal polyp3. Pancreatic adenoma4. Pancreas divisum5. Congenital Pyloricstenosis
  43. 43. 13y boy. Recurrent pancreatitis attacks. Nowpresents with weight loss since a year, pedaledema. ? Diagnosis1 2 3 4 50% 0% 0%0%0%1. Annular pancreas2. Ectopic pancreas3. Pancreatic adenoma4. Pancreas divisum5. Congenital Pyloricstenosis
  44. 44. Major risk factors for Pancreatic cancer?1 2 3 4 50% 0% 0%0%0%1. Fatty, female, Forty..2. Life style & Diet3. Smoking & Diabetes4. Hypertension & lackof exercise5. Gall stones &Diabetes.
  45. 45. 65y Male, “positive Courvoisiers sign” ??1 2 3 4 50% 0% 0%0%0%1. Painful jaundice with purpuric spots.2. Jaundice with high colored urine.3. Painful jaundice with itching.4. Palpable gall bladder with jaundice5. Jaundice with abdominal pigmentation.
  46. 46. 65y M, Wt loss, pedal edema, Pancreaticbiopsy: Identify B ?1 2 3 4 50% 0% 0%0%0%? A? C1. Malignant glands2. Pancreatic Islets3. Fibrous tissue4. Inflammatory cells5. Benign glands
  47. 47. 65y M, Wt loss, pedal edema, Pancreaticbiopsy: Identify B ?1 2 3 4 50% 0% 0%0%0%? A? CBAC1. Malignant glands2. Pancreatic Islets3. Fibrous tissue4. Inflammatory cells5. Dilated ducts
  48. 48. 38y Female episodic fainting, Sweating, hunger &weight gain. Scan shows 1.5cm circumscribed roundmass in pancreas.? Diagnosis1 2 3 4 50% 0% 0%0%0%1. Adenocarcinoma2. Gastrinoma3. Glucagonoma4. Insulinoma5. Carcinoid tumor
  49. 49. 65y man, Acromegaly, epigastric pain, melena,hypercalcemia, hyperlipidemia, hyperacidity.? Diagnosis1 2 3 4 50% 0% 0%0%0%1. Glucagonoma2. Insulinoma3. MEN I4. Pancreatic Carcinoid5. MEN II
  50. 50. 52y F, severe multiple peptic ulcers in both duodenumand jejunum not responding to treatment. Pancreas shows1.2cm rounded tumor. ? Diagnosis.1 2 3 4 50% 0% 0%0%0%Peptic ulcers1. H.pylori & peptic ulcer2. Insulinoma3. MEN II syndrome4. Pancreatic Carcinoid5. Gastrinoma
  51. 51. A man with outward couragedares to die.A man with inward couragedares to live.Lao Tzu
  52. 52. Self Assessment is the key…!Retention of LearningTime Delay No review Review7 Days 33% 83%63 Days 14% 70%Whether new information is "stored" or "dumped"depends, then, on our Interest, Reciting, Writing &Reviewing the information.Source: http://www.web-us.com/memory/human_memory.htm
  53. 53. 53Living becomes a glorious experienceonly when there is tolerance and love.Willingness to compromise with otherpeople’s ways of living andcooperation in common tasks, thesemake happy and successful societies.Divine Discourse, 17th February 1980 - Baba.Love is Selfless Service.
  54. 54. 545 A’s & SNAP• Ask: 1. patients with diabetes, hypertension,hyperlidaemia, obesity or existing vascular disease• Assess: 2.Number of cigarettes or equivalent/day,Dependance 3.readiness to change/motivation• Advise: 4.provide written information, 5.motivationalinterviewing• Assist: 6.NRT ? Bupropion(Zyban) 7.Support• Arrange: 8.referral to QUIT 9.follow up with the GPSNAP Counseling: Smoking, Nutrition, Alcohol &Physical Activity.
  55. 55. Silence…55To the question "Who am I?" the only relevant answer is silence. Youneed to discard all answers in words, including "I am Nothing" or "Iam the Cosmic Self" or "I am the Self" - and just stick to the question"Who am I?". All other answers are just thoughts. Thoughts cannever be complete. Only Silence is complete.Thoughts are not the goal in themselves. Their goal is Silence. Whenyou ask the question "Who am I?" you get no answer, there issilence. That is the real answer. For your soul is solidified silence.This solidified silence is wisdom, is knowledge.The easy way to silence the thoughts is to arouse the feelings. For,through feelings only peace, joy and love dawn. And they are allyour very nature.- Sri Sri Ravishankar
  56. 56. Viral serology interpretation:1 2 3 4 50% 0% 0%0%0%HBsAg Negative,Anti HBsAg PositiveAnti HBcAg PositiveAnti HBcAg IGMNegativeA. Acute Viral Hepatitis BB. Immunised against Hep. BC. Past Hepatitis BD. Hepatitis B carrier stageE. Carrier state of Hepatitis B

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