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Pathology of Hepatitis - Quiz

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

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Pathology of Hepatitis - Quiz

  1. 1. "Its not the will to win, but the will toprepare to win that makes thedifference."Bear Bryant1913-1983, Football Coach
  2. 2. 2Pathology ofCommon Liver DisordersDr. Venkatesh M. Shashidhar.Assoc.Prof & Head of Pathology
  3. 3. 3Viral serology interpretation:HBsAg Positive,Anti HBcAg PositiveAnti HBcAg IGM NegativeAnti HBsAg Negative1 2 3 4 541%7%0%26%26%A. Acute Viral HepatitisB. Immunised against Hep. BC. Chronic Hepatitis BD. Hepatitis B carrier stageE. Fulminant hepatitis BIgM anti-HAVantibodyAcute Hepatitis AHBsAg Hepatitis B orcarrier – exp./inf.HBeAg Active hepatitis BinfectionAnti-HCV antibody Hepatitis C virusexposureHCV RNA Active hepatitis Cinfection
  4. 4. 4?A. B. C. D. E.20% 20% 20%20%20%A. Chronic Passive Hepatitis BB. Chronic Viral Hepatitis AC. Hepatitis CD. Alcoholic Hepatitis.E. Transfusion Haemochromatosis.
  5. 5. 551y M, Alcoholic: Look at Arrow ? Pathogenesis.1 2 3 4 50% 0% 0%13%88%A. Porta-systemic shuntB. Hyper-oestrogenemiaC. Portal hypertensionD. Hypo-albuminemiaE. Decreased vit-K
  6. 6. 6?1 2 3 4 518%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. 7. 42y M, alcoholic, recurrent fatigue 3 years.Liver biopsy. ? Diagnosis1 2 3 4 50% 0%6%0%94%A. Acute HepatitisB. Chronic Active hepatitis.C. Chronic Persistant hepatitis.D. Fulminant Hepatitis.E. Cirrhosis.
  8. 8. 8?1 2 3 4 565%0% 0%29%6%1. Acute Alcoholic hepatitis.2. Drug induced Hepatitis.3. Fulminant Hepatitis.4. Acute Viral hepatitis5. Budd Chiari Syndrome.
  9. 9. Pathogenesis - typical of which virus?1 2 3 4 5100%0% 0%0%0%1. HAV2. HBV3. HCV4. HDV5. Non Specific
  10. 10. 10?1 2 3 4 559%6%0%0%35%1. Hepatic failure – cirrhosis.2. Hepatic encephalopathy.3. Hepatorenal syndrome.4. Chronic renal failure.5. Budd Chiari Syndrome.
  11. 11. A 42year travelling salesperson has routine medical test forinsurance. Following initial testing he was advised liverbiopsy. This is a image of his Liver Biopsy. What is themost likely diagnosis?A. B. C. D. E.31%0% 0%19%50%A. Acute Viral HepatitisB. Alcoholic hepatitis.C. Chronic viral Hepatitis.D. Post viral cirrhosis.E. Alcoholic Cirrhosis.
  12. 12. 69y Female, Chronic bronchitis. Died followingchronic Cardiac failure. Liver specimen. Likelydiagnosis?1 2 3 4 50%7%14%79%0%A. Alcoholic HepatitisB. Dubin-Johnson SyndromeC. Alcoholic cirrhosisD. Nutmeg liverE. Metastatic deposits
  13. 13. 13Viral serology interpretation:HBsAg Negative,Anti HBcAg Ab NegativeAnti HBcAg IGM NegativeAnti HBsAg Ab PositiveA. Acute Viral HepatitisB. Immunised against Hep. BC. Past Hepatitis BD. Hepatitis B carrier stageE. Fulminant hepatitis B
  14. 14. 28y M, alcoholic, homosexual icterus and fever.Liver biopsy. ? diagnosisA. B. C. D. E.80%0%10%0%10%A. Acute viral hepatitisB. Hemolytic anemiaC. Chronic persistent hepatitisD. Alcoholic fatty liver.E. Alcoholic Hepatits.
  15. 15. 15Viral serology interpretation:1 2 3 4 50% 0% 0%50%50%HBsAg Negative,Anti HBsAg Ab PositiveAnti HBcAg Ab PositiveAnti HBcAg IGM NegativeA. Acute Viral Hepatitis BB. Immunised against Hep. BC. Past Hepatitis BD. Hepatitis B carrier stageE. Carrier state of Hepatitis B
  16. 16. 58y M, alcoholic, distended abdomen & icterus.Liver biopsy. ? diagnosis1 2 3 4 50% 0%50%0%50%A. Chronic active hepatitis.B. Chronic Persistant hepatitis.C. Hepatocellular carcinoma.D. CirrhosisE. Chronic alcoholic hepatitis.
  17. 17. 17Lab Investigations interpretation:A. B. C. D. E.57%14%0%14%14%Protein (Total) 59 g/LAlbumin 30 g/LGlobulin 29 g/LBilirubin (Total) 27 μmol/LALP 71 U/LGGT 523 U/LALT 79 U/LAST 151 U/LA. Alcoholic Liver diseaseB. Acute Viral Hepatitis.C. Past Hepatitis BD. Hepatitis B carrier stageE. Carrier state of Hepatitis B
  18. 18. 1851y M, Alcoholic: Look at Arrow ? Pathogenesis.1 2 3 4 50%81%0%13%6%A. Porta-systemic shuntB. Hyper-oestrogenemiaC. Portal hypertensionD. Hypo-albuminemiaE. Decreased vit-K
  19. 19. 19Lab Investigations interpretation:A. B. C. D. E.33% 33% 33%0%0%Urea 5.8 mmol/LCreatinine 80 μmol/LProtein (Total) 66 g/LAlbumin 35 g/LGlobulin 31 g/LBilirubin (Total) 192 μmol/LBilirubin (Conj.) 130 μmol/LALP 203 U/LGGT 470 U/LALT 6055 U/LAST 4860 U/LA. Alcoholic Fatty liverB. Past Hepatitis BC. Acute Viral Hepatitis.D. Hepatitis B carrier stageE. Chronic Hepatitis
  20. 20. 62 year Male, malaise, lethargy since 2 years. Liver mildly enlarged. Nojaundice. Liver function tests normal. Image from liver biopsy. Most likelydiagnosis?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. 21. MG, 29 year old man presents with arthritis, darkening of skin and fatiguesince 3 years. He has also recently developed congestive cardiac failure.His Hb A1c is 11.2%. Image shows his liver biopsy stained with Prussianblue 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. 22. 22y M, alcoholic, 3wk fatigue, icterus & fever. Liverbiopsy. ? Identify the structure1 2 3 4 50%33% 33%33%0%A. Mallory hyalineB. Apoptotic cellC. Viral inclusionD. Hepatocyte necrosisE. Inflammatory cell
  23. 23. 34y M, icterus and fever.Liver biopsy. ? diagnosis1 2 3 4 50%100%0%0%0%A. Acute HepatitisB. Chronic Persistent Hepatitis.C. Chronic active HepatitisD. Fulminant HepatitisE. Cirrhosis
  24. 24. 56y chronic alcoholic, 2 days fever, abdomendistended, tender, tap yielded cloudy yellow fluidwith 98% neutrophils, Blood culture E.coli. Patientdies 3 days later. Image shows his liver.1 2 3 4 50% 0% 0%0%0%A. A1 antitrypsin deficiencyB. HEV infectionC. Hereditary hemochromatosisD. Primary sclerosing cholangitisE. Alcoholic cirrhosis
  25. 25. 22y M, alcoholic, 3wk fatigue, icterus & fever. Liver biopsy.? Identify the structure1 2 3 4 50% 0% 0%0%0%A. Mallory hyalineB. Apoptotic cellC. Viral inclusionD. Hepatocyte necrosisE. Inflammatory cell
  26. 26. 26Learn from the mistakesof others. You cant livelong enough to makethem all yourself…!61% of 5th year students exceeded ‘sensible’ limitsDrugs and alcohol were taken mainly for pleasure and wereperceived as a normal part of life for many students…Capability of advising patients…?http://www.lycaeum.org/research/researchpdfs/1996_webb_1.pdf
  27. 27. 51y M, Alcoholic, surgery for pigmented skinlesion: Liver specimen. Likely diagnosis?1 2 3 4 50% 0% 0%0%0%A. Amoebic Liver abscessesB. Multiple Liver InfarctsC. Alcoholic HepatitisD. Macronodular cirrhosisE. Metastatic deposits
  28. 28. 59y Male, Alcoholic, presents withfatigue, anorexia. Normal liver function tests. Liverspecimen. Likely diagnosis?1 2 3 4 50% 0% 0%0%0%A. Dubin-Johnson SyndromeB. Alcoholic cirrhosisC. Alcoholic HepatitisD. Fatty LiverE. Metastatic deposits
  29. 29. 28y Male, 3 weeks after visiting east Timor, presentswith malaise, fatigue, loss of appetite. Mild icterus.AST & ALT mild elevation. Total bil 3.9mg/dl (Direct2.8). Which of the following would be positive?1 2 3 4 50% 0% 0%0%0%1. Anti HBs2. IgM anti-HDV3. Anti HCV4. IgM anti HAV5. Anti HBc
  30. 30. 28y Male, 3 weeks after visiting east Timor, presentswith malaise, fatigue, loss of appetite. Mild icterus.AST & ALT mild elevation. Total bil 3.9mg/dl (Direct2.8). Which of the following would be positive?1 2 3 4 50% 0% 0%0%0%1. Anti HBs2. IgM anti-HDV3. Anti HCV4. IgM anti HAV5. Anti HBc
  31. 31. 41y Female, increasing malaise, 10kg weight losssince last year. Developed coma and died.Specimen of her Liver. Most likely etiologic agent?1 2 3 4 50% 0% 0%0%0%1. Aspirin abuse2. Ferrous sulphate3. Acetaminophen4. Aflatoxins5. Raw Oysters.
  32. 32. A 48y man referred following high ALT in health screening.HCV immunoassay +ve. Past h/o appendectomy 10 yearsago. Examination is normal. Which of the following testswould determine if he has Chronic HCV infection?1 2 3 4 50% 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. 33Alcohol Metabolism:

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