Pathology

Question 1

treatment of alcoholic hepatitis

Answer 1

glucocorticoids and pentoxyfylline (if active infection and steroids are contraindicated)

Question 2

3 major risk factors for non-alcoholic fatty liver disease

Answer 2

obesity, diabetes mellitus, hypertriglyceridemia

Question 3

difference between NAFL and NASH

Answer 3

NASH has inflammation and ballooning of hepatocytes and can lead to liver failure

Question 4

treatment for NAFLD

Answer 4

weight loss of 10% body weight

Question 5

treatment or NASH

Answer 5

pioglitazone, vitamin E

Question 6

vitamin E contraindication for NASH patients

Answer 6

diabetics

Question 7

two mutations responsible for hereditary hemochromatosis

Answer 7

H282Y, H63D in HFE gene

Question 8

role of HFE

Answer 8

downregulates transferrin when iron supplies are adequate

Question 9

impotence in males

Answer 9

hereditary hemochromatosis

Question 10

unique symptoms of hereditary hemochromatosis

Answer 10

skin hyperpigmentation, diabetes, impotence in males, ECG abnormalities

Question 11

what hereditary hemochromatosis patients should you get a liver biopsy from?

Answer 11

homozygotes who are over 40 or if elevated ALT/AST

Question 12

treatment for hereditary hemochromatosis

Answer 12

phlebotomy (goal ferritin <50)

Question 13

role of ceruloplasmin

Answer 13

binds copper so that it does not deposit in tissues

Question 14

unique symptoms of Wilson disease

Answer 14

dystonia, dysarthria, seizures, personality changes, psychosis, movement disorders

Question 15

diagnosis of Wilson disease

Answer 15

low ceruloplasmin, copper in urine, kayser-fleischer rings

Question 16

treatment of Wilson disease

Answer 16

trientine, zinc

Question 17

role of alpha-1 antitrypsin

Answer 17

inhibits elastase

Question 18

most common cause of genetic emphysema in adults

Answer 18

A1AT deficiency

Question 19

A1AT deficiency: effects in lung vs. liver

Answer 19

lung: loss-of-function, unopposed elastases –> damage to lung parenchyma
liver: gain-of-function, accumulation of misfolded A1AT in ER –> hepatotoxic

Question 20

stains red on PAS stain

Answer 20

A1AT globules

Question 21

what autoantibodies are found in autoimmune hepatitis?

Answer 21

ANA, ASMA

Question 22

most commonly associated condition with autoimmune hepatitis

Answer 22

thyroid disease

Question 23

treatment for autoimmune hepatitis

Answer 23

prednisone and azathioprine

Question 24

destruction of intrahepatic bile ducts (microscopic bile ducts)

Answer 24

primary biliary cirrhosis (PBC)

Question 25

what autoantibodies are found in primary biliary cirrhosis?

Answer 25

AMA

Question 26

target of AMAs in PBC

Answer 26

PDC-E2 (on membrane of biliary epithelial cells)

Question 27

unique findings of PBC

Answer 27

AMA+, pruritis, xanthomas

Question 28

ddx: steatorrhea

Answer 28

PBC, chronic pancreatitis, cancer in pancreatic head, somatostatinoma

Question 29

ddx: prolonged PT

Answer 29

PBC

Question 30

most commonly associated condition with PBC

Answer 30

Sjogren's

Question 31

3-4x normal alk phos, elevated cholesterol

Answer 31

PBC

Question 32

florid duct lesion: diagnosis, what is it

Answer 32

PBC; inflammatory changes around bile ducts

Question 33

treatment for PBC

Answer 33

ursodeoxycholic acid, cholestyramine

Question 34

seroconversion in HepB infection

Answer 34

loss of HBeAg, development of HBeAb

Question 35

treatment for chronic HepB

Answer 35

interferon, entecavir, tenofovir

Question 36

sign of active hepC infection

Answer 36

hepC viral RNA

Question 37

which hepatitis viruses cannot cause cirrhosis?

Answer 37

hepA&E

Question 38

prophylactic treatment for varices that haven't bled yet

Answer 38

non-selective beta-blockers (propranolol, nadalol)

Question 39

treatment for actively bleeding varices

Answer 39

octreotide (somatostatin analog)

Question 40

pathophysiology of ascites

Answer 40

portal hypertension --> splanchnic arterial vasodilation --> decreased effective circulating volume --> activation of vasoconstrictor and antinatriuretic factors --> sodium and water retention

Question 41

treatment for ascites

Answer 41

sodium-restricted diet, diuretics

Question 42

fulminant liver failure

Answer 42

ACUTE liver failure characrerized by hepatocyte necrosis: coagulopathy, encephalopathy, cerebral edema

Question 43

treatment for hepatic encephalopathy

Answer 43

lactulose and rifaximin

Question 44

pregnant woman with pruritis during third trimester, jaundice: diagnosis and treatment

Answer 44

intrahepatic cholestasis of pregnancy (IHCP); cholestyramine and urso (same treatment as PBC)

Question 45

difference between pre-eclampsia and eclampsia

Answer 45

pre-eclampsia: HTN, proteinuria, edema | eclampsia: pre-eclampsia + seizures

Question 46

treatment for acute fatty liver of pregnancy

Answer 46

urgent delivery

Question 47

HELLP syndrome symptoms and treatment

Answer 47

hemolytic anemia, elevated liver tests, low platelets; urgent delivery

Question 48

liver lesion associated with oral contraceptives

Answer 48

hepatic adenoma

Question 49

liver lesion associated with history of primary sclerosing cholangitis (PSC)

Answer 49

cholangiocarcinoma

Question 50

most common benign liver lesion

Answer 50

hemangioma

Question 51

hemangioma: mechanism

Answer 51

congenital vascular malformations

Question 52

diagnose: small benign lesion in liver caused by intrahepatic anomolous artery leading to hyperperfusion

Answer 52

focal nodular hyperplasia

Question 53

only benign liver lesion with malignant potential

Answer 53

hepatic adenoma

Question 54

confirmation test for hepatocellular carcinoma (HCC)

Answer 54

alpha fetoprotein (AFP) >200

Question 55

leading cause of hepatocellular carcinoma worldwide vs. US

Answer 55

worldwide: hepB US: hepC

Question 56

bile secretion decreases with ________________

Answer 56

splanchnic nerve stimulation

Question 57

diagnose: steady, right epigastric pain with fever, leukocytosis, tachycardic, normal liver panel, history of symptomatic gallstones

Answer 57

acute cholecystitis (inflammation of gallbladder)

Question 58

what is Charcot's triad?

Answer 58

clinical syndrome of acute cholangitis consisting of fever, jaundice, and abdominal pain

Question 59

what is acute cholangitis?

Answer 59

infection/stasis in biliary tract

Question 60

what is primary sclerosing cholangitis (PSC)?

Answer 60

chronic progressive disorder characterized by inflammation, fibrosis, stricturing of medium/large ducts in intrahepatic/extrahepatic biliary tree --> liver failure

Question 61

condition most commonly associated with primary sclerosing cholangitis (PSC)

Answer 61

ulcerative colitis

Question 62

diagnose: severe, constant pain that begins in mid-epigastrium and radiates to right shoulder/scapular area

Answer 62

gallbladder problem

Question 63

where do cholangiocarcinomas usually develop?

Answer 63

perihilar region of biliary tree

Question 64

major risk factors for cholangiocarcinoma

Answer 64

1. PSC 2. biliary cysts 3. biliary parasitosis 4. thorotrast

Question 65

biliary condition most commonly associated with ulcerative colitis

Answer 65

primary sclerosing cholangitis (PSC)

Question 66

pruritis with cholangiocarcinoma: intrahepatic or extrahepatic?

Answer 66

extrahepatic

Question 67

jaundice with cholangiocarcinoma: intrahepatic or extrahepatic?

Answer 67

extrahepatic

Question 68

ddx: (CA) 19-9

Answer 68

cholangiocarcinoma, exocrine pancreatic cancer

Question 69

major risk factors for gallbladder cancer

Answer 69

1. porcelain gallbladder 2. gallbladder polyps/adenoma 3. cholelithiasis (stones)

Question 70

causes of acute pancreatitis

Answer 70

gallstones, alcohol, hypertriglyceridemia, scorpion venom, mumps, seat belt injuries, pancreas divisum

Question 71

#1 cause of acute pancreatitis

Answer 71

gallstones

Question 72

3 genetic causes of acute pancreatitis

Answer 72

PRSS1, CFTR, SPINK1

Question 73

systemic response to acute pancreatitis

Answer 73

SIRS, ARDS, myocardial depression, renal failure, infection

Question 74

treatment for acute pancreatitis

Answer 74

pain control, aggressive IV fluids

Question 75

#1 cause of chronic pancreatitis

Answer 75

alcohol abuse

Question 76

distinguishing features of chronic pancreatitis (compared to acute)

Answer 76

can be asymptomatic, amylase and lipase may be normal, patchy, pancreatic duct calcification

Question 77

proteinaceous ductal plugs

Answer 77

chronic pancreatitis

Question 78

autoimmune pancreatitis: pathogenesis, treatment

Answer 78

IgG4-related disease; corticosteroids

Question 79

ddx: pancreatic mass

Answer 79

autoimmune pancreatitis, cancer

Question 80

major risk factors for exocrine pancreatic cancer

Answer 80

cigarette smoking, chronic pancreatitis

Question 81

symptoms of cancer in pancreatic head

Answer 81

painless jaundice, steatorrhea, weight loss

Question 82

ovarian-like stroma that secretes mucin in pancreatic body or tail: diagnosis and treatment

Answer 82

mucinous cystic neoplasm; surgical resection due to risk of malignancy

Question 83

what kind of intraductal papillary mucinous neoplasm (IPMN) has risk of malignancy?

Answer 83

main duct

Question 84

pancreatic lesion lined by glycogen-rich cells originating from acinar cells with central scar

Answer 84

serous cystadenoma

Question 85

pancreatic NET that can cause venous thrombosis

Answer 85

glucagonoma

Question 86

symptoms of somatostatinoma

Answer 86

diabetes mellitus, cholelithiasis, steatorrhea

Question 87

symptoms of VIPoma

Answer 87

"pancreatic cholera"=watery diarrhea, hypokalemia, achlorhydria

Question 88

anti-mitochondrial antibodies

Answer 88

PBC

Question 89

anti-smooth muscle antibodies

Answer 89

autoimmune hepatitis

Question 90

thorotrast-associated liver tumors

Answer 90

angiosarcoma and cholangiosarcoma