pt12

Question 1

How is the severity of acute liver injury best assessed?

Answer 1

Prothrombin time and bilirubin levels (reflect synthetic dysfunction and excretory capacity).

Question 2

Define chronic hepatitis.

Answer 2

Persistent hepatic inflammation > 6 months, due to viral, chemical (e.g., alcohol), or autoimmune causes.

Question 3

How is hepatitis A virus transmitted and what is its typical outcome?

Answer 3

Fecal–oral spread; short incubation, self‐limiting, no chronic stage; rare fulminant hepatitis.

Question 4

What prophylactic measures exist for hepatitis A?

Answer 4

Active immunization with inactivated vaccine; passive immunoglobulin for post‐exposure or short‐notice protection.

Question 5

Describe the hepatitis B virus structure relevant to diagnostics and vaccination.

Answer 5

DNA virus with core antigen (HBcAg), e antigen (HBeAg) indicating infectivity, and surface antigen (HBsAg) used in vaccines.

Question 6

What defines a chronic HBV carrier and their risks?

Answer 6

HBsAg persistence > 6 months; HBeAg or HBV DNA indicates high infectivity; risk of chronic hepatitis, cirrhosis, HCC.

Question 7

Outline key features of hepatitis C infection.

Answer 7

RNA virus; blood‐borne/rare vertical transmission; short incubation; 60–90% become chronic carriers; high risk of cirrhosis and hepatocellular carcinoma; no vaccine.

Question 8

How is acute HCV exposure in healthcare workers managed?

Answer 8

Immediate testing and early interferon‐based therapy post–needle‐stick to prevent chronic infection.

Question 9

Which lab finding is true for haemolytic jaundice?

Answer 9

Increase in serum unconjugated bilirubin.

Question 10

What is the principal transmission route for hepatitis A?

Answer 10

Faecal–oral route.

Question 11

What are the three learning outcomes for this lecture?

Answer 11

Understand cirrhosis pathogenesis; describe liver tumour pathology; know alcoholic liver disease features.

Question 12

How is cirrhosis defined histologically?

Answer 12

Diffuse, irreversible fibrosis and regenerative nodule formation following chronic hepatocyte necrosis.

Question 13

What are the two main consequences of cirrhosis?

Answer 13

Impaired liver cell function and gross architectural distortion leading to portal hypertension and eventual liver failure.

Question 14

List four major causes of cirrhosis.

Answer 14

Viral hepatitis (B, C, D), alcohol (Western world), autoimmune hepatitis, Wilson’s disease; plus drugs/NAFLD.

Question 15

Describe the two histological patterns of nodules in cirrhosis.

Answer 15

Micronodular (small, uniform nodules) and macronodular (larger, variable nodules), often mixed.

Question 16

What clinical signs arise from portal hypertension in cirrhosis?

Answer 16

Variceal haemorrhage (e.g., oesophageal varices), ascites, splenomegaly.

Question 17

What features reflect decompensated cirrhosis?

Answer 17

Portal-systemic encephalopathy, hepatorenal syndrome, refractory ascites, coagulopathy.

Question 18

Which primary malignancy arises almost exclusively on a background of cirrhosis?

Answer 18

Hepatocellular carcinoma (HCC).

Question 19

Name three risk factors for HCC.

Answer 19

Chronic HBV/HCV infection, cirrhosis (especially viral), aflatoxin exposure; androgenic steroids & (weakly) OCPs.

Question 20

Outline the stepwise progression to HCC.

Answer 20

Cirrhosis → dysplastic nodules → overt hepatocellular carcinoma.

Question 21

How does well-differentiated HCC appear histologically?

Answer 21

Neoplastic hepatocyte cords, thicker than normal, with identifiable hepatocytic features.

Question 22

What distinguishes poorly-differentiated HCC microscopically?

Answer 22

Pleomorphic cells, giant nuclei, loss of normal hepatic architecture.

Question 23

What clinical presentation in a cirrhotic patient suggests HCC?

Answer 23

New weight loss, fever, anorexia, ascites or abdominal pain; or detection of a focal liver lesion.

Question 24

Which tumour marker is elevated in ~⅔ of HCC patients?

Answer 24

Alpha-fetoprotein (AFP).

Question 25

What imaging findings support HCC diagnosis?

Answer 25

Ultrasound/CT showing filling defects; MRI or angiography if doubt remains.

Question 26

When is liver biopsy indicated in suspected HCC?

Answer 26

Only if noninvasive tests (AFP + imaging) are inconclusive due to seeding risk.

Question 27

What criteria confirm HCC non‐invasively in cirrhosis?

Answer 27

Cirrhosis plus a liver mass >2 cm on imaging.

Question 28

What are the main treatment options for early HCC?

Answer 28

Surgical resection or liver transplantation; chemoembolisation in selected cases.

Question 29

Why are chemotherapy and radiotherapy generally unhelpful for HCC?

Answer 29

HCC is relatively chemo- and radio-resistant.

Question 30

What is the typical prognosis for advanced HCC?

Answer 30

Survival often <6 months without early intervention.

Question 31

What are the three major pathological lesions of alcoholic liver disease?

Answer 31

Alcoholic fatty liver, alcoholic hepatitis, alcoholic cirrhosis.

Question 32

How does alcoholic fatty liver present and reverse?

Answer 32

Asymptomatic hepatomegaly; ↑ MCV and γ-GT; reversible on alcohol cessation.

Question 33

What histological feature is pathognomonic for alcoholic hepatitis?

Answer 33

Mallory (Mallory–Denk) bodies plus hepatocyte necrosis and neutrophilic infiltrate.

Question 34

Which lab findings typify alcoholic hepatitis?

Answer 34

Leucocytosis, moderate ↑ AST/ALT (<500 IU/L, AST>ALT), ↑ bilirubin, ↓ albumin, prolonged PT.

Question 35

What is the mainstay of treatment for severe alcoholic hepatitis?

Answer 35

Supportive care, nutritional support; corticosteroids in severe cases.

Question 36

Describe the morphology of alcoholic cirrhosis.

Answer 36

Micronodular regeneration nodules surrounded by fibrous septa in a fatty liver background.

Question 37

How does abstinence affect alcoholic cirrhosis outcome?

Answer 37

Lifelong alcohol cessation improves 5-year survival significantly.

Question 38

Which statement is not true about cirrhosis?

Answer 38

That it is a localised (it’s diffuse) process; it is irreversible.

Question 39

Which statement is correct regarding alcoholic liver disease?

Answer 39

All of the above: it’s the most common chronic liver disease in the West; more common in men; alcohol is hepatotoxic; major lesions include fatty liver and cirrhosis.

Question 40

What are the main layers/components of the tracheal wall?

Answer 40

C-shaped cartilage plates, smooth muscle, pseudostratified ciliated epithelium, and submucosal glands.

Question 41

How do bronchi differ from bronchioles histologically?

Answer 41

Bronchi have cartilage foci, a thicker smooth-muscle layer, respiratory epithelium and glands; bronchioles lack cartilage, have thinner muscle, simple ciliated epithelium and Clara cells.

Question 42

What are the two pneumocyte types and their functions?

Answer 42

Type I for gas exchange; Type II secrete surfactant and serve as progenitors for Type I.

Question 43

Describe the respiratory mucosa and its defence role.

Answer 43

Pseudostratified columnar ciliated epithelium with goblet cells; cilia beat ~1,000 times/min to move mucus—and trapped pathogens—up the airway.

Question 44

What defines a catarrhal disorder of the upper respiratory tract?

Answer 44

Inflammation of nasal mucosa with abundant muco-purulent secretions (runny nose).

Question 45

Which virus causes the common cold and why can’t we vaccinate against it?

Answer 45

Rhinoviruses (>100 strains in the picornavirus family); impractical to cover all strains.

Question 46

What are the two key surface proteins of influenza and their roles?

Answer 46

Haemagglutinin (H) for cell attachment; Neuraminidase (N) for viral penetration and release.

Question 47

Differentiate antigenic drift vs. antigenic shift in influenza.

Answer 47

Drift: minor genetic changes causing seasonal epidemics; Shift: major reassortment leading to pandemics.

Question 48

What is the incubation period and main symptoms of influenza?

Answer 48

1–3 days; fever, shivering, generalized myalgia, severe headache, sore throat, dry cough.

Question 49

Who should receive annual influenza vaccination and why?

Answer 49

Elderly (≥ 60 yrs) and immunocompromised patients, due to higher risk of severe disease and death (~10,000 UK deaths/yr).

Question 50

Define lobar pneumonia vs. bronchopneumonia anatomically.

Answer 50

Lobar: consolidation of an entire lobe; Bronchopneumonia: patchy foci of exudate in bronchioles and adjacent alveoli.