Liver and Biliary Pathology Practice Questions

Q: Mallory hyaline is composed of which of the following proteins?

Cytokeratin. **Explanation:** **Mallory hyaline** (also known as Mallory-Denk bodies) are eosinophilic, rope-like intracytoplasmic inclusions found within hepatocytes [1]. They are primarily composed of tangled **intermediate filaments**, specifically **Cytokeratin 8 and 18**, complexed with other proteins like ubiquitin and p62. 1. **Why Cytokeratin is Correct:** Hepatocytes are epithelial cells, and their structural framework is maintained by cytokeratin intermediate filaments. Under conditions of oxidative stress or toxic injury (most classically in alcoholic liver disease), these filaments undergo misfolding, cross-linking, and aggregation, forming the characteristic "hyaline" appearance [1]. 2. **Why other options are incorrect:** * **Vimentin:** This is the intermediate filament characteristic of mesenchymal cells (e.g., fibroblasts, endothelium), not epithelial hepatocytes. * **Keratin:** While cytokeratin is a type of keratin, in medical pathology, "Keratin" usually refers to the specific filaments found in squamous epithelium (e.g., skin). Cytokeratin is the more precise term for internal epithelial organs. * **Collagen:** This is an extracellular matrix protein involved in fibrosis (cirrhosis), not an intracellular inclusion [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Association:** Most commonly associated with **Alcoholic Hepatitis** [1]. * **Other Associations (Mnemonic: "W-I-L-S-O-N"):** **W**ilson’s disease, **I**ndian Childhood Cirvis, **L**iver cell adenoma, **S**teatohepatitis (NASH), **O**bstructive biliary cirrhosis (Primary Biliary Cholangitis), and **N**eoplasms (Hepatocellular Carcinoma) [1]. * **Staining:** They appear bright pink on H&E stain and can be highlighted using **ubiquitin** immunohistochemical stains. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 388-390.

Q: What is the main cause of congenital hyperbilirubinemia?

Gilbert's Syndrome. **Explanation:** **Gilbert’s Syndrome** is the correct answer because it is the **most common** cause of hereditary hyperbilirubinemia, affecting approximately 3–7% of the general population. It is an autosomal recessive condition characterized by a mild reduction (about 30% of normal) in the activity of the enzyme **UDP-glucuronosyltransferase (UGT1A1)** [1]. This leads to intermittent, mild unconjugated hyperbilirubinemia, often triggered by stress, fasting, or illness. **Analysis of Incorrect Options:** * **Crigler-Najjar Syndrome:** This is much rarer than Gilbert’s. Type I involves a total absence of UGT1A1 (fatal without transplant), while Type II involves a severe deficiency (<10% activity) [1]. * **Dubin-Johnson Syndrome:** A rare autosomal recessive disorder involving a defect in the **MRP2 transport protein**, leading to conjugated hyperbilirubinemia and a characteristic **black liver** due to pigment deposition [1]. * **Rotor’s Syndrome:** Similar to Dubin-Johnson but even rarer; it involves a defect in OATP1B1/B3 transporters. It presents with conjugated hyperbilirubinemia but **lacks** the black liver pigmentation [1]. **NEET-PG High-Yield Pearls:** * **Gilbert’s Syndrome:** Look for a young patient with mild jaundice during exams or infection, with normal LFTs except for isolated unconjugated bilirubin (<3 mg/dL). No treatment is required. * **Enzyme Deficiency:** Gilbert’s and Crigler-Najjar involve **UGT1A1** (Unconjugated); Dubin-Johnson and Rotor involve **excretion defects** (Conjugated) [1]. * **Diagnostic Test:** The "Fasting Test" (bilirubin increases upon caloric restriction) is classic for Gilbert’s. * **Biopsy:** Dubin-Johnson shows coarse brown-black granules in hepatocytes (epinephrine metabolites); Rotor’s biopsy is histologically normal [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, p. 860.

Question 1

All of the following are prehepatic causes of cirrhosis except?

Accepted Answer

Severe congestive heart failure

Answer

Portal vein thrombosis

Answer

Splenic vein thrombosis

Answer

Massive splenomegaly

Question 2

Rokitansky-Aschoff sinuses are a feature of which of the following conditions?

Accepted Answer

Adenomyomatosis of the gallbladder

Answer

Chronic cholecystitis

Answer

Acute cholecystitis

Answer

Carcinoma of the gallbladder

Question 3

A patient presents with bilirubin 20 mg/dl, AST=313 IU/L, ALT=103 IU/L, and GGT=44 IU/L. What is the most probable diagnosis?

Accepted Answer

Alcoholic hepatitis

Answer

Viral hepatitis

Answer

Biliary atresia

Answer

Drug-induced liver injury

Question 4

Mallory hyaline is composed of which of the following proteins?

Accepted Answer

Cytokeratin

Answer

Vimentin

Answer

Keratin

Answer

Collagen

Question 5

Which of the following statements regarding hepatocellular carcinoma is incorrect?

Accepted Answer

Focal nodular hyperplasia is the most malignant variant.

Answer

Hepatitis C virus is a risk factor.

Answer

Oral contraceptive pills can increase the risk.

Answer

Chromosomal abnormalities are common.

Question 6

Non-alcoholic steatohepatitis is caused by which of the following?

Accepted Answer

Wilson's disease

Answer

Diabetes Mellitus

Answer

Obesity

Answer

Triglyceridemia

Question 7

All of the following are risk factors for Hepatocellular carcinoma except?

Accepted Answer

Animal fat in diet

Answer

Hepatitis C infection

Answer

Alcoholism

Answer

Aflatoxins

Question 8

Venoocclusive disease of the hepatic vein is characterized by which of the following?

Accepted Answer

Budd-Chiari syndrome

Answer

Central venous congestion

Answer

Hepatomegaly

Answer

Portal vein obstruction

Question 9

Which of the following statements regarding Fibrolamellar Carcinoma of the liver is FALSE?

Accepted Answer

It is associated with a worse prognosis compared to conventional Hepatocellular carcinoma.

Answer

It is a variant of Hepatocellular carcinoma.

Answer

AFP levels are typically normal.

Answer

It commonly occurs in young adults.

Question 10

What is the main cause of congenital hyperbilirubinemia?

Accepted Answer

Gilbert's Syndrome

Answer

Crigler-Najjar Syndrome

Answer

Rotor's Syndrome

Answer

Dubin-Johnson Syndrome

Liver and Biliary Pathology — MCQs

Liver and Biliary Pathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?