Liver and Biliary Pathology Practice Questions

Q: Anti-LKM antibodies are seen in which condition?

Drug-induced hepatitis. **Explanation:** The presence of **Anti-Liver Kidney Microsome (Anti-LKM) antibodies** is a classic marker for autoimmune-mediated liver injury, but their specific subtype determines the clinical association [1]. **Why Drug-induced Hepatitis is correct:** While Anti-LKM-1 is the hallmark of Type II Autoimmune Hepatitis (AIH) [1], **Anti-LKM-2** antibodies are specifically associated with **Drug-Induced Liver Injury (DILI)**, historically linked to the drug **Ticrynafen** (a diuretic) [1]. These antibodies are directed against Cytochrome P450 2C9. In the context of this specific question, "Drug-induced hepatitis" is a recognized association for the LKM antibody family [1]. **Analysis of Incorrect Options:** * **Type I Autoimmune Hepatitis:** This is the most common form of AIH. It is characterized by **Anti-Nuclear Antibodies (ANA)** and/or **Anti-Smooth Muscle Antibodies (ASMA)**, not Anti-LKM [1]. * **Type II Autoimmune Hepatitis:** This subtype is characterized by **Anti-LKM-1** antibodies (targeting CYP2D6) and Anti-Liver Cytosol type 1 (ALC-1) antibodies [1]. It typically affects children and young girls. * **Chronic Hepatitis D:** While some patients with Chronic Hepatitis C or D may transiently develop Anti-LKM-3 antibodies, it is not the primary diagnostic marker for Hepatitis D. **High-Yield Clinical Pearls for NEET-PG:** * **LKM-1:** Type II Autoimmune Hepatitis (Target: CYP2D6) [1]. * **LKM-2:** Drug-induced hepatitis (Target: CYP2C9). * **LKM-3:** Chronic Hepatitis D (Target: UDP-glucuronosyltransferase). * **SLA/LP (Soluble Liver Antigen):** Most specific marker for Autoimmune Hepatitis [1]. * **Type I AIH** is associated with **HLA-DR3 or DR4**, whereas **Type II** is associated with **HLA-DRB1 and DQB1**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 845-846.

Question 1

What are the most likely histological findings on a liver biopsy from a 20-year-old male who died due to acetaminophen overdose?

Accepted Answer

Centrizonal necrosis

Answer

Focal scattered necrosis

Answer

Midzonal necrosis

Answer

Steatohepatitis

Question 2

Microvascular steatosis is seen in all of the following conditions except?

Accepted Answer

Alcoholic liver disease

Answer

Acute fatty liver of pregnancy

Answer

Methotrexate toxicity

Answer

Reye syndrome

Question 3

A 1-month-old newborn presents with conjugated hyperbilirubinemia, intrahepatic cholestasis, and high alkaline phosphatase. Eosinophilic, PAS-positive cytoplasmic granules are seen in a liver biopsy specimen. What is the diagnosis?

Accepted Answer

Alpha-1-antitrypsin deficiency

Answer

Congenital hepatic fibrosis

Answer

Extrahepatic biliary atresia

Answer

Ductal plate abnormality

Question 4

Midzonal necrosis in the liver may occur in which of the following conditions?

Accepted Answer

Yellow fever

Answer

Enteric fever

Answer

Scarlet fever

Answer

Rheumatic fever

Question 5

Which of the following is false regarding Dubin-Johnson syndrome?

Accepted Answer

It causes unconjugated hyperbilirubinemia

Answer

Liver is darkly pigmented

Answer

It is an autosomal recessive disorder

Answer

It is caused by a mutation in the canalicular multidrug resistance protein 2

Question 6

A patient with cirrhosis is positive for HBsAg and has increased levels of alpha-fetoprotein. What is the most probable diagnosis?

Accepted Answer

Hepatocellular carcinoma

Answer

Submassive hepatic necrosis

Answer

Massive hepatic necrosis

Answer

None of the above

Question 7

Sclerosing cholangitis is most likely seen in which of the following conditions?

Accepted Answer

Ulcerative colitis

Answer

Hemochromatosis

Answer

Wilson disease

Answer

Primary biliary cirrhosis

Question 8

Anti-LKM antibodies are seen in which condition?

Accepted Answer

Drug-induced hepatitis

Answer

Type I Autoimmune hepatitis

Answer

Type II Autoimmune hepatitis

Answer

Chronic hepatitis D

Question 9

A macroscopic hepatic change known as nutmeg liver is indicative of?

Accepted Answer

Chronic congestive heart failure

Answer

Acute left-sided heart failure

Answer

Acute right-sided heart failure

Answer

Alcohol toxicity

Question 10

All of the following are true about fibrolamellar hepatocellular carcinoma except?

Accepted Answer

Associated with raised Alpha-fetoprotein (AFP)

Answer

Recurrences are seen despite a better prognosis

Answer

Increased neurotensin and vitamin B12 binding globulin

Answer

Lymph node metastasis is seen

Liver and Biliary Pathology — MCQs

Liver and Biliary Pathology — MCQs

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