Liver and Biliary Pathology Practice Questions

Q: Which of the following characterizes Gilbert's syndrome?

Normal liver histology. **Explanation:** **Gilbert’s Syndrome** is the most common hereditary cause of hyperbilirubinemia, affecting approximately 3–7% of the population. It is caused by a genetic mutation (typically a TATAA box polymorphism) in the **UGT1A1 gene**, leading to a reduction (about 30% of normal) in the activity of the enzyme **UDP-glucuronosyltransferase**. 1. **Why "Normal liver histology" is correct:** Gilbert’s syndrome is a benign condition. Since the pathology is limited to a mild functional deficiency in bilirubin conjugation, there is no structural damage to the hepatocytes or the biliary architecture. Under a microscope, the liver appears completely normal. 2. **Why the other options are incorrect:** * **Option A:** While most LFTs (ALT, AST, Alkaline Phosphatase) are normal, the **total bilirubin is elevated** (predominantly unconjugated). Therefore, saying "all" LFTs are normal is technically inaccurate in a clinical context. * **Option B:** Gilbert’s syndrome is a benign condition and does **not** progress to inflammation, fibrosis, or cirrhosis. * **Option D:** The condition is characterized by **unconjugated** (indirect) hyperbilirubinemia. While it is indeed precipitated by fasting, stress, or illness, the type of bilirubin is unconjugated, not conjugated. **High-Yield Clinical Pearls for NEET-PG:** * **Inheritance:** Usually Autosomal Recessive. * **Triggers:** Jaundice is typically mild (<3 mg/dL) and triggered by **fasting (caloric restriction)**, dehydration, physical exertion, or febrile illness. * **Diagnostic Test:** The "Fasting Test" (bilirubin rises significantly after a 48-hour fast) or the "Rifampicin Test." * **Management:** No treatment is required; reassurance is key. * **Differential:** Distinguish from **Crigler-Najjar Syndrome** (more severe UGT1A1 deficiency) and **Dubin-Johnson/Rotor Syndromes** (which present with conjugated hyperbilirubinemia).

Question 1

In anoxia of the liver, in which region is necrosis typically seen?

Accepted Answer

Centrilobular

Answer

Around the periphery

Answer

Around the central vein

Answer

Around the bile duct

Question 2

Which of the following histological features is most characteristic of acute viral hepatitis?

Accepted Answer

Necrosis around central veins

Answer

Mononuclear cell infiltration

Answer

Scarring

Answer

Interface hepatitis

Question 3

Nodular regenerating hyperplasia is associated with which of the following?

Accepted Answer

Drug toxicity

Answer

Budd-Chiari syndrome

Answer

Alcohol abuse

Answer

Hepatitis B infection

Question 4

A 40-year-old male with a history of chronic alcoholism is diagnosed with cirrhosis and presents with a lump in the right lobe of the liver. His serum AFP level is normal. What is the most probable diagnosis?

Accepted Answer

Hepatocellular carcinoma

Answer

Fibrohyperplasia

Answer

Metastases

Answer

Hepatocellular adenoma

Question 5

Increased lipolysis of fat stores, which can result from starvation, diabetes mellitus, or corticosteroid use, is most likely to cause steatosis (fatty liver) through which one of the listed mechanisms?

Accepted Answer

Increased free fatty acid delivery to the liver leads to triglyceride accumulation in hepatocytes

Answer

Decreased free fatty acid excretion from the liver leads to free fatty acid accumulation in hepatocytes

Answer

Excess NADH (high NADH/NAD ratio) causes excess production of lactate from pyruvate, which accumulates in hepatocytes

Answer

Inhibition of apoprotein synthesis by the liver leads to phospholipid accumulation in hepatocytes

Question 6

Which of the following characterizes Gilbert's syndrome?

Accepted Answer

Normal liver histology

Answer

Normal liver function tests

Answer

Increased risk of cirrhosis

Answer

Conjugated hyperbilirubinemia precipitated by fasting

Question 7

Which of the following is NOT a risk factor for Hepatocellular Carcinoma?

Accepted Answer

Irritable Bowel Syndrome (IBS)

Answer

Hepatitis B Virus (HBV)

Answer

Hepatitis C Virus (HCV)

Answer

Alcohol

Question 8

Which of the following is the single most important indicator of the likelihood of progression of hepatitis to liver cirrhosis?

Accepted Answer

Etiology

Answer

Associated serological findings

Answer

Presence of bridging necrosis

Answer

Presence of Mallory hyaline

Question 9

A patient presents with jaundice. Physical examination reveals an enlarged nodular liver. CT of the abdomen shows a cirrhotic liver with a large mass. CT-guided biopsy of the mass demonstrates a malignant tumor derived from hepatic parenchymal cells. Which of the following viruses is most directly related to the development of this tumor?

Accepted Answer

Hepatitis B virus

Answer

Epstein-Barr virus

Answer

Human Herpes virus type 6

Answer

Human T-lymphotropic virus

Question 10

Which of the following is a causative agent for cholangiocarcinoma of the liver?

Accepted Answer

Clonorchis sinensis infection

Answer

Hepatitis B infection

Answer

Cirrhosis of the liver

Answer

Alpha-fetoprotein

Liver and Biliary Pathology — MCQs

Liver and Biliary Pathology — MCQs

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