Liver and Biliary Pathology Practice Questions

Q: A 23-year-old woman presents after a motor vehicle accident. An abdominal CT scan revealed a questionable mass in the right lobe of the liver. A subsequent fine-needle biopsy confirmed the presence of a liver adenoma. Which of the following is associated with the development of this lesion?

Oral contraceptives. **Explanation:** **Hepatic Adenoma** is a benign epithelial liver tumor that occurs most commonly in young women of childbearing age. **1. Why Oral Contraceptives (OCPs) are correct:** There is a strong, well-established causal relationship between the long-term use of **oral contraceptives** and the development of hepatic adenomas [1]. The risk increases with the duration of use and the potency of the estrogen component [1]. These tumors are often highly vascular and carry a significant risk of **spontaneous rupture and life-threatening intraperitoneal hemorrhage**, especially during pregnancy or menstruation. Regression may occur upon discontinuation of OCPs [1]. **2. Why other options are incorrect:** * **Hepatitis B & C (Options A & B):** These viral infections are primary risk factors for **Hepatocellular Carcinoma (HCC)** and cirrhosis, but they are not associated with benign hepatic adenomas. * **Polycythemia Vera (Option D):** This myeloproliferative disorder is a major risk factor for **Budd-Chiari Syndrome** (hepatic vein thrombosis) due to hypercoagulability, but it does not cause adenomas. **3. High-Yield Clinical Pearls for NEET-PG:** * **Risk Factors:** Besides OCPs, hepatic adenomas are associated with **Anabolic Steroids** and **Glycogen Storage Diseases** (especially Type I - von Gierke disease) [1]. * **Morphology:** Characterized by sheets of hepatocytes without portal tracts or bile ducts. * **Molecular Subtypes:** * *HNF1-α inactivated:* Low malignancy risk [1]. * *β-catenin activated:* High risk of malignant transformation to HCC. * *Inflammatory:* Associated with obesity and CRP elevation. * **Management:** Large adenomas (>5 cm) or those with β-catenin mutations are usually resected due to the risk of rupture or malignancy. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, p. 874.

Question 1

What is the most common tumor found in the liver?

Accepted Answer

Metastasis

Answer

Cavernous hemangioma

Answer

Hepatocellular carcinoma

Answer

Adenoma

Question 2

A 23-year-old woman presents after a motor vehicle accident. An abdominal CT scan revealed a questionable mass in the right lobe of the liver. A subsequent fine-needle biopsy confirmed the presence of a liver adenoma. Which of the following is associated with the development of this lesion?

Accepted Answer

Oral contraceptives

Answer

Hepatitis B

Answer

Hepatitis C

Answer

Polycythemia vera

Question 3

Mallory hyaline is a characteristic feature of?

Accepted Answer

Alcoholic liver disease

Answer

Hepatocellular carcinoma

Answer

Primary biliary cirrhosis

Answer

Wilson's disease

Question 4

Which of the following is a predisposing factor for cholangiocarcinoma?

Accepted Answer

Primary Sclerosing Cholangitis (PSC)

Answer

Gallstones

Answer

Ankylostomiasis

Answer

All of the above

Question 5

Increased deposition of fat in the liver in a patient with alcoholism is due to which of the following mechanisms?

Accepted Answer

Increased catabolism of fat peripherally

Answer

Decreased fatty acid oxidation

Answer

Increased triglyceride synthesis

Answer

Accumulation of triglycerides in the terminal hepatic venular zone

Question 6

Which of the following conditions is associated with non-alcoholic steatohepatitis?

Accepted Answer

Diabetes Mellitus (DM)

Answer

Obesity

Answer

Ischemic Heart Disease (IHD)

Answer

Gallstones

Question 7

What is the most common cause of Budd-Chiari syndrome?

Accepted Answer

Polycythemia vera

Answer

Hepatic vein valves

Answer

Hypercoagulable state in Nephrotic syndrome

Answer

Paroxysmal nocturnal hemoglobinuria (PNH)

Question 8

True regarding fibrolamellar carcinoma (FLC) of the liver are all the following EXCEPT?

Accepted Answer

Occurs in a pre-existing cirrhotic liver

Answer

Age group of occurrence is between 20-40 years

Answer

Extensive fibrosis

Answer

Favorable prognosis

Question 9

Which of the following statements regarding Hepatocellular carcinoma (HCC) is true?

Accepted Answer

NASH is a risk factor for HCC.

Answer

Oral contraceptive pills (OCPs) are implicated in HCC development.

Answer

Focal Nodular Hyperplasia is a premalignant lesion for HCC.

Answer

Chromosomal abnormalities are characteristically seen in HCC.

Question 10

What is the predominant constituent of pale yellow gallstones found in the gallbladder?

Accepted Answer

Cholesterol

Answer

Mucin glycoprotein

Answer

Calcium carbonate

Answer

Calcium phosphate

Liver and Biliary Pathology — MCQs

Liver and Biliary Pathology — MCQs

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