FMGE 2025 - Pathology Practice Questions

Q: A 58-year-old male with history of multiple sexual partners presented with anorexia and jaundice. The biopsy shows ground-glass opacity in the cells. What is the most probable diagnosis?

Hepatitis B. ***Hepatitis B***- The biopsy finding of **ground-glass opacity** in hepatocytes is pathognomonic for chronic **Hepatitis B Virus (HBV)** infection, caused by the accumulation of **Hepatitis B surface antigen (HBsAg)** in the endoplasmic reticulum [1].- The patient's presentation of jaundice and anorexia, combined with the risk factor of **multiple sexual partners**, is highly suggestive of HBV transmission [3].*Hepatitis A*- Hepatitis A is transmitted via the **fecal-oral route** and rarely leads to chronic liver disease, making it unlikely given the patient's risk profile and chronic signs [2].- Histologically, it causes predominantly **acute panlobular hepatitis** without the distinguishing ground-glass inclusions.*Hepatitis C*- Histologic evaluation of Hepatitis C often reveals **lymphoid aggregates** within the portal tracts and prominent **steatosis** (fatty change), rather than ground-glass inclusions [1].- While transmitted parenterally and potentially sexually, the absence of the characteristic HCV histological features makes this diagnosis less likely.*Hepatitis D*- Hepatitis D is a **defective virus** requiring co-infection or superinfection with **Hepatitis B** for replication.- Although often co-existing with HBV, the specific **ground-glass appearance** results from the accumulation of **HBsAg**, the protein produced primarily by the Hepatitis B virus [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 843-844. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 844-845. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, p. 838.

Q: A diabetic male presented with seizures. Radiological examination shows a lesion. Histopathological examination shows liquefactive necrosis. What is the most important mechanism responsible for this?

Enzymatic degradation. ***Enzymatic degradation*** - Liquefactive necrosis, common in the brain (e.g., in stroke or brain abscess as suggested by the presentation in a **diabetic** patient), is defined by the complete dissolution of dead tissue into a viscous liquid mass [1]. - This dissolution is mediated by the robust release of **hydrolytic enzymes** from inflammatory cells (like **neutrophils** in an abscess) and the deceased parenchymal cells themselves, leading to the formation of a fluid-filled cavity [1]. *Mechanical* - Mechanical injury (trauma) is a *cause* of cell death and tissue damage, but it does not describe the specific biochemical process of liquefying the dead cells. - Mechanical factors primarily lead to **coagulative necrosis** initially if blood supply is compromised, or immediate cellular disruption, which is then processed by other mechanisms. *Ischemic* - Ischemia (lack of blood flow) is a common *cause* of necrosis (e.g., cerebral infarction), which often results in liquefactive necrosis in the CNS due to its high lipid content [1]. - While ischemia is the initiating event in many cases of liquefaction (especially stroke), the actual conversion of solid dead tissue into a liquid consistency requires the action of catabolic **enzymes**. *Pressure* - Pressure usually leads to generalized **atrophy** or localized **ischemia** (e.g., pressure sores or hydrocephalus), but it is not the fundamental molecular mechanism defining liquefactive necrosis. - Severe localized pressure that compromises microcirculation leads to ischemic injury, and the subsequent type of necrosis (liquefactive or coagulative) depends on the affected organ. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1268-1269.

Q: A newborn presents with jaundice, conjugated hyperbilirubinemia, intrahepatic cholestasis, and elevated alkaline phosphatase. Liver biopsy reveals eosinophilic, PAS-positive cytoplasmic granules in hepatocytes. What is the most likely diagnosis?

Neonatal hepatitis. ***Neonatal hepatitis***- **Neonatal hepatitis** is a broad term encompassing various causes of **intrahepatic cholestasis** in infants, including viral infections and metabolic disorders like **Alpha 1 AT deficiency**.- The presence of eosinophilic, **PAS-positive cytoplasmic granules** in the liver biopsy is virtually pathognomonic for **Alpha 1 AT deficiency**, which is a leading identifiable cause grouped under this overall diagnosis.*Hypoplasia of the biliary tract*- This refers to a reduction or paucity of bile ducts (e.g., in **Alagille syndrome**) leading to cholestasis, but it is less common than other causes of intrahepatic cholestasis.- While it causes conjugated hyperbilirubinemia, the damage pattern is primarily related to duct paucity rather than the specific hepatocyte injury and granule accumulation of **A1AT deficiency**.*Choledochal cyst*- A **choledochal cyst** is an extrahepatic cause of cholestasis resulting from obstruction and dilatation of the **common bile duct**.- It typically presents with extrahepatic obstruction, and while it causes conjugated hyperbilirubinemia, it would not explain the classic **intrahepatic cellular findings** (PAS-positive granules) seen with A1AT deficiency.*Physiological*- **Physiological jaundice** is caused by the inability of the immature liver to process bilirubin, resulting exclusively in **unconjugated hyperbilirubinemia**.- Since this neonate presents with **conjugated hyperbilirubinemia**, physiological jaundice is excluded, as this finding always mandates immediate investigation for underlying pathology (**cholestasis**).

Question 1

Acute hemolytic blood transfusion reactions are mediated by which type of hypersensitivity reaction?

Accepted Answer

Type II

Answer

Type I

Answer

Type III

Answer

Type IV

Question 2

A 58-year-old male with history of multiple sexual partners presented with anorexia and jaundice. The biopsy shows ground-glass opacity in the cells. What is the most probable diagnosis?

Accepted Answer

Hepatitis B

Answer

Hepatitis D

Answer

Hepatitis A

Answer

Hepatitis C

Question 3

A diabetic male presented with seizures. Radiological examination shows a lesion. Histopathological examination shows liquefactive necrosis. What is the most important mechanism responsible for this?

Accepted Answer

Enzymatic degradation

Answer

Ischemic

Answer

Mechanical

Answer

Pressure

Question 4

A newborn presents with jaundice, conjugated hyperbilirubinemia, intrahepatic cholestasis, and elevated alkaline phosphatase. Liver biopsy reveals eosinophilic, PAS-positive cytoplasmic granules in hepatocytes. What is the most likely diagnosis?

Accepted Answer

Neonatal hepatitis

Answer

Physiological

Answer

Hypoplasia of the biliary tract

Answer

Choledochal cyst

FMGE 2025 — Pathology