PA24.1-9 | Hepatobiliary System — Practice Quiz

A 19-year-old male presents with mild jaundice noted during a viral illness. His total bilirubin is 3.2 mg/dL, direct bilirubin 0.4 mg/dL, liver enzymes normal, haemoglobin 14.8 g/dL, and reticulocyte count 1.1%. He has had similar episodes with fasting and stress. Which is the MOST likely diagnosis?

A 55-year-old man with known gallstones presents with progressive jaundice, pale stools, and dark urine for 3 weeks. Investigations show: total bilirubin 14 mg/dL, direct bilirubin 11 mg/dL, ALP 680 U/L, GGT 520 U/L, ALT 60 U/L. Which type of jaundice does this pattern represent?

A 32-year-old woman presents with 2 weeks of fatigue, anorexia, right upper quadrant discomfort, and jaundice. Serology: HBsAg +, anti-HBs −, HBeAg +, anti-HBe −, anti-HBc IgM +, anti-HCV −. What is the MOST accurate interpretation?

A 48-year-old man with a 20-year history of daily alcohol use presents with anorexia, jaundice, fever, and tender hepatomegaly. Liver biopsy shows hepatocyte ballooning with intracytoplasmic eosinophilic inclusions, neutrophilic infiltration, and centrilobular necrosis. Which histological finding is MOST specific for the diagnosis?

A 40-year-old woman is found to have asymptomatic elevation of liver enzymes. Investigations: ALT 280 U/L, AST 310 U/L, ALP 90 U/L (normal), total bilirubin 1.8 mg/dL, HBsAg −, anti-HCV +, HCV RNA +, HCV genotype 1. Liver biopsy shows portal lymphoid aggregates, bile duct damage, and periportal fibrosis with bridging. What is the MOST likely diagnosis?

A 26-year-old nurse accidentally ingests a large dose of paracetamol (acetaminophen) with alcohol. After 24 hours of nausea and vomiting, she develops right upper quadrant pain. On day 3, ALT is 4,800 U/L, PT is prolonged, and she develops encephalopathy. Liver biopsy would MOST likely show which pattern of necrosis?

A 58-year-old chronic alcoholic with established cirrhosis develops worsening confusion, asterixis (flapping tremor), and fetor hepaticus. His serum ammonia is 140 µmol/L. Which mechanism BEST explains his neurological deterioration?

A 50-year-old man with alcohol-related cirrhosis presents with haematemesis. Upper GI endoscopy reveals large oesophageal varices with active bleeding. What is the PRIMARY pathophysiological basis of variceal formation in this patient?

A 65-year-old man from sub-Saharan Africa with known chronic hepatitis B presents with a 3-month history of weight loss, right hypochondrial pain, and a palpable liver mass. AFP is 1,200 ng/mL. CT shows a solitary 6 cm hepatic mass with arterial enhancement and venous washout, with portal vein tumour thrombus. Which of the following features is MOST characteristic of this tumour?

A 45-year-old obese woman with type 2 diabetes presents with recurrent right upper quadrant colicky pain radiating to the right shoulder, worse after fatty meals. Ultrasound shows multiple echogenic foci with posterior acoustic shadowing in the gallbladder. Which type of gallstone is MOST likely, and what is the pathogenic mechanism?

A liver biopsy from a 52-year-old man with end-stage liver disease shows regenerative nodules of varying size (3–10 mm), some exceeding 3 mm, separated by broad fibrous septa. What type of cirrhosis does this morphological pattern represent, and which aetiology is MOST commonly associated?

A 60-year-old man with alcohol-related cirrhosis presents with increasing abdominal distension for 4 weeks. Examination reveals a fluid thrill and shifting dullness. Serum albumin is 2.4 g/dL. Which combination of mechanisms BEST explains ascites formation in cirrhosis?

A 38-year-old woman presents with acute-onset right upper quadrant pain, fever (38.9°C), and jaundice (Charcot's triad). She had an elective cholecystectomy 3 years ago. Ultrasound shows a dilated common bile duct (12 mm) with a hyperechoic shadow. Which complication of gallstone disease is MOST likely?

A 55-year-old man with alcoholic cirrhosis develops haematemesis. His prothrombin time is 22 seconds (control 12 s) and platelet count is 62,000/µL. He is managed with vitamin K but his PT fails to correct. Which mechanism BEST explains his coagulopathy?