Block 14 GI Pathology Hepatitis Radiology
CTL Week 8 - Radiology of the GI system
CTL Week 8 - Miscellaneous GI pathology
CTL Week 8 - Hepatitis
Questions and Answers
- 1.
This 69 year old female presents with a mass in her abdomen. The most likely diagnosis is:
- A.
Adenocarcinoma of the colon.
- B.
Large bowel obstruction.
- C.
Hemorrhagic ovarian cyst.
- D.
Ventral hernia.
Correct Answer
D. Ventral hernia.Explanation
The most likely diagnosis in this case is a ventral hernia. A ventral hernia occurs when there is a weakness or defect in the abdominal wall, allowing abdominal contents to protrude through. This can result in the appearance of a mass in the abdomen. Adenocarcinoma of the colon and large bowel obstruction typically present with symptoms such as changes in bowel habits, abdominal pain, and weight loss. A hemorrhagic ovarian cyst may cause pelvic pain and abnormal bleeding, but it is less likely to present as a mass in the abdomen. Therefore, based on the information given, a ventral hernia is the most likely diagnosis.Rate this question:
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- 2.
A 60 year old male who has a long history of esophageal reflux disease presents with the complaint of gradually worsening dysphagia to solid foods and not liquids. He denies anorexia or weight loss. Which of the following (may be more than one) would one expect to find on his barium esophagogram (barium swallow)?
- A.
A
- B.
B
- C.
C
- D.
D
- E.
E
Correct Answer(s)
A. A
B. B
E. E -
- 3.
A two-and-a-half-week-old male infant presents with persistent projectile vomiting and regurgitation. What is the most likely cause of this clinical presentation?
- A.
Diaphragmatic hernia
- B.
Pyloric stenosis
- C.
Esophageal atresia
- D.
Esophageal rings
- E.
Gastric heterotopia in the duodenum
Correct Answer
B. Pyloric stenosisExplanation
The most likely cause of the infant's persistent projectile vomiting and regurgitation is pyloric stenosis. Pyloric stenosis is a condition in which the muscle between the stomach and small intestine (pylorus) becomes thickened, leading to narrowing of the passage and preventing food from passing through easily. This can result in forceful vomiting and regurgitation of food. The age of the infant is also consistent with pyloric stenosis, as it typically presents in the first few weeks of life.Rate this question:
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- 4.
A 28 year old Caucasian woman complains of abdominal pain, weight loss, and diarrhea. Physical examination reveals a pale thin woman with orthostatic hypotension. Laboratory data is significant for an elevated erythrocyte sedimentation rate. A colonoscopy and biopsy are done. A biopsy from the ileum shows segmental transmural granulomatous inflammation with mucosal ulcerations, fissures and fistulas. Which of the following is the most likely diagnosis?
- A.
Ulcerative Colitis
- B.
Diverticulitis
- C.
Crohn Disease
- D.
Diverticulosis
- E.
Famililial polyposis
Correct Answer
C. Crohn DiseaseExplanation
The patient's symptoms of abdominal pain, weight loss, and diarrhea, along with the physical examination findings of a pale thin woman with orthostatic hypotension, suggest a chronic inflammatory condition. The elevated erythrocyte sedimentation rate further supports an inflammatory process. The biopsy findings of segmental transmural granulomatous inflammation with mucosal ulcerations, fissures, and fistulas are characteristic of Crohn's disease, a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract. Ulcerative colitis typically presents with continuous inflammation limited to the colon, diverticulitis is inflammation of the diverticula in the colon, diverticulosis is the presence of diverticula without inflammation, and familial polyposis is a hereditary condition characterized by the development of multiple polyps in the colon.Rate this question:
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- 5.
A 50 year old man complains of diarrhea, weight loss, anorexia, and abdominal pain. His stool is extremely malodorous and greasy. Physical exam reveals a pale thin man with petechiae. His red blood cell count hemoglobin and hematocrit are decreased. Which of the following is the most likely cause of his condition?
- A.
Pancreatic insufficiency
- B.
Iatrogenic
- C.
Infectious
- D.
Lymphatic obstruction
Correct Answer
A. Pancreatic insufficiencyExplanation
The patient's symptoms and physical exam findings are consistent with malabsorption syndrome, which can be caused by pancreatic insufficiency. Pancreatic insufficiency results in inadequate production of digestive enzymes, leading to impaired absorption of nutrients, particularly fats. The malodorous and greasy stool is indicative of steatorrhea, which occurs when there is excessive fat in the stool due to poor fat absorption. The decreased red blood cell count, hemoglobin, and hematocrit suggest anemia, which can result from malabsorption of iron and other nutrients. Overall, these findings point towards pancreatic insufficiency as the most likely cause of the patient's condition.Rate this question:
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- 6.
A 66-year-old female presents to the clinic with watery, non-bloody diarrhea. History revealed that she had recently been discharged from hospital following a respiratory tract infection. On physical examination she was found to have mild abdominal tenderness. Investigations indicated no pathogens in the stool but colonoscopy indicated pseudomembranous colitis. Which of the following is most likely to be the cause of her diarrhea?
- A.
Irritable bowel syndrome
- B.
Clostridium difficile
- C.
Celiac disease
- D.
Colorectal carcinoma
- E.
Clostridium botulinum
Correct Answer
B. Clostridium difficileExplanation
The most likely cause of the patient's diarrhea is Clostridium difficile infection. This is suggested by the presence of pseudomembranous colitis, which is a characteristic finding in C. difficile infection. The patient's recent hospitalization and respiratory tract infection are also risk factors for acquiring C. difficile. Irritable bowel syndrome, celiac disease, colorectal carcinoma, and Clostridium botulinum are less likely causes of her symptoms.Rate this question:
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- 7.
A 25-year-old male complains of recurrent bouts of diarrhoea with crampy abdominal pain, irregular fever, and loss of weight. On examination you found the patient is underweight, anemic and has a tender mass with an ill-defined margin at the lower right abdomen. A small bowel enema showed a narrow irregular lumen of the small bowel. What is the provisional diagnosis?
- A.
Mesenteric embolism
- B.
Ulcerative colitis
- C.
Crohn’s disease
- D.
Carcinoid syndrome
- E.
Peutz Jeghers syndrome
Correct Answer
C. Crohn’s diseaseExplanation
The provisional diagnosis for this patient is Crohn's disease. Crohn's disease is a chronic inflammatory condition that can affect any part of the gastrointestinal tract, but most commonly involves the small intestine and colon. The patient's symptoms of recurrent bouts of diarrhea, crampy abdominal pain, irregular fever, and weight loss are characteristic of Crohn's disease. The tender mass with an ill-defined margin at the lower right abdomen and the narrow irregular lumen of the small bowel seen on small bowel enema are also consistent with Crohn's disease.Rate this question:
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- 8.
A 28 year old white male presents to his primary care doctor with complaints of fever, headache, abdominal pain, and intermittent loose stools after traveling to Guatemala. On physical exam he is noted to have hepatomegaly, splenomegaly, and flat “rose spots” on his chest and abdomen. The most likely agent causing his symptoms and physical findings would be
- A.
Entamoeba hystolitica
- B.
Vibrio cholera
- C.
Shigella
- D.
Salmonella typhi
- E.
Entero-hemorrhagic E coli (EHEC) O157:H7
Correct Answer
D. Salmonella typHiExplanation
The most likely agent causing the patient's symptoms and physical findings is Salmonella typhi. This is indicated by the patient's travel history to Guatemala, as well as the presence of hepatomegaly, splenomegaly, and flat "rose spots" on his chest and abdomen. Salmonella typhi is the causative agent of typhoid fever, which is characterized by fever, headache, abdominal pain, and gastrointestinal symptoms such as loose stools. Additionally, hepatomegaly and splenomegaly are common findings in typhoid fever, and the presence of rose spots is a classic sign of the disease.Rate this question:
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- 9.
This liver biopsy was most likely taken from a patient with:
- A.
Hemachromatosis
- B.
Wilson’s disease
- C.
Alpha-1 anti-trypsin disease
- D.
Cirrhosis
- E.
Amebiasis
Correct Answer
D. CirrhosisExplanation
The liver biopsy is most likely taken from a patient with cirrhosis. Cirrhosis is a condition characterized by the scarring and damage of liver tissue, leading to impaired liver function. This can be caused by various factors such as chronic alcohol abuse, viral hepatitis, or autoimmune diseases. A liver biopsy is often performed to confirm the diagnosis of cirrhosis by examining the extent of liver damage and the presence of scar tissue. Hemachromatosis, Wilson's disease, Alpha-1 anti-trypsin disease, and amebiasis are all conditions that can affect the liver, but they are less likely to be associated with the specific findings seen in this liver biopsy.Rate this question:
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- 10.
Which of the following is the most likely cause of the pathology shown in the gross and microscopic images?
- A.
Viral or bacterial infections
- B.
Furosemide or estrogens
- C.
Hyperlipidemia or hypercalcemia
- D.
Thrombosis and ischemia
- E.
Alcohol or biliary tract disease
Correct Answer
E. Alcohol or biliary tract diseaseExplanation
The most likely cause of the pathology shown in the gross and microscopic images is alcohol or biliary tract disease. This is because alcohol abuse can lead to liver damage, which can be seen in the images. Biliary tract disease, such as cholelithiasis or cholecystitis, can also cause similar changes in the liver. Both alcohol and biliary tract disease can result in inflammation, fatty infiltration, and fibrosis of the liver, which are consistent with the findings in the images.Rate this question:
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- 11.
An autopsy is performed on a 75 chronic alcoholic year old man with jaundice, icteric sclera, ascites, peri-umbilical caput medusa, and spider angiomas. Which of the following circulatory disorders is the most likely involved in this diagnosis? (See Attached colored images)
- A.
Impaired hepatic blood inflow
- B.
Impaired intrahepatic blood flow
- C.
Impaired hepatic blood outflow
- D.
Portal vein obstruction
Correct Answer
B. Impaired intrahepatic blood flowExplanation
The given symptoms of jaundice, icteric sclera, ascites, peri-umbilical caput medusa, and spider angiomas are indicative of liver dysfunction. Impaired intrahepatic blood flow is the most likely circulatory disorder involved in this diagnosis because it suggests a problem within the liver itself, such as liver cirrhosis or hepatitis. This can lead to congestion and obstruction of blood flow within the liver, causing the symptoms observed in the patient.Rate this question:
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- 12.
Postmortem examination of a 56-year-old female reveals liver changes shown for you evaluation (Trichrom stain). Investigation of the laboratory data from patient’s case reveals markedly elevated serum levels of total and direct bilirubin, alkaline phosphatase, gamma-glutamyl transpeptidase and antimitochondrial antibodies. Which of the following is the most likely diagnosis?
- A.
Primary biliary cirrhosis
- B.
Secondary biliary cirrhosis
- C.
Primary sclerosing cholangitis
- D.
Wilson disease
Correct Answer
A. Primary biliary cirrhosisExplanation
The postmortem examination of the liver revealed changes consistent with Primary biliary cirrhosis. This diagnosis is supported by the markedly elevated serum levels of total and direct bilirubin, alkaline phosphatase, gamma-glutamyl transpeptidase, and antimitochondrial antibodies. Primary biliary cirrhosis is an autoimmune disease that affects the bile ducts in the liver, leading to inflammation, scarring, and ultimately cirrhosis.Rate this question:
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- 13.
A 31-year-old primigravida gives birth at term following an uncomplicated pregnancy to a male infant with no apparent congenital anomalies. At 4 weeks of age the infant begins to exhibit forceful vomiting after each meal. The infant had been fine previously and gaining weight normally. Which of the following conditions is the probable cause for his vomiting?
- A.
Congenital duodenal atresia
- B.
Pyloric stenosis
- C.
Tracheo-esophageal fistula
- D.
Mallory-Weiss syndrome
Correct Answer
B. Pyloric stenosisExplanation
Pyloric stenosis is the probable cause for the infant's forceful vomiting after each meal. Pyloric stenosis is a condition characterized by the narrowing of the pylorus, the opening between the stomach and the small intestine. This narrowing prevents food from passing through easily, resulting in forceful vomiting. The onset of symptoms at 4 weeks of age is consistent with pyloric stenosis, as symptoms typically appear within the first few weeks of life. Congenital duodenal atresia, tracheo-esophageal fistula, and Mallory-Weiss syndrome are not typically associated with forceful vomiting in infancy.Rate this question:
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- 14.
A 44 year old obese patient presents with fever, pain in the right hypochondrium and nausea. His stool is normal in color. On examination he looks ill and is jaundiced with right upper quadrant tenderness and no splenomegaly. Lab data: Hb 14 gm, PCV 42, WBC 12,000, platelet count 150,000 red cells are normochromic normoctytic with normal morphorology. There is an increased direct and indirect bilirubin, a marked increase in his transaminases (AST and ALT) and a moderated increase in his alkaline phosphatase. What is the most likely diagnosis?
- A.
Viral hepatitis
- B.
Gallstones
- C.
Hereditary spherocytosis
- D.
Dubin Johnson syndrome
- E.
Gilbert’s syndrome
Correct Answer
A. Viral hepatitisExplanation
The patient's symptoms, such as fever, pain in the right hypochondrium, and jaundice, along with the laboratory findings of increased bilirubin and transaminases, suggest liver inflammation and dysfunction. These are characteristic features of viral hepatitis, which is an infection of the liver caused by a virus. The other options, such as gallstones, hereditary spherocytosis, Dubin Johnson syndrome, and Gilbert's syndrome, do not typically present with the same combination of symptoms and laboratory findings as seen in this patient.Rate this question:
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- 15.
A 28 year old thin, male accountant presents with jaundice and pale stools dark urine and intermittent right upper quadrant abdominal pain. On examination his sclera are icteric and he has splenomegaly. Labs Hb 12 gm/dl, film shows spherocytes with increased osmotic fragility. He has a marked increase in his alkaline phosphatase and a moderate increase in his transaminases (ALS and AST). His direct bilirubin is more markedly increased than his indirect. What is the most likely diagnosis:
- A.
Cirrhosis
- B.
Acute hepatitis
- C.
Leptospirosis
- D.
Gallstones
- E.
Hepatocellular carcinoma
Correct Answer
D. GallstonesExplanation
The patient's presentation of jaundice, pale stools, dark urine, and intermittent right upper quadrant abdominal pain, along with the finding of icteric sclera and splenomegaly, suggests a biliary obstruction. The increased osmotic fragility of spherocytes seen on the film indicates hemolysis. The marked increase in alkaline phosphatase and moderate increase in transaminases suggest biliary obstruction rather than hepatocellular injury. The more marked increase in direct bilirubin compared to indirect bilirubin further supports the diagnosis of biliary obstruction. Therefore, the most likely diagnosis is gallstones.Rate this question:
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- 16.
In the above patient what is the most likely etiology of this disorder?
- A.
Increased cholesterol secretion in the gall bladder
- B.
Increased pigment deposition in the gall bladder
- C.
Bacterial infection
- D.
Viral infection
Correct Answer
B. Increased pigment deposition in the gall bladderExplanation
The most likely etiology of the disorder in this patient is increased pigment deposition in the gall bladder. This is indicated by the presence of excess pigment in the gall bladder, which can lead to the formation of gallstones. Increased cholesterol secretion in the gall bladder may also contribute to gallstone formation, but it is not the most likely cause in this case. Bacterial and viral infections are less likely to be the etiology of the disorder in this patient.Rate this question:
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- 17.
A 29 year-old female developed right upper quadrant pain, nausea, and fever. Two days later she noted yellow eyes and brown urine. She was an unemployed single mother who didn’t drink alcohol or use IV drugs but admitted to having a boyfriend who used IV drugs. A blood test was positive for HBsAg. What is true about other blood tests?
- A.
If virus is replicating in severe disease, HBV DNA will be positive and HBeAg will be negative.
- B.
After resolution of illness 2 months later, HBsAg remains positive and IgG antibody to HBsAg rises.
- C.
If she develops chronic hepatitis, HBsAg remains positive and IgG antibody to HBCAg is negative.
- D.
After onset of acute infection, IgM antibody to HBCAg rises before IgM antibody to HBsAg.
Correct Answer
D. After onset of acute infection, IgM antibody to HBCAg rises before IgM antibody to HBsAg. -
- 18.
Which graph best exemplifies the case of a resolved, acute hepatitis B infection?
- A.
![Block 14 GI Pathology Hepatitis Radiology - Quiz]()
- B.
![Block 14 GI Pathology Hepatitis Radiology - Quiz]()
- C.
![Block 14 GI Pathology Hepatitis Radiology - Quiz]()
- D.
![Block 14 GI Pathology Hepatitis Radiology - Quiz]()
Correct Answer
C. -
- 19.
Using the graph below depicting the progression of a hepatitis A infection, around which week is the IgM titer most likely to peak?
- A.
4
- B.
6
- C.
8
- D.
10
- E.
12
Correct Answer
B. 6Explanation
Based on the graph, the IgM titer is likely to peak around week 6. This is because the graph shows a steady increase in the IgM titer from week 4 to week 6, after which it starts to decline. Therefore, week 6 is the most likely time for the IgM titer to reach its highest point before decreasing.Rate this question:
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- 20.
Your patient is a 20-year old man who presents with extreme fatigue and malaise with upper abdominal tenderness. There is no evidence of icterus and there are no other physical signs of disease. The patient feels he might have the flu. Upon questioning, the patient admits to having coffee colored urine and creamy colored stools. The patient has no tattoos and has no evidence of IVDA and in fact he denies being upon any medications whatsoever. He lives with his parents and shares many of his meals with them (but he does enjoy oysters, which the parents don’t eat) and they are currently healthy. He does have a girlfriend whom he has unprotected sex with, and he has been in this relationship for three years (He is concerned about her fidelity though). What is your most likely prognosis for this patient?
- A.
He stands about an 80% chance of the condition becoming chronic
- B.
He will recover without any treatment
- C.
He stands about a 5% chance of the disease becoming chronic
- D.
You think he may be overdosing on acetaminophen and he is likely to continue this way unless you intervene
Correct Answer
B. He will recover without any treatmentExplanation
Based on the information provided, the patient's symptoms of extreme fatigue, malaise, coffee-colored urine, and creamy-colored stools are consistent with acute viral hepatitis. The absence of icterus and other physical signs of disease suggests that the condition is in its early stages. Additionally, the patient's denial of medication use and lack of evidence for IV drug abuse make other causes less likely. The fact that the patient's parents are currently healthy suggests that the infection is not due to a common source of contaminated food or water. Therefore, the most likely prognosis for this patient is that he will recover without any treatment.Rate this question:
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- 21.
A 36-year-old male IV drug user developed fever, right upper quadrant pain, and jaundice. What features of hepatitis B virus (HBV) and hepatitis C virus (HCV) help to distinguish them from each other?
- A.
HCV is more likely than HBV to cause symptomatic hepatitis
- B.
HBV is more readily transmitted by sexual intercourse than is HCV
- C.
HBV is more likely than HCV to cause chronic life-long infection
- D.
HCV is more readily passed from mother to child at birth than is HBV
Correct Answer
B. HBV is more readily transmitted by sexual intercourse than is HCVExplanation
HBV is more readily transmitted by sexual intercourse than HCV. This is because HBV is primarily transmitted through contact with infected blood, semen, or other body fluids, while HCV is mainly transmitted through contact with infected blood. Sexual intercourse is a common mode of transmission for HBV, while it is less common for HCV.Rate this question:
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- 22.
Histologic examination of the liver biopsy obtained from a 45-year-old man with long history of alcohol abuse reveals preserved tissue architecture, prominent interlobular fibrous septa, moderate mononuclear infiltration of the portal tracts and adjacent lobular parenchyma, and minimal necrotic changes of the hepatocytes. Which of the following is the most likely diagnosis?
- A.
Acute hepatitis
- B.
Chronic hepatitis
- C.
Liver cirrhosis
- D.
Hepatic steatosis
Correct Answer
B. Chronic hepatitisExplanation
The histologic examination findings of preserved tissue architecture, prominent interlobular fibrous septa, moderate mononuclear infiltration, and minimal necrotic changes of the hepatocytes are consistent with chronic hepatitis. Acute hepatitis usually presents with more severe necrotic changes and less fibrosis. Liver cirrhosis typically shows extensive fibrosis and architectural distortion. Hepatic steatosis is characterized by fat accumulation in hepatocytes, which is not mentioned in the histologic findings. Therefore, chronic hepatitis is the most likely diagnosis based on the given information.Rate this question:
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.JPG "This 69 year old female presents with a mass in her abdomen.
The most likely diagnosis is:")
.JPG "A 60 year old male who has a long history of esophageal reflux disease presents with the complaint of gradually worsening dysphagia to solid foods and not liquids. He denies anorexia or weight loss. Which of the following (may be more than one) would one expect to find on his barium esophagogram (barium swallow)?")
.JPG "This liver biopsy was most likely taken from a patient with:")
.JPG "Which of the following is the most likely cause of the pathology shown in the gross and microscopic images?")
.JPG "An autopsy is performed on a 75 chronic alcoholic year old man with jaundice, icteric sclera, ascites, peri-umbilical caput medusa, and spider angiomas. Which of the following circulatory disorders is the most likely involved in this diagnosis? (See Attached colored images)")
.JPG "Postmortem examination of a 56-year-old female reveals liver changes shown for you evaluation (Trichrom stain). Investigation of the laboratory data from patient’s case reveals markedly elevated serum levels of total and direct bilirubin, alkaline phosphatase, gamma-glutamyl transpeptidase and antimitochondrial antibodies.
Which of the following is the most likely diagnosis?")
.JPG)
.JPG)
.JPG)
.JPG)
.JPG "Using the graph below depicting the progression of a hepatitis A infection, around which week is the IgM titer most likely to peak?")
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Mar 21, 2023Quiz Edited by
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