A 48-year-old man presents with fatigue and slight malaise. Physical exammation is unremarkable except for slight tenderness in the upper right quadrant of his abdomen. Laboratory examination reveals mild elevation of the liver enzymes. He is followed over the next year and is found to have intermittent hyperbilirubinemia along with episodic elevations in his serum transaminase levels (AST and ALT). During these episodes the AST/ALT ratio is less than 1. A liver biopsy reveals chronic inflammation of U the portal triads that spills over into the hepatocytes and moderate fatty change of the hepatocytes. No hepatocytes with ground-glass cytoplasm are found. Which of the following viruses is the most likely cause of chronic hepatitis in this individual?
Hepatitis A virus
Hepatitis B virus
@Hepatitis C virus
Hepatitis D virus
Hepatitis E virus
#
During surgical operation a blood transfusion was made. The blood must be checked to find antigens of some disease. What disease is expected to be found?
Adenovirus
Enterovirus
Virus of hepatitis E
Virus of hepatitis A
@Virus of hepatitis B
#
The donor who had not donated the blood for a long time was examined with IFA method. Anti-HBs antibodies were revealed. What does positive result of IFA in this case mean?
Chronic hepatitis Ñ
Chronic hepatitis Â
Acute hepatitis B
@Previous hepatitis B
Acute hepatitis C
#
A 35-year-old man exhibits clinical symptoms of the virus hepatitis B. A puncture liver biopsy revealed: a destruction of the liver's beam architecture with polymorphism of hepatocytes and plural mitosis figures. Hepatocytes were enlarged, filled by vacuoles which contained a transparent liquid. What kind of a dystrophy is characteristic for the described case?
@Hydropic dystrophy
Fatty dystrophy
Hyalin dystrophy
Carbohydrate dystrophy
-
#
A patient being treated for viral hepatitis type B got symptoms of hepatic insufficiency. What blood changes indicative of protein metabolism disorder will be observed in this case?
Absolute hyperglobulinemia
@Absolute hypoalbuminemia
Absolute hyperfibrinogenemia
Absolute hyperalbuminemia
Proteinic blood composition is unchanged
#
A 27-year-old woman presents with headaches, muscle pain (myalgia), anorexia, nausea, and vomiting. She denies any history of drug or alkohol use, but upon further questioning she states that recently she has lost laste for coffee and cigarettes. Physical examination reveals a slight yellow discoloration of her scleras, while laboratory results indicate a serum bilirubin level of 1.8 mg/dL, and aminotransferases (AST and ALT) levels are increased. Which of the following is the most likely diagnosis?
Gilbert's syndrome
Chronic hepatitis
Amebic liver abscess
@Acute viral hepatitis
Acute hepatic failure
#
A 38 year old patient with full-blown jaundice, small cutaneous hemorrhages, general weakness and loss of appetite underwent puncture biopsy of liver. Histological examination revealed disseminated dystrophy, hepatocyte necrosis, Councilman's bodies. Lobule periphery has signs of significant infiltration by lymphocytes, there are also individual multinuclear hepatocytes. What is the most probable diagnosis?
Chronic hepatitis
@Acute viral hepatitis
Toxic degeneration of liver
Acute alcoholic hepatitis
Miliary hepatic cirrhosis
#
A mononuclear portal inflammatory infiltrate that disrupts the limiting plate and surrounds individual hepatocytes (piecemeal necrosis), as shown in the photomicrograph below, is characteristic of
ascending cholangitis
@chronic active hepatitis
acute alcoholic hepatitis
cholestatic jaundice
nutritional cirrhosis
#
A 49-year-old woman presents with increasing fatigue and is found in have elevated liver enzymes (AST and ALT). You follow her in your clinic ,ind find over the next 9 months that her liver enzymes have remained ele-vnieAll serologic tests for viral markers are within normal limits. A liver Inopsy reveals chronic inflammation in the portal triads that focally ilestroys the limiting plate and "spills over" into the adjacent hepatocytes. I'here are no granulomas present, and there is no evidence of fibrosis surrounding any of the bile ducts within the portal triads. Anti-smooth-muscle antibodies and antinudear antibodies are found in the patient's icrum. An LE cell test is positivWhich of the following is the most likely diagnosis?
@Autoimmune hepatitis
Chronic persistent hepatitis
Primary biliary cirrhosis
Primary sclerosing cholangitis
Systemic lupus erythematosus
#
A 52-year-old patient presented with fatigue, loss of appetite, muscle and joint aches, an increase in body temperature to 38°C. On the 7th day a patient exhibited a yellow color in the skin, urine and around the whites of the eyes and also an acute pain in right hypochondrium. A histological investigation of his liver biopsy revealed a destruction of the liver's beam architecture, vacuolar and ballooning dystrophies of hepatocytes, some cells were necrotic. The Councilman's bodies were also determined. On the periphery of lobes were registered the enlarged quantity of multinuclear hepatocytes. What form of virus hepatitis is most likely?
@Icteric hepatitis
Malignant hepatitis
Chronic hepatitis
Cholestatic hepatitis
Anicteric hepatitis
#
After consumption of rich food a patient has nausea and heartburn, steatorrhe A. This condition might be caused by:
Disturbed phospholipase synthesis
Increased lipase secretion
Amylase deficiency
@Bile acid deficiency
Disturbed tripsin synthesis
#
Because of present gallstone in the common bile duct, a patient has no bile excretion into duodenum. What disorder can it cause?
Carbohydrates digestion
Proteins absorption
Proteins digestion
Carbohydrates absorption
@Lipids digestion
#
A patient complains of frequent diarrheas, especially after consumption of fattening food, and of body weight loss. Laboratory examination revealed steatorrhea; hypocholic feces. What can be the cause of this condition?
Mucous membrane inflammation of small intestine
@Obturation of biliary tracts
Lack of pancreatic phospholipase
Lack of pancreatic lipase
Unbalanced diet
#
A patient with cholelithiasis fell ill with mechanic jaundice. Examination revealed that the stone was in the common bile duct. What bile-excreting ducts make up the obturated duct?
@Ductus hepaticus communis et ductus cysticus
Ductus hepaticus sinister et ductus cysticus
Ductus hepaticus dexter et ductus cysticus
Ductus hepaticus communis et ductus choledochus
Ductus hepaticus dexter et sinister
#
A 48 y.o. patient was admitted to the hospital with complaints about weakness, irritability, sleep disturbance. Objectively: skin and scleras are yellow. In blood: conjugated bilirubin, cholalemia. Feces are acholic. Urine is of dark colour (bilirubin). What jaundice is it?
@Mechanic
Gilbert's syndrome
Parenchymatous
Hemolytic
Crigler-Najjar syndrome
#
Which of the folowing cells found within the liver is the major source of the excess collagen deposited in cirrhosis?
Hepatocytes
Kupffer cells
@Ito cells
Endothelial cells
Bile duct epithelial cells
#
In chronically diseased liver some cells proliferate and acquire the feature of myofibroblasts with or without the lipid droplets. These cells are found close to the damaged hepatocytes and play a major role in development of fibrosis. What are these cells?
@Ito’s cells
Hepatocyte
Kupffer cells
Pit cells
Endothelium
#
A 55-yar-old man presents with increasing fatigue, weakness, anorexia and jaundice over the past several months. Physical examination finds mild ascites and gynecomastia. A liver biopsy reveals regenerative nodules of hepatocytes surrounded by fibrosis, as seen in the picture below. Which of the following is the source of the excess collagen deposited in these fibrotic bands?
Hepatocytes
Kuppfer cells
@Ito cells
Endothelial cells
Bile duct epithelial cells
#
A patient suffers from hepatic cirrhosis. Examination of which of the following substances excreted by urine can characterize the state of antitoxic function of liver?
Kreatinine
Uric acid
Ammonium salts
@Hippuric acid
Aminoacids
#
An autopsy of a 53-year old patient, with a history of a chronic alcoholism and repeated attacks of an alcoholic hepatitis, revealed a firm, yellow color liver with pointed edge. A liver surface was coarsely scarred with multiple fine knots on a cut surface. What is the most likely diagnosis?
@Cirrhosis of liver.
Cancer of liver.
Fatty dystrophy of liver.
Chronic hepatitis.
Acute hepatitis.
#
Analysis of a punction biopsy material of liver revealed hepatocyte dystrophy with necroses as well as sclerosis with disorder of beam and lobulous structure, with formation of pseudolobules and regenerative nodes. What is the most probable diagnosis:
Progressive massive liver necrosis
Chronic hepatosis
Acute hepatitis
@Liver cirrhosis
Chronic hepatitis
#
A microscopical investigation of a liver biopsy revealed a dystrophy, necroses of hepatocytes, a sclerosis, accompanied with destruction of a hepatic beam and a lobular structure, a formation of false lobes and regenerative nodes. What is the most likely diagnosis?
@Cirrhosis of liver
Chronic gepatoz
Chronic hepatitis
Massive diffuse necrosis of liver
Acute hepatitis
#
The liver biopsy is taken from the patient with symptoms of a parenchymatous icterus and a portal hypertension. Histological investigation revealed a fatty dystrophy of hepatocytes, a destruction of a hepatic beam and a lobular structure, a formation of false lobes and regenerative nodes. These were accompanied with a porto- portal fibrous septae formation and periportal lympho- macrophageal infiltrates. What is the most likely diagnosis?
@Cirrhosis of liver
Alcoholic hepatitis
Chronic hepatosis
Viral hepatitis
Toxic dystrophy
#
A patient with the symptoms of acute alcoholic poisoning was brought to the hospital. What carbohydrates metabolism changes are typical for this condition?
The anaerobic glucose metabolism predominates in muscles
The gluconeogenesis is increased in liver
The breakage of glycogen is increased in liver
@The gluconeogenesis velocity in liver is decreased
The anaerobic breakage of glucose is increased in muscles
#
A 45-year-old man presents with weight loss, steatorrhea, and mal absorption. A CT scan of the abdomen reveals a questionable mass in the head of the pancreas. A biopsy specimen microscopically reveals chronic inflammation and atrophy of the pancreatic acini with marked fibrosis. No malignancy is identifie. Which of the following is the most common cause of this disorder in adults?
Abdominal trauma
@Chronic alcoholism
Cystic fibrosis
Gallstones
Hyperlipidemia
#
An autopsy of a male, with a history of a chronic alcohol abuse, revealed a small, firm, micronodular liver. Histological investigation showed a fatty dystrophy of hepatocytes, a formation of small regenerative (false) nodes separated by fibrous septae with lympho- macrophageal infiltration. What is the most likely diagnosis?
@Alcoholic cirrhosis.
Chronic active alcoholic hepatitis.
Chronic persistent alcoholic hepatitis.
Toxic dystrophy of liver.
Fatty hepatosis.
#
On autopsy of the man with alcohol abuse for a long time it was revealed: dense, small-knobby, small size liver. Microscopically: small pseudo-lobules, divided with thin layers of connective tissue with lymphomacrophagial infiltrates; hepatocytes in the state of globular fatty dystrophy. What is the most likely diagnosis?
Toxic liver dystrophy
Chronic persistent alcohol hepatitis
Chronic active alcohol hepatitis
Fatty hepatosis
@Alcohol cirrhosis
#
At the section of a man, who had alcohol abuse for a long time, the liver was small, solid, micro tuberous. Microscopically: pseudo lobules were poky and were separated by thin strata of connective tissue with lymphomacrophagal infiltrates. Hepatocytes were at the stage of a giant-drop adiposal dystrophy. What is the most possible diagnosis?
@Alcoholic cirrhosis
Chronic active alcoholic hepatitis
Chronic persistent alcoholic hepatitis
Toxic dystrophy of the liver
Adiposal hepatosis
#
Finely nodular (micronodular) cirrhosis, as illustrated in the photomicrograph below, is seen in all the following conditions EXCEPT
@postnecrotic cirrhosis
secondary biliary cirrhosis
primary biliary cirrhosis
alcoholic cirrhosis
hemachromatosis
#
A 42-year-old male, with a history of rheumatic stenosis of the left atrioventricular orifice resulted in chronic heart insufficiency, presented at the hospital with dyspnea at small physical exercises, tachycardia, a cyanosis of his lips, bubbling rales in the inferior segments of lungs, leg's edema. What histological changes will be characteristic for a liver?
@Necrosis of hepatocytes in the center of lobule, fatty dystrophy on periphery
Necrosis of hepatocytes in the center of lobule, hyalin dystrophy on periphery
Necrosis of hepatocytes in the center of lobule, hydropic dystrophy on periphery
Fatty dystrophy of hepatocytes in the center of lobule, necrosis on periphery
Hydropic dystrophy of hepatocytes in the center of lobule, necrosis on periphery
#
An autopsy of a female, with a history of a rheumatic disease with a mitral stenosis, resulted in decompensation stage, revealed a general venous plethora, small, firm and micronodular liver. Gross investigation of a cut surface showed a lobular structure and yellowish-brown color of hepatic tissue. Define the most probable pathology diagnosed in a liver.
@Portal cirrhosis
Fatty dystrophy
Billiary cirrhosis
Postnecrotic cirrhosis
Atrophy
#
A 62-year old patient, with a history of chronic virus hepatitis, died of an acute posthemorrhagic anaemia resulted from an esophageal varicose veins bleeding. An autopsy revealed the reduced, dense liver with coarsely scarred surface. A microscopical investigation showed regenerative false nodules separated by fibrous tissue, contained the remnants of portal tracts. What morphogenetic type of cirrhosis took place in this case?
@Portal cirrhosis.
Postnekrotic cirrhosis.
Mixed cirrhosis.
Viral cirrhosis.
Biliary cirrhosis.
#
A patient with chronic viral hepatitis died of acute posthemorrhagic anaemia because of the haemorrhage from the varicous dilation of esophagus veins. At the section the liver is hardly diminished, of solid consistence; its surface is micro tuberous. Microscopically: thin-stitched net of connective tissue and small pseudo lobules. Name the morphogenetic type of cirrhosis.
Postnecrotic
@Portal
Mixed
Viral
Biliary
#
A patient complains of frequent diarrheas, especially after consumption of rich food, weight loss. Laboratory examination revealed steatorrhea; his feces were hypocholic. What might have caused such condition?
Unbalanced diet
@Obturation of biliary tracts
Lack of pancreatic lipase
Lack of pancreatic phospholipase
Inflammation of mucous membrane of small intestine
#
A 62-year old patient, with a history of a cholelithiasis accompanied with cholangitis and cholangiolitis, presented to the hospital liver cirrhosis. What is the most likely type of cirrhosis presented?
@Biliary
Infection
Toxins
Nutritional deficiency
Circulatory
#
Am 38-year-old woman complains of fatigue and pruritus. she is found to have high serum alkalaine phosphatase and slightly elevated serum bilirubin levels, and serum antimitochondrial antibodies are present. A liver biopsy reveals a marked lymphocytic infiltrate in the portal tracts along with occasional granulomas. The most likely diagnosis is
inpacted gallstone
@Primary biliary cirrosis
primary sclerosing cholangitis
von Meyenburg's complex
Caroli's disease
#
A patient presented to the hospital an ascites, twice enlarged spleen, a varicose esophagogastric veins and veins around and within the rectum. A histological investigation of liver biopsy revealed micronodular cirrhosis. What process has complicated cirrhosis?
@Portal hypertension
Cardiac insufficiency
Hepatotenal syndrome
Hepatic-cellular insufficiency
-
#
A 45-year-old male alcoholic with a history of portal hypertension presents with vomiting of blood (hematemesis) and hypotension. He denies any history of vomiting nonblood material or retching prior to vomiting blood. During work-up he dies suddenly. Which of the following histologic changes is most likely to be seen in a biopsy specimen taken from his esophagus?
Metaplastic columnar epithelium
Decreased ganglion cells in the myenteric plexus
@Dilated blood vessels in the submucosa
Mucosa outpouchings
Numerous intraepithelial neutrophils
#
A 62-year-old man with hepatic failure secondary to cirrhosis develops a pungent odor in his breath (fetor hepaticus). He is also noted to have marked ascites, gynecomastia, asterixis, and palmar erythema. His serum ammonia levels are found to be elevated. Which of the following is the basic defect that caused this patient's gynecomastia?
Decreased synthesis of albumin
Defective metabolism of the urea cycle
Deranged bilirubin metabolism
@Impaired estrogen metabolism
The formation of mercaptans in the gut
#
A 48-year-old man with fatigue is being evaluated for a 1-year history of elevated serum liver enzymes. A liver biopsy is taken and the pathology report of this specimen states there is grade 2 inflammatory activity with piecemeal necrosis and stage 1 fibrosis. The term "piecemeal necrosis" refers to which one of the following pathologic abnormalities?
Congo red-positive extracellular deposits surrounding necrotic hepatocytes in acinar zone 1
@Destruction of the limiting plate with necrosis of hepatocytes surrounding the portal triad
Fibrosis around the central hepatic veins with apoptosis of adjacent hepatocytes
Necrosis of hepatocytes extending from the portal area of one hepatic lobule to the central vein of an adjacent lobule
Random necrosis of individual or small clusters of hepatocytes in acinar zone 3
#
A 2-year-old girl is being evaluated for strikingly yellow skin and is found to have elevated serum levels of indirect bilirubin. After appropriate work-up the diagnosis of type II Crigler-Najjar syndrome is made. She is then treated with phenobarbital, which causes hyperplasia of the smooth endoplasmic reticulum in hepatocytes and decreases the serum indirect bilirubin levels. Which of the following enzymes is most likely to be deficient in this child?
Aspartate aminotransferase
@Bilirubin-UDP-glucuronyl transferase
Galactosylceramide beta-galactosidase
Gamma-glutarnyl transpeptidase
L-iduronosulfate sulfatase
#
A 44-year-old man presents with the sudden onset of severe right i quadrant (RUQ) abdominal pain, ascites, tender hepatomegaly, and hematemesis. These symptoms are suggestive of Budd-Chiari syndrom. Which of the following is the most likely cause of this disorder?
Obctruction of the common bile duct
Obctructionof the intrahepatic sinusoids
Thrombosis of the hepatic artery
@Thrombosis of the hepatic vein
Thrombosis of the portal vein
#
A full-term normal male infant develops a slight yellow color to li skin on his second day of life. Laboratory examination finds his serum bilirubin levels to be slightly elevated (due to increased indirect bilirubin), but the levels are less than 6 mg/dL. Additionally, serum hemoglobin levels are within normal limits. By the fifth day his bilirubin levels have returned to normal levels and the abnormal yellow skin color has disappeared. No therapy was given to this infant. Which of the following is the most likely cause of these signs and symptoms?
Crigler-Najjar syndrome
Hemolytic disease of the newbom
Inspissated bile syndrome
Inirauierine varicella infection
@Physiologic jaundice of the newbom
#
An autopsy is performed on a 19-year-old woman who died fruin oi overdose of acetaminophen. Which of the following hisiologic changes is most likely to be seen in a biopsy specimen taken from her liver?
@Centrilobular necrosis
Focal scattered necrosis
Geographic necrosis
Midzonal necrosis
Periponal necrosis
#
A 51-year-old male alcoholic with a history of chronic liver disease presents with increasing weight loss and ascites. Physical examination reveals a slightly enlarged, soft, nontender prostat. Examination of the scrotum is unremarkable, and fecal occult blood tests are negative. A chest X-ray is unremarkable, but a CT scan of the abdomen reveak a single mass in the left lobe of the liver. Work-up reveals elevated levels of a-fetoprotein in this patient's blood. Which of the following is the most likely diagnosis?
Angiosarcoma
Cholangiocarcinoma
Hepatoblastoma
@Hepatocellular carcinoma
Metastatic colon cancer
#
A 36-year-old man presents with jaundice and pruritus. Physical examination finds a diffuse yellow discoloration to his skin. Laboratory examination reveals markedly elevated serum levels of alkaline phosphatase, but neither antinuclear nor antimitochondrial antibodiesare present. A liver biopsy revealed reactive hepatocytes and fibrosis in the sinusoids. The portal tracts showed marked fibrosis around the bile ducts, but no granulomas were seen. While waiting for a liver transplant he developed a malignancy and dieWhich of the following tumors is most closely associated with his liver disease?
@Cholangiocarcinoma
Gallbladder carcinoma
Gastric carcinoma
Hepatoblastoma
Pancreatic carcinoma
#
A 26-year-old presents with right upper quadrant abdominal pain and is found to have a large cyst in the right lobe of his liver. X-rays reveal the cyst to have a calcified wall. The cyst is then surgically excised. Examination of this tissue histologically reveals a thick, acellular, laminated eosinophilic wall. The fluid within the cyst is found to be granular and contain numerous small larval capsules with scoleces ("brood capsules"). Which of the following is the most likely diagnosis?
Pyogenic liver abscess
Amebic liver abscess
@Hydatid cyst
Schistosomiasis
Oriental cholangiohepatitis
#
A 40-year-old man was admitted to the surgical department with spleen rupture. What anatomic formation will accumulate the blood?
@Bursa pregastrica
Right lateral canal
Hepatic bursa
Rectovesical excavation
Omental bursa
#
A 27-year-old man has purulent inflammation of gallblader. What region of the peritoneal cavity will the pus fall into if gallblader ruptures in his typical position?
@Into hepatic bursa
Into epiploic bursa
Into the superior duodenal sinus
Into the left lateral duct
Into pancreatic bursa
#
Obturative jaundice developed in a 60-year-old patient because of malignant tumour of the big papillary of the duodenal. Lumen of what anatomical structure is squeezed with tumour?
Left hepatic duct
Cystic duct
Right hepatic duct
Common hepatic duct
@Hepatopancreatic ampulla
#
A 54-year-old male alcoholic presents with the sudden onset of severe, constant epigastric pain that radiates to his midback. Further evaluation finds fever, steatorrhea, and discoloration around his flank and umbilicus. Laboratory tests find elevated seram levels of amylase and lipase.Which of the following is the most likely diagnosis?
Acute appendicitis
Acute cholangitis
Acute cholecystitis
Acute diverticulitis
@Acute pancreatitis
#
After clinical examination of the patient surgeon supposed an acute pancreatitis. What biochemical test can confirm this supposition?
@Activity of alpha-amylase in blood and urine
Activity of aminotraspherases in blood and urine
Activity of creatin phosphokinase in blood
Activity of alkaline phospatase in blood
Activity of lactate dehydrogenase 1 in blood
#
A 12-year-old nonobese boy presents for evaluation after becoming sick at school. Pertinent recent medical history includes weight loss with polyphagia, polydipsia, and polyuria. Laboratory examination finds hyperglycemia, while urinary examination reveals increased glucose and trace ketones. Which of the following abnormalities is most likely to be present in this boy?
Amyloid deposition in the pancreatic islets
Atrophy and destruction of the pancreatic acini
Decreased numbers of insulin receptors on adipocytes
@Lymphocytic infiltration in the pancreatic islets
Mutations in the gene that codes for hexokinase
#
A 48-year-old male alcoholic presents with malaise, fever, and mid abdominal pain that radiates to his back. Pertinent medical history includf-i repeated bouts of pancreatitis that mainly occur after times of binge drink ing. Physical examination finds a low-grade fever, and a mass is palpated in the epigastric area. An abdominal CT scan finds a fluid-filled mass in thr pancreas. This mass is removed at celiotomy and has a similar appearance to the cystic mass shown in the photograph below. It is filled with clear fluid, and histologic sections reveal a large cystic structure that lacks an epithelial lining. Which of the following is the most likely diagnosis?
Cylindroma
Hydrocystoma
@Pseudocyst
Pseudomyxoma
Syringoma
#
A 44-year-old woman presents with repeated episodes of feeling "light-headed" that are associated with sweating and a feeling like she is about to faint. She says that she feels better if she drinks some orange juice and eats a candy bar during one of these episodes. Physical examination is unremarkable, but laboratory examination finds decreased serum levels of glucose along with elevated levels of glucose along with elevated levels of insulin. The combination of hypoglycemia, symptoms of hypoglycemia, and symptoms of hypoglycemia relieved by glucose is the definition of which of the following clinical triads?
Beck's triad, as seen with acute tamponade
Charcot's triad, as seen with acute inflammation of the gallbladder
Marchiafava's triad, as seen with overwhelming sepsis
Virchow's triad, as seen with carcinoma of the exocrine pancreas
@Whipple's triad, as seen with a beta-cell tumor of the endocrine pancreas
#
Glomerulopathy
#
A 58-year-old patient with acute cardiac insufficiency has decreased volume of daily urine - oliguria. What is the mechanism of this phenomenon?