1. A 54-year-old man with long-standing alcohol-related liver disease develops progressive abdominal distension and signs of portal hypertension. Liver biopsy shows bridging fibrosis and regenerative nodules. In liver cirrhosis, which cells are the primary producers of collagen leading to fibrosis?
2. A 52-year-old man with long-standing liver cirrhosis develops bilateral breast enlargement and testicular atrophy. Laboratory evaluation suggests an altered estrogen-to-androgen ratio. What is the underlying cause of gynecomastia in male patients with liver cirrhosis?
3. The presence of spider angiomas (telangiectasias) on the skin of the upper body is indicative of:
4. A 58-year-old man with decompensated liver cirrhosis presents with progressive abdominal distension and shifting dullness. Diagnostic paracentesis reveals clear, straw-colored ascitic fluid. The protein concentration in ascitic fluid due to cirrhosis is typically:
5. A healthy medical student undergoes routine screening before clinical rotations. Hepatitis B serology shows no evidence of current or past infection, but there is a protective antibody present due to prior immunization. Which hepatitis B serological profile indicates immunity due to vaccination?
6. A liver biopsy from a patient with chronic hepatitis shows dense portal inflammatory infiltrates extending beyond the limiting plate into the adjacent periportal hepatocytes. This pattern indicates active ongoing hepatocyte injury at the portal-parenchymal interface. This histologic finding is called ;
7. A liver biopsy from a patient with chronic hepatitis B shows hepatocytes with finely granular, pale eosinophilic cytoplasm producing a characteristic “ground-glass” appearance on light microscopy. This appearance is caused by cytoplasmic accumulation of:
8. A patient from an endemic region presents with splenomegaly, abdominal distension, and features of chronic liver disease. Liver biopsy shows periportal “pipestem” fibrosis caused by deposition of parasite eggs in the portal tracts. This pattern of fibrosis most commonly leads to which complication:
9.A patient from a rural area presents with a slowly enlarging cystic lesion in the liver. Imaging suggests a well-defined cyst with internal septations, raising suspicion for a parasitic infection involving the larval stage of a tapeworm. Hydatid cyst disease of the liver is caused by the larval stage of which parasite?
10. A 50-year-old man presents with fatigue, abdominal discomfort, and pigmentation of the skin (“bronze colored”). He is found to have liver cirrhosis and newly diagnosed diabetes mellitus. Lab tests show a markedly elevated serum ferritin level. The combination of these findings is most characteristic of which metabolic disorder?
11. A 45-year-old man with a history of alcohol use presents with mild hepatomegaly. Liver biopsy shows intracellular fat accumulation in hepatocytes. In most cases of alcoholic and non-alcoholic fatty liver disease, hepatocellular steatosis begins in which region of the hepatic acinus ?
12. A 25-year-old otherwise healthy individual is found to have mild jaundice on routine examination. Laboratory tests show total bilirubin of 4.0 mg/dL with direct bilirubin of 0.8 mg/dL. Liver enzymes are normal. What is the most likely cause of this isolated unconjugated hyperbilirubinemia?
13. A 38-year-old patient presents with abdominal pain, hepatomegaly, and ascites. Imaging shows hepatic congestion with impaired venous drainage from the liver. A diagnosis of Budd–Chiari syndrome is considered. Budd–Chiari syndrome is caused by thrombotic occlusion of which vessel(s)?
14. A 35-year-old asymptomatic woman undergoes imaging for an unrelated reason, which reveals a solitary liver lesion. Resection shows a well-demarcated but unencapsulated nodule with a central gray-white depressed stellate scar. What is the most likely diagnosis?
15. A patient with chronic liver disease undergoes surveillance imaging, which reveals a suspicious hepatic mass. A serum tumor marker is ordered to aid in screening and diagnosis of hepatocellular carcinoma. Which serum tumor marker is most useful in this setting?
16. A patient presents with recurrent right upper quadrant pain. Imaging reveals gallstones. Analysis shows dark brown, soft stones. Brown pigment gallbladder stones are typically associated with which condition?
17. A patient is found to have multiple small, hard, black gallstones composed of calcium bilirubinate. Laboratory evaluation shows a persistently elevated reticulocyte count. Black pigment gallstones are most often associated with which condition?
