Pathology

Question 1

Clinical findings of Primary biliary cholangitis

Answer 1

Middle-age women.
Pruritus before jaundice, fatigue, hepatosplenomegaly, and xanthomatous lesions in eyelids, skin and tendons
Cholestatic pattern of LFTs
Anti mitochondrial antibodies
Associated with other autoimmune conditions

Question 2

Interstitial pancreatitis macroscopic and microscopic findings

Answer 2

Grossly edematous macroscopically

Focal fat necrosis, calcium deposition and interstitisal edema microscopically

Question 3

Macroscopic findings of necrotizing (hemorrhagic) pancreatitis

Answer 3

Chalky-white areas of fat necrosis with black areas of hemorrhage

Question 4

Acute viral hepatitis (HAV) histologic findings

Answer 4

Hepatocyte necrosis: swelling and cytoplasmatic emptying (ballooning degeneration)
Hepatocyte apoptosis: Shrinkage and nuclear eosinophilia (Councilman bodies)
Mononuclear infiltration

Question 5

Autoimmune hepatitis histologic findings

Answer 5

Immune response vs hepatic antigens: lymphoplasmacytic infiltration in portal and periportal regions.
Anti-smooth muscle antibodies

Question 6

Hepatitis B histologic findings

Answer 6

Ground-glass hepatocytes, central balloon degeneration, cytotoxic T cells mediated damage

Question 7

Histologic findings in nonalcoholic fatty liver disease

Answer 7

Lipid accumulation on cytoplasm and ballooning degeneration

Question 8

Alcoholic cirrhosis histological findings

Answer 8

Swollen and necrotic hepatocytes with neutrophilic infiltration (also seen in acetaminophen overdose). Mallory bodies. Hepatic steatosis

Question 9

Periductal “onion skin” fibrosis and luminal obliteration of biliary ducts. Associated with CUCI and p-ANCA +

Answer 9

Primary sclerosing cholangitis

Question 10

Medical findings of Sclerodermal esophageal dysmotility

Answer 10

Smooth muscle atrophy: fibrous replacement of muscularis in lower esophagus; acid reflux → Barrett esophagus. Part of CREST sx

Question 11

CREST syndrome

Answer 11

Calcinosis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly and Telangiectasia

Question 12

Immunologic response in HAV infection

Answer 12

CD8 lymphocytic and NK response

Question 13

Portal vein thrombosis clinical findings

Answer 13

Portal hypertension, splenomegaly, varicosities at portocaval anastomoses. No histologic changes to hepatic parenchyma

Question 14

Histological findings of Whipple disease.

Answer 14

Infection with Tropheryma whipplei.

PAS +, foamy macrophages in intestinal lamina propria, mesenteric nodes.

Question 15

Classical findings of Crohn disease.

Answer 15

Skip lesions in many portions of GI with rectal sparing.
Cobblestone mucosa, noncaseating granulomas, fistulas, erythema nodosum, bowel wall (muscularis) thickening. Risk of deficiency of vit B12 due malabsorption.

Question 16

Clinical difference between right and left sided colorectal cancer

Answer 16

Right side: cecal, ascending colon. Occult bleeding

Left side: rectosigmoid. Hematochezia and obstruction

Question 17

Diffuse gastric adenocarcinoma histological findings

Answer 17

Diffuse carcinoma infiltrates stomach wall: thickened and leathery (linitis plastica) and displays signet ring cells.

Question 18

From the colonic polyps, which one has the greatest risk of malignancy

Answer 18

Adenomatous polyps → villous

Serrated polyps

Question 19

Classical findings of Ulcerative Colitis

Answer 19

Continuous colonic lesions, rectal involvement, mucosal and submucosal inflammation, loss of haustra (lead pipe)
Th2 mediated, pANCA association
Toxic megacolon, perforation

Question 20

Most common neoplasia found in upper 2/3 portions of esophagus

Answer 20

Squamous cell carcinoma, that presents with keratin pearls and intercellular bridges

Question 21

Cause of formation of black gallstones

Answer 21

Supersaturation of bilirrubin

1. ↑ bilirrubin production (chronic hemolysis)
2. Altered enterohepatic circulation (ileal disease)

Question 22

Gilbert syndrome clinical characteristics

Answer 22

Mildly ↓ UDP-glucuronosyltransferase conjugation and impaired bilirrubin uptake.
Mild jaundice
Triggers: stress, illness, fasting, hemolysis, physical exertion
↑ unconjugated bilirrubin, normal liver function test

Question 23

Site of the stomach where H. pylori colonizes first

Answer 23

Gastric antrum

Question 24

Lab markers of biosynthetic capacity of the liver

Answer 24

Albumin and Prothrombin time

Question 25

Lab marker of transport and metabolic capacity of the liver

Answer 25

Bilirrubin

Question 26

Vitamin deficiency seen in cystic fibrosis that can lead to hemolytic anemia

Answer 26

Vitamin E

Question 27

Most common via fot liver metastasis

Answer 27

Portal circulation

Question 28

Classical findings of Hemochromatosis

Answer 28

AR. HFE hene. HLA-A3 association. ↑ intestinal absorption
Lab: ↑ ferritin, ↑ iron, transferrin saturation, ↓ TIBC
Bx: prussian blue stain
Cirrhosis, diabetes and skin pigmentation, arthropay, hypogonadism, HCC

Question 29

Difference betweeen Grade and Stage in tumors

Answer 29

Grade: degree of cellular differentiation and mitotic activity
Stage: degree of localization/spread based on site and size of 1° lesion, lymphatic spread and metastases. More prognostic value

Question 30

Difference between Curling ulcer and Cushing ulcer

Answer 30

Curling ulcer: due trauma/ischemia. Hypovolemia → muchosal ischemia
Cushing ulcer: due brain injury. ↑ vagal stimulation → ↑ ACh → ↑ H+ production

Question 31

Histological findings of focal nodular hyperplasia

Answer 31

Small, solitary pale nodules composed of cords of normal-appearing hepatocytes and central stellate scar with fibrous septate.

Question 32

Pathogenic factor for Shigellosis

Answer 32

Invasion of M cells (at Peyer patch through endocytosis

Question 33

Serum marker for Hepatocellular carcinoma

Answer 33

Alfa fetoprotein