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Pathology of Biliary & Pancreatic Disorders - Quiz

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Pathology of Biliary & Pancreatic Disorders - Quiz

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  1. Pathology of Biliary & Pancreatic Disorders - Quiz Great wars & Great creationsstart first in human mind…!-- Thoughts are seeds with potential.

  2. 54y man with chornic intermittend right upper quadrant painnow presents with severe abdominal pain. Raised Bilirubin(direct), ALP, Amylase. Image abdominal CT. Diagnosis ?.1 2 3 4 57% 7%14%0%71%1. Acute Cholecystitis.2. Chronic Pancreatitis.3. Acute pancreatitis.4. Acute Hepatitis.5. Pancreatic carcinoma.1. Explain the clinical features? – acute, sudden over chronic.2. Explain the laboratory data? – Bil, ALP, Amylase (pancreatitis).3. What are possible risk factors? – smoking, alcoholism, diabetes, cholelithiasis.4. What is the pathogenesis? – activation of enzymes, inflammation, fat necrosis. 54y man with chornic intermittend right upper quadrant painnow presents with severe abdominal pain. Raised Bilirubin(direct), ALP, Amylase. Image abdominal CT. Diagnosis ?.1 2 3 4 57% 7%14%0%71%1. Acute Cholecystitis.2. Chronic Pancreatitis.3. Acute pancreatitis.4. Acute Hepatitis.5. Pancreatic carcinoma.1. Explain the clinical features? – acute, sudden over chronic.2. Explain the laboratory data? – Bil, ALP, Amylase (pancreatitis).3. What are possible risk factors? – smoking, alcoholism, diabetes, cholelithiasis.4. What is the pathogenesis? – activation of enzymes, inflammation, fat necrosis.

  3. 38y F, Obese, abdominal colicky pain, Gallbladder:? Type of stones1 2 3 4 575%19%0%0%6%A. Pure cholesterolB. Mixed cholesterol.C. PigmentD. CalciumE. Triple phosphate. 38y F, Obese, abdominal colicky pain, Gallbladder:? Type of stones1 2 3 4 575%19%0%0%6%A. Pure cholesterolB. Mixed cholesterol.C. PigmentD. CalciumE. Triple phosphate.

  4. 38y F, Obese, abdominal colicky pain, Gallbladder:? Type of stones1 2 3 4 50%71%0%0%29%A. Pure cholesterolB. Mixed cholesterol.C. PigmentD. CalciumE. Triple phosphate. 38y F, Obese, abdominal colicky pain, Gallbladder:? Type of stones1 2 3 4 50%71%0%0%29%A. Pure cholesterolB. Mixed cholesterol.C. PigmentD. CalciumE. Triple phosphate.

  5. A 45y mildly obese woman, 1-week history of upperabdominal pain, fever, shaking chills, and vomiting. P/Esevere right upper quadrant tenderness. Lab: serumbilirubin of 1.0 mg/dL, AST of 25 U/L, ALT of 35 U/L, ALP220 U/L (high), WBC of 14,000/µL, and amylase of 95 U/L(normal).Most likely diagnosis?1 2 3 4 587%0%13%0%0%1. Acute Cholecystitis2. Acute Pancreatitis3. Carcinoma pancreas4. Carcinoma Gall bladder5. Primary biliary cirrhosis. A 45y mildly obese woman, 1-week history of upperabdominal pain, fever, shaking chills, and vomiting. P/Esevere right upper quadrant tenderness. Lab: serumbilirubin of 1.0 mg/dL, AST of 25 U/L, ALT of 35 U/L, ALP220 U/L (high), WBC of 14,000/µL, and amylase of 95 U/L(normal).Most likely diagnosis?1 2 3 4 587%0%13%0%0%1. Acute Cholecystitis2. Acute Pancreatitis3. Carcinoma pancreas4. Carcinoma Gall bladder5. Primary biliary cirrhosis.

  6. 40y Black woman, indigestion, abdominal pain,Gallbladder: Most likely associated disease?1 2 3 4 517%0%72%6%6%1. Chronic Pancreatitis2. Diabetes mellitus3. Familial hypercholesterolemia4. Hyperparathyroidism5. Sickle cell disease 40y Black woman, indigestion, abdominal pain,Gallbladder: Most likely associated disease?1 2 3 4 517%0%72%6%6%1. Chronic Pancreatitis2. Diabetes mellitus3. Familial hypercholesterolemia4. Hyperparathyroidism5. Sickle cell disease

  7. 69y M, Massive GI bleeding, jaundice.Section of liver ? Pathogenesis1 2 3 4 525%19%0%6%50%1. Cholangiocarcinoma2. Hepatocellular carcinoma3. Metastatic carcinoma4. Liver abscesses5. Tuberculosis. 69y M, Massive GI bleeding, jaundice.Section of liver ? Pathogenesis1 2 3 4 525%19%0%6%50%1. Cholangiocarcinoma2. Hepatocellular carcinoma3. Metastatic carcinoma4. Liver abscesses5. Tuberculosis.

  8. 38y F, Obese, intermittent abdominal colicky painsince 2y, Gallbladder: ? DiagnosisA. B. C. D. E.14%43%0%0%43%A. AdenocarcinomaB. CholelithiasisC. CholecystitisD. CholesterosisE. Primary Biliary Cirrhosis. 38y F, Obese, intermittent abdominal colicky painsince 2y, Gallbladder: ? DiagnosisA. B. C. D. E.14%43%0%0%43%A. AdenocarcinomaB. CholelithiasisC. CholecystitisD. CholesterosisE. Primary Biliary Cirrhosis.

  9. A 21 year old man, abdominal pain, rigidity since 3 days.Serum Lipase raised but calcium normal. Image showsappearance of his pancreas. He had 4 similar attacks since8 years. ? Most likely Etiology.1 2 3 4 538%8% 8%38%8%1. Explain the clinical features? – acute, sudden recurrent.2. Explain the laboratory data? – Lipase, Calcium.3. What are possible risk factors? – Genetic AD Trypsin mutation (PRSS1),4. What is the pathogenesis? – uncontrolled activation of enzyme trypsin,1. Chronic Acoholism.2. Chronic Cholecystitis.3. Type 1 Diabetes.4. Genetic disorder.5. Unknown. A 21 year old man, abdominal pain, rigidity since 3 days.Serum Lipase raised but calcium normal. Image showsappearance of his pancreas. He had 4 similar attacks since8 years. ? Most likely Etiology.1 2 3 4 538%8% 8%38%8%1. Explain the clinical features? – acute, sudden recurrent.2. Explain the laboratory data? – Lipase, Calcium.3. What are possible risk factors? – Genetic AD Trypsin mutation (PRSS1),4. What is the pathogenesis? – uncontrolled activation of enzyme trypsin,1. Chronic Acoholism.2. Chronic Cholecystitis.3. Type 1 Diabetes.4. Genetic disorder.5. Unknown.

  10. . 69y Female, Chronic bronchitis. Died followingchronic pulmonary failure. Liver specimen.Likely diagnosis?1. Alcoholic Hepatitis2. Dubin-Johnson Syndrome3. Liver cirrhosis4. Passive congestion liver5. Primary Biliary cirrhosis

  11. . A 46 year old man, 8 year history of intermittent abdominalpain now presents with steatorrhoea. Image showsabdominal CT. ? Most likely Diagnosis.1 2 3 4 50% 0%47%37%16%1. Explain the clinical features? – chronic steatorrhoea - pancreas.2. What are possible risk factors? – alcohol, diabetes, cholelithiasis,3. What is the pathogenesis? pancreatitis  fat storage  steatorrhoea  fatty liver1. Fatty liver.2. Chronic Cholecystitis.3. Chronic pancreatitis4. Cholelithiasis & fatty liver.5. Both 1 & 3

  12. . 38y F, Obese, abdominal colicky pain, Gallbladder:Most likely metabolic abnormality?1 2 3 4 511%0%89%0%0%1.Decreased bilirubin conjugation.2.Decreased serum albumin.3.Increased bilirubin uptake4.Increased hepatic calcium secretion.5.Increased hepatic cholesterol secretion.

  13. . Complications of Cholelithiasis include all thefollowing EXCEPT:1 2 3 4 513%0%60%7%20%A. Secondary Biliary CirrhosisB. Recurrent CholangitisC. Liver AbscessD. Chronic PancreatitisE. Primary Biliary cirrhosis.

  14. . 62y F, Abd. Pain & jaundice. Gall bladder biopsy ? Diag1 2 3 4 50% 0% 0%7%93%A. CholecystitisB. CholesterosisC. AdenocarcinomaD. Aschoff-RokitanskysinusesE. Primary Biliary Cirrhosis.

  15. . 38y F, jaundice. Gall bladder ? Pathogenesis1 2 3 4 535%0% 0%65%0%A. Excess BilirubinB. Low cholesterolC. Low Bile SaltsD. Infection.E. Cholestasis.

  16. . 34y M, alcholic, fever, abdominal pain, mild icterusand malaise 6 months. Liver biopsy. ? diagnosis1 2 3 4 520%0% 0%73%7%1. Alcoholic Hepatitis2. Chronic Persistent Hepatitis.3. Hepatitis C infection4. Fatty Liver5. Alcoholic Cirrhosis

  17. . 78y woman, epigrastric pain & 4 kg weight loss since 6m.Bilirubin raised, AST & ALT normal, but ALP 216 u/l (<125).Image shows her abd. CT & Microscopy. Likely diagnosis ?.1 2 3 4 514%5%71%0%10%1. Explain the clinical features? – Chronic, weight loss, pain, jaundice – Ca Pan.2. Explain the laboratory data? – AST/ALT Hepatocytes normal, ALP –bile obstr.3. What are possible risk factors? – smoking, chronic pancreatitis, ca. syndromes.4. What is the pathogenesis? – PanIN -1A, PanIN -1B, K-RAS, PanIN -2, 3, Ca.1. Cholecystitis.2. Cholelithiasis.3. Chronic pancreatitis.4. Chronic Hepatitis.5. Pancreatic carcinoma.

  18. . 26y female, medical student, day before pathology exam presents withmild scleral jaundice. Physical Examination normal, Liver functiontests: Protein total-7.9, Albumin 4.8 g/dl, AST-36 U.L, ALT 16 U/L, ALP-36 U/L, Total Bilirubin 4.9, direct 0.7 mg/dl. Jaundice resolves weeklater after exams. Most likely diagnosis?1 2 3 4 55%0%29%5%62%1. Alcoholic hepatitis.2. Primary biliary cirrhosis.3. Gilbert Syndrome.4. Acute HAV infection.5. Acetaminophen poisoning.

  19. . Viral serology interpretation:HBsAg Positive,Anti HBc Ab PositiveAnti HBc IGM NegativeAnti HBs Ab NegativeA. Acute Viral HepatitisB. Immunised against Hep. BC. Chronic Hepatitis BD. Hepatitis B carrier stageE. Fulminant hepatitis B

  20. . 52y F, multiple red-brown, tender subcutaneous nodules with15kg wt. Loss since 3m. Microscopy of nodule inflammation, fat necrosis, no malignant cells. ? Diagnosis.1 2 3 4 50%25%35%20%20%1. Acute Pancreatitis2. Chronic Pancreatitis3. Adenocarcinoma4. Pancreatic Pseudocyst5. MEN I Syndrome

  21. . “The ancestor of every action is athought.”--Ralph Waldo Emerson

  22. . 34y M, alcoholic, homosexual- icterus andfever 6 months. Liver biopsy. ? diagnosisA. Acute HepatitisB. Chronic active Hepatitis.C. Cirrhosis  CarcinomaD. Fulminant HepatitisE. Hepatitis  Cirrhosis

  23. . 34y M, icterus and fever.Liver biopsy. ? diagnosis1. Acute Hepatitis2. Chronic Persistent Hepatitis.3. Chronic active Hepatitis4. Fulminant Hepatitis5. Cirrhosis

  24. . 56y chronic alcoholic, 2 days fever, abdomen distended,tender, tap yielded cloudy yellow fluid with 98%neutrophils, Blood culture E.coli. Patient dies 3 dayslater. Image shows his liver. Most Likely diagnosis?1 2 3 4 50% 0% 0%0%0%1. A1 antitrypsin deficiency2. HEV infection3. Hereditary hemochromatosis4. Primary sclerosing cholangitis5. Alcoholic cirrhosis

  25. . 58y M, alcoholic, distended abdomen & icterus.Liver biopsy. ? diagnosis1 2 3 4 50% 0% 0%0%0%1. Chronic active hepatitis.2. Chronic Persistant hepatitis.3. Hepatocellular carcinoma.4. Cirrhosis5. Chronic alcoholic hepatitis.

  26. . Viral serology interpretation:A. B. C. D. E.0% 0% 0%0%0%HBsAg Negative,Anti HBc Ab NegativeAnti HBcAg IGM NegativeAnti HBs Ag PositiveA. Acute Viral HepatitisB. Immunised against Hep. BC. Past Hepatitis B infection.D. Hepatitis B carrier stageE. Chronic hepatits B

  27. . 59y Male, Alcoholic, presents with fatigue, anorexia.Normal liver function tests. Liver specimen.Likely diagnosis?1 2 3 4 50% 0% 0%0%0%A. Dubin-Johnson SyndromeB. Alcoholic cirrhosisC. Alcoholic HepatitisD. Fatty LiverE. Nutmeg liver

  28. . 42y male smoker presented with recurrent cough& dyspnoea. Image shows cut section of hislung. What is the most likely diagnosis?1 2 3 4 50% 0% 0%0%0%1. Emphysematous bullae2. Panlobular emphysema3. Centrilobular emphysema4. Chronic Bronchitis + Emphysema.5. Smokers lung with Silicosis

  29. . 46 year male on treatment for lymphoma presentswith pallor, shortness of breath and mild jaundice.Image shows his blood film appearance. What isthe most likely type of anemia?1 2 3 4 50% 0% 0%0%0%1. Anemia of chronic disorder2. Megaloblastic anemia3. Hemolytic anemia4. Aplastic anemia5. Iron deficiency Anemia

  30. . 42y M, alcoholic, recurrent fatigue.Liver biopsy. ? Diagnosis1 2 3 4 50% 0% 0%0%0%1. Acute Hepatitis2. Chronic Active hepatitis.3. Chronic Persistant hepatitis.4. Fulminant Hepatitis.5. Cirrhosis.

  31. . 78year female presents with prolonged weakness,fatigue and anemia. She has palpable spleen & fewenlarged cervical Lymphnodes. Image shows herblood film. What is the most likely diagnosis?1 2 3 4 50% 0% 0%0%0%1. Acute myeloid leukaemia2. Acute lymphatic leukaemia3. Chronic myeloid leukaemia4. Chronic lymphatic leukaemia5. Non-hodgkins lymphoma

  32. . Health is the greatestpossession. Contentment is thegreatest treasure. Confidence isthe greatest friend. Non-being(selfless) is the greatest joyLao Tzu

  33. . Do you have Problems learningPathology ?Need a personal coach….?email/call me for an appointmentvenkatesh.shashidhar@jcu.edu.auTel: 47814566Remember…100% pass…!

  34. . CPC-2.7– GIT–Ca Pan+dep• Pathology - Core Learning Issues:– Pathology of exocrine Pancreas – Acute & ChronicPancreatitis & complications.– Neoplasms – Endocrine-adenoma, exocrinemalignancy – Adeno-carcinoma. & complications.– Paraneoplastic syndromes and common tumourmarkers. – MEN, Insulinoma, Gastrinoma,• Basic science - Core Learning Issues:– Structure & Function of Pancreas.– Pancreatic enzymes.– Neoplasia – Carcinogenesis, biology of neoplasms.

  35. . Uncommon risk factor for Acute Pancreatitis ?1 2 3 4 50% 0% 0%0%0%1. Alcohol abuse2. Gallstones3. Hyperlipidemia4. Genetic5. Hyperparathyroidism

  36. . Histopathology Image is from lung biopsy of a 61 yearmale chronic smoker. What is the most likely type ofcarcinoma?1 2 3 4 50% 0% 0%0%0%1. Small cell carcinoma2. Adenocarcinoma3. Metastatic deposits4. Squamous carcinoma5. Lung abscesses

  37. . The gross image of lung specimen from a 59yearold male heavy smoker presented with high fever,shortness of breath. Likely type of pneumonia?1 2 3 4 50% 0% 0%0%0%1. Lobar pneumonia2. Interstitial pneumonia3. Broncho pneumonia4. Fungal pneumonia5. Carcinomatous pneumonia

  38. . 42y obese female. Acute abdomen.Elevated serum amylase, Normal Lipase & AST.? Diagnosis1 2 3 4 50% 0% 0%0%0%A. Acute cholecystitisB. Acute PancreatitisC. Acute alcoholic hepatitisD. Chronic pancreatitisE. Recurrent Pancreatitis

  39. . Mary, 58y, 6m h/o epigastric pain, weight loss, foul smellingdiarrhoea. Lab Results:Serum Amylase-P – 56 U/L (Range 30-110)Serum Lipase – 460 U/L (Range 30-300)Serum Calcium – 1.92 (Range 2.1-2.55)What is the most likely diagnosis?1 2 3 4 50% 0% 0%0%0%A. Acute AppendicitisB. Chronic CholecystitisC. Acute PancreatitisD. Chronic PancreatitisE. Ulcerative colitis

  40. . Which of the following findings is most likely to beencountered in Mary?1 2 3 4 50% 0% 0%0%0%1. Alcoholic hepatitis2. Melena3. Pernicious anemia4. Steatorrhea5. Hypoglycemia

  41. . Mary presents again after 3 years. Physicalexamination shows jaundice. A CT scan of theabdomen shows a large fluid-filled cyst in the lessersac. What is the most likely diagnosis?1 2 3 4 50% 0% 0%0%0%1. Adenocarcinoma2. Carcinoid tumor3. True Pancreatic cyst4. Abscess in Pancreas5. Pancreatic Pseudocyst

  42. . 1y male, bilious vomiting. Mid duodenal narrowing.? Diagnosis1 2 3 4 50% 0% 0%0%0%1. Annular pancreas2. Duodenal polyp3. Pancreatic adenoma4. Pancreas divisum5. Congenital Pyloricstenosis

  43. . 13y boy. Recurrent pancreatitis attacks. Nowpresents with weight loss since a year, pedaledema. ? Diagnosis1 2 3 4 50% 0% 0%0%0%1. Annular pancreas2. Ectopic pancreas3. Pancreatic adenoma4. Pancreas divisum5. Congenital Pyloricstenosis

  44. . Major risk factors for Pancreatic cancer?1 2 3 4 50% 0% 0%0%0%1. Fatty, female, Forty..2. Life style & Diet3. Smoking & Diabetes4. Hypertension & lackof exercise5. Gall stones &Diabetes.

  45. . 65y Male, “positive Courvoisiers sign” ??1 2 3 4 50% 0% 0%0%0%1. Painful jaundice with purpuric spots.2. Jaundice with high colored urine.3. Painful jaundice with itching.4. Palpable gall bladder with jaundice5. Jaundice with abdominal pigmentation.

  46. . 65y M, Wt loss, pedal edema, Pancreaticbiopsy: Identify B ?1 2 3 4 50% 0% 0%0%0%? A? C1. Malignant glands2. Pancreatic Islets3. Fibrous tissue4. Inflammatory cells5. Benign glands

  47. . 65y M, Wt loss, pedal edema, Pancreaticbiopsy: Identify B ?1 2 3 4 50% 0% 0%0%0%? A? CBAC1. Malignant glands2. Pancreatic Islets3. Fibrous tissue4. Inflammatory cells5. Dilated ducts

  48. . 38y Female episodic fainting, Sweating, hunger &weight gain. Scan shows 1.5cm circumscribed roundmass in pancreas.? Diagnosis1 2 3 4 50% 0% 0%0%0%1. Adenocarcinoma2. Gastrinoma3. Glucagonoma4. Insulinoma5. Carcinoid tumor

  49. . 65y man, Acromegaly, epigastric pain, melena,hypercalcemia, hyperlipidemia, hyperacidity.? Diagnosis1 2 3 4 50% 0% 0%0%0%1. Glucagonoma2. Insulinoma3. MEN I4. Pancreatic Carcinoid5. MEN II

  50. . 52y F, severe multiple peptic ulcers in both duodenumand jejunum not responding to treatment. Pancreas shows1.2cm rounded tumor. ? Diagnosis.1 2 3 4 50% 0% 0%0%0%Peptic ulcers1. H.pylori & peptic ulcer2. Insulinoma3. MEN II syndrome4. Pancreatic Carcinoid5. Gastrinoma

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