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The patent with the viral hepatitis A entered the infectious hospital. Which antibodies will synthesize first? @IgM. IgG. IgA. IgD. IgE. # 5 An autopsy of a male, with a history of a drug abuse, revealed vacuolar dystrophy of hepatocytes, a Councilman's bodies, periportal inflammation consisted mainly of chronic inflammatory cells, lymphocytes, plasma cells and histiocytes. What is the most likely etiology of the disease? @Viral Bacterial Toxic Parasite Fungus # 6 At the histological exam of a dead man, who was given numerous drug injections, were revealed the hydropic dystrophy of hepatocytes, dim-glasslike hepatocytes, acidophilic Kaunsilmann corpuscles, and lymphocytic-macrophagocytic conglomerations in portal tracts. What is the most possible etiology of the disease? Bacterial @Viral Toxic Parasitic Fungus # 7 In biopsy of the liver of a 40-year-old man, who received injections of narcotics the pathologist has found out acidophilic Councilmen’s bodies, lymphocytes and macrophages surrounding portal tracts, "ground-glass” hepatocytes (an etiology of disease is virus B). Call this disease @Virus hepatitis B Tuberculosis Virus chirrosis Parasitogenic hepatitis Steatosis # 8 A patient presented with vomiting, loss of appetite and jaundice. A histological investigation of his liver biopsy revealed vacuolar and ballooning dystrophies of hepatocytes and necrosis of some cells. The Councilman's bodies were also determined. Besides, a destruction of the liver's beam architecture within lobes and inflammation consisted mainly of chronic inflammatory cells, lymphocytes, plasma cells and histiocytes were registered. What form of virus hepatitis is most likely? @Viral hepatitis Purulent hepatitis Cirrhosis of the liver Toxic dystrophy of the liver Malaria # 9 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 # 10 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 # 11 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 С Chronic hepatitis В Acute hepatitis B @Previous hepatitis B Acute hepatitis C # 12 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 - # 13 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 # 14 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 # 15 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 # 16 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 # 17 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 sur¬rounding 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 # 18 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 # 19 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 # 20 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 # 21 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 # 22 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 # 23 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 # 24 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 # 25 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 # 26 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 # 27 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 # 28 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. # 29 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 # 30 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 # 31 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 # 32 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 # 33 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 # 34 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. # 35 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 # 36 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 # 37 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 # 38 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 # 39 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 # 40 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. # 41 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 # 42 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 # 43 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 # 44 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 # 45 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 - # 46 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 # 47 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 # 48 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 # 49 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 # 50 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 # 51 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 # 52 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 # 53 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 # 54 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 antibodies are 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 devel¬oped a malignancy and dieWhich of the following tumors is most closely associated with his liver disease? @Cholangiocarcinoma Gallbladder carcinoma Gastric carcinoma Hepatoblastoma Pancreatic carcinoma # 55 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. Exami¬nation of this tissue histologically reveals a thick, acellular, laminated eosinophilic wall. The fluid within the cyst is found to be granular and con¬tain 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 # 56 |