Liver EQA Scheme Circulation D1 Summer 2011



Liver EQA Scheme Circulation I1 - Autumn 2013

Educational Participant MCQ answer sheet

Welcome to the electronic submission site for educational participants in liver EQA circulation I1.

This uses the 12 cases in liver EQA circulation I1 as liver CPD for non-EQA members. It is NOT a form of quality assurance. The cases will be discussed at the BSG/BDIAP liver meeting on 28th November 2013.

You can view the cases either using the powerpoint of photomicrographs, or the digital virtual slides, or both.

Please identify the single most appropriate response from the list of 5 alternatives.

The list of responses are derived from the actual responses in the EQA circulaion.

Please submit your response by Tuesday 26th November.

The cases will be discussed during the BSG/BDIAP liver meeting on 28th November.

After the meeting, you will receive your result, and a CPD certificate.

Case I1/422 Age 53, Female

Patient with multisystemic sarcoidosis - deranged liver tests. Suspicious of liver sarcoidosis

One core 17mm long

a. most likely primary biliary cirrhosis

b. granulomatous hepatitis NOS

c. differential diagnosis includes sarcoidosis, TB, drug reaction

d. most likely sarcoidosis

e. most likely tuberculosistuberculosis

Case I1/423 Age 66, Male

Persistently high ALT. AMA Positive. Serum electrophoresis = polyclonal hypergammaglobulmena

Core biopsies tan liver tissue

a. primary biliary cirrhosis (PBC)

b. autoimmune hepatitis, differenital diagnosis Wilson disease, PBC

c. Wilson disease

d. autoimmune hepatitis(AIH)

e. overlap of AIH and PBC

Case I1/424 Age 53, Male

HIV (CD4 =370) on HAART, history of diabetes mellitus, excesss alcohol. Hepatomegaly

Single core 16mm length

a. cirrhosis, autoimmune hepatitis

b. cirrhosis, hepatitis C

c. cirrhosis, alcoholic/non-alcoholic fatty liver disease

d. cirrhosis, alcoholic and HAART treatment

e. cirrhosis, HIV related.

Case I1/425 Age 24, Male

Abnormal LFT's. Portal hypertension ? Non-cirrhotic portal hypertension ?

Pale core 29mm

a. non-cirrhotic portal hypertension

b. cirrhosis

c. chronic hepatitis

d. venous outflow obstruction

e. canalicular cholestasis

Case I1/426 Age 39, Male

E antigen positive hepatitis B ALT>60, viral load 2 x 106. Biopsy 2006 no fibrosis. To re-stage disease.

Tan core 30mm

a. hepatitis E

b. viral hepatitis, early stage/grade

c. hepatitis B, mild activity, early stage

d. autoimmune hepatitis

e. chronic hepatitis NOS

Case I1/427 Age 56, Female

MTX therapy. Increased LFTs. Ultrasound scan indicates fatty change/fibrosis ? Cirrhosis

Two pale yellow cores measuring 17mm and 15mm.

a. cirrhosis, steatohepatitis, due to methotrexate

b. cirrhosis, chronic active hepatitis

c. cirrhosis, drug induced

d. cirrhosis, fatty change

e. cirrhosis, steatohepatitis, may be alcohol, metabolic syndrome; methotrexate as co-factor

Case I1/428 Age 64, Female

Recurrent ovarian tumour + liver; right lobe R1 resection

Liver measuring 11 x 8 x 6cm, attached to a irregular mass of tumour 16 x 11 x 5 cm, together weighing 553g;

a. metastatic granulosa cell tumour

b. primary chondrosarcoma of liver

c. metastatic osteosarcoma

d. consistent with metastasis from ovary, compare primary ? MMT/teratoma

e. metastatic chondrosarcoma

Case I1/429 Age 60, Female

GIST tumour stomach, lesion noted in liver and resected

Wedge of liver 2.2x2x1.1cm

a. liver cell adenoma

b. focal nodular hyperplasia

c. cirrhosis, steatohepatitis, no tumour

d. haemangioma

e. nodular regenerative hyperplasia

Case I1/430 Age 70, Male

Tumour mid CBD

27mm segment of bile duct up to a diameter of 13mm

a. bile duct adenoma

b. neurendocrine tumour

c. cholangiocarcinoma

d. intraductal papillary neoplasm

e. carcinoid tumour

Case I1/431 Age 67, Female

Past medical history of chondrosarcoma. Segment IV&V lesion? Metastatic disease

40mm homogeneous white lesion with gritty cut surface

a. Adenocarcinoma, probably metastatic

b. metastatic chondrosarcoma

c. Brenner tumour metastasis

d. mixed cholangiocarcinoma/hepatocellular carcinoma

e. fibrolamellar carcinoma

f. bile duct adenoma, no malignancy.

Case I1/432 Age 72, Male

4.5cm lesion in seg 2/4 ? HCC, background liver fibrotic

Left Hepatectomy 473g, 140x115x60mm circumscribed soft tan tumour 45mm across

a. hepatocellular carcinoma, background alpha 1 antitrypsin deficiency

b. hepatocellular carcinoma, background chronic biliary disease

c. well differentiated adenocarcinoma - cholangio or metastasis

d. low grade dysplastic nodule, background cirrhosis

e. hepatocellular carcinoma, background fatty liver disease, with PASD inclusions

Case I1/433 Age 52, Female

Right hepatectomy for slowly enlarging rt lobe lesion and GB. Clinically ? Benign.

liver measuring 14.8 x 11 x 7cm weighing 550g well defined rounded lesion measuring 5.5cm in maximum dimension. The inner part of the lesion appears congested where as the outer part is lined by a rim of pale tissue with an irregular inner border and a smooth outer border. background liver appears normal.

a. haemangioma

b. peliosis hepatis

c. macroregenerative nodule

d. nodular regenerative hyperplasia

e. liver cell adenoma

f. hepatocellular carcinoma

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download