Liver EQA Scheme Circulation D1 Summer 2011
Liver Circulation J1 – Spring 2014
Educational Participants MCQ version
Welcome to the electronic submission site for educational participants in liver circulation J1.
This uses the 12 cases in liver EQA circulation J1 as liver CPD for non-EQA members. It is NOT a form of quality assurance. The cases will be discussed at the liver pathology meeting on 20th November 2014, and the MCQs marked after that, by the EQA facilitator.
You can view the cases either using the powerpoint of photomicrographs, or the digital virtual slides, or both.
Please use the word answer sheet on the website to record and save your MCQ answers, and then enter them into this electronic format to submit them.
The lists of MCQ alternatives are based on responses submitted by the EQA members.
Please enter your name and address at the end, so that the scheme facilitator can send you your results and CPD certificate. This information will be kept confidential. Information on your experience and type of practice is collected to compare groups of responders.
Case J1/434 Age 53, Female
AID,AMA++ and PBC?
a) non-specific inflammation, no further comment
b) non-specific, but consistent with autoimmune hepatitis
c) non-specific but consistent with primary biliary cirrhosis
d) chronic hepatitis
e) primary sclerosing cholangitis.
Case J1/435 Age 21, Female
ANA positive 1:80 ASM positive; AMA negative. IgG elevated = 37, IgM mild increase 2.8
a) mixed primary biliary cirrhosis/autoimmune hepatitis (overlap)
b) veno-occlusive disease
c) autoimmune hepatitis
d) IgG4 disease
e) primary sclerosing cholangitis
Case J1/436 Age 68, Female
Right Hemihepatectomy and gallbladder
Hemihepatectomy weighing 613g and M 15 x 9 x 10 cm. Slicing reveals a well circumscribed yellow nodule with a multilobular contour measuring 2.8 x 2 x 1.5cm. Uninvolved liver has a normal cut surface.
a) nodular regenerative hyperplasia
b) fibrolamellar carcinoma
c) adenoma, inflammatory type
d) mixed hepatocellular and cholangiocarcinoma
e) focal nodular hyperplasia
Case J1/437 Age 64, Female
Colorectal liver mets?? Previous colectomy Right hepatectomy.
Liver M 15x8.5x9.5cm with attached gall bladder, together weighing 575g. Gallbladder m 8x3.5cm. On slicing the liver contains 3 separate nodules 1.5, 2.7 and 6.8cm across. The nodules are heavily calcified. The softer areas show cut surfaces which are pale with focal haemorrhage and possible necrosis. background liver appears normal. the gall bladder contains bile, the mucosa is flecked with yellow.
a) metastatic colorectal adenocarcinoma, post chemotherapy
b) angiomyolipoma
c) epithelioid haemangioendothelioma
d) metastatic renal cell carcinoma
e) fibrolamellar carcinoma
J1/438 Age 49, Female
Liver Ovarian mets
Partial hepatectomy measuring 21x15x5cm. Slicing reveals a single tumour 8x8x10cm. The tumour has a pale surface. No other lesions identified. The background liver appears normal. TAH + BSO in 2004 – clear cell carcinoma of left ovary.
a) metastatic clear cell carcinoma of ovary
b) hepatocellular carcinoma
c) either metastatic tumour of hepatocellular carcinoma
d) metastatic renal cell carcinoma
e) focal nodular hyperplasia
Case J1/439 Age 27, Female
Lesion in segment 2
septate cyst 145x110x125mm smooth walled, containing serous fluid
a) choledochal cyst
b) intraductal papillary neoplasia of bile duct (IPNB), cystic variant
c) simple bile duct cyst
d) cystadenoma
e) mucinous cystic neoplasm
Case J1/440 Age 58, Male
Hepatitis C positive, fibroscan value raised
a) chronic hepatitis, consistent with hepatitis B
b) steatohepatitis
c) autoimmune hepatitis
d) chronic hepatitis, consistent with hepatitis C
e) chronic biliary disease
Case J1/441 Age 66, Female
Abnormal LFT's ANA positive, raised lgG * ALT 136, br9, alk p 84,
2 cores 12mm and 15mm
a) primary sclerosing cholangitis
b) autoimmune hepatitis and primary biliary cirrhosis (overlap)
c) sarcoidosis
d) acute hepatitis with confluent necrosis
e) suspicious of lymphoma
Case J1/442 Age 82, Male
Non-targetted liver biopsy. Raised ALP + GGT. Anaemia.
a) large bile duct obstruction
b) sinusoidal dilatation, ? veno-occlusive disease
c) heart failure
d) amyloidosis
e) primary sclerosing cholangitis
Case J1/443 Age 53, Female
Deranged LFT's presented with lethargy and itch, recent course of antibiotics
a) steatohepatitis and cholestasis
b) drug induced liver injury
c) acute cholestatic hepatitis with bridging necrosis, ? viral or autoimmune
d) acute cholestatic hepatitis with bridging necrosis, consistent with drugs, exclude virus/AIH
e) cholestatic hepatitis with bile infarcts ? large bile duct obstruction
Case J1/444 Age 64, Female
Liver transplant for PBC in 1995 (18 years ago). Deranged LFTs. Anastomotic stricture in 2007 stented, follow up ERCP = no stricture. Rising ALP? Recurrent PBC? Chronic rejection
a) chronic biliary features, most likely graft v host disease
b) chronic biliary features, most likely large bile duct obstruction
c) chronic biliary features, most likely ductopenic chronic rejection
d) chronic hepatitis, not otherwise specified
e) chronic biliary features, most likely recurrent primary biliary cirrhosis
Case J1/445 Age 34, Male
Hepatitis C ? Fibrosis
a) chronic hepatitis with steatosis
b) chronic hepatitis C with steatosis
c) chronic hepatitis C with steatohepatitis
d) alcoholic liver disease
e) steatohepatitis
the end.
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