KMU Past Paper Practice

Question:

A 16-year-old girl presents with jaundice and markedly raised aminotransferases. Serum IgG is elevated, and autoimmune hepatitis is suspected. ANA and anti-smooth muscle antibodies are absent. Which additional antibody would particularly support type 2 autoimmune hepatitis?

Correct Answer: Anti-LKM-1 antibody

Explanation: Anti-LKM-1 is classically associated with type 2 autoimmune hepatitis, particularly in younger patients.

Question:

A woman with untreated autoimmune hepatitis has rapidly worsening jaundice and markedly elevated aminotransferases. Liver biopsy demonstrates portal inflammation extending into the lobules with areas of necrosis connecting adjacent vascular regions. Which morphological feature indicates severe hepatocellular injury?

Correct Answer: Bridging necrosis

Explanation: Severe autoimmune hepatitis may produce bridging necrosis, reflecting extensive hepatocyte destruction and risk of progressive fibrosis.

Question:

A patient develops acute hepatitis while taking a medication at the recommended therapeutic dose. The reaction is uncommon, cannot be predicted from the dose, and appears to depend on individual susceptibility. Which type of drug-induced liver injury best describes this event?

Correct Answer: Idiosyncratic drug reaction

Explanation: Idiosyncratic hepatotoxicity is uncommon, unpredictable and not simply related to the administered dose.

Question:

A drug undergoes extensive hepatic metabolism after oral absorption, resulting in low systemic bioavailability. The same drug is required to reach the circulation without first passing through the portal venous system. Which route would best reduce this hepatic effect?

Correct Answer: Sublingual administration

Explanation: Sublingual absorption enters the systemic circulation without initial passage through the portal liver circulation, reducing first-pass metabolism.

Question:

A 64-year-old man receiving long-term treatment for a cardiac rhythm disorder develops persistent elevation of liver enzymes. Biopsy shows steatosis with features of steatohepatitis. Which medication is a recognized cause of this pattern?

Correct Answer: Amiodarone

Explanation: Amiodarone can produce hepatic steatosis and steatohepatitis during prolonged therapy.

Question:

A man with chronic heavy alcohol intake develops progressive hepatocyte injury despite adequate nutrition. Ethanol metabolism generates a reactive compound that binds cellular proteins and contributes directly to hepatic damage. Which mechanism is being described?

Correct Answer: Acetaldehyde-mediated protein injury

Explanation: Acetaldehyde, a metabolite of ethanol, forms protein adducts and contributes to hepatocyte dysfunction and inflammatory injury.

Question:

A patient with long-standing alcohol-related cirrhosis develops increasing abdominal distension and other features caused by increased resistance to blood flow through the scarred liver. Which major complication most directly results from this structural change?

Correct Answer: Portal hypertension

Explanation: Cirrhotic fibrosis distorts hepatic vascular architecture and increases resistance to portal blood flow, producing portal hypertension.

Question:

Two liver biopsies show macrovesicular steatosis, hepatocyte ballooning and lobular inflammation. One patient is obese with diabetes, while the other consumes large quantities of alcohol. Which information is most important for distinguishing the underlying causes?

Correct Answer: Exposure and metabolic history

Explanation: Alcoholic and metabolic steatohepatitis can overlap morphologically, so the clinical exposure and metabolic context are essential for interpretation.

Question:

An obese woman with insulin resistance denies significant alcohol intake. Liver biopsy shows steatohepatitis and several hepatocytes contain Mallory-Denk bodies. Which interpretation is most appropriate?

Correct Answer: NASH can also produce these inclusions

Explanation: Mallory-Denk bodies are associated with alcoholic hepatitis but are not specific; they may also be present in non-alcoholic steatohepatitis.

Question:

A liver biopsy from a patient with suspected iron-overload disease contains coarse golden-brown cytoplasmic granules. The pathologist wants to confirm that the pigment represents iron. Which stain is most appropriate?

Correct Answer: Perls’ Prussian blue

Explanation: Perls’ Prussian blue stain demonstrates hemosiderin and is used to confirm tissue iron deposition.

Question:

A patient with hereditary iron overload undergoes liver biopsy before advanced cirrhosis has developed. Which distribution of iron is most characteristic early in hereditary hemochromatosis?

Correct Answer: Periportal hepatocytes

Explanation: In hereditary hemochromatosis, iron deposition is prominent in hepatocytes and characteristically begins in periportal regions.

Question:

A young man with chronic liver disease develops tremor and dysarthria. Slit-lamp examination shows a brown-green ring at the corneal periphery. Copper is deposited in which ocular structure to produce this finding?

Correct Answer: Descemet membrane

Explanation: Kayser-Fleischer rings result from copper deposition in Descemet membrane of the cornea.

Question:

A patient with symptomatic Wilson disease requires pharmacological removal of excess copper. Penicillamine cannot be continued because of intolerance. Which alternative drug from the same therapeutic strategy is appropriate?

Correct Answer: Trientine

Explanation: Trientine is a copper-chelating agent and provides an alternative to penicillamine for copper removal in Wilson disease.

Question:

A child from a family with inherited alpha-1 antitrypsin deficiency is found to have a severe deficiency state with high risk of hepatic protein retention. Which phenotype is classically associated with severe disease?

Correct Answer: PiZZ

Explanation: The PiZZ phenotype is strongly associated with severe alpha-1 antitrypsin deficiency and hepatocellular retention of abnormal protein.

Question:

An 18-year-old patient has chronic hepatitis with fatty change on liver biopsy. Several months later he develops tremor, dysarthria and behavioral change. Which diagnosis best unifies the hepatic and neurological findings?

Correct Answer: Wilson disease

Explanation: Wilson disease can produce fatty change or chronic hepatitis in the liver together with neurological manifestations from copper deposition.

Question:

A middle-aged woman has chronic pruritus and a persistent cholestatic biochemical pattern. Liver pathology shows progressive loss of the structures primarily responsible for carrying bile through the hepatic parenchyma. Which structure is principally affected?

Correct Answer: Small intrahepatic bile ducts

Explanation: Primary biliary cholangitis is characterized by autoimmune destruction and progressive loss of small intrahepatic bile ducts, producing cholestasis.

Question:

A 34-year-old woman develops painful hepatomegaly and rapidly accumulating ascites during a prothrombotic state. Imaging demonstrates obstruction of blood leaving the liver while the portal vein remains patent. Which vessels are primarily involved?

Correct Answer: Hepatic veins

Explanation: Budd-Chiari syndrome results from hepatic venous outflow obstruction, classically involving the hepatic veins.

Question:

A patient with hepatic venous outflow obstruction develops tense ascites and tender hepatomegaly. Which hemodynamic change most directly explains the development of ascites in this condition?

Correct Answer: Increased sinusoidal pressure

Explanation: Obstruction of hepatic venous drainage raises sinusoidal pressure, producing hepatic congestion and promoting ascites.

Question:

Doppler assessment in a patient with suspected hepatic venous obstruction suggests abnormal flow but does not fully define the extent of the lesion. Which investigation is most useful for further anatomical assessment of the venous obstruction and hepatic morphology?

Correct Answer: CT or MRI

Explanation: CT or MRI can further define hepatic venous obstruction, hepatic morphology and associated complications after initial Doppler assessment.

Question:

A patient receiving long-term treatment for epilepsy develops hepatic dysfunction. Liver biopsy demonstrates prominent fatty change without evidence of iron or copper accumulation. Which medication is a recognized cause of this pattern of hepatotoxicity?

Correct Answer: Valproate

Explanation: Valproate is a recognized hepatotoxic drug that may produce prominent hepatic fatty change and, in severe cases, significant liver injury.