JCU MB4 Term 2 Week 4 (Gall Bladder and Pancreas)

1

38yo female, obese, colicky abdominal pain, gross specimen of gall bladder shown. What type of stones are present?

Gall bladder pure cholesterol


2

38yo female, obese, colicky abdominal pain, gross specimen of gall bladder shown. What type of stones are present?

Gall bladder mixed stones


3

A 45yo mildly obese woman, 1-week history of upper abdominal pain, fever, shaking chills and occasional vomiting. Physical examination shows severe right upper quadrant tenderness. Laboratory studies include serum bilirubin of 1.0 mg/dL, AST of 25 U/L, ALT of 35 U/L, alkaline phosphatase of 220 U/L (high), WBC of 14,000/┬ÁL and amylase of 95 U/L (normal). An ultrasound examination of the abdomen reveals a normal-appearing liver and bile duct and thickening of the wall of gallbladder. Most likely diagnosis?


4

40yo black woman, indigestion, abdominal pain, gross specimen of gall bladder shown. What is the most likely associated disease?

Gall bladder pigment stones


5

69yo male, massive GI bleeding, jaundice, section of gross liver specimen shown. What is the likely pathogenesis?

Liver metastatic carcinoma


6

38yo female, obese, abdominal colicky pain, gall bladder microscopy shown. What is the diagnosis?

Gall bladder cholecystitis


7

38yo female, abdominal colicky pain, gross specimen of gall bladder shown. What is the most likely metabolic abnormality?

Gall bladder pure cholesterol


8

62yo female, abdominal pain and jaundice. Biopsy of gall bladder shown. What is the diagnosis?

Gall bladder adenocarcinoma


9

38yo female, jaundice, gross specimen of gall bladdder shown. What is the pathogenesis?

Gall bladder pigment stones


10

34yo male, alcoholic, mild icterus and malaise for 6 months. Liver biopsy shown. What is the diagnosis?

Fatty liver


11

42yo male, alcoholic, recurrent fatigue. Liver biopsy shown. What is the diagnosis?

Liver chronic hepatitis


12

26yo female, medical student, day before pathology exam presents with mild scleral icterus. Physcial examination normal. Liver function tests: Protein total 7.9, albumin 4.8 g/L, AST 35 U/L, ALT 16 U/L, ALP 36 U/L, total bilirubin 4.9, direct 0.7 mg/dL. Icterus resolves week later after exams. What is the most likely diagnosis?


13

Viral serology interpretation. HBsAg positive, HBcAg positive, anti-HBcAg IgM negative, anti-HBsAg Ig negative, HBeAg positive.


14

1yo male, bilious vomiting. Mid duodenal narrowing. What is the diagnosis?


15

65yo male, "positive Courvoisier's sign". What does this mean?


16

65yo male, weight loss, pedal oedema. Pancreatic biopsy shown. Identify B.

Pancreatic carcinoma micro


17

52yo female, multiple red-brown, tender subcutaneous nodules with 15kg wt loss since 3 months. Microscopy of nodules show inflammation, fat necrosis, no malignant cells. What is the diagnosis?

Migrating thrombophlebitis


18

65yo male, weight loss, pedal oedema. Pancreatic biopsy is shown. Identify B.

Pancreas biopsy dilated ducts


19

38yo female episodic fainting, sweating, hunger and weight gain. Scan shows 1.5cm circumscribed round mass in pancreas. What is the diagnosis?

Pancreas round mass


20

65yo male, acromegaly, epigastric pain, malaena, hypercalcaemia, hyperlipidaemia, hyperacidity. What is the diganosis?


21

52yo female, severe multiple peptic ulcers in both deodenum and jejunum not responding to treatment. Pancreas shows 1.2cm rounded tumour. What is the diagnosis?

Multiple peptic ulcers


22

Which of the following is an uncommon risk factor for acute pancreatitis?


23

Mary, 58yo female, 6 month history of epigastric pain, weight loss, foul smelling diarrhoea. Lab results: amylase 56 U/L (30-110), lipase 460 U/L (30-300), Ca2+ 1.92 (2.1 - 2.55). What is the most likely diagnosis?


24

Which of the following findings is most likely to be encountered in the patient from question 24 (58yo female with 6mo history of epigastric pain, weight loss, foul smelling diarrhoea with elevated serum lipase).


25

The patient from question 24 presents again after 3 years. Physical examination shows jaundice. A CT scan of the abdomen shows a large fluid-filled cyst in the lesser sac. What is the most likely diagnosis?


26

34yo male, alcoholic homosexual - icterus and fever for 6 months. Liver biopsy shown. What is the diagnosis?

Liver biopsy chronic hepatitis


27

34yo male, icterus and fever. Livery biopsy shown. What is the diagnosis?

Liver biopsy acute hepatitis


28

56yo chronic alcoholic, 2 days of fever, abdomen distended, tender. Abdominal tap yielded cloudy yellow fluid with 98% neutrophils. Blood culture shows E. coli. Patient dies 3 days later. Gross specimen of liver shown. What is the most likely diagnosis?

Liver cirrohsis


29

58yo male, alcoholic, distended abdomen and icterus. Liver biopsy shown. What is the diagnosis?


30

Viral serology interpretation: HBsAg negative, anti-HBcAg Ig negative, anti-HBcAg IgM negative, anti-HBsAg Ig positive.


31

69yo female, chronic bronchitis. Died following chronic cardiac failure. Gross liver specimen shown. What is the likely diagnosis?

Nutmeg liver


32

Viral serology interpretation: HBsAg negative, anti-HBsAg Ig positive, anti-HBcAg Ig positive, anti-HBcAg IgM negative.


33

59yo male, alcoholic, presents with fatigue and anorexia. Normal liver function tests. Liver specimen. What is the likely diagnosis?

Fatty liver


34

Shown is a histopathology specimen from lung biopsy of 61yo male chronic smoker. What is the most likely type of carcinoma?

Lung squamous cell carcinoma


35

The gross image of lung specimen from a 59yo male heavy smoker presented with high fever and shortness of breath. What is the likely type of pneumonia?

Bronchopneumonia


36

46yo male on treatment for lymphoma presents with pallor, shortness of breath and mild jaundice. Image shows his blood film appearance. What is the most likely type of anaemia?

Haemolysis


37

12yo girl presents with two week history of fever and joint pain. The image shows her heart specimen. What feature of the disease is shown by the arrow?

Fibrinous pericarditis


38

78yo female presents with prolonged weakness, fatigue and anaemia. She has a palpable spleen and a few enlarged cervical lymph nodes. Image shows her blood film. What is the most likely diagnosis?

CLL