Pathology EMQ template.

Name:

Candidate number:

Theme: Liver and Biliary Disease

 

OPTION LIST

 

A	Alpha-1 antitrypsin deficiency	I	Hepatitis B
B	Budd-Chiari syndrome	J	Hepatitis C
C	Cirrhosis	K	Hepatocellular carcinoma
D	Dubin-Johnson syndrome	L	Paracetamol overdose
E	Gilbert’s syndrome	M	Primary biliary cirrhosis
F	Haemochromatosis	N	Primary sclerosing cholangitis
G	Head of pancreas cancer	O	Tail of pancreas cancer
H	Hepatitis A	P	Wilson’s disease

 

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

 

1. A 63 year old retired actress presents with a 2 week history of itchiness, pale stools and dark urine. She says she might be a bit yellower than normal. On direct questioning, she admits to losing 10 kg over the past 2 months, but that this was intentional. She smokes like a chimney and drinks like a fish.

Bilirubin 100, Albumin 28, ALT 39, AST 45, ALP 471, GGT 100

 

2. An 18 man presents soon after returning from a holiday in Kazakhstan. He has been feeling very poorly for the past week, with fever, malaise, myalgia, headache, jaundice, and an ache over his right upper quadrant. As you examine him, he chats about his love for shellfish.

 

3. One of the medical students in your year is an Iranian Jew. You notice that he has jaundice on occasion, but appears otherwise healthy. You ask him if you could palpate his abdomen, and you find that his liver is slightly enlarged and slightly tender.

 

4. A 16 year old boy falls out with his parents and runs away from home. After wandering around for a day without food or money, he realises he has turned yellow, and goes to see his GP.

 

5. A famous author presents to your clinic with pain in the first two fingers of his right hand, which is preventing him from writing. He also complains of having to get up to go to the bathroom up to 20 times a day. He is not happy. When you compliment him on his tan, he snaps back that he hasn’t been on holiday for a year, and would you please hurry up and diagnose him.

 

 

 

ANSWERS

1. G

2. H

3. D

4. E

5. F