USMLE Step 1 Medical Subject Review:
Pathology Liver and Pancrease
An obese 38-year-old woman presents with episodic upper right-sided abdominal pain.
She reports that the pain comes on "out of the blue" and lasts for a couple of hours at a
time. It seems to happen shortly after she eats and often radiates to her back and her
right shoulder. She admits to nausea with the pain but denies vomiting or diarrhea.
Based on the most likely diagnosis, what might be found on this patient's physical
exam? - answerMurphy's sign
1. 40-year-old female from the Middle East attends the clinic as she noticed a swelling
in the abdomen. However, she does not have any pain. On examination, the swelling is
situated in the right lobe of the liver. CT scan shows a sharply defined cystic lesion with
septation and calcification. The other systems are normal. The laboratory tests reveal
the following:
Serum bilirubin
0.8 mg/dL
S. AST
20 IU/L
S. ALT
28 IU/L
S. Alkaline phosphatase
/L
Surgery was performed. Perioperatively, the cyst measures 15 cm in diameter.
Microscopy showed an inner cellular layer and an outer layer consisting of dense
hyalinized lamination. From the inner wall, there are bulbous projections and daughter
cysts. What is the most likely diagnosis? - answerHydatid cyst
1. A 50-year-old man presents with weakness and abdominal discomfort. Upon
questioning, he acknowledges a lack of sexual desire. He denies any photosensitivity.
On physical examination, his liver is enlarged. He has an abnormal skin pigmentation
that is located on his face, neck, and elbows; it gives his skin a slate-gray hue. His
laboratory results are in the chart.
TEST
RESULTS
REFERENCE RANGE
TIBC
275 μg/dL
250 - 375 μg/dL
Plasma iron
220 μg/dL
50 - 150 μg/dL
, Transferrin saturation
90%
20 - 40%
What is a common complication of this condition? - answerHepatocellular carcinoma
13-year-old boy has symptoms of frequent urination and thirst associated with fatigue,
dizziness, headache, and blurred vision. Laboratory tests show that this patient has type
1 or juvenile-onset diabetes mellitus. Which is the MOST common cause of this
disease? - answerdysfunction of pancreatic B-cells
58-year-old man with chronic liver disease presents with recent onset of ascites and
rapid weight loss. Examination reveals a palpable tender liver mass. Paracentesis
reveals hemorrhagic ascitic fluid. CT scan of the liver shows a large intrahepatic
multifocal tumor. Percutaneous fine needle aspiration is positive for hepatocellular
carcinoma. The patient deteriorates rapidly and dies 3 months following presentation.
What is the most important predisposing condition to this cancer in the U.S.? -
answerCirrhosis
56-year-old man with a history of alcohol abuse is diagnosed with chronic pancreatitis.
He is advised to avoid alcohol and is prescribed a low-fat (<20 g/day) diet and
pancreatic enzyme supplements. 1 month later, he presents with fatigue and weight
loss. You suspect a calorie deficit and a poor response to the enzyme supplements.
What is most effective in treating these new symptoms? - answerMedium-chain
triglycerides
63-year-old man, with a 7-year history of chronic pancreatitis believed to be caused by
alcohol consumption, presents with mild abdominal pain. He mentions that he has
occasional abdominal pain, but he is mostly concerned about a sudden weight loss of
15 lb during the last 2 months; he has frequent 'greasy and malodorous' stools. Lab
analysis reveals 169 mg elastase/g stool, and 17 ng/mL of serum trypsin. What is the
most appropriate next step in the patient's treatment? - answerDaily administration of
lipase per meal together with a proton pump inhibitor
50-year-old man presents with 3 weeks of increased urinary frequency, fatigue, weight
loss, and blurred vision. He has a good appetite and tries to stay hydrated by drinking
lots of fluids. Physical exam is remarkable for sores on the feet. Laboratory evaluation
reveals glucosuria and elevated serum glucose. What biochemical effect is associated
with this patient's most likely diagnosis? - answerDecreased tyrosine kinase activity in
skeletal muscle
32-year-old nurse had refractory ulcerative disease, with multiple ulcers in the
duodenum and jejunum. She also had chronic diarrhea. Partial pancreatectomy relieved
some of her symptoms. Figure L7.2 is a light micrograph of a portion of her excised
pancreas. The MOST likely diagnosis is which of the following conditions? -
answergastrinoma
Pathology Liver and Pancrease
An obese 38-year-old woman presents with episodic upper right-sided abdominal pain.
She reports that the pain comes on "out of the blue" and lasts for a couple of hours at a
time. It seems to happen shortly after she eats and often radiates to her back and her
right shoulder. She admits to nausea with the pain but denies vomiting or diarrhea.
Based on the most likely diagnosis, what might be found on this patient's physical
exam? - answerMurphy's sign
1. 40-year-old female from the Middle East attends the clinic as she noticed a swelling
in the abdomen. However, she does not have any pain. On examination, the swelling is
situated in the right lobe of the liver. CT scan shows a sharply defined cystic lesion with
septation and calcification. The other systems are normal. The laboratory tests reveal
the following:
Serum bilirubin
0.8 mg/dL
S. AST
20 IU/L
S. ALT
28 IU/L
S. Alkaline phosphatase
/L
Surgery was performed. Perioperatively, the cyst measures 15 cm in diameter.
Microscopy showed an inner cellular layer and an outer layer consisting of dense
hyalinized lamination. From the inner wall, there are bulbous projections and daughter
cysts. What is the most likely diagnosis? - answerHydatid cyst
1. A 50-year-old man presents with weakness and abdominal discomfort. Upon
questioning, he acknowledges a lack of sexual desire. He denies any photosensitivity.
On physical examination, his liver is enlarged. He has an abnormal skin pigmentation
that is located on his face, neck, and elbows; it gives his skin a slate-gray hue. His
laboratory results are in the chart.
TEST
RESULTS
REFERENCE RANGE
TIBC
275 μg/dL
250 - 375 μg/dL
Plasma iron
220 μg/dL
50 - 150 μg/dL
, Transferrin saturation
90%
20 - 40%
What is a common complication of this condition? - answerHepatocellular carcinoma
13-year-old boy has symptoms of frequent urination and thirst associated with fatigue,
dizziness, headache, and blurred vision. Laboratory tests show that this patient has type
1 or juvenile-onset diabetes mellitus. Which is the MOST common cause of this
disease? - answerdysfunction of pancreatic B-cells
58-year-old man with chronic liver disease presents with recent onset of ascites and
rapid weight loss. Examination reveals a palpable tender liver mass. Paracentesis
reveals hemorrhagic ascitic fluid. CT scan of the liver shows a large intrahepatic
multifocal tumor. Percutaneous fine needle aspiration is positive for hepatocellular
carcinoma. The patient deteriorates rapidly and dies 3 months following presentation.
What is the most important predisposing condition to this cancer in the U.S.? -
answerCirrhosis
56-year-old man with a history of alcohol abuse is diagnosed with chronic pancreatitis.
He is advised to avoid alcohol and is prescribed a low-fat (<20 g/day) diet and
pancreatic enzyme supplements. 1 month later, he presents with fatigue and weight
loss. You suspect a calorie deficit and a poor response to the enzyme supplements.
What is most effective in treating these new symptoms? - answerMedium-chain
triglycerides
63-year-old man, with a 7-year history of chronic pancreatitis believed to be caused by
alcohol consumption, presents with mild abdominal pain. He mentions that he has
occasional abdominal pain, but he is mostly concerned about a sudden weight loss of
15 lb during the last 2 months; he has frequent 'greasy and malodorous' stools. Lab
analysis reveals 169 mg elastase/g stool, and 17 ng/mL of serum trypsin. What is the
most appropriate next step in the patient's treatment? - answerDaily administration of
lipase per meal together with a proton pump inhibitor
50-year-old man presents with 3 weeks of increased urinary frequency, fatigue, weight
loss, and blurred vision. He has a good appetite and tries to stay hydrated by drinking
lots of fluids. Physical exam is remarkable for sores on the feet. Laboratory evaluation
reveals glucosuria and elevated serum glucose. What biochemical effect is associated
with this patient's most likely diagnosis? - answerDecreased tyrosine kinase activity in
skeletal muscle
32-year-old nurse had refractory ulcerative disease, with multiple ulcers in the
duodenum and jejunum. She also had chronic diarrhea. Partial pancreatectomy relieved
some of her symptoms. Figure L7.2 is a light micrograph of a portion of her excised
pancreas. The MOST likely diagnosis is which of the following conditions? -
answergastrinoma
