Hepatobiliary: primary biliary cholangitis: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Hepatobiliary: primary biliary cholangitis

Sample item

A 50-year-old woman has pruritus, fatigue, xanthelasma and a raised alkaline phosphatase. Antimitochondrial antibody is positive. A liver biopsy would most likely show which lesion?

AGround-glass hepatocytes with portal lymphoid folliclesBMacrovesicular steatosis with Mallory-Denk bodiesCOnion-skin periductal fibrosis of large bile ductsDGranulomatous destruction of interlobular bile ducts (florid duct lesion)

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Granulomatous destruction of interlobular bile ducts (florid duct lesion)

Primary biliary cholangitis is an autoimmune disease of small intrahepatic bile ducts and the florid duct lesion shows lymphocytic and granulomatous destruction of the duct. It affects middle-aged women and is marked by AMA against the E2 subunit of pyruvate dehydrogenase. Onion-skin fibrosis is typical of primary sclerosing cholangitis.

Option by option

A. Ground-glass hepatocytes with portal lymphoid follicles
Ground-glass cells and lymphoid follicles suggest viral hepatitis.
B. Macrovesicular steatosis with Mallory-Denk bodies
Steatosis with Mallory-Denk bodies suggests alcoholic liver disease.
C. Onion-skin periductal fibrosis of large bile ducts
Onion-skin fibrosis of large ducts characterises primary sclerosing cholangitis.
D. Granulomatous destruction of interlobular bile ducts (florid duct lesion) (correct)
Correct. The florid duct lesion is the hallmark of PBC.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is D, Granulomatous destruction of interlobular bile ducts (florid duct lesion). Primary biliary cholangitis is an autoimmune disease of small intrahepatic bile ducts and the florid duct lesion shows lymphocytic and granulomatous destruction of the duct.

Why is "Ground-glass hepatocytes with portal lymphoid follicles" not the answer?

Ground-glass cells and lymphoid follicles suggest viral hepatitis.

Why is "Macrovesicular steatosis with Mallory-Denk bodies" not the answer?

Steatosis with Mallory-Denk bodies suggests alcoholic liver disease.

Why is "Onion-skin periductal fibrosis of large bile ducts" not the answer?

Onion-skin fibrosis of large ducts characterises primary sclerosing cholangitis.

What concept does this question test?

It tests Hepatobiliary: primary biliary cholangitis in Pathology. It affects middle-aged women and is marked by AMA against the E2 subunit of pyruvate dehydrogenase. Onion-skin fibrosis is typical of primary sclerosing cholangitis.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Hepatobiliary: primary biliary cholangitis?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.