SPECIAL PATHOLOGY MCQS

Respiratory system

1.

a. b. c. d. e. 2.

a. b. c. d. e. 3.

a. b. c. d. e. 4.

a. b. c. d. e. 5.

a. b. c.

A 25-year-old male patient presents with acute renal failure, which is not amenable to dialysis. He has history of recurrent episodes of hemoptysis and chest radiograph shows focal lung consolidation. What type of antibodies can be responsible for his pulmonary and renal symptoms? Anti smooth muscle antibodies Anti neutrophil cytoplasmic antibodies Antinuclear antibodies Autoantibodies to type IV collage Autoantibodies to type III collagen A 55-year-old huqqa smoker presents with severe dyspnea and slight dry cough. He has a barrel-chest and expiration is prolonged. FEV1 is decreased. Chest X ray shows voluminous lungs overshadowing the heart. What is the principle pathogenetic mechanism for this patients lung disease? Production of autoantibodies against alveolar basement membrane Type IV Hypersensitivity Vasculitis of pulmonary arterioles Protease production by neutrophils and macrophages Squamous metaplasia of bronchial epithelium Following renal transplantation a patient develops high-grade fever with chills and cough productive of mucopurulent sputum. Chest radiograph shows foci of consolidation. Which bacterial infection would you most suspect in this patient? Staphylococcus aureus Klebsiella pneumoniae Pseudomonas Streptococcus pneumoniae Legionella pneumophilia A resident in the surgery department is conducting a survey to identify risk factors for lung cancer in the local population. In which subset of patients is he likely to encounter the highest frequency of tobacco smokers? Squamous cell carcinoma Small cell carcinoma Adenocarcinoma Large cell carcinoma Bronchoalveolar carcinoma A Pathology resident is reviewing slides of cases of lung cancer reported during the last two years. He finds 20 cases of Squamous cell carcinoma, 12 cases of adenocarcinoma, 4 cases of small cell carcinoma, and 2 each of Bronchoalveolar carcinoma and large cell carcinoma. If he orders p53 staining on all these cases which tumor type is likely to be most frequently positive? Adenocarcinoma Squamous cell carcinoma Small cell carcinoma

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d. e. 6. Bronchoalveolar carcinoma Large cell carcinoma A 32-year old female presents with severe respiratory distress. She has a protracted history of dyspnea on mild exertion for the past many years. Chest radiograph shows right ventricular enlargement. There is no history of congenital heart disease, interstitial lung disease or obstructive pulmonary disease. Serological tests for autoimmune conditions are negative. A lung biopsy shows marked medial hypertrophy and intimal fibrosis of pulmonary arterioles. What is the most likely cause for this patients symptoms? Right sided cardiac failure Emphysema Good pasture syndrome Primary pulmonary hypertension Secondary pulmonary hypertension A 4-year-old child, resident of Islamabad has seasonal bouts of breathing difficulty with prolonged cough productive of copious Mucinous secretions, each spring season. Peripheral smear shows eosinophlia during an episode and sputum exam reveal charcoat-laden crystals. What is the most potent mediator of bronchospasm in this patient? TNF- Leukotrienes Interleukins Histamine Prostaglandins What is the common pathogenetic mechanism for all atypical (viral and Mycoplasmal) pneumonias? Production of cross-reacting antibodies to alveolar basement membrane Direct invasion of lung parenchyma by the causative organism Hypersensitivity reaction to mycoplasmal/viral antigens Attachment of organism to upper respiratory tract epithelium followed by necrosis and inflammation Exotoxin production ACTH and ADH production is associated with which histological subtype of lung cancer? Squamous cell carcinoma Adenocarcinoma Small cell carcinoma Carcinoid tumor Large cell carcinoma A 56-year-old male patient of lung cancer develops hoarseness of voice. This symptom is attributable to tumor invasion of: Larynx Trachea Recurrent laryngeal nerve Vagus nerve Sympathetic chain Following bilateral hip replacement surgery a 75-year-old female expires on the tenth post op day. The autopsy pathologist recovers a saddle embolus lying astride the main right and left pulmonary arteries. What is the most probable source of this embolus? Pulmonary veins Inferior vena cava Renal veins Deep veins of the leg Mesenteric veins In pathogenesis of Bronchiectasis the susceptibility to infections is due to: Progressive fibrosis of lung parenchyma Accumulation of thick and viscid secretions obstructing the airways Chronic inflammation of airways leading to epithelial sloughing Immunodeficient status Repeated hospital admissions and exposure to nosocomial infections

a. b. c. d. e. 7.

a. b. c. d. e. 8. a. b. c. d. e. 9. a. b. c. d. e. 10. a. b. c. d. e. 11.

a. b. c. d. e. 12. a. b. c. d. e.

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13. A pathologist performing an autopsy on a 65-year-old male who died after an acute respiratory tract illness notices that the lower lobe of his left lung shows appears grayish brown, firmer than the rest of the lung and has dry cut surfaces. Histological sections from the same show fibromyxoid masses infiltrated by macrophages and fibroblasts. What will you label this lesion as? Lung abscess Squamous cell carcinoma Gray hepatization Red hepatization Atelectasis While examining a bronchoscopic biopsy a pathologist notices a tumor composed of cells smaller than lymphocytes with deeply staining nuclei and scanty cytoplasm. What is the likeliest diagnosis? Adenocarcinoma Large cell carcinoma Squamous cell carcinoma Bronchoalveolr carcinoma Small cell carcinoma During a thoracotomy performed for lung cancer, the surgeon notices a 3.5 cm tumor in hilar region of right lung involving the visceral pleura. How will this tumor be staged according to the International System for Staging of Lung cancer? T1 TIS T2 T3 T4 Male Genital System 16. A 32-year-old male presents with a painless, large testicular mass. Orchidectomy specimen reveals s large pale fleshy mass, 12cm in diameter. Histology consists of nests of uniform cells separated by fibrous bands showing lymphocyte infiltration. The tumor stains negative for AFP and HCG and positive for placental alkaline phosphatase. What germ cell tumor are these features most characteristic of? Seminoma Choriocarcinoma Yolk sac tumor Embryonal carcinoma Teratoma A 32-year-old male presents with cahexia and hemoptysis. Chest X ray reveal multiple hemorrhagic foci in the lungs. Colonoscopy and upper GI endoscopy are unremarkable. No testicular mass is palpable. Serum HCG level is raised; CEA and AFP are within normal range. Lung biopsy from one of the lesions shows massive hemorrhage with few cytotrophoblast and syncitiotrophoblast like elements. What is the diagnosis? Lymphoma Squamous cell carcinoma Metastatic Yolk sac tumor Metastatic Choriocarcinoma Metastatic adenocarcinoma In a patient with mixed germ cell tumor of the testis, which serum marker/markers are best used to monitor response to chemotherapy? AFP and HCG LDH and CEA CEA and AFP Ca-125 CA-19-9 A 55-year-old patient diagnosed to have nodular hyperplasia of prostate is prescribed a 5 alpha reductase inhibitor. Which trophic factor responsible for prostatic hyperplasia will this agent inhibit? Testosterone

a. b. c. d. e. 14. a. b. c. d. e. 15.

a. b. c. d. e.

a. b. c. d. e. 17.

a. b. c. d. e. 18. a. b. c. d. e. 19. a.

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b. Estrogen c. Dihydrotestosterone d. Epinephrine e. Epidermal growth factor 20. While examining a prostatic needle biopsy a pathologist notices a cluster of small crowded, closely packed glands lacking the myoepithelial layer; epithelial cells show prominent pink nucleoli. Adjacent to these are larger glands lined by epithelium and myoepithelium and showing branching and tufting. How will these two types of glands differ in behavior? a. Both are benign b. Both are malignant c. The first cluster is benign d. The second cluster is benign e. The first cluster is more likely to be malignant 21. Of the major specific inflammatory conditions of testis, which invariably effects testis before epididymus? a. Gonorrhoea b. Tuberculosis c. Chlamydia d. Syphilis e. All Gram negative bacterial infections 22. Two males each aged 28 years are diagnosed with Cryptorchidism. One patient has abdominal undescended testis and the other has inguinal undescended testis, what is the risk of both developing testicular cancer? a. The patient with inguinal testis has the higher risk b. The patient with abdominal testis has the higher risk c. Both have equal risk d. Undescended testis is not related to the risk of testicular cancer e. Undescended testis protects against testicular cancer 23. A 25-year-old male presents with a rapidly enlarging painless testicular mass. Serum HCG is markedly raised. A diagnosis of mixed germ cell tumor is made on Histopathology of the orchidectomy specimen. Which component of the mixed tumor is most responsible for the rise in HCG? a. Embryonal carcinoma b. Yolk sac tumor c. Teratoma d. Choriocarcinoma e. Seminoma 24. A 50-year-old male develops acute urinary retention and is catheterized. The prostate is found moderately enlarged on digital rectal examination. Later on serum PSA level is found slightly elevated (8ng/dL). How best will you interpret this result? a. Diagnostic for prostatic adenocarcinoma b. Diagnostic for nodular hyperplasia c. May have resulted from catheterization and digital rectal examination d. The value is falsely high due to analytical lab error e. Normal level for this age 25. A patient with diagnosis of nodular prostatic hyperplasia is unresponsive to medical therapy and is anxious about his risk of developing cancer. What is the most pertinent information you can give this patient? a. He has an 80% risk of developing prostate cancer in the next 5 years b. He has a 50% risk of developing prostate cancer in the next 5 years c. He has a 10% risk of developing prostate cancer in the next 5 years d. He has a 100% risk of developing prostate cancer in the next 5 years e. He is not at risk for prostate cancer since nodular hyperplasia is not a premalignant condition 26. A 25-year-old male presents with infertility and oligospermia is found on semen analysis. Left scrotal sac is empty and an undescended testis is palpable in the left inguinal region, which is excised. The excised testis will most likely show: a. Active spermatogenesis b. Atrophy with no spermatogenesis

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c. d. e. 27. Granulomatous orchitis Hydrocele Leydig cell tumor A 28-year-old male presents with a rapidly enlarging painless testicular mass. Serum alpha feto protein is markedly raised. A diagnosis of mixed germ cell tumor is made on Histopathology of the orchidectomy specimen. Which component of the mixed tumor is most responsible for the rise in alpha feto protein? Embryonal carcinoma Yolk sac tumor Teratoma Choriocarcinoma Seminoma H and E sections from testicular mass of a 24-year-old patient reveal disorganized clusters of glands, cartilage, smooth muscle, bronchial and bronchiolar epithelium. The junior resident examining the case seeks the help of a senior colleague about the presence or absence of immature elements in the teratoma to determine its malignant potential. He is advised that he does not need to search for the immature components in this tumor because: In post pubertal males all teratomas are considered benign All teratomas are benign irrespective of presence or lack of immature components All teratomas are malignant irrespective of presence or lack of immature components All teratomas are considered malignant in post pubertal males Excision is curative for all testicular teratomas A 55-year-old male presents with low back pain, dysuria and suprapubic discomfort. Expressed prostatic secretions contain 15 leukocytes/HPF. Bacterial cultures are negative. What is the diagnosis? Granulomatous prostatitis Acute prostatitis Chronic bacterial prostatitis Chronic abacterial prostatitis Nodular hyperplasia For predicting prognosis of prostatic adenocarcinoma, what is the most important factor besides tumor stage? Perineural invasion Comorbid conditions Tumor grade Immune status Serum PSA levels Female genital System 31. Colposcopic biopsy of a 48-year old woman reveals diffuse Atypia of Squamous epithelium with complete lack of maturation in all layers and no surface maturation. Basement membrane is intact. How will you label this lesion? Normal Squamous metaplasia Invasive Squamous carcinoma CIN I CIN II CIN III A 68-year-old obese postmenopausal woman is at a greater risk of developing endometrial carcinoma than a 40-year-old premenopausal woman with normal weight. How best would you explain this? Advancing age renders the endometrium genetically unstable Post menopausal women are more likely to be taking exogenous hormones Progesterone levels are higher in post menopausal women In post menopausal women there is a greater synthesis of estrogen from body fat Estrogen levels are higher in premenopausal women Endometrial hyperplasia is the forerunner of: Poorly differentiated endometrial carcinoma Moderately differentiated endometrial carcinomas

a. b. c. d. e. 28.

a. b. c. d. e. 29. a. b. c. d. e. 30. a. b. c. d. e.

a. b. c. d. e. 32. a. b. c. d. e. 33. a. b.

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SPECIAL PATHOLOGY MCQS

c. d. e. 34. a. b. c. d. e. 35. Well differentiated endometrial carcinomas All Endometroid endometrial carcinomas Serous endometrial carcinomas H and E stained sections from all ovarian tumors reported in the past one year are reviewed by a pathology resident. What histologic features would favor a diagnosis of serous cyst adenoma? Cyst lined by columnar epithelium with abundant cilia Cyst lined by columnar epithelium without mucin or cilia Cyst lined by transitional epithelium Solid tumor composed of nests of transitional cells Cyst lined by stratified Squamous epithelium A cystic mass removed from the right ovary of a 28-year-old female consists of a cyst wall lined by mature stratified Squamous epithelium with skin appendages. Mature gut and bronchial epithelium, cartilage and thyroid tissue are also present. What malignant transformation is this tumor most likely to undergo? Immature teratoma Squamous cell carcinoma Thyroid follicular carcinoma Adenocarcinoma Chondrosarcoma A 45-year-old female having history of multiple sexual partners is diagnosed as Squamous cell carcinoma of cervix. Genetic material of which virus is most likely to be detected in the tumor? HPV 16 HPV 6 EBV HSV type I HSV type II A 28-year-old female presents with dysmenorrhea, pelvic pain and irregular vaginal bleeding. Ultrasound examination reveals a partly cystic right adnexal mass. Cystectomy specimen is filled with thick chocolate colored fluid and histologic sections reveal a cyst wall lined showing marked hemorrhage, with endometrial glands and stroma along with hemosiderin-laden macrophages. What is the diagnosis? Mucinous cystadenoma Serous cyst adenoma Endometriotic cyst Hemangioma Endometrial carcinoma Papillary serous endometrial carcinoma is graded as: G1 G2 G3 Grading is not applicable Grading would depend on cellular Atypia A 22-year-old female is diagnosed with a malignant germ cell tumor of the ovary that is metastatic to liver, lungs and bone at the time of diagnosis. What is this tumor most likely to be? Yolk sac tumor Dysgerminoma Choriocarcinoma Embryonal carcinoma Teratoma A cystic mass removed from the right ovary of a 28-year-old female consists of a cyst wall lined by mature stratified Squamous epithelium with skin appendages. Mature gut and bronchial epithelium and cartilage are also present. What is the expected karyotype of this tumor? 46XX 46XY 45Y 47XXY 45X

a. b. c. d. e. 36. a. b. c. d. e. 37.

a. b. c. d. e. 38. a. b. c. d. e. 39. a. b. c. d. e. 40.

a. b. c. d. e.

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41. While working in a gynecology department in a remote district of southern Punjab you notice a high number of patients presenting with advanced cervical cancer. In order to screen for cervical cancer so that these patients can be detected at an earlier stage of the disease what test would you request your laboratory to start doing? a. HPV DNA by PCR b. HPV DNA by hybridization c. p53 staining on all colposcopic biopsies d. p16 staining on all colposcopic biopsies e. Papanecolaou cytology for cervical smears 42. A 58-year-old nulliparous woman with history of functional menstrual abnormalities is most likely to develop: a. b. c. d. e. 43. Endometroid endometrial carcinoma Cervical Squamous cell carcinoma Cervical adenocarcinoma Ovarian cystadenocarcinoma Endometrial stromal tumor

a. b. c. d. e. 44. a. b. c. d. e. 45.

a. b. c. d. e.

An endometrial adenocarcinoma grossly involving the uterine corpus and extending into cervix hiostologically shows a well-differentiated and easy recognizable glandular pattern. What is the tumor grade and stage? Stage I, Grade I Stage II, Grade I Stage I, Grade II Stage II, Grade II Stage III, Grade I Struma ovarii is a monodermal teratoma composed of: Bone Cartilage Thyroid tissue Skin and appendages Skeletal muscle A 45-year-old female presents with massive abdominal distension causing respiratory distress. An emergency laparotomy reveals massive Mucinous ascites and adhesions with a large left ovarian tumor, which is later, reported as a borderline Mucinous neoplasm. What is this condition known as? Meigs syndrome Pseudomyxoma peritonei Krukenberg tumor Carcinomatosis Mullerian Mucinous cystadenoma Diseases of the breast

46.

a. b. c. d. e. 47.

a.

A 32-year-old female presents with a painless, irregular firm to hard mass in her right breast. She has history of trauma to the breast. Excised mass consists of foci of necrotic fat cells surrounded by macrophages and intense inflammatory reaction. What is the diagnosis? Acute mastitis Invasive carcinoma Fat necrosis Fibroadenoma Lipoma During a mastectomy for invasive carcinoma of breast, the surgeon injects dye into the tumor, localizes and resects the first lymph node to take up the dye. The lymph node is reported negative for metastases on frozen section examination. How will this effect the management of this patient? The patient must undergo complete axillary clearance

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SPECIAL PATHOLOGY MCQS

b. c. d. e. 4 Lumpectomy will be curative in this patient Quardrantectomy will be curative in this patient The patient can be spared complete axillary clearance A negative result is of no significance 48. Two female patients of the same age are diagnosed with breast cancer. Mastectomy specimen of the first patient reveals Ductal carcinoma in situ without invasive component; the other patient has a 2cm invasive component in her tumor. Both are node negative and have no distant metastases. What does this tell you about the prognosis of these patients? Prognosis will be similar in both patients Patient with DCIS is likely to have a better prognosis Patient with invasive component is likely to have a better prognosis Prognosis is determined by response to chemotherapy Prognosis will depend on the histological type of both tumors 49. A surgeon examines two patients of clinically suspected breast carcinoma; the palpable tumor size is 2cm in one patient and 4cm in the second patient. What can he deduce about the lymph node status of these patients? Tumor size does not predict lymph node status First patient will have involved axillary lymph nodes Second patient will have involved axillary lymph nodes Both will have involved axillary lymph nodes Both will have uninvolved axillary lymph nodes 50. Which breast lesion carries the greatest risk of developing into an invasive carcinoma? Fibroadenoma Papilloma Atypical ductal hyperplasia Low grade DCIS High grade DCIS What is the commonest causative organism for acute mastitis? Streptococcus aureus Staphylococcus aureus E coli Pseudomonas Candida albicans A 35-year old female patient is diagnosed to have Invasive ductal carcinoma of the right breast. Her grandmother and two maternal aunts have had breast cancer below 40 years of age. What genetic mutation is she likely to carry? c-Myc K-Ras BRCA 1 or 2 p53 INK4A A 55-year-old female is found to have 3cm mammographic density with irregular borders and calcification in her left breast. There is a 90% likelihood that this lesion is a: Benign lesion Invasive carcinoma Insitu carcinoma Sclerosing condition Sarcoma The designations ductal and lobular with reference to carcinoma of the breast refer to: Tumor growth patterns Cell of origin of the tumor Tumor Grade Degree of invasiveness Anatomic site of origin of tumor Examination of a mastectomy specimen in the pathology lab reveals an eczema-like erythematous eruption on the nipple with scale crust. Underlying this is an invasive ductal carcinoma. H & E sections

a. b. c. d. e.

a. b. c. d. e. 5 a. b. c. d. e. 51. a. b. c. d. e. 52.

a. b. c. d. e. 53. a. b. c. d. e. 54. a. b. c. d. e. 55.

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a. b. c. d. e. 56. from the nipple show presence of large atypical cells in the epidermis with no breech of the basement membrane of the skin. What is this condition called? Dermatitis Psoriasis Inflammatory carcinoma Comedocarcinoma Pagets disease A 30-year-old female smoker presents with a painful subareolar mass in her left breast. On examination the nipple is found to be inverted. Histology of excised lesion shows squamous metaplasia of lactiferous duct with abundant keratin trapped in the lumen. Adjacent tissue shows chronic inflammation. What is the diagnosis? a. b. c. d. e. 57. a. b. c. d. e. 58. Pagets disease Acute mastitis Fat necrosis Periductal mastitis Mammary duct ectasia

a. b. c. d. e. 59.

a. b. c. d. e. 60. a. b. c. d. e.

The history of a 35-year-old female presenting with menorrhagia shows that she was operated for a fibroadenoma in her left breast five years back. What is this lesion? Inflammatory disease Malignant epithelial neoplasm Benign epithelial neoplasm Reactive fibrohistiocytic lesion Sarcoma Two 60-year-old women are recruited into a screening program for breast cancer. The first woman (A) gave birth to her first child at 18 years of age while the second woman (B) had her first issue at 34 years. If all other factors are considered equal which statement is most accurate regarding the relative risk of the two women developing breast cancer? Both have equal risk A has the greater risk B has the greater risk Both have no risk since parity prevents breast cancer Both have no risk since breast cancer is rare after 60 years of age FDA has banned hormonal replacement therapy for treatment of postmenopausal symptoms since it was found to be associated with an increased risk of developing breast cancer. How can this be best explained? Prolonged exposure to estrogen increases the risk of breast cancer Prolonged exposure to progesterone increases the risk of breast cancer All hormones exogenously administered increase the risk of breast cancer Post menopausal women are at increased risk of breast carcinoma regardless of hormonal status The relative excess of androgens in post menopausal women is protective against breast cancer Of the histological subtypes of breast carcinoma, which metastasizes most frequently to peritoneum, reteroperitoneum and leptomeninges? Invasive ductal carcinoma Lobular carcinoma Mucinous carcinoma Medullary carcinoma Metaplastic carcinoma Musculoskeletal, Bones and joints

61.

A 55-year-old female patient presents with deep aching pain in the right knee joint. Clinical exam reveal osteophytes (Heberdon nodes) at distal interphalangeal joints of hands. X ray shows narrowing of joint

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a. b. c. d. e. 62. space, subchondral sclerosis and osteophytes lipping. Serum RA factor is negative. This pathological process primarily targets: Hyaline cartilage Subchondral bone Articular cartilage Synovium Periosteum A 30-year old female presents with morning stiffness with pain and swelling of metacarpophalangeal joints and proximal interphalangeal joints of her hands. Serum RA factor is positive. This condition results from an autoimmune reaction against: Articular cartilage Periosteum of bone Hyaline cartilage Synovium Unknown arthritogenic antigen Juvenile rheumatoid arthritis affects: a. b. c. d. e. 64. Larger joints more frequently than smaller joints Smaller joints more frequently than larger joints Both large and small joints equally Only knee joint Only small joints of fingers

a. b. c. d. e. 63.

a. b. c. d. e. 65.

a. b. c. d. e. f.

Several days after an episode of urethritis a 28 yr old man develops acute pain and swelling of the left knee. On physical examination the knee is swollen and is warm and tender to touch. No other joints appear to be affected. Lab exam of fluid aspirated from the left knee joint shoes numerous neutrophils. A gram stain of the fluid shows gram ve intracellular diplococcic. No crystals are seen. Which is the most likely orgasnism? Borrelia burgdorferi Treponema pallidum Neisseria gonorrhoeae Staphylococcus aureus Haemophilus influenza A 47 yr old man sees the physician because he has had dull constant pain in the mid section of the right thigh for the past 4 months. On physical exam there is pain on palpation opf the anterior right thigh which worsens slightly with movement. The right thigh appears to have a larger circumference than the left thigh. A radiogaraph of the right upper leg and pelvis shows no fracture but there is an ill defined soft tissue mass anterior to the femur. MRI shows a 10 8 7 cm solid mass deep to the quadriceps but it does not involve the femur. What is the most likely diagnosis? Nodular fasciitis Liposarcoma Osteosarcoma Rhabdomysarcoma Haemangioma Chondrosarcoma - See more at: http://medilinks.blogspot.com/2011/10/normal-0-false-false-false-en-us-xnone.html#sthash.sVt4uoqa.dpuf

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