PATHOLOGY MCQ POOL (RMC 4TH YEAR)

(COURTESY PROF-DR ABBASS HAYAT- HOD RMC)

NOTE: the answers have been marked but don’t blindly follow them,
use your knowledge & mind.

DEPARTMENT OF PATHOLOGY, RAWALPINDI MEDICAL COLLEGE

RAWALPINDI Send Up 17/09/2012
MCQ`S Paper Time allowed: 65 minutes
Total Marks: 65
Attempt all questions. Mark the appropriate square on the response
sheet

A 29 years old women presents with heat intolerance, nervousness, weight

loss, protruded eyes & diffuse enlargement of thyroid. On Lab examination,
TSH is decreased. Histologic sections from thyroid reveal increased
cellularity with scalloping of the colloid at the margins of the follicles. Which
of the following antibodies are more specific for this individual disease:

1. Antimicrosomal antibodies
2. Antithyroglobulin antibodies
3. TSH – receptor – stimulating antibodies
4. d. Antithyroid peroxidase antibodies
5. TSH – receptor – blocking antibodies

A 45 year old female diagnosed case of follicular variant of papillary

carcinoma of thyroid presented with mass in the abdomen. CT scan shows
left adrenal mass. Excision biopsy shows metastatic thyroid carcinoma on
the basis of microscopic features which includes colloid follicles, nuclear
grooves , optically clear nuclei and the presence of:

1. Russell’s bodies
2. b. Psammoma bodies
3. Apoptotic bodies
4. Myelin figures
5. Mallory bodies

Most common form of Cushing’s Syndrome is :

1. Due to pituitary tumors

2. Due to adrenal lesions
3. Due to Ectopic production of Cortisol
4. d. Iatrogenic(drug induced)
5. Due to renal insufficiency.

A patient of Cushing’s syndrome was given high doses of Dexamethasone.

It can suppress hyper cortisolism is due to:

1. a. Pituitary or hypothalamic lesions

2. Adrenal carcinoma
 3. Ectopic Cortisol production
4. Exogenous glucocorticoids intake
5. Loading effect

An old lady 58 years of age c/o gradual on set of bone pain, anorexia,
constipation, polyuria, polydipsia and muscular weakness. Her serum Ca
and Alk phosphatase were raisedand PO4 was low. She was probably
suffering from:

1. Hypercalcemia
2. Hypophosphatemia
3. Bone tumor
4. d. Hyperparathyroidism
5. Hypoparathyroidism

An old-man living alone was found comatosed inhis home in the suburbs of
Newyork city on sunday morning. He was shifted to hospital. His LFT
showed SBilirubin 150mg/dl, ALT 400 iu, AST 1600 iu, Alk Phosphatase
300iu. What further test would you like to perform to look for the cause of
his unconciousness?

1. PT & APTT
2. HBsAG
3. AntiHCVab
4. d. GTT
5. S Albumin

A 58yrs old man presented to his family doctor with weight loss,
generalized weakness, and lethargy of 6 months’ duration. He c/o Polyuria
especially at night. He had become impotent. On examination, pt found
tobe slightly anemic, BP was 185/115. His urine contained protein but no
glucose. His serum Na was 130, K 5.2,HCO3 16 mmol/L, Urea 65mg/dl,
creatinine 5.3 mg/dl, Glucose R 135mg/dl, Alk phosphatase 205 U/L, &Hb
9.1 g/dl. Patient was suffering from,

1. Diabetes mellitus
2. Diabetes insipidus
3. Nephrotic syndrome
4. Renal osteodystrophy
5. Chronic renal failure

1. An 8 yrs old girl was admitted to hospitalwith generalized oedema.

Her urine became frothy and family doctor had found proteinuria.
Results of other investigations showed serum is lipemic with raised
total cholesterol and triglyceride levels. Her Na, K, Urea, Creatinine
levels were low. Total proteins and serum albumin were also low.
 Urinary protein excretion in 24 hrs was 12g/L. In your opinion what is
the diagnosis?
2. Hyperlipidemia
3. Hypoproteinemia
4. Ac. renal failure
5. Ac. fluid overload
6. Nephrotic syndrome

Bulla is fluid filled raised lesion 5mm or less in diameter. Which skin lesion
is associated with bulla formation?

1. Erythema multiforme
2. Lichen planus
3. Psoriasis
4. Pemphigus
5. Panniculitis

In most laboratories a serum PSA level of 4ng/mL is taken as cutoff point

between normal and abnormal. Serial measurements of PSA are of great
value in;

1. a. Assessing response to radiotherapy

2. Diagnosing prostatic cancer
3. Chronic prostatitis
4. Benign prostatic hyperplasia
5. Prostatic Infarction

In prostatic adenocarcinoma fatal outcome is associated with;

1. Gleason score
2. Gleason grade
3. Raised PSA levels
4. Associated chronic prostatitis
5. e. Lymph node Metastases

Following serum tumor markers are helpful in supporting testicular

neoplasm. In yolk sac tumour of testis which marker is raised?

Beta HCG

Alpha Fetoprotein

LDH

Placental Alkaline phosphate

Placental lactogen
Alzheimer disease is the most common cause of dementia in the elderly.
Autopsy of the patient died of this disease shows characteristic histological
features in the brain which of the following is not a feature of this disease.

1. Neuritic plaques
2. Neurofibrillary tangles
3. Cerebral amyloid angiopathy
4. Granulovacuolar degeneration
5. e. Lewy body

A 40 year old male is diagnosed to have gout. The different pathological

lesions associated with gout do not includes.

1. Acute arthritis
2. Chronic tophaceous arthritis
3. Tophi
4. Gouty nephropathy
5. e. Gouty retinopathy

A 5 year old child presented with a mass in the nasal cavity. A biopsy was
taken from the mass. Morphology shows hyperchromatic round tumor cells
forming submucosalzone of hypercellularity called cambium layer. This
feature is seen in which type of sarcoma?

1. Alveolar
Rhabdomyosarcoma
2. Ewing sarcoma
3. c. Embryonal
Rhabdomyosarcoma
4. Ostesarcoma
5. PNET

1. Malignant melanoma is a very aggressive neoplasm. Its common site

is skin. Other primary sites are oral and anogenital mucosal surfaces,
esophagus and meninges. Identify one more primary site where this
lesion can occur.
2. Breast
3. Brain
4. c. Eye
5. Liver
6. Testis

X-ray skull of a 60 year old male showed multiple punched out lytic lesions.
Identify the neoplasm which produces such lesions.

1. Ewing sarcoma
2. Giant cell tumor
3. Lymphoma
 4. d. Multiple myeloma
5. Metastatic prostatic carcinoma

A 50 year old female presented with bilateral breast lumps. Mammography

showed densities with irregular borders. FNA of both lumps shows
malignant cells. Which histological type of malignancy usually presents with
this clinical picture.

1. Invasive ductal carcinoma

2. b. Invasive lobular carcinoma
3. Medullary carcinoma
4. Mucinous carcinoma
5. Tubular carcinoma

In a 30 year old female breast lump of 2cm is excised having irregular

borders. Histopathology report shows sclerosing adenosis. Which lesion is
not a part of benign proliferative breast disease?

1. Complex sclerosing lesion

2. Duct ectasia
3. Epithelial hyperplasia
4. d. Fibrocystic change
5. Papilloma

Which one is the most important prognostic factor in the carcinoma of

breast?

1. Age
2. b. Axillary lymph node metastases
3. Involvement of resection margin
4. Tumor grade
5. Tumor necrosis

Mammographic report of 40 year old female shows linear branching pattern

of calcification. This type of calcification is characteristic of;

1. a. Ductal carcinoma in Situ

2. Fibrocystic change
3. Fibroadenoma
4. Invasive ductal carcinoma
5. Phyllodes tumor

Liver biopsy of thalassemic patient was submitted to look for Iron pigment
load. Which stain can be helpful in the demonstration of iron in liver tissue?

1. Crystal violet
2. Fontana Masson
3. c. Perl stain
4. Reticulin stain
5. Von Kossa
A liver biopsy of a 45year old obese female shows hepatic steatosis .Which
condition is not associated with Hepatic steatosis?

1. Alcoholic hepatitis
2. Aspirin toxicity
3. HCV positive Hepatitis
4. NASH
5. e. Rotor’s syndrome

A 45 year old female gives h/o off and on RHC pain from the last 1
year . Her U/S shows multiple gall stones. Patient is not willing for the
surgery. The clinician explains the complication of cholelithiasis to the
patient. Which one is not associated with it?

1. Biliary obstruction
2. b. Hepatic abscess
3. Intestinal obstruction
4. Malignancy
5. Pancreatitis

25. A 35 year old married female having multiple gallstones is waiting for
the surgery. One day she presented in the emergency with acute abdomen.
Pain is continuous and also referred to the upper back. Lab investigation
shows elevated Serum amylase and lipase levels. What is your diagnosis?

1. a. Acute pancreatitis
2. Acute gastritis
3. Chronic pancreatitis
4. Ruptured tubal pregnancy
5. Perforated duodenal ulcer

A healthy medical student has completed the course of HBV vaccination.

To check his immunization status which serological test should be positive?

1. HBsAg
2. Anti-HBC IgM
3. Anti-HBC IgG
4. d. Anti HBS
5. Raised serum ALT levels

Liver biopsy of a 35 year old female suffering from jaundice and pruritus
showsperiductal onion skin fibrosis a characteristic feature of;

1. Chronic hepatitis
2. Cirrhosis
3. c. Primary sclerosing cholangitis
4. Primary biliary cirrhosis
 5. Secondary biliary cirrhosis

After few months of modified radical mastectomy and axillary lymph node
dissection for carcinoma of left breast patient develops swelling and
puffiness of left arm. On examination the swelling was generalized painless
and non- pitting in nature .What could be the reason of this swelling?

1. a. Lymph edema due to lymphatic

obstruction
2. Subclavian artery thrombosis
3. Thrombophlebitis
4. Tumour embolization
5. Vasculitis

Autopsy of a 50 year old male with sudden death showed 80 % narrowing

of left coronary artery due to atherosclerosis. Which of the following cells is
least involved in the pathogenesis of this type of coronary lesion?

1. Endothelial cells
2. Monocytes
3. c. Neutrophils
4. Platelets
5. Smooth muscle cells

A 55 year old male with severe attack of acute myocardial infarction dies
within half hour. Which complication is the cause of his death?

1. Myocardial rupture
2. Pericarditis
3. Thromboembolism
4. Ventricular aneurysm
5. e. Ventricular fibrillation

A patient of Non Hodgkin lymphoma is receiving cytotoxic antitumour

drugs. Which type of cystitis is suspected in these patients?

1. Chronic cystitis
2. Eosinophilic cystitis
3. Follicular cystitis
4. d. Hemorrhagic cystitis
5. Suppurative cystitis

A 40 year old male presented with right testicular enlargement.

Orchidectomy was performed and histological diagnosis of Seminoma was
given. An identical tumour arises in the ovary is called as;

Choriocarcinoma

Dysgerminoma

Embryonal carcinoma
Endodermal sinus tumour

Granulosa cell tumour

The skin lesion which is not associated with disorders of pigmentation is;

Freckles

Melasma

Leucoderma

Psoriasis

Vitiligo

The disease associated with reduced osteoclasts bone resorption results

in brittle and fragile bone called as;

Osteomas

Osteomalacia

Osteoporosis

Osteopetrosis

Osteodystrophy

35. A 50 yrs old alcoholic male develops bilateral enlargement of breasts

resembling adolescent female breast. The lesion is termed

Fibroadenoma

Fibrocystic disease

Gynaecomastia

Phyllodes tumor

Mastitis

A 65 yrs old female reports with recurrence of a mass in her left breast.
She gives history of lumpectomy two years back but has lost her medical
record. Bipsy of the lesion shows increased stromal cellularity and
cytologicatypia giving rise to the typical leaf like architcture. The diagnosis
is
Fibroadenoma

Lactational adenoma

Myofibroblastoma

Phyllodes tumor

Gynaecomastia

A 20 yrs old lady with a family history of breast carcinoma is very

apprehensive. The hereditary susceptibility to breast cancer is associated
most strongly with the following gene/genes mutation

APC

BRCA 1

P53

CHEK 2

e. BRCA 1 & BRCA 2

The screening test used for the early detection of breast cancer in elderly
is called

Ultrasonography

Fine needle aspiration

Mammography

CT scan

MRI

A 23 yrs old female patient presents in the outpatient department two

weeks after delivery with red, swollen, very painful left breast. The nipples
of both breasts are cracked and she is running high grade fever. The most
likely diagnosis is

1. a. Acute mastitis
2. Periductal mastitis
3. Mammary duct ectasia
4. Fat necrosis
5. Pagets disease
A 20 yrs old male presents in the surgical OPD with multiple slightly painful
slowly growing swellings on his back. Biopsy of one of the swellings reveals
fibrousstroma and interspersed short fascicles of spindle cells having wavy
nuclei. The lesion is

1. Schwannoma
2. b. Neurofibroma
3. Meningioma
4. Fibroma
5. Metastatic carcinoma

Transtentorial herniation of the temporal lobe of the brain is most

commonly a consequence of which of the following

1. Intracranial hemorrhage
2. b. Increased intracranial pressure
3. Cerebral edema
4. Hydrocephalus
5. Meningitis

A 14 yrs old boy in a village died after being bitten by a stray dog, which
was diagnosed to be suffering from Rabies. On autopsy the pathognomic
microscopic findings are bullet shaped cytoplasmic inclusion in pyramidal
neurons of the hippocampus and Purkinje cells of cerebellum. These
inclusions are called

1. Lofra bodies
2. b. Negri bodies
3. Corpora amylacea
4. Polyglucason bodies
5. Lewybodles

An 8 yrs old boy complains of severe headache and vomiting. On

examination his gait is also disturbed. On suspicion of brain tumor, CT scan
was ordered which showed a tumor located in the mid line of cerebellum.
The tumor is removed by surgery. Grossly it is gray and friable. On
microscopic examination extremely cellular neoplasm composed of sheets
of small round cells having hyperchromatic nuclei. The tumor is

1. Astrocytoma
2. Ependymoma
3. Meningioma
4. d. Medulloblastoma
5. Lymphoma

Glioblastomamultiforme a variant of infiltrating astrocytoma belongs to

which of the following WHO tumor grade

1. Grade 0/IV
2. Grade I/IV
 3. Grade II/IV
4. Grade III/IV
5. e. Grade IV/IV

A 50 yrs old diabetic female patient visits the gynecology OPD with
complaints of marked vulvoviginalpruritis and curd like vaginal discharge.
On PAP smear there are benign squamous cells, endocervical cell groups,
neutrophils and filamentous hyphae. The causative agent of this infection is

1. Trichomonas
2. Gardenerella
3. c. Candida
4. Chlamydia
5. Mycoplasma

A 40 yrs old female went to her gynaecologist for PAP screening after
reading an article about cervical cancer in a magazine. She gave history of
having sex with multiple partners. The report of the PAP smear showed
severe dysplasia of exfoliated squamous cells. Colposcopy was performed.
Cervical biopsy was taken and was reported as carcinoma in situ. This
means

1. Low grade SIL

2. b. High grade SIL
3. Microinvasive carcinoma
4. Invasive carcinoma
5. Inflammatory lesion

Endometriosis is the presence of endometrial tissue outside the uterus. The

most common site includes;

1. a. Ovaries
2. Uterine ligaments
3. Retrovaginal septum
4. Cul de sac
5. Pelvic peritoneum

A 54 yrs old post menopausal female suffering from irregular vaginal

bleeding for last two months undergoes ultrasound examination. A mass 9
cm in diameter, invading the uterine wall is reported. Hysterectomy is
performed. On gross examination the mass is bulky and fleshy.
Histopathologist reports it as leiomyosarcoma. Which microscopic features
distinguish it from leiomyoma?

1. Nuclear atypia
2. Mitotic index
3. Anaplasia
4. Nuclear atypia and mitotic index
 5. e. Nuclear atypia, mitotic index and zonal necrosis.

A 19 yrs old female presents in the OPD with a gradually enlarging mass in
the lower abdomen. She is having regular menstrual cycles. Ultrasound
shows a cystic mass 10cm in diameter in the right ovary. The mass is
removed. On cut opening unilocularcyst filled with cheesy material,tufts of
hair and tooth is seen. Which of the following tumors shows these
features?

1. a. Benign mature cystic Teratoma

2. Dysgerminoma
3. Endodermal sinus tumor
4. Teratoma
5. Sertoli-Leydig cell tumor

A 32 yrs old female married for 7 yrs is seeking treatment for primary
infertility. She gives history of irregular menstrual cycles, dysmennorhea
and pelvic pain. Ultrasound pelvis shows distortion of both ovaries by cystic
masses 3-5 cm in diameter, filled with reddish brown thick fluid. The most
probable diagnosis in this lady is

1. Dysfunctional uterine bleeding

2. b. Endometriosis
3. Adenomyosis
4. Ovarian tumors
5. Pelvic inflammatory disease

A teenage boy presented with orbital odema and proteinuria. The

commonest cause of nephrotic syndrome in children is

1. Membranous glomerulonephritis
2. b. Minimal change disease
3. Focal segment glomeruloseclerosis
4. Membranoproliferative glomerulonephritis.
5. IgA nephropathy

A 6 yrs old child is brought to the paeds department. He is suffering from

generalized edema. Serum albumin level is 2g/dl and there is massive
proteinuria. Which other feature is required for a diagnosis of nephrotic
syndrome.

1. Hyperbilirubinemia
2. Azotemia
3. Glycosuria
4. d. Hyperlipidemia &lipiduria
5. Lipiduria

Acute kidney injury (AKI) is a clinicopathological entity characterize byacute

diminution of renal function. The renal tissue shows morphologic evidence
of
 1. Glomerular injury
2. Interstitial inflammation
3. c. Tubular injury
4. Arteritis
5. Medullary injury

A 50 yrs old female suffering from fever and painless hematuria. On

palpation there is mass in the left flank. Ultrasound confirms a tumor 7 cm
in diameter on the upper pole of left kidney. These findings suggest
diagnosis of

1. Adrenocortical carcinoma
2. Renal cell carcinoma
3. Renal cyst
4. Renal adenoma
5. Pheochromocytoma

1. A 70 yrs old male has developed swelling in the left parotid gland. It is
6cm in diameter and has gradually reached the present size over a
period of 4 yrs. FNA of the lesion shows chondromyxoidstroma and
groups of epithelial and myoepithelial cells. The tumor is
2. Pleomorphic adenoma
3. Mucoepidermoid carcinoma
4. Warthin tumor
5. Sialadentis
6. Acinar cell tumor

A 53 year old female cardiac patient underwent unremarkable

hysterectomy but suddenly collapsed on the second post operative day
after becoming breathless. This is a presentation of

1. Pulmonary hemorrhage
2. Pulmonary embolism
3. Pulmonary infarction
4. Pulmonary hypertension
5. Pulmonary odema

A lung condition characterized by enlargement of air spaces distal to the

terminal bronchiole accompanied by destruction of walls and without
obvious fibrosis is labeled as:

1. Chronic bronchitis
2. Bronchiectasis
3. Asthma
4. Emphysema
5. Pneumonia
A lung condition characterized by formation of non-caseating granulomas
and asteroid bodies is known as

1. Sarcoidosis
2. Tuberculosis
3. Idiopathic pulmonary fibrosis
4. Pneumoconiosis
5. Silicosis

A 53 year old male having chronic cough develops hemoptysis. He is a

heavy smoker for the last 30 years. X-ray chest shows an opacity 3cm in
diameter on the left side. Sputum examination is positive for malignant
cells. The most common lung tumor correlated with a history of smoking is

1. Large cell carcinoma

2. Small cell carcinoma
3. Squamous cell carcinoma
4. Adenocarcinoma
5. Carcinoid tumour

Persons with heavy exposure to asbestos are at risk of developing

1. Pleuritis
2. Hydrothorax
3. Malignant mesothelioma
4. Pneumothorax
5. Pleural effusion

A 4 years old boy presented with history of fluctuating jaundice .On

examination the patient was pale, jaundiced with splenomegaly .Initial
laboratory evaluation revealed Hb 6g/dl, MCV 99fl, MCH 27pg, WBC 6x
109/l, platelet count 250x109/l. Reticulocyte count is increased .What is the
most probable diagnosis.

1. Iron deficiency anaemia

2. Aplastic anaemia
3. Leukaemia
4. Haemolyticanaemia
5. Haemophilia

A 60 years old male presented with complaints of abdominal pain and fever
for last 1 month.On examination there is massive splenomegaly.
Laboratory evaluation shows leucocytosis 50x109/l. Hb 9g/dl with normal
platelet count. Bone marrow examination showed myeloid hyperplasia
with bimodal peak of neutrophils and myelocytes .What is the most
probable diagnosis:

1. Infection/sepsis
2. Chronic neutrophilic
leukemia
 3. Chronic lymphocytic
leukemia
4. Chronic myeloid leukemia
5. Acute myeloid leukemia

Autosomal Dominant pattern of inheritance is seen in

1. Pyruvate kinase deficiency

2. Hereditary spherocytosis
3. Sickle cell anaemia
4. Gauchers disease
5. G6PD Defeciency

A 34 years old multigravida pregnant lady presented with complaints of

shortness of breath on mild exertion and fatigue. Complete blood picture
showed Hb 7.8g/dl , MCV 62fl , MCH 17pg ,WBC 5x109/l and platelet count
300x109/l.Peripheral film showed microcytic hypochromic picture with
pencil cells .Laboratory investigation will reveal :

1. Serum Iron ↓ , TIBC ↑ ,Serum ferritin↓.

2. Serum Iron ↓ , TIBC ↓ ,Serum Ferritin Normal
3. Serum Iron ,TIBC ,Serum ferritin all normal
4. Serum Iron ↑ , TIBC Normal, Serum Ferritin ↑
5. Serum Iron ↓, TIBC ↓,Serum Ferritin ↓

A 14 years old boy presented with complaints of high grade fever, fatigue
,anorexia and gum bleed for last 1 week .Complete blood picture showed
pancytopenia with increased WBC count. Peripheral film showed
blasts.Bone marrow aspiration showed hyper cellular marrow with 98%
blasts.

1. Chronic lymphocytic leukemia

2. Lymphoma
3. Acute leukemia
4. Multiple myeloma
5. Chronic myeloid leukemia

Paper setters: Prof. Abbas Hayat . Asst. Prof. Dr Erum Nadeen Rana ,
Asst. Prof. Dr. Imtiaz Qureshi

TOPIC= ENDOCRINOLOGY
MCQS:
1. A 25 year old lady suffers from secondary amennorhea (loss of mensus) and
galactorhea, she is diagnosed the most common pituitary tumor, the lady is
suffering from
a) Acromegaly
 b) Prolactinoma
c) Growth hormone adenoma
d) Bronchogenic carcinoma
2. Name the excellent test for screening of thyroid dysfunction
a) T3
b) T4
c) TSH
d) Anti peroxidase antibodies
3. A lady suffers from bradycardia, proximal myopathy, menorrhagia, on
examination there is delayed recovery of Achilles deep tendon reflex, what
is your diagnosis?
a) Graves disease
b) Addisons disease
c) Hypothyroidism
d) Cushing syndrome
4. A patient presents with lab findings consistent with hyperthyroidism, on
examination he has all features of hyperthyroidism except exophthalamus
& pretibial myxedema.what is the diagnosis
a) Grave’s disease
b) Hashimoto’s thyroditis
c) Sub acute granulomatous thyroiditis
d) Toxic multinodular goiter
5. A 34 yr old female is diagnosed with the most common endocrine
malignant tumor, she works in radiology department.histology shows
psamomma bodies & orphan annie eye nuclei. Diagnosis
a) Follicular adenoma of thyroid
b) Papillary adenocarcinoma of thyroid
c) Neuroblastoma
d) pheochromocytoma
6. A patient presents with renal colic, he is found to have calcium stones in
kidneys. He also gave a history of constipation, dyspepsia and bone pains.
XRAY shows salt & pepper appearance of skull.diagnose
a) Primary hyperparathyroidism
b) Secondary hyperparathyroidism
c) Autoimmune hypoparathyroidism
d) Digeorge syndrome
7. A 50 yr old lady presents with weakness and dizziness, on examination
diffuse hyperpigmentation can be seen on buccal mucosa & skin creases.lab
reports show eosinophilia, lymphocytosis & neutropenia. What is your
diagnosis?
 a) Addisons disease
b) Graves disease
c) Adrenogenital syndrome
d) Cushing disease
8. A fetus is screened for abnormalities by chorionic villus sampling, he is
found to have increased serum 17-OH progesterone. What is he suffering
from?
a) Diabetes type 1
b) Cretinism
c) Adrenogenital syndrome
d) dwarfism
9. A child 2 yrs old presents with myoclonic jerks of extremities and chaotic
eye movements in all direction. Homer- wright rosettes are present, he is
suffering from
a) Pheochromocytoma
b) Neuroblastoma
c) Papillary carcinoma thyroid
d) insulinoma
10.Knuckle- knuckle-dimple-dimple sign present in
a) Acute pancreatitis
b) Diebetic ketoacidosis
c) Pseudohypoparathyroidism
d) cretinism

TOPIC CVS MCQS

1. superficial migratory thrombophlebitis is associated with which
carcinoma?
a) Small cell carcinoma of lung
b) Renal cell carcinoma
c) Pancreatic carcinoma
d) Squamous cell carcinoma of skin
2. A 25 yr old pregnant lady presented to OPD with severe pain in right
leg, on examination right leg was swollen and its circumference was
>3 cm as compared to left leg. Homan’s sign was positive. What is
she suffering from?
a) Superficial thrombophlebitis
b) Deep venous thrombosis
c) Peripheral arterial disease
d) Ruptured popliteal aneurysm
3. A women complaint of paresthesias and frequent falling asleep of her
arms, on examination adson test is positive, what is your diagnosis?
 a) Peripheral arterial diseases
b) Superior vena caval syndrome
c) Thoracic outlet syndrome
d) Deep venous thrombosis
4. A women complaints of cough that is noisy(brassy cough),on
examination she has wide pulse pressure & bounding pulse, the
doctor calls it water hammer pulse, there is an early diastolic
murmur. What is your diagnosis?
a) Reynaud’s phenomena
b) Wegener granulomatosis
c) Chrug strauss syndrome
d) Endarteritis obliterans
5. A 70 yr old man who is hypertensive presents to ER with complaint of
severe occipital headache that he describes as worst headache I ever
had, on examination he has nuchal rigidity, and CT scan brain is
advised. What do you think the patient is suffering from?
a) ruptured berry aneurysm
b) space occupying lesion
c) meningitis
d) encephalitis

6. A person presents with severe dyspnea, complaining that he cannot

take a full inspiration, on examination bibasilar inspiratory crackles
(rales) are heard. He also complains of cough with rust colored
sputum. Chest radiographs show bat wing configuration, kerley lines
and fluffy alveolar infiltrates. Diagnosis
a) right heat failure
b) pulmonary fibrosis
c) left heart failure
d) myocardial infarction
7. A person presents to ER with pain in right hypochondrium, on
examination he is cyanosed and has tender hepatomegaly, he was
diagnosed a case of right heart failure, what other finding you expect
in this patient?
a) Pulmonary rales
b) Batwing appearance in radiograph
c) Pillow orthopnea
d) Prominent JVP
8. Coagulation necrosis is seen in myocardial infarction within
a) 12-24 hrs
 b) 1-3 days
c) 3-7 days
d) 7-10 days
9. A patient presents to ER with complaints of substernal chest pain
that is relieved by leaning forward & aggravated on leaning
backwards. There is history of recent MI.diagnosis?
a) Arrhythmia
b) Heart block
c) Ruptured aneurysm
d) Fibrinous pericarditis

DEPARTMENT OF PATHOLOGY RAWALPINDI MEDICAL COLLEGE .

ENDOCRINOLOGY AND CVS 2nd TERM TEST 4th YEAR 2012 MAY
2012

1. A 31-year-old woman, who has two healthy children, notes that she
has had no menstrual periods for the past 6 months, but she is not
pregnant and takes no medications. Within the past week, she has
noted some milk production from her breasts. She has been bothered
by headaches for the past 3 months. After nearly hitting a bus while
changing lanes driving her vehicle, she is concerned with her vision.
An optometrist finds her lateral vision to be reduced. On physical
examination she is afebrile and normotensive. Which of the following
laboratory test findings is most likely to be present in this woman?
1. Increased serum cortisol
2. Lack of growth hormone suppression
3. Increased serum alkaline phosphatase
4. d. Hyperprolactinemia
5. Hyponatremia

(D) CORRECT. The most common mass lesion of the pituitary in the adult
is an adenoma that secretes prolactin, and this explains the amenorrhea-
galactorrhea that she has been experiencing. A large sellar mass can
compress the optic chiasm to produce bitemporal hemianopsia.
(A) CORRECT. She has an adrenal cortical adenoma producing excess
corticosteroids and leading to Top of Form

1. A 28-year-old woman has had difficulty concentrating at work for the

past month. She is constantly getting up and walking around to visit
co-workers. She complains that the work area is too hot. She seems
nervous and often spills her coffee. She has been eating more but
has lost 5 kg in the past 2 months. On physical examination her
temperature is 37.5 C, pulse 101/minute, respiratory rate 22/minute,
 and blood pressure 145/85 mm Hg. Which of the following laboratory
findings is most likely to be present in this woman?
1. Decreased catecholamine
2. Decreased iodine uptake
3. Decreased plasma insulin
4. d. Decreased TSH
5. Increased ACTH

(D) CORRECT. There are both thyroid-stimulating immunoglobulins (TSI)

and thyroid growth-stimulating immunoglobulins (TGI) in Graves disease
that produce hyperthyroidism. The amount of thyroid hormone production
goes up, suppressing TSH secretion from the pituitary.

1. Top of Form
2. A 19-year-old previously healthy woman has had a mild pharyngitis
followed by a high fever over the past 24 hours. When seen in the
emergency room, her skin now shows extensive areas of purpura.
Vital signs include temperature 39 C, pulse rate 102/minute,
respiratory rate 21/minute, and blood pressure 80/55 mm Hg.
Laboratory studies show a serum sodium of 115 mmol/L, potassium
5.3 mmol/L, chloride 92 mmol/L, CO2 22 mmol/L, glucose 42 mg/dL,
and creatinine 1.1 mg/dL. Which of the following is the most likely
diagnosis?
1. Idiopathic adrenalitis
2. Disseminated tuberculosis
3. Reactive systemic amyloidosis
4. Sheehan syndrome
5. e. Meningococcemia
6. Hemochromatosis

(E) CORRECT. This is acute adrenal insufficiency marked by

hyponatremia, hyperkalemia, and hypoglycemia. Infection with Neisseria
meningitidis can produce the Waterhouse-Friderischsen syndrome.

1. A 40-year-old woman has noted enlargement of her anterior neck

region over the past 8 months. On physical examination her vital
signs include T 36.8 C, P 64/minute, RR 15/minute, and BP 155/105
mm Hg. There is diffuse, symmetrical thyroid enlargement without
tenderness. A chest radiograph is normal. Fine needle aspiration of
the thyroid yields cells consistent with a neoplasm. Laboratory studies
show that she is euthyroid, but her serum ionized calcium is elevated.
She is taken to surgery and frozen sections of several thyroid masses
show a malignant neoplasm composed of polygonal cells in nests. A
thyroidectomy is performed. Immunostaining for calcitonin of the
permanent sections is positive, and the neoplasm has an amyloid
stroma with Congo red staining. Which of the following neoplasms is
she most likely to have?
1. Anaplastic carcinoma
 2. b. Medullary carcinoma
3. Papillary thyroid carcinoma
4. Metastatic renal cell carcinoma
5. Parathyroid carcinoma
6. Follicular carcinoma

(B) CORRECT. She has MEN IIa, with medullary thyroid carcinomas (often
multiple when familial), parathyroid hyperplasia, and pheochromocytoma.

1. A 38-year-old man experiences abdominal pain, nausea, and

constipation for the past 3 days. On physical examination he has no
palpable abdominal masses and bowel sounds are present. His lungs
are clear to auscultation. He has a heart rate of 80 with an irregular
rhythm. An electrocardiogram demonstrates a shortened
QT(corrected) interval and a prolonged PR interval. He has a stool
positive for occult blood. Upper GI endoscopy reveals multiple 1 cm
diameter shallow ulcerations of the gastric antrum. Which of the
following laboratory test findings is most likely to be present in this
man?
1. Thyroid peroxidase antibody of 4 IU/mL
2. b. Serum calcium of 12.4 mg/dL
3. Blood glucose of 225 mg/dL
4. Total serum thyroxine of 21 ng/mL
5. Plasma cortisol of 45 microgm/dL at 8 am

(B) CORRECT. He most likely has a parathyroid adenoma secreting

excessive parathormone to increase serum calcium and decrease serum
phosphorus. The hypercalcemia leads to increased gastrin production and
peptic ulcer disease. Hypercalcemia produces cardiac arrhythmias (or
asystole).

1. A 55-year-old woman has had a 4 kg weight loss over the past 3

months. She exhibits decreased mentation over the past 10 days. On
physical examination she is afebrile and hypotensive. Bilateral
papilledema is noted. A head CT scan shows marked diffuse cerebral
edema with effacement of the lateral ventricles. Laboratory studies
show a sodium of 108 mmol/L, potassium 4.0 mmol/L, chloride 83
mmol/L, CO2 14 mmol/L, glucose 82 mg/dL, and creatinine 0.5
mg/dL. Which of the following is most likely to cause these findings?
1. a. Small cell lung carcinoma
2. Blunt head trauma
3. Hypothalamic glioma
4. Meningitis
5. Pituitary macroadenoma

(A)CORRECT. This is the most frequent cause for the syndrome of

inappropriate ADH (SIADH) leading to her pronounced hyponatremia from
lack of free water clearance. Paraneoplastic syndromes are often seen with
oat cell carcinomas of the lung.

1. A 29-year-old primigravida who received no prenatal care has

marked vaginal bleeding after the onset of labor at 38 weeks
gestation. Cesarean section is performed and a lacerated low-lying
placenta is removed. She remains hypotensive for 6 hours and
requires transfusion of 12 packed RBC units. Postpartum, she
becomes unable to breast-feed the infant. She does not have a
resumption of normal menstrual cycles. She becomes more sluggish
and tired. Laboratory findings include hyponatremia, hyperkalemia,
and hypoglycemia. Which of the following pathologic lesions is she
most likely to have had following delivery?
1. Bilateral adrenal hemorrhage
2. b. Pituitary necrosis
3. Subacute thyroiditis
4. Metastatic choriocarcinoma
5. Insulitis

Correct: (b) Pituitary hormones, including gonadotrophic hormone

deficiency. The pituitary enlarges in pregnancy, which makes its blood
supply more tenuous, and the pituitary is more susceptible to necrosis from
events that lead to hypotension.

1. A 58-year-old man with a history of diabetes mellitus has noted the

presence of bone pain, especially of his hands, for the past 6 months.
On physical examination there is no swelling or redness of his hands,
no joint deformity, but the range of motion is slightly decreased.
Laboratory studies show sodium 139 mmol/L, potassium 4.0 mmol/L,
chloride 98 mmol/L, C02 22 mmol/L, glucose 153 mg/dL, creatinine
7.8 mg/dL, calcium 7.8 mg/dL, phosphorus 5.7 mg/dL, total protein
6.2 g/dL, and albumin 4.0 g/dL. Which of the following conditions is
this man most likely to have?
1. Adrenal adenoma
2. Medullary thyroid carcinoma
3. Extra-adrenal pheochromocytoma
4. d. Parathyroid hyperplasia
5. Pituitary adenoma

(D) CORRECT. He has secondary hyperparathyroidism from chronic renal

failure. Renal failure with retention of phosphorus drives the calcium down
and parathormone secretion up, leading to osteitis fibrosa cystica and bone
pain.

1. A 49-year-old woman has had increasing cold intolerance, weight

gain of 4 kg, and sluggishness over the past two years. A physical
examination reveals dry, coarse skin and alopecia of the scalp. Her
 thyroid is not palpably enlarged. Her serum TSH is 11.7 mU/L with
thyroxine of 2.1 micrograms/dL. A year ago, anti-thyroglobulin and
anti-microsomal autoantibodies were detected at high titer. Which of
the following thyroid diseases is she most likely to have?
1. DeQuervain disease
2. Papillary carcinoma
3. c. Hashimoto thyroiditis
4. Nodular goiter
5. Graves disease

C) CORRECT. Hashimoto thyroiditis is the most common cause for

hypothyroidism in adults. Though the thyroid may initially have been
painlessly enlarged, over time the inflammation leads to atrophy of the
thyroid with hypothyroidism. Anti-thyroid autoantibodies are helpful in
establishing the diagnosis.

1. A clinical study is performed with subjects who were diagnosed with

hyperthyroidism, compared with a control group of subjects who were
euthryoid. The pathologic findings in the thyroid glands of these
subjects are analyzed to determine the spectrum of disease
processes present. Which of the following pathologic processes is
most likely to be found with equal frequency in both the study and the
control subjects?
1. Subacute granulomatous thyroiditis
2. Multinodular goiter
3. c. Medullary carcinoma
4. Hashimoto thyroiditis
5. Follicular adenoma

(C) CORRECT. Medullary carcinomas, derived from interstitial 'C' cells, do

not secrete thyroid hormone and are not associated with hyperthyroidism.

1. A 47-year-old woman feels a "lump" in her neck that she didn't notice
5 months before. Her physician palpates a firm nodule about 2 cm in
size to the left of midline in the region of the thyroid gland. By
scintigraphic scanning this nodule appears "cold" with normal activity
in the surrounding normally sized thyroid gland. Which of the
following is the most likely diagnosis?
1. Papillary carcinoma
2. b. Follicular adenoma
3. Thyroglossal duct cyst
4. Toxic nodular goiter
5. Granulomatous thyroiditis

B) CORRECT. The majority of 'cold' thyroid nodules are benign and many
are adenomas.
 1. A 55-year-old woman has had diffuse, dull, constant abdominal pain
for the past 2 months. On physical examination no abnormal findings
are noted. An abdominal CT scan shows a 3 cm right adrenal mass.
The right adrenal is excised and on microscopic examination the
mass is composed of cells resembling adrenal cortex. Which of the
following features is the most reliable indicator that this mass is
malignant?
1. Cellular atypia
2. Presence of mitoses
3. c. Invasion
4. Size of the mass
5. Cellular necrosis

C) CORRECT. Only a malignant endocrine tumor would invade and/or

metastasize. The other features listed are suggestive of malignancy, but
are not absolute.

1. A 40-year-old truck driver has had difficulty using his side mirrors for
traffic behind him. He has never had any major medical problems in
the past. He visits an optometrist, who determines that he has
bilateral homonymous hemianopsia, but his residual vision is 20/20. A
head CT scan reveals slight enlargement of the sella turcica. Which
of the following hormones is most likely being secreted in excessive
amounts in this man?
1. Antidiuretic hormone
2. b. Prolactin
3. ACTH
4. Growth hormone
5. Luteinizing hormone

B) CORRECT. More pituitary adenomas secrete prolactin than any other

hormone. Also, he did not have symptoms indicative of any other hormonal
secretion. In a man, prolactinemia may not have major effects. The
adenoma pressing on the optic chiasm is a mass effect that did explain his
visual problem

1. Which lung cancer is most likely to produce ectopic ACTH?

1. Adenocarcinoma, common type
2. Bronchiolo-alveolar cell carcinoma
3. Large cell anaplastic carcinoma
4. d. Oat cell carcinoma (*)
5. Squamous cell carcinoma

1. Squamous cell carcinoma of the lung is more likely than oat cell
carcinoma of the lung to produce paraneoplastic
1. blindness
 2. cushingism
3. hypercalcemia*
4. hyponatremia
5. muscle weakness

1. Failure to make red blood cells is a common paraneoplastic

syndrome in patients with
1. acromegaly
2. glucagonoma
3. insulinoma
4. neuroblastoma
5. thymoma (*)

1. Type I (IDDM) diabetes:

1. Always effects females
2. Is associated with high circulating insulin levels
3. Is associated with obesity
4. Genetic factors do not play a role in its pathogenesis
5. e. Results from immunologically mediated destruction
of B cells.

1. Waterhouse Friedrichsen syndrome is associated with:

1. a. Massive adrenal hemorrhage
2. Chronic viral infections
3. Adrenal adenoma
4. Addison’s disease
5. Pheochromocytoma
2. Primary hyperaldosteronism results in:
1. Hyperkalemia
2. b. Hypernatremia
3. Hypotension
4. Virilization
5. Osteoporosis
3. Papillary carcinoma of thyroid is characterized by all of the following
except:
1. Psammoma bodies
2. Orphan Annie nuclei
3. Branching papillae with fibrovascular core
4. d. Follicles with colloid

1. A 30-year old female recovered from influenza suddenly develops a

painful, enlarged thyroid. The most likely diagnosis is?
 1. Hashimoto’s thyroiditis
2. Reidel’s thyroiditis
3. c. Sub-acute granulomatous thyroiditis
4. Sub-acute lymphocytic thyroiditis
5. Thyroid abscess

Key word: D
Topic: Endocrine system

1. Adult male presented with hypertension, sodium and water retention

and hypokalemia with decreased serum rennin levels. He was
diagnosed as a case of:
1. Bartter’s syndrome
2. b. Conn’s syndrome
3. Cushing’s syndrome
4. Cushing’s disease
5. Nelson’s syndrome

Key word: B
Topic: Endocrine system

1. Which one of the following is not affected by the inhibitory control of

somatostatin?
1. Growth hormone
2. Glucagon
3. c. Insulin
4. Prolactin
5. Thyrotrophin

Key word: C

Topic: Endocrine system

1. Pheochromocytoma is not associated with increase urinary excretion

of:
1. Epinephrine
2. Norepinephrine
3. Metanephrine
4. d. Serotonin
5. Vanillylmandelic acid

Key word: D
Topic: Adrenal gland

1. Amyloid deposition is seen in which type of thyroid neoplasm?

1. Follicular adenoma
2. Follicular carcinoma
3. Hurthle cell adenoma
4. d. Medullary carcinoma
 5. Papillary carcinoma

Key word: D
Topic: Thyroid gland

1. A 2cm pituitary adenoma in a 22-year old female associated with

amenorrhoea is most likely to be:
1. a. Prolactinoma
2. Growth hormone adenoma
3. Corticotroph adenoma
4. Thyrotroph adenoma
5. Non functioning adenoma

1. A 54-year old female presents with diffuse symmetrical enlargement

of thyroid gland with palpitation. Clinical examination reveals lid lag,
exophthalmos and pretibial myxedema. Serum T3 and T4 levels are
high and TSH is low. What autoantibodies play a pivotal role in
pathogenesis of this condition?
1. a. Antibodies to TSH receptor
2. Antibodies to circulating T3
3. Antibodies to circulating T4
4. Antibodies to thyroid hormone receptors
5. Antibodies to G-protein

1. In diabetes mellitus Advanced glycation end products (AGEs) cause

cross-linking of extra cellular matrix proteins which makes them:
1. Sensitive to proteolytic digestion
2. b. Resistant to proteolytic digestion
3. Prone to oxidation
4. Prone to methylation
5. insensitive to degree of hyperglycemia

1. Cushing syndrome associated with exogenous glucocorticoid intake

is associated with:
1. Diffuse adrenal hyperplasia
2. Nodular adrenal hyperplasia
3. Unilateal adrenal atrophy
4. d. Bilateral adrenal atrophy
5. Normal adrenal glands
2. A 48 year old woman presented with nodular thyroid gland swelling.
Abdominal ultrasound examination shows liver tumor. The probable
diagnosis is
1. Anaplastic carcinoma of thyroid
 2. Medullary carcinoma of thyroid
3. c. Follicular carcinoma of thyroid
4. Papillary carcinoma of thyroid
5. Lymphoma of thyroid

1. A 17 year old girl came to OPD with complaint of swelling in middle of

neck. FNAC was performed. It revealed cellular smears with nuclear
grooving and intranuclear cytoplasmic inclusions. The diagnosis on
cytological findings is:
1. a. Papillary carcinoma of thyroid
2. Medullary carcinoma of thyroid
3. Follicular carcinoma of thyroid
4. Anaplastic carcinoma of thyroid
5. Lymphoma of thyroid
2. A 35 year old male presents to the ER in confused state. He is
diaphoretic and having palpitations. Lab shows serum glucose of
35mg/dl. On further evaluation pro-insulin and C-reactive peptide is
also raised. What is the most likely diagnosis:
1. Factitious insulin
2. Glucagonoma
3. c. Insulinoma
4. Pheochromocytoma
5. Zollinger Ellison disease
3. A 2-year old child has had failure to thrive. The child is short, with
coarse fascial features, a protruding tongue, and an umbilical hernia.
Profound mental retardation is apparent as the child matures. These
findings are best explained by a lack of:
1. Cortisol
2. Norepinephrine
3. Somatostatin
4. Thyroxine (T4)
5. Insulin
4. A 0.7-cm microadenoma of the adenohypophysis is seen by head
MRI in a 25-year- old female. Which of the following complications is
she most likely to have?
1. a. Amenorrhea with galactorrhea
2. Hyperthyroidism
3. Acromegaly
4. Cushing disease
5. Syndrome of inappropriate antidiuretic hormone (SIADH)
5. A 60-year-old woman has been feeling tired and sluggish for more
than a year. Thyroid gland is not palpable. Serum T4 level is
decreased but TSH is markedly increased. Which of the following
factors is important in the pathogenesis of this condition?
1. Irradiation to neck during childhood.
2. b. Prolonged iodine deficiency
3. Anti-microsomal and anti-thyroglobulin antibodies
4. Mutations in the RET protooncogene
 5. Recent viral upper respiratory tract infection.
6. A 59 year old woman with advanced metastatic lung cancer develops
profound fatigue, weakness and altering diarrhea and constipation.
Physical examination demonstrates hyper pigmentation of skin even
in areas protected from the sun. Tumor involvement of which
endocrine organ is most strongly suggested by this patient’s
presentation?
1. a. Adrenal gland.
2. Endocrine pancreas.
3. Ovaries.
4. Pituitary glands.
5. Thyroid gland.
7. During physical examination a 45 years old man is noted to have a 3
cm palpable nodule in one lobe of an otherwise normal size thyroid
gland. Needle aspiration of the nodule demonstrates polygonal tumor
cells and amyloid, but only very scanty colloid and normal follicular
cells. Which of the following is the most likely diagnosis?
1. Follicular thyroid carcinoma.
2. Hashimotos disease.
3. c. Medullary thyroid carcinoma.
4. Papillary thyroid carcinoma.
5. Thyroid adenoma.
8. Most common cause of death in diabetic patients is
1. Stroke
2. Peripheral vascular disease
3. Chronic renal failure
4. Diabetic Ketoacidosis
5. e. Myocardial infarction
6. Hyperosmolar non ketotic coma
9. The diagnostic tests of Grave’s disease typically show
1. a. Increased T4 T3, decreased TSH, increased
radioactive iodine uptake (RAI)
2. Increased T4 T3, increased TSH, increased RAI
3. Increased T4 T3, decreased TSH, decreased RAI
4. Decreased T4 T3, decreased TSH, increased RAI
5. Decreased T4 T3, increased TSH, decreased RAI
10. Eosinophils in the islands of Langerhans suggest
1. insulinoma
2. newborn child of a diabetic mother
3. maturity onset diabetes of the young
4. d. type I diabetes
5. type II diabetes, usual type
11. Cotton wool patches on the diabetic retina are
1. amyloid deposits
2. proliferative retino pathy
3. protein deposits
4. d. ischemic areas
5. thread-like vascular proliferations
 1. Multiple endocrine neoplasia type I features which island cell tumor?
1. gastrinoma
2. glucagonoma
3. c. insulinoma
4. somatostatinoma
5. VIPoma
2. Hyperglycemia in the "Dawn phenomenon" is mediated by
1. cortisol
2. epinephrine
3. glucagon
4. growth hormone
5. e. somatostatin

Topic: CVS

1. A 38-year-old man has had increasing dyspnea with peripheral

edema, worsening for the past two years. On physical examination he
has diffuse crackles auscultated in both lungs. A chest radiograph
shows that the heart nearly fills the chest. A chest CT scan
demonstrates a 10 cm mass involving the right ventricle that appears
to have areas of hemorrhage and necrosis within it. Which of the
following neoplasms is this man most likely to have?
1. Rhabdomyosarcoma
2. Mesothelioma
3. Myxoma
4. d. Angiosarcoma
5. Papillary fibroelastoma
6. Kaposi sarcoma

(D) CORRECT. This is a rare neoplasm (all cardiac neoplasms are rare)
but the size alone suggests a malignancy.

1. A 24-year-old woman with rheumatic heart disease becomes febrile.

On physical examination she has a systolic murmur. An
echocardiogram shows vegetations of the aortic valve cusps. A blood
culture is positive for Staphylococcus epidermidis. She receives a
porcine bioprosthesis because of her desire to have children and not
to take anticoagulant medication. After ten years, she must have this
prosthetic valve replaced. Which of the following pathologic findings
in the bioprosthesis has most likely led to the need for replacement?
1. Dehiscence
2. Endocarditis
3. Strut failure
4. d. Calcification
 5. Thrombosis

(D) CORRECT. The bioprosthesis has the advantage of not requiring

anticoagulation, but it does not wear well with time, and typically must be
replaced within 5 to 10 years when its leaflets undergo progressive
calcification leading to stenosis.

1. A 65-year-old man has had congestive heart failure with increasing

pulmonary congestion and edema for the past year. He had been
previously healthy all his life with no major illnesses. On physical
examination his blood pressure is 125/85 mm Hg and he is afebrile. A
chest radiograph shows cardiomegaly with a prominent left heart
border and pulmonary edema. Laboratory studies show a serum
glucose of 95 mg/dL and total serum cholesterol of 175 mg/dL. His
serum creatine kinase is not elevated. Which of the following
underlying diseases is he most likely to have?
1. Alcoholic cardiomyopathy
2. b. Calcified bicuspid aortic valve
3. Tricuspid valve endocarditis
4. Aortic dissection
5. Amyloidosis

(B) CORRECT. Although bicuspid aortic valves are present from birth, they
do not manifest with significant calcification and stenosis until later adult
life. The lack of peripheral edema points to a left-sided cause for
congestive failure.

1. A 35-year-old man was found down and was delirious and talking
incoherently. On examination in the emergency department his
temperature is 39.3 C, pulse 110/minute, and blood pressure
70/palpable. He has a heart murmur, palpable spleen tip, and splinter
hemorrhages of fingernails. Which of the following laboratory findings
is most likely to be present in this man?
1. a. Positive urine screen for opiates
2. Elevated anti-streptolysin O (ASO)
3. Increased urinary free catecholamines
4. Elevated Coxsackie B viral titer
5. Rising creatine kinase (CK) in serum

(A) CORRECT. This history points to an infective endocarditis. A common

risk factor for infective endocarditis is intravenous drug use

1. Top of Form
2. A 69-year-old woman with a 7 kg weight loss over the past 6 months
now has developed painless jaundice over the past 2 weeks. On
 physical examination she is afebrile. An abdominal CT scan shows a
large mass involving the head of the pancreas, along with widespread
nodules in the liver. Nodules are seen in both lungs by chest
radiograph. Which of the following cardiac lesions is she most likely
to develop?
1. Dilated cardiomyopathy
2. b. Non-bacterial thrombotic endocarditis
3. Acute fibrinous pericarditis
4. Endocardial fibrosis
5. Acute myocardial infarction

Bottom of Form
(B) CORRECT. Such cancers can be associated with a hypercoagulable
state (Trousseau's syndrome) with formation of marantic cardiac valvular
vegetations.

1. A 58-year-old man develops deep venous thrombosis during a

hospitalization for prostatectomy. He exhibits decreased mental
status 10 days postoperatively, with right hemiplegia. A CT scan of
the head shows an acute cerebral infarction in the distribution of the
left middle cerebral artery. A chest radiograph reveals cardiac
enlargement and prominence of the main pulmonary arteries
consistent with pulmonary hypertension. Laboratory studies show a
serum troponin I of <0.4 ng/mL. Which of the following lesions is most
likely to be present on echocardiography?
1. Coarctation of the aorta
2. Tetralogy of Fallot
3. c. Ventricular septal defect
4. Pulmonic stenosis
5. Dextrocardia

(C) CORRECT. This is the infamous 'paradoxical embolus' from right to left.
This can only happen if there is a defect that allows passage from right-to
left. This can happen across a patent foramen ovale. In this case, the
pulmonary hypertension suggests that there may have been a shunt
persistent for a long time--a so-called Eisenmenger complex. An atrial or a
ventricular septal defect can provide the shunt.

1. A 49-year-old man has the sudden onset of substernal chest pain

with radiation to his left arm. This persists for the next 6 hours. He
goes to the emergency department and on examination is afebrile.
Laboratory studies show a serum troponin I of 18 ng/mL and CK-MB
of 8%. Angiography reveals a thrombosis of the left anterior
descending coronary artery. During the next 24 hours, which of the
following is the most likely complication he will experience?
1. Constrictive pericarditis
 2. b. Cardiac arrhythmia
3. Hepatic necrosis
4. Thromboembolism
5. Myocardial rupture

(B) CORRECT. A primary reason for putting a patient with an acute

myocardial infarction in hospital is to prevent arrhythmias

1. A 27-year-old man has become severely ill with fever and malaise
over the past three days. On examination in the emergency room, he
has a temperature of 38.8 C, heart rate of 105/minute, respiratory
rate of 24, and blood pressure of 80/40 mm Hg. A grade IV/VI
diastolic murmur is audible. He has small hemorrhages visible on nail
beds. His spleen tip is palpable. Which of the following diseases is
most likely to predispose him to this acute illness?
1. Hypoplastic left heart syndrome
2. b. Rheumatic heart disease
3. Cardiac amyloidosis
4. Coronary atherosclerosis
5. Hypertrophic Cardiomyopathy

(B) CORRECT. This acquired condition can lead to valvular deformity that
predisposes to infective endocarditis.

1. A 74-year-old man has had increasingly severe headaches for 2

months, centered on the right. He sees his physician, who records
vital signs of T 36.9 C, P 82/minute, RR 15/minute, and BP 130/85
mm Hg. There is a palpable tender cord-like area over his right
temple. His heart rate is regular with no murmurs, gallops, or rubs.
Pulses are equal and full in all extremities. A biopsy of this lesion is
obtained, and microscopic examination reveals a muscular artery with
luminal narrowing and medial inflammation with lymphocytes,
macrophages, and occasional giant cells. He improves with a course
of high-dose corticosteroid therapy. Which of the following laboratory
test findings is most likely to be present with this man's disease?
1. a. Erythrocyte sedimentation rate of 110 mm/hr
2. Rheumatoid factor titer of 80 IU/mL
3. HDL cholesterol of 15 mg/dL
4. Anti-double stranded DNA titer of 1:1024
5. pANCA titer of 1:160

A) CORRECT. These are classic findings for temporal arteritis, the most
typical involvement with giant cell arteritis. Corticosteroid therapy typically
produces a diminution in the symptoms. Biopsy of the artery can remove
the offending site of inflammation and relieve symptoms (don't worry--there
are collateral branches). Not treating this condition puts the patient at risk
for involvement of other branches of the external carotid artery, the worst of
which would be the ophthalmic branch. The elevation of the sed rate is way
out of proportion to the extent and amount of inflammation in this one
arterial segment.

1. A 35-year-old previously healthy woman dies suddenly and

unexpectedly. At autopsy, one of her cardiac valves demonstrates
attenuation of the chordae tendineae, with rupture of one of the
chordae. On microscopic examination, one of the mitral leaflets show
myxomatous change. Which of the following is the most likely cause
for her death?
1. Carcinoid heart syndrome
2. b. Mitral valve prolapse
3. Rheumatic heart disease
4. Infective endocarditis
5. Acute myocardial infarction

B) CORRECT. The valve leaflet can balloon upward. This condition can be
associated with Marfan's syndrome

1. A 51-year-old man has the sudden onset of substernal chest pain

which radiates to his left arm and neck. He becomes light-headed
and diaphoretic over the next 3 hours. He goes to the emergency
room. On examination he is afebrile but has a heart rate of 96/minute
with an irregular rhythm. Laboratory studies show a serum CK-MB of
15% with total CK of 524 mg/dL. Which of the following features
would be most prominent by histopathologic examination of his
myocardium at this point in time?
1. Macrophage infiltration
2. b. Contraction band necrosis
3. Neutrophilic infiltration
4. Capillary proliferation
5. Collagen deposition

(B) CORRECT. This is an initial change as the myocardial fibers begin to

die

1. A healthy, sedentary adult's heart usually weighs no more than

1. 150 gm
2. 250 gm
3. c. 350 gm
4. 450 gm
5. 550 gm
1. Wavy fibers in the absence of other myocardial pathology suggest
what to the autopsy pathologist?
1. amyloidosis
2. cobalt cardiomyopathy
3. hypertrophic cardiomyopathy
4. long QT (abnormal waves)
5. e. sudden coronary death

1. Most "unstable angina" is probably due to

1. a thrombus forming and lysing
2. extreme hypercholesterolemia and rapid atherogenesis
3. multiple emboli to the coronaries
4. serial hemorrhages within a plaque
5. various rhythm disturbances developing and disappearing

1. Which is most likely to produce dextrocardia, i.e., a heart on the right

side instead of the left? A folic-acid deficient diet probably places a
person at risk for coronary disease by raising plasma
1. homocysteine
2. homogentisic acid
3. oxidized LDL
4. lipoprotein A
5. total LDL cholesterol

1. The fundamental lesion in the "pink puffer" and "blue bloater" is

1. failure of ciliary function
2. failure to produce nitric oxide
3. loss of pulmonary elasticity
4. plugging of the small bronchi by mucus
5. ulceration of the bronchial mucosa

1. The myocardial hypertrophy seen in patients with aortic stenosis,

which is often extreme but which usually allows the heart to empty
adequately, is considered an example of:
1. concentric hypertrophy
2. eccentric hypertrophy
3. egocentric hypertrophy
4. hypertrophic cardiomyopathy
5. physiologic hypertrophy

1. Infamous as a cause of sudden death:

 1. aortic regurgitation
2. b. aortic stenosis
3. mitral stenosis
4. pulmonic stenosis
5. tricuspid insufficiency

1. In "sudden cardiac death" without an acute coronary artery lesion, the

pathologist usually finds at least what percent stenosis of all three
coronary arteries?
1. 50-55%
2. 60-65%
3. 70-75%
4. 80-85%
5. 90-95%
2. In temporal arteritis, the pathologist expects to see granulomas
attacking the
1. adventitia
2. endothelium
3. internal elastic membrane
4. myointimal cells
5. smooth muscle

1. The microangiopathy of diabetes is best described as

1. hyalinization of the arteriolar media
2. hyperplasia of the arteriolar endothelium
3. hyperplasia of the arteriolar smooth muscle
4. necrosis of small arteries and veins
5. thrombosis of the small veins

1. What accumulates in the heart in Pompe's disease?

1. cholesterol
2. glycogen
3. lipofuscin
4. mitochondria
5. non-pigmented lipid breakdown products

1. Which is most likely to produce tricuspid valve stenosis?

1. carcinoid heart disease
2. Ebstein's anomaly
3. endocarditis from IV drug use
4. severe atherosclerosis
5. tetralogy of Fallot
1. In Kawasaki's disease, you will probably NOT see
1. enlarged lymph nodes containing granulomas (*)
2. erythema of the palms
3. fever
4. reddening of the oral mucosa
5. reddening of the surfaces of the eyes

1. What's the major risk factor for Buerger's thromboangiitis obliterans?

1. alcohol abuse
2. cocaine use
3. old age
4. sexual promiscuity / multiple partners
5. e. smoking

1. A 30 year old woman has had coldness and numbness in her arms
and decreases vision in the right eye for the past 5 months. On
physical examination, she is afebrile. Her blood pressure is 100/70
mm Hg. Radial pulses are not palpable, but femoral pulses are
strong. She has decreased sensation and cyanosis in her arms but
no warmth or swelling. A chest radiograph shows a prominent border
on the right side of the heart and prominence of the pulmonary
arteries. Laboratory studies show serum glucose of 74mg/dL, and
negative ANA test result. Her condition remains stable for the next
year. Which of the following is most likely diagnosis?
1. Aortic dissection
2. Kawasaki disease
3. Microscopic polyangitis
4. d. Takayasu arteritis
5. Tertiary syphilis
6. Thromboangitis obliterans

1. A 61 year old man had a myocardial infarction (MI) 1 year ago, which
was the first major illness in his life. He now wants to prevent another
MI and is advised to begin a program of exercise and change his diet.
A reduction in the level of which of the following serum laboratory
findings 1 year later would best indicate the success of this diet and
exercise regime?
1. a. Cholesterol
2. Glucose
3. Potassium
4. Renin
5. Calcium
2. A 40 year old man has had worsening abdominal pain for the past
week. On physical examination, his vital signs include a temperature
of 35.9oC, pulse 77/min, respirations 16/min, and blood pressure
140/90 mm Hg. A pulsatile abdominal mass is palpated. An
abdominal CT scan shows a 6 cm fusiform shaped enlargement of
the abdominal aorta secondary to atherosclerosis. An abdominal
aortic graft is surgically inserted. Which of the following is the most
likely underlying disease process in the patient?
1. Polyarteritis nodosa
2. Obesity
3. Diabetes mellitus
4. Systemic lupus erythematosus
5. e. Syphilis
3. A 10 year old boy is brought to the physician for a routine health
maintenance examination. The physician notes a 2cm spongy, dull
red, circumscribed lesion on the upper outer left arm. The parents
have noticed it since infancy. The lesion is excised, and its
microscopic appearance shows thin walled blood capilaries. Which of
the following is most likely diagnosis?
1. Kaposi sarcoma
2. Angiosarcoma
3. Lymphangioma
4. Telangiectasia
5. e. Hemangioma
4. For the past 3 weeks, a 70 year old woman has been bedridden while
recuperating from a bout of viral pneumonia complicated by bacterial
pneumonia. Physical examination now shows some swelling and
tenderness of the right leg, which worsens when she raises or moves
the leg. Which of the following terms best describes the condition
involving the patient’s right leg?
1. Lymphedema
2. Disseminated intravascular coagulopathy
3. c. Thrombophelibitis
4. Thromboangiitis obliterans
5. Varicose veins

1. A 50 year old man has a 2 year history of angina pectoris that occurs
during exercise. On physical examination, his blood pressure is
135/75 mm Hg, and his heart rate is 79/min and slightly irregular.
Coronory angiaography shows a fixed 75% narrowing of the anterior
descending branch of the left coronary artery. Which of the following
types of cells is the initial target in the pathogenesis of this arterial
lesion?
1. Monocytes
2. Smooth muscle cells
3. Platelets
4. Neutrophils
5. e. Endothelial cells
2. A 30 year old schoolteacher is known to be a strict disciplinarian in
the classroom. She has angina pectoris of 6 months duration. On
physical examination, her blood pressure is 165/85 mm Hg. She is
168 cm tall and weighs 82 kg(BMI 29). Coronoary angiography shows
75% narrowing of the anterior descending branch of the left coronary
artery. Angioplasty with stent placement was done. Which of the
following is the major risk factor associated with these findings?
1. Obesity
2. b. Type A personality
3. Diabetes mellitus
4. Sedentary lifestyle
5. Age
3. An epidemiologic study seeking to determine possible risk factors for
neoplasia is reviewing patients cases of neoplasms reported to
tumour registries. Analysis of the data shows that one type of
neoplasm is seen in two widely desperate situations: (1) the liver of
persons exposed to plyvinyl choloride, and (2) the soft tissue of the
arm ipsilateral to a prior radical mastectomy.The pathology reports
about the neoplasms in these two groups of patients show a smilar
gross appearance---an irregular, infiltrative, soft reddish mass---and a
similar microscopic appearance---pleomorphic spindle cells positive
for CD31. Which of the following neoplasms is most likely to be
described by these findings?
1. a. Angiosacroma
2. Hemangioendothelioma
3. Hemangioma
4. Hemangiopericytoma
5. Kaposi sarcoma
4. A 37 year old obese man presents with signs and symptoms of
hyperglycemia. After appropriate workup, he is diagnosed as having
type II dabetes mellitus, which is due in part to insulin resistance.
Laboratory evaluation of his serum also finds hypertriglyceridemia,
which is due to his diabetes. The most common type of secondary
hyperlipidemia associated with diabetes mellitus is characterized by
elevated serum levels of which one of the following substances?
1. Chylomicrons
2. High density lipoproteins
3. Intermediate density lipoproteins
4. d. Low density lipoproteins
5. Very low density lipoproteins
5. A 60 year old man died secondary to coronary artery disease. At the
time of autopsy marked atherosclerotic changes were present within
his coronary arteries. Sections from these abnormal areas revealed
complicated atherosclerotic plaques with calcification and
hemorrhage. Within these plaques were cellular zones, composed of
smooth muscle cells and macropahges and central core with foam
cells and cholesterol clefts. These foam cells are smooth muscles
cells or macrophages that have phagocytized lipid. Which one of the
following substances promotes atherosclerosis by stimulating smooth
 muscle cells to proliferate, phagocytes lipid, and excrete extracellular
matrix material?
1. Alpha-interferon
2. Beta transforming growth factor
3. c. Interleukin 1
4. Platelet derived growth factor
5. Tumour necrosis factor
6. A 51 year old woman presents with a long history of poorly controlled
hypertension, diabetes mellitus, and signs of renal failure. During the
workup of her disease, a renal biopsy is performed and reveals the
lumens of the small blood vessels to be narrowed by uniform,
homogenous, pink deposits within the walls of the vessels. No
“onionskining” or necrosis of blood vessels of blood vessels is seen.
What is the best diagnosis?
1. Medical calcific sclerosis
2. Arteriosclerosis obliterans
3. Hyperplastic arteriolosclerosis
4. d. Hyaline arteriolosclerosis
5. Thronboangiiitis obliterans
7. An 30 yr old male smoker presents with gangrene of his extremities.
Which one of the following histological findings from the biopsy of the
blood vessel supplying this area would be most consistent with the
diagnosis of Buerger’s disease?
1. Granulomatous inflammation with giant cells
2. Fibrinoid necrosis
3. Focal aneurysmal dilation
4. Fragmentation of neutrophils
5. e. Thrombosis with microabscesses
8. During a routine physical examination a 60 yr old man is found to
have a 5 cm pulsatile mass in his abdomen. Angiography reveals a
marked dilation of his aorta distal to his renal arteries. Which of the
following is the most likely cause of this aneurysm?
1. a. Atherosclerosis
2. A congenital defect
3. Hypertension
4. A previous syphilitic infection
5. Trauma
9. A 6 month old boy is being evaluated for a lesion on his chin.
Physical examination finds a raised, non tender, bright red strawberry
colored vascular lesion measuring 4 mm in greatest dimension. At
this time, which of the following is the best therapy in this infant?
1. a. Leave alone & follow up on a routine basis
2. Photocoagulation
3. Repeated injection with steroids
4. Shave biopsy with frozen section diagnosis
5. Wide local excision with sentinel node sampling
10. A 23yr old man who is HIV positive presents with a irregular,
slowly enlarging, 1cm brown lesion located on his left forearm.
 Physical examination finds several similar lesions on his trunk. Which
of the following is the correct diagnosis?
1. Liposarcoma
2. Angiosarcoma
3. Lipoma
4. Hemangioma
5. e. Kaposi sarcoma
11. A 68 yr old man has had progressive dyspnoea for the past
year. On physical examination extensive rales are heard in all lung
field.An echocardiogram shows that the left ventricular wall is
markedly hypertrophied. A chest radiograph shows pulmonary edema
& prominent left sided heart shadow. Which of the following condition
has most likely produced these findings?
1. Centrilobular emphysema
2. b. Hypertension
3. Tricuspid valve regurgitation
4. Alcoholism
5. Silicosis
12. A 45 year old man experiences crushing sub-sternal pain after
arriving at work one morning. Over the next 4 hours, the pain persists
& begins to radiate to his left arm. He becomes diaphoretic & short of
breath but waits until the end of his 8 hour shift to go the hospital. An
elevated serum value of which of the following lab tests would be
most useful for diagnosis of this patient on admission to the hospital?
1. Lipase
2. AST
3. c. CK-MB fraction
4. ALT
5. C-reactive protein
13. One year ago a 2 year old child had an illness characterized by
a high fever. Staph epidermidis was cultured from the blood. The
child was given antibiotic therapy & recovered. On GPE a harsh
waxing & waning machinery like murmur is now heard on auscultation
of upper chest. A chest X-ray shows prominence of pulmonary artery.
Echo-cardiography shows all valves to be normal in configuration.
Lab tests show normal arterial oxygen saturation level. Which of the
following congenital heart diseases is most likely to explain these
findings?
1. Atrial septal defect
2. Tetrology of Fallot
3. Aortic coarctation
4. d. Patent ductus arteriosus
5. Aortic atresia
14. A 10 year old girl develops subcutaneous nodules over the skin
of her arms and torso 3 weeks after a bout of acute pharyngitis. She
manifests choreiform movements and begins to complain of pain in
her knees and hips particularly with movement. A friction rub is heard
on auscultation of her chest. Which of the following serum lab
findings is most characteristic of the disease affecting this patient.
 1. Elevated cardiac troponin I levev
2. Positive ANA test
3. Elevated creatinine level
4. Positive rapid plasma reagent test
5. e. Elevated anti streptolysin O level
15. A 48 year old woman has had increasing dyspnea for past two
days. She experiences sudden cardiac arrest and cannot be
resuscitated. The light microscopic appearance of left ventricular free
wall shows deeply eosinophilic myocardial fibres with loss of nuclei
indicative of coagulative necrosis at autopsy. Which of the following is
the most likely diagnosis
1. Viral myocarditis
2. b. Myocardial infarction
3. Acute rheumatic myocarditis
4. Septic embolization
5. Restrictive cardiomyopathy

1. A 45 year old woman presents to the ER with severe upper abdominal pain
with vomiting. The pain is focused in epigastrium radiating to the back.
There is no history of chronic epigastric pain. Which of the following are the
most likely predisposing factors for this condition?
a. H. pylori infection and excess gastric acid secretion
b. Gallstone or alcohol use [ as diagnosis is acute pancreatitis]
c. Obesity and high serum cholesterol
d. Stress and cigarette use
e. Hepatitis B and D co-infection
2. A 56 year old obese female presents to ER after being found unconscious by
her daughter. Paramedics report that the female is found in stuporous
condition covered with vomit. On arrival at ER, she is clammy and her BP is
85/50mmHg. Her serum amylase is raised. Which of the following is the
most likely cause of hypotension?
a. Alpha cell tumor of pancreas
b. Ectopic pancreas
c. Acute hemorrhagic pancreatitis
d. Pancreatic adenocarcinoma
e. Cystic fibrosis
3. A 51 year old male diagnosed with Decompensated Chronic Liver Disease
suddenly starts vomiting blood and eventually loses consciousness. His wife
finds him lying on the bedroom floor. He has no prior history of
hematemesis, bleeding diathesis and had not been vomiting prior to the
appearance of the blood. Which of the following is the most likely cause of
this man’s presentation?
a. Achalasia
b. Esophageal varices
c. Mallory weiss tear
d. Plummer Winson syndrome
e. Zenker’s diverticulum
4. A 45 year old man presents with malaise,anorexia and vomiting to
emergency room. The physician notices slight jaundice. Blood examination
shows marked elevation of ALT and AST with AST/ALT ratio being 2.5.
Alkaline phosphatase is near normal. Serum Copper and Iron are
normal.histopathological reports show Mallory bodies in hepatocytes. Liver
damage from which of the following diseases most likely accounts for these
findings?
a. Biliary cirrhosis
b. Viral hepatitis
c. Alcoholic hepatitis
d. Hemochromatosis
e. Wilson’s disease
5. A 30 year old married woman presents to gynaecology OPD for routine
checkup. She is taking Oral Contraceptive Pills for contraception for the last
4 years. She reports slight discomfort in the right hypochrondrium. Alpha
protein level is essentially within normal limits. Ultrasound shows a space
occupying lesion. She is physically fine otherwise. This lesion is most likely
a. Hepatocellular carcinoma
b. Hepatic adenoma
c. Angiosarcoma
d. Hepatic amebiasis
e. Echinococcus granulosus cyst
6. A 65 year old male presents with complaint of right upper quadrant pain. He
was diagnosed HCV 20 years back. He also gives a history of ill health,
fever, decreased appetite and fatigue. Biopsy specimen shows presence of
bile and atypical lymphocytes. Apart from CT scan and other tests which
tumor marker you will order to support your diagnosis?
a. Beta HCG
 b. Carcino-embryonic antigen
c. Alpha feto protein
d. CA-125
e. CA-15
7. A 12 year old male child presents with pitting edema, ascites and prolonged
bleeding from wound sites. His biological parents are not known and he was
adopted from orphanage. His abdominal Ultrasound reveals cirrhosis and
viral serology for HBV and HCV comes out as negative. What is the most
likely cause of cirrhosis in children of his age?
a. Wilson’s disease [ as no bronze diabeties(e), emphysema©, adult
female (d), hepatospleenomegaly/ cerebral s/s of lysosomal storage
disorder(b)]
b. Gaucher’s disease
c. Alpha 1 Antitrypsin deficiency
d. Primary Biliary cirrhosis
e. Hemochromatosis
8. A 30 year old male presents with dementia, Hemiballism and de-arranged
liver enzymes. On further evaluation his abdominal Ultrasound shows
cirrhosis of the liver. His Viral serology is negative. What is the most likely
next finding in this patient?
a. Periodic Acid Schiff Stain shows red cytoplasmic granules in
hepatocytes.
b. Kayser Fleisher rings in cornea
c. Highly increased Alpha feto proteins
d. Antimitochondrial antibodies in blood
e. Central cyanosis
9. A 3 year old boy is brought to ER in a comatose condition. He had an
episode of viral infection for which he was given aspirin by his mother to
relieve fever. But his condition deteriorated and later he was brought to ER.
His blood samples are taken and deranged liver enzymes are found. Most
probably his diagnosis is:
a. Alpha 1 anti-trypsin deficiency
b. Reye Syndrome
c. Wilson’s disease
d. Neonatal cholestasis
e. Primary Biliary Cirrhosis
10.A 26 year old malnourished female presents to medicine OPD with mild
abdominal discomfort in Right hypochondrium. On taking further
history,she has had diarrhea for 2 weeks. Ultrasound abdomen shows space
occupying lesion. Biopsy specimen shows abscess. Most likely cause of this
liver abscess is:
a. E. coli
b. Klebsiella sp.
c. Entamoeba histolytica.
d. Acute hepatitis
e. Echinococcus granulosus cyst
11.A 25 year old man had been experiencing intermittent diarrhea which, over
years, progressed to severe diarrhea, alternating with constipation, rectal
bleeding, and passage of mucus. On physical examination, the abdomen is
 tender over the left iliac fossa . Stools examination fails to reveal parasites.
Colonoscopy demonstrates inflammation limited to the rectum, with no
higher lesions. Which of the following is the most likely diagnosis?
a. Celiac Disease
b. Crohn Disease
c. Hirschprung Disease
d. Tropical sprue
e. Ulcerative colitis
12.Exploratory laparotomy of a patient with an acute abdomen demonstrates a
several foot long loop of small intestine with a dark red-to-brown,
edematous appearance.The patient has a history of atrial fibrillation. The
lesion ends abruptly on both the distal and proximal edges. Which of the
following diagnosis is suggested by this appearance?
a. Adenocarcinoma of the colon
b. Crohn disease
c. Ulcerative colitis
d. Ischemic bowel disease [as A.fab will dislodge the mural thrombi]
e. Tuberculosis
13.A 60 year old man presents to his physician because of progressive
dysphagia, first to solids and then to liquids. Endoscopy reveals a large
fungating mass 2cm above the Gastroesophageal junction. Biopsy of the
mass shows that the glands have extended into muscular layer and contain
large hyperchromatic nuclei. A diagnosis of esophageal adenocarcinoma is
made. Which of the following conditions can result in the development of
this lesion?
a. Esophageal rings
b. Esophageal webs
c. Reflux esophagitis
d. Scleroderma
e. Sliding hiatal hernia
14.A 65 year old man develops peri-umbilical pain which then shifted to the
right iliac fossa. On physical examination, his temperature is 38C rectally
and his abdomen is tender. Which of the following is the most likely
diagnosis?
a. Acute Appendicitis
b. Diverticulitis
c. Hemorrhoids
d. Pancreatitis
e. Pyelonephritis
15.A 57 year old woman with anemia is found to have a decreased Vitamin B12
level. Antibodies to intrinsic factor are identified. Levels of all other
vitamins are within normal limits. Which of the following is most likely to
be associated with this condition?
a. Duodenal ulcer
b. Ulcerative colitis
c. Dietary Vit. B12 deficiency
d. Atrophic gastritis
e. Angiodysplasia
16.A 54 year old woman complains of burning pain in her epigastrium and
vomiting a few days after she started taking medication for her rheumatoid
arthritis. Which of the following forms of gastritis would most likely be
found in this patient?
a. Acute gastritis
b. Chronic antral gastritis
c. Chronic fundal gastritis
d. Hypertrophic gastritis
e. Lympocytic gastritis
17.A 32 year old woman presents with complaints of several months of burning
substernal chest pain exacerbated by large meals, cigarettes and caffeine.
Her symptoms are worse when she lies on her back, especially while
sleeping at night. Antacids often improve her symptoms. This patient is at
risk for which of the following conditions?
a. Cardiac ischemia
b. Columnar metaplasia of distal esophagus
c. Esophageal web
d. Leiomyoma of the esophagus
e. Mallory Weiss lesion in the esophagus
18.A patient develops anemia and weight loss and slight abdominal discomfort.
On questioning, the patient is a known case of chronic gastritis. Which of the
following type of malignancy is most strongly associated with this patient’s
condition?
a. Gastric lymphoma
b. Intestinal type of gastric adenocarcinoma
c. Diffuse type of gastric adenocarcinoma [ as anemia is there, this
tumor is a consequence of chronic atrophic autoimmune type
gastritis]
d. Squamous type of oesophageal carcinoma
e. Adenocarcinoma of oesophagus
19.A 50 year old man with a history of alcohol abuse is found to have elevated
liver enzymes. A liver biopsy shows the microscopic features of fatty change
(steatosis). If the patient abstains from further drinking, this condition will
most likely evolve into which of thee following?
a. Acute hepatitis
b. Chronic hepatitis
c. Complete regression
d. Hyperplastic nodules
e. Malignant degeneration
20.A patient presents to a physician complaining of recurrent episodic diarrhea,
triggered by eating too much or drinking alcohol. His wife states that “he
turns as red as a beet and starts wheezing” during these episodes. Chest X-
Ray demonstrates a lung mass. Which of the following would be the most
likely cause of his symptoms?
a. Carcinoid tumor
b. Primary TB
c. Recurrent TB
d. Lung cancer
e. Superior vena cava syndrome
21.A 40 year old woman with polycythemia vera develops progressive severe
ascites and tender hepatomegaly over a period of several months. Liver
function tests are near normal. Which of the following is the most likely
diagnosis?
a. Acute hepatitis
b. Hepatic vein obstruction
c. Hemochromatosis
d. Chronic hepatitis/cirrhosis
e. Carcinoid syndrome
22.A 10 year old boy complains of intermittent abdominal pain. Endoscopy
fails to demonstrate peptic ulcer or chronic gastritis. The clinician suspects
that the patient may have a heterotopic rest of gastric mucosa that is
producing enough acid to cause ulceration of adjacent mucosa. Which of the
following is the most likely diagnosis?
a. Ectopic pancreatic tissue
b. Meckel’s diverticulum
c. False diverticulum
d. Appendicitis
e. Cancer of the cecum
23.A 65 year old woman dies of metastatic liver cancer. The liver at autopsy
shows a multinodular vascular tumor that histologically is composed of
anastomosing channels lined by anaplastic endothelial cells. The liver
parenchyma between tumor nodules appears normal. The histopathologist
gives a preliminary diagnosis of angiosarcoma of the liver. Which of the
following risk factors is associated with this form of liver cancer?
a. Cirrhosis
b. Hemochromatosis
c. Exposure to vinyl chloride
d. Hepatitis B virus infection
e. Oral contraceptive use
24.A 65 year old man presents to a physician because of a palpable mass
immediately above the left clavicle. Biopsy of the mass demonstrates
metastatic adenocarcinoma in a lymph node. Which of the following organs
should be most strongly suspected as containing the primary tumor?
a. Bladder
b. Large bowel
c. Liver
d. Stomach
e. Pancreas
25.Chronic Gastritis is associated with:
a. Helicobacter pylori
b. Contaminated food
c. Drug poisoning
d. Trauma
e. Schistosoma infection
26.Major site of Peptic Ulcer is :
a. Ileum
b. Duodenum
c. Esophagus
 d. Pancreas
e. Cecum
27.Inflammatory bowel diseases are associated with:
a. Viruses
b. Autoimmune disorders
c. Refined diet
d. Psycho – somatic factors
e. Elderly age
28.The granulomas of Crohns’s disease are differentiated from granulomas of
tuberculosis due to:
a. Presence of necrosis
b. Presence of casseation [ absent in crohn’s disease.]
c. Presence of giant cells
d. Presence of lymphocytes
e. Presence of epitheloid cells
29.Which of the following features of the polyps of the colon indicates a better
prognosis?
a. Villous histology
b. Large size
c. Higher degrees of dysplasia
d. Pedunculated
e. Proximal location
30.Which of the following is a major predisposing factor for the development
of pseudomembranous colitis?
a. Young age
b. Malnutrition
c. Antibiotic use
d. Refined diet
e. Obesity
31.A 6 year old boy presents with abdominal pain and vomiting. The pain first
started in the peri umbilical region and then shifted to the right lower
quadrant. His temperature is 102F and pulse is 110. A laparotomy is
performed and his appendix is removed. What will be observed if the
appendix is examined by the histopathologist?
a. Lymphocytic infiltrate
b. Necrosis
c. Neutrophilic infiltrate
d. Perforation of the appendix
e. Adhesions
32.Schistosoma hematobium is associated with:
a. Adenocarcinoma of the kidney
b. Squamous cell carcinoma of the bladder
c. Hepatocellular carcinoma
d. Colon cancer
e. Ureteric colic
33.Barrets esophagus is a predisposing factor of
a. Squamous cell carcinoma
b. Adeno carcinoma
c. Basal cell carcinoma
 d. Gastric carcinoma
e. Esophagus reflex disease

34.A 50yr old man who is on NSAIDs for his heart problem for last 4yrs and
smokes 2 pack cigarette per day last 10-15yrs presents in OPD with the c/o
recurrent epigastric pain 15-20 min after taking meal which is relieved by
vomiting. What is the diagnosis?
a. Coelic disease
b. Peptic ulcer disease [nsaids and smoking..]
c. Gastric ca
d. Gastro Esophageal Reflux Disease
e. Cholecystitis
35.A 42yrs old man presents in OPD with the complaints of passage of
abnormally bulky, frothy, greasy, yellow stools for 3 days accompanied by
weight loss anorexia, abdominal distention and flatus. On biopsy small
intestine was found to be laden with distended macrophages in the lamina
propria. What is the most likely diagnosis?
a. Whipples disease
b. Tropical sprue
c. Celiac disease
d. Giardiasis
e. Cholera
36.What is another name for apthous ulcer?
a. Leukoplakia
b. Erythroplakia
c. Bed sore
d. Canker sores
e. Oral candidiasis
37.A 60yrs old lady presents with a small swelling at the angle of the jaw for
last 2 years which is painless. On exam it is non-tender and palpated as
discrete mass. Surgeon wants to excise the lesion but he is worried about the
facial nerve that may get damaged during the excision. What is most likely
the diagnosis?
a. Saladenitis
b. Warthin tumor
c. Parotitis
d. Papillary cystadenoma
e. Pleomorphic adenoma
38.Classic lesion of crohns disease is
a. Skip lesion
b. Flask shaped ulcer
c. Pseudopolyps
d. Crypt abscess
e. Macrophages laden lamina propria
39.Deep ulcers, marked lymphoid reaction, fibrosis, serositis, granuloma mass
and fistulas are the features of
a. Ulcerative colitis
b. Crohns disease
 c. Intestinal polyposis
d. Malabsorbtion syndrome
e. Colorectal carcinoma
40.Most common colorectal carcinoma is
a. Squamous carcinoma
b. Basal cell carcinoma
c. Adenoma
d. Adenocarcinoma
e. Mucinous carcinoma
41.A 70yrs old lady who is case of colon cancer. On biopsy, her cancer as
invaded the muscularis propria. Two pericolic nodes are involved with no
metastasis. What is the TNM stage of her colon cancer?
a. T2N1M0
b. T1N2M0
c. T2N2M0
d. T2N1M1
e. T2N0M0
42.What is the histological criteria for the diagnosis of acute appendicitis
a. Cytological atypia
b. Frond like villiform extensions of mucosa
c. Mucosal atrophy
d. Submucosal fibrosis
e. Neutrophilic infiltration of muscularis propria
43.Identify the risk factors associated with gastric carcinoma
a. Family history
b. H.pylori
c. Fatty food
d. Sedentary life style
e. More use of fruits in diet

44.The most common fungal infection of the oral cavity in

immunocompromised individuals is:
a. Thrush (candidiasis) [ aspergillus and mucormycosis follow]
b. Blastomycosis
c. Histoplasmosis
d. Mucormycosis
e. Coccidioidomycosis
45.A department of pathology reviews pathology reports of colorectal
adenomas over the past 15 years and correlates them with clinical data. What
set of factors is most likely to correlate with the risk of developing colorectal
carcinoma?
a. Polyp size, histologic type, severity of dysplasia
b. Polyp size and anatomic location
c. Patient age, polyp size
d. Polyp size and gender of patient
e. Patients age and histologic type
46.During the pathogenesis of Pancreatitis which enzyme after activation from
its proenzyme form can activate other enzymes and clotting, Kinin and
compliment systems?
 a. Lipase
b. Phospholipase
c. Trypsin
d. Elastase
e. Alpha amylase
47.An outbreak of acute hepatitis in the months of July and August is traced to
the mixing of sewage with drinking water. The patients had jaundice,
arthralgias and low-grade fever. Transaminases were markedly raised. None
of the patients developed chronic disease. Only two patients died during the
outbreak, both were pregnant females. What is the likeliest cause of this
outbreak?
a. HAV
b. HEV
c. HBV
d. HDV
e. HCV
48.A 41year old man presents to his physician complaining of swollen ankles.
He states that he never had this problem before. Physical examination
demonstrates marked lower extremity edema and periorbital swelling. His
pulse is strong and regular. Urine dipstick is 4+ positive for protein but
negative for blood and glucose. A 24 hour urine collection demonstrates
proteinuria if 6 gm / day.Spike like protrusion of GBM matrix is seen on
histology Which of the following is the most likely cause of this man’s
problem?
a. Berger’s disease
b. Diabetic nephropathy
c. Membranoproliferative glomerulonephritis
d. Membranous glomerulonephritis
e. Minimal change disease
49.A 6 year old child develops a large erythematous rash around the site of
mosquito bite. One month later she is taken to a pediatrician because of a
puffy face and swollen ankles. The scanty urine sample has a reddish brown
hue and contains both Red Blood Cells and proteins. Which of the following
distinctive features will be most likely to be seen on renal biopsy?
a. Fusion of podocyte foot processes
b. IgA in the mesangium
c. Linear IgG deposits
d. Onion skinning of renal arterioles
e. Sub epithelial electron dense humps
50.An IV drug abuser develops an aggressive form of nephrotic syndrome that
does not respond to steroids. A renal biopsy is performed. Which of the
following histological diagnosis will most likely be made from the biopsy
tissue?
a. Focal segmental glomerulosclerosis
b. IgA nephropathy
c. Lipoid nephrosis
d. Membranoproliferative glomerulonephritis
e. Membranous glomerulonephritis
 GOOD LUCK!
(Paper setters: Prof. Dr. Abbas Hayat, Dr. Homera Niazi, Dr. Nabeel M.
Syed, Dr. Ali Mujtaba, Dr. Ahmed Salman Qadir, Dr. Misbah Hamid, Dr. Rubab,
Dr. Wajiha Raza, Dr. Rabeea Nazir)

PAPER I :

CARDIOVASCULAR SYSTEM:
Q1. The most common cause of death immediately following the onset of acute
myocardial infarction is:
A) Arrhythmia
B) Left ventricular rupture
C) Congestive heart failure
D) Shock
E) Pulmonary edema
Q2. Which of the two valves listed below is least commonly associated with
rheumatic heart disease?
A) Aortic and pulmonary
B) Mitral and tricuspid
C) Aortic and mitral
D) Pulmonary and tricuspid
E) Aortic and tricuspid
Q3. Nonbacterial thrombotic endocarditis is most frequently associated with
which of the following conditions?
A) Terminal neoplastic disease
B) Systemic Lupus erythematosus (SLE)
C) Old rheumatic endocarditis
D) Sub diaphragmatic abscess
E) Congenital Heart disease.
Q4. The most frequent cause of corpumonale with right-sided heart failure is:
A) Constrictive pericarditis
B) Disease of the lungs or pulmonary vessel
C) Left-sided heart failure
D) Pulmonary infundibular or valvular stenosis
E) Systemic Hypertension
Q5. Which of the following is not associated with Dissecting aortic aneurysm?
A) Death from hemopericardium
B) Degenerative changes of aortic media.
C) Hypertension.
D) Severe, tearing chest pain.
E) Severe atherosclerosis.
Q6. A 30 year old female has splenomegaly and anemia with spherocytosis. The
circulating RBCs demonstrate an increased osmotic fragility on laboratory testing.
An inherited abnormality in which of the following RBC components best explains
these findings:
A) Glucose-6-phosphate dehydrogenase.
B) A membrane cytoskeletal protein.
 C) Α-globin chain
D) Heme
E) Β-globin chain
Q7. A 60 year old man with H/O joint pains and is on NSAIDs, is becoming
increasingly tired and listless. He occasionally passes dark stools. A CBC indicates
a hemoglobin concentration of 9.7g/dl, hematocrit of 29.9%, MCV of 69.7fL/red
cell, RBC count of 4.8x106/uL, and WBC count of 5500/uL. The most probable
explanation of these findings is:
A) Iron deficiency.
B) Autoimmune hemolytic anemia.
C) Β-thalassemia major.
D) Chronic alcoholism.
E) Vitamin B12 deficiency.
Q8. A 9 year-old-boy has less than 1% factor VIII activity measured in plasma.
If he is not given transfusions of factor VIII concentrate, which of the following
manifestations of this deficiency is most likely to occur?
A) Hemolysis.
B) Splenomegaly.
C) Conjunctival petechiae.
D) Hemochromatosis.
E) Hemarthroses.
Q9. A 20 year old female present with fever of two weeks duration. A CBC
shows a Hb concentration 14g/dL, hematocrit of 42.0%,MCV of 89fL,platelet
differential count shows 60 segmented neutrophils,16 band cells, 6
metamyelocytes, 1blast,8 lymphocytes, 2 monocytes, and 2 eosinophils per100
WBCs. The pheripheral blood leukocyte alkaline phosphatase score is increased.
The most likely diagnosis is:
A) Chronic myeloid leukemia (CML).
B) Hairy cell leukemia.
C) Hodgkin disease, lymphocyte depletion type.
D) Leukemoid reaction.
E) Acute lymphoblastic leukemia (ALL).
Q10. A new born baby is suspected to be suffering from neonatal sepsis. Which of
the following abnormality in peripheral blood picture is most helpful in reaching
the diagnosis?
A) Microcytosis.
B) Reticulocytoses.
C) Thrombocytosis.
D) High percentage of band cells.
E) Hypochromia.

RESPIRATORY SYSTEM:

Q11. The most common source of pulmonary thrombo-embolism is:

A) Femoral vein
B) Popliteal vein
C) Deep veins of calf
D) Sephaneous vein
E) Anti cubital veins
Q12. Over several decades which of the following inhaled pollutants is most
likely to produce extensive pulmonary fibrosis?
A) Silica
B) Tobacco smoke
C) Wood dust
D) Carbon monoxide
E) Ozone
Q13. An 18year old female student before entry into a medical college had to
undergo medial tests. She developed a 10mm area of induration on her forearm 3
days after intracutaneous injection of 0.1 ml of purified protein derivative (PPD).
She appeared healthy. A chest radiograph would most likely demonstrate:
A) Marked hilar lymphadenopathy
B) Upper lobe calcification
C) Extenive opacification
D) Cavitary change
E) No abnormal findings
Q14. An 85 years old female had left eye problems including enophthalmos,
meiosis, anhidrosis and ptosis. A chest X-Ray showed right upper lobe
opacification. Which of the following conditions she is most likely to have?
A) Bronchopneumomia
B) bronchiectasis
C) Bronchogenic carcinoma
D) Sarcoidosis
E) Tuberculosis
Q15. A 35 year old male has flushing and diarrhoeal episodes. Bronchoscopsy
reveals an obstructing mass filling the bronchus to the right upper lobe. Biopsy
showed neuroendocarine nature of the tumor cells on immunostaining. The
diagnosis is:
A) Hamartoma
B) Adenocarcinoma
C) Large cell carcinoma
D) Kaposi sarcoma
E) Carcinoid tumor

GASTROINTESTINAL TRACT:

Q16. A 39 year old male presented with on and off epigastric pain, provisional
diagnosis of peptic ulcer disease was made. For confirmation of diagnosis on
edoscopy, from where one should take the biopsy?
A) Gastric antrum
B) Gastric ulcer
C) Gastroesophageal junction
D) Duodenal ulcer
E) Greater curvature
Q17. The most frequent esophageal malignancy is:
A) Adenocarcinoma
B) Fibrosarcoma
C) Leimyosarcoma
D) Rhabdomyosarcoma
 E) Squamous Cell Carcinoma
Q18. A 68 year old female has suffered from burning substernal pain for many
years. This pain occurs after meal. She now has dysphagia. Endoscopy reveals a
lower esophageal mass that nearly occludes the esophageal lumen. Biopsy of the
mass is most likely to reveal which of the following neoplasm?
A) Adenocarcinoma.
B) Leiomyosarcoma.
C) Squamous cell carcinoma.
D) Non-Hodgkins lymphoma
E) Carcinoid tumor.
Q19. A 73 year old female has iron deficiency anemia. She has no vaginal
bleeding, hematemesis, hemoptysis or melana.. However a stool Guaiac test result
is positive. A colonoscopy reveals an obstructive lesion that is most likely to be a:
A) Malignant Lymphoma.
B) Adenocarcinoma.
C) Leiomyosarcoma.
D) Tubular adenoma.
E) Carciniod tumor.
Q20. A 59-Years old male presents with 2 month history of intermittent burning
substernal and retrosternal pain radiating to his neck. The burning is usually
relieved quickly with antacids. There is no relationship of these symptoms to
exercise or exertion. Which of the following must be considered in the differential
diagnosis of this patient’s problem?
A) Acid reflux disease.
B) Myocardial ischemia.
C) Peptic ulcer disease.
D) Panic disorder.
E) Carcinoma stomach.
Q21. A 10 year old boy comes to emergency with H/O nausea, vomiting, right
iliac fossa pain and mild fever. On physical examination there is tenderness in
paraumblical region and right iliac fossa. The provisional diagnosis is:
A) Intestinal obstruction.
B) Acute appendicitis.
C) Acute pancreatitis.
D) Acute peptic ulcer disease.
E) Ischemia Bowel Disease.
Q22. Which salivary gland is the most frequent site for tumor involvement?
A) Parotid gland.
B) Sub maxillary gland
C) Sublingual gland
D) Minor salivary gland
E) Parathyroid gland.
Q23. A 60-year-old man with H/O cigarette smoking and alcohol abuse develops
a protruding centrally ulcerated mass in the oral cavity. The lesion is suspected to
be carcinoma. Which of the following locations is most commonly the primary site
of oral squamous cell carcinoma?
A) Base of the tongue.
B) Buccal mucosa
C) Floor of mouth
 D) Palate
E) Tip of the tongue
Q24. A 40 year old man has severe abdominal pain for 03 days. Physical
examination reveals board like rigidity of abdominal muscles. His pancreas shows
chalky white fat necrosis. What is the most likely predisposing factor in the
development of this disorder?
A) Cytomegalovirus (CMV) infection.
B) Hyperlipidemia.
C) Ischemia.
D) Peptic ulcer disease.
E) Chronic alcoholism.

HEPATOBILIARY SYSTEM:

Q25. Chronic Hepatitis is most likely to occur after acute infection with which of
the following virus?
A) Hepatitis A virus
B) Hepatitis C virus
C) Hepatitis E virus
D) Hepatitis G virus
E) Hepatitis D virus
Q26. Three weeks after a meal at road site restaurant a 20 years old male presents
with loss of appetite, malaise, fatigue and mild yellowness of sclera. Which of the
following laboratory test findings is he most likely to have?
A) Hepatitis A IgM antibody
B) Hepatitis D IgM antibody
C) Hepatitis C antibody
D) Hepatitis B core antibody
E) Hepatitis B surface antigen
Q27. A 45 year female presents with ascites. Liver biopsy reveals diffuse portal
tract bridging fibrosis and nodular regeneration of liver cells without hepatocyte
necrosis and cholestasis. The findings are characteristic for:
A) Alcoholic hepatitis
B) Viral hepatitis
C) Drug toxicity
D) Cirrhosis
E) Chronic congestion
Q28. At autopsy, the liver of a 40 years old male shows irregular nodular mass.
On cut surface the lesion is grey white with extensive fibrotic bands. What is the
most likely diagnosis?
A) Hepatocellular carcinoma
B) Hepatitis
C) Cirrhosis
D) Primary Sclerosing Cholangitis
E) Hematochromatosis
Q29. A 25 years old male notices mild degree of scleral yellowness after her
examination. Her liver function profile shows total bilirubin 4.9 mg/dl and direct
bilirubin 0.8 mg/dl. Her other liver function tests are unremarkable. The condition
is most likely to be:
 A) Choledochal cyst
B) Primary biliary cirrhosis
C) Gilbert’s syndrome
D) Dubin-Johnson syndrome
E) Hepatitis C

URINARY SYSTEM:

Q30. Which of the following is most likely cause of the clinical combination of
generalized edema, hypoalbuminemia and hypercholesterolemia in an adult whose
urinalysis demonstrated marked proteinuria with fatty casts and oval fat bodies?
A) Nephritic syndrome
B) Nephrotic syndrome
C) Acute renal failure
D) Renal tubular acidosis
E) Urinary tract infection
Q31. After an acute myocardial infarction, a 50 years old male is in stable
condition. However 2 days later, his urine output drops and his serum urea nitrogen
increases to 33mg/dl. This oliguria persists for a few days and is followed by
polyuria for 2 more days. His is then discharged from the hospital. What lesion
best explains his renal abnormalities?
A) Acute tubular necrosis
B) Benign nephrosclerosis.
C) Acute renal infarction.
D) Hemolytic uremic syndrome.
E) Rapidly progressive glomerulonephritis.
Q32. A 28 years old female presents with a 2 days history of dysuria with
frequency and urgency. A urine culture grows more than 100.000 colonies/ml of
E.Coli. She is treated with antibiotic therapy. However, if she continues to suffer
recurrences of this problem she is at great risk for development of:
A) Diffuse glomerulosclerosis.
B) Chronic glomerulonephritis.
C) Amyloidosis.
D) Membranous glomerulonephritis.
E) Chronic pyelonephritis
Q33. A 60 year old male presents with painless haematuria. On physical there is
no significant finding. IVP shows a filling defect in the urinary bladder. What is
the most likely diagnosis?
A) Stone in urinary bladder.
B) Schistosomiasis
C) Acute hemolysis.
D) Stone in urethra
E) Bladder carcinoma.
Q34. A 24 year old male is suffering from painless haematuria. What is the most
probable diagnosis?
A) Stone in renal pelvis.
B) Stone in ureter.
C) Renal cell carcinoma
D) Acute glomerulonephritis.
 E) Chronic pyelonephritis.

MALE GENITAL SYSTEM:

Q35. CA prostate most commonly involves:

A) Transitional zone of prostate.
B) Outer (Peripheral) zone of prostate.
C) Central zone of prostate.
D) Periurethral zone of prostate.
E) Capsule of the prostate.
Q36. The right testis of a 33 years old male is enlarged to twice normal size. The
testis is removed, and the epididymis and the upper aspect of the right testis are
involved with extensive granulomatous inflammation with epithelioid cells,
Langhans giant cells, and caseous necrosis. The most common cause for these
findings is:
A) Mumps
B) Syphilis
C) Tuberculosis
D) Gonorrhea
E) Sarcoidosis
Q37. Which of the following tumor marker is routinely performed in patients
suspected of having carcinoma prostate?
A) PAP
B) AFP
C) PSA
D) CEA
E) CA-19-9
Q38. Which of the following tumor is most radiosensitive?
A) Breast carcinoma.
B) Prostate carcinoma.
C) Astrocytoma.
D) Colorectal adenocarcinoma.
E) Seminoma
Q39. Histology of a testicular tumor in a 24 year old man revealed syncitial sheet
of polymorphic cells with vesicular nuclei, prominent nucleoli and prominent
lymphocytic infiltrate in the stroma. The most likely diagnosis is:
A) Yolk sac tumor.
B) Seminoma
C) Teratoma.
D) Choriocarcinoma.
E) Embryonal carcinoma.

FEMALE GENITAL SYSTEM:

Q40. 54 year old woman with an abdominal mass undergoes exploration

laparoscopy. Both ovaries are enlarged and hence resected. Pathology report is
Krukenberg tumor, indicating which of the following:
A) Ectopic pregnancy.
B) Endometriosis.
 C) Hyperestrogenic state.
D) Immunosuppression.
E) Metastatic carcinoma
Q41. You obtain a routine Pap smear while performing a physical examination on
a 28-year old female. Gross inspection of the vulva, vagina, and cervix reveals no
apparent lesions. The results of the Pap smear are consistent with cervical
intraepithelial neoplasia (CIN) II. What is the major significance of this finding?
A) A cervicitis needs to be treated.
B) She has an increased risk for cervical carcinoma
C) Condyloma acuminata are probably present.
D) An endocervical polyp needs to be excised.
E) She needs to discontinue oral contraceptives.
Q42. A 58-year old female has had dull pain in the lower abdomen for the past 6
months, along with some minimal vaginal bleeding on three occasions. An
abdominal ultrasound reveals a solid, 8-cm right adnexal mass. A total abdominal
hysterectomy is performed, and the mass is diagnosed as an ovarian granulose-
theca cell tumour. Which of the following additional lesions is most likely to be
seen in the surgical specimen?
A) Condyloma acuminata of the cervix
B) Endometrial hyperplasia
C) Metastases to the uterine serosa
D) Bilateral chronic salpingitis
E) Partial mole of the uterus
Q43. A 20-year old female has had a bloody, brownish vaginal discharge for the
past day. She now presents with shortness of breath. A chest radiograph
demonstrates numerous 2- to 5- cm. nodules in both lungs. A red brown 3 cm
mass is seen on the lateral wall of the vagina, and a biopsy of this mass reveals
malignant cells resembling syncytiotrophoblasts. Serum level of which the
following proteins, is likely to be elevated in this patient?
A) Human chorionic gonadotrophin
B) Alpha-fetoprotein
C) Estrogen
D) Androgen
E) Thyroxin
Q44. The malignant surface epithelial tumours of ovary include:
A) Mucinous cysadenoma
B) Stromal tumour
C) Sarcomatoid tumour of Ovary
D) Squamous cell carcinoma
E) Leiomyoma

DISEASE OF BREAST:

Q45. A 52 year old female presented with a lump in her breast . Biopsy of the
lump showed invasive ductal carcinoma. The connective tissue adjacent to the
tumour was densly collagenous. This is an example of:
A) Anaplasia
B) Dysplasia
C) Desmoplasia
 D) Carcinoma
E) Metaplasia
Q46. A 20 years old female presents with lump in her right breast which is freely
mobile and nontender. What is the most likely diagnosis?
A) Invasive ductal carcinoma
B) Fibroadenoma
C) Intaductal pappiloma
D) Fibrocystic disease
E) Abscess
Q47. Which of the following risk factors play the most important role in the
development of male breast carcinoma?
A) Obesity
B) Age older than 70 years
C) Long term digoxin therapy
D) Klinefelter syndrome
E) Chronic alcoholism
Q48. A microbiology laboratory reports growth of staphylococcus aureus from pus
drained from a breast abscess. What is the most likely predisposing condition for
the development of a breast abscess?
A) Breast feeding
B) Endocarditis.
C) Inflammatory breast carcinoma.
D) Menopause.
E) Paget’s disease of breast.
Q49. Of the histological subtypes of breast carcinoma, which metastasizes most
frequently to peritoneum, reteroperitoneum and leptomeninges?
A) Invasive ductal carcinoma
B) Lobular carcinoma
C) Mucinous carcinoma
D) Medullary carcinoma
E) Metaplastic carcinoma

ENDOCRINOLOGY:

Q50. A 2-year old child has had failure to thrive. The child is short, with coarse
fascial features, a protruding tongue, and an umbilical hernia. Profound mental
retardation is apparent as the child matures. These findings are best explained by a
lack of:
A) Cortisol
B) Norepinephrine
C) Somatostatin
D) Thyroxine (T4)
E) Insulin
Q51. A 0.7-cm microadenoma of the adenohypophysis is seen by head MRI in a
25-year- old female. Which of the following complications is she most likely to
have?
A) Amenorrhea with galactorrhea
B) Hyperthyroidism
C) Acromegaly
 D) Cushing disease
E) Syndrome of inappropriate antidiuretic hormone (SIADH)
Q52. A 60-year-old woman has been feeling tired and sluggish for more than a
year. Thyroid gland is not palpable. Serum T4 level is decreased but TSH is
markedly increased. Which of the following factors is important in the
pathogenesis of this condition?
A) Irradiation to neck during childhood.
B) Prolonged iodine deficiency
C) Anti-microsomal and anti-thyroglobulin antibodies
D) Mutations in the RET protooncogene
E) Recent viral upper respiratory tract infection.
Q53. A 59 year old woman with advanced metastatic lung cancer develops
profound fatigue, weakness and alterning diarrhea and constipation. Physical
examination demonstrates hyperpigmentation of skin even in areas protected from
the sun. Tumor involvement of which endocrine organ is most strongly suggested
by this patient’s presentation?
A) Adrenal gland.
B) Endocrine pancreas.
C) Ovaries.
D) Pituitary glands.
E) Thyroid gland.
Q54. During physical examination a 45 years old man is noted to have a 3 cm
palpable nodule in one lobe of an otherwise normal size thyroid gland. Needle
aspiration of the nodule demonstrates polygonal tumor cells and amyloid, but only
very scanty colloid and normal follicular cells. Which of the following is the most
likely diagnosis?
A) Follicular thyroid carcinoma.
B) Hashimotos disease.
C) Medullary thyroid carcinoma.
D) Papillary thyroid carcinoma.
E) Thyroid adenoma.

MUSCULOSKELETAL SYSTEM AND BONES AND JOINTS:

Q55. Most common pathogen responsible for acute osteomyelitis in a two year old
child is:
A) Streptococcus pneumoniae.
B) Escherichia Coli
C) Candida albicans
D) Haemophilis influenzae
E) Salmonella typhi.
Q56. Most common malignant tumor seen in bone is:
A) Osteosarcoma
B) Chondrosarcoma
C) Secondaries(mets)
D) Lymphoma
E) Enchondromas
Q57. Histopathological features of Duchenne type muscular dystrophy include all
of the following EXCEPT:
 A) degeneration of muscle fibers
B) Infiltration of macrophages
C) Fibrosis
D) Granulation tissue
E) Regeneration of unaffected muscle fibers.
Q58. Reiter’s syndrome is not associated with:
A) Arthritis.
B) Urethritis.
C) Positivity for HLA-DRB1
D) History of some enteric infection
E) Positivity for HLA-B27
Q59. Main causes of peripheral neuropathies are:
A) Excessive physical work.
B) Deficiency of Vitamin D
C) Chondropplasia.
D) Hypertension
E) Diabetes mellitus

CENTRAL NERVOUS SYSTEM:

Q60. Which of the following is not a tumor of central nervous system?

A) Astrocytoma.
B) Oligodendroglioma.
C) Meningioma.
D) Ependymoma.
E) Retinoblastoma.
Q61. Which of the following CNS tumor has the best prognosis?
A) Anaplastic astrcytoma (WHO grade III)
B) Glioblastoma multiforme.
C) Pilocytic astrocytoma (WHO grade I)
D) Medulloblastoma.
E) Oligodendroglioma (WHO grade II)

CLINICAL CHEMISTRY:

Q62. A 60 year old male presents with acute retrosternal chest pain to emergency
department. Lab investigations show total CK 360U/L (NV: upto 195U/L), CK
MB 32 U/L (NV: upto 25U/L), SGOT 54U/L (NV: 5-40U/L), LDH 418U/L (NV:
230-460U/L). ECG was consistant with Acute Myocardial Infarction. What is the
possible duration of his present attack?
A) 30 minutes
B) 2 hours
C) 12 hours
D) 36 hours
E) 5 days
Q63. A 15-year-old boy is brought to the emergency in coma. The doctor on duty
notes that the patient’s breath smells like acetone. This would be most consistent
with which of the following?
A) Alcohol intoxication.
 B) Diabetic hyperosmolar coma.
C) Diabetic ketoacidosis
D) Heroin overdosage.
E) Profound hypoglycemia.
Q64. A 10-year-old boy sustains 25% burns over his body. Next day his serum
urea nitrogen (BUN) is 30mg/dl and serum Creatinine is 0.8 mg/dl. I/V fluids are
given continuously and there is no drop in blood pressure or urinary output. Which
of the following most likely accounts for the BUN and Creatinine values:
A) Decreased renal perfusion.
B) Distal urinary tract obstruction.
C) Increased synthesis of urea
D) Renal glomerular disease.
E) Renal tubule interstitial disease.

SKIN:

Q65. A 2cm pigmented lesion is excised from the back of a 45 year old woman as
it became more nodular and darker recently. Microscopic examination confirmed
the diagnosis of malignant melanoma composed of epitheliod cells. The lesion
extended 2 mm below the reticular dermis. Lymphocytes were present below the
melanoma. Which of the following statements will be suitable for this patient?
A) The immune response will prevent metastasis.
B) The prognosis is poor
C) Family is at risk of developing this condition
D) The primary site of this lesion is eye.
E) Nevi on outer parts of the body may become malignant.
 PAPER II

51.A 45 year old woman presents to the ER with severe upper abdominal pain
with vomiting. The pain is focused in epigastrium radiating to the back.
There is no history of chronic epigastric pain. Which of the following are the
most likely predisposing factors for this condition?
f. H. pylori infection and excess gastric acid secretion
g. Gallstone or alcohol use
h. Obesity and high serum cholesterol
i. Stress and cigarette use
j. Hepatitis B and D co-infection
52.A 56 year old obese female presents to ER after being found unconscious by
her daughter. Paramedics report that the female is found in stuporous
condition covered with vomit. On arrival at ER, she is clammy and her BP is
85/50mmHg. Her serum amylase is raised. Which of the following is the
most likely cause of hypotension?
f. Alpha cell tumor of pancreas
g. Ectopic pancreas
h. Acute hemorrhagic pancreatitis
i. Pancreatic adenocarcinoma
j. Cystic fibrosis
53.A 51 year old male diagnosed with Decompensated Chronic Liver Disease
suddenly starts vomiting blood and eventually loses consciousness. His wife
finds him lying on the bedroom floor. He has no prior history of
hematemesis, bleeding diathesis and had not been vomiting prior to the
appearance of the blood. Which of the following is the most likely cause of
this man’s presentation?
f. Achalasia
g. Esophageal varices
h. Mallory weiss tear
i. Plummer Winson syndrome
j. Zenker’s diverticulum
54.A 45 year old man presents with malaise,anorexia and vomiting to
emergency room. The physician notices slight jaundice. Blood examination
shows marked elevation of ALT and AST with AST/ALT ratio being 2.5.
Alkaline phosphatase is near normal. Serum Copper and Iron are
normal.histopathological reports show Mallory bodies in hepatocytes. Liver
damage from which of the following diseases most likely accounts for these
findings?
f. Biliary cirrhosis
g. Viral hepatitis
h. Alcoholic hepatitis
 i. Hemochromatosis
j. Wilson’s disease
55.A 30 year old married woman presents to gynaecology OPD for routine
checkup. She is taking Oral Contraceptive Pills for contraception for the last
4 years. She reports slight discomfort in the right hypochrondrium.Alpha
protein level is essentially within normal limits. Ultrasound shows a space
occupying lesion. She is physically fine otherwise. This lesion is most likely
f. Hepatocellular carcinoma
g. Hepatic adenoma
h. Angiosarcoma
i. Hepatic amebiasis
j. Echinococcus granulosus cyst
56.A 65 year old male presents with complaint of right upper quadrant pain. He
was diagnosed HCV 20 years back. He also gives a history of ill health,
fever, decreased appetite and fatigue. Biopsy specimen shows presence of
bile and atypical lymphocytes. Apart from CT scan and other tests which
tumor marker you will order to support your diagnosis?
f. Beta HCG
g. Carcino-embryonic antigen
h. Alpha feto protein
i. CA-125
j. CA-15
57.A 12 year old male child presents with pitting edema, ascites and prolonged
bleeding from wound sites. His biological parents are not known and he was
adopted from orphanage. His abdominal Ultrasound reveals cirrhosis and
viral serology for HBV and HCV comes out as negative. What is the most
likely cause of cirrhosis in children of his age?
f. Wilson’s disease
g. Gaucher’s disease
h. Alpha 1 Antitrypsin deficiency
i. Primary Biliary cirrhosis
j. Hemochromatosis
58.A 30 year old male presents with dementia, Hemiballism and de-arranged
liver enzymes. On further evaluation his abdominal Ultrasound shows
cirrhosis of the liver. His Viral serology is negative. What is the most likely
next finding in this patient?
f. Periodic Acid Schiff Stain shows red cytoplasmic granules in
hepatocytes.
g. Kayser Fleisher rings in cornea
h. Highly increased Alpha feto proteins
i. Antimitochondrial antibodies in blood
j. Central cyanosis
59.A 3 year old boy is brought to ER in a comatose condition. He had an
episode of viral infection for which he was given aspirin by his mother to
relieve fever. But his condition deteriorated and later he was brought to ER.
His blood samples are taken and deranged liver enzymes are found. Most
probably his diagnosis is:
f. Alpha 1 anti-trypsin deficiency
g. Reye Syndrome
 h. Wilson’s disease
i. Neonatal cholestasis
j. Primary Biliary Cirrhosis
60.A 26 year old malnourished female presents to medicine OPD with mild
abdominal discomfort in Right hypochondrium. On taking further
history,she has had diarrhea for 2 weeks. Ultrasound abdomen shows space
occupying lesion. Biopsy specimen shows abscess. Most likely cause of this
liver abscess is:
f. E. coli
g. Klebsiella sp.
h. Entamoeba histolytica.
i. Acute hepatitis
j. Echinococcus granulosus cyst
61.A 25 year old man had been experiencing intermittent diarrhea which, over
years, progressed to severe diarrhea, alternating with constipation, rectal
bleeding, and passage of mucus. On physical examination, the abdomen is
tender over the left iliac fossa . Stools examination fails to reveal parasites.
Colonoscopy demonstrates inflammation limited to the rectum, with no
higher lesions. Which of the following is the most likely diagnosis?
f. Celiac Disease
g. Crohn Disease
h. Hirschprung Disease
i. Tropical sprue
j. Ulcerative colitis
62.Exploratory laparotomy of a patient with an acute abdomen demonstrates a
several foot long loop of small intestine with a dark red-to-brown,
edematous appearance.The patient has a history of atrial fibrillation. The
lesion ends abruptly on both the distal and proximal edges. Which of the
following diagnosis is suggested by this appearance?
f. Adenocarcinoma of the colon
g. Crohn disease
h. Ulcerative colitis
i. Ischemic bowel disease
j. Tuberculosis
63.A 60 year old man presents to his physician because of progressive
dysphagia, first to solids and then to liquids. Endoscopy reveals a large
fungating mass 2cm above the Gastroesophageal junction. Biopsy of the
mass shows that the glands have extended into muscular layer and contain
large hyperchromatic nuclei. A diagnosis of esophageal adenocarcinoma is
made. Which of the following conditions can result in the development of
this lesion?
f. Esophageal rings
g. Esophageal webs
h. Reflux esophagitis
i. Scleroderma
j. Sliding hiatal hernia
64.A 65 year old man develops peri-umbilical pain which then shifted to the
right iliac fossa. On physical examination, his temperature is 38C rectally
 and his abdomen is tender. Which of the following is the most likely
diagnosis?
f. Acute Appendicitis
g. Diverticulitis
h. Hemorrhoids
i. Pancreatitis
j. Pyelonephritis
65.A 57 year old woman with anemia is found to have a decreased Vitamin B12
level. Antibodies to intrinsic factor are identified. Levels of all other
vitamins are within normal limits. Which of the following is most likely to
be associated with this condition?
f. Duodenal ulcer
g. Ulcerative colitis
h. Dietary Vit. B12 deficiency
i. Atrophic gastritis
j. Angiodysplasia
66.A 54 year old woman complains of burning pain in her epigastrium and
vomiting a few days after she started taking medication for her rheumatoid
arthritis. Which of the following forms of gastritis would most likely be
found in this patient?
f. Acute gastritis
g. Chronic antral gastritis
h. Chronic fundal gastritis
i. Hypertrophic gastritis
j. Lympocytic gastritis
67.A 32 year old woman presents with complaints of several months of burning
substernal chest pain exacerbated by large meals, cigarettes and caffeine.
Her symptoms are worse when she lies on her back, especially while
sleeping at night. Antacids often improve her symptoms. This patient is at
risk for which of the following conditions?
f. Cardiac ischemia
g. Columnar metaplasia of distal esophagus
h. Esophageal web
i. Leiomyoma of the esophagus
j. Mallory Weiss lesion in the esophagus
68.A patient develops anemia and weight loss and slight abdominal discomfort.
On questioning, the patient is a known case of chronic gastritis. Which of the
following type of malignancy is most strongly associated with this patient’s
condition?
f. Gastric lymphoma
g. Intestinal type of gastric adenocarcinoma
h. Diffuse type of gastric adenocarcinoma
i. Squamous type of oesophageal carcinoma
j. Adenocarcinoma of oesophagus
69.A 50 year old man with a history of alcohol abuse is found to have elevated
liver enzymes. A liver biopsy shows the microscopic features of fatty change
(steatosis). If the patient abstains from further drinking, this condition will
most likely evolve into which of thee following?
f. Acute hepatitis
 g. Chronic hepatitis
h. Complete regression
i. Hyperplastic nodules
j. Malignant degeneration
70.A patient presents to a physician complaining of recurrent episodic diarrhea,
triggered by eating too much or drinking alcohol. His wife states that “he
turns as red as a beet and starts wheezing” during these episodes. Chest X-
Ray demonstrates a lung mass. Which of the following would be the most
likely cause of his symptoms?
f. Carcinoid tumor
g. Primary TB
h. Recurrent TB
i. Lung cancer
j. Superior vena cava syndrome
71.A 40 year old woman with polycythemia vera develops progressive severe
ascites and tender hepatomegaly over a period of several months. Liver
function tests are near normal. Which of the following is the most likely
diagnosis?
f. Acute hepatitis
g. Hepatic vein obstruction
h. Hemochromatosis
i. Chronic hepatitis/cirrhosis
j. Carcinoid syndrome
72.A 10 year old boy complains of intermittent abdominal pain. Endoscopy
fails to demonstrate peptic ulcer or chronic gastritis. The clinician suspects
that the patient may have a heterotopic rest of gastric mucosa that is
producing enough acid to cause ulceration of adjacent mucosa. Which of the
following is the most likely diagnosis?
f. Ectopic pancreatic tissue
g. Meckel’s diverticulum
h. False diverticulum
i. Appendicitis
j. Cancer of the cecum
73.A 65 year old woman dies of metastatic liver cancer. The liver at autopsy
shows a multinodular vascular tumor that histologically is composed of
anastomosing channels lined by anaplastic endothelial cells. The liver
parenchyma between tumor nodules appears normal. The histopathologist
gives a preliminary diagnosis of angiosarcoma of the liver. Which of the
following risk factors is associated with this form of liver cancer?
f. Cirrhosis
g. Hemochromatosis
h. Exposure to vinyl chloride
i. Hepatitis B virus infection
j. Oral contraceptive use
74.A 65 year old man presents to a physician because of a palpable mass
immediately above the left clavicle. Biopsy of the mass demonstrates
metastatic adenocarcinoma in a lymph node. Which of the following organs
should be most strongly suspected as containing the primary tumor?
f. Bladder
 g. Large bowel
h. Liver
i. Stomach
j. Pancreas
75.Chronic Gastritis is associated with:
f. Helicobacter pylori
g. Contaminated food
h. Drug poisoning
i. Trauma
j. Schistosoma infection
76.Major site of Peptic Ulcer is :
f. Ileum
g. Duodenum
h. Esophagus
i. Pancreas
j. Cecum
77.Inflammatory bowel diseases are associated with:
f. Viruses
g. Autoimmune disorders
h. Refined diet
i. Psycho – somatic factors
j. Elderly age
78.The granulomas of Crohns’s disease are differentiated from granulomas of
tuberculosis due to:
f. Presence of necrosis
g. Presence of casseation
h. Presence of giant cells
i. Presence of lymphocytes
j. Presence of epitheloid cells
79.Which of the following features of the polyps of the colon indicates a better
prognosis?
f. Villous histology
g. Large size
h. Higher degrees of dysplasia
i. Pedunculated
j. Proximal location
80.Which of the following is a major predisposing factor for the development
of pseudomembranous colitis?
f. Young age
g. Malnutrition
h. Antibiotic use
i. Refined diet
j. Obesity
81.A 6 year old boy presents with abdominal pain and vomiting. The pain first
started in the peri umbilical region and then shifted to the right lower
quadrant. His temperature is 102F and pulse is 110. A laparotomy is
performed and his appendix is removed. What will be observed if the
appendix is examined by the histopathologist?
f. Lymphocytic infiltrate
 g. Necrosis
h. Neutrophilic infiltrate
i. Perforation of the appendix
j. Adhesions
82.Schistosoma hematobium is associated with:
f. Adenocarcinoma of the kidney
g. Squamous cell carcinoma of the bladder
h. Hepatocellular carcinoma
i. Colon cancer
j. Ureteric colic
83.Barrets esophagus is a predisposing factor of
f. Squamous cell carcinoma
g. Adeno carcinoma
h. Basal cell carcinoma
i. Gastric carcinoma
j. Esophagus reflex disease

84.A 50yr old man who is on NSAIDs for his heart problem for last 4yrs and
smokes 2 pack cigarette per day last 10-15yrs presents in OPD with the c/o
recurrent epigastric pain 15-20 min after taking meal which is relieved by
vomiting. What is the diagnosis?
f. Coelic disease
g. Peptic ulcer disease
h. Gastric ca
i. Gastro Esophageal Reflux Disease
j. Cholecystitis
85.A 42yrs old man presents in OPD with the complaints of passage of
abnormally bulky, frothy, greasy, yellow stools for 3 days accompanied by
weight loss anorexia, abdominal distention and flatus. On biopsy small
intestine was found to be laden with distended macrophages in the lamina
propria. What is the most likely diagnosis?
f. Whipples disease
g. Tropical sprue
h. Celiac disease
i. Giardiasis
j. Cholera
86.What is another name for apthous ulcer?
f. Leukoplakia
g. Erythroplakia
h. Bed sore
i. Canker sores
j. Oral candidiasis
87.A 60yrs old lady presents with a small swelling at the angle of the jaw for
last 2 years which is painless. On exam it is non-tender and palpated as
discrete mass. Surgeon wants to excise the lesion but he is worried about the
facial nerve that may get damaged during the excision. What is most likely
the diagnosis?
f. Saladenitis
 g. Warthin tumor
h. Parotitis
i. Papillary cystadenoma
j. Pleomorphic adenoma
88.Classic lesion of crohns disease is
f. Skip lesion
g. Flask shaped ulcer
h. Pseudopolyps
i. Crypt abscess
j. Macrophages laden lamina propria
89.Deep ulcers, marked lymphoid reaction, fibrosis, serositis, granuloma mass
and fistulas are the features of
f. Ulcerative colitis
g. Crohns disease
h. Intestinal polyposis
i. Malabsorbtion syndrome
j. Colorectal carcinoma
90.Most common colorectal carcinoma is
f. Squamous carcinoma
g. Basal cell carcinoma
h. Adenoma
i. Adenocarcinoma
j. Mucinous carcinoma
91.A 70yrs old lady who is case of colon cancer. On biopsy, her cancer as
invaded the muscularis propria. Two pericolic nodes are involved with no
metastasis. What is the TNM stage of her colon cancer?
f. T2N1M0
g. T1N2M0
h. T2N2M0
i. T2N1M1
j. T2N0M0
92.What is the histological criteria for the diagnosis of acute appendicitis
f. Cytological atypia
g. Frond like villiform extensions of mucosa
h. Mucosal atrophy
i. Submucosal fibrosis
j. Neutrophilic infiltration of muscularis propria
93.Identify the risk factors associated with gastric carcinoma
f. Family history
g. H.pylori
h. Fatty food
i. Sedentary life style
j. More use of fruits in diet

94.The most common fungal infection of the oral cavity in

immunocompromised individuals is:
f. Thrush (candidiasis)
g. Blastomycosis
h. Histoplasmosis
 i. Mucormycosis
j. Coccidioidomycosis
95.A department of pathology reviews pathology reports of colorectal
adenomas over the past 15 years and correlates them with clinical data. What
set of factors is most likely to correlate with the risk of developing colorectal
carcinoma?
a. Polyp size, histologic type, severity of dysplasia
b. Polyp size and anatomic location
c. Patient age, polyp size
d. Polyp size and gender of patient
e. Patients age and histologic type
96.During the pathogenesis of Pancreatitis which enzyme after activation from
its proenzyme form can activate other enzymes and clotting, Kinin and
compliment systems?
f. Lipase
g. Phospholipase
h. Trypsin
i. Elastase
j. Alpha amylase
97.An outbreak of acute hepatitis in the months of July and August is traced to
the mixing of sewage with drinking water. The patients had jaundice,
arthralgias and low-grade fever. Transaminases were markedly raised. None
of the patients developed chronic disease. Only two patients died during the
outbreak, both were pregnant females. What is the likeliest cause of this
outbreak?
f. HAV
g. HEV
h. HBV
i. HDV
j. HCV
98.A 41year old man presents to his physician complaining of swollen ankles.
He states that he never had this problem before. Physical examination
demonstrates marked lower extremity edema and periorbital swelling. His
pulse is strong and regular. Urine dipstick is 4+ positive for protein but
negative for blood and glucose. A 24 hour urine collection demonstrates
proteinuria if 6 gm / day.Spike like protrusion of GBM matrix is seen on
histology Which of the following is the most likely cause of this man’s
problem?
f. Berger’s disease
g. Diabetic nephropathy
h. Membranoproliferative glomerulonephritis
i. Membranous glomerulonephritis
j. Minimal change disease
99.A 6 year old child develops a large erythematous rash around the site of
mosquito bite. One month later she is taken to a pediatrician because of a
puffy face and swollen ankles. The scanty urine sample has a reddish brown
hue and contains both Red Blood Cells and proteins. Which of the following
distinctive features will be most likely to be seen on renal biopsy?
f. Fusion of podocyte foot processes
 g.IgA in the mesangium
h.Linear IgG deposits
i.Onion skinning of renal arterioles
j.Sub epithelial electron dense humps
100. An IV drug abuser develops an aggressive form of nephrotic
syndrome that does not respond to steroids. A renal biopsy is performed.
Which of the following histological diagnosis will most likely be made from
the biopsy tissue?
a. Focal segmental glomerulosclerosis
b. IgA nephropathy
c. Lipoid nephrosis
d. Membranoproliferative glomerulonephritis
e. Membranous glomerulonephritis

PAPER III

1. A 12 year boy presents to the OPD medicine department with swelling of knee
after a trauma. Family history reveals his maternal uncle also suffered from
similar complaints. The boy is most likely suffering from

a) Von willebrand disease

b) Hemophilia
c) Thrombocytopenic purpura
d) Hereditary hemorrhagic telengiectasia
e) Disseminated intravascular coagulation

2. A 59 year old man with a history of coronary artery disease and a severe mitral
regurgitation has surgery to replace his mitral valve. Post operatively there
were no complications until 6 months after the surgery when he presented with
 increasing fatigue. Workup finds a normocytic normochromic anemia that is
due to fragmentation of RBCs by his artificial heart valves. Which of the
following abnormality is indicative of intravascular hemolysis and is most
likely to be seen in peripheral blood film of this patient?

a) Drepanocytes
b) Heinz bodies
c) Pappenheimer bodies
d) Schistocytes
e) Target cells

3. Two days after receiving the anti malarial drug primaquine, a 27 year old man
develops sudden intravascular hemolysis resulting in a decreased hematocrit,
hemoglobinemia and hemoglobinuria. Examination of the peripheral blood
reveals erythroctyes with a defect forming bite cells, when crystal violet stain
is applied many Heinz bodies area also seen. Which of the following is the
most likely diagnosis?

a) Hereditary spherocytosis
b) Glucose 6 phosphate dehydrogenase deficiecny
c) Paroxysmal hemoglobinuria
d) Autoimmune hemolytic anemia
e) Micro angiopathic hemolytic anemia

4. A 49 year old woman presents with signs of anemia and states that every
morning her urine is dark. Investigations reveal that her RBC lyse in vitro with
acid(positive HAMs tests). Which of the following Is the most likely
diagnosis?

A) Warm autoimmune hemolytic anemia

B) Paroyxsmal nocturnal hemogolbinuria
C) Paroxysmal cold hemogolbinuria
D) Isoimmune hemolytic anemia
E) Cold agglutinin autoimmune hemolytic anemia

5. A 41 year woman presents with increasing fatigue lethargy and muscle

weakness. Her CBC reveals decreased number of erythrocytes, leukocytes and
platelets along with an increase in the MCV of the erythrocytes. Her blood
smear shows hypersegmented neutrophils. Which of the following substances
is most likely to be deficient in this individual.

a) Amino levulinic acis

b) Ascorbic acid
c) Folic acid
d) Retinoic acid
 e) Vanillyl mandelic acid

6. A 61 year old woman presents with inceasing fatigue and is found to have
hypochromic microcytic RBC in her periopheral smear. Physical examination
finds her heart rate and respiratory rate to be both increasd in frequency. Lab
examination finds decreased serum ferritin, the levels of which are inversely
propotional to the serum levels of which of the following substances.

A) Bilirubin
B) Haptoglobin
C) Hemosiderin
D) TIBC
E) Transferring

7. A 23 year old woman in her 25th week of pregnancy has felt no fetal
movement for the past 3 years. Three weeks later, she still has not given birth
and suddenly develops dyspnea with cyanosis. On physical examination, her
temperature is 36.9 C, pulse 102/min, respiration 21/min and blood pressure
80/40 mm Hg. She has large ecchymoses over the skin of her entire body. A
stool sample is positive for her occult blood. Lab studies show elevated
prothrombin time and partial thromboplastin time. The platelet count is
decreased, plasma fibrinogen is markedly decreased and fibrin split products
are detected. A blood culture is negative. Which of the following is most likely
cause of the bleeding diathesis?
a) Increased vascular fragility
b) Toxic injury to the endothelium
c) Reduced production of the platelets
d) Increased consumption of clotting factors and platelets
e) Defects in platelet adhesion and aggregation
8. A 65 year old patient presents with generalized lymphadenopathy.
Immunophenotype shows CD10+ BCL2+ mature B cells expressing surface
immunoglobulin. Chromosomal studies show t(14:18). Which lymphoid
neoplasms is most likely he suffering from:

a) Mantle cell lymphoma

b) Burkitt lymphoma
c) Follicular lymphoma
d) MALT lymphoma
e) Plasmacytoma

9. Lacunar cells, a variant of Reed Stenberg cells is seen in which of the

following subtypes:

a)Lymphocyte predominant
 b) Mixed cellularity
c)Lymphocyte depleted
d) Nodular sclerosis
e)Lymphocyte rich

10.A 3 year old boy in Japan presents with fever and rash that is desquamating.
On examination he has enlarged cervical lymph nodes conjunctival and oral
erythema and erosion. He also has edema of the hands and feet. The physician
says the disease is classically self limited however if left untreated the
important sequelae will be:

a)Cerebral artery aneurysms

b) Coronary artery aneurysms
c)Cervical abscess
d) Renal artery aneurysms
e)Conjunctival hemorrhage

11.A 65 year old gentleman presents with headache which is most common along
the course of superficial temporal artery. On palpation the temples are tender.
The patient also complaints of transient visual loss. Biopsy of the temporal
artery would show:

a)Transmural inflammation demonstrating neutrophils, mononuclear cells with

fibrinoid necrosis
b) Necrotizing granulomas rimmed by lymphocytes, plasma cells
macrophages and giant cells
c)Granulomatous inflammation with lymphocyte and multinucleate giant cells
with fragmentation of internal elastic lamina
d) Onion skin, concentric, laminated thickening of the arterioles
e)Homogeneous pink hyaline thickening with loss of underlying structural
detail

12.C-ANCA is seen in

a)PAN
b) Wegners granulomatosis
c)Microscopic polyangiitis
d) Churg strauss syndrome
e)Takayasu arteritis

13.Following component has a pro coagulant effect:

 a)Prostacyclin
b) Plasminogen activator
c)Plasminogen activator inhibitor
d) Thrombomodulin
e)Heparin like molecules

14.Use of lipid lowering drugs (statins) and antiplatelet drugs in a patient

suffering from ATH and coronary artey disease is and example of:

a)Primary prevention
b) Secondary prevention
c)Tertiary prevention
d) Both primary and secondary
e)Both secondary and tertiary

15.A 72 year old man presents with increasing fatigue. Physical examination
reveals multiple enlarged non tender lymph nodes with enlarged liver and
spleen. Lab examination of his peripheral blood reveals a normocytic
normochromic anemia and a slighty decreased platelet count and a leukocyte
count of 72,000/microlitre. Examination of the peripheral smear reveals a
marked increase in the number of mature looking lymphyocytes and many
smudge cells. What is the most likely diagnosis:

a)Acute lymphoblatic leukemia

b) Atypical lymphocytosis
c)Chronic lymophocytic leukemia
d) Immunoblastic lymphoma
e)Prolymphocytic leukemia

16.A 22 year old woman presents with fever weight loss night sweats and
painless enlargement of various supraclavicular lyphnodes. A biopsy from one
of the enlarged lymph nodes shows binucleated giant cells with prominent
acidophilic owl eye nucleoli. Wht is the most likely diagnosis:

a)Anaplastic large cell lymphoma

b) Diffuse non hodgkins lymphoma
c)Hodgkins disease
d) Reactive lymphnode hyperplasia
e)Mantle cell lymphoma

17.A 28 year old man presents with vague muscle pain involving his right arm
that developed several weeks after eating undercooked pork. Lab examination
reveals increased serum activity of CPK. A biopsy from the affected muscle
 reveals rare encysted forms of Tricinella Spiralis. What type of WBC is most
likely to be increased in peripheral blood of this individual:

a)Basophil
b) Eiosinophil
c)Neutrophil
d) Macrophage
e)Lymophocyte

18.Administration of which one of the following substances would theoretically

correct the abnormal bleeding lab tests in an individual who is deficient in
factor V:

a)Activated factor VIII

b) Activated factor X
c)Fibrinogen
d) Plasmin
e)Thrombin

19.The commonest vessel involved in myocardial infarction is:

a)Right coronary artery

b) Left circumflex artery
c)Left anterior descending artery
d) Posterior descending artery
e)Left interventricular artery

20.In which of the following conditions PT is prolonged and aPTT is normal:

a)Von willibrand disease

b) Factor IX deficeiny
c)DIC
d) Factor VII deficiency
e)ASD

21.A 60 year old man died secondary to coronary artery disease. At the time of
autopsy marked atherosclerotic changes were present within his coronary
arteries. Section from these abnormal areas revealed complicated
atheroscelrotic plaques with calcification and hemorrhage. Within these
plaques were cellular zones composed of smooth muscle cells and
macrophages and a central core with foam cells and cholesterol clefts. Which
one the following substances promotes atherosclerosis by stimulating smooth
 muscles cells to proliferate, phagocytize lipids and excrete extracellular matrix
material.

a)Alpha interferon
b) Beta transforming growth factor
c)Interleukin 1
d) Platelet derived growth factor
e)Tumor necrosis factor

22. A 30 year old male smoker presents with gangrene of his extremities. Which
one of the following histologic findings from the biopsy of blood vessels
supplying this area would be most consistent with a diagnosis of Beurgers
disease:

a)Granulomatous inflammation with giant cells

b) Fibriniod necrosis with overlying thrombosis
c)Focal aneurysmal dilatation
d) Fragmentation of neutrophils
e)Thrombosis with micro abscesses

23.During a routine physical examination a 67 year old man is found to have a 5

cm pulsatile mass in his abdomen. Angiography reveals a marked dilatation of
his aorta distal to his renal arteries. Which of the following is the most likely
cause of his aneurysm:

a)Atherosclerosis
b) A congential defect
c)Hypertension
d) Trauma
e)A previous syphilitic infection

24.A 56 year old man presents with a sudden onset of excrutiating pain. He
describes the pain beginning in the anterior chest, radiatind to the back and
then moving downwards to the abdomen. His blood pressure is found to b
160/115 mm Hg however no changes are seen on ECG. X ray abdomen shows
a double barrel aorta. Which of the following is basiuc cause of his
abnormality:

a)A microbial infection

b) Loss of elastic tissue in the media
c)A congential defect in the wall of aorta
d) Atherosclerosis of the aorta
e)Abnormal collagen synthesis
25.A known patient of Stable Angina visits his cardiologist with the complaints
of breathlessness and tightness in chest at rest. He says these symptoms are
progressively worsening. What is the likely mechanism underlying his new
development?
a) Dissolution of atherosclerotic plaque
b) Fibrosis in plaque
c) Vasoconstriction
d) Acute plaque change
e) Aneurysm development in plaque

26.Foam cells are formed by phagocytosis of:

a) Free fatty acids
b) Triglycerides
c) LDL
d) HDL
e) VLDL
27.Plaque change includes all of following except one, which?
a) Rupture
b) Fibrinoid necrosis
c) Thrombosis
d) Haemorrhage
e) Aneurysmal dilation

28.A 30 year old female has splenomegaly and anemia with spherocytosis.The
circulating RBCs demonstrate an increased osmotic fragility on laboratory
testing. An inherited abnormality in which of the following RBC components
best explains these findings:

F) Glucose-6-phosphate dehydrogenase.
G) A membrane cytoskeletal protein.
H) Α-globin chain
I) Heme
J) Β-globin chain

29.“Tree barking” appearance of aorta is seen in:

a) Atherosclerosis
b) Inflammatory aortic aneurysms
c) Syphilitic aortitis
d) Mycotic aneurysms
e) Aortic dissection

30.one of the following statements about Hemangiomas is not true:

a) They are benign tumors of blood vessels
b) Capillary haemangioma commonly involves skin and mucosal tissue
c) Cavernous haemangiomas involve deeper structures
d) These tumors are encapsulated
 e) Strawbwerry haemangioma is a variant present at birth.

31.A 48 year old woman presented with nodular thyroid gland swelling.
Abdominal ultrasound examination shows adrenal gland tumor. The probable
diagnosis is
a) Anaplastic carcinoma of thyroid
b) Medullary carcinoma of thyroid
c) Follicular carcinoma of thyroid
d) Papillary carcinoma of thyroid
e) Lymphoma of thyroid

32.A patient has presented in ER with severe chest pain for the last 4
days. On examination he is breathless with weak thready pulse. His ECG
shows T wave inversion. Which of the following cardiac enzymes will be
diagnostic of myocardial infarction at this stage.
a) CPK
b) CK-MB
c) LDH
d) Troponin I
e) AST

33.Injury after myocardial ischemia is reversible for:

a) 01 hour
b) 30 – 40 min
c) 10 – 20 min
d) 1 – 2 hrs
e) 01 day

34. Granulation tissue appears after infarction on day:

a) 5 - 6
b) 1 - 3
c) 7 - 10
d) 12 - 15
e) After 15 days

35. Rheumatic fever is caused by:

a) Streptococus pyogenes
b) Streptococcus Viridans
c) Staphylococcus aureus
d) Streptococcus pneumonae
e) Staphylococcus epidermidis

36. A 17 year old girl came to OPD with complaint of swelling in middle of neck.
FNAC was performed. It revealed cellular smears with nuclear grooving and
intranuclear cytoplasmic inclusions. The diagnosis on cytological findings is:
a) Papillary carcinoma of thyroid
b) Medullary carcinoma of thyroid
c) Follicular carcinoma of thyroid
 d) Anaplastic carcinoma of thyroid
e) Lymphoma of thyroid

37.A 30 years old heroin drug addict starts having fever with chills, weight loss
and fatigue. On investigations he is diagnosed to be suffering from infective
endocarditis. The most likely cause for his infection is:

a) Streptococus viridans
b) Streptococcus pyogenes
c) H Influenza
d) Streptococcus pneumonae
e) Staphylococcus aureus

38.A 60 year old smoker and occasional drinker presents to the ER with severe
pain in the epigastrium radiating to the back. He is feeling nauseated and has
vomited twice. Lab shows markedly raised amylase and lipase and low serum
calcium. What is the most likely diagnosis?
a) Acute cholecystitis
b) Acute pancreatitis
c) Acute appendicitis
d) Acute intestinal obstruction
e) Perforated peptic ulcer

39.The commonest site for myxoma is:

a) Right atrium
b) Inter ventricular septum
c) Left atrium
d) Left ventricle
e) Inter ventricular septum

40. A 10 year boy is brought to the physician for routine physical examination.
The physician notes a 2 cm spongy dull red circumscribed lesion on the upper left
arm. The parents state that this lesion has been present since infancy. On excision
the lesion shows dilated endothelial lined spaces filled with RBCs. Which of the
following is the likely diagnosis
a) Kaposi sarcoma

b) Angiosarcoma

c) Lymphangioma

d) Telengiectasia

e) Hemangioma
41. A pharmaceutical company is developing an anti atherosclerotic agent. An
experiment investigates mechanism of actions of several potential drugs to
determine their efficacy in reducing atheroma formation. Which of the following
mechanism of action is likely to have the most effective anti atherosclerotic effect:
a) Inhibits the release of platelet derived growth factor(PDGF) and
macrophage mediated lipoprotein oxidation

b) Promotes the release of PDGF and inhibits macrophage mediated

lipoprotein oxidation

c) Inhibits the release of PGDF and promotes macrophage mediated

lipoprotein oxidation

d) Decreases the level of HDL and inhibits macrophage mediated

lipoprotein oxidation

e) Increases the level of intercellular adhesion molecule 1 (ICAM-1) and

VCAM-1

42. Lipoprotein fraction which contains the highest concentration of triacylglycerol

is:
a) Chylomicron
b) Intermediate density lipoprotein
c) High density lipoprotein
d) Low density lipoprotein
e) Very low density lipoprotein

43. Auer rods are characteristically seen in:

a) ALL-L2
b) AML-M1
c) AML-M2
d) AML-M3
e) AML-M4

44. M spike in multiple myeloma is usually due to:

a) IgG
b) Light chains
c) IgA
d) Heavy chains
e) Both light and heavy chains

45. A 60 years old sweeper presents with off & on diarrhea for the last 6 months
which has led to weakness, pallor and numbness of hands & feet. On examination
he is pale. His blood CP reveals Hb of 6.5 g/dl, TLC 3.0 x 10 3/ul and platelets
count of 85,000/cmm. MCV is 110 fl with oval macrocytosis and hypersegmented
neutrophils. What is the probable diagnosis?
a) Iron deficiency anemia
b) Megaloblastic anemia
 c) Aplastic anemia
d) Hemolytic anemia
e) Anemia of underlying disorder

46. What investigation would you like to do next?

a) Serum Ferritin
b) Serum iron, TIBC
c) Bone Marrow examination
d) Hb electrophoresis
e) Coombs test.

47. The gene for beta globin chain of Hb is located on chromosome

a) 11
b) 9
c) X
d) 16
e) 1

48. G6PD deficiency is:

a) Inherited as an autosomal dominant disorder
b) Associated with extravascular hemolysis only
c) X linked
d) Characterized by presence of target cells in blood
e) Associated with aggravation of symptoms in hypoxic conditions

49. Sickle cell anemia is

a) Because of a defect in the alpha globin chain of Hb
b) Associated with intravascular hemolysis
c) Diagnosed on bone marrow examination
d) Diagnosed on Hb electrophoresis
e) Associated with painful crisis resulting from acute severe vasoconstriction

50. What is the diagnostic test of choice for iron deficiency anaemia?
a) Peripheral blood film
b) Serum Ferritin levels
c) Serum iron, TIBC
d) Bone Marrow examination
e) Percent Transferrin saturation

51. A 45 year old smoker presents to the ER with history of recurrent pain in the
epigastrium and diarrhea. He is taking H2 antagonists and proton pump inhibitors
but his pain is not settling completely. He is giving analgesics and I.V fluids. After
stabilizing his vitals upper endoscopy is done and multiple ulcers are seen in
duodenum and jejunum. What is your most likely diagnosis
 a) Pancreatic carcinoma
b) Zollinger Ellison syndrome
c) Glucagonoma
d) Insulinoma
e) Pheochromocytoma

52. A young otherwise healthy female presents with sudden onset of symptoms of
anaemia after taking medicine for throat infection. She is very pale with mild
splenomegaly. Her blood CP shows severe normocytic normochromic anaemia
with normal TLC & platelet count. Spherocytes are also seen. What is the likely
cause of her anemia?
a) Autoimmune hemolytic anemia
b) Megaloblastic anemia
c) Iron deficiency anemia
d) PNH
e) Cold haemagglutinin disease
53. What is the diagnostic test for your provisional diagnosis in above case?
a) Bone marrow examination
b) Urine for hemosidrin
c) Coombs test
d) Hb electrophoresis
e) Iron profile

54.You have diagnosed a child with beta thalassaemia major. How will you
manage this child?
a. Regular blood transfusions
b. Regular blood transfusion with iron chelation.
c. Haematinics therapy
d. Give supportive care only
e. Advise bone marrow transplant immediately

55.A 35 year old male presents to the ER in confusional state. He is diaphoretic

and having palpititions. Lab shows serum glucose of 35mg/dl. On further
evaluation pro-insulin and C-reactive peptide is also raised. What is the most
likely diagnosis:
a. Factitious insulin
b. Glucagonoma
c. Insulinoma
d. Pheochromocytoma
e. Zollinger Ellison disease

56.Parasite producing iron deficiency is:

a. Ascaris Lumbricoides
b. Entrobius vermicularis
c. Shistosoma haematobium
d. Entamoeba Histolytica
e. Ankylostoma Duodenale
57.Pernicious anaemia is produced due to:
a) Defective absorption of folic acid
b) Defective absorption of Vit B 12 resulting from deficient R binder
c) Vit B 12 deficiency due to deficiency of Intrinsic Factor
d)Ileal resection
e) Deficiency of transcobalamine

58. Which one of the following is the one of the most common cause
of death in young individual:
a. Dilated cardiomyopathy
b. Restrictive cardiomyopathy
c. Hypertrophic cardiomyopathy
d. Amyloidosis
e. ASD

59. Which of the following can be used as a marker for endothelium:

a. CD29
b. CD30
c. CD31
d. CD32
e. CD33

60. The best source of folic acid is

a. Milk
b. Eggs
c. Vegetables
d. Meat
e. Animal liver

61. Bleeding does not become evident until platelet count is less than:
a. 1,00,000/ul
b. 75,000/ul
c. 50,000/ul
d. 20,000/ul
e. 10,000/ul

62. Individuals infected by Plasmodium Falciparum are protected

against:
a. Thalasemia
b. Iron deficiency anemia
c. Sickle cell anemia
d. Megaloblastic anemia
e. Anemia of chronic disease

63.A 2-year old child has had failure to thrive. The child is short, with coarse
fascial features,a aprotuding tongue, and an umbilical hernia. Profound
 mental retardation is apparent as the child matures.These findings are best
explained by a lack of

a) Cortisol
b) Norepinephrine
c) Somatostatin
d) Thyroxine (T4)
e) Insulin

64.Nonbacterial thrombotic endocarditis is most frequently associated with

which of the following conditions?

F) Terminal neoplastic disease

G) Systemic Lupus erythematosus (SLE)
H) Old rheumatic endocarditis
I) Subdiaphragmatic abscess
J) Congenital Heart disease.

65.Aplastic anaemia is diagnosed on:

a) Blood counts and reticulocyte count
b) Hb electrophoresis
c) Bone marrow aspirate alone
d) Bone marrow trephine alon
e) Both aspirate and trephine biopsy

himoto thyroiditis are at increase risk for developing

A)Papillary thyroid carcinoma

B)Follicular thyroid carcinoma

C)B cell non Hodgkin lymphoma

D)Hodgkin lymphoma

E)Medullary carcinoma

All lesions of thyroid can b diagnosed on fine needle cyto except

A)Papillary thyroid carcinoma

B)Follicular thyroid carcinoma

C)Medullary carcinoma

D)Anaplastic carcinoma

E)Hodgkin lymphoma

Difference between follicular ca and follicular adenoma can be

A)Capsular vascular invasion

B)Metastasis

C)Calcification foci

D)RAS mutation

E)Central fibrosis

Low TSH, high T3 and T4 is possible in all except

A)Endemic goiter

B)glaucomatous throiditis

C)Subacute lymphocytic thyroiditis

D)hashimoto thyroiditis

E)Graves’s disease

All can b seen in diabetic nephropathy except

A)Hyaline arteriolosclerosis

B)Nodular glomerulosclerosis

C)Diffuse mesengial sclerosis

D)granulomatous pyelonephritis

E)necrotizing papillitis
ACTH levels are elevated and cannot be suppressed by low dose of
dexamethasone but respond with higher dose of dexamethasone in case of

A)Ectopic ACTH

B)Adrenal tumor

C)Pituitary located tumor

D)Paraneoplastic syndrome

E)None of these

Patient with intractable peptic ulcers can be suspected for

A)adrenal tumor

B)tumor of islets of langerhens

C)MEN 2A

D)MEN 2B

E)Pituitary tumor

medullary carcinoma of thyroid initially manifest with

A)hypocalcemia

B)hypercalcemia

C)vomiting

D)Diarrhea

E)Hyperthyroidism

Antibodies central for graves disease is

A)TSI

B)TGI

C)TBIT

D)TSHR
E)LATS

Benign localized hyperplasia of melanocytes and common in infancy and

childhood is

A)Vitligo

B)Frenkles

C)Lentigo

D)Melanocytic nevus

E)melasma

Verruca valgaris is caused by which virus

A)EBV

B)HPV

C)Smallpox

D)Chickenpox

E)Rubeolla

One of the following is not bullous or blistering disease of skin

A)pemphigus

B)bullous pemphigous

C)dermatitis herpetiformis

D)porphyria

E)discoid lupus erthematosis

Premalignant condition of skin is

A)actinic keratosis

B)dysplastic nevi

C)seborrheic keratosis
D)acanthosis nagricans

E)keratocanthoma

Molluscum contagiosum

A)EBV

B)HPV

C)Pox virus

D)Chickenpox

E)Rubeolla

Basal cell ca of eyelid

A)2nd most common Ca of eyelid

B)Predilection for lower eyelid

C)Predilection for upper eyelid

D)None of these

E)Both a and b

Necrotic dead piece of bone is

A)involvecrum

B)sequestrum

C)woven bone

D)lamellar bone

E)cancellous bone

Unmeneralised bone is called

A)osteoid
B)involvecrum

C)woven bone

D)lamellar bone

E)cancellous bone

Primary osteogenic tumor is

A)osteoblastoma

B)chondroblastoma

C)Ewing tumor

D)giant cell tumor

E)multiple myeloma

Achodrogenesis type II defect in

A)Collagen type 1

B)Collagen type 2

C)Collagen type 3

D)Collagen type 4

E)Collagen type 5

All seen in juvenile rheumatoid arthritis except

A)RA factor present

B)Begins before 16 year

C)Oligoarthritis is common

D)Large joints are affected

E)Rheumatoid nodules absent

All factors of these stimulate osteoblast except

A)Endothelial factor

B)IGF

C)TGF

D)PDGF

E)IL

Primary small bone cell tumor

A)osteoblastoma

B)chondroblastoma

C)Ewing tumor

D)giant cell tumor

E)multiple myeloma

Patient with acute pain in foot , that aggravated with alcohol intake relieved
for many years without medicines it can be

A)osteogenic imperfecta

B)reactive arthritis

C)supparative arthritis

D)acute gout

E)synovial cyst

Reinke’ crystalloids characteristic present in

A)leydig cell tumor

B)sertoli cell tumor

C)gonadoblastoma
D)testicular lymphoma

E)seminoma

ITGCN not seen in

A)Seminoma

B)Spermatocytic seminoma

C)Embryonal carcinoma

D)Yolk sac tumor

E)Choriocarcinoma

Which one can be stated as extra embryonal germ cell carcinoma

A)Seminoma

B)Spermatocytic seminoma

C)Embryonal carcinoma

D)Yolk sac tumor

E)Teratoma

27. In urinary bladder carcinoma, invasion of muscularis propria shows

grade

A)T1

B)T2

C)T3

D)T4

E)T5

In bowen and bowenoid diseases difference is that bowenoid is

A)Not invasive
B)Invasive

C)Occurs in older persons

D)Solitary lesion

E)Non pigmented

Regarding gullian barre syndrome

A)5 cases per 1 lace in usa

B)Descending paralysis

C)Polyrediculoneuropathy

D)Causative agent polio virus

E)Deep tendon reflex exaggerated

30. In renal failure GFR reduces to

A)50%

B)20-50%

C)20-25%

D)10%

E)5%

31.False regarding Duchene disease

A)less severe than Becker disease

B)most common

C)x linked

D)dystrophin is affected

E)all these are true

32.Regarding nerve regeneration

A)the proximal segment of degenerated axons sprouts and elongate

B)the distal segment of degenerated axons sprouts and elongate

C)grow 1 cm per day

D)regenerating clusters are not formed

E)muscle reinnervation is not associated

33. It is not a reaction of muscle to nerve injury

A)Segmental necrosis

B)Vacoulisation

C)Regeneration

D)Hypertrophy

E)Dystrophy

34.Analgesic nephropathy complicated to

A)renal failure

B)malignancy

C)papillary necrosis

D)chronic tubulointerstial

E)none of these

35.Correct about ARPKD

A)kidney is small
B)is present in adults

C)also called medullary sponge kidney

D)dilated channels are right angle to cortical surface

E)kidneys are irregular in appearance

36. Kidney secretes all except

A)Renin

B)Insulin

C)Erythopoitein

D)a & c

37.In anti GBM antibody induced nephritis, the deposits are

A)Linear

B)Granular

C)Lumpy

D)Spiked

E)Subepithelial

38. Complication of renal cystic dysplasia

A)Chronic renal failure

B)Uteropelvic obstruction

C)Ureteral agenesis

D)Ureteral stenosis

E)Liver cystic disease

39.In focal segmental G. sclerosis deposits contain

A)Igm and c3

B)Iga and c3

C)Only Iga

D)Iga Igg and c3

E)Igm iga and c3

40.A aptient with hematuria , flank pain , fever , dysuria, if infection is

suspected then diagnosis confirmed by

A)urine DR

B)pus casts

C)quantitive urine culture

D)ultrasound

E)none of these

41.Patient history of bladder cancer , his occupation would be worker at

A)plastic factory

B)rubber factory

C)dye factory

D)coal mine worker

E)arsenic industry

42.Amyloid deposits in kidney is stained with

A)Masson trichrome

B)Congo red

C)Methylene blue

D)H & E Stain

E)Persian blue

43.Causative agent for staghorn calculi in kidney is

A)proteus

B)e coli

C)streptococcus

D)uric acid

E)cysteine

44.Regarding malignant nephrosclerosis

A)hyaline arteriolosclerosis occur

B)gross kidney leathery appearance

C)cortical shrinking and scarring

D)all of the above

E)hyperplasic retinopathy

45.All are important in etiology of membranous GN except

A)atopy

B)malignancies

C)drugs

D)infections

E)SLE

46.IgA nephropathy mostly presents as

A)ARF
B)Necrotising pappilitis

C)Recurrent haematuria

D)Acute nephrotic syndrome

E)Nephritic syndrome

47.Dilation of renal pelvis and calyces associated with progressive atrophy

of the kidney due to obstruction to outflow of urine is

A)hydrnephrosis

B)necrotizing papplitis

C)papillary necrosis

D)pyelonephritis

E)pyonephrosis

48.The main cause of renal dysfunction in multiple myeloma is

A)hypercalcemia

B)urinary tract obstruction

C)hyperurecemia

D)bence jones protein

E)pyelonephritis

49.In acute nephritic syndrome the cardinal symptom is

A)proteinuria

B)generalised edema

C)severe HTN

D)lipidemia

E)gross haemtuia
50. Renal cell carcinoma most commonly metastasize to

A)Lungs

B)Lymph nodes

C)Adrenals

D)Bones

E)liver

ANSWERS:

1-C)

2-B)

3-A)

4-A)

5-D)

6-C)

7-B)

8-D)

9-D)

10-C)

11-B)

12-E)

13-A)

14-C)

15-B)

16-B)

17-A)
18-A)

19-B)

20-A)

21-A)

22-C)

23-D)

24-A)

25-B)

26-D)

27-B)

28-A)

29-C)

30-C)

31-A)

32-A)

33-E)

34-B)

35-D)
36-B)

37-A)

38-A)

39-A)

40-C)

41-B)

42-B)

43-A)

44-E)

45-A)

46-E)

47-A)

48-D)

49-E)

50-A)

RMC-Dept. of Pathology 4th year Class Test, 7th,March 2012 MCQ`s

(GIT, LIVER. , PANCREAS, GALL BLADDER) Total Marks: 60 Time:
1hr 10min (You see only what you know.—Goethe)
1. A 68 years old woman with a history of rheumatic heart disease is
hospitalized with severe CCF. Several days after admission, she develops
abdominal distension. Physical examination shows she is afebrile.
Abdomen is tympanic without fluid wave, bowel sounds absent. Stool
positive for occult blood. X-ray abdomen shows no free air. Colonoscopy
shows areas Of mucosal erythema with overlying tan exudate in ascending
and descending colon. No polyp or masses are found. What is the most
likely diagnosis
 1. Ulcerative colitis
2. Mesenteric vasculitis
3. Shigellosis
4. Ischemic colitic
5. Volvulus

2. A 27 year old man had intermittent cramping abdominal pain and low
volume for several weeks. On physical examination, he is afebrile. There is
mild lower abdominal tenderness but no masses and bowel sounds
present. Stool sample positive for oocult blood. Symptoms subside within 1
week. 6 months later, abdominal pain recurs with perianal pain. On
physical examination, there is now a peri anal fistula. Colonoscopy shows
areas of mucosal edema and ulceration with some normal areas.
Microscopic examination of biopsy specimen from an ulcerated area shows
patchy acute and chronic inflammatory infiltrate, crypt abscesses and
several non-caseating granulomas. Which of the following underlying
disease processes best explains this disease.

1. Ulcerative colitis
2. Amoebiasis
3. Pseudomembranous colitis
4. Shigellosis
5. Crohn`s disease

3. Over past 3 months, 45 yrs old woman noticed her skin has become
progressively more yellow. On physical examination, she is afebrile and
has sclera icterus and generalised jaundice. Laboratory studies show total
serum bilirubin 8.9mg/dl. Direct bilirubin 6.8 mg/dl, serum ALT 125U/L, and
serum AST 108 U/L. Liver biopsy specimen shows histological features of
sclerosing cholangitis. Which of the following diseases of GI tract is most
likely the co exist with liver disease

1. Chronics pancreatitis
2. Diverticulitis
3. Ulcerative colitis
4. Celiac sprue
5. Peptic ulceration

4. A 48 yr old man sees his physician because he had nausea and colicky
right upper quadrant pain for last 2 days. On physical examination, his
temp is 38 C. Lab studies show a WBC count of 11200/ mm3 with 71%
segmented neutrophils, 9% bands, 13 % lymphocytes and 7 % monocytes.
What is the most likely diagnosis?

1. Acute Hepatitis
2. Biliary atresia
3. Acute cholecystitis
4. Primary sclerosing cholangitis
5. Adenocarcinoma of gallbladder
5. A 55 yr old man presents with increasing fatigue, weakness, anorexia
and jaundice over the past several months. Physical examination finds mild
ascites and gynecomastia. A liver biopsy reveals regenerative nodules of
hepatocytes surrounded by fibrosis. What is the most probable diagnosis?

1. Cholangitis
2. Cholestasis
3. Cirrhosis
4. Hepatitis
5. Steatosis

6. A 51 year old male alcoholic with a history of chronic liver disease

presents with increasing weight loss and ascites. Serum examination was
unremarkable and test for fecal occult blood was negative. A chest X ray
was unremarkable but a CT scan of the abdomen reveals a single mass in
the left lobe of the liver. Workup reveals elevated enzymes of alpha
fetoprotein in this patient’s blood. Which of the following is the most likely
diagnosis?

1. Angiosarcoma
2. Cholangiocarcinoma
3. Hepatoblastoma
4. Hepatocellular carcinoma
5. Metastatic colon cancer

7. A 44 yr old man presents with the sudden onset of severe right upper
quadrant ( RUQ) abdominal pain, ascites, tender hepatomegaly and
hemetemesis. An ultrasound shows the thrombosis of the hepatic veins.
Which is the most probable diagnosis?

1. Budd chiari syndrome

2. Fitz Hugh Curtis syndrome
3. Rotor syndrome
4. Veno occlusion disease
5. Arnold chiari syndrome

8. A 27 yr old woman presents with headache, myalgia, anorexia followed

by nausea and vomiting for the past few days. She denies any history of
drug or alcohol use but on further questioning she states that recently she
has lost taste for coffee and cigarettes. Physical examination reveals a
slight yellow discoloration of her sclera. Lab investigations indicate a serum
bilirubin level of 1.8 mg/dl. And AST and ALT levels are markedly elevated .
Which of the following is the most likely diagnosis?

1. Gilbert syndrome
2. Chronic hepatitis
3. Amoebic liver abscess D. Acute viral hepatitis E. Acute hepatic
failure
9. One year after having an acute myocardial infarction, a 55 year old man
saw his physician because of severe abdominal pain and bloody diarrhea.
On GPE the abdomen was diffusely tender and bowel sounds were absent.
Abdominal plain film shows no free air. Lab studies show a normal CBC
and normal levels of serum amylase, lipase and bilirubin. His condition
deteriorated and he developed irreversible shock. At autopsy, which of the
following lesions is most likely to be found?

1. Acute appendicitis
2. Acute pancreatitis
3. Intestinal infarction
4. Acute cholecystitis
5. Pseudomembranous colitis

10. A 17 year old girl notices a small sensitive grey white area forming
along the lateral border of her tongue 2 days before the end of her facial
examination. On GPE, the girl is afebrile. There is a shallow, ulcerated 0.3
cm lesion with an erythematous rim. No specific therapy is given and the
lesion disappears within 2 weeks. The past history shows that the girl does
not smoke or chew tobacco. Which of the following is the most probable
cause of her lesion?

1. Aphthous ulcer
2. Oral thrush
3. Herpes simplex stomatitis
4. Leukoplakia
5. Sialadenitis

11. A epidemiologic study of HBV infected patients is conducted over a

period of 10 years, in a developed area, to determine the mode of
transmission of HBV. The patients received periodic serologic testing for
HBsAg, anti HBs, anti HBc and serum determinations of total bilirubin, AST,
ALT, alkaline phosphatase and prothrombin time. The study identified a
subset of patients who were found to be carrier of HBV. The study is most
likely to show an association between the carrier state and which of the
following modes of transmission of HBV?

1. Blood transfusion
2. Heterosexual transmission
3. Vertical transmission during childbirth
4. Oral transmission
5. Needle stick injury

12. A 53 yr old man comes to the emergency department because of

marked hematemesis that has continued for the past 3 hours. On GPE, he
has a temperature of 35.9 C , pulse 112/min, rep 26/min and blood
pressure of 90/45 mm Hg. He has a distended abdomen with a fluid wave
and the spleen tip is palpable. What liver disease is most likely to present in
this patient?
 1. Cirrhosis
2. Cholangiocarcinoma
3. Massive hepatic necrosis
4. Fatty change
5. HAV infection

13. A middle aged chronic smoker went to the dentist, on examination of

oral cavity maxillary gingiva showed red velvety eroded area in level with
the surrounding mucosa. What is your clinical diagnosis?

1. Erythema multiforme
2. Erythroplakia
3. Squamous cell carcinoma
4. Lichen planus
5. Leukoplakia

14. A 38 yr old chronic alcoholic male has repeated bouts of acute

pancreatitis. Recently he has had a low- grade fever. On examination a
mass is palpated in the epigastrium. Esophageal ultrasound showed cystic
mass in the pancreas measuring 25cm in size, FNA performed; smears
prepared reveal necrotic haemorrhagic material without any epithelial cells.
What is your diagnosis?

1. Pancreatic carcinoma
2. Mucinous cystadenoma
3. Serous cyst adenoma
4. Pancreatic pseudocyst
5. Congenital cyst

15. Strawberry gallbladder is commonly associated with

1. Hypersecretion of cholesterol by the liver.

2. Gallstones
3. Porcelain
4. Acute cholecystitis
5. Empyema of gall bladder

16. A 38 yr old man presents with jaundice and pruritis. Laboratory

examination reveals markedly elevated serum levels of alkaline
phosphatase. Antinuclear antibodies are not present, but a serologic test
for p-ANCA is positive. An endoscopic retrograde
cholangiopancreatography reveals beading of the bile ducts. A liver biopsy
specimen showed onion skin fibrosis around bile ducts. What is the best
diagnosis?

1. Autoimmune hepatitis
2. Chronic active hepatitis
3. Chronic persistent hepatitis
4. Primary biliary cirrhosis
5. Primary sclerosing cholangitis
17. A 49 yr old woman presents with increasing difficulty in swallowing
food. X ray studies with contrast reveal that she has a markedly dilated
esophagus above the level of the lower esophageal sphincter (LES).
Endoscopic examination reveal annular thickening of the esophageal wall
with narrowing of the lumen. Biopsy was taken and histological diagnosis
showed intramucosal carcinoma which is interpreted as;

1. Invasion of neoplastic epithelial cells into the lamina propria

2. Invasion of neoplastic epithelial cells into the mucosa
3. Invasion of neoplastic epithelial cells into the submucosa
4. Invasion of neoplastic epithelial cells into the lymphatic vessels
5. Invasion of neoplastic epithelial cells into the muscularis propria

18. A 69 year old man presents with slowly progressive jaundice, weight
loss, abdominal pain and migratory thrombophlebitis. GPE reveals a
palpable gallbladder in the right upper quadrant of the abdomen. Lab
investigation reveal the presence of the obstruction o f the biliary tract,
while a CT scan of the abdomen reveals a mass in the head of the
pancreas. Histologic sections taken from the mass would most likely reveal
which of the following?

1. Acinic cell carcinoma

2. Adenocarcinoma of the pancreas
3. Mucinous cystadenocarcinoma
4. Papillary cystic tumor
5. Squamous cell carcinoma

19. Carcinoma of the gallbladder has a strong association with:

1. Exposure of aflatoxins
2. Exposure to thorotrast
3. Exposure to vinyl chloride
4. Presence of gallstones
5. Accumulation of biliary sludge

20. A 68 yr old man presents with history of fatigue, weakness and change
in bowel habit. On lab examination, there is iron defiency anemia and
occult blood in stool. On colonoscopy there is a large irregular annular
mass in distal colon with heaped up and beaded margins. What is the most
likely diagnosis?

1. Tubular adenoma
2. Hyperplastic polyp
3. Colorectal carcinoma
4. Villous adenoma
5. Pseudomembranous colitis
21. Hirschsprung’s disease is usually caused by the congenital absence of
ganglion cells in the myenteric plexus of which segment of the intestine?

1. Caecum
2. Ascending colon
3. Transverse colon
4. Descending colom
5. Rectum

22. What is the name given to the persistent vitelline duct remnant?

1. Omphalocele
2. Heisters diverticulum
3. Rokitanskys diverticulum
4. Meckels diverticulum
5. Nicks diverticulum

23. A 39 yr old man presents with bloody diarrhea. Multiple stool

examinations fail to reveal ove or parasites. Barium examination of patients
colon reveals the characteristic ‘string sign’. Colonoscopy reveals rectum
and sigmoid portions of colon to be unremarkable. Biopsy of terminal oleum
reveals numerous acute and chronic inflammatory cells within lamina
propria. Worsening of symptoms result in emergency resection of distal
small intestines. Gross examination of this resected bowel reveals deep,
long mucosal fissures extending into the muscle wall. Several transmural
fistulas are also found. Which of the following is the most likely diagnosis?

1. Ulcerative colitis
2. Crohns disease
3. Lymphocytic colitis
4. Infectious colitis
5. Eosinophilic colitis

24. A four year old boy presents with mild fatigue and malaise. Several
other children in the day care centre he attends 5 days a week have
developed similar illness. Physical examination finds mild liver tenderness,
elevated serum levels of liver enzymes and bilirubin. The boy recovers from
his mild illness without incident. Which of the following organisms is the
most likely cause of this child illness?

1. Cytomegalovirus
2. Epstein Barr Virus
3. Group A Beta hemolytic streptococcus
4. Hepatitis A virus
5. Hepatitis B virus

25. A 55 years old man visited his dentist for a routine examination. The
dentist noticed a whitish, well-defined mucosal patch on his tongue. The
plaque could not be removed by scraping. The past medical history showed
no significant finding. Which of the following etiologic factor most likely
contributed to the development of this lesion?

1. Dental caries
2. Herpes simplex virus type 1
3. Eating smoked and pickled food. D. Chronic sialadenitis
E. Smoking tobacco

26. A 40 years old man with a lengthy history of chronic alcoholism has had
increasing difficulty in swallowing and has noticed a 6 kg weight loss over
the past 2 months. On physical examination there are no significant
findings. Upper gastrointestinal endoscopy shows a large ulcerated lesion
with heaped up margins in the mid-esophagus which partially occludes the
esophageal lumen. Esophagotomy is performed. Which of the following is
most likely to be seen on microscopic section of this mass?

1. Multinucleated cells with intracellular inclusions

2. Squamous cell CA
3. Dense collagenous scan
4. Adenocarcinoma
5. Thrombosed vascular channels

27. A 30 years old man has sudden onset of hematemesis after a weekend
in which he consumed large amounts of alcohol. The bleeding stops but he
has another episode under similar circumstances one month later.
Endoscopy shows longitudinal tears at the esophagogastric junction. What
is the most likely mechanism which has resulted in hematemesis in this
patient?

1. Absent myenteric ganglia

2. Autoimmune inflammation
3. Herpes simplex virus infection
4. Portal hypertensions
5. Vomiting

28. A 51 years old man has sudden onset of massive emesis of bright red
blood. On physical examination his temperature is 36.9 C, pulse is 103/min,
respiratory rate is 19/min and BP is 85/50 mmHg. Studies show a
hematocrit of 21%. The serological test for HBsAg is positive. He has had
no prior episodes of hematemesis. This hematemesis is most likely to be a
consequence of which of the following?

1. Esophageal varices
2. Barret’s esophagus
3. Reflux esophagitis
4. Squamous cell CA
5. Zenker’s diverticulum

29. A 26 years old man is brought to the emergency department after

sustaining abdominal gunshot injuries. At laprotomy, while repairing the
small intestine the surgeon notices a one cm mass at the tip of the
appendix. The yellow coloured submucosal mass is removed. Electron
microscopy of mass shows the mass to be made up of cells which contain
small, dark, round granules with a dense core. Which of the following is the
most likely cell of origin of this lesion?

1. Lipoblast
2. Ganglion cell
3. Neuroendocrine cell
4. Smooth muscle cell
5. Mucin secreting epithelial cell

30. A 20 years old woman has had nausea and vague lower abdominal
pain for last 24 hours. Now the pain has become worse. On GPE, pain is
worst in the right lower quadrant and there is rebound tenderness. A stool
sample is negative for occult blood. Abdominal plain X-ray shows no free
air. Serum pregnancy test is negative. Which of the following lab finding is
most useful to aid in the diagnosis of this patient?

1. Hyperamylasemia
2. Hypernatremia
3. Increased serum Carcinoembryonic antigen
4. Increased serum alkaline phosphatase
5. Leucocytosis

31. A 65 years old woman has had upper abdominal pain for the past
month. On examination, the pain is localized to the epigastric region.
Abdominal CT scan shows a well circumscribed 8cm mass in the body of
the pancreas that has many small fluid filled filled areas. The mass is
removed. On microscopic examination, glycogen rich cuboidal cells are
seen surrounding spaces filled with clear fluid. There is no recurrence of
the lesion. What is the most likely diagnosis?

1. Acute pancreatitis
2. Cystic fibrosis
3. Pseudocyst
4. Chronic pancreatitis
5. Serous cystadenoma of pancreas

32. A 2 week old infant with a firm, ovoid, olive shaped palpable mass in
the region of the pylorus would most likely to have which of the following
findings?

1. Cyanosis that is worse when feeding

2. Double bubble sign on X-ray
3. Failure to pass meconium
4. Peristaltic bowel sounds in thorax
5. Projectile nonbilous vomiting
33. A 46 years old woman taking ibuprofen for increasing pain in her hands
presents with increasing pain in her midsternal area. Gastroscopy reveals
multiple, scattered, punctuate hemorrhagic areas in her gastric mucosa.
Biopsies from one of these hemorrhagic lesions reveal mucosal erosions
with edema and hemorrhage. No mucosal ulceration is seen. Which of the
following is the most likely diagnosis?

1. Active chronic gastritis

2. Acute gastritis
3. Autoimmnune gastritis
4. Chronic gastritis
5. Peptic ulcer disease

34. An autopsy is performed on a 19 years old girl who died from an

overdose of acetaminophen. Which of the following histologic changes is
most likely to be seen in a biopsy specimen taken from her liver?

1. Centrilobular necrosis
2. Focal scattered necrosis
3. Geographic necrosis
4. Midzonal necrosis
5. Periportal necrosis

35. Dilated sinusoids and irregular cystic spaces filled with blood within the
liver, which may rupture and lead to massive intra-abdominal hemorrhage,
are most closely associated with which one of the following substance?

1. Salicylates
2. Estrogens
3. Anabolic steroids
4. Acetaminophens
5. Vinyl chloride

36. A 55 years old man presents with increasing fatigue, weakness,

anorexia and jaundice over the past several months. Physical examination
finds mild ascites and gynaecomastia. A liver biopsy reveals regenerative
nodules of hepatocytes surrounded by fibrosis. What is the diagnosis?

1. Cholangitis
2. Cholestasis
3. Cirrhosis
4. Hepatitis
5. Steatosis

37. A 12 years old boy with sickle cell anemia presents with recurrent
severe right upper quadrant colicky abdominal pain. At the time of surgery,
multiple dark black stones are found within gall bladder. These stones are
composed of which of the following substances?

1. Bilirubin
2. Carbon
3. Cholesterol
4. Struvite
5. Urate

38. A 54 years old man presents with high fever, jaundice and abdominal
pain in right upper quadrant. The gall bladder cannot be palpated. An
ultrasound reveals a dilated area with the common bile duct. Further work
up reveals a normal Hb level, but increased levels of bilirubin and alkaline
phosphatase. What is the diagnosis?

1. Acute cholecystitis
2. Ascending Cholangitis
3. Choledocholithiasis
4. Cholelithiasis
5. Chronic cholecystitis

39. A 54 years old man with a history of alcoholism presents after a bringe
of heavy drinking with vomiting and severe epigastric pain which radiated to
back. On examination, he is febrile and there is discoloration around his
flank and umbilicus. Lab tests finds elevated serum amylase and lipase.
What is the most likely cause of these findings?

1. Acute cholecystitis
2. Acute colitis
3. Acute pancreatitis
4. Chronic gastritis
5. Chronic hepatitis

40. A 45 years old man with a 2 years history of a mild non-ketotic diabetes
mellitus and anemia presents with the new onset of a necrolytic migratory
skin rash. What is the cell of origin of a tumor that would most likely
produce this set of clinical signs?

1. A cells of pancreas
2. B cells of pancreas
3. C cells of thyroid
4. D cells of stomach
5. G cells of stomach

41. A 10 months old previously healthy male infant develops a severe

watery diarrhea 2 days after visiting the pediatrician for a routine check up.
Which of the following complication is most likely to develop in this infant?

1. Aplastic anemia
2. Intestinal obstruction
 3. Iron deficiency
4. Megaloblastic anemia
5. Severe dehydration

42. A biopsy of the antrum of the stomach of an adult who presents with
epigastric pain reveals numerous lymphocytes and plasma cells within the
lamina propria, which is of normal thickness. There are also scattered
neutrophils within the glandular epithelial cells. A Steiner silver stain from
this specimen is positive for a small, curved organism. These histologic
changes are most consistent with infection by which one of the following
organism?

1. Enteroinvasive E.coli
2. Enterotoxigenic E.coli
3. Helicobacter pylori
4. Salmonella typhi
5. Shigella species

43. A 45 years old man presents with increasing heartburn especially after
eating or when lying down. Endoscopic examination finds a red velvety
plaque located the distal esophagus. Biopsies from this area taken
approximately 4 cm proximal to the gastro-esophageal junction reveal
metaplastic columnar epithelium. Which of the following is the most likely
diagnosis?

1. Acquired Achalasia
2. Barret’s esophagus
3. Hamartomatous polyp
4. Metastatic adenocarcinoma
5. Reflux esophagitis

44. Which of the following congenital defect of bilirubin metabolism is

characterized by conjugated and unconjugated hyperbilirubinemia and
causes black discoloration of liver due to pigment accumulation in the
hepatocytes?

1. Rotor’s syndrome
2. Crigler-Najjar syndrome
3. Dubin-Johnsons syndrome
4. Gilbert’s syndrome
5. Neimann-Pick syndrome

45. An adolescent who presents with lassitude, jaundice, fever,

hypersplenism and Kayser Fleischer rings, has which of the following
disorder?

1. Alpha 1 antitrypsin deficiency

 2. Wilson’s disease
3. Hepatitis B
4. Gilbert’s syndrome
5. Hemochromatosis

46. Hepatocellular carcinoma metastasize most often to which of the

following sites?

1. Lungs
2. Portal lymph nodes
3. Portal veins
4. CNS
5. Kidneys

47. A 67 years old woman has experienced severe nausea, vomiting, early
satiety and a 9 kg weight loss over past 4 months. On physical
examination, she has mild muscle wasting. Upper GI endoscopy shows
that the entire gastric mucosa is eroded and has an erythematous
cobblestone appearance. Upper GI radiograph shows that stomach is small
and shrunken. Which of the following is most likely to be found on
histological examination of a gastric biopsy specimen?

1. Early gastric CA
2. GI stromal tumor
3. Granulomatous inflammation
4. Chronic atrophic gastritis
5. Signet ring cell adenocarcinoma

48. A 24 years old woman gives birth to an infant at term after an

uncomplicated pregnancy. APGAR scores are 9 and 10 at 01 and 05
minutes after birth. The infant’s length and weight are at 55th percentile.
There is no significant passage of meconium. On physical examination,
infant is afebrile but abdomen is distended & tender and bowel sounds
reduced. An abdominal ultrasound scan shows marked colon dilation
above narrow segment in sigmoid region. A biopsy specimen from narrow
region shows absence of ganglion cells in muscle wall and sub-mucosa.
Which of the following is most likely to produce these findings?

1. Volvulus
2. Trisomy 21
3. C. Hirchsprung disease
4. Chronic Atresia
5. Intussusceptions

49. A 38 years old man with HIV positive for 10 years has had severe
nausea and vomiting for past 2 weeks. On physical examination, he is
afebrile. Stool sample positive for occult blood. Abdomen not distended, no
palpable mass or organomegaly, bowel sounds present. Patient has oral
thrush, several reddish purple 0.5-1.0 cm nodules on skin of trunk.
Laboratory studies shows CD4+ lymphocyte count of 118/ul. Upper GI
endoscopy shows 12 reddish purple, 0.6-0.8 cm gastric mucosal nodules.
Biopsy specimen of nodules is most likely to show which of the following
neoplasm?

1. Non-Hodgkin lymphoma
2. Carcinoid tumor
3. Squamous cell CA
4. D. Kaposi sarcoma

50. You will see no anatomic pathology at all in the gut in a case of

1. amebiasis
2. cholera
3. cryptosporidiosis
4. ischemic colitis
5. shigellosis

51. What is the predominant cell in the small-intestinal lesions

of typhoid fever?

1. eosinophil
2. lymphocyte
3. macrophage
4. neutrophil
5. plasma cell

52. Classic "hypersecretory" gastritis involves primarily the

1. antrum
2. cardia
3. entire mucosa
4. fundus
5. muscularis throughout the organ

53. Metaplasia of the stomach mucosa near a primary fundic

cancer usually resembles

1. antral mucosa
2. colon
3. esophagus
4. pancreas
5. E. small intestine (*)

54. A tree-like, branching core of smooth muscle distinguishes

adenomatous polyp?

1. hyperplastic polyp
2. juvenile retention polyp
3. C. Peutz-Jegher polyp
4. pseudopolyp
55. Where's the thrombus in "Budd-Chiari" syndrome?

1. hemorrhoidal plexus
2. B. hepatic vein
3. inferior mesenteric vein
4. portal vein
5. umbilical vein

56. Infamous for those "flask-shaped ulcers" in the colon?

1. A. amoeba
2. Crohn's
3. shigella
4. typhoid
5. ulcerative colitis

57. Crohn's regional enteritis gets blamed for causing B12 deficiency
because it often involves the
A. colon
B. duodenum
C. proximal jejunum
D. stomach, interfering with intrinsic factor production
E. terminal ileum
58. The pentetreotide (octreotide-analogue) nuclear-medicine scan is a
good way to light up
A. carcinoids
B. helicobacter
C. ischemic bowel
D. premalignant colon polyps
E. small peptic ulcers

59. Which layer is typically thickened in reflux esophagitis? A. basal la

yer of the epithelium B. keratin layer of the epithelium C. muscular
is mucosae D. spiny layer of the epithelium E. venous muscular tuni
c60. On endoscopy of the stomach, if the antrum is obviouslyinflamed but
the fundus seems much less involved, the cause is probably A. alcohol
B. aspirin / NSAIDS C. autoimmunity D. helicobacter E. Zol
linger-Ellison

Please evaluate yourself