patomorph-cycles-2024

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Cycle 1

1) ACUTE left sided heart failure everything

-Myocardial infarction
-Myocarditits
-Myocardial degeneration (cardiomyopathy)
-Systemic Hypertension
-Atherosclerosis
-Coaraction of the aorta
-Mitral valve stenosis
-Mitral and Aortic valve diseases —> Rheumatic fever, Bacteria (Endocarditis), LUES

3) Chronic right sided heart failure Consequences


a. Liver cirrhosis
b. hepatosplenomegalty
c. caput medusae
d. Splenomegalty

-Hydrothorax
-Peripheral edema of lower limbs
-Anasarca
-Bronchitis —> catarrhal
-Ascites
-Cyanosis
-Gastritis —> catarrhal
-Enteritis —> catarrhal
-Hydropericardium
-Visceral congestion
-Congestion in liver (hepatomegaly), spleen (splenomegaly), kidneys, brain

4) Red infarct
-In tissues that were previously congested because of sluggish venous outflow
-In tissues with dual circulations (lung and small intestine)
-With venous occlusions (ovarian torsion)
-When flow is reestablished after infarction has occurred (after angioplasty of an arterial
obstruction)
- In loose tissues where blood can collect in infarcted zones (lung)
-Lungs, Testis, Ovary, small intestine, liver

White infarcts:
-Spleen
-Heart
-Kidney
-In solid organs, where the solidity of the tissue limits the amount of hemorrhage that can
deep into the area of ischemic necrosis from adjoining capillaries bed
-With arterial thrombosis —> arterial occlusions
-Solid organs with end-arterial circulations
-Where tissue density limits the seepage of blood from adjoining patent vascular beds

5) Gohn Complex
a. Miliary TB - (lungs,liver, spleen, meninges, etc.)
b. Organ isolated TB
c. secondary TB
d. staining is ziehl Nelson suggesting mycobacterium tuberculosis

6) Amyloidosis
a. intracellular deposition of Congo red
b. intracellular deposition of fibrillar protein
c. Extracellular deposition of fibrillar protein

7) Hamartoma of lung
- is a mass of disorganized tissue indigenous to particular site
- mass of mature: disorganized hepatic cells, blood vessels or nodule in lung
containing islands of cartilage, bronchi and blood vessels
- acquired translocation, suggesting neoplastic origin
- benign
- Refers to an excessive but focal overgrowth of cells and tissues native to the organ in
which it occurs
8) Duret Hemorrhage:
a. pons - midline and paramedian regions of the midbrain and pons
b. Parietal lobe
c. Frontal lobe
d. Cerebellum
e. Occipital lobe

Duret Hemorrhage: Progression of transtentorial herniation is often accompanied by linear or


flame-shaped hemorrhages in the midbrain and pons

9) 4th position in sequence of morphological changes in myocardial infarction


a. lysosomal release of enzymes
b. Proteolysis/Granulation
c. Necrosis
d. Phagocytosis
e.
1. Lyzosomes destruction
2. enzymes
3. proteolysis
4. necrosis
5. phagocytosis
6. granulation
7. scar

10) Virchow ́s Triad


a. Endothelial Injury, Abnormal Blood Flow, Hypercoagulability
Alteration in normal blood flow, hypercoagulability of blood, endothelial injury - describes
main factors in cause of thrombosis
Main causes of intravascular thrombosis are:
- Endothelial injury
- Stasis or turbulent blood flow
- Hypercoagulability of the blood
- Collectively known as “Virchow triad”

11) Edema results from which of the following:


A. Increased hydrostatic pressure
B. Decreased colloid osmotic pressure
C. Lymphatic obstruction that impairs interstitial fluid clearance
D. Primary renal sodium retention
E. Decreased vascular permeability

12) Feature of cerebral edema


- Reye syndrome
- flattened gyri
- narrowed sulci
- compressed ventricular cavities
- softer texture

13) N1 according to TNM grading means


T: component is defined by the size or contiguous extension of the primary tumor.
N: component is defined by the absence, or presence and extent of cancer in the regional
draining lymph nodes
M: component is defined by the absence or presence of distant spread or metastases,
generally in locations to which the cancer spread by vascular channels, or by lymphatics
beyond the nodes defined as “regional.”

T0 - No evidence of primary tumor


Tis - Carcinoma in situ
TI,T2, T3, T4 - Increasing size and/or local extension of the primary tumor
TX - Primary tumor cannot be assessed

N0 - No regional lymph node metastases


N1,N2,N3 . Increasing Number Or Extent Of region lymph node involvement
NX - Regional lymph nodes cannot be assessed

M0 - No distant metastases
M1 - Distant metastases present

14) Linitis plastica


- Found in Gastric Adenocarcinoma
- Term that describes thickening of gastric wall

15) Liquefactive necrosis (example)


- Liquefactive necrosis is characteristic of ischemic brain tissue and is often observed
in the context of an infarction, such as in ischemic stroke.
- Liquefactive necrosis --- is seen in focal bacterial and, occasionally, fungal infections
- Ischemic tissue injury in the central nervous system results in: Liquefactive necrosis
- In BRAIN
- bacterial and fungal infections

16) Fat embolism (example)


- Occurs after major soft tissue trauma —> Crush injury or rupture of marrow vascular
sinusoids t.ex due to a long bone fracture, release microscopic fat globules into the
circulation
- Occurs after severe burns
- Most common caused by long bone and pelvic fracture

17) Cor pulmonale caused by all EXCEPT


a. Acute Pulmonary Hypertension
b. Emphysema
c. Chronic Bronchitis
d. Fibrosis
e. Pneumoconiosis

In chronic pulmonary congestion alveolar spaces contain:


A. Thrombi
B. Fibroblasts
C. "Heart failure" cells - Macrophages laden with Hemosiderin
D. Neutrophils
E. Plasma cells

19) Acute inflammation

- Vascular changes - Vasodilation


- Neutrophil recruitment
- Mediators

20) Neoplasms with mesenchymal origin


21) Example: Patient with acute pancreatitis, which type of necrosis?
a. Fibrinoid
b. Fat
c. Caseous
d. Gangrene

22) Components of atherosclerotic plaque all EXCEPT


a. Foam Cells
b. Cholesterol Clefts
c. Eosinophils
-

23) Thrombus is build in


a. Alive outside Vessels
b. Alive Inside Vessels
c. After Death

24) Location of thrombus


a. Deep Veins Of Leg (DVT) - or superficial

25) Renal cell carcinoma first sign


a. Hematuria
b. Palpable Mass
c. Pain
d. Proteinuria

26) Wrong combination:


a. SLE - hematoxylin
b. Cytomegalovirus – asterisk/asteroid body - Sarcoidosis
c. Rheumatoid endocarditis – Aschoff nodule
d. Schwannoma - Virocay body
e. Sarcoidosis – Schaumann body

Rheumatic myocarditis - Rheumatic fever

27) Man with pancreatic problem – fat necrosis

- Typical results from release of activated pancreatic lipases into the substance of the
pancreas and the peritoneal cavity
- Characterized by chalky white areas on gross examination released —> fatty acids
combine with calcium to produce grossly visible chalky white areas (fat
saponification)
- Characterized by foci of necrosis that contain shadowy outlines of necrotic fat cells
with basophilic calcium deposits, surrounded by an inflammatory reaction
- Occurs in acute pancreatitis

28) Woman smoking and drinking – liver cirrhosis

- Hepatic Failure : Spider angiomas, Gynecomastia, Hypoalbuminemia, Palmar


erythema, Hypogonadism, decreases synthesis of clotting factors, jaundice
- Portal Hypertension: Esophageal varices, Splenomegaly + caput medusa,
Hemorrhoids, Anemia, infections, diathesis
- Both: Ascites, Hepatic encephalopathy (loss of neuron function, Brain edema)
- Bridging fibrous septa
- Massive hepatic necrosis
- Alcoholic cirrhosis -> massive fatty change
- Nodules containing proliferating hepatocytes (parenchymal)
- Disruption of architecture of entire liver
Factors:

- Alcohol (60-70%)
- Viral hepatitis → HBV 5.10% , HVC >50%, HDV
- Biliary disease
- Primary hemochromatosis
- Wilson disease
- alpha1-antitrypsin deficiency

29) Fainting lady – woke with inability to speak and move right arm – CT scan show
cyst in parietal lobe – what is it?
a. Liquefactive necrosis
b. Gangrene
c. Coagulative necrosis
d. Amyloidosis

30) Which is present in fibroid necrosis EXCEPT:


a. Immune complexes
b. Complement
c. Bacterial colonies - liquid/liquefactive necrosis
d. Pink necrosis in arterial wall

31) What caused: subcutaneous nodule, fibrinoid necrosis, fibroblast and histiocyte
in extensor part of forearm:
a. SLE
b. Rheumatoid arthritis
c. Tuberculosis
d. Syphilis
e. Leprosy
32) Metaplasia is a change in which:
A. Glandular epithelium is replaced by squamous epithelium
B. Immature cell type is replaced by adult cell type
C. One immature cell type is replaced by another immature cell type
D. Adult cell type is replaced by immature cell type
E. One adult cell type is replaced by another adult cell type
- Metaplasia is a reversible change in which one adult cell type (epithelial or
mesenchymal) is replaced by another adult cell type.

33) coarctation of aorta

Coarctation of the aorta - Postductal


- Ductus arteriosus obliterated (90%)
- Hypertension of the upper extremities > Aneurysms(brain)
- Atherosclerosis (proximal to coarctation)
- Hypertrophy of the L.V.
- Collateral flow:
> Intercostal aa.
>atrophia e compressione costarum

Coarctation of the aorta - Preductal


- Ductus arteriosus apertus (patent) (94%)
- Cyanosis of the lower 1⁄2 of the body
- Congestive heart failure
- Hypertrophy of the R.A. & R.V.

34) Hemosiderin in brown induration of lung

Chronic left sided heart failure - hemosiderin + macrophages= heart failure cells in brown
induration of lung

35) Consequence of acute MI

-Cardiac arrhythmias
-Left ventricular aneurysm
-Mural thrombosis
-Papillary muscle rupture/dysfunction
-Cardiac rupture
-Anterior free wall myocardial rupture
-Ventricular septal rupture
-Fibrinous Pericarditis
-Cardiogenic shock
-Pulmonary edema
-Mitral valve insufficiency
-Cardiac tamponade
- Hypotension
-Contractile dysfunction, Right ventricular infarction, Myocardial rupture, Chamber dilation,
Ventricular aneurysm, Progressive late heart failure → Ischemic cardiomyopathy,
Progressive heart failure secondary to ischemic myocardial damage, When compensatory
mechanisms fail t.ex hypertrophy

36) Which isn't true?


a. Hyperplasia of because of hypertension - Hypertrophy
b. Can be physiologic
c. Can be pathological
d. Hypertrophy increase in size of cells

37. Features of malignant cancer cells EXCEPT


a. multiple nuclei
b. cellular polymorphism - PLEO
c. nucleus / cytoplasm ratio
d. hyper chroma sth
e. expansion of nuclear membrane
stream (hematogenous spread) and Carcinomas spread through the lymphatic system

38. The risk factor of renal cell carcinoma include


a) Smoking
b) Arterial hypertension
c) Occupational exposure to cadmium
d) Obesity
e) Diabetes

40. Consequence of Artherosclerosis except


a. Liver cirrhosis
b. Cerebral infarction
c. Myocardial infarction
d. Aneurysm
e. Gangrene of extremities

Cycle 2

PSA is produced by: (prostate specific antigen)

a. Hepatocytes
b. Sertoli cells
c. Normal prostatic epithelium 20%- 40%of prostatic cancer found in men with “normal”
PSA levels
d. Neoplastic prostatic epithelium Serum PSA level used as the upper limit of normal: 4.0
ng/l
e. Testicular germ cell
Malignant Melanoma cells reveal positive staining for presence of
a) LCA (leukocyte common antigen)
b) S-100
c) HMB-45
d) cytokeratin (negative)
e) vimentin

The peak incidence of follicular carcinoma of the thyroid is:

A. Between 30 and 40 years of age


B. Between 40 and 60 years of age
C. After 70 years of age
D. Between 10 and 20 years of age
E. Between 60 and 70 years of age

Psammoma bodies location

A. Serous papillary cystadenoma


B. Medullary carcinoma of thyroid
C. Papillary carcinoma thyroid
D. Follicular thyroid
E. Mucinous ovarian

5. Annie Lennox eves are found in

A. Serous papillary cystadenoma


B. Medullary carcinoma of thyroid
C. Papillary carcinoma thyroid
D. Follicular thyroid
E. Mucinous ovarian

6. Pheochromocytoma – 10% rule EXCEPT:

a. Malignant
b. Associated with EBV
c. Extra-adrenal + bilateral, not hypertension
d. Familial (25%) (congenital)

7. Medullary carcinoma of thyroid


- Make up more than 50% of cases of thyroid cancer - less than 5% of thyroid cancers
- Are derived from neuroendocrine cells - parafollicular C cells
- Arise sporadically in about 50% of cases - 70%
- In familial cases occur in the setting MEN syndrome 2A or 2B
- Are composed of spindle-shaped or polygonal cells
-

8. Which of the clinical variants of malignant melanoma begins with the vertical
growth phase without an obvious radial growth phase?

1. Lentigo malignant melanoma (lateral)


2. superficial spreading melanoma
3. Nodular melanoma
4. Acral/lentiginous melanoma (lateral)
5. uvenile melanoma

9.Luminal A breast carcinomas are typically:

A. lower-grade ER-positive
B. HER2 negative
C. higher-grade ER-positive
D. HER2 positive
E. ER-negative

10. Endometriosis:

a. Is defined by the presence of endometrial glands and stroma in a location outside the
endometrium
b. Occurs in as many as 10% of women in their reproductive years and in nearly half of
women with infertility
c. Frequently is multifocal
d. Often involves pelvic structures (ovaries, pouch of Douglas, uterine ligaments, tubes
and rectovaginal septum)
e. Never produce infertility (can produce discomfort and eventual sterility)
f. Sex cord stromal tumor

11. Picture of DCIS

A. Include following histologic types: solid, comedo, cribriform, papillary, micropapillary


B. Can be low or high nuclear grade
C. Frequently reveals calcification
D. Constitutes up to 30% in screened populations
E. Despite current treatment strategies has bad prognosis
12. 3 year old with testicular mass what is likely

1. Seminoma (40-50)
2. Yolk sac tumor (90% of patients have elevated AFP)
3. Teratoma (all ages)
4. Leydig cell tumor (all ages)
5. Embryonal carcinoma (20-30)

65 y/o women with 1 cm fixed mass in left upper outer quadrant breast. Which is most
likely present

A. Fibroadenoma - painless mobile mass in younger women


B. Fibrocytic changes
C. Paget disease
D. Intraductal papilloma
E. Carcinoma

A 50-year-old woman sees her physician because she has noticed a bloody
discharge from the left nipple. Upon physical examination, there are no palpable
masses in the breast and no skin lesions in this area. Which of the following is the
most likely cause of this discharge:

A. Invasive ductal carcinoma


B. Apocrine metaplasia
C. Solitary cyst
D. Fibrocystic change
E. Intraductal papilloma

5-year-old girl with sexual characteristics like pubic hair, breasts. Which cell
component is common for this type of ovarian tumour

A. Schiller Duval - yolk sac and its 3y


B. Fibrotic changes
C. Thyroid tissue changes
D. Signet cells
E. Call – exner - Granulosa theca → produce a lot of estrogen

Partial mole karyotype:

A. 46 XX (complete)
B. 46 XY (complete)
C. 69 XXY
D. 47 XXY

17. Which of the following sentences are true?

a. unilateral cryptorchidism may be associated with atrophy of contralateral descended


gonad and therefore may also lead to sterility (cryptorchidism —> no testes)

b. cryptorchidism is associated with a 3-5-fold increased risk of testicular malignancy

c. individuals with unilateral cryptorchidism are at increased risk of development of


cancer in the contralateral, normally descended patients
d. surgical placement of undescended testis into scrotum (orchiopexy) before puberty
decreases the likelihood of testicular atrophy and reduces but does not eliminate
the risk of cancer and infertility (surgery by 18 month of age)
e. by 1 year of age, cryptorchidism is present on 90% on male population (1%)
Bilateral in 10% of affected patients – cause sterility

18. Which of the following sentences are true:

A. In melanomas, depth of invasion correlates with survival


B. Most melanocytic nevi have activating mutation in BRAF or NRAS (less often NRAS)
C. Melanomas are highly aggressive malignancies
D. Most melanomas progress from an intraepithelial (in situ) to an invasive (dermal)
form
E. Most melanocytic nevi undergo malignant transformation (mostly benign)

19. Histologic examination revealed cords and islands of malignant cells with hyper
chromatic nuclei, and peripheral tumour cell nuclei palisading, embedded in a fibrotic
or mutinous stroll matrix. The most likely diagnosis is:

A. Kaposi sarcoma of skin


B. Hemangiosarcoma of skin
C. Basal cell carcinoma of skin
D. Malignant melanoma of skin
E. Squamous cell carcinoma of skin

20. PAP
a. Cytological examination of tissue from the vaginal portion and the canal of cervix
- screening tool for detection of cervical dysplasia & carcinoma

b. Every gynecologist can perform it


c. Can detect precancerous states
d. Performed on women over 35y (from age 18 or sexually active)
e. Performed every 6th year (every year to every third year)
f. Pap smear changes most likely found koilocytes

21.Which of the following are true regarding BRCA1 and BRCA2 genes?

A. BRCA1 and BRCA2 genes belong to tumor suppressor genes


B. .Women with BRCA1 gene mutations have a substantially higher risk of epithelial
ovarian cancers
C. Mutations in BRCA2 gene increase the risk of breast cancer in both men and women
as well as cancer of the ovary, prostate, pancreas, bile ducts and stomach.
D. BRCA1 gene is frequently inactivated in sporadic cases of breast cancer (mutation of
BRCA1 and 2 is rare in sporadic cancer; BRCA1 is 50% inactive in triple negative
cancer)
E. Mutations in BRCA1 and BRCA2 genes, account for 80% of cases of familial breast
cancer (25%)

22. Ovarian tumor shown ( IT WAS MATURE TERATOMA)


A. is prone to undergo torsion
B. is malignant - Mature is benign
C. is a sex-cord stromal tumor - Germ cell
D. may produce infertility
E. typically is bilateral - Unilateral → Benign
F. Most likely presence of mature squamous epithelial cells

23. difference between malignant melanoma and melanocytic nevi

1. lack of pleomorphism
2. increased number of mitotic figures
3. prominent nucleoli
4. melanin in the cytoplasm (both have)
24. Which of following are risk factors for the development of CIN and invasive
cervical carcinoma:
a. Early age at first intercourse
b. Persistent infection by HPV type 16 - high-risk HPV types 16, 18, 31, 33
c. Multiple sexual partners
d. Smoking
e. Oral contraceptive
f. Nulliparity - multiparity
g. Family history
h. HSV-2, HIV - STD
i. 40-45 y - peak incidence at age 45
j. Ovulatory

25. Risk factor for cutaneous squamous cell carcinoma

A. HHV 8 infection
B. Fair skin
C. UV light exposure
D. Exposure to carcinogenic chemicals
E. Chronic skin inflammation and scarring

26. complete mole


46, XX
46, XY
P57- complete mole – no fetal parts
P57+ - Partial
69, XXY - Partial

28. granulosa cells tumors assoc with


A. Endometrial stromal sarcoma
B. Benign stromal nodule
C. Endometrial hyperplasia
D. Endometrial polyp
E. Endometrioid adenocarcinoma

29. Hashimoto disease


a) most common cause of hypothyroidism in areas of world where iodine levels are
sufficient
b) characterized by gradual thyroid because of autoimmune destruction of thyroid gland
c) most prevalent between 45-65 years of age
d) more common in men than in women (more women)
e) characterized by extensive fibrosis involving thyroid and contiguous neck
structures (Riedel thyroiditis)

30. Condylomata acuminata of the vulva are caused by:


warty growth on the external genitals or at the anus

A. HIV.
B. HPV 6.
C. HPV 11.
D. HPV 16.
E. HPV 18.

31. Verruca vulgaris is mostly found in:

A. Neck
B. Leg - Plantaris and verruca Palmaris occur on the soles and palms, respectively
C. Trunk
D. Hand (many warts on hands)
E. Face - Or dorsal surfaces of the hand → Plana

32. distinction between papillary adenoma and papillary thyroid carcinoma

A. Necrosis
B. Capsular invasion
C. KI-67 index (breast cancer)
D. Vascular invasion
E. Cellular atypia

33. BPH

A. symptomsoms present in 90 percent of men with BPH - 10%


B. Prostatic stroma contains smooth muscles and fibrous tissue
C. BPH occurs in transitional zone + 70% to 80% of prostate cancer arise in outer
(peripheral) glands
D. Proliferation of stromal and glandular tissue - fibroblasts, SMC, epithelial cells,
Glandular cells (2 layers)
E. Normal prostate contains glands with two cell layers
F. Hyperplastic glands are lined by two cell layers: an inner columnar layer and an
outer layer composed of basal cells.
G. Acute urinary obstruction may occur.
Symptoms of BPH

Bladder diverticulum
Hydroureter
Pyelonephritis
Cystitis
34. Proliferative breast disease without atypia includes:

A. epithelial hyperplasia
B. sclerosing adenosis complex
C. sclerosing lesion
D. papilloma
E. fibrosis - Fibroadenoma should be correct

35. Seminomas / Testicular cancer


a) account for about 50% of testicular germ cell neoplasms
b) they are histologically identical to ovarian dysgerminomas

c) are composed of large, uniform cells with distinct cell borders, clear cytoplasm, and
round nuclei with conspicuous nucleoli arrayed in small lobules with intervening fibrous
septa

d) present most frequently with painful enlargement of the testis - Painless


e) are typically confined to the testis by an intact tunica albuginea

Subacute granulomatous (de Quervain) thyroiditis:

A. Is self-limited disease
B. May be caused by viral infection
C. Is most common between 30-50 years of age
D. Is more common in women
E. Is characterised by acute onset with neck pain, fever and thyroid enlargement
37. Skin lesions Warning signs

A. Change in color/size of pigmented lesions


B. Rapid enlargement of preexisting nevus
C. Itching or pain in a lesion
D. Development of new pigmented lesion during adult life
E. Irregularity of the borders of a pigmented lesion
F. Variegation of color within pigmented lesion

39. Which of the following sentences are true regarding HER2 in breast carcinomas:
A. HER2 is a receptor tyrosine kinase
B. HER2 promotes cell proliferation
C. HER2 promotes apoptosis by stimulating the RAS- and PI3K-AKT signaling
pathways - inhibits apoptosis
D. Cancers that overexpress HER2 are highly proliferative
E. Cancers that overexpress HER2 can be treated by inhibitors of HER2

40. Which of the following sentences are true regarding breast carcinomas:

A. The lifetime risk of developing breast cancer for an American woman is 1 in 8


B. A majority of breast cancers are diagnosed after the age of 50
C. When carcinoma develops in a woman with a previous diagnosis of LCIS, two-thirds
are in the same breast and one-third is in the contralateral breast
D. When carcinoma develops in a woman with a previous diagnosis of untreated DCIS,
it is usually an invasive ductal carcinoma in the same breast
E. Prognosis is not dependent on the stage of the breast carcinoma
F. Ductal carcinoma in situ is a precursor to invasive ductal carcinoma
G. Ductal carcinoma in situ is typically found on mammographic examination
as calcifications
H. Prognosis depends on tumor size
I. The majority (over 50%) of breast cancers are related to inherited mutations in
BRCA1 gene (10%)

41. Increased risk of breast cancer:

a. Exogenous estrogen replacement therapy


b. Smoking
c. Low fat diet (obesity)
d. Late age of first childbirth
e. Ionizing radiation

42. The presence of osteoblastic metastases in an older male is strongly suggestive


of
A. Colorectal carcinoma
B. Testicular seminoma
C. Testicular embryonal carcinoma
D. Gastric carcinoma
E. Prostatic adenocarcinoma

43. Some type of breast lesion that creates “single file”

a. DCIS
b. B. LCIS
c. Invasive ductal
d. Invasive tubular
e. Invasive lobular - carcinoma, cells invade stroma individually

44. Bloom and Richardson classification is based on:


a. Mitosis – Karyorrhexis index
b. Tubule formation
c. Intratumoral Calcification
d. Nuclear polymorphism
e. Mitotic rate

Cycle 3

1. GIST reveals positive immunohistochemical reaction


A. DOG1+
B. CD117+
C. CD34+
D. S100-
E. Desmin -
3. Which types of emphysema cause severe COPD?
A.Centriacinar+irregular
B.Distal acinar+irregular
C.Panacinar + Centriacinar
D.Panacinar+irregular

4. Most common sites for Crohn disease:


A. Ileum + Cecum
B. Colon - Colitis
C. Stomach
D. Esophagus
E. Duodenum

5. Viral pneumonia - choose true


A. Neutrophilic infiltrate
B. Total collapse
C. Cellular exudate
D. Eryhtrocytes
E. Alveoli without exudate

6. Viral what predominates ? If they asked about Viral Pneumonia


Neutrophils
Lymphocytes + Plasma cells

7. Viral myocarditis
A. Edema
B. Interstitial inflammatory infiltrates (mononuclear cells)
C. Myocyte injury
D. Diffuse lymphocytic infiltrate - is most common
8. What features are seen in Crohn disease that are not seen in ulcerative colitis:
A. Skip lesion
B. Noncaseating granulomas
C. Only mucosal involvement - transmural
D. Continuous colonic involvement - Ulcerative Colitis

9. Classic PAN

10. What is correct kawasaki and PAN?


Pan part of lungs - kidney, heart, liver, GI tract vessels affected
Kawasaki mostly affects medium sized arteries - large- to medium-sized vessels
Kawasaki & PAN affect the same vessels - Medium vessel vasculitis yes
Pan MI - Kawasaki causes MI
Kawasaki in the kidney - Hands, feet

11. Pictures: Tumor located in the hand → Glomus tumor


A. Benign painful tumor originating from modified s.m.
B. Cells that are involved in thermoregulation in the fingertips - affect distal portions of
digits

12. Pictures → Sacrococcygeal teratoma: Derived from all 3 germ cell layers:
Ectoderm, Endoderm, Mesoderm

14. Squamous cell carcinoma in upper third of esophagus metastasises to where?


A. Cervical LN
B. Mediastinal, paratracheal & tracheobronchial LN - Middle third
C. Axillary LN
D. Gastric & celiac LN - Lower third
E. Inguinal LN

15. Which of the following forms of Kaposi sarcoma characteristically occurs in older
men of Eastern European or Mediterranean descent, presents with multiple red to
purple skin plaques, usually in distal lower extremities and is not associated with HIV
infection eastern, Eastern Europe

A. Classic KS - Can be associated with malignancy, altered immunity, Not associated


with HIV infection, Manifests as multiple red-purple skin plaques or nodules, usually
on distal lower extremities, Typically asymptomatic
B. Lymphadenopathies
C. Endemic
D. Transplant-associated
E. Epidemic

48.Vascular lesions in classic polyarteritis nodosa: all EXCEPT

A) Involve small veins


B) Transmural
C)Segmental
D)Often with superimposed thrombosis
E) Necrotizing
-

What factors predispose to esophageal squamous cell carcinoma


a)smoking
b)alcohol consumption
c)esophageal varices
d)long-standing esophagitis + Achalasia, hot drinks, nutritional deficiency, poverty,
Plummer-Vinson syndrome, Polycyclic hydrocarbons, Nitrosamines, Esophageal injury
e)EBV infection - HPV

Pneumocystis jirovecii (carinii) pneumonia:


a. Usually occurs in immunocompetent subjects (immunocompromised)
b. Gives a histological picture of a foamy pink alveolar exudate - Cotton candy exudate
c. May be diagnosed by cytological examination of bronchoalveolar
lavage + Chest x-ray
d. Is rarely life threatening
e. Produces hyaline membranes which line the alveoli
f. severely malnourished infants
g. patients with aids
h. immunosuppressed individuals after organ transplantation
i. individuals receiving cytotoxic chemotherapy (or corticosteroids )

Primary Adrenal Tumor - Choose wrong

A. Pheochromocytoma
B. Schwannoma
C. Paraganglioma - aka extra adrenal Pheochromocytoma
D. ParaGanglioblastoma

Inflammation predominantly confined to alveolar septa with generally clear alveoli


Atypical Pneumonia

Causes of Lung Abscess:


- Aspiration of infective material from carious teeth or infected sinuses or tonsils
- Aspiration of gastric contents, usually accompanied by infectious organisms from the
oropharynx
- As a complication of necrotizing bacterial pneumonias
- Bronchial obstruction
- Septic embolism
- Hematogenous spread of bacteria in disseminated pyogenic infection

Focal nodular hyperplasia


A.It is usually an incidental finding, most commonly in children (young
females)
B.It is found most often in otherwise normal liver
C.It is a localised and well-demarcated lesion
D.It consists of dilated vascular spaces filled with red blood cells
E.It carries no risk for malignancy
F)is typically found in cirrhotic liver - NON cirrhotic
G)consist of hyperplastic hepatocyte nodules with central, stellate fibrous
scar - CT: central scar
H) is typically an accidental finding
I)is typically present in women in reproductive age - But NOT related to use of oral
contraceptives
J) increases risk for HCC - Not premalignant

Lady in the Polyvinyl Factory with Abdominal distension and discomfort:

HCC
hemangioma
Focular nodal hyperplasia

Hepatic Angiosarcoma

Most common cause of chronic gastritis

A. Most common cause is H.pylori


B. Remaining by NSAIDs, alcohol, or Autoimmune Gastritis
C. Less common Radiation injury and Chronic bile reflux

Juvenile hemangioma
- Strawberry hemangioma
- Of newborn skin, extremely common (1 in 200 births)
- Can be multiple
- Grow rapidly for few months but fade by age of 1 to 3 years (complete regression by
age 7)

Histologic features of chronic Hepatitis C include:


a.fatty change (also large lymphoid aggregates)
b.eosinophilic infiltrate in portal tracts
c.interface hepatitis
d.mallory bodies - Hep A
e.bridging necrosis

Where are peptic ulcers most common


Stomach - Usually antrum, lesser curvature (20%)
Esophagus
Proximal duodenum - first portion (78%)
Ileum
Colon

Pancreatic carcinoma risks


Smoking, which doubles the risk.
Long-standing chronic pancreatitis and diabetes mellitus
Fatty diet
Alcohol
Oral contraceptive
-
- TP53 Inactive 50-70%, BRCA2 mutated in late

What is CFTR protein normally responsible for?

Secretes sodium

Reabsorbs chloride from gastric lumen

Reabsorbs potassium

Esophageal Adenocarcinoma precursor?

Esophageal varices
Barret esophagus

GIST found most often in?


Stomach (60%)
Duodenum (5%)
Colorectum (5%)
Esophagus and appendix (1%)
Jejunum and ileum (30%)
Colon
Esophagus and appendix (1%)

Precursor for pancreatic cancer?

Intraepithelial mucous neoplasia (IPMN)

Pancreatic intraepithelial neoplasia

Which gene mutations are mutually exclusive in GIST?

KIT - Tyrosine Kinase → 75-85%

PDGFRA - 8%

What is NOT true about pneumonia?


Most common community acquired is S. Pneumonia - True also
Causes lung abscess - True
Pneomocystis jirovecii is the most common cause of viral pneumonia -
Viral infections affect alveoli walls but alveolar spaces are clear of infection - True

Wilms tumor origin?

Neural epithelium
Podocytes
Nephrogenic rests

In which parts of the lungs are coal macules and coal nodules present?

Upper lobes and Upper zones of the lower lobes -

Cycle 4

Which of the following bone tumors is most commonly associated with the presence
of t(11;22) translocation:
A. Chondrosarcoma
B. Giant cell tumor of tendon sheath
C. Ewing sarcoma
D. Metastatic neuroblastoma
E. Osteosarcoma
+

In what location are childhood CNS tumors more likely to arise:

1. Posterior fossa
2. Meninges
3. Ventricles
4. Spinal cord
5. Cerebral hemispheres - Adult CNS tumors (supratentorial)

3.The light microscopic appearance of the intracranial tumor → Meningioma

A. It is most common in the fourth and fifth decades - Oligodendroglioma


B. It grows as well-defined dura based masses that compress underlying brain
C. It commonly reveals mutations in isocitrate dehydrogenase (IDH) genes -
Oligodendroglioma
D. It may show calcification - Oligodendroglioma
E. It is found mostly in the cerebral hemispheres - Oligodendroglioma


All the following are manifestations of SLL/CLL EXCEPT:

A. Hepatosplenomegaly
B. Generalized lymphadenopathy
C. Anemia
D. Hypergammaglobulinemia - Hypo
E. Thrombocytopenia

What is the most common symptom of carcinoma of the larynx:

A. Cough
B. Weight loss
C. Difficulty swallowing
D. Persistent hoarseness - more than 3 weeks
E. Sore throat
+

What is the most common immunophenotype of SLL/CLL cells:

A. CD5+, CD23+, CD19-


B. CD5-, CD23-, CD19-
C. CD5+, CD23+, CD19+ + BCL2, CD20
D. CD5-, CD23+, CD19+
E. CD5+, CD23-, CD19-
+

All the following factors increase the risk of laryngeal carcinoma EXCEPT:

A. Obesity - Renal carcinoma + Hypertension


B. HPV
C. Smoking
D. Asbestos exposure - Radiation
E. Alcohol

What is the most common cause of nephrotic syndrome in children:

A. Lupus nephritis
B. Membranous nephropathy
C. Focal segmental glomerulosclerosis (FSGS) - Adults
D. Diabetic nephropathy
E. Minimal change disease
+ Causes but not MAJOR
Membranous nephropathy
Diabetic nephropathy
Amyloidosis
Systemic lupus erythematous

The microscopic changes of chronic pyelonephritis include all the following EXCEPT:

A. Acellular nodules in the glomeruli - Associated with diabetic nephropathy


(Kimmelstiel-Wilson nodules)
B. Interstitial fibrosis
C. Glomerulosclerosis
D. Mononuclear inflammatory infiltrate in stroma
E. Atrophy of tubules

Osteosarcoma most frequently metastasizes to which location:

A. Lymph nodes
B. Lungs - Distant (hematogeneous)
C. Bones
D. Brain
E. Liver

+ Markers RB, CDKN2A, MDM2, CDK4

Which of the following is the most common site of IgA deposition in IgA nephropathy:

A. Bowman's capsule
B. Mesangium - of the glomeruli, electron-dense deposits in there
C. Along glomerular basement membrane
D. Wall of the medium sized blood vessels
E. Along tubular basement membrane

Which cancer is most likely to metastasize to the brain:


A. Lung cancer + Breast, Malignant Melanoma, Kidney, GIT
B. Gastric cancer
C. Pancreatic cancer
D. Prostate cancer
E. Ovarian cancer

Conditions predisposing to acute pyelonephritis include all the following EXCEPT:

A. Smoking
B. Pregnancy
C. Urinary catheterisation
D. Diabetes
E. Immunosuppressive therapy

IDH-wild-type glioblastoma is always considered as:

A. Grade 5
B. Grade 1
C. Grade 2
D. Grade 3
E. Grade 4

Which joints are commonly affected by rheumatoid arthritis:

A. Temporomandibular and sacroiliac joints


B. Knee and axillary joints
C. Metacarpophalangeal and proximal interphalangeal joints - principally affecting the
small joints of the hands and feet + Metatarsophalangeal
D. Elbow and sternoclavicular joints
E. Axillary and elbow joints

Which of the following is a characteristic histological description of a cholesteatoma:


A. Spindle-shaped cells with pleomorphic nuclei and prominent nucleoli
B. Papillary structures with fibrovascular cores
C. Cyst lined by stratified squamous epithelium - keratinizing squamous epithelium,
which forms a cystic structure containing keratin debris
D. Sheets of polygonal cells with clear cytoplasm
E. Nests of small, blue cells with scant cytoplasm
+ Chronic inflammation, granulation tissue, and bone erosion may be observed
surrounding the cholesteatoma.
+ In the middle ear.

A biopsy of a salivary gland tumor shows cribriform structures. Which of the


following is the most likely diagnosis:

A. Paraganglioma
B. Warthin tumor - Cleft-like, papillary
C. Pleomorphic adenoma - Rounded, well- demarcated masses, encapsulated in some
locations (particularly the palate) gray-white and typically contains myxoid and blue
translucent chondroid (cartilage-like) areas
D. Adenoid cystic carcinoma
E. Mucoepidermoid carcinoma - Circumscribed, lack well-defined capsules and often
are infiltrative, pale gray to white small, mucinous cysts, these tumors contain cords,
sheets, or cysts lined by squamous, mucous, or intermediate cells.

Which of the following autoantibodies is most strongly associated with rheumatoid


arthritis:

A. Anti-double-stranded DNA (anti-dsDNA)


B. Anti-cyclic citrullinated peptide (anti-CCP)
C. Anti-Smith (anti-Sm)
D. Anti-SSA - (ro), Sjögren
E. Anti-SSB - (la), Sjögren

Chronic lymphocytic leukemia and small lymphocytic lymphoma differ primarily in the
extent of which involvement:
A. Spleen
B. Liver
C. Peripheral blood - CLL: Significant peripheral blood involvement, SLL: minimal or no
circulating malignant lymphocytes in the peripheral blood
D. Bone marrow
E. Lymph nodes

Giant cell tumor of tendon sheath is composed of all the following EXCEPT:

A. Osteoclast-like multinucleated giant cells


B. Macrophages
C. Synovial cells
D. Fibroblasts
E. Neuroendocrine cells

What is the estimated percentage of familial cases of Alzheimer's disease:

A. 5% to 10% - Most cases of AD are sporadic


B. 15% to 20%
C. Over 25%
D. 2% to 5%
E. Less than 1%

What is a Codman triangle:

A. A type of biopsy technique


B. A classification system for bone tumors
C. A specific type of bone graft
D. A radiographic feature of osteosarcoma
E. A surgical approach for tumor resection

- Arise from the metaphysis near the growth plate of long tubular bone

Which glioma is most common in the adult population:

A. Meningioma
B. Astrocytoma, IDH-mutant
C. Oligodendroglioma, IDH-mutant
D. Medulloblastoma
E. Glioblastoma, IDH-wild-type

The light microscopic appearance of the intracranial tumor is shown in figure. All the
following are true EXCEPT: → Meningioma

A. Is intracranial but extra cerebral - Meningioma


B. Is usually attached to the dura - Meningioma
C. Typically occurs in children - 60-70y
D. Is typically solid - Meningioma
E. Is found along the external surfaces of the brain - Meningioma

Hodgkin lymphoma – NS:

A. Has poor prognosis


B. It derives from lymphatics
C. Is characterized morphologically by “popcorn cells”
D. Has a striking propensity to involve the lower cervical, supraclavicular, and
mediastinal lymph nodes
E. Is the least common form of HL

Which of the following components are present in neuritic plaques in Alzheimer's


disease:

A. Beta-amyloid protein (Aβ) and dystrophic neurites


B. Amyloid precursor protein (APP) and Hirano bodies
C. Amyloid precursor protein (APP) and apolipoprotein E (ApoE)
D. Apolipoprotein E (ApoE) and Homer - Wright rosettes
E. Tau protein and amyloid precursor protein (APP)
-

A 30-year-old woman presents with nephrotic syndrome. Renal biopsy shows diffuse
capillary wall thickening and subepithelial “spike” formation. What is the most likely
diagnosis:

1. IgA nephropathy
2. Focal segmental glomerulosclerosis
3. Minimal change disease
4. Membranoproliferative glomerulonephritis
5. Membranous nephropathy

Which laryngeal tumors are likely to metastasize early due to rich lymphatic supply:

A. Tumors arising from vocal cord polyps


B. Subglottic tumors - Subglottic tumors tend to remain clinically quiescent, usually
manifesting as advanced disease
C. Glottic tumors - Sparse lymphatic supply
D. Tumors on the vocal cord nodules
E. Supraglottic tumors - Rich in lymphatic spaces

Renal failure in multiple myeloma is most commonly due to:

A. Hypercalcemia and dehydration


B. Direct tumor infiltration
C. Chronic bacterial infection
D. Obstructive proteinaceous casts in tubules - Most important, distal convoluted
tubules and the collecting ducts. The casts consist mostly of Bence Jones proteins
along with variable amounts of complete immunoglobulin, Tamm-Horsfall protein, and
albumin
E. Acute glomerulonephritis
What age group is most commonly affected by bladder cancer:

A. 40-50 years
B. Over 80 years
C. 20-30 years
D. 30-40 years
E. 50-80 years

What is the characteristic histopathological finding in the salivary gland of patients


with Sjögren syndrome:

A. Areas of necrosis and hemorrhage


B. Amyloid deposition
C. Psammoma bodies
D. Epithelioid granulomas
E. Lymphocytic inflammatory infiltrate

Which HPV types are most commonly associated with laryngeal papillomatosis in
children:

1. Types 1 and 2
2. Types 16 and 18
3. Types 45 and 58
4. Types 6 and 11
5. Types 31 and 33

All the following sentences are true regarding chondrosarcoma EXCEPT:

A. Conventional chondrosarcomas may arise from a preexisting enchondroma or


osteochondroma
B. Chondrosarcomas are subclassified into conventional, dedifferentiated, clear cell,
and mesenchymal types
C. Individuals with conventional chondrosarcoma are usually in between 40 and 60
years of age
D. Chondrosarcomas are malignant tumors that produce cartilage
E. Chondrosarcomas are typically located in the distal extremities
Where do glottic tumors typically arise:

A. Within the vocal cord muscles


B. Above the vocal cords - Supraglottic → 25%- 40%
C. Directly on the vocal cords - 60%-75%
D. Below the vocal cords - Subglottic → <5%
E. On the outer surface of the larynx

Which of the following is a major risk factor for squamous cell carcinoma of the
bladder in certain regions:

A. Radiation therapy
B. Chronic bladder irritation and schistosomiasis infection - in areas where it is endemic
C. Asbestos exposure
D. Genetic predisposition
E. Smoking

Figure shows the immunohistochemical staining with the antibody against IgG. What
is the most likely diagnosis:

A. Membranous nephropathy -
B. IgA nephropathy
C. Chronic pyelonephritis
D. Crescentic glomerulonephritis
E. Minimal change disease

Which of the following is a characteristic feature of multiple myeloma on bone marrow


biopsy:

A. Malignant small round blue cells - Ewing


B. Presence of large pleomorphic cells - Osteosarcoma
C. Formation of hyaline cartilage by the tumor cells - Chondrosarcoma
D. Formation of osteoid by the tumor cells - Osteosarcoma
E. Sheets of plasma cells -
The light microscopic appearance of the enlarged cervical lymph node is shown in
figure. The cell indicated by the arrow will most likely reveal the positive
immunohistochemical staining for the presence of:

A. CD5+, CD20+
B. CD45+, CD117+
C. CD15+, CD30+ + PAX5 (+) & posterior cervical, axillary, and groin region
D. CD19+, CD5+
E. CD15+, LCA+

A 60-year-old man presents with rapidly progressive renal failure. Renal biopsy shows
crescentic glomerulonephritis. Immunofluorescence (or immunohistochemistry)
reveals no immune complex deposition. What is the most likely diagnosis:

A. Pauci-immune glomerulonephritis
B. Minimal change disease
C. Focal segmental glomerulosclerosis
D. IgA nephropathy
E. Membranoproliferative glomerulonephritis

The CRAB criteria for multiple myeloma refers to what symptoms/signs:

A. Cachexia, Renal insufficiency, Anemia, Bone lesions


B. C-reactive protein, Renal insufficiency, Anemia, Bone lesions
C. Calcium elevation, Renal insufficiency, Anemia, Bone lesions
D. C-reactive protein, Renal artery stenosis, Anemia, Bone pain
E. Cachexia, Rheumatoid factor, Anemia, Bone lesions

On histologic examination, the affected joints in rheumatoid arthritis show all the
following EXCEPT:

A. Synovial cell hyperplasia


B. Increased vascularity
C. Aggregates of organizing fibrin on the synovial surface
D. Epithelioid granulomas in the synovium - Necrotizing

Dense inflammatory cell infiltrates (may form lymphoid follicles) in the synovium
What is the most common type of M protein found in multiple myeloma patients:

A. IgE
B. IgD
C. IgA
D. IgG -Monoclonal protein
E. IgM

Pleomorphic adenoma is most commonly found in which salivary gland:

A. All are equally common


B. Parotid - 60%
C. Minor salivary glands
D. Sublingual
E. Submandibular

Osteochondroma typically arises from which part of the bone:

A. Endosteum
B. Diaphysis
C. Epiphysis
D. Metaphysis
E. Periosteum

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