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Clinical Pathology (501-530) MCQs- Year 4 PMU

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Clinical Pathology (501-530) MCQs- Year 4 PMU

Question 1 of 29

1

During third trimester of pregnancy, a 28 year old woman discovers a lump in her right breast. It is a circumscribed, 2-cm, freely movable mass beneath the nipple. After delivery of a term infant the mass appears to decrease slightly In size. This breast lesion is most likely to be a (an):

Select one of the following:

  • intraductal papilloma

  • phyllodes tumor

  • fibroadenoma

  • lobular carcinoma in situ

Explanation

Question 2 of 29

1

A patient was admitted to the surgical department with clinical signs of acute abdomen and died before the surgical intervention. The autopsy revealed bluish to dark red color of the jejunum and part of the ileum. Intestines were inflated and when opened - with leakage of bloody matter. The histological examination of the intestinal wall showed hemorrhagic infarction. In what pathological process can the described picture be observed?

Select one of the following:

  • acute hemorrhagic necrosis of the pancreas

  • phlegmonous appendicitis

  • acute viral enteritis

  • mesenteric thrombosis

Explanation

Question 3 of 29

1

The autopsy of 57 years old female revealed papillary formation in the area of the trigonum of the urinary bladder, which significantly narrowed the urethra. Ureters and renal pelvis were highly enlarged and the renal parenchyma was thin. Point out the changes in the kidneys:

Select one of the following:

  • hydronephrosis

  • big white kidney

  • glomerulonephritic nephrosclerotic

  • atrophy of pressure

Explanation

Question 4 of 29

1

The autopsy of 67 years old woman revealed carcinoma of the ascending colon with significant size. The skin, mucous membranes and internal organs were pale, the bone marrow In the long bones was red and the heart appeared as “tiger heart”. Set the correct diagnosis of the changes in the hematopoietic system.

Select one of the following:

  • iron deficiency anemia

  • hemolytic anemia

  • pernicious anemia

  • aplastic anemia

Explanation

Question 5 of 29

1

At the autopsy of a 29 day-old baby with total hypotrophy is observed: diffuse purulent inflammation of the skin (pyoderma), cyanosis of the phalanges and mucosal membranes, bilateral fibrino-purulent pleuritic and dense subpleural areas in the back parts of the lungs. What is the most probable etiological agent of the infection and how was the baby infected?

Select one or more of the following:

  • Streptococcus pneumoniae

  • Staphylococcus aureus

  • The infection was due to intestinal obstruction

  • This is an example of nosocomial infection

Explanation

Question 6 of 29

1

At the autopsy of 41 yrs-old man the whole middle lobe of the right lung is firm, greyish, airless. The cut surface is finely granular and the texture resembles that of the liver. The adjacent pleural surface is covered by fibrino-purulent exudate. What is the diagnosis?

Select one of the following:

  • lung abscess

  • fungal pneumonia

  • pneumonia crouposa

  • pneumoconiosis

Explanation

Question 7 of 29

1

At the autopsy of 41 yrs-old man the whole middle lobe of the right lung is firm, greyish, airless. The cut surface is finely granular and the texture resembles that of the liver. The adjacent pleural surface is covered by fibrin-purulent exudate. On which day of the illness did death occur?

Select one of the following:

  • 2nd day

  • 10th day

  • 14th-16th day

  • 4th-6th day

Explanation

Question 8 of 29

1

A 33 years old woman complains of fatigue, night sweats and unilateral enlarged lymph nodes for several months. The biopsy shows effaced lymph node structure with multiple inflammatory cells - small mature lymphocytes, eosinophils, macrophages. Large bean-shaped nuclei, located with its concave parts as ‘mirror’ image and 1 or 2 well visible red nucleoli. Lymph nodes are
dissected by strands of connective tissue that creates the impression of nested structure of the lymph node. CT scan of the abdominal organs and the bone marrow biopsy show no pathological changes.
Identify the type of lymphoma, its form and stage:

Select one of the following:

  • Non-Hodgkin large cell B-cell lymphoma in 2nd stage

  • Non-Hodgkin T-cell lymphoma in 1st stage

  • Hodgkin lymphoma, nodular sclerosis 1st stage

  • Hodgkin lymphoma, nodular sclerosis, 2nd stage

Explanation

Question 9 of 29

1

At the autopsy of a 39yrs old man are found: enlarged 6kgs spleen, liver - 4.5kgs, greyish (purulent) bone marrow and plenty of post-mortem clots in blood vessels. In the left large brain hemisphere there is a blood clot, which destroys brain tissue. What is the diagnosis and the cause of death?

Select one of the following:

  • Chronic lymphogenic leucosis; brain hemorrhage

  • Chronic myeloleukemia; brain hemorrhage

  • Chronic myeloleukemia; brain infarction

  • Chronic lympholeukemia, brain infarction

Explanation

Question 10 of 29

1

At the autopsy of a 39yrs old man are found: enlarged 6kgs spleen, liver -4,5kgs, greyish (purulent) bone marrow and plenty of post-mortem clots in blood vessels. In the left large brain hemisphere there is a blood clot, which destroys brain tissue. What is the reason for the hepato-splenomegaly?

Select one of the following:

  • portal hypertension

  • extramedullary hematopoiesis

  • congenital abnormality

  • none of the above

Explanation

Question 11 of 29

1

The examination of the oral cavity of 42yrs old patient shows slightly elevated pale plaque-like lesion with uneven surface, slit spaces and erosive areas, located on the back surface of the tongue and the mouth floor. It cannot be scraped off. Two weeks antibiotic therapy is not helpful. Incisional biopsy is done. The’pathologist describes hyperkeratosis, parakeratosis, acanthosis of the epithelium, severe chronic inflammation, but also disorganization and moderate cellular atypia in the basal two thirds of the stratified squamous epithelium. The integrity of the basal membrane Is retained.
What is the clinical diagnosis?

Select one of the following:

  • squamous cell carcinoma

  • in situ squamous cell carcinoma

  • leukoplakia with moderate dysplasia

  • leukoplakia without dysplasia

Explanation

Question 12 of 29

1

A 53yrs old woman is diagnosed with malignant lymphoma based of a biopsy of a painless, moderately mobile nodule, located on the left, supraclavicularly. She complains of weakness, loss of weight, anorexia, nausea, discomfort, dizziness and unclear pain in the epigastrium. No palpable peripheral lymph nodes. From the laboratory results: iron deficiency anemia, hypo-proteinemia. The biopsy was sent for revision. What conclusion do you expect from the consulting pathologist and how could it be proved?

Select one or more of the following:

  • B-cell large cell lymphoma, proved using immunohistochemistry

  • Metastasis from gastric carcinoma, proved with PAS, PAS control and immunohistochemistry

  • Recommendation for gastroscopy

  • Mantoux test

Explanation

Question 13 of 29

1

The autopsy of a 28yrs old male shows expressed changes in the kidneys and lungs. The lungs are enlarged, heavy, with rusty color. Histologically, there are multiple hemorrhages, fibrinoid necrosis of alveolar walls, hemosiderophages in the alveoli. The kidneys are enlarged, the cortex is widened, fleshy, with hemorrhages. The clinical diagnosis is crescentic glomerulonephritis.
What is the final pathological diagnosis?

Select one of the following:

  • Rapidly progressing glomerulonephritis

  • Mesangiocapillary glomerulonephritis

  • Goodpasture syndrome

  • Minimal change disease

Explanation

Question 14 of 29

1

The autopsy of a 28yrs old male shows expressed changes in the kidneys and lungs. The lung are enlarged, heavy , with rusty color. Histologically, there are multiple hemorrhages, fibrinoid necrosis of alveolar walls, hemosiderophages in the alveoli. The kidneys are enlarged, the cortex is widened, fleshy, with hemorrhages. The final pathological diagnosis is Goodpasture
syndrome. Which are the most common clinical symptoms in this disease?

Select one of the following:

  • non-productive chronic cough; proteinuria

  • hemoptoe; hematuria

  • headache; tonsillitis

  • none of the above

Explanation

Question 15 of 29

1

The autopsy of a 28yrs old male shows expressed changes in the kidneys and lungs. The lungs are enlarged, heavy, with rusty color, Histologically, there are multiple hemorrhages, fibrinoid necrosis of alveolar walls, hemosiderophages in the alveoli. The kidneys are enlarged, the cortex is widened, fleshy, with hemorrhages. The final pathological diagnosis is Goodpasture
syndrome. What changes can be observed in the heart?

Select one of the following:

  • cor villosum

  • left-sided heart failure

  • right-sided heart failure

  • cor bovium

Explanation

Question 16 of 29

1

A 29yrs old nulliparous female has a high grade intraepithelial lesion of the cervix. After the targeted biopsy, conization is done. The entire cervix is received at the laboratory and 16 cut sections are submitted. The biopsy report claims that in situ carcinoma is seen only in the area of portio vaginalis coli uteri. The gynecologist considers the answer inadequate. Why?

Select one of the following:

  • the initial diagnosis was high grade dysplasia

  • there is no comment on the findings in the tip of the cone

  • there is no comment on the depth of invasion into the myometrium

  • the gynecologist has no reason to complain

Explanation

Question 17 of 29

1

47yrs old female has been sent to surgery for a breast lump, attached to the adjacent tissues, measuring 4cm in diameter, located in the upper breast quadrant. The biopsy of the lump shows distorted breast structure, small almost identical cells arranged in an ‘Indian file’ pattern.
What is the diagnosis?

Select one of the following:

  • fibroadenoma

  • fibro-cystic disease

  • thecoma

  • breast carcinoma

Explanation

Question 18 of 29

1

47yrs old female has been sent to surgery for a breast lump, attached to the adjacent tissues, measuring 4cm in diameter, located in the upper breast quadrant. ‘The biopsy of the lump shows distorted breast structure, small almost identical cells arranged in an ‘Indian file’ pattern. What type of tumor is described?

Select one of the following:

  • ductal in situ carcinoma

  • fibroadenoma

  • invasive lobular carcinoma

  • invasive ductal carcinoma

Explanation

Question 19 of 29

1

At the autopsy of a 70yrs old male the prostate is enlarged, measuring 85gr, 6-7cm in diameter. The cut surface shows lobular architecture and preserved capsule. The prostate part of the urethra is folded and narrow. The urinary bladder shows hypertrophy of the muscle layer. Bladder mucosa is hyperemic and covered with fibrino-purulent exudate. Both ureters and pyelon are dilated. The kidneys are enlarged, but the parenchyma is thin. What is the diagnosis of the changes in the prostate and kidneys?

Select one of the following:

  • benign prostate hyperplasia and renal cell carcinoma

  • benign prostate hyperplasia and hydronephrosis

  • prostate cancer and hydronephrosis

  • prostate cancer and renal cell cancer

Explanation

Question 20 of 29

1

30yrs old male patient, married with no children is admitted for surgery due to a right sided inguinal hernia. The right testis could not be palpated. The ultrasound reveals hypo-echogenic area measuring 5/5cm behind the urinary bladder. CT scan shows a mass measuring 2/1cm in close proximity to the inguinal canal. The tumor is resected. The histology shows two types of
cells - large, highly atypical and monstrous, and small spindle shaped cells set among blood mass. No stroma is seen. The human chorionic gonadotropin is highly elevated. Is there any relation between the ‘missing’ testis and the tumor formation?

Select one of the following:

  • yes, it gave rise to the primary tumor mass

  • no, because it is far from the tumor mass behind the urinary bladder

  • yes, but it gave rise to a separate tumor

  • no, because it was removed in childhood

Explanation

Question 21 of 29

1

A 22yr old female felt a painless nodule on the right side of her neck. She reported she underwent ionizing therapy years ago for a capillary hemangioma. Histologically, 3 lymph nodes were identified, entirely replaced by thyroid tissue. Some of the follicles show papillary structures, in Which the lining epithelium is with large, vesicular, optically ‘’empty’’ nuclei. Some of the papillae show calcium deposits. After the biopsy, thyroidectomy followed. What is your diagnosis of the findings in the lymph nodes?

Select one of the following:

  • Ectopic thyroid tissue

  • Lymph node metastasis from thyroid carcinoma

  • Metastasis from capillary hemangioma

  • Grave’s disease

Explanation

Question 22 of 29

1

A 22yr old female felt a painless nodule on the right side of her neck. She reported she underwent ionizing therapy years ago for a capillary hemangioma. Histologically 3 lymph nodes were identified, entirely replaced by thyroid tissue. Some of the follicles show papulary Structures, In which the lining epithelium is with large, vesicular, optically “empty’’ nuclei. Some of the papillae show calcium deposits. After the biopsy, thyroidectomy followed. What is the expected finding in the thyroid gland?

Select one of the following:

  • Hashimoto thyroiditis

  • Grave’s disease

  • Papillary thyroid carcinoma

  • Follicular thyroid carcinoma

Explanation

Question 23 of 29

1

28yr old female complained from facial hair, lower type obesity, fleshy stretch marks on the lower abdomen and arterial hypertension. CT reveals retroperitoneal tumor measuring 10/5/3cm, set above the kidney. Grossly, the tumor is lobular, tan-yellow, lacking a capsule. Histology shows nested structure. Tumor cells are with pale, vacuolar cytoplasm with centrally locate’
nuclei. Cellular atypia is observed, large ‘monstrous’ cells are seen. Tumor emboli are found in the veins.
What kind of neoplasm is described?

Select one of the following:

  • Benign kidney tumor

  • Malignant kidney tumor

  • Malignant suprarenal tumor

  • Benign suprarenal tumor

Explanation

Question 24 of 29

1

28yr old female complained from facial hair, lower type obesity, fleshy stretch marks on the lower abdomen and arterial hypertension. CT reveals retroperitoneal tumor measuring 10/3/3cm, set above the kidney. Grossly, the tumor is lobular, tan-yellow, lacking a capsule. Histology shows nested structure. Tumor cells are with pale, vacuolar cytoplasm with centrally located
nuclei. Cellular atypia is marked, large ‘monstrous’ cells are seen. Tumor emboli are found in the veins. Specify your diagnosis taking into consideration the given data.

Select one of the following:

  • hormone active adenoma of the suprarenal gland

  • clear cell carcinoma of the kidney

  • adenocarcinoma of the suprarenal gland

  • suprarenal gland metastasis by clear cell lung carcinoma

Explanation

Question 25 of 29

1

13yrs old boy was sent back home from school due to general weakness, high fever and headache. In the evening a livid skin rush appeared on his body. The boy lost consciousness, his blood pressure dropped, the heart rate was rapid and arrhythmic. The boy died 16hrs after the onset of the symptoms. The cerebrospinal fluid shows plenty of leucocytes, protein and coccoid
flora- Neisseria meningitides. The autopsy reveals large suprarenal glands transformed in to hemorrhagic ‘pouches’. The brain shows to remarkable changes, mainly edema and small hemorrhages.
Which is the main disease’?

Select one of the following:

  • epidemic meningitis

  • tuberculous meningitis

  • purulent meningitis

  • viral meningitis

Explanation

Question 26 of 29

1

13yrs old boy was sent back home from school due to general weakness, high fever and headache. In the evening a livid skin rush appeared on his body. The boy lost consciousness, his blood pressure dropped, the heart rate was rapid and arrhythmic. The boy died 16hrs after the onset of the symptoms. The cerebrospinal fluid shows plenty of leucocytes, protein and coccoid
flora- Neisseria meningitides. The autopsy reveals large suprarenal glands transformed in to hemorrhagic ‘pouches’. The brain shows to remarkable changes, mainly edema and small hemorrhages.
What is the main complication of the main disease?

Select one of the following:

  • acute polio encephalitis

  • meningococcal sepsis

  • suprarenal hemorrhagic infarctions

  • pyoderma

Explanation

Question 27 of 29

1

13yrs old boy was sent back home from school due to general weakness, high fever and headache. In the evening a livid skin rush appeared on his body. The boy lost consciousness, his blood pressure dropped, the heart rate was rapid and arrhythmic. The boy died 16hrs after the onset of the symptoms. The cerebrospinal fluid shows plenty of leucocytes, protein and coccoid
flora- Neisseria meningitides. The autopsy reveals large suprarenal glands transformed in to hemorrhagic ‘pouches’. The brain shows to remarkable changes, mainly edema and small hemorrhages.
What is the cause of death?

Select one of the following:

  • Acute meningitis

  • Acute polioencephalitis

  • Pyoderma

  • Waterhouse-Friderichsen syndrome (acute adrenal failure)

Explanation

Question 28 of 29

1

A well circumscribed nodule attached to dura mater was resected, greyish-white in color, firm, and measuring 4cm in diameter. The tumor is easily detached from the underlying dura and the underlying brain tissue shows a compression ‘pit’.
Which is the tumor?

Select one of the following:

  • glioblastoma multiforme

  • schwannoma

  • meningioma

  • astrocytoma

Explanation

Question 29 of 29

1

The biopsy of a recurrent brain tumor shows polymorphous cells in a necrotic background. There are large giant multinucleated tumor cells, some of them highly atypical, called ‘monstrous’. The tumor cells form palisades around the necrosis and hemorrhages.
Identify the tumor.

Select one of the following:

  • malignant meningioma

  • malignant schwannoma

  • glioblastoma multiforme

  • astrocytoma

Explanation

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