Patho Compre

November 19, 2017 | Author: Aldreen M. Quirit | Category: Colorectal Cancer, Adenoma, Neoplasms, Lymphoma, Crohn's Disease
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PATHO COMPRE A 35 y\o man with a hx of familial adenomatous polyposis (FAP), status post colectomy and now with duodenal polyps. Biopsy shows an adenoma of low grade dysplasia. A 1. Which of the ff. statements about small bowel manifestations of these polyps are true? a. polyps are usually evident at about the same age as colorectal polyps b. polyps develop preferentially in the duodenum c. these polyps carry only a slight lifetime risk for cancer d. these polyps are usually solitary E 2. Which of the ff. predisposes risks for developing small bowel adenoCA? a. hereditary non-polyposis colorectal cancer syndrome (HNPCC) b. Crohn’s dse c. familial adenomatous polyposis (FAP) d. Celiac dse e. all CASE: A 65 y/o lady with a family history of colon cancer undergoing screening colonoscopy and was found to have a 1.5 cm nodule in the cecum. Biopsy shows nests of cells, with round and uniform nuclei, morphologically consistent with low grade neuroendocrine neoplasm (carcinoid tumor). C 3. Which statement is true about this lesion of the colorectum? a. patients generally are diagnosed in the 4th decade b. patients most commonly present with symptoms of flushing and diarrhea c. it is more commonly found in the rectum than the outer parts of the colon d. rectal location is generally associated with a poor prognosis CASE: A 65 y/o lady with abdominal pain. Endoscopy revealed gastric erosions and mucosal granularity. E 4. Prior to immunohistochemical studies, the differential diagnosis includes the ff., EXCEPT: a. follicular lymphoma b. small lymphocytic lymphoma/ chronic lymphocytic leukemia c. extranodal marginal zone B-cell lymphoma (MALT lymphoma) d. helicobacter gastritis e. reactive gastropathy C 5. What is the expected immunophenotype of the atypical infiltrate in the extranodal marginal zone lymphoma (MALT lymphoma)? a. CD20+, CD79a+, CD5-, CD10+, BCL2+, BCL6+, CD43b. CD20+, CD5+, CD10-, BCL2+, BCL6-, FMC7-, CD43+ c. CD20+, CD79a+, CD5-, CD10-, CD23-, CD43+/-, CD11c+/- (weak) d. CD20+ (weak), CD79a+, CD5+, CD10-, CD23+, CD43-, FMC7B 6. Which of the ff. is NOT associated with this diagnosis? a. mucocutaneous pigmentation b. autosomal recessive inheritance c. tumors of the ovary d. increase risk for the development of breast and pancreatic cancer e. mutations in the serine threonine kinase (STK11) tumor suppressor gene on chromosome 19 CASE: A 67 y/o woman with heme positive stool. Endoscopy revealed a gastric polyp which is consistent with an anti inflammatory fibroid polyp. C 7. Which of the ff. statements regarding this lesion is TRUE? a. stomach is the least common site in the GIT for this lesion b. it responds to Gleevac treatment c. it is thought to be reactive in nature d. it is associated with peripheral eosinophilia

CASE #s 8-9: A 51 y/o woman with symptomatic internal hemorrhoids. Hemorrhoidectomy was performed. In addition to hemorrhoids, the surgeon felt that there was an additional mass in the rectum. The lesion appear histologically as bundles of smooth muscles and collagen extending into the lamina propia around the crypts, with focally hyperplastic epithelium but no features of neoplasia are noted. A 8. The patient has hemorrhoids, and in addition a 2nd diagnosis for the rectal lesion is made. What is the most likely diagnosis for the rectal lesion? a. mucosal prolapse b. tubular adenoma c. hyperplastic polyp d. invasive adenoCA e. diverticulosis B 9. Which of the ff. is TRUE of the rectal lesion discussed in the previous question? a. it occurs exclusively in the rectum b. it is easily confused clinically with the ulcers of Crohn’s dse c. it usually shows ulceration of the mucosa d. the epithelium is seldom hyperplastic CASE: A 55 y/o, 2 months status post lung transplantation, developed abdominal pain and diarrhea. She subsequently underwent a segmental resection of the colon. B 10. Which of the ff. statements regarding pseudomembranous colitis is FALSE? a. it is most likely associated with clostridium defficile b. it is rarely associated with antibiotic use c. clostridium defficile toxins are the main cause of this dse d. similar histologic changes maybe seen in ischemia C 11. A 30 y/o woman presented with chronic watery diarrhea. Colonoscopy showed normal appearing colon and terminal ileum. What is the most likely diagnosis? a. acute self-limited colitis b. pseudomembranous colitis c. collagenous colitis d. Crohn’s dse e. Ulcerative colitis D 12. A 33 y/o man with intermittent dysphagia and “ringed esophagus” on endoscopy. Biopsy was performed from the mid-esophagus showing prominent eosinophils in the esophageal epithelium. Which of the ff. statements is FALSE when eosinophilic esophagitis is compared to reflux esophagitis? a. eosinophilic esophagitis responds to steroid treatment b. the number of eosinophils in eosinophilic esophagitis tend to be higher c. the infiltration of eosinophils tend to involve both epithelium and submucosa in eosinophilic esophagitis d. eosinophilic infiltration tend to be found in distal esophagus A 13. Which of the ff. is NOT true regarding the infarction of the cortical area (Line of Gennari in the visual cortex)? a. blockage of the anterior cerebral arteries b. blockage of the posterior cerebral arteries c. bilateral infarction will lead to Anton syndrome d. A & C e. B & C C 14. The weight of the brain at the time of birth of a full term baby is about: a. 120 grams b. 240 grams c. 360 grams d. 800 grams e. 1450 grams E 15. Baston’s plexus is: a. located in choroids plexus b. the vascular that arises from the circle of Willis and supply the deep gray area c. associated with circumventricular organs d. located in the retina e. a paravertebral venous plexus

D 16. Which of the ff. is NOT correct for Cajal-Reitzus cells? a. they are the 1st neurons to mature b. they are most prominent during the 16th-20th week of the gestation c. they are found in the superficial or the subpial location in the cerebral cortex d. they are found exclusively in the spinal cord E 17. Which of the ff. is TRUE about the striae of Gennart? a. it is a band of intracortical myelinated fibers in between lamina II & III b. it is a band of intracortical myelinated fibers in between lamina IV & V c. it is found in neocortex d. A & C e. B & C E 18. Which of the ff. Antigens would be widely detected in reactive and neoplastic astrocytes? a. epithelial membrane antigens b. HMB-45 c. Synatophysin d. Neurofilament proteins e.Cytokeratin AE1/AE3 B 19. Medulloblastoma in a midline location is likely to cause which of the ff? a. gait ataxia and intentional tremor b. truncal ataxia c. limb ataxia d. alien limb e. none C 20. Which of the ff. is most likely to produce Kluver-Bucy syndrome? a. congenital CMV infection b. congenital rubella infection c. Rasmussen’s encephalitis d. herpes simplex encephalitis e. poliomyelitis C 21. Crossed cerebellar atrophy refers to: a. atrophy of the decussation of superior cerebellar peduncle b. atrophy of 1 hemisphere that extends and cross to involve the ipsilateral cerebellar hemisphere c. atrophy of 1 hemisphere associated with crossed atrophy of the contralateral cerebellar hemisphere d. crossed atrophy of both cerebellar hemisphere e. all C 22. Which of the ff. tract is involved in coordinating the motor function of the nucleus of the occulomotor, trochlear, and abducens nerves: a. central tegmental tract b. medial lemniscus c. medial longitudinal fascicle d. mammalothalamic tract e. decussation of the superior cerebellar peduncle B 23. Which of the ff. is true regarding decortical posture? a. when the comatose patient receives a stimulus, there is extension of the upper limbs and flexion of the lower limbs b. the level of impairment of the brainstem activity is between the levels of the rostral poles of the red nuclei and the vestibular nuclei. (subthalamus to mid pons) c. when the comatose patient receives a stimulus, there is extension of both upper and lower limbs d. the level of impairment of brainstem activity is usually above the level of red nucleus e. all are true E 24. Which of the ff. is/are TRUE about Mobius syndrome? a. facial diplegia b. internal strabismus c. conscious and no central respiratory depression d. no skeletal muscle problem in limbs and respiratory muscle e. all

D 25. Which of the ff. can cause high output cardiac failure? a. berry aneurysm b. dolichoectasia c. microaneurysm of the brain d. aneurismal malformation of the great vein of Galen e. none A 26. Which of the ff. are produced by prolonged fixation in formalin? a. Buschino bodies b. Lewy bodies c. Hirano bodies d. Lafora bodies e. Marinesco bodies B 27. Chromatolysis refers to: a. depigmentation of pigmented neurons in substancia nigra that is observed in Parkinson’s dse b. loss of Nissi substance accompanied by weak eosinophilic changes and swelling in neurons under stress c. degeneration of the pigmented layers of the retina d. loss of pigmented cells in locus ceruleus in Alzheimer’s dse e. failure to demonstrate Nissi substance by Nissi stain due to over differentiation of Nissi stain D 28. Which of the ff. is NOT true about childhood meningiomas? a. they are more likely to behave more aggressive and recur more frequently b. they are associated with neurofibromatosis 2 (NF 2) c. they are more likely to be found at infratentorial, intraventricular, or intraparenchymal locations d. meningiomas are common tumors in infants and children E 29. Which type of meningioma is most likely to be found in patients under 20 years of age? a. fibrous meningioma b. transitional meningioma c. secretory meningioma d. psammomatous meningioma e. chordoid meningioma C 30. Which of the ff. is NOT true about optic nerve glioma? a. optic nerve gliomas in children tend to behave in indolent, slowing growing fashion b. optic nerve gliomas are associated with neurofibromatosis 1 (NF 1) c. optic nerve gliomas in adults tend to be non-familial and behave in a benign fashion d. spontaneous regression has been described in childhood cases of optic nerve gliomas e. optic nerve gliomas tend to grow outside the optic nerve and expand the subarachnoid and subdural space E 31.Dysplastic gangliocytoma of the cerebellum (Lhermitte-Ducios disease) is associated with: a. ataxia-telangiectasia b. Currarino triad c. Meckel-Gruber syndrome d. Aicardi syndrome e. Cowden syndrome A 32. Which of the ff. syndromes are not associated with increased risk for developing malignancy? a. Miller Dieker syndrome b. Gorlin syndrome c. Turcot syndrome d. Bloom syndrome e. Down syndrome D 33. Which of the ff. is true about melanotic neuroectodermal tumor of infancy? a. these tumors typically occur as solitary, solid tumor in the brain b. recurrence is uncommon and metastases is practically unknown c. most tumors occur in older children d. these tumors contain large, pigmented melanotic cells, and small primitive neuroectodermal cells. Synatophysis is positive in both cell population e. the large, melanotic cells are usually positive for HMB45 and S100 protein D 34. The most common organ for extracranial metastatic medulloblastoma is/are: a. lung and lymph node b. liver c. skin & soft tissue d. bone e. pleura A 35. Which of the ff. is not true about choroids plexus carcinoma? a. they occur almost exclusively in adults b. immunohistochemistry can demonstrate transthyretin c. brain invasion is common d. the tumor cells are positive for Vimentin, Cytokeratin, and S100 protein e. junctional membrane complex can be demonstrated by electron microscopy

A 36. This primary tumor is obtained from a 12 y/o boy, showing morphologically with clear cell tumor suggestive of hemangioblastoma. The most likely syndrome that is associated with this boy is: a. Von Hipppel-Lindau syndrome b. Neurofibromatosis 1 (NF 1) c. Turcot syndrome d. Gorlin syndrome e. Neurofibromatosis 2 (NF 2) D 37. Subependymal giant cell astrocytoma can be immunoreactive for? a. Glial fibrillary acidic protein (GFAP) b. Neurofilament c. Vimentin d. all e. none A 38. Which of the ff. is NOT true for endolymphatic sac tumor? a. these tumors are more common in children than adult b. these tumors are associated with Von Hippel-Lindau dse c. these tumors are morphologically very similar to, if not indistinguishable from, choroids plexus papilloma d. these tumors are of osseous origin and often invade into the cerebellopontine angle with possible extension into the posterior fossa e. these tumors are positive for carcinoembryonic antigen, epithelial membrane origin, and cytokeratin A 39. Which of the ff. is NOT true about meningioangiomatosis: a. they are associated with neurofibromatosis 1 (NF 1) b. it is a rare, benign, focal, hamartomatous, type of lesion of leptomeninges and the underlying cerebral cortex leptomeningeal and and meningovascular proliferation c. a majority of them are found in the frontal-temporal region d. a schwannian component can be present e. mitotic figures are rare and the Ki67 (MIB 1) labeling index is low B 40. The most common location for primary extraosseous, intra-parenchymal (intra-axial) location for Langerhan’s cells histiocytosis is: a. Pineal gland b. Hypothalamus c. Basal ganglia d. Cerebellum e. Brainstem B 41. Women at high risk of hereditary Nonpolyposis Colorectal Cancer (HNPCC) should not only Undergo colon/rectum screening, but also screening of their: a. lungs b. uterus-endometrium c. kidneys d. heart e. none D 42. Which of the ff. immunohistochemical stains would be the least helpful in the workup to support a diagnosis of gestational trophoblastic dse: a. hPL b. beta hCG c. PLAP d. Cytokeratin 5,6 e. CD146 A 43. All of the ff. are true regarding molar pregnancy, EXCEPT: a. Complete moles consist of hyperplastic trophoblastic dse that is usually associated with fetal development b. Complete mole may derive from an ovum fertilized by a single sperm c. Complete mole may derive from an ovum fertilized by a 2 sperm d. Partial moles are often triploid e. Complete moles confer a greater risk of invasion tan partial moles A 44. All of the ff. statements regarding the gross findings in early complete hydatidiform mole are TRUE, EXCEPT: a. Botryoid clusters are usually visible in 1st trimester abortuses b. Enlarged villi forming clusters with fuzzy surfaces are rarely seen c. Specimen rarely requires multiple containers for transport d. During curettage, expanded villi may collapse making their presence difficult to detect e. Hydropic change may not be apparent A 45. The largest cells are typically found in which of the ff.? a. Low grade squamous intraepithelial lesion (LSIL) b. High grade squamous intraepithelial lesion (HSIL) c. Squamous cell CA d. AdenoCA A 46. All of the f. are helpful in diagnosing dysplasia, EXCEPT: a. Prominent nucleolus b. nuclear enlargement c. nuclear hyperchromasia d. coarsening and clumping of chromatin

D 47. High grade squamous intraepithelial lesion (HSIL) is characterized by which of the ff? a. large cell size c. keratinization b. prominent nucleolus d. higher nuclear/cytoplasmic ratio D 48. Which of the ff. is characterized by flat cohesive sheets of cells with low N/C ratio, prominent nucleoli, and without a conspicuous component of atypical single cells: a. Low grade squamous intraepithelial lesion (LSIL) b. High grade squamous intraepithelial lesion (HSIL) c. Squamous cell CA d. Repair/regeneration D 49. Which of the ff. is the most likely diagnosis if cells are multinucleated, the nuclei mold one another, and nuclear material marginates? a. radiation effects b. repair and/ regeneration c. Low grade squamous intraepithelial lesion (LSIL) d. Herpes simplex D 50. Non- keratinizing squamous cell CA is characterized by which of the ff? a. rarely occurring tumor diathesis b. mainly isolated cancer cells c. nuclear area which is greater than in dysplastic cells d. macronucleoli C 51. Keratinizing squamous cell CA of the cervix is characterized by which of the ff? a. tumor diathesis b. prominent syncytial groupings c. cellular pleomorphism d. relatively small uniform cells D 52. Which of the ff. cytologic features of malignant cells is most important in distinguishing benign from malignant lesions? a. Nuclear enlargement b. Nuclear hyperchromasia c. nucleolar enlargement d. decreased cohesion C 53. Based on good and consistent scientific evidence, the risk of having HSIL within 2 years in women with high risk HPV who have ASC-US/LSIL (atypical squamous cells of undetermined significance/ low grade squamous intraepithelial lesion) cytology but are not found to have HSIL at their initial colposcopy is? a. 90% b. 50% c. 10% d. less than 1% D 54. A 49 y/o male presents with symptoms that developed ff. a long weekend of binge drinking. His serum reveals a gamma-glutamyl transferase (GGT) level of 65 IU/L. A liver biopsy reveals fatty change (steatosis) of numerous hepatocytes. This patient’s liver abnormality is most likely the result of: a. decreased free fatty acid delivery to the liver b. decreased production of triglycerides c. increased mitochondrial oxidation of fatty acids d. increased NADH production e. increased released of lipoproteins C 55. A 48 y/o male who has a long history of excessive drinking presents with signs of alcoholic hepatitis. Microscopic examination of a biopsy of this patient’s liver reveals irregular eosinophilic hyaline inclusions within the cytoplasm of the hepatocytes. These eosinophilic inclusions are composed of: a. Ig b. Excess plasma proteins c. Prekeratin intermediate filaments d. Basement membrane material e. Lipofuscin D 56. A growth factor that is capable of inducing all the steps necessary for angiogenesis is: a. epidermal growth factor (EGF) b. transforming growth factor- α (TGF-α) c. platelet derived growth factor (PDGF) d. basic fibroblast growth factor (FGF) e. transforming growth factor- β (TGF-β) D 57. The cells of the mononuclear phagocyte system originate from the: a. spleen b. liver c. LN d. BM e. Thymus

B 58. Which one of the ff. features would have differentiate a lesion of lipoma from a normal adipose tissue? a. Anaplasia c. numerous mitoses e. prominent nucleoli b. Fibrous capsule d. uniform population of cells D 59. An example of cancer suppressor gene is: a. C-abl b. Bcr c. C-mycd. P53 e. Ras A 60. An apathetic male infant in an underdeveloped country is found to have peripheral edema, a “moon” face, and an enlarged fatty liver. Which of the ff. is one mechanism involved in the pathogenesis of this child’s abnormalities? a. decreased caloric intake leading to hypoalbuminemia b. decreased carbohydrate intake leading to hypoglycemia c. decreased fluid intake leading to hypernatremia d. decreased fat absorption leading to hypovitaminosis B 61. If a mutant gene is not expressed phenotypically in a person, this is said to represent: a. variable expressivity c. codominance e. nondisjunction b. reduced penetrance d. genetic heterogeneity C 62. A chromosomal aberration that results in a disturbance in the normal gene balance is termed: a. nondisjunction b. euploidy c. aneuploidy d. breakage e. variance A 63. A 2 month old girl presents with a soft, high pitched, mewing cry and is found to have several congenital heart defects. The most likely chromosomal abnormality producing these symptoms is: a. 5pb. 11pc. 13qd. 21qe. 22qD 64. A 15 y/o phenotypically female patient presents for workup of primary amenorrhea and is found to have an XY karyotype. The most likely diagnosis is: a. Turner syndrome b. Mixed gonadal dysgenesis c. True hermaphroditism d. Male pseudohermaphroditism e. Female pseudohermaphroditism B 65. Rearrangement of Ig chains is seen in: a. T-lymphocytes b. B-lymphocytes c. Macrophages d. Langerhan’s cells e. NK cells D 66. There is a strong association between hemochromatosis and: a. HLA-B27 b. HLA-DR3 c. HLA-DR4 d. HLA-A3 e. HLA-BW47 C 67. Which of the ff. conditions is most likely to be associated with cancer? a. SLE d. Autoimmune thyroiditis b. HPN e. Arteriosclerosis c. Polymyositis D 68. Sections of tissue infected with Blastomyces would be expected to show organisms with: a. non-branching psedohyphae and blastocysts b. acute-angle branching, septate hyphae c. wide-angle branching, nonseptate hyphae d. broad-based budding e. large spheres with external budding E 69. Effects of radiation exposure on tissue includes all of the ff., EXCEPT: a. double-stranded chromosomal breaks b. formation of free radicals c. abnormal mitotic figures d. endothelial swelling e. epidermal hyperplasia B 70. All of the ff. genetic disorders are autosomal recessive (AR), EXCEPT: a. Alkaptonuria b. Familial hypercholesterolemia c. Phenylketonuria (PKU) d. Myeloperoxidase deficiency e. Cystic fibrosis E 71. Mechanisms responsible for Down’s Syndrome include all of the ff., EXCEPT: a. Nondisjunction during the 1st meiotic division b. Mosaicism c. Translocation d. Centric fusion (Robertsonian translocation) e. Formation of Isochromosomes

D 72. Characteristically, B lymphocytes do all the ff. EXCEPT: a. Constitute 10-15% of peripheral blood lymphocytes b. Occur in lymphoid follicles and the superficial cortex of lymph nodes c. Express surface immunoglobulin IgD and IgM d. Express surface cluster differentiation antigen CD8 e. Possesses complement component (C3) receptors C 73. Parathyroid hormone, by its action on target organs, is known to cause all of the ff. EXCEPT: a. increase renal tubular reabsorption of calcium b. increase intestinal absorption of calcium c. increased serum phosphate levels d. mobilization of calcium from bone e. decreased renal tubular reabsorption of phosphate C 74. Elevated levels of serum creatinine kinase (CK) are seen in all of the ff.,EXCEPT: a. muscular dystrophy b. polymotisis c. myasthenia gravis d. myocardial infarction e. hypothyroidism D 75. An XX infant is found to have an external male genitalia and internal female genitalia. PE reveals decreased BP, while lab exam reveals a serum sodium level of 132 meq/L. Additionally, bilateral adrenal cortical hyperplasia is present. The findings in this infant are most likely the result of the deficiency of: a. 3 β-dehydrogenase b. 11- hydroxylase c. 17- hydroxylase d. 21- hydroxylase e. 1 α- hydroxylase B 76. A 35 y/o male who presents with a neck mass is found to have a serum calcium level of 11.8 mg/dl and periodic elevation of his blood pressure. Extensive work up reveals the presence of medullary CA of the thyroid, a pheochromocytoma, and hyperplasia of the parathyroid glands. This patient most likely has: a. Multiple endocrine neoplasia syndrome (MEN) type 1 b. MEN syndrome type IIa c. MEN syndrome type IIb d. Polyglandular syndrome type I e. Polyglandular syndrome type II B 77. A lesion that originates within and selectively destroys the ventromedial nucleus of the hypothalamus would most likely result in: a. decreased appetite b. increased appetite c. increased urination d. paralysis of the EOM e. tunnel vision B 78. Follicular CA of the thyroid may show all of the ff. features, EXCEPT: a. vascular invasion and hematogenous metastases b. multiple foci within the gland c. a clear cell variant that resemble renal CA d. absence of ground-glass nuclei e. an insular type that is aggressive in form C 79. Components of the normal thymus glands include all of the ff., EXCEPT: a. thymocytes b. epithelial cells c. germinal centers d. neuroendocrine cells e. myoid cells C 80. Malacoplakia of the urinary bladder is considered to be associated with: a. TB b. urothelial CA c. Schistosomiasis d. Staph. Infection e. defects in phagocytosis

C 81. Histologic exam of an excision specimen from a lesion on the dorsal surface of the penis reveals a papillary lesion with clear vacuolization of epithelial cells on the surface and extension of the hyperplastic epithelium into the underlying tissue along a broad front. The most likely diagnosis of this lesion is: a. Bowen’s dse b. Squamous cell CA c. Verrucous CA d. Condyloma accuminatum C 82. Failure of the uterus to develop (agenesis) is directly related to the failure of what embryonic structure to develop? a. urogenital ridge b. mesonephric duct c. paramesonephric duct d. metanephric duct e. epoophoron D 83. A 29 y/o female presents with severe pain during menstruation (dysmenorrhea). During work up, an endometrial biopsy is obtained. The pathology report from this specimen makes the diagnosis of endometritis. Based on this pathology report, which one of the ff. was present in the biopsy sample of the endometrium? a. neutrophils b. lymphocyte c. lymphoid follicles d. plasma cells e. decidualized stromal cells C 84. A 32 y/o female presents with the recent onset of oligomenorrhea followed by amenorrhea, and then the loss of female secondary characteristics. She also has developed acne, deepening of her voice, and temporal balding. Which one of the ff. ovarian tumors would most likely produce these symptoms? a. epithelial tumor c. germ cell tumore. metastasis b. stromal tumor d. surface tumor D 85. All the ff. renal disorders are associated with nephritic syndrome, EXCEPT: a. membranous glomerulonephritis b. lipoid nephrosis c. acute tubular necrosis d. membranoproliferative glomerulonephtitis e. focal segmental glomerulosclerosis B 86. Within prostatic glands, features consistent with prostatic intraepithelial neoplasia (PIN) include all of the ff., EXCEPT: a. cellular crowding b. absence of basal cell layer c. variation of nuclear size d. hyperchromatism e. nucleoli D 87. Carcinoma of the prostate tends to do all of the ff. EXCEPT: a. be AdenoCA b. arise in the posterior lobe c. cause elevation of the serum acid phosphatase d. be-estrogen dependent e. form esteoblastic metastasis C 88. A pathognomonic feature of denervation followed by reinnervation is the histologic finding of: a. atrophic fibers c. type-specific grouping of fibers e. target fibers b. angular fibers d. checkboard pattern of type 1 and type 2 fibers E 89. Features of the normal process of fracture healing include: a. pseudoarthrosis c. an involucrum e. a cartilagenous callus b. a sequestrum d. a cloaca E 90. Characteristics or components of normal bone in the adult skeleton include all of the ff. EXCEPT: a. osteoblast c. type I collagen e. woven bone b. osteoid d. lamellar bone D 91. Euploidy can result from: a. inversions c. deletions e. trisomy b. duplications d. balanced translocation

C 92. Association with the loss of Rb suppressor gene and the development of retinoblastoma: a. 5pb. 11pc. 13qd. 21qe. 22qA 93. Rearrangement of TCR gene is seen in: a. T-lymphocytes d. Langerhan’s cells b. B-lymphocytes e. Natural killer cells c. Macrophages C 94. There is a strong association between rheumatoid arthritis and: a. HLA-B27 b. HLA-DR3 c. HLA-DR4 d. HLA-A3 e. HLA-BW47 E 95. Mechanism responsible for Turner’s syndrome include which of the ff? a. nondisjunction during the 1st meiotic division b. mosaicism c. translocation d. centric fusion (Robertsonian translocation) e. formation of isochromosomes C 96. A 39 y/o male who presents with a neck mass is found to have multiple mucocutaneous neuromas and elevation of BP. Extensive work up reveals the presence of medullary CA of the thyroid and pheochromocytoma of the adrenal medulla. This patient, most likely has: a. MEN type I d. Polyglandular syndrome type I b. MEN type IIa e. Polyglandular syndrome type II c. MEN type IIb D 97. A feature of a normal skeletal muscle is the histologic finding of: a. atrophic fibers d. checkboard pattern of type I and type II fibers b. angular fibers e. target fibers c. type-specific grouping of fibers D 98. Formed of an irregular arrangement of type I collagen fibers and numerous osteocytes, it is formed rapidly and is always pathologic if found in the adult skeleton. a. osteoblast b. osteoid c. lamellar bone d. woven bone B 99. Sections to be viewed under electron microscope (ultra thin sections) are usually cut at what thickness? a. 5-10nm b. 60-90nm c. 190-240nm d. 0.5-1.0um e. none C 100. The paraffin sections for routine diagnostic surgical pathology are cut at a thickness of: a. 4-8nm b. 40-80nm c. 4-8um d. 40-80um e. none B 101. A 44 y/o woman noted to have a 3 cm firm, irregular, non movable mass located in the upper outer quadrant of her left breast on PE. Cells obtained from the mass are consistent with infiltrating ductal CA. Which of the ff findings will best predict a better prognosis? a. the tumor cells are strongly estrogen Rc positive b. no metastases are found in the sampled LN c. flow cytometric analysis demonstrates aneuploidy and a high S-phase d. she has one relative who had a similar type of breast cancer e. the tumor has a high grade A 102. A change in bowel habits prompt a 53 y/o woman to see her physician. On PE her stool is positive for occult blood. A colonoscopy reveals a 6 cm friable mass located in the cecum. Microscopic exam shows a moderately differentiated adenoCA. Which of the ff. findings is most likely to be present? a. A k-ras mutation in the neoplastic cells b. an immunoperoxidase stain positive for vimentin in the neoplastic cells c. A stool culture positive for Shigella flexneri d. A plasma HIV-1 RNA level of 40,000 copies/ml e. A high titer DNA topoisomerase I autoantibody D 103. A 45 y/o healthy woman has a routine CXR taken and shows a peripheral 2.5 cm diameter “coin lesion” in the right mid lung field. Which of the ff. biologic characteristics best distinguishes this lesion as a neoplasm, rather than a ganuloma? a. recurrence ff. excision b. rapid increase in size c. sensitivity to radiation or chemotherapy d. uncontrolled (autonomous) growth e. necrosis

D 104. A clinical study is performed on biopsy specimens and shows a neoplasm composed predominantly of cells with a spindle shape and a high N/C ratio with marked pleomorphism. These cells are vimentin positive, cytokeratin negative, and CD45 negative by immunohistochemical staining. This type of neoplasm is most likely to have been diagnosed in which of the ff. patients? a. A 35 y/o woman with a left breast mass and enlarged axillary LN b. A 55 y/o woman with a massive ascites and multiple peritoneal metastases c. A 25 y/o man with an enlarged left testis d. A 15 y/o man with a mass in the left femur and lung metastases e. A 5 y/o boy with a right renal mass E 105. A 48 y/o woman has a 4 cm diameter, fixed, nontender mass palpated in her right breast. Another 2 cm non tender mass is palpable in the left axilla. A chest radiograph reveals multiple 0.5-2cm nodules in both lungs. Which of the ff. classifications best indicates the stage of her disease? a. T1 N1 M0 b. T1 N0 M1 c. T2 N1 M0 d. T3 N0 M0 e. T4 N1 M1 C 106. Review of a series of surgical pathology reports that a certain type of neoplasm is graded as grade I on a scale of I to IV. Clinically some of the patients with this neoplasm are found to be stage I. Which of the ff. is the best interpretation of a neoplasm with this stage I designation: a. is unlikely to be malignant b. has probably arisen from epithelium c. may spread via lymphatics d. has an in situ component e. is well-differentiated and localized C 107. A child is born with a single functional allele of a tumor suppressor gene. At the age of 5 the remaining normal allele is lost through a point mutation. As a result, the ability to continue the transition to G1 to the S phase of cell cycle is lost. Which of the ff. neoplasms is most likely to arise via this mechanism? a. infiltrating ductal CA of breast b. small cell anaplastic CA of the lung c. retinoblastoma of eye d. cerebral astrocytoma e. chronic myeloid leukemia B 108. A 22 y/o woman has a papillary CA of the thyroid. Which of the ff. findings would you consider most relevant in her past history to indicate a risk factor for this neoplasm: a. chronic alcoholism b. radiation therapy in childhood c. ataxia telangiectasia d. blunt trauma from a fall e. exposure to arsenic compounds E 109. A 50 y/o man has felt vague abdominal discomfort for the past 4 months. He has no lymphadenopathy, and no abdominal masses can be palpated. An abdominal CT scan shows a 20 cm retroperitoneal soft tissue mass obscuring the left psoas muscle. A stool specimen tested for occult blood is negative. Which of the ff. neoplasms is this man most likely to have? a. melanoma b. hamartoma c. adenoCA d. lymphoma e. liposarcoma E 110. It is observed that some neoplasms appear to develop from viral oncogenesis, with serologic confirmation of past viral infection. Which of the ff. neoplasms is most likely to arise in this manner? a. Retinoblastoma b. Small cell anaplastic CA of lung c. T cell leukemia d. Prostatic adenoCA e. Hepatic angiosarcoma A 111.

A 112. A 14 y/o healthy girl has a 0.3 cm reddish, slightly raised nodule on the skin of the upper part of her chest found on a routine PE. She states that this lesion has been present for years and has not appreciably changed in size and color. Which of the ff. neoplasms is this nodule most likely to be: a. hemangioma b. melanoma c. Wilm’s tumor d. lymphoma e. glioma D 113. A 60 y/o man who has a 90 pack year history of cigarette smoking has had a chronic cough for the past 11 years. He has begun to lose weight (3 kg) during the past year. He has a chest radiograph that reveals a right hilar mass. A sputum cytology shows atypical, hyperchromatic squamous cells. What is the most common initial pathway of spread of this lesion? a. blood stream b. pleural cavity c. contiguous spread to chest wall d. lymphatics e. bronchi C 114. A 25 y/o woman has experienced episodes of myalgias, pleural effusions, pericarditis, and arthralgias without joint deformity over the course of the past 3 years. A CBC reveals a mild normocytic anemia. Which of the ff. lab screening tests is most appropriate to begin the work up for her condition: a. CD4 lymphocyte count b. Blood culture c. Antinuclear Antibody test d. Sedimentation rate e. Creatinine phosphokinase E 115. A male infant is born at term with no congenital anomalies. A year later he now has failure to thrive and has been getting 1 bacterial pneumonia after another with both Hemophilus influenzae and Strep. pneumoniae cultured from his sputum. Which of the ff. diseases is he most likely to have? a. DiGeorge Syndrome b. Selective IgA deficiency c. EBV infection d. Acute leukemia e. X-linked agammaglobulinemia D 116. It is noted that patients who received renal allografts with matching to the donor by tissue typing for HLA-DR (Class II) antigens has a low rate of complications. Which of the ff. immunologic abnormalities is most likely to be diminished by tissue typing: a. Amyloidosis b. Cell lysis by CD8 lymphocytes c. Graft vs. host disease d. CD4 lymphocyte activation e. Serum sickness E 117. An appropriate, useful type I hypersensitivity response of the immune system, accompanied by eosinophilia, would most likely to be directed against which of the ff? a. Amyloid protein b. Spirochetes c. Neoplasms d. Inhaled dusts e. Liver flukes D 118. 12 hours after going on a hike through dense foliage, a 40 y/o man notices a slightly raised and tender irregular reddish rash on one forearm that was covered by clothing. This rash gradually increases in intensity for 2 days and then fades after 2 weeks. Which of the ff. forms of hypersensitivity is most likely demonstrated in this patient: a. Type I Hypersensitivity b. Type II Hypersensitivity c. Type III Hypersensitivity d. Type IV Hypersensitivity C 119. A 40 y/o woman has had increasing difficulty swallowing for over the past year and finds it hard to move her fingers, though the joints are not painful. She has lost the facial wrinkles that she was beginning to develop in the middle age. A skin biopsy shows extensive dermal fibrosis but almost no inflammatory cell infiltrates. These findings are most typical for which of the ff. condition? a. Mixed connective tissue disease b. Discoid lupus erythematosus c. CREST syndrome d. Dermatomyositis e. Amyloidosis

D 120. A 20 y/o woman was given IV Penicillin to treat infective endocarditis. Within minutes of starting this therapy, she begins to have severe difficulty of breathing with respiratory stridor and tachypnea. She suddenly develops an erythematous skin rash over most of her body. Her symptoms are most likely to be produced by which of the ff. chemical mediators? a. IL-1 b. bradykinin c. complement C5a d. histamine e. thromboxane B 121. A 28 y/o woman undergoes allogenic bone marrow transplantation for acute leukemia. 3 weeks later, she has marrow engrafment and her Hgb and WBC count are returning to normal. However, she has an appearance of a fine, scaling skin rash over her trunk and upper extremities. These findings are most consistent with which of the ff. complications: a. reduced numbers of megakaryocyets b. apoptosis of epidermal keratinocytes c. dry gangrene d. contact dermatitis e. abrasions from a fight in ICU D 122. A bee sting is suffered by a 28 y/o man, and his wife searches frantically for the medical kit with the injectable epinephrine. Which of the ff. immunologic mechanisms are they trying to prevent? a. local immune complex formation b. IL release from macrophages c. binding of anti-receptor Ab d. systemic anaphylaxis e. complement activation A 123. A 45 y/o man has been plagued by mild chronic diarrhea and increased numbers of minor respiratory infections for most of his life. Ff. a motor vehicle accident, he has a significant blood loss requiring transfusion of blood products. During the transfusion, he is noted to have an anaphylactic transfusion reaction. Which of the ff. diseases is he most likely to have? a. Selective IgA deficiency b. Amyloidosis c. SLE d. Niemann-Pick dse e. Graft vs. host dse D 124. A 55 y/o woman has had increasing difficulty with swallowing over the past year. On PE her BP is 220/110 mmHg. She has a positive antinuclear antibody test with a nucleolar pattern of immunoflourescence. Her serum complement levels were normal. Which of the ff. lesions is most likely to be seen in her kidneys with renal biopsy? a. renal cell CA b. nodular glomerulosclerosis c. acute glomerulonephritis d. hyperplastic arteriosclerosis e. polycyctic change C 125. A study of immunoflourescence patterns in skin biopsies is performed. The immunoflourescence pattern in the skin with Ab to IgG, which shows a band of immunoflourescence at the dermalepidermal junction, is most likely to be based upon which of the ff. pathologic mechanisms: a. Increased numbers of CD4 lymphocytes infiltrating the dermis b. degranulation of mast cells c. trapping of Ag-Ab complexes d. macrophages are releasing cytokines e. neutrophils are emigrating from capillaries A 126. Pathologic findings in idiopathic hypertrophic subaortic stenosis include all of the ff. EXCEPT: a. infiltration of eosinophils in myocardium b. myocardial fiber disorientation in interventricular septum c. thickening of anterior leaflet of mitral valve d. small ventricular cavities

B 127. Infiltrative (restrictive) cardiomyopathy occurs in all of the ff., EXCEPT a. Amyloidosis b. Gaucher’s dse c. Glycogen storage dse d. Sarcoidosis C 128. A 60 y/o man who had been diagnosed 3 days before as having had an acute myocardial infarct suddenly developed mitral insufficiency. This was most likely due to: a. Coincidental rheumatic mitral stenosis b. Extension of the infarct to a mitral valve leaflet c. Rupture of an infracted interventricular septum d. Rupture of an infracted papillary muscles D 129. The most frequent cause of an acute myocardial infarction is occlusion of a major coronary artery by: a. Atherosclerosis b. Embolism c. Spasm d. Thrombosis C 130. Malignant neoplasm which most commonly give rise to cardiac metastases include all of the ff., EXCEPT: a. Bronchogenic CA b. CA of the breast c. CA of the thyroid gland d. Lymphomas C 131. The causes of cor pulmonale include all of the ff., EXCEPT: a. emphysema of the lungs b. Kyphoscoliosis c. lung abscess d. recurrent pulmonary embolism D 132. A 10 y/o boy was found to have mild jaundice, with an elevation mainly of unconjugated bilirubin, and splenomegaly. His erythrocyte count was 4 million/mm3 and the red cells showed increased fragility in hypotonic saline. The most likely dx is: a. α-thalassemia b. aplastic anemia c. autoimmune hemolytic anemia d. hereditary spherocytosis A 133. A 40 y/o African-American Vietnam veteran developed episodes of hemolysis on using certain drugs. Numerous Heinz bodies were found in his erythrocytes during these periods. The most likely dx is: a. G6PD deficiency b. Myelophthisic anemia c. Pernicious anemia d. Sideroblastic anemia B 134. The presence of HbF in the blood of children and adults is a characteristic of: a. α- thalassemia c. megaloblastic anemia b. β- thalassemia d. sickle cell anemia A 135. The most distinctive feature of acute myeloblastic leukemia is the presence of : a. Auer bodies in myeloblasts b. blast crises c. Philadelphia chromosomes in neutrophils d. virus particles in myeloblasts A 136. Features of chronic myelocytic leukemia include all of the ff., EXCEPT: a. Autoimmune hemolytic anemia b. conversion to acute leukemia c. hyperviscosity of blood d. low alkaline phosphatase level in leukemic granulocytes C 137. A 60y/o man complained of bone pain, especially in his spine. X-rays revealed lytic lesions in the vertebrae and skull. He also had anemia and hypercalcemia. The most likely dx is: a. Burkitt’s lymphoma b. Chronic lymphocytic lymphoma c. Multiple myeloma d. Waldenstrom’s macroglobulinemia

C 138. An association with an increased incidence of lymphomas has been found with all of the ff., EXCEPT: a. autoimmune disorders b. chromosome abnormalities c. cigarette smoking d. viruses C 139. A 40y/0 man presented with weight loss, and painless lymphadenopathy. A node biopsy showed proliferation of germinal centers in the cortex and medulla. The enlarged centers consisted of poorly differentiate lymphocytes. The likeliest dx is: a. acute lymphadenitis b. Burkitt’s lymphoma c. Follicular (nodular) lymphocytic lymphoma d. diffuse poorly differentiated lymphocytic lymphoma A 140. All of the ff. statements are true concerning Hodgkin’s dse, EXCEPT: a. Burkitt’s lymphoma is a variant occurring in Africa b. Leukemia and other malignancies have appeared in patients successfully treated for Hodgkin’s disease c. Lymph nodes and spleen are commonly involved d. Reed-Sternberg cells are the most important diagnostic feature D 141. A young boy had excessive bleeding from minor wounds and even spontaneously. He was found to have a severe deficiency of coagulation factor VIII. Factor IX levels were normal, as was platelet adhesiveness. The most likely dx is? a. Christmas dse b. Stuart factor deficiency c. vonWillebrand’s dse d. hemophilia C 142. The principal target of the organ specific autoimmune dse pernicious anemia is: a. Acetylcholine Rc c. gastric parietal cells b. pancreatic islet cells d. glomerular and lung basement membrane D 143. Amyloid deposits are associated with all of the ff., EXCEPT: a. Alzheimer’s dse b. chronic osteomyelitis c. multiple myeloma d. Syphilis D 144. The ff. are associated with SLE, EXCEPT: a. Hematoxylin bodies b. soluble immune complex deposits in glomeruli c. sterile vegetations on heart valves d. fibrinoid necrosis of medium-sized arteries C 145. All of the ff. are characteristic of DiGeorge’s syndrome, EXCEPT: a. hypoparathyroidism b. hypoplasia of T-dependent areas in lymph nodes c. inheritance as autosomal recessive d. recurrent viral and fungal infections C 146. Lobar pneumonia microscopically is most likely described as: a. hyaline membranes lining alveoli with mononuclear leukocytic infiltration of alveolar septa b. patchy infiltration of alveolar spaces with neutrophils, especially around bronchioles c. uniform infiltration of alveolar spaces with neutrophils and fibrin d. hyaline infiltration of alveoli within a lobe D 147. Am 18-y/o male, with a history of malabsorption and steatorrhea since infancy, died after having a chronic productive cough, hemoptysis, and recurrent pulmonary infections for several years. The lung at autopsy was found to have dilated bronchial walls. The most likely dx is? a. Bronchopneumonia b. TB c. Chronic pneumonitis d. Bronchiectasis A 148. The ff. are characteristic of chronic bronchitis, EXCEPT: a. bacteria play an important role in its causation b. bronchial walls are infiltrated by lymphocytes and macrophages c. bronchial walls show smooth muscle hypertrophy d. bronchial mucus glands are hyperplastic B 149. α-1 antitrypsin deficiency is most closely related to: a. centrilobular emphysema b. panlobular emphysema c. lobar emphysema d. all A 150. Progressive massive fibrosis of the lungs occurs in: a. Coal worker’s pneumoconiosis b. Healed tuberculosis c. Sarcoidosis

d. Radiation pneumonitis

♠♣♦♥ LIVERLUVERZ OCCUPATIONAL HAZARDS ♠♣♦♥ an anatomy of the day to day ailments of liverluverz life

by: Mrs. Bean #2 Let’s-Go Memory Lapse: Characterized by lapses in memory that it is time to leave and everyone does last-minuteultra-important chores or call of nature-quiet-timesalone-naked???, hence, resulting in the next syndrome, the… (to be cont…☺)

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