Pathology Questions. Year 1.
Questions
1. On a routine visit to the physician, an otherwise healthy 40 y/o man has a blood
pressure of 150/95 mmHg. If the patient’s hypertension remains untreated for years,
which cellular alterations will most likely be seen in the myocardium?
a. Atrophy
b. Hyperplasia
c. Hypertrophy
d. Metaplasia
e. Dysplasia
2. What is the first sign of anoxic cell injury?
a. Cell swelling
b. Vacuolization
c. Karyorrhexis
d. Mitochondrial calcification
e. Pyknosis
3. Which of the following clinical scenarios would most likely lead to liquefaction?
a. Infection with bacteria
b. Infection with fungus
c. Infection with mycobacteria
d. Trauma to the pancreas
e. Decreased blood flow to the heart
4. 25 y/o medical student doing an elective in Haiti experiences nausea for 1 wk and mild
scleral icterus. PE shows RUQ tenderness and a slightly enlarged liver. His AS is 1280,
ALT 1580, and a total bilirubin of 5.1. Hep A Ab is high. The increase in the student’s
enzyme levels most likely results from which of the following changes in the
hepatocytes?
a. Dispersion of ribosomes
b. Swelling of the mitochondria
c. Clumping of nuclear chromatin
d. Defects in the cell membrane
e. Apoptosis
5. In ischemic cell injury which of these options occur?
a. Efflux of K and Na
b. Influx of K and Ca
c. Influx of K and H2O
d. Influx of Na and Ca
e. Influx of Na and K
6. An increase in the size of an organ caused by an increase in the number of cells is called
a. Hypertrophy
b. Regeneration
c. Metaplasia
d. Hyperplasia
e. Atrophy
7. Malignant neoplasm originating in tissue derived from either ectoderm or endoderm are
usually classified as
a. Hamartomas
b. Teratomas
c. Choristomas
d. Carcinomas
e. Sarcomas
8. Neoplasm arising from totipotential cells is a/an
a. Hamartoma
b. Teratoma
c. Emryonal tumor
d. Mixed tumor
e. Choristoma
9. Of the factors listed below, the one most important in determining prognosis in a
patient with a benign neoplasm is the
a. Age of the patient
b. Removal of the tumor with the limiting capsule intact
c. Rate of tumor growth
d. Location of tumor
e. Likelihood of malignant transformation
10. The cancer causing most deaths in females is which one of the following?
a. Lung
b. Breast
c. Uterine
d. Leukemia
e. Thyroid
11. Which one of the following oncogenes is most commonly implicated in human
malignant neoplasm
a. p53
b. Cyclin-D1
c. Bcl2
d. Ras
e. BRCA
12. The translocation (9:22)(q34:q11) is seen in which one of the following malignant
neoplasms?
a. Burkett lymphoma
b. Follicular lymphoma
c. T-cell acute lymphoblastic leukemia
d. Chronic myelogenous leukemia
e. Ewings sarcoma
13. A 2 y/o boy is diagnosed with retinoblastoma in both the following steps in the cell cycle
is most likely deficient
a. G0 to G1
b. G1 to S
c. S to G2
d. G2 to M
e. M to G0
14. Induction of p53 by DNA damage results in which of the following changes in the cell?
a. Cell cycle arrest in G1 phase by upregulation of p21
b. DNA repair by induction of c-myc
c. Apoptosis of irreparable cell by induction of BCL-2
d. Cell division by enhanced activity of E2F
e. No change in cell cycle
15. Most the carcinogens are metabolized by which one of the liver enzyme systems?
a. Cyt P150 dependent mono-oxygenase
b. Cyt P250 dependent mono-oxygenase
c. Cyt P350 dependent mono-oxygenase
d. Cyt P450 dependent mono-oxygenase
e. Cyt P550 dependent mono-oxygenase
16. A 46 y/o man is treated for recurrent H. pylori infection of stomach. This patient is at
most risk for development of which of the following tumors in the stomach as a result of
this infection?
a. Melanoma
b. Lipoma
c. Leiomyoma
d. Sarcoma
e. Lymphoma
17. Which of the following neoplasms has been associated with vinyl chloride products in
the plastics industry?
a. Retroperitoneal sarcoma
b. Angiosarcoma of liver
c. Hemangioma of liver
d. Carcinoma of pancreas
e. Fibrosarcoma
18. Induction of p53 by DNA damage results in which of the following changes in the cell?
a. Cell cycle arrest in G1 phase by upregulation of p21
b. DNA repair by induction of c-myc protein
c. Apoptosis of irreparable cell by induction of bcl-2
d. Cell division by enhanced activity of E2F
e. No change in cell cycle
19. The Li-Fraumeni syndrome is caused by mutations in which one of the following genes?
a. Rb
b. NF-1
c. NF-2
d. p53
e. APC
20. A 63 y/o man has cough and hemoptysis. He has a 65 pack-year history of smoking. CT
scan shows a 5 cm R hilar mass. Bronchoscopy and biopsy shows a small cell lung His
family history shows 3 first degree maternal relatives who developed leukemia, sarcoma
and carcinoma before age 40. Which of the following genes is most likely to have
undergone mutations to produce these findings?
a. APC (tumor suppressor)
b. Bcl-2 (anti-apotosis)
c. K-RAS (GTP-binding)
d. NF-1 (GTPase activating)
e. p53 (DNA damage response)
21. 37 y/o man inadvertently received excessive radiation to the skin during an experiment
that resulted in damage to the skin. Which of the following molecules is most
responsible for repairing any DNA damage in epidermal cells?
a. Cyclin-D/CDK-4 complex
b. Rb
c. p53
d. p21
e. Ras
22. Which single manifestation of neoplastic growth is the most certain evidence that it is
malignant?
a. Cellular atypia and pleomorphism
b. Compression of surrounding tissue
c. Large size
d. Necrosis
e. Metastisis
23. Cushing syndrome may be seen as a paraneoplastic syndrome in which one of the
following tumors?
a. Small cell cancer of lung
b. Adult T-cell lymphoma
c. Fibrosarcoma
d. Cerebellar hemangioma
e. Burkett lymphoma
24. Elevation of alpha-fetoprotein is seen in which one of the following tumors?
a. Liver cx
b. Prostate cx
c. Lung cx
d. Multiple myeloma
e. Breast cx
25. The process shown in the above photograph is caused most frequently by? (It is pitting
edema)
a. Left heart failure
b. Right heart failure
c. Lymphatic obstruction
d. Excessive drinking of water
26. A 65 y/o man with long hx of CHF is found on Chest X-ray to have diffuse, fluffy
pulmonary infiltrates interpreted as pulmonary edema, a fluid level at the base of the
right pleural cavity, and an ill-defined density in the upper lobe of the right lung.
Aspirated fluid from the right pleural cavity has a SG of 1.006. The best explanation of
the fluid accumulation is
a. Hypoalbuminemia
b. Lymphatic obstruction within the lung
c. Acute bacterial pneumonia
d. Increased pulmonary venous pressure
e. Lung cancer
27. Infarcts of which organ are most likely to be hemorrhagic?
a. Lung
b. Liver
c. Spleen
d. Kidney
28. A 56 y/o diabetic man who has had afib since a MI two years ago, developed acute
appendicitis. ON the 4th post-op day he experienced R flank pain associated with
hematuria, paralysis of the R body and sharply demarcated ischemic changes on the L
foot. On the 4th post op day he experiences R flank pain associated with hematuria.
These signs and symptoms are due to?
a. Arterial emboli
b. Atherosclerosis
c. Fat embolism
d. Septicemia
e. Venous thrombi
29. A 40 y/o construction worker underwent op fixation of fracture of the femoral shaft.
Shortly after the operation he became short of breath, cyanotic, hypotensive, and
comatose. You would suspect
a. Coronary artery thrombosis
b. Fat emboli
c. Pulmonary infarction
d. Venous thrombi
30. Widespread edema (anasarca) is most likely seen in
a. Angiogenesis
b. Capillary damage
c. Hypoalbuminemia
d. Inflammation
e. Lymphatic obstruction
31. The primary hemostatic plug is composed of
a. An embolus
b. Endothelium
c. Fibrin
d. Platelets
32. Neurogenic, septic and cardiogenic shock are all characterized by
a. Increased urine output
b. Need for blood transfusion
c. Normal blood volume at early stages
d. Peripheral vasodilation at onset
33. The most important overall prognostic factor in malignancies is usually
a. Grading
b. Staging
c. Differentiation
d. Paraneoplastic syndromes
e. Radiosensitivity of neoplastic cells
34. A 53 y/o man was dx with oral cx and treated with radiation and chemotherapy 1 year
ago. He now has a PET scan of his neck that shows a single focus of uptake. It is resected
and show metastatic squamous cell carcinoma. Which of the metabolic pathways is
most likely upregulated to promote his cx survival and proliferation?
a. Aerobic glycolysis
b. Gluconeogensis
c. Hexose monophosphate shunt
d. Ox phos
e. Purine degregation
Answers
1. b, hypertrophy because heart cells get larger. Accumulation of DNA results in boxcar
nuclei.
2. a, cell swelling is first sign of anoxic cell injury. Vacuolization is a sign of irreversible cell
damage.
3. a, bacteria will liquefy. Brain infarcts also cause liquefacation. Fungus = caseous,
mycobacteria = caseous, pancreases trauma = enzymatic fat, heart damage =
coagulation
4. d, lack of ATP makes cell membranes semi-permeable in this case of Hep A. Note that
AST and ALT are highest concentration in liver. Apoptosis is not taking place, necrosis is.
Other options are seen but not causing change in liver enzymes.
5. d, influx of Na and Ca from mitochondria and ER
6. d, hyperplasia is increase in number of cells. Hypertrophy is increase in size. Metaplasia
is change of epithelium cell type (eg. Squamous metaplasia of columnar cells in cervix)
7. e, Carcinoma is malignant tissue from ecto/endoderm. Sarcoma is mesoderm
malignancy. Hamartoma is disorganized. Teratoma is germline cell with teeth or hair.
Choristoma is tissue in incorrect place.
8. b, teratoma
9. e, likelihood of malignant transformation. This is for a benign tumor so it could exhibit
mass effect in bad places, such as meningioma blocking CSF flow to brain
10. a, Lung cancer is the leading deadly cancer for men and women. It should be noted most
common cancer is prostate (men) and breast (women).
11. d, Ras is the oncogene most frequently involved. Normally MAPK pathway stimulated by
GF but in this case Ras stuck turned on with GTP bound. p53 is a tumor suppressor, also
known the guardian of the genome, not an oncogene.
12. d, chronic myelogenous leukemia (MML). Note: Burketts lymphoma also due to
translocation, affects B-cells, head/neck cancer.
13. b, remember the “double-hit” hypothesis in familial form of disease.
14. a, p53 causes cell cycle arrest by upregulating p21 (CDK inhibitor)
15. d, Cytochrome P450 dependent mono-oxygenase
16. e, lymphoma. Note: lymphoma is technically a type of sarcoma.
17. c, angiosarcoma of liver. Vinyl choloride exposure causes hemangiomas of liver, without
exposure cancer is very rare. Hemangioma of liver is benign tumor.
18. a
19. d, Li-Fraumeni is hereditary cancer syndrome with one mutated p53 (similar to familial
Rb)
20. e
21. c
22. e
23. a, small cell lung cancer releases ACTH. Cerebellar hemangioma would have increased
RBCs due to EPO secretion.
24. a, alpha-fetoprotein elevation also sign of testicular tumor.
25. b, right sided heart failure usually caused by left sided heart failure.
26. d, SG < 1.012 suggests trasudate. If SG > 1.020 then could be exudate associated with
bacterial pneumonia. Hypoalbunemia occurs with kidney problems.
27. a, lung because of dual blood supply. Liver could be argued since also has dual blood
supply, but usually white infarcts occur there.
28. a
29. b, apparently heparin sulfate can desolve a fat emboli???
30. c, hypoalbunemia (either by liver damage or kidney damage) causes widespread edema.
Though you may think thoracic duct would have similar effect if it is blocked then only
intestine edema occurs.
31. d, platlets form the first plug. Fibrin clot happens after.
32. c
33. b
34. a, PET scan is useful because of this.