2nd midterm Syspath

Q1: A mother notices that her 3-month-old infant son has an enlarging left testicle. A serum hCG is not elevated. What is the MOST LIKELY diagnosis? A. Yolk sac tumor B. Seminoma C. Sertoli cell tumor D. Hepatoblastoma

A. Yolk sac tumor

Q2: This pneumoconiosis is seen radiographically as an eggshell calcification of hilar lymph nodes described as stained glass in appearance? A. Asbestosis B. Coal worker's pneumoconiosis C. Silicosis D. Berylliosis

C. Silicosis

Q3: Paget's disease of the nipple presupposes the existence of: A. Ductal carcinoma B. Simple eczema C. Sclerosing adenosis D. Lobular carcinoma

A. Ductal carcinoma

Q4: What is the most frequent type of hyperfunctioning pituitary adenoma? A. Lactotroph adenoma B. Corticotroph adenoma C. Somatotroph adenoma D. Gonadotroph adenoma

A. Lactotroph adenoma

Q5: 40-year-old male presented with repeated episodes of bloody stools. Workup revealed multiple superficial broad-based ulcers with diffuse inflammation limited to the colon; biopsy showed inflammation limited only to the submucosal area. What is the most likely condition? A. Bacillary dysentery B. Crohn's disease C. Ulcerative colitis D. Amoebic colitis

C. Ulcerative colitis

Q6: All are true about Goodpasture Syndrome EXCEPT: A. The patient usually develops an initial respiratory or GI infection resulting in increased synthesis of IgA1 which gets trapped in the mesangium B. Immunofluorescence shows linear deposits of immunoglobulins along alveolar septa and GBM C. The main cause is antibodies against the non-collagenous domain of α3 chain of collagen IV causing destruction of basement membrane in renal glomeruli and pulmonary alveoli D. It is an autoimmune disorder (type II hypersensitivity reaction)

A. The patient usually develops an initial respiratory or GI infection resulting in increased synthesis of IgA1 which gets trapped in the mesangium

Q7: A couple brings their 2-year-old daughter for a well-child check-up. Physical exam reveals short stature, flat midface with prominent forehead, and shortening of the limbs. The child's father exhibits similar features. What is the underlying defect? A. Autosomal dominant cell-signaling defect of fibroblast growth factor receptor B. X-linked recessive defect C. Autosomal dominant defect in fibrillin 1 D. Autosomal recessive defect in fibrillin 1

A. Autosomal dominant cell-signaling defect of fibroblast growth factor receptor

Q8: Classically, a fibroadenoma of the breast is: A. More likely to be found in women over 40 B. Associated with the development of breast cancer C. A solitary, slow-growing, small, firm mobile breast mass D. Composed of anaplastic epithelium

C. A solitary, slow-growing, small, firm mobile breast mass

Q9: What is the microscopic finding in diabetic glomerulonephropathy? A. All of the above B. Eosinophilic nodular glomerulosclerosis C. Mesangial expansion D. GBM thickening E. Renal atherosclerosis

A. All of the above (Eosinophilic nodular glomerulosclerosis, mesangial expansion, GBM thickening, renal atherosclerosis)

Q10: Most common cause of atypical pneumonia is: A. Mycoplasma pneumoniae B. Pneumocystis jirovecii C. Staphylococcus aureus D. Viral pneumonia

A. Mycoplasma pneumoniae

Q11: This pathological process is characterized by acute vascular lesions including fibrinoid necrosis of renal arteries and arterioles, with onion skin lesions: A. Interstitial nephritis B. Renal artery stenosis C. Vasculitis D. Malignant hypertension

D. Malignant hypertension

Q12: Which of the following would LEAST LIKELY account for an ulcer in the distal esophagus? A. Severe reflux esophagitis B. Adenocarcinoma of the esophagus C. Herpes simplex virus D. Zenker diverticulum

D. Zenker diverticulum

Q13: What is the microscopic finding in diabetic glomerulonephropathy? A. Eosinophilic nodular glomerulosclerosis B. Renal atherosclerosis C. GBM thickening D. All of the above E. Mesangial expansion

D. All of the above (Eosinophilic nodular glomerulosclerosis, renal atherosclerosis, GBM thickening, mesangial expansion)

Q14: Chronic calcific pancreatitis is most often associated with: A. Mumps B. Chronic alcoholism C. Malnutrition D. Cholelithiasis

B. Chronic alcoholism

Q15: Which of the following is the most common cause of chronic pancreatitis? A. Alcoholism B. Hypercholesterolemia C. Smoking D. Hereditary predisposition

A. Alcoholism

Q16: A patient presents with recurrent attacks of hypoglycemia following fasting or strenuous exercise, with relief after glucose ingestion. What is the most likely diagnosis? A. Carcinoma of the tail of the pancreas B. Beta-cell adenoma of pancreatic islets C. Hemochromatosis D. Diabetes insipidus

B. Beta-cell adenoma of pancreatic islets

Q17: Breast cancer is suggested by physical findings which include all of the following EXCEPT: A. Alterations of breast contour B. Edema of the skin C. Nipple inversion D. Skin dimpling E. Pain on palpation

E. Pain on palpation

Q18: A four-year-old child develops steroid-sensitive nephrotic syndrome. Renal biopsy shows normal glomeruli by light microscopy and fusion of foot processes by electron microscopy. Which protein would be present in the urine in the highest concentration? A. Ceruloplasmin B. Albumin C. IgE D. IgA

B. Albumin

Q19: A 20-year-old man has a testicular mass showing malignant tumor with yolk sac differentiation on orchiectomy. Which tumor marker is specific for yolk sac tumor? A. Prostate-specific antigen (PSA) B. Alpha-fetoprotein (AFP) C. S-100 D. Carcinoembryonic antigen (CEA)

B. Alpha-fetoprotein (AFP)

Q20: A 32-year-old woman has been unable to conceive for 2 years and has had extremely painful menstrual cramping. Laparoscopy shows multiple red-blue nodules on the ovaries and uterine ligaments. What is the most likely diagnosis? A. Endometrial hyperplasia B. Leiomyoma C. Endometriosis D. Adenomyosis

C. Endometriosis

Q21: A 23-year-old woman has vaginal bleeding in her fifth month of pregnancy, but the uterus is enlarged to the size of a 7-month pregnancy. Ultrasound fails to detect a fetal heartbeat and shows a 'snowstorm pattern.' HCG is markedly elevated. What is the most likely diagnosis? A. Preeclampsia B. Eclampsia C. Hydatidiform mole D. Ectopic pregnancy

C. Hydatidiform mole

Q22: Which of the following features of liver cirrhosis is NOT associated with impaired estrogen metabolism and hyperestrogenism? A. Internal hemorrhoids B. Testicular atrophy C. Gynecomastia D. Palmar erythema

A. Internal hemorrhoids

Q23: Which of the following is NOT an estrogen-dependent carcinoma? A. Endometrial leiomyosarcoma B. Prostate carcinoma C. Lobular carcinoma of the breast D. Follicular thyroid carcinoma

B. Prostate carcinoma

Q24: A 45-year-old woman with poorly controlled diabetes mellitus has proteinuria. Renal biopsy reveals hyaline arteriosclerosis of afferent and efferent arterioles along with Kimmelstiel-Wilson lesions. What is the most likely diagnosis for these glomerular abnormalities? A. Membranous glomerulonephropathy B. Diffuse proliferative glomerulonephritis C. Focal segmental glomerulosclerosis D. Nodular glomerulosclerosis

D. Nodular glomerulosclerosis

Q25: Which organ is always involved in ulcerative colitis? A. Jejunum B. Ileum C. Duodenum D. Rectosigmoid

D. Rectosigmoid

Q26: A 75-year-old man with gout passed a stone in his urine. What type of renal stone was most likely passed? A. Uric acid B. Struvite C. Cysteine D. Calcium phosphate

A. Uric acid

Q27: A breast lesion microscopically shows dense collagenous stroma with small nests and rows of round/polygonal cells with hyperchromatic nuclei forming rudimentary acinar structures, with infiltration of fibroadipose tissue at margins. What is the diagnosis? A. Infiltrating ductal carcinoma B. Paget's disease C. Medullary carcinoma D. Fibrocystic disease E. Fibroadenoma

A. Infiltrating ductal carcinoma

Q28: Which polyp has the highest risk of progression to carcinoma? A. Hyperplastic polyp of the stomach B. Adenomatous polyp of the stomach C. Hyperplastic polyp of the colon D. Pseudopolyps in ulcerative colitis

B. Adenomatous polyp of the stomach

Q29: A feature which distinguishes inflammatory carcinoma of the breast from other breast carcinomas is: A. Marked lymphocyte response B. History of trauma to the breast C. Relatively favorable prognosis D. Cured by antibiotics E. Obstruction of dermal lymphatics by neoplasm

E. Obstruction of dermal lymphatics by neoplasm

Q30: Bleeding from the nipple in a 45-year-old woman without a palpable breast mass should suggest: A. Sclerosing adenosis B. Fibroadenoma C. Fat necrosis D. Chronic cystic mastitis E. Intraductal papilloma

E. Intraductal papilloma

Q31: Penile carcinoma in situ has a strong association with: A. HPV 6 B. HPV 16 C. HPV 18 D. HPV 31

B. HPV 16

Q32: Which of the following confers a DECREASED risk of breast cancer? A. Early menarche B. Obesity C. Multiparity D. Hormone replacement therapy

C. Multiparity

Q33: Which one of the following conditions is NOT part of the spectrum of pathology associated with Crohn disease? A. Periodic acid-Schiff (PAS) stain positive B. Serosal extension ('creeping') of mesenteric fat C. Presence of occasional noncaseating granulomas D. Involvement of the terminal ileum

A. Periodic acid-Schiff (PAS) stain positive

Q34: A 35-year-old man presents with painless enlargement of one testicle. Exam finds a single nontender 3 cm testicular mass that does not transilluminate. Which type of testicular tumor is most likely? A. Mesenchymal tumor B. Sex cord tumor C. Germ cell tumor D. Gonadal stromal tumor

C. Germ cell tumor

Q35: In men, cryptorchidism is the condition when: A. The testis degenerates in the scrotum B. There are two testes in each scrotum C. The testes do not descend into the scrotum

C. The testes do not descend into the scrotum

Q36: This type of gastritis is characterized by auto-antibodies to gastric parietal cells and intrinsic factor: A. Type C B. Type A C. Type AB D. Type B

B. Type A

Q37: An 18-year-old man presents with acute left hemiplegia. MRI reveals a right parietal lobar hematoma and multiple lesions in the liver and spleen. A 1 cm mass is found in the left testicle and HCG is elevated. A biopsy of the testicular mass would most likely show: A. Seminoma B. Yolk sac tumor C. Embryonal carcinoma D. Sertoli cell tumor E. Choriocarcinoma

E. Choriocarcinoma

Q38: A young woman in her fourth week of breastfeeding presents with a locally painful, warm, and red right breast. What is the MOST likely diagnosis? A. Papilloma B. Inflammatory carcinoma C. Paget disease D. Acute mastitis

D. Acute mastitis

Q39: A 34-year-old woman with a known suprasellar tumor suddenly develops blindness, severe headache, and vomiting. She has acute hemorrhage into an adenoma. What is the diagnosis? A. Prolactinoma B. Pituitary microadenoma C. Pituitary apoplexy D. Craniopharyngioma

C. Pituitary apoplexy

Q40: A 30-year-old woman presents with peripheral edema, hypertension, massive proteinuria, and elevated serum cholesterol. Renal biopsy silver stain shows a 'spike and dome' pattern; EM shows subepithelial electron-dense deposits. Which immunofluorescence pattern is most characteristic? A. Linear pattern of IgE and C4 B. Linear pattern of IgM and C3 C. Granular pattern of IgA and C3 D. Granular pattern of IgG and C3

D. Granular pattern of IgG and C3