CLINICAL CASES MCQs FINAL Gen. Path

The following microscopic description of a liver specimen indicate: “After preparation of the specimen with paraffin method and staining with H-E, hepatocytes show empty vacuoles with different size, the nuclei are often displaced to the periphery and the cytoplasm looks empty.”

a) liver steatosis/fatty liver

b) liver anthracosis

c) liver jaundice

d) liver hemosiderosis

The following microscopic description of a liver specimen indicate: “After preparation of the specimen with paraffin method and staining with H-E, hepatocytes show empty vacuoles with different size, the nuclei are often displaced to the periphery and the cytoplasm looks empty.”

a) liver steatosis/fatty liver

b) liver anthracosis

c) liver jaundice

d) liver hemosiderosis

Which type of liver degeneration can be proved with the following description? – The specimen is prepared from fresh unfixed tissue or fixed with formalin, cut on a frozen microtom and stained with Sudan III in orange.

a) carbohydrate degeneration

b) cell edema

c) bilirubin accumulation/jaundice in the liver

d) fatty degeneration/liver steatosis

Which type of liver degeneration can be proved with the following description? – The specimen is prepared from fresh unfixed tissue or fixed with formalin, cut on a frozen microtom and stained with Sudan III in orange.

a) carbohydrate degeneration

b) cell edema

c) bilirubin accumulation/jaundice in the liver

d) fatty degeneration/liver steatosis

The following gross description “red and yellow stripes in the papillary muscles” is characteristic for:

a) lipomatosis of the heart

b) tiger heart

c) fatty liver

d) jaundice of the liver

The following gross description “red and yellow stripes in the papillary muscles” is characteristic for:

a) lipomatosis of the heart

b) tiger heart

c) fatty liver

d) jaundice of the liver

The following gross description “fatty accumulation along the coronary vessels, but in severe cases the lipid accumulation is diffusely spread under the epicardium” is characteristic for:

a) lipomatosis of the heart

b) tiger heart

c) fatty degeneration of the heart

d) all of the above

The following gross description “fatty accumulation along the coronary vessels, but in severe cases the lipid accumulation is diffusely spread under the epicardium” is characteristic for:

a) lipomatosis of the heart

b) tiger heart

c) fatty degeneration of the heart

d) all of the above

The following description indicate which type of change: “Peribronchial and perivascular spaces revealed black pigment which on high magnification appears as small granules. Some of the pigment is found in the macrophages lying in the alveolar spaces (coniophages).” (2)

a) coal dust in lungs

b) antracosis pulmonis

c) brown induration of lungs

d) lung infarction

The following description indicate which type of change: “Peribronchial and perivascular spaces revealed black pigment which on high magnification appears as small granules. Some of the pigment is found in the macrophages lying in the alveolar spaces (coniophages).” (2)

a) coal dust in lungs

b) antracosis pulmonis

c) brown induration of lungs

d) lung infarction

What change of the lung is described? – H-E staining: The alveoli are filled with siderophages. They accumulate golden-brown pigment as a result of phagocytosis of the hemolized erythrocytes due to intra-alveolar per-diapedesin hemorrhages. Intra-alveolar septa are thickened because of the development of connective tissue.

a) antracosis pulmonis

b) hemorrhagic infarction of the lung

c) hemosiderosis pulmonis

d) lung edema

What change of the lung is described? – H-E staining: The alveoli are filled with siderophages. They accumulate golden-brown pigment as a result of phagocytosis of the hemolized erythrocytes due to intra-alveolar per-diapedesin hemorrhages. Intra-alveolar septa are thickened because of the development of connective tissue.

a) antracosis pulmonis

b) hemorrhagic infarction of the lung

c) hemosiderosis pulmonis

d) lung edema

The following microscopic description indicates: “Yellow-brown-green pigment is accumulated as tiny granules in the cytoplasm of the hepatocytes, in the lumens of the biliary capillaries as bile thrombi and in the lumens of bile ducts as cylinders.”

a) fatty degeneration of the liver

b) massive necrosis of the liver

c) chronic venous congestion of the liver

d) jaundice of the liver

The following microscopic description indicates: “Yellow-brown-green pigment is accumulated as tiny granules in the cytoplasm of the hepatocytes, in the lumens of the biliary capillaries as bile thrombi and in the lumens of bile ducts as cylinders.”

a) fatty degeneration of the liver

b) massive necrosis of the liver

c) chronic venous congestion of the liver

d) jaundice of the liver

The following microscopic description indicates: H-E staining: The epithelial cells of the renal tubules accumulate yellow-brown-green pigment as tiny granules in their cytoplasm. The same pigment is accumulated as cylinders in the lumens of the straight and collective renal tubules.

a) argyria of the kidney

b) jaundice of the kidney/icterus renis

c) carbohydrate degeneration of the kidney

d) chronic pyelonephritis

The following microscopic description indicates: H-E staining: The epithelial cells of the renal tubules accumulate yellow-brown-green pigment as tiny granules in their cytoplasm. The same pigment is accumulated as cylinders in the lumens of the straight and collective renal tubules.

a) argyria of the kidney

b) jaundice of the kidney/icterus renis

c) carbohydrate degeneration of the kidney

d) chronic pyelonephritis

The following microscopic description indicates: H-E staining: The lesion consists of nests of normal melanocytes that accumulate different quantity of brown-black pigment. These cells can be found in papillary or reticular derma of the skin.

a) naevus pigmentosus

b) melanoma malignum

c) skin oedema

d) basal cell carcinoma

The following microscopic description indicates: H-E staining: The lesion consists of nests of normal melanocytes that accumulate different quantity of brown-black pigment. These cells can be found in papillary or reticular derma of the skin.

a) naevus pigmentosus

b) melanoma malignum

c) skin oedema

d) basal cell carcinoma

The following gross description of the lungs is typical for: “Brick-red to brown colour of the lungs, firm consistency, decreased elasticity”

a) antracosis pulmonis

b) brown induration of the lungs

c) pneumonia developing in both lungs

d) lung infarction

The following gross description of the lungs is typical for: “Brick-red to brown colour of the lungs, firm consistency, decreased elasticity”

a) antracosis pulmonis

b) brown induration of the lungs

c) pneumonia developing in both lungs

d) lung infarction

The following clinical features: left-sided heart failure, dyspnea (shortness of breath), frequent cough with rusty colour expectoration, can be seen in:

a) brown induration of the lungs/hemosiderosis of lungs

b) heart tamponade

c) 1st degree AV-block

d) all of the above

The following clinical features: left-sided heart failure, dyspnea (shortness of breath), frequent cough with rusty colour expectoration, can be seen in:

a) brown induration of the lungs/hemosiderosis of lungs

b) heart tamponade

c) 1st degree AV-block

d) all of the above

Which heart disease can be described with the following microscopic picture: The cuspid valve when stained with H-E shows loose area – clear and unstained spaces between fibrous structures representing interstitial mucoid oedema/swelling. Fibroblasts are seen around this clear zone and in the periphery of the cuspid valve (sign of fibrosis). The valve contains many newly formed capillaries (the process is called vascularization).

a) acute endocarditis

b) subacute endocarditis

c) age-related degeneration of the valve

d) rheumatism

Which heart disease can be described with the following microscopic picture: The cuspid valve when stained with H-E shows loose area – clear and unstained spaces between fibrous structures representing interstitial mucoid oedema/swelling. Fibroblasts are seen around this clear zone and in the periphery of the cuspid valve (sign of fibrosis). The valve contains many newly formed capillaries (the process is called vascularization).

a) acute endocarditis

b) subacute endocarditis

c) age-related degeneration of the valve

d) rheumatism

Which answer is correct for the following microscopic description: H-E staining: The liver columns are atrophic, the sinusoids look dilated. The hepatocytes are smaller in size and contain brown-golden pigment granules with perinuclear localization.

a) nutmeg liver

b) cyanosis hepatis

c) acute hepatitis

d) atrophy of the liver

Which answer is correct for the following microscopic description: H-E staining: The liver columns are atrophic, the sinusoids look dilated. The hepatocytes are smaller in size and contain brown-golden pigment granules with perinuclear localization.

a) nutmeg liver

b) cyanosis hepatis

c) acute hepatitis

d) atrophy of the liver

The following description of the liver is indicative for: The liver is increased in size, with firm texture, red-purple color, congested vessels, microscopically the sinusoids are dilated and filled with erythrocytes.

a) hepar muschatum/nutmeg liver

b) cyanosis of the liver

c) brown atrophy of the liver

d) liver cirrhosis

The following description of the liver is indicative for: The liver is increased in size, with firm texture, red-purple color, congested vessels, microscopically the sinusoids are dilated and filled with erythrocytes.

a) hepar muschatum/nutmeg liver

b) cyanosis of the liver

c) brown atrophy of the liver

d) liver cirrhosis

The following description of the liver is indicative for: The liver is increased in size, with motley cut surface showing red areas surrounded by yellow halo:

a) nutmeg liver

b) cyanosis of the liver

c) brown atrophy of the liver

d) liver cirrhosis

The following description of the liver is indicative for: The liver is increased in size, with motley cut surface showing red areas surrounded by yellow halo:

a) nutmeg liver

b) cyanosis of the liver

c) brown atrophy of the liver

d) liver cirrhosis

The following microscopic description is indicative for: H-E staining: Sinusoids are dilated and filled with blood. “Bloody lakes” are seen in the centro-lobular areas among the necrotic hepatocytes. The hepatocytes around them are with lipid degeneration and look like “signet-ring” cells. In the intermediate lobular areas the hepatocytes are atrophic.

a) cyanosis hepatis

b) nutmeg liver

c) liver cirrhosis

d) liver amyloidosis

The following microscopic description is indicative for: H-E staining: Sinusoids are dilated and filled with blood. “Bloody lakes” are seen in the centro-lobular areas among the necrotic hepatocytes. The hepatocytes around them are with lipid degeneration and look like “signet-ring” cells. In the intermediate lobular areas the hepatocytes are atrophic.

a) cyanosis hepatis

b) nutmeg liver

c) liver cirrhosis

d) liver amyloidosis

The following microscopic description is indicative for: H-E staining: Alveolar spaces are filled with precipitated homogenous pink fluid. Alveolar septi and capillaries are dilated and filled with erythrocytes. Airy bubbles can be found in the alveolar cavities and in the lumens of bronchi.

a) hemorrhagic infarction of the lung

b) hemosiderosis pulmonis

c) pulmofibrosis

d) lung edema

The following microscopic description is indicative for: H-E staining: Alveolar spaces are filled with precipitated homogenous pink fluid. Alveolar septi and capillaries are dilated and filled with erythrocytes. Airy bubbles can be found in the alveolar cavities and in the lumens of bronchi.

a) hemorrhagic infarction of the lung

b) hemosiderosis pulmonis

c) pulmofibrosis

d) lung edema

Indicate the cause of death according to the described test: “After Y-shaped opening of the pericardium, the pulmonary artery is cut on 2cm after its beginning. Tweezers are inserted in the vessel and its content is taken out, which looks dry and crumblie”.

a) massive thromboembolism in the trunk of a. pulmonalis (saddle embolus)

b) air embolism

c) amniotic embolism

d) heart tamponade

Indicate the cause of death according to the described test: “After Y-shaped opening of the pericardium, the pulmonary artery is cut on 2cm after its beginning. Tweezers are inserted in the vessel and its content is taken out, which looks dry and crumblie”.

a) massive thromboembolism in the trunk of a. pulmonalis (saddle embolus)

b) air embolism

c) amniotic embolism

d) heart tamponade

Indicate the cause of death according to the described test: “After Y-shaped opening, the pericardial sac is filled with water. After puncture of the right heart ventricle with a sharp knife are seen air bubbles”.

a) massive thromboembolism in the trunk of a. pulmonalis (saddle embolus)

b) air embolism

c) amniotic embolism

d) heart tamponade

Indicate the cause of death according to the described test: “After Y-shaped opening, the pericardial sac is filled with water. After puncture of the right heart ventricle with a sharp knife are seen air bubbles”.

a) massive thromboembolism in the trunk of a. pulmonalis (saddle embolus)

b) air embolism

c) amniotic embolism

d) heart tamponade

The following microscopic description is indicative for: H-E staining. Thrombus formation with layered structure, occluding completely or partially the lumen of the blood vessel. In the area of disturbed endothelial layer is seen alternation of pink stripes and bands (aggregated thrombocytes and fibrin fibres) and orange accumulations (erythrocytes).

a) red thrombus

b) white thrombus

c) mixed thrombus

d) hyaline thrombus

The following microscopic description is indicative for: H-E staining. Thrombus formation with layered structure, occluding completely or partially the lumen of the blood vessel. In the area of disturbed endothelial layer is seen alternation of pink stripes and bands (aggregated thrombocytes and fibrin fibres) and orange accumulations (erythrocytes).

a) red thrombus

b) white thrombus

c) mixed thrombus

d) hyaline thrombus

The following microscopic description of the kidney is indicative for: H-E staining: On low magnification is seen pinkish area with no nuclei or picnotic nuclei and the cytoplasms of the necrotic cells is granular and eosinophillic. Kidney structures look like shadows. This pinkish area is surrounded by blue rim, of inflammatory cells (lymphocytes and leucocyts) and thin band of erythrocytes (the so called hyperemic-hemorrhagic area).

a) acute pyelonephritis

b) anemic infarction of the kidney

c) amyloidosis of the kidney

d) chronic pyelonephritis

The following microscopic description of the kidney is indicative for: H-E staining: On low magnification is seen pinkish area with no nuclei or picnotic nuclei and the cytoplasms of the necrotic cells is granular and eosinophillic. Kidney structures look like shadows. This pinkish area is surrounded by blue rim, of inflammatory cells (lymphocytes and leucocyts) and thin band of erythrocytes (the so called hyperemic-hemorrhagic area).

a) acute pyelonephritis

b) anemic infarction of the kidney

c) amyloidosis of the kidney

d) chronic pyelonephritis

The following microscopic description of the lung indicates for: On H-E staining: Necropsy material taken 24 hours after death. The alveoli are filled with agglutinated and hemolized erythrocytes, the alveolar walls are necrotic. The preserved alveoli are filled with edematous fluid and hemosiderophages. The latest changes are a sign for chronic venous congestion.

a) hemorrhagic infarction of the lung and hemosiderosis

b) pneumonia and hemosiderosis

c) small cell cancer and hemosiderosis

d) pneumonia and lung edema

The following microscopic description of the lung indicates for: On H-E staining: Necropsy material taken 24 hours after death. The alveoli are filled with agglutinated and hemolized erythrocytes, the alveolar walls are necrotic. The preserved alveoli are filled with edematous fluid and hemosiderophages. The latest changes are a sign for chronic venous congestion.

a) hemorrhagic infarction of the lung and hemosiderosis

b) pneumonia and hemosiderosis

c) small cell cancer and hemosiderosis

d) pneumonia and lung edema

The following microscopic description of the lung is indicative for: The specimen is prepared by frozen section of unfixed tissue. Sudan III staining shows round, oval, elongated or branched, orange stained drops in the capillaries, with complete occlusion of their lumen.

a) parasite embolism of the lung

b) thromboembolism of the lung

c) amniotic embolism

d) fat embolism of the lung

The following microscopic description of the lung is indicative for: The specimen is prepared by frozen section of unfixed tissue. Sudan III staining shows round, oval, elongated or branched, orange stained drops in the capillaries, with complete occlusion of their lumen.

a) parasite embolism of the lung

b) thromboembolism of the lung

c) amniotic embolism

d) fat embolism of the lung

What is the organ diagnosis if during autopsy are seen the following changes: Complicated atherosclerotic plaques of the aorta and renal arteries with ulceration and thrombosis, small in size right kidney showing depressed area in its middle part, which is 3x4cm in size, with pale color, firm texture and triangular shape.

a) chronic pyelonephritis

b) anemic infarction of the kidney

c) chronic glomerulonephritis

d) abscess of the kidney

What is the organ diagnosis if during autopsy are seen the following changes: Complicated atherosclerotic plaques of the aorta and renal arteries with ulceration and thrombosis, small in size right kidney showing depressed area in its middle part, which is 3x4cm in size, with pale color, firm texture and triangular shape.

a) chronic pyelonephritis

b) anemic infarction of the kidney

c) chronic glomerulonephritis

d) abscess of the kidney

The following microscopic description of the heart is indicative for: H-E staining: Among the myocardium are found cavities filled with purulent exudate. In the centre of some of them are seen groups of microorganisms, stained in dark blue. The adjacent cardiomyocytes are with dystrophic changes, multitude neutrophiles are seen in the interstitium.

a) acute purulent pericarditis

b) acute absceding myocarditis

c) acute viral myocarditis

d) rheumatic myocarditis

The following microscopic description of the heart is indicative for: H-E staining: Among the myocardium are found cavities filled with purulent exudate. In the centre of some of them are seen groups of microorganisms, stained in dark blue. The adjacent cardiomyocytes are with dystrophic changes, multitude neutrophiles are seen in the interstitium.

a) acute purulent pericarditis

b) acute absceding myocarditis

c) acute viral myocarditis

d) rheumatic myocarditis

What is the described disease in the liver? H-E staining “Description of the wall of a cyst. Pink slender membrane is pathognomonic for the disease. It represents tick, multilayered acellular band which looks like “cigarette smoke”. There is a fibrous capsule between the membrane and the normal liver tissue, compoused of collagen connective tissue. Single bile ducts and chronic inflammatory cells are included among the collagen fibres.”

a) actinomycosis

b) amebiasis

c) chronic abscess

d) echinococcus

What is the described disease in the liver? H-E staining “Description of the wall of a cyst. Pink slender membrane is pathognomonic for the disease. It represents tick, multilayered acellular band which looks like “cigarette smoke”. There is a fibrous capsule between the membrane and the normal liver tissue, compoused of collagen connective tissue. Single bile ducts and chronic inflammatory cells are included among the collagen fibres.”

a) actinomycosis

b) amebiasis

c) chronic abscess

d) echinococcus

Indicate the correct answer for the following description: “Tumor-like process located on the gingiva. Histologically, under the stratified squamous gingival epithelium are found fibroblast-like cells and giant cells looking like osteoclasts, located in optically empty spaces. Light stripe of connective tissue separates the epithelium and the tumor-like process.

a) fibroma

b) giant cell epulis

c) adamantinoma

d) cementoma

Indicate the correct answer for the following description: “Tumor-like process located on the gingiva. Histologically, under the stratified squamous gingival epithelium are found fibroblast-like cells and giant cells looking like osteoclasts, located in optically empty spaces. Light stripe of connective tissue separates the epithelium and the tumor-like process.

a) fibroma

b) giant cell epulis

c) adamantinoma

d) cementoma

Indicate the diagnosis according to the following microscopic description: H-E staining: The thyroid gland is lavishly infiltrated by the lymphocytes and plasma cells. Plenty of lymph follicles are also formed, they are with the wide light centres. The lymphoid infiltration disrupts the lymph follicles; in the preserved ones the colloid is scanty or missing. High cubic eosinophilic cells of Hurtle type can be seen.

a) goiter

b) Riddle thyroiditis

c) lymphoma in the thyroid gland

d) Hashimoto thyroiditis

Indicate the diagnosis according to the following microscopic description: H-E staining: The thyroid gland is lavishly infiltrated by the lymphocytes and plasma cells. Plenty of lymph follicles are also formed, they are with the wide light centres. The lymphoid infiltration disrupts the lymph follicles; in the preserved ones the colloid is scanty or missing. High cubic eosinophilic cells of Hurtle type can be seen.

a) goiter

b) Riddle thyroiditis

c) lymphoma in the thyroid gland

d) Hashimoto thyroiditis

Suggest the correct answer according to the following microscopic description. H-E staining: The tumor is composed of branches and nests of basal type cells – spindle, with scanty cytoplasm and moderate atypia of nuclei. Mitoses are rarely seen. In the solid nests tumor cells have palisade peripheral arrangement The stromal reaction is presented by lymphocytes and plasma cells. The tumor nests infiltrate the deep dermal layers.

a) basal cell papilloma of the skin

b) squamous cell carcinoma of the skin

c) pigmented nevus

d) basal cell carcinoma of the skin

Suggest the correct answer according to the following microscopic description. H-E staining: The tumor is composed of branches and nests of basal type cells – spindle, with scanty cytoplasm and moderate atypia of nuclei. Mitoses are rarely seen. In the solid nests tumor cells have palisade peripheral arrangement The stromal reaction is presented by lymphocytes and plasma cells. The tumor nests infiltrate the deep dermal layers.

a) basal cell papilloma of the skin

b) squamous cell carcinoma of the skin

c) pigmented nevus

d) basal cell carcinoma of the skin

Suggest the diagnosis according to the following microscopic description: H-E staining: Capsulated tumor with uneven, lobular structure. Different lobules are made up of cells containing optically empty vacuoles in their cytoplasm They push the cells’ nuclei to the periphery under the cytoplasmic membrane.

a) fibroma

b) leiomyoma

c) lymphangioma

d) lipoma

Suggest the diagnosis according to the following microscopic description: H-E staining: Capsulated tumor with uneven, lobular structure. Different lobules are made up of cells containing optically empty vacuoles in their cytoplasm They push the cells’ nuclei to the periphery under the cytoplasmic membrane.

a) fibroma

b) leiomyoma

c) lymphangioma

d) lipoma

Suggest the correct diagnosis according to the following microscopic description. H-E staining: Unencapsulated intradermal tumor which is poorly distinguished from the adjacent tissue and covered by the atrophic epidermis. The tumor is composed of the capillary vessels with erythrocytes in their lumena.

a) cavernous hemangioma of the skin

b) capillary lymphangioma of the skin

c) capillary hemangioma of the skin

d) hygroma of the skin

Suggest the correct diagnosis according to the following microscopic description. H-E staining: Unencapsulated intradermal tumor which is poorly distinguished from the adjacent tissue and covered by the atrophic epidermis. The tumor is composed of the capillary vessels with erythrocytes in their lumena.

a) cavernous hemangioma of the skin

b) capillary lymphangioma of the skin

c) capillary hemangioma of the skin

d) hygroma of the skin

Suggest the diagnosis according to the following microscopic description. H-E staining: Unencapsulated liver tumor which is well distinguished from the adjacent tissues. It is composed of the large vascular spaces resembling similar vascular structures in the penis. Erythrocytes and hemolyzed blood are seen in the lumina of these large vessels. The walls of these structures represent fibrous septi covered with one or two lines of endothelial cells.

a) cavernous hemangioma

b) capillary hemangioma

c) angiosarcoma

d) lymphangioma

Suggest the diagnosis according to the following microscopic description. H-E staining: Unencapsulated liver tumor which is well distinguished from the adjacent tissues. It is composed of the large vascular spaces resembling similar vascular structures in the penis. Erythrocytes and hemolyzed blood are seen in the lumina of these large vessels. The walls of these structures represent fibrous septi covered with one or two lines of endothelial cells.

a) cavernous hemangioma

b) capillary hemangioma

c) angiosarcoma

d) lymphangioma

Suggest the diagnosis according to the following microscopic description: H-E staining: Unencapsulated uterine tumor which is composed of the spindle cells arranged in bundles. These bundles cross in different directions. Slight tissue atypia is seen, presented by chaotic bundles of spindle cells.

a) leiomyosarcoma uteri

b) leiomyoma uteri

c) endometrial carcinoma

d) endometrial sarcoma

Suggest the diagnosis according to the following microscopic description: H-E staining: Unencapsulated uterine tumor which is composed of the spindle cells arranged in bundles. These bundles cross in different directions. Slight tissue atypia is seen, presented by chaotic bundles of spindle cells.

a) leiomyosarcoma uteri

b) leiomyoma uteri

c) endometrial carcinoma

d) endometrial sarcoma

Suggest the diagnosis according to the microscopic description. H-E staining: The tumor is composed of highly differentiated tissue elements from the three germinal cell layers -- mesodermal layer (connective tissue, collagen fibres, fatty tissue, cartilage and others), endodermal layer (glands) and ectodermal layer (skin, columnar epithelium, stratified squamous epithelium, brain substance). They create a variety of the morphological picture. There isn’t any sign of cell atypia. Cystic changes are often seen.

a) teratocarcinoma

b) mature teratoma

c) dermoid cyst

d) pleomorphic adenoma

Suggest the diagnosis according to the microscopic description. H-E staining: The tumor is composed of highly differentiated tissue elements from the three germinal cell layers -- mesodermal layer (connective tissue, collagen fibres, fatty tissue, cartilage and others), endodermal layer (glands) and ectodermal layer (skin, columnar epithelium, stratified squamous epithelium, brain substance). They create a variety of the morphological picture. There isn’t any sign of cell atypia. Cystic changes are often seen.

a) teratocarcinoma

b) mature teratoma

c) dermoid cyst

d) pleomorphic adenoma

A resident in surgery is looking for a consultation with regard to a breast nodule in a young woman: can a morphological examination be done prior to surgery? How the specimen should be taken and in what fixative? Which are the other options for a routine examination? What addition morphological methods can be involved?

a) complete excision if the tumor is small in size and frozen section during surgery

b) incision biopsy if the tumor is bigger in size followed by frozen section during surgery

c) thin-needle biopsy followed by cytology examination

d) all of the listed above

A resident in surgery is looking for a consultation with regard to a breast nodule in a young woman: can a morphological examination be done prior to surgery? How the specimen should be taken and in what fixative? Which are the other options for a routine examination? What addition morphological methods can be involved?

a) complete excision if the tumor is small in size and frozen section during surgery

b) incision biopsy if the tumor is bigger in size followed by frozen section during surgery

c) thin-needle biopsy followed by cytology examination

d) all of the listed above

The autopsy of a 65-year old patient, alcohol addicted with diabetes, emphysema and pneumonia revealed gross changes in the liver. It’s enlarged and heavy (2110g) with smooth surface and soft consistency. The cut surface is yellow-brown and the lobular structure is unclear. What is the diagnosis?

a) fatty degeneration

b) carbohydrate degeneration

c) protein degeneration

d) all the three are possible

The autopsy of a 65-year old patient, alcohol addicted with diabetes, emphysema and pneumonia revealed gross changes in the liver. It’s enlarged and heavy (2110g) with smooth surface and soft consistency. The cut surface is yellow-brown and the lobular structure is unclear. What is the diagnosis?

a) fatty degeneration

b) carbohydrate degeneration

c) protein degeneration

d) all the three are possible

The autopsy of a patient with pernicious anemia showed dilated right heart chamber. The myocardium is loose and pale. As a result of the hypoxia, the major changes are seen under the endocardium, mainly in the area of papillary muscles. What changes do you expect to see?

a) lipomatosis of the heart

b) carbohydrate degeneration of the heart

c) tiger heart/fatty degeneration of the heart

d) heart infarction

The autopsy of a patient with pernicious anemia showed dilated right heart chamber. The myocardium is loose and pale. As a result of the hypoxia, the major changes are seen under the endocardium, mainly in the area of papillary muscles. What changes do you expect to see?

a) lipomatosis of the heart

b) carbohydrate degeneration of the heart

c) tiger heart/fatty degeneration of the heart

d) heart infarction

A 52-year old woman with medical history of tonsillitis, developed heart valve defect. She complained of cough, sometimes with rusty expectoration and difficulties in breathing when she is lying in bed. Auscultation revealed small moist noises in both lung bases. What is the cause for all these complains and clinical findings?

a) mitral valve stenosis

b) tricuspidal valve stenosis

c) aortic valve stenosis

d) aortic valve insufficiency

A 52-year old woman with medical history of tonsillitis, developed heart valve defect. She complained of cough, sometimes with rusty expectoration and difficulties in breathing when she is lying in bed. Auscultation revealed small moist noises in both lung bases. What is the cause for all these complains and clinical findings?

a) mitral valve stenosis

b) tricuspidal valve stenosis

c) aortic valve stenosis

d) aortic valve insufficiency

Body of a man with total cachexia is sent for an autopsy. The skin is dark-bronze. The two suprarenal glands are entirely ruined by tuberculosis. Which is the disease?

a) Cohn’s disease

b) Addison’s disease

c) Cushing’s syndrome

d) Waterhouse-Fridricksen’s syndrome

Body of a man with total cachexia is sent for an autopsy. The skin is dark-bronze. The two suprarenal glands are entirely ruined by tuberculosis. Which is the disease?

a) Cohn’s disease

b) Addison’s disease

c) Cushing’s syndrome

d) Waterhouse-Fridricksen’s syndrome

Nodule measuring 2cm from the parotid gland of a 32-year old male patient was sent for the histological examination. Histological result showed jelly-like and at some areas chondroid substance which surrounds glandular structures and strands of flat cylindrical and spindle cells. Suggest the diagnosis.

a) adenocarcinoma of the parotid gland

b) acute syalodenitis

c) pleomorphic adenoma

d) mucinous carcinoma

Nodule measuring 2cm from the parotid gland of a 32-year old male patient was sent for the histological examination. Histological result showed jelly-like and at some areas chondroid substance which surrounds glandular structures and strands of flat cylindrical and spindle cells. Suggest the diagnosis.

a) adenocarcinoma of the parotid gland

b) acute syalodenitis

c) pleomorphic adenoma

d) mucinous carcinoma

Autopsy of a young man who died 2 days after a car accident reveals fracture of the femur and massive crush of the soft tissues. Lungs are normal in shape and size but with expressive hyperemia. The cut surface is shiny with minute droplets of the size of the head of a pin. Indicate the cause of death:

a) fat embolism

b) air embolism

c) thromboembolism

d) bacterial embolism

Autopsy of a young man who died 2 days after a car accident reveals fracture of the femur and massive crush of the soft tissues. Lungs are normal in shape and size but with expressive hyperemia. The cut surface is shiny with minute droplets of the size of the head of a pin. Indicate the cause of death:

a) fat embolism

b) air embolism

c) thromboembolism

d) bacterial embolism

Autopsy of a patient with pernicious anemia shows dilated right ventricle with anemic infarction. On papillary muscles are detected yellowish stripes. What pathological finding is seen in this case?

a) hyperplasia of fat cells

b) „tiger heart” - fatty degeneration of cardiomyocites

c) lipomatosis

d) brown atrophy

Autopsy of a patient with pernicious anemia shows dilated right ventricle with anemic infarction. On papillary muscles are detected yellowish stripes. What pathological finding is seen in this case?

a) hyperplasia of fat cells

b) „tiger heart” - fatty degeneration of cardiomyocites

c) lipomatosis

d) brown atrophy

A tumor from the left forearm in a 39-year old woman was resected. Grossly it is well circumscribed, with a diameter of 3 cm. On histology: tumor cells are spindle-shaped, grouped in bundles, nuclei form palisade structures. Set the diagnosis:

a) fibroma

b) leiomyoma

c) myxoma

d) neurinoma

A tumor from the left forearm in a 39-year old woman was resected. Grossly it is well circumscribed, with a diameter of 3 cm. On histology: tumor cells are spindle-shaped, grouped in bundles, nuclei form palisade structures. Set the diagnosis:

a) fibroma

b) leiomyoma

c) myxoma

d) neurinoma

An autopsy of a 60-years old man revealed a thickened and soft wall of the stomach with indistinct layers. Cut surface showed presence of the dirty grayish-green pus-like material. What disease is this:

a) chronic gastritis

b) phlegmonous gastritis

c) acute gastric ulcer

d) chronic gastric ulcer

An autopsy of a 60-years old man revealed a thickened and soft wall of the stomach with indistinct layers. Cut surface showed presence of the dirty grayish-green pus-like material. What disease is this:

a) chronic gastritis

b) phlegmonous gastritis

c) acute gastric ulcer

d) chronic gastric ulcer

At an autopsy in the temporal lobe of the brain a cyst with a diameter of 2 cm, with smooth walls and clear pale yellow liquid was found. What can it be:

a) abscess of the brain

b) pseudocyst of the brain

c) tumor

d) encephalitis

At an autopsy in the temporal lobe of the brain a cyst with a diameter of 2 cm, with smooth walls and clear pale yellow liquid was found. What can it be:

a) abscess of the brain

b) pseudocyst of the brain

c) tumor

d) encephalitis

A man of 68 years is complaining of severe pain in the muscles of the legs occurring when walking fast, which disappears after a short rest. Indicate the correct diagnosis:

a) Varicose veins in the lower extremities

b) intermittent claudication

c) polio-encephalitis

d) popliteal vein thrombosis

A man of 68 years is complaining of severe pain in the muscles of the legs occurring when walking fast, which disappears after a short rest. Indicate the correct diagnosis:

a) Varicose veins in the lower extremities

b) intermittent claudication

c) polio-encephalitis

d) popliteal vein thrombosis

A week after surgery for inguinal hernia at the site of operation appears a nodule. Microscopically there are macrophages, lymphocytes and lots of capillaries with scattered neutrophils. What is a diagnosed:

a) repair tissue

b) granulation tissue

c) tumor process

d) disorder of microcirculation

A week after surgery for inguinal hernia at the site of operation appears a nodule. Microscopically there are macrophages, lymphocytes and lots of capillaries with scattered neutrophils. What is a diagnosed:

a) repair tissue

b) granulation tissue

c) tumor process

d) disorder of microcirculation

During an opera performance a singer suddenly lost consciousness and after a few hours died with the signs of hemorrhagic shock without clear source of bleeding. At the autopsy are found 2.5 L. blood in the abdomen from subcapsular rupture of an unencapsulated tumor formation in the liver, with spongy structure, cherry-red color and size - 15 x 15cm. Which are the causes of death: (2)

a) ruptured cavernous hemangioma of the liver

b) mesenteric thrombosis and paralytic ileus

c) diffuse peritonitis due to hemorrhage

d) hemorrhagic shock due to blood loss

During an opera performance a singer suddenly lost consciousness and after a few hours died with the signs of hemorrhagic shock without clear source of bleeding. At the autopsy are found 2.5 L. blood in the abdomen from subcapsular rupture of an unencapsulated tumor formation in the liver, with spongy structure, cherry-red color and size - 15 x 15cm. Which are the causes of death: (2)

a) ruptured cavernous hemangioma of the liver

b) mesenteric thrombosis and paralytic ileus

c) diffuse peritonitis due to hemorrhage

d) hemorrhagic shock due to blood loss

The left hemisphere of brain demonstrates a well circumscribed tumor with a diameter of 3cm, greyish-brown color and a thick consistency, attached to the dura mater. The underlying brain tissue shows a compression pit. Point the most likely macroscopic diagnosis:

a) meningioma

b) astrocytoma

c) neurinoma

d) medulloblastoma

The left hemisphere of brain demonstrates a well circumscribed tumor with a diameter of 3cm, greyish-brown color and a thick consistency, attached to the dura mater. The underlying brain tissue shows a compression pit. Point the most likely macroscopic diagnosis:

a) meningioma

b) astrocytoma

c) neurinoma

d) medulloblastoma

On the plantar surface of a 35 year old woman there is a bluish-black tumor with lobulated uneven surface covered with bloody crusts. Histology shows epithelioid cells with different shapes and sizes with pigment granules in the cytoplasm. Infiltrative growth in respect to dermis and epidermis is present. Give a diagnosis:

a) nevus pigmentosus

b) efelides

c) melanoma malignum

d) basal cell carcinoma

On the plantar surface of a 35 year old woman there is a bluish-black tumor with lobulated uneven surface covered with bloody crusts. Histology shows epithelioid cells with different shapes and sizes with pigment granules in the cytoplasm. Infiltrative growth in respect to dermis and epidermis is present. Give a diagnosis:

a) nevus pigmentosus

b) efelides

c) melanoma malignum

d) basal cell carcinoma

At an autopsy in the upper area of the right lung are detected changes including two foci with stone-hard density. The cut-surface is whitish and is grinding like sand. How to explain the presence of these calcium salts:

a) calcium gout

b) deposits of uric acid crystals

c) degenerative calcification in old tuberculosis focus

d) metastatic calcification

At an autopsy in the upper area of the right lung are detected changes including two foci with stone-hard density. The cut-surface is whitish and is grinding like sand. How to explain the presence of these calcium salts:

a) calcium gout

b) deposits of uric acid crystals

c) degenerative calcification in old tuberculosis focus

d) metastatic calcification

68 year-old man complains of a face ulcer with thick edges and black base covered with brownish crusts. Histologically nests of round cells that form peripheral palisade structures are seen. Which is the correct diagnosis:

a) basal cell carcinoma

b) squamous cell carcinoma

c) malignant melanoma

d) nevus pigmentosus

68 year-old man complains of a face ulcer with thick edges and black base covered with brownish crusts. Histologically nests of round cells that form peripheral palisade structures are seen. Which is the correct diagnosis:

a) basal cell carcinoma

b) squamous cell carcinoma

c) malignant melanoma

d) nevus pigmentosus

A man of 62, smoker with obesity, treated in a dermatological clinic due to skin problems, dies suddenly after a severe chest pain. Clinicians set as the final diagnosis the skin disease for which he has been admitted to the hospital. At the autopsy a 3.5 cm clay-like area with irregular shape in the anterior wall of the left ventricle was seen. The descending left coronary artery was almost entirely occluded by atherosclerosis. What is the correct diagnosis:

a) rupture of the heart

b) myocardial infarction

c) acute heart failure

d) cerebral infarction

A man of 62, smoker with obesity, treated in a dermatological clinic due to skin problems, dies suddenly after a severe chest pain. Clinicians set as the final diagnosis the skin disease for which he has been admitted to the hospital. At the autopsy a 3.5 cm clay-like area with irregular shape in the anterior wall of the left ventricle was seen. The descending left coronary artery was almost entirely occluded by atherosclerosis. What is the correct diagnosis:

a) rupture of the heart

b) myocardial infarction

c) acute heart failure

d) cerebral infarction

The autopsy of a 43 years old man reveals brain meninges covered by the thick yellowish exudate. Meningeal vessels are hyperemic, brain tissue is edematous. What is your diagnosis:

a) acute encephalitis

b) polio-encephalitis

c) cerebellar herniation

d) acute purulent meningitis

The autopsy of a 43 years old man reveals brain meninges covered by the thick yellowish exudate. Meningeal vessels are hyperemic, brain tissue is edematous. What is your diagnosis:

a) acute encephalitis

b) polio-encephalitis

c) cerebellar herniation

d) acute purulent meningitis

A 35 year old man felt his right parotid gland enlarged, with a nodule 2 cm in diameter, well demarcated and dense. Histology shows jelly-like structures and immature cartilage and between them glandular structures and strands of cubic, cylindrical cells and ducts. Specify the diagnosis:

a) pleomorphic adenoma of the parotid gland

b) adenocarcinoma of the parotid gland

c) myxoma of parotid gland

d) chondroma of parotid gland

A 35 year old man felt his right parotid gland enlarged, with a nodule 2 cm in diameter, well demarcated and dense. Histology shows jelly-like structures and immature cartilage and between them glandular structures and strands of cubic, cylindrical cells and ducts. Specify the diagnosis:

a) pleomorphic adenoma of the parotid gland

b) adenocarcinoma of the parotid gland

c) myxoma of parotid gland

d) chondroma of parotid gland

During the autopsy in the temporal lobe of the brain is found a cyst 2cm in diameter, with smooth walls filled with a clear pale yellow liquid. Indicate what it is:

a) brain abscess

b) pseudocyst of the brain

c) tumor

d) encephalitis

During the autopsy in the temporal lobe of the brain is found a cyst 2cm in diameter, with smooth walls filled with a clear pale yellow liquid. Indicate what it is:

a) brain abscess

b) pseudocyst of the brain

c) tumor

d) encephalitis

At autopsy, in the abdominal cavity and on appendices epiploice, many “chalky” white spots are clearly seen. The finding is the same in the pancreas. Point the diagnosis:

a) steatonecrosis in acute pancreatitis

b) fibrino-purulent peritonitis

c) carcinomatosis of peritoneum

d) serous peritonitis

At autopsy, in the abdominal cavity and on appendices epiploice, many “chalky” white spots are clearly seen. The finding is the same in the pancreas. Point the diagnosis:

a) steatonecrosis in acute pancreatitis

b) fibrino-purulent peritonitis

c) carcinomatosis of peritoneum

d) serous peritonitis

The autopsy of a young man who died several hours after a car accident shows fracture of his left femur with massive smash of the soft tissues. The lungs are normal in shape and size, but intensively congested. Their cut surface is shiny and small droplets the size of a ‘pin head’ appear on it. Specify the cause of death:

a) fat embolism

b) air embolism

c) thromboembolism

d) bacterial embolism

The autopsy of a young man who died several hours after a car accident shows fracture of his left femur with massive smash of the soft tissues. The lungs are normal in shape and size, but intensively congested. Their cut surface is shiny and small droplets the size of a ‘pin head’ appear on it. Specify the cause of death:

a) fat embolism

b) air embolism

c) thromboembolism

d) bacterial embolism

69 year old male, who has suffered from varicose veins of the legs for 20 years, is admitted for surgical treatment. 15 days after surgery, when he suddenly rose up from bed, he felt sick, complained of severe shortness of breath, lost consciousness and died within a few minutes. Indicate the most likely cause of death:

a) mesenteric thrombosis

b) cerebral infarction

c) thromboembolism of pulmonary artery

d) myocardial infarction

69 year old male, who has suffered from varicose veins of the legs for 20 years, is admitted for surgical treatment. 15 days after surgery, when he suddenly rose up from bed, he felt sick, complained of severe shortness of breath, lost consciousness and died within a few minutes. Indicate the most likely cause of death:

a) mesenteric thrombosis

b) cerebral infarction

c) thromboembolism of pulmonary artery

d) myocardial infarction

28 year old woman a year ago felt a ‘knot’ in the breast 2 centimeters in diameter, well demarcated, painless, mobile, thick. Histology shows concentric connective tissue around the ducts of the breast without compressing and distortion of the ducts. Specify the exact histologic diagnosis:

a) adenocarcinoma

b) pericanalicular fibroadenoma

c) intracanalicular fibroadenoma

d) scirrous cancer

28 year old woman a year ago felt a ‘knot’ in the breast 2 centimeters in diameter, well demarcated, painless, mobile, thick. Histology shows concentric connective tissue around the ducts of the breast without compressing and distortion of the ducts. Specify the exact histologic diagnosis:

a) adenocarcinoma

b) pericanalicular fibroadenoma

c) intracanalicular fibroadenoma

d) scirrous cancer

Bilateral on the skin of the eyelids are seen bulging above the level of the skin nodules yellow color with the size of rice grains. What is it:

a) deposition of hemosiderin

b) common mole

c) nevus

d) xantelasmas

Bilateral on the skin of the eyelids are seen bulging above the level of the skin nodules yellow color with the size of rice grains. What is it:

a) deposition of hemosiderin

b) common mole

c) nevus

d) xantelasmas

The autopsy of a deceased patient shows swollen and very soft meninges of the temporal area with greyish-green color. Microscopic examination reveals that the meninges are rich of leukocytes. What illness is concerned:

a) purulent meningitis

b) brain abscess

c) tuberculous meningitis

d) encephalitis

The autopsy of a deceased patient shows swollen and very soft meninges of the temporal area with greyish-green color. Microscopic examination reveals that the meninges are rich of leukocytes. What illness is concerned:

a) purulent meningitis

b) brain abscess

c) tuberculous meningitis

d) encephalitis

The autopsy of an old man who died suddenly found complicated atherosclerotic plaques in the aorta, coronary and cerebral arteries. The heart is enlarged with dilated heart chambers. The right atrium shows brittle grey-brown material with uneven surface, close to the endocardium. The main trunk and two main branches of the pulmonary artery show ‘saddle’ grey-brown brittle material. Identify the immediate cause of death:

a) myocardial infarction

b) embolism of the pulmonary vein

c) thromboembolism of pulmonary artery

d) mesenteric thrombosis

The autopsy of an old man who died suddenly found complicated atherosclerotic plaques in the aorta, coronary and cerebral arteries. The heart is enlarged with dilated heart chambers. The right atrium shows brittle grey-brown material with uneven surface, close to the endocardium. The main trunk and two main branches of the pulmonary artery show ‘saddle’ grey-brown brittle material. Identify the immediate cause of death:

a) myocardial infarction

b) embolism of the pulmonary vein

c) thromboembolism of pulmonary artery

d) mesenteric thrombosis

39 year old female underwent surgery to remove a tumor from her left forearm. The tumor is 3cm in diameter, well demarcated and dense. Histology shows fusiform (spindle) cells which are grouped in bundles, with nuclei arranged in palisades (‘fence wall’ pattern). Set the diagnosis:

a) fibroma

b) mixoma

c) lleiomyoma

d) neurinoma

39 year old female underwent surgery to remove a tumor from her left forearm. The tumor is 3cm in diameter, well demarcated and dense. Histology shows fusiform (spindle) cells which are grouped in bundles, with nuclei arranged in palisades (‘fence wall’ pattern). Set the diagnosis:

a) fibroma

b) mixoma

c) lleiomyoma

d) neurinoma

39-year-old female has surgically removed tumor from her left forearm measuring 3 cm in diameter, well demarcated and dense. Histology shows fusiform (spindle) cells grouped in bundles, with palisading (‘fence’ type pattern) nuclei. Specify the diagnosis:

a) fibroma

b) lleiomyoma

c) mixoma

d) neurinoma

39-year-old female has surgically removed tumor from her left forearm measuring 3 cm in diameter, well demarcated and dense. Histology shows fusiform (spindle) cells grouped in bundles, with palisading (‘fence’ type pattern) nuclei. Specify the diagnosis:

a) fibroma

b) lleiomyoma

c) mixoma

d) neurinoma

At autopsy the stomach is with a large tumor with gelatinous appearance. Microscopically, the tumor cells show ‘signet ring’-shaped appearance, in whose cytoplasm PAS reaction is positive. What type of degeneration is the pathological process associated the gelatinous appearance of tumor:

a) mucoid degeneration

b) hyaline degeneration

c) fatty degeneration

d) fibrinoid edema

At autopsy the stomach is with a large tumor with gelatinous appearance. Microscopically, the tumor cells show ‘signet ring’-shaped appearance, in whose cytoplasm PAS reaction is positive. What type of degeneration is the pathological process associated the gelatinous appearance of tumor:

a) mucoid degeneration

b) hyaline degeneration

c) fatty degeneration

d) fibrinoid edema

At autopsy in the frontal lobe of the brain is found well visible and demarcated area with 3 cm in diameter, with gray-green color, well circumscribed from the surrounding tissue, filled with decaying substance. What illness is described:

a) purulent meningitis

b) encephalitis

c) chronic abscess

d) tuberculous meningitis

At autopsy in the frontal lobe of the brain is found well visible and demarcated area with 3 cm in diameter, with gray-green color, well circumscribed from the surrounding tissue, filled with decaying substance. What illness is described:

a) purulent meningitis

b) encephalitis

c) chronic abscess

d) tuberculous meningitis

At autopsy, in the abdominal cavity and on appendices epiploice, many “chalky” white spots are clearly seen. The finding is the same in the pancreas. Point the diagnosis:

a) serous peritonitis

b) carcinomatosis of peritoneum

c) fibrino-purulent peritonitis

d) steatonecrosis in acute pancreatitis

At autopsy, in the abdominal cavity and on appendices epiploice, many “chalky” white spots are clearly seen. The finding is the same in the pancreas. Point the diagnosis:

a) serous peritonitis

b) carcinomatosis of peritoneum

c) fibrino-purulent peritonitis

d) steatonecrosis in acute pancreatitis