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MED4 ACP > Past paper > Flashcards

Past paper Flashcards

1
Q

40y/o women found to have a thyroid mass. By FNAC, it is revealed to be a papillary thyroid carcinoma, which of the following histological features is INCORRECT?

A. Optically clear nuclei
B. Psammoma bodies
C. Nuclear moulding
D. Cells proliferate in papillary structure
E. Cells proliferate in follicular structure

A

C

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2
Q

A 74-year-old man is suspected with per rectal bleeding. Per rectal examination shows negative result with normal mucus and stool. You then proceed for faecal occult blood test. Colonoscopy and sigmoidoscopy were performed. A protruding and ulcerative mass measuring 3 cm was detected in the descending colon. There was fresh blood and the lumen was narrowed. What was the most likely stated on the subsequent pathological report of the tumour biopsy?

A. Diagnosis is tubular adenoma
B. Finger like protrusions with unremarkable mucosa
C. Submucosa lipoma
D. Fine bundles of smooth muscles fibres
E. Adenocarcinoma

A

E. Others not associated with fresh bleeding

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3
Q

A 66-year-old drinker, a known hepatitis B carrier, presented with the yellow sclera, distended abdomen, and fluctuating consciousness. A blood test revealed elevated alpha-fetoprotein. CT-abdomen confirmed multiple mass lesions in the liver, which of the following diagnosis is the most appropriate?

A. Liver metastasis
B. Liver abscess
C. Hepatocellular carcinoma (HCC)
D. Polycystic liver
E. All of the above

A

C. HCC can be with multiple lesions. Increase AFP and history of Hep B suggest more likely HCC

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4
Q

Common hepatic tumours in children except:
A. Hepatocellular carcinoma (HCC)
B. Hepatoblastoma
C. Rhabdomyosarcoma of biliary tree
D. Mesenchymal hamartoma
E. Haemangioendothelioma

A

A

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5
Q

An uncle with acute onset (1 day) of hypotension tachycardia, distended and painful abdomen (generalised) (likely to be peritonitis) Which of the following pieces of information is most useful for formulating the current differential diagnosis?

A. Appendicectomy was done 32 years ago
B. HBV chronic infection for 20 years
C. Father with history of hepatocellular carcinoma (HCC) who died at 45 years old
D. Impaired fasting glucose half years ago and need restriction to sugar

A

B. Not C as HCC is not directly inhereditary

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6
Q

A 53-year-old alcoholic presents with constant upper abdominal pain, recurrent low-grade fever, frequent passage of bulky, grey, soft, sticky and foul-smelling stools. Small chronic peptic ulcer, no gallstones, several calcified spots are found in pancreas. Which of the followings is the most likely pathological finding?

A. Acute haemorrhage, necrosis of pancreas
B. Infiltrative CA in pancreas
C. Superficial gastric erosion
D. Islet cell hyperplasia
E. Fibrosis, chronic inflammatory cells surrounding pancreatic acini

A

E. alcholic –> chronic (gallstone –> acute)

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7
Q

56yo lady with good past health presented with fever & right erythematous swelling lower leg and put on antibiotics. She then develops impaired renal function and haematuria. Which of the following is likely to be her condition?

A. Diffuse proliferative glomerulonephritis
B. Membranous glomerulonephritis
C. Minimal change nephropathy
D. Nephrosclerosis
E. Diffuse glomerulosclerosis

A

A.
DPGN can be caused by infection

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8
Q

Which of the following about Reed-Sternberg cells is incorrect?

A. RS cell is the histologic landmark of Hodgkin lymphoma
B. RS cells are large cells of bi-nucleation in mirror image
C. RS cells are surrounded by characteristic plasma cells
D. One of the variants of RS cell is mononuclear Hodgkin cell, which has large inclusion-like nucleolus
E. RS cells can become mummified

A

C

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9
Q

60 years old male, dyspnoea, frothy sputum. Physical examination shows rales (Creptiation) in all lung field. Echocardiogram shows ejection fraction 30%, concentric left ventricular hypertrophy, heart valves are normal. What is the most likely cause?

A. Myocarditis

B. Pericarditis

C. Hypertension

D. Amyloidosis

E. Cardiomyopathy

A

C

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10
Q

What is the mechanism of H. pylori-associated gastritis?

A

H. Pylori is well adapted to the stomach:
● Secretes urease → break down urea and raise pH
● Flagella → to swim in thick mucus
● Adhesins → adheres to surface of gastric mucosa
● Produces toxin

Colonisation of H. Pylori in the stomach → infection and inflammation in stomach → gastritis

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11
Q

the indication for liver biopsy

A

inconclusive imaging results

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12
Q

How to differentiate HCC and colonic metastasis under microscope?

A

by background of cirrhosis
by architecture (hepatocellular differentiation with thickened trabeculae v.s. glandular differentiation)
by IHC (HBsAg v.s. mucin)

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13
Q

What is the most important complication in a patient with portal hypertension and variceal bleeding?

A

hepatic encephalopathy

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14
Q

Which of the following statements regarding caseous granuloma is inappropriate?

A. central caseous necrosis
B. palisading epithelioid histiocytes
C. Langerhans cell histiocytes
D. eosinophills
E. acid fast bacilli

A

C

it’s Langhans cell not Langerhans cells

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15
Q

Which of the following diseases is associated with septic shock?

A. Atelectasis
B. ARDS
C. Obstructive lung disease
D. Interstitial lung disease
E. Pneumonia

A

B

Sepsis is the 2nd most common aetiology of ARDS

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16
Q

JAK 2 mutation is seen in
A. diagnostic of polycythemia vera
B. 90% of essential thrombocytopenia
C. Clonal marker of myeloproliferative diseases
D. Common in childhood ALL
E. found in viral infections

A

C

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17
Q

A patient had fever and headache for a week. She now developed decreased renal function and decreased consciousness. Investigation shows MAHA with schistocytes and decreased platelet count.

(1) Treated predominantly by plasma exchange (=plasmapheresis)
(2) Associated with connective tissue diseases and SLE
(3) Likely diagnosis is TTP
(4) High mortality if not timely diagnose and treat
(5) ADAMTS13 activity low with anti-ADAMTS13-antibodies

A

All True

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18
Q

DDx for bone lesion + constitutional symptoms

A

**Multiple myeloma
Primary bone tumour
Bone metastasis
TB
Osteomyelitis

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19
Q

Which of the following about Reed-Sternberg cells is incorrect?

A. Reed-Sternberg cell is the histologic landmark of Hodgkin lymphoma.
B. Reed-Sternberg cells are large cells of bi-nucleation in mirror image.
C. Reed-Sternberg cells are surrounded by characteristic plasma cells.
D. One of the variants of Reed-Sternberg cell is mononuclear Hodgkin cell, which has large inclusion-like nucleolus.
E. Reed-Sternberg cells can become mummified.

A

C

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20
Q

35 y/o patient complains of dyspepsia. Least likely finding in upper GI biopsy?

A. Helicobacter bacilli seen

B. Intestinal metaplasia

C. Atypical gland with hyperchromatic and pleomorphic cells

D. Granulation tissues seen

E. Acute and chronic inflammatory infiltrates in mucosa

A

C

(among chronic gastritis (ABE), PUD (D), and CA stomach (C), CA stomach shd be least common, esp. for a 35yo patient)

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21
Q

Definition of cerebral infarct

A

Irreversible liquefactive necrosis of the brain due to ischaemia

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22
Q

In order to rule out other causes of dementia, imaging of the brain by CT and MR was performed. What would you look for in the images?

A

Vascular dementia:
- infarcts (hypodense lesions on CT)
Binswanger disease:
- leukoaraiosis (periventricular radiolucency)
SOL
- e.g. tumour, abscess, haematoma,
- esp. chronic subdural haematoma

Alzheimer’s disease:
- cerebral atrophy (i.e. widened sulci, narrow gyri)
- dilated ventricles

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23
Q

45yo female had painless breast lump for 2 months, 2cm, FNA done. Which of the following is true for FNA for patient breast lesion?
A. It is useful in confirming benign lesion
B. FNA should be performed by radiologist under ultrasound guidance
C. Breast cancer can be diagnosed with malignant cell seen in FNA
D. In breast cancer patient can diagnose axillary met with FNAC
E. Always do FNAC before breast biopsy

A

C

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24
Q

A 35-year-old lady came for gynecological checkup. Pap smear was done. The pathological report shows High-grade squamous intraepithelial lesion (HSIL). What is the correct interpretation?
A. Patient has cervical cancer
B. Isolation of HPV from the cervical epithelium has been achieved
C. Interpretation of the pathological lesion may have been affected by menstrual cycle
D. Dysplastic squamous cell seen in lesion
E. Atypical cell through whole lamina propria

A

D

25
Q

Which of the following is inappropriate for Alzheimer’s disease?
A. It’s the most common form of dementia in adult
B. Histochemical changes are believed to be first found in the limbic system.
C. Amyloid plaques consist of A-beta protein
D. Neurofibrillary tangles are found in the astrocytes
E. Cerebral amyloid angiopathy found in Alzheimer’s predisposes rupture and hemorrhage

A

D (inside neurons)

26
Q

Many congenital heart defects produce non-laminar turbulent jet of blood flow. These turbulent jets may leave the patients susceptible to:
A. valvular calcification
B. infective endocarditis
C. heart failure
D. myocardial infarction
E. arrhythmia

A

B
(Turbulent jets may damage the endothelium along heart valves, and those micro-lesion can serve as potential site of bacterial colonisation.)

27
Q
  1. Which of the following statement(s) is (are) correct?
    A. Bicuspid aortic valve is present in 1-2% of the normal population.
    B. Bicuspid aortic valve is associated with dilatation of the aortic root.
    C. Floppy mitral valve is associated with pulmonary edema.
    D. (A) & (B)
    E. All of the above.
A

E

28
Q
  1. What is not the pathophysiology of patient with long history of hypertension in development of symptoms of congestive heart failure?
    A. Diastolic dysfunction.
    B. Ischemia.
    C. Decompensation with left ventricular dilatation.
    D. Renal dysfunction.
    E. Mitral regurgitation.
A

E

29
Q
  1. Which of the following about calcification of heart valve is false?
    A. Calcification of heart valves is always pathological.
    B. Calcification of heart valves can cause a systolic murmur over the affected valve
    C. Calcification of heart valves can be caused by primary hyperparathyroidism
    D. Calcification of heart valves can lead to stenosis.
    E. Calcification of heart valves can be visible on chest X-ray.
A

A

30
Q
  1. Which of the following is correct?
    A. Tuberculosis is an acute infection caused by M. tuberculosis, mainly affects the lung but can occur in virtually any extra-pulmonary organs
    B. Primary infection produces antibodies and hypersensitivity causes tuberculin skin test positive
    C. Cell-mediated CD8+ T cells responsible for immunity
    D. Primary pulmonary tuberculosis in immunocompetent individuals is asymptomatic, only causes healed lesion in subpleural focus and a draining lymph node
    E. Secondary tuberculosis is symptomatic and causes lung cavitary lesions in lung bases
A

D

31
Q
  1. Which of the following statements on diverticular bleeding is WRONG?
    A. Bleeding arising from the right sided colon is more common than the left sided
    B. Bleeding is usually caused by inflammation of the diverticulum
    C. Bleeding is usually caused by chronic injury to vasa recta
    D. NSAID may be a risk factor for diverticular bleeding
    E. Barium enema is not the investigation of choice at the time of active bleeding
A

B

32
Q
  1. Which of the following statements is not true concerning the management of massive lower gastrointestinal bleeding?
    A. Hospitalization is often required.
    B. Close monitoring of vitals is necessary.
    C. All investigations have to be completed before discharge.
    D. Meckel’s scan is indicated for young patients.
    E. Surgery has to be considered in patients requiring massive blood transfusion with evidence of ongoing bleeding.
A

C

33
Q
  1. Which of the following statements of drug- and toxin–induced hepatic injury is INVALID?
    A. Bland hepatocellular cholestasis without inflammation is associated with contraceptive pills.
    B. Massive hepatocellular necrosis is associated with acetaminophen overdose.
    C. Microvesicular steatosis associated with aspirin use in children is known as Reye’s syndrome.
    D. Steatohepatitis with Mallory-Denk bodies is associated with ethanol abuse.
    E. Budd-Chiari syndrome is associated with isoniazid.
A

E

34
Q
  1. Which description of oesophageal squamous cell carcinoma (SCC) is INCORRECT?
    A. SCC occurring in lower-third of the oesophagus may cause malignant stricture.
    B. SCC is a malignant tumour with squamous differentiation, which is brush-like.
    C. SCC risk factors include alcohol, smoking, achalasia and hot beverages.
    D. SCC gross features include early plaque-like thickenings and late tumour masses.
    E. SCC gross features include a mass in mid-third of the oesophagus in 90% cases.
A

E

35
Q
  1. Which of the following summaries of large bowel polyps is true?
    A. All polyps are masses obstructing the lumen.
    B. All neoplastic polyps are benign polyps.
    C. All benign neoplastic polyps are precursors of colonic adenocarcinoma.
    D. All Peutz-Jeghers polyps are hamartomatous polyps.
    E. All tubular adenoma are serrated polyps.
A

C

36
Q
  1. During routine checkup 62 y/o male found to have anemia. FOBT is positive. Which of the following is likely?
    A. All of below
    B. Oesophageal squamous cell carcinoma
    C. Gastric ADC
    D. Gastric ulcer associated with NSAID use
    E. Duodenal ulcer associated with H. pylori infection
A

A

37
Q
  1. Which of the following is associated with Helicobacter pylori infection?
    A. Atrophy in gastric body
    B. Gastric body inflammation
    C. Warthin-Starry stain negative
    D. Macrophage-rich inflammation
    E. Lymphoid aggregate with germinal centre
A

E

38
Q
  1. Highest incidence of prostate cancer in
    A. American Black
    B. American White
    C. European
    D. Chinese
    E. Japanese
A

A

39
Q
  1. Which of the following statements concerning germinoma of testis is false?
    A. Germinoma may be mixed with other types of germ cell tumours
    B. Germinoma is malignant tumour
    C. Germinoma is typically associated with lymphocytes
    D. Germinoma secretes α-fetoprotein
    E. Germinoma may be associated with teratoma
A

D

40
Q
  1. Which of the following description of urothelial neoplasm is true?
    A. Papilloma is invasive and therefore commonly recurs.
    B. Carcinoma in situ (CIS) is an invasive papillary lesion lined by malignant-appearing cells.
    C. Papillary urothelial neoplasm of low malignant potential (PUNLMP) has high risk of metastasis.
    D. High-grade papillary urothelial carcinoma co-exist with invasion in 80% cases.
    E. Grading is the most important prognostic factor of an invasive papillary carcinoma.
A

D

41
Q
  1. Which of the following features is NOT suggestive of subacute thyroiditis?
    A. Fever for 2 weeks
    B. Weight loss of 5 kg in 1 month
    C. Seeing double (Diplopia)
    D. TSH < 0.01; fT4 58.0 (Normal TSH: 0.3 – 4.0, fT4: 12.0 – 22.0)
    E. Erythrocyte sedimentation rate (ESR) of 100
A

C

42
Q
  1. A 60-year-old lady had a painless breast mass for few months. On palpation, there is an ill-defined 1 cm mass. Sample obtained by imaging-guided FNAC. The pathology report says “lymphocytic infiltrate and normal acinar cells”. What pathology is compatible with this condition?
    A. Fibroadenoma
    B. Fibrocystic change
    C. Fat necrosis
    D. Duct ectasia
    E. Malignancy
A

C

43
Q
  1. Which one of the following descriptions about breast diseases is most appropriate?
    A. Fibroadenoma consists of proliferation of epithelial cells only
    B. Phyllodes tumour consists of proliferation of stromal cells only
    C. Phyllodes tumour shows a spectrum of malignant potential
    D. Sclerosing adenosis is a pre-malignant condition
    E. Breast carcinoma, which is HER2 positive, is associated with germline TP53 motivation
A

C

44
Q
  1. Which one of the following descriptions of growth patterns of invasive breast carcinoma is INCORRECT?
    A. Invasive ductal carcinomas grow as tubules and stimulate a desmoplastic stromal reaction.
    B. Invasive ductal carcinomas appear as dense masses with spicular margins in mammograms.
    C. Invasive lobular carcinomas are composed of noncohesive tumor cells that invade as linear cords and initiate little stromal response.
    D. Invasive lobular carcinomas appear as subtle irregular masses in mammograms.
    E. Carcinoma with medullary features consists of tightly adhesive clusters of cells. The appear as dense masses with spicular margins in mammograms.
A

E

45
Q
  1. What is correct for autoimmune thyroid pathology?
    A. Graves’ disease is characterised by atrophic thyroid with germinal center and Hurthle cell B. Hashimoto thyroiditis is characterised by hyperthyroidism, ophthalmoplegia, and dermatopathy
    C. Anti-TSH receptor antibodies found in both Graves’ disease and Hashimoto thyroiditis
    D. Age 45-65 and female is typical profile
    E. Granulomatous depositions are found in Hashimoto’s thyroiditis
A

C

46
Q
  1. The following diseases can lead to a dementia syndrome EXCEPT:
    A. Hypothyroidism
    B. Hydrocephalus
    C. AIDS
    D. Subdural haematoma
    E. Acromegaly
A

E

47
Q
  1. Axonal injury is associated with
    A. Alert mental state
    B. Haemorrhage seen in neuroimaging in corpus callosum
    C. Haemorrhage seen in neuroimaging in parietal lobe
    D. Myelin retraction balls
    E. Neuronal necrosis
A

B

48
Q
  1. In a cerebral infarct of about two weeks’ duration, one would expect to see the following
    histologic features in the brain EXCEPT:
    A. Mature liquefactive necrosis
    B. Loss of neurons
    C. Macrophage infiltration
    D. Loss of myelin
    E. Some inflammatory cellular infiltrates
A

A

49
Q
  1. In comparing cerebral infarct and cerebral haemorrhage, one of the statements is correct:
    A. They are the same
    B. Both are due to microaneurysm
    C. Cerebral infarct is associated with atherosclerosis and cerebral haemorrhage is not
    D. Both can be due to cardiac arrhythmias
    E. Cerebral infarct has a better prognosis than cerebral haemorrhage in general
A

E

50
Q
  1. One of the following diseases typically presents with a frontotemporal dementia syndrome:
    A. Parkinson’s disease
    B. Huntington’s disease
    C. Pick’s disease
    D. Creutzfeldt-Jakob disease
    E. Progressive supranuclear palsy
A

C

51
Q
  1. You are asked to assist in an autopsy study of aging. You aim to find out the incidence of neurodegenerative changes in Chinese. You are given a large number of glass slides of brains of old people who have died in PWH. The glass slide which would give most information to you as regards the aim of your study is:
    A. A section of the frontal lobe stains for PrP
    B. A section of cerebellum stained by the Golgi method to look for Purkinje cells
    C. A section of the hippocampus stained for Nissl stain, which stains neurones
    D. A section of the hippocampus stained by a silver stain
    E. A section of the pons with the cranial nuclei stained by H&E
A

D

52
Q
  1. A middle-aged male survived from coronavirus pneumonia, during which he was treated with corticosteroids. He presented with progressive hip pain during follow-up. Which of the following is the most likely pathology?
    A. Osteopetrosis
    B. Osteonecrosis
    C. Osteoarthritis
    D. Osteoporosis
    E. Osteomalacia
A

B

53
Q
  1. A 60 years old lady presented to A&E in the middle of the night with gum bleeding. She was noted to have prolonged APTT (60 sec.); normal PT and normal platelet count.
    A. Lupus anti-coagulant
    B. Platelet function tests
    C. Factor assays
    D. Repeat APTT which 1:1 mix with normal plasma
    E. Bleeding time
A

B

54
Q
  1. Afterwards the patient develops fever and generalized maculopapular rash. Skin and rectal biopsy are taken. Which of the following is the most likely reason for taking the specimen?
    A. To find out the cause of infection
    B. To find out possible graft vs host disease
    C. Check for relapse of leukaemia
A

B

55
Q
  1. She accidentally took overdosed Fe supplement. What is used for antidote?
    A. N-acetylcysteine
    B. Ethanol
    C. Deferoxamine
    D. Naloxone
    E. Glucose
A

C

56
Q
  1. Select the most appropriate statement:
    A. Hodgkin lymphoma is characterized with the presence of Hodgkin cell
    B. Typical cytological feature of Hodgkin lymphoma is inconspicuous nucleoli
    C. Most nodular sclerosing Hodgkin lymphoma is associated with EBV infection
    D. Hodgkin lymphoma commonly involves the mesenteric nodes and the Waldeyer ring.
    E. Hodgkin lymphoma contains Hodgkin cells and a mixed inflammatory cell component.
A

E

57
Q
  1. Which of the following about thymus is incorrect?
    A. Thymus is important for T cell differentiation
    B. Thymic disease associated with RA, MG, SLE
    C. Thymoma is thymic epithelial cell tumour, can be benign or malignant
    D. Thymoma macroscopy shows encapsulated, lobulated, cystic degeneration
    E. Thymoma microscopy shows epithelial tumour cells and immature T cells
A

D

58
Q
  1. Which of the following about oropharyngeal carcinoma is most correct?
    A. All oropharyngeal carcinoma are squamous cell carcinoma.
    B. Most oropharyngeal carcinoma develops from papillomas.
    C. Those associated with HPV infections have a good prognosis.
    D. Cancer cells are admixed with abundant lymphocytes.
    E. All of the above
A

C

MED4 ACP (13 decks)

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