Histopathology

Question 1

A patient was suspected to have pemphigoid. In order to confirm this, a section of frozen tissue was placed onto a microscopic plate. A drop of fluorescent labelled anti-IgG antibody was added and incubated. This excess was washed off and observed under a UV light microscopy. What method of diagnostic test is this?

Answer 1

Direct immunofluorescence test

Question 2

A biopsy should be done in the following situations except?
A) Bleeding on gentle palpation
B) Erythroplasia
C) Induration
D) Ulceration of 1 week

Answer 2

D

Question 3

Which of the following should not be done during an aspiration biopsy?
A) Inject local anesthetic into the lesion to be removed
B) Stop aspirating if you see blood
C) Use a wide-bore needle on a 10ml syringe
D) Aspirate air if in maxillary sinus

Answer 3

A

Question 4

When should a biopsy NOT be conducted
A) When keratotic changes persist
B) When lesions interfere with local function
C) When lesion persists more than 2 weeks with no apparent cause
D) When pain at site is unbearable

Answer 4

D

Question 5

What does keratin aspirate correlate most with?
A) Haemorrhagic tumour
B) Infected cyst/abscess
C) Odontogenic keratosis
D) Radicular/dentigerous cyst

Answer 5

C

Question 6

When preparing to do a biopsy, we should not?
A) Prepare 10% formal saline of 10x the volume of the lesion.
B) Provide accurate & adequate information of the lesion
C) Remove biopsy tissue at the margin of the lesion when doing an incisional biopsy
D) Inject LA solution into lesion to be removed

Answer 6

D

Question 7

In order to test for candidal hyphae, cells were scraped off from the surface of the oral lesion and smeared on a clean glass slide. It was then stained with toluidine blue and the slide was examined under the microscope. What was the test done?

A) Brush biopsy
B) Exfoliative cytology
C) Fine needle aspiration
D) Immunofluorescence

Answer 7

B

Question 8

Which of the following statements about aspiration biopsy is false?
A) Aspiration is used commonly for solid tumours
B) Blood is a possible aspirate in a haemorrhagic tumour
C) It is carried out for cystic/ fluctuant lesions
D) Wide-bore needle is to be used

Answer 8

A

Question 9

Smears are mainly used to confirm the diagnosis of which of the following?
A) Chronic hyperplastic candidosis
B) Dental abscess
C) Oral cancer
D) Vesiculobullous diseases

Answer 9

D

Question 10

Which of the following is not an indication for a biopsy?
A) When an inflammatory lesion does not respond to local treatment after 2 weeks
B) When inflammatory lesions of unknown cause persist for long periods
C) When the lesion is ulcerated for >2 weeks, mobile and increases in size
D) When the lesion is ulcerated for >2 weeks, fixated and increases in size

Answer 10

C

Question 11

When would a biopsy NOT be needed?
A) When antibiotics are given and the inflammation does not subside in the next 2 weeks
B) When a lesion has been in the oral mucosa for 1 week
C) When the colour of the lesion changes from pink to white
D) When the patient cannot move his tongue due to a lesion

Answer 11

B

Question 12

Which of the following does NOT describe aspiration biopsy?
A) It requires the use of a wide-bore needle and 10ml syringe
B) It is a minimally invasive procedure
C) It is carried out for all cystic lesions
D) It is indicated when there is presence of a fixed mass

Answer 12

D

Question 13

Which of the following characteristics of a lesion does not call for a biopsy procedure?
A) Bleeding on gentle palpation
B) Induration
C) Ulceration lasting 10 days
D) Very rapid growth rate

Answer 13

C

Question 14

Which of the following is not related to epithelial pathology?
A) Drop shaped rete ridges
B) Endophytic lesion
C) Hyperchromatic nuclei
D) Small nuclear-cytoplasmic ratio

Answer 14

D

Question 15

A biospy can be ordered when inflammatory lesions of unknown cause persist for long periods. One such procedure is Aspiration Biospy. Which of the following is false about Aspiration Biopsy?

A) Aspirate air if in maxillary sinus
B) A narrow-bore needle is used
C) Carried out for all cystic/fluctuant lesions
D) Unable to aspirate solid tumours

Answer 15

B

Question 16

Which of the following is incorrect for an aspiration biopsy procedure?

A) A fine bore needle must be used
B) Air must be aspirated if in the maxillary sinus
C) It cannot be conducted for a solid tumor
D) It is a convenient and simple investigation

Answer 16

A

Question 17

Upon aspiration of a lesion, a straw coloured fluid was obtained. What does this suggest?

A) The lesion is likely to be a haemorrhagic tumour
B) The lesion is likely to be a radicular or dentigerous cyst
C) The lesion is likely to be an abscess
D) The lesion is likely to be an odontogenic keratocyst

Answer 17

B

Question 18

A patient presents with a lesion on his tongue that has been persistent for around 3 weeks. It has grown rapidly over the past few weeks and exhibits bleeding on gentle palpation. The patient complains that it is hard to eat properly. Which is the most likely reason further investigations in the form of a biopsy should be done, and what precautions should be taken during this process?

A) No biopsy should be done as there is no noted induration or erythroplasia.
B) The lesion has been present for more than 2 weeks, raising suspicion of malignancy. Be careful not to inject LA into the lesion during the process.
C) The lesion has been present for more than 2 weeks, with rapid growth rate and bleeding on gentle palpation, raising suspicion of malignancy. Be careful not to inject LA into the lesion during the process.
D) The lesion interferes with local function of the patient and hence a biopsy should be done. Be careful not to inject LA into the lesion during the process.

Answer 18

C

Question 19

Which of the following is NOT a reason to do a biopsy?

A) To confirm clinical diagnosis
B) To establish definitive diagnosis
C) To include malignancy
D) To check clearance of margin of excision intraoperatively

Answer 19

C

Question 20

In which of the following does the type of aspirates obtained from an aspiration biopsy match the diagnosis?

A) Blood aspirate indicates an infected cyst.
B) Pus aspirate indicates dentigerous cyst.
C) Keratin aspirate indicates odontogenic keratocyst.
D) Straw color fluid indicates hemorrhagic tumor.

Answer 20

C

Question 21

What type of biopsy is being conducted in the picture below?
(Picture of syringe with wide bore needle inserted into lesion)

Answer 21

Aspiration biopsy

Question 22

Select the type of aspirate that correctly corresponds to the underlying pathology:

A) Keratin in odontogenic keratocyst
B) Pus in hemorrhagic tumor
C) Straw color fluid in abscess
D) Blood in radicular cyst

Answer 22

A

Question 23

Which of the following clinical investigations are BEST used for oral cancer?

A) Brush biopsy
B) DNA cytology
C) Excisional biopsy
D) Exfoliative cytology

Answer 23

B

Question 24

Which of the following is NOT a suitable reason for conducting a biopsy?

A) To check for clearance of margins of excisions intraoperatively
B) To exclude malignancy
C) To establish a definitive diagnosis
D) To remove potentially malignant growths when observed clinically

Answer 24

D

Question 25

Which of the following statement is true A) During Aspiration Biopsy, it is important to inject into the abscess B) Clinical investigations are always required for the diagnosis for all oral lesions C) Biopsy is recommended when an ulcer is present in the mouth for more than 2 weeks D) Smears are the recommended clinical investigation for bony lesions

Answer 25

C

Question 26

Which of the following should not be done during an aspiration biopsy? A) Aspirate air if in maxillary sinus B) Inject local anesthetic into the lesion to be removed C) Stop aspirating if you see blood D) Use a wide-bore needle on a 10ml syringe

Answer 26

B

Question 27

A 79 year old patient who wears complete dentures complains of swollen gums in her upper jaw. Intraorally, you note white color palatal lesions and you decide to conduct a smear to confirm your diagnosis. What is your most likely finding upon microscopic examination? A) Fungal cells with spores B) Gram negative rods C) Gram positive coccus, in clusters D) Yeast cells with pseudohyphae

Answer 27

D

Question 28

A 50 year old patient comes into your clinic due to a burning sensation and pain in his cheek. While checking intra orally, you notice a white and reddish lesion on the right side of his cheek. The patient says that there is sensitivity when eating spicy, acidic and hot food. What would be the choice of biopsy for this lesion?

Answer 28

Incisional biopsy

Question 29

Which of the following are not strong reasons to do a biopsy of the tissue? A) 2 week old lesion with no apparent cause B) Patient presents with white lesion that cannot be scraped off C) Increase in the firmness of the tissue D) Patient’s mucosa turned purple while eating a sweet

Answer 29

D

Question 30

Which of the following is false for aspiration biopsy? A) Aspirate air if in the maxillary sinus B) Carried out for cystic lesions C) Carried out for solid tumours D) Wide-bore needle on a 10ml syringe is used

Answer 30

C

Question 31

Biopsy is mandatory in the case of a suspected or possible malignancy. Which of the following is NOT a characteristic of a lesion that would raise the suspicion of malignancy? A) Fixation B) Induration C) Rapid growth rate D) Ulceration for 10 days

Answer 31

D

Question 32

Which of the following is not a histopathology finding that would lead to the diagnosis of Submucous Fibrosis? A) Atrophic surface epithelium with lack of rete ridges B) Orthokeratinisation C) Juxta-epithelial stroma shows dense collagen bundles with relatively low fibroblasts D) Late hyalinisation of collagen bundles

Answer 32

D

Question 33

Some possible consequences of a biopsy include the following except: A) Infection B) Hemorrhage C) Spread of tumor cells D) Enhanced wound healing

Answer 33

D

Question 34

Which of the following is NOT an indication to take a biopsy? A) Suspected malignancy B) Lesions interfere with local function C) Inflammatory lesions of known causes persist for more than 2 weeks D) Keratotic changes persists

Answer 34

C

Question 35

Which of the following best matches the clinical presentation of a lesion with its most suitable investigation procedure? A) Do an excisional biopsy for a patient with a loss of stippling, blistering and erosion of his gums. B) Do an incisional of a patient with white lesions which cannot be scraped off on his buccal mucosa. C) Do aspiration biopsy for a patient with swelling, pain and tenderness at his periapical region. D) Take a smear sample for a patient with multiple yellowish-white papular on his buccal mucosa.

Answer 35

C

Question 36

What is exfoliative cytology not used to test for A) Diagnosis of candida B) Diagnosis of cancer C) Detecting virally-damaged cells D) Detecting acantholytic cells of pemphigus

Answer 36

B

Question 37

Which of the following should not be done while performing biopsy? A) Areas with ulcers avoided B) Histopathology form completed C) Local anesthetic injected into the lesion D) Normal tissue margin included, if lesion is friable, or suspecting malignancy

Answer 37

C

Question 38

Which of the following substances when applied, does not stabilise tissue architecture for histological evaluation? A) Formalin B) Methylene blue C) Toluene D) Acetone

Answer 38

B

Question 39

Which of the following options is a correct step in a biopsy procedure? A) Injecting LA into the lesion to be removed B) Preparing just enough 10% formalin solution to submerge the lesion C) Crushing up the lesion before preserving it D) Preparing <4g soluble protein /100ml of solution for investigation of suspected keratocyst via electrophoresis

Answer 39

D