[SEM2] PATHOLOGY REVIEWER (05/25)

Question 1

A syphilitic aortic aneurysm of a 68-year-old male would most likely reveal which one of the following findings?

A. Giant cells
B. Cystic medial necrosis
C. Obliterative endarteritis
D. Small platelet and fibrin vegetations

Answer 1

Question 2

A 45-year-old woman is hypertensive at 250/150 mm Hg, and her renal function is deteriorating. Which one of the following lesions is most likely to accompany the hypertension?

A. Renal artery thrombosis
B. Hyperplastic arteriosclerosis
C. Fibromuscular dysplasia
D. Monckeberg’s arteriosclerosis

Answer 2

Question 3

This is a segmental transmural necrotizing inflammation of small to medium-sized arteries that does not involve the lungs:

A. Takayasu arteritis
B. Giant cell arteritis
C. Churg-Strauss disease
D. Polyarteritis nodosa

Answer 3

Question 4

A 35-year-old nonsmoking woman presents with symmetric cyanosis of the second to fifth fingers of both hands. Which one of the following conditions would least likely be associated with this finding?

A. Takayasu disease
B. CREST syndrome
C. Progressive systemic sclerosis
D. Thromboangiitis obliterans

Answer 4

Question 5

An 8-year-old boy with an uncorrected large ventricular septal defect develops increasing dyspnea with hypoxia and cyanosis. The reason for these symptoms is most likely which one of the following?

A. Spontaneous closure of the defect
B. Left atrial thrombosis
C. Acute myocardial infarction
D. Pulmonary hypertension

Answer 5

Question 6

A failure of development of the endocardial cushions in the developing fetus will result in which one of the following lesions?
A. Atrial septal defect, secundum type
B. Atrio-ventricular septal defect
C. Muscular ventricular septal defect
D. Coarctation of the aorta

Answer 6

Question 7

A 69-year-old man develops a cerebral infarction in the left middle cerebral artery distribution. The most likely cardiac lesion to be associated with this finding is which one of the following?
A. Non-bacterial thrombotic endocarditis
B.Acute rheumatic fever
C. Libman-Sacks endocarditis
D. Left atrial myxoma

Answer 7

Question 8

Aschoff bodies in an endomyocardial biopsy indicate a diagnosis of:
A. Lyme disease
B. Toxoplasma myocarditis
C. Rheumatic heart disease
D. Chagas disease

Answer 8

Question 9

A 45-year-old woman presents with dysphagia for two weeks along with fatigue and a craving for ice and clay. Which of the following is the most likely diagnosis?
A. Achalasia
B.Plummer-Vinson syndrome
C. Esophagitis
D. Esophageal cancer

Answer 9

Question 10

A 70-year-old man has nucleated red blood cells on peripheral blood exam. His direct and indirect Coombs test results are both negative. Which one of the following is the most likely cause?
A. Chronic blood loss
B. Malabsorption
C. Chronic alcoholism
D.Metastatic cancer to bone marrow

Answer 10

Question 11

Which one of the following findings is least likely to be associated with drug use?
A. Aplastic anemia
B. Macrocytic anemia
C. Microcytic anemia
D. G6PD deficiency

Answer 11

Question 12

A patient with low serum haptoglobin concentration and increased urine hemosiderin most likely has which of the following disorders?
A. Severe calcific aortic stenosis
B. Congenital spherocytosis
C. Alpha-thalassemia minor
D. Aplastic anemia

Answer 12

Question 13

Which one of the following individuals is most likely to have an enlarged lymph node that histologically demonstrates prominent, well-defined paracortical follicles with germinal centers?
A. A 60-year-old woman with an infiltrating ductal carcinoma of the breast and widespread metastases
B. A 40-year-old man with basophilia on a peripheral blood smear
C. A 60-year-old man with Bence-Jones proteins in the urine
D. A 5-year-old boy with a sore throat and runny nose

Answer 13

Question 14

A 65-year-old man has several painless, movable, lymph nodes felt in both his neck and axillae. Biopsy reveals numerous crowded follicles of small, monomorphic lymphocytes. The patient’s case is most typical for which one of the following?
A. Reactive hyperplasia
B. Chronic lymphocytic leukemia
C. Poorly differentiated lymphocytic lymphoma
D. Lymphocyte predominant Hodgkin lymphoma

Answer 14

Question 15

A 60-year-old man presents with bone pain, renal failure, and pneumococcal pneumonia. In this case, a bone marrow biopsy is most likely to reveal which one of the following?
A. Blasts
B. Reed-Sternberg cells
C. Small mature lymphocytes
D. Plasma cells

Answer 15

Question 16

Generalized, nontender lymphadenopathy in a man over 65 years of age is most likely caused by:

A. A normal age-dependent process
B. Acute myelogenous leukemia
C. Primary lung cancer with metastasis
D. Chronic lymphocytic leukemia

Answer 16

Question 17

Inspiratory stridor characterizes which one of the following groups of diseases?

A. Chronic bronchitis and foreign body obstruction
B. Respiratory distress syndrome and adult respiratory distress syndrome
C. Bronchopneumonia and laryngeal carcinoma
D. Acute epiglottitis and croup

Answer 17

Question 18

A 57-year-old man develops a slow-growing but aggressive neoplasm of the parotid gland that has caused pain by invading surrounding structures, including his facial nerve. Histologic exam of the tumor will most likely reveal:

A. Atypical cells forming tubular and cribriform patterns
B. Papillary folds composed of a double layer of oncocytic cells
C. A mixture of squamous epithelial cells and mucous-secreting cells
D. A mixture of epithelial structures and mesenchyme-like stroma

Answer 18

Question 19

Patients with multiple odontogenic keratocysts merit evaluation for which one of the following conditions?

A. Gardner syndrome
B. Turcot syndrome
C. Cowden syndrome
D. Gorlin syndrome

Answer 19

Question 20

In which one of the following lung diseases is obstruction least likely to be a primary pathophysiologic factor?
A. Bronchiectasis
B.Pneumoconioses
C. Primary lung cancer
D. Atelectasis

Answer 20

Question 21

Of the following combinations of primary neoplasm and paraneoplastic syndrome finding, which one is least likely to be found?

A. Large cell carcinoma and polycythemia
B. Adenocarcinoma and a hypercoagulable state
C. Small cell carcinoma and diabetes insipidus
D. Squamous cell carcinoma and hypercalcemia

Answer 21

Question 22

Work-up of a 50-year-old woman with no history of smoking reveals a respiratory tract lesion. Biopsy of the lesion shows infiltrating groups of cells that form glandular structures. What is the most likely presentation of this lesion?

A. In-situ lesion
B. Carinal mass
C. Large hilar mass
D. Peripheral nodule

Answer 22

Question 23

Which one of the following patients has the greatest likelihood for progression into cor pulmonale? A patient with:

A. Mitral stenosis
B. A ventricular septal defect
C. Pulmonary stenosis
D. Multiple recurrent pulmonary emboli

Answer 23

Question 24

Which one of the following is least likely to be responsible for hematemesis in an alcoholic?
A. Plummer-Vinson syndrome
B. Ruptured esophageal varices
C. Peptic ulcer disease
D.Mallory-Weiss syndrome

Answer 24

Question 25

All the following diverticula have the same pathogenesis, except: A. Meckel's diverticulum B. Sigmoid diverticulum C. Zenker's diverticulum D. Multiple small-bowel diverticula

Answer 25

Question 26

In which of the following groupings are both disorders associated with fistula formation? A. Carcinoid tumor of small bowel - volvulus B. Adenocarcinoma of the ascending colon - amebiasis in the cecum C. Diverticulitis - Crohn disease D. Ulcerative colitis - angiodysplasia

Answer 26

Question 27

Which one of the following factors is more often associated with Crohn disease than with ulcerative colitis? A. Anal involvement B. Colorectal adenocarcinoma C. Pseudopolyps D. Toxic megacolon

Answer 27

Question 28

A 19-year-old woman attempted suicide by overdosing herself with acetaminophen. Histologic changes in her liver would most likely show: A. Centrilobular necrosis B. Focal scattered necrosis C. Periportal necrosis D. Geographical necrosis

Answer 28

Question 29

An oval lesion is noted in the right hepatic lobe in an asymptomatic 25-year-old woman. Surgical resection finds a single well-emarcated lesion that has a prominent, central, stellate scar. Histologic exam of the lesion would most likely reveal: A. Nodular regenerative hyperplasia B. Hemangioma C. Hepatoma D. Focal nodular hyperplasia

Answer 29

Question 30

A 40-year-old woman presents with hepatic failure, greenish-brown deposits in Descemet's membrane of the cornea, and choreiform movements. The defect most likely responsible for this patient's disease is: A. An abnormality in galactose metabolism B. A defect in the excretion of copper into bile C. A defect in the synthesis of alpha-1-antitrypsin D. An abnormality in glycogen synthesis

Answer 30

Question 31

A liver biopsy is done because of a clinical diagnosis of chronic hepatitis. The presence of "ground-glass" hepatocytes would favor a diagnosis of: A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Primary biliary cirrhosis

Answer 31

Correct Answer: B. Hepatitis B ⸻ ✅ High-Yield Explanation: • “Ground-glass” hepatocytes are hepatocytes with finely granular, eosinophilic cytoplasm seen on histology. • They are characteristic of chronic Hepatitis B infection, due to the accumulation of hepatitis B surface antigen (HBsAg) within the cytoplasm. ⸻ ❌ Why the Other Options Are Incorrect: • A. Hepatitis A → Causes acute, self-limiting hepatitis, not chronic infection. Does not produce ground-glass cells. • C. Hepatitis C → Causes chronic hepatitis, but the typical features are lymphoid aggregates in portal tracts and fatty change, not ground-glass hepatocytes. • D. Primary biliary cirrhosis (now primary biliary cholangitis) → Characterized by destruction of intrahepatic bile ducts, granulomas, and portal inflammation, not ground-glass hepatocytes. ⸻ 🧠 Key Takeaway: Ground-glass hepatocytes = pathognomonic for chronic Hepatitis B, due to intracytoplasmic HBsAg accumulation.

Question 32

A 13-year-old girl with sickle cell anemia presents with recurrent severe right upper quadrant colicky abdominal pain. At the time of surgery, multiple black stones are noted within her gallbladder. These stones are composed of which one of the following substances? A. Struvite B. Urate C. Bilirubin D. Cholesterol

Answer 32

Question 33

An immunofluorescence-stained kidney specimen from a patient with poststreptococcal glomerulonephritis is likely to show: A. Granular deposits of IgA B. Granular deposits of streptococcal antigen C. Linear deposits of IgG D. Granular deposits of IgG

Answer 33

Question 34

A child presents with nephrotic syndrome after a viral illness. Which pathology can be expected? A. Nodular glomerulosclerosis B.About 50% crescent formation C. Diffuse effacement of the visceral epithelial podocytes D. Linear deposition of the IgG on the glomerular basement membrane

Answer 34

Question 35

A 55-year-old homeless immigrant presents with fever, hemoptysis, night sweats, and a sterile pyuria with hematuria. The man most likely has: A. Goodpasture syndrome involving the lungs and kidneys B. Primary tuberculosis of the lungs with extrapulmonary spread to the kidneys C. Wegener granulomatosis D. Primary renal cancer with metastasis to the lungs

Answer 35

Question 36

Red blood cell casts would most likely be found in the urine of a patient with: A. Goodpasture syndrome B. Membranous glomerulonephritis C. Acute pyelonephritis D.Kimmelstiel-Wilson disease

Answer 36

Question 37

A 47-year-old woman presents with gross hematuria. Imaging study confirms a mass at the renal pelvis. Biopsy of this tumor will most likely reveal: A. Renal cell carcinoma B. Adenocarcinoma C. Urothelial Cell Carcinoma D.Squamous cell carcinoma

Answer 37

Question 38

Work-up of a 60-year-old man with hematuria reveals a 3-cm exophytic lesion in the bladder dome. Histopathologic exam of this lesion shows fibrovascular cores covered by a thick layer of transitional cells. Which of the following risk factors is most likely to have led to development of this lesion? A. Schistosomiasis B. NSAID's use C. Cigarette smoking D. Recurrent urinary tract infection

Answer 38

Question 39

A pathologist receives a "urinary bladder mass" specimen biopsied from a 6-year-old patient. Microscopic examination shows a tumor composed of a mucinous matrix with sheets of small blue cells. Some of the tumor cells accumulate beneath the mucosa forming a noticeable "cambium layer." Diagnosis? A. Adenocarcinoma B. Lymphoma C. Urothelial carcinoma D. Rhabdomyosarcoma

Answer 39

Question 40

A pathologist receives an orchiectomy specimen from a 63-year-old patient with a testicular mass. Histopathology will most likely reveal which one of the following tumors? A. Lymphoma B. Spermatocytic tumor C. Classic seminoma D. Embryonal carcinoma

Answer 40

Question 41

A pathologist receives an orchiectomy specimen from a 40-year-old patient with a testicular mass. Histopathology will most likely reveal which one of the following microscopic findings? A. Numerous lymphocytes in the fibrous stroma between groups of tumor cells having distinct cell membranes and clear cytoplasm B. Sheets of undifferentiated tumor cells having focal glandular differentiation C. Abnormal tissue derived from all three germ layers with scattered immature neural elements D. A mixture of malignant cytotrophoblasts and syncytiotrophoblasts

Answer 41

Question 42

The most common testicular tumor in infants and children up to three years of age is most likely to exhibit: A. OCT4 positivity B. Disorganized collection of glands, cartilage, smooth muscle, and immature stroma C. Rod-shaped crystalloids of Reinke D. Glomerulus-like structures

Answer 42

Question 43

Rectal exam finds a single, hard, irregular prostatic nodule in a 70-year-old man. Biopsy of the lesion reveals small glands lined by a single layer with enlarged, prominent nucleoli. From what part of the prostate did this lesion most likely originate? A. Anterior zone B. Central zone C. Transition zone D. Peripheral zone

Answer 43

Question 44

A 29-year-old woman follows up with her gynecologist with a Pap smear result of "HSIL". What is the most likely molecular pathogenesis for this result? A. Inheritance of a tumor suppressor gene mutation B. Up-regulation of antiapoptosis genes C. Viral inactivation of the RB1 gene product D. Estrogenic stimulation of cell proliferation

Answer 44

Question 45

Gross exam of an abortus from a 14-week gestation finds a mass of vesicles varying from 0.1-0.3 cm in size. Microscopically, all trophoblastic villi are swollen and devoid of central veins. The lining trophoblastic cells are variably hyperplastic. No fetal parts are seen. This condition is characterized by: A. No significant risk of choriocarcinoma B. Triploidy C. Normal volume of uterus D.Absence of p57 protein in villi

Answer 45

Question 46

A diffusely enlarged uterus is removed from a 45-year-old woman who has a history of irregular menstrual bleeding and pelvic pain. This microscopic exam of her myometrial wall is most likely to reveal: A. Endometrial glands and stroma B. Trophoblastic cells C. Malignant biphasic tumor D.De novo leiomyosarcoma

Answer 46

Question 47

A 55-year-old woman presents with weight loss, a left-sided pleural effusion, and bilateral, partially cystic ovarian masses. Her CA-125 antigen is positive. You would expect the masses to have: A. Schiller-Duval bodies B. Call-Exner bodies C. Reinke crystals D.Psammoma bodies

Answer 47

Question 48

Fibroadenoma affects which components? A. Ducts B. Lobes C. Stroma D. Lobules

Answer 48

Question 49

Indian file pattern is pathognomonic in which type of breast carcinoma: A. Invasive ductal carcinoma B. Invasive lobular carcinoma C. Medullary carcinoma D. Paget disease of the breast

Answer 49

Question 50

An eczematous area about 1 cm in diameter has been present for months on the skin of the areola of the right breast of a 38-year-old woman. Biopsy of this lesion reveals large cells at the dermal-epidermal junction that stain positively for mucin. What is the most likely diagnosis? A. Dermatophyte infection B. Paget disease of the breast C. Intraductal carcinoma D.Inflammatory carcinoma

Answer 50

Question 51

Which one of the following findings in the primary breast carcinoma of a 45-year-old woman suggests a better prognosis? A. Aneuploidy by flow cytometry B. An intraductal histologic pattern C. A tumor size of 5 cm D. A solitary axillary lymph node metastasis

Answer 51

Question 52

Hypertension is found in all the following disorders, except: A. Pheochromocytoma B. Conn syndrome C.Addison disease D. Cushing syndrome

Answer 52

Question 53

A 30-year woman who received radiation on her face for acne as a teenager presents with a solitary, cold nodule in the right lobe of her thyroid gland. A few, nontender cervical nodes are palpable in the right anterior cervical chain. A biopsy of the nodule would most likely reveal: A. Vessel and capsular invasion by malignant thyroid follicles B. Foci of atrophic and hyperplastic thyroid follicles C. An amyloid stroma intermixed with neoplastic C cells D. Papillary fronds with fibrovascular cores and psammoma bodies

Answer 53

Question 54

Severe head trauma that results in interruption of the hypothalamo-hypophyseal portal vessels would most likely lead to which one of the following conditions? A. Hyperpigmentation B. Acromegaly C. Insulin resistance D. Hyperprolactinemia

Answer 54

Question 55

None of the following features is present in both a neuroblastoma and a pheochromocytoma, except: A. Increased incidence in children B. Homer-Wright pseudorosettes C. Prognosis related to age of patient D. Increased urinary catecholamines

Answer 55

C. Prognosis related to age of patient 🧬 Both neuroblastoma and pheochromocytoma are neural crest-derived tumors 🧠 In neuroblastoma, younger age = better prognosis ⚠️ Although pheochromocytoma is rare in children, age still influences prognosis in both ❌ A. Increased incidence in children – Only true for neuroblastoma, not pheochromocytoma (adult tumor) ❌ B. Homer-Wright pseudorosettes – Seen in neuroblastoma, not typically in pheochromocytoma ❌ D. Increased urinary catecholamines – Both may have ↑ catecholamines, but more diagnostic for pheochromocytoma

Question 56

Vhich one of the following bullous diseases is pathogenetically related to autoantibodies against antigens of epidermal intercellular junctions? A. Bullous pemphigoid B. Dermatitis herpetiformis C. Epidermolysis bullosa D. Pemphigus vulgaris

Answer 56

Question 57

Which one of the following lesions most closely resembles the clinical and microscopic features of Kaposi sarcoma? A. Molluscum contagiosum B. Bacillary angiomatosis C. Dermatofibrosarcoma protuberans D. Dermatofibroma

Answer 57

Question 58

The clinical condition known as Bowen disease of the skin is characterized histologically by: A. Melanocytic atypia B. Epidermal atypia with koilocytosis C. Acantholytic suprabasal bullae D. Squamous cell carcinoma in situ

Answer 58