SAMSONPLAB ACADEMY LIMITED BOW BUSINESS CENTRE 153-159, BOW ROAD LONDON E3 2SE. EMAIL: info@samsonplab.co.uk Telephone: 07940433068 SAMSONPLAB ACADEMY Clinical Pathology Notes 2017 . A565 year old man presents to the hospital with acute abdomen and hematemesis. He undergoes gastrointestinal endoscope which shows a well-circumscribed punched-out mucosal defects with granulation tissue at the base in the(duodenum) What is the single most likely cause? a) Gastric carcinoma b) Gastric lymphoma c) Oesophageal varices d) Gastric ulcer . \e)/Mallory weiss tears Dusdenal uicer 2. A465 year old man has had abdominal pain and diarrhea for the past 6 months. Biopsy from the small intestine shows flattening of the villland histopathology shows increased intraepithelial lymphocytes (villous atrophy) and crypt hyperplasia. What is the single most likely cause of his abdominal symptoms? a) Peptic ulcer disease b) Inflammatory bowel disease ~ (c)Coeliac disease d) gastroenteritis e) Small bowel carcinomaAor Ss 3.A70 year old man who had myocardial infarction)1 week ago presented with acute abdominal pain with bloody diarrhea and hypovolemia. On laparotomy the small bowel appears dusky purple and when the bowels were opened, large amount of blood was present in the lumen and mucosal surface was friable and necrotic. What is the single most likely cause? a) Peptic ulcer disease b))Small bowel infarction c) Ulcerative colitis d) Peritonitis e) Angiodysplasia 4. A60 year old man presents to the hospital with per/rectal bleed! On colonoscopy a polypoid mass with areas of ulceration) projecting into the bowel lumen was seen in the sigmoid region. The cut surface shows a firm white tumors mass with\poorly defined marginsiinfiltrating\into the bowel wall. What is the single most likely cause of the symptoms? a) Cecum carcinoma ¢ b) Sigmoid carcinoma c) Diverticulitis mass d) Crohn's disease e) Ulcerative colitis 5. A60 year old man presented with the lower abdominal pain and bleeding per rectal. On colonoscopy, there is presence of outpouchings of the colonic mucosa that havelherniated\through the circular muscular layer of the large bowel. The outpouchings herniate between the taenia coli of the sigmoid colon. What is the single most likely diagnosis? a) Crohn's disease /(b))Diverticulitis c) Sigmoidal carcinoma d) Colovesicular fistula ) Ulcerative colitis6. A 30 year old woman with history of the chronic constipation presents with per rectal bleed. on the examination she is found to have prolapsed anal masses which when excised contaminated large distended blood vessels with overlying hyper-plastic squamous epithelium What is the single most likely cause of per rectal bleed? a) Ulcerative colitis b) Anal fissure c) Diverticulitis disease d) Rectal carcinoma (e) Hemorrhoids 7. A30 years old woman with history of constipation present with per rectal bleed. On examination she is found to have a tear of the in the mucosa of the lower anal canal which is located posteriorly in the midline. What is the single most likely cause of per rectal bleeding? a) Hemorrhoids b)/Anal fissure c) Anal tags d) Anal canal e) Anorectal fistula 8. A50 year old man was found dead in his house. on the postmortem it was found to have small firm liver and liver biopsy show portal inflammation and high levels of the stainable coppers) associated protein in the hepatocytes. What is the single most likely cause of death? a) Alcoholic liver disease ~-(b) Wilson disease c) Chronic viral hepatitis d) Hepatocelluar carcinoma e) Primary Biliary Cirrhosis9.A 50 year old man presents with joint pains and fatigue. On examination he is found to have skin pigmentation. he has history of diabetes mellitus and heart failure. he was found to have abnormal liver function tests on routine follow up. Liver biopsy shows accumulation of iron within hepatocytes. What is the single most likely cause of the symptoms? a) Alcoholic liver disease b) wilson disease (c))Hereditary hemochromatosis d) Ischemic heart disease 10. A 60 year old lady presented to the the GP feeling generally unwell with intermittent abdominal discomfort. Liver functions test showed high AST, ALT and bilirubin. Liver biopsy shows epithelial cells resembling hepatocytes which grew in a trabeculae- Large number of(heoplastic\cells with abundant granular pink cytoplasm separated by dense fibrous bands. What is the most likely cause of symptoms? a) Liver cirrhosis “(b))Hepatocelluar carcinoma c) Chronic Hepatitis d) Liver metastasis e) Fat liver © 11.70 year old man presents to hospital with severe abdominal pain radiating to the back and shock. On examination he was found to have pulsatile mass in the abdomen. He was resuscitated but eventually he died. What would be the finding on postmortem? a))Atheroma of the aorta b) Giant cells in the arteries C) infarction of the aorta d) Necrotic pancreas e) Free peritoneal fluid 12. A.45 year old man who has had persistent cough and haemoptysis. He had never smoked in his life. he presented to the hospital with chest infection. He died with respiratory failure after a week of treatment withbroad spectrum antibiotics. he had a postmortem, histopathology showed bronchial dilatation with marked chronic inflammation in the walls. What is the single most likely cause of death? a) COPD b) Pneumonia c))Bronchiectasis d) Acute respiratory distress syndrome e) Lung fibrosis 13.A 5 year old boy has been presenting to the GP with recurrent chest infections. he has history of rectal prolapse and meconium ileum at birth. What is the cause of the problem? “(a))Thick mucus secretions cy - b) Lack of cilia motility Gearon c) Deficiency of an enzyme d) Respiratory failure e) Iron deficiency 14. A 70 year old man had chronic cough with haemoptysis for a 6 months. He was later diagnosed with metastatic lung cancer and died. On postmortem histopathology, showed a malignant epithelial tumour showing | keratinzation) and intercellular bridges. What is the single most likely diagnosis? a) Adenocarcinoma ~(b))Squamous cell carcinoma C) Large cell carcinoma d) Small cell carcinoma 15. A 60 year old man died of lung cancer. On postmortem histopathology, showed a malignant epithelial tumour showing glandular differentiation and mucin production. What type of cancer did this man die from? a) Squamous cell carcinoma b) Small cell carcinoma c) Large cell carcinoma~« d)Adenocarcinoma 16. A 2 year old child presents with chronic constipation which is not responding to laxatives. Rectal biopsy shows(absence of ganglion}cells in the submucosa and abnormally thick nerve fibres in the mucosa. What is the most likely diagnosis? a) Ischemic enterocolitis b) Imperforate anus ~(¢))Hirschsprung disease d) Meckel's diverticulum e) Coeliac disease 17.A 30 year old man presents with chronic diarrhoea. Bowel biopsy shows diffuse mucosal inflammation with cryptitis and (crypt access |formation. What is the single most likely diagnosis? a) Crohn's disease .b) Ulcerative colitis c) Coeliac disease d) Colonic carcinoma e) Lymphoma 18. A35 year old man presents with chronic diarrhoea. Bowel biopsy shows Lvariability inflammation Within the same biopsy and poorly formed granulomatous. What is the most likely diagnosis? a) Ulcerative colitis v’ b)‘Crohn's disease c) Bowel carcinoma d) Coeliac disease e) Gastroenteritis 19. A 49 year old lady has had jaundice and abdominal distention in the one year. Lives biopsy shows'chronic portal inflammation;composed of {lymphocytes and (piecemeal necrosis.)What is the most likely diagnosis? a) Liver cirrhosis (roc 9'o>? /(b) Hepatitis B c) Hepatitis A d) Fatty Liver e) Pancreatic carcinoma 20. A 60 year old man presents with abdominal pain radiating to the back associated with nausea, vomiting and fever. Unfortunately he dies. his serum amylase was high. On postmortem he is found to have white/yellow fat necrosis in the peri-pancreatic area. What is the most likely cause? a) Aortic aneurysm b))Acute pancreatitis c) Chronic pancreatitis d) Pancreatic cancer e) Peritonitis 21. A 25 year old man presenting with a swelling in the testes. On biopsy of the testes, shows tissues of{teeth and hairs) What is the most likely diagnosis? a) Seminoma b) Adenoma c))Teratoma d) Choriocarcinoma e) Embryonal carcinoma 22. A 25 year old woman presents with a mass in the upper outer quadrant of her right breast. Core biopsy of the mass showed a well- circumscribed mobile mass. Histopathology showed multi nodular mass which was well demarcated from the surrounding breast tissue. What is the most likely cause of the mass? a) Breast carcinoma (b)Fibroadenoma °C) Fribroadenosis d) Cyst e) Fat necrosis23. A55 year old woman presents with a mass in the upper outer quadrant of the right breast. Core biopsy was done which showed a mass which is \poorly definitely infiltratingyinto the surrounding tissues. What is the most likely cause? a) Fibroadenoma ¢b) Carcinoma c) Cyst d) Fat necrosis e) Fibroadenosis 24. A70 year old man with chronic dementia dies and had a postmortem. Histopathology shows lewy bodies. What is the most likely diagnosis? a) Alzheimers disease 'b))Lewy body dementia . »v seo c) Parkinsons disease d) Picks disease e) Huntington’s disease 25.A 76 year old man fell down and hit his head. Five days later he comes back with confusion. he developed severe headache and then dies.On post-mortem, which vessel is he most likely to bleed from? a. Middle meningeal artery .(b.Internal cerebral artery c.Cerebral vein plexus d.Berry aneurysm e.Internal carotid vein 26. A70 year old man presents with back pain, anaemia and raised calcium. What finding will be on bone marrow aspirate? ~ \(@) Increased plasma B cells b. Increased leucocytes c. Increased T-cellsd. Reduced plasma cells e. Increased neutrophils 27. 35 year old woman suddenly fell and died. Post mortem shows bleeding from a berry aneurysm. What type of hemorrhage was it? a. Extradural hemorrhage b, Subdural hemorrhage » (¢) Subarachnoid hemorrhage d. Intracranial hemorrhage e. Intraventricular hemorrhage 28. Which of the following histological findings is associated with Barrett's Oesophagus? ,(a) Columnar Metaplasia b. Squamous Metaplasia c. Columnar Dysplasia d. Squamous Dysplasia e. Columnar-squamous metaplasia 29. Awoman who returned from abroad after 3 weeks of holiday complains of severe diarrhea of 3 weeks. She also developed iron deficiency anemia and folic acid defiency. What is most likely to be found on the biopsy? a) Jejunal villous atrophy b. Chronic diarrhea secretions c. Malabsorption d. Increased catabolism e. Increased secretions of acid 30. A 30 year old man died of sudden onset of severe headache. What is the single most likely location of the bleeding? a. Intra-Cerebral b. Extradural c. Subdural(@ Subarachnoid e. Intra-Cerebellar 31. A 60 year old man who worked in an asbestos factory has been diagnosed with lung cancer. A biopsy has been done and shows black neutrophils. Chest X-Ray shows pleural effusion. Which of the following factors would have contributed? .) Asbestos . Nicotine Dust Dye . Smoking ea0cp 32. A 25 year old man presents with chronic diarrhoea and per rectal bleeding. Histopathology report after endoscopy shows crypt abscesses and ulcers on the mucosa. Patient has bloody diarrhoea. What is the diagnosis? a) Ulcerative Colitis b. Crohn's Disease c. Lymphoma d. Gastroenteritis 33.A 70 year old man with lung cancer had a biopsy done producing {keratin'with inter-epithelial bridging. Which of the following is the most likely malignancy? a) Squamous Cell b. Basal Cell c. Small Cell d. Melanoma e. Mesothelioma 34. An old man who has dementia was admitted with suspected intestinal obstruction and had laparotomy which he did not survive from. He hadhemicolectomy but no history could be elicited from the patient about the cause of death.At autopsy the pathology of the liver describes various nodules at the surface of the liver just below the capsule showing central umblication. These lesions are yer wets) /(@) Secondaries — b. Hepatoma c. Hemangioma d. Abdominal aortic aneurism 35. A31 year old female having a history of diarrhoea and weight loss. She has an iron and folate biopsy. What will you see on the biopsy? a. Increased lymphocyte in the submucosa ’ Cb) Villous atrophy c. Increased Brunnel glands cells d. Proliferation of epithelial cells e. Hypertrophy of epithelial cells 36. A60 year old man had a duodenal biopsy on which he was found to have villous atrophy and crypt hyperplasia. What is the single most likely diagnosis? a. Cystic Fibrosis b. Crohn's disease c. Ulcerative colitis /“@ Coeliac disease e. Duodenal carcinoma 37. A 32-year old man presents with abdominal pain, bloody diarrhoea and rectal pain. Rectal examination reveals oedematous skin tags and anal fistula. Rectal biopsy shows granulomata. Patient has oral ulcers. What is the most likely diagnosis? A. Rectal carcinoma B. Ulcerative colitis “(1 Crohn's disease D. Gastroenteritis E. Diverticulitis