2001 PATHOLOGY MCQ

1. Which of the following is unlikely to be a cause of pharyngitis?

A. Epstein-Barr virus
B. Streptococcus pyogenes
C. Corynebacterium diphtheriae
D. Coronavirus and rhinovirus
E. Haemophilus parainfluenzae

2. Which statement regarding stem cells is incorrect?

A. Stem cells are required for haemopoiesis
B. Stem cells are pluripotent
C. Stem cells morphologically resemble monocytes
D. Stem cells may be present both in the bone marrow and the peripheral blood
E. G-CSF therapy releases stem cells from the bone marrow into the blood

3. Transferrin:
A. Is absorbed in the duodenum
B. Is the iron storage protein
C. Is elevated in iron deficiency
D. Is elevated in the anaemia of chronic disease
E. Is the best test for iron deficiency

5. A 40-year-old male has a high serum potassium on electrolytes testing as part of a preemployment
screen. Which of the following would not explain the hyperkalaemia.
A. Haemolysis
B. Delayed separation
C. Thiazide diuretic therapy
D. EDTA contamination
E. Spironolactone therapy

7. In acute pyelonephritis, all are associated except:

A. Costovertebral angle pain.
B. Vesicoureteric reflux.
C. Leucocytosis.
D. More common in young males than females.
E. Fever

8. The direct antiglobulin test:

A. Is a test of the intrinsic pathway of coagulation
B. Is a test of the extrinsic pathway of coagulation
C. Is positive in fragmentation haemolysis
D. Is positive in autoimmune haemolytic anaemia
E. Is positive in thalassaemia

10. The most common cause of meningitis in this community is:

A. Neisseria meningitides
B. Mumps virus
C. Streptococcus pneumoniae
D. Enterovirus
E. Herpes simplex virus

12. A 21-year-old healthy female presented to casualty complaining of breathlessness, and was found to
have tetany. The diagnosis was psychogenic hyperventilation due to anxiety. Which of the following is
correct.
A. The acid base disturbance in this patient is respiratory acidosis
B. Total calcium would be high in this patient
C. Ionised calcium would be normal in this patient
D. Prolonged application of tourniquet during venipuncture causes a reduction in total calcium
E. Respiratory alkalosis causes a reduction in ionised calcium without change in total calcium

17. Which of the following statements is not true regarding the anaemia of Vitamin B12 deficiency?
A. It is characterized by a peripheral blood film that shows changes in erythrocytes and sometimes
polymorphonuclear leukocytes and platelets
B. It is characterized by changes that are consequent on impaired nucleic acid synthesis
C. It is characterized by an elevated erythrocyte volume
D. It is rarely caused by dietary deficiency
E. Because of the very slow turnover of Vitamin B12, it can be treated effectively with infrequent oral
doses of hydroxycobalamin

19. Which of the following is NOT a characteristic pathological finding in benign systemic hypertension:
A. Hypertrophy of the muscular media of the arterial wall
B. Reduplication of the internal elastic lamina
C. Intimal fibrosis
D. Fibrinoid necrosis of arterioles
E. Hyaline arteriolosclerosis

21. Which of the following is NOT a major criterion necessary for the diagnosis of rheumatic fever?
A. Subcutaneous nodule formation
B. Migratory arthritis of the large joints
C. Fever
D. Erythema marginatum skin rash
E. Chorea
22. A 55-year-old man treated with lipid lowering therapy had a serum cholesterol of 9.5 mmol/L. His
previous cholesterol was 10.0 mmollL. Assuming total intra-individual variation for cholesterol
(expressed as CV) of 4%, which of the following is untrue
A. There has not been a significant reduction in his cholesterol following treatment
B. Least significant change is calculated as 2.77 times the total intra individual variation
C. Components of total intra-individual variation include analytical variation and biological variation
D. Biological variation is generally higher than analytical variation
E. There has been a significant reduction in his cholesterol following treatment

23. Which of the following is incorrect? Haemolysis of blood sample can cause an increase in:
A. Sodium
B. Potassium
C. LDH
D. Phosphate
E. AST

24. Which of the following is not a clinical sign associated with bacterial endocarditis?
A. Kemig's sign
B. Osler's node
C. Changing cardiac murmur
D. Roth spots
E. Finger clubbing

25. Hydronephrosis is associated with all the following, except:

A. Benign prostatic hypertrophy.
B. Acute cystitis.
C. Normal pregnancy.
D. Tumours.
E. Posterior urethral valves.

26. You have been asked to evaluate a new test for clinical use. In the performance characteristics of a
test, which of the following terms is described incorrectly?
A. Accuracy is the extent to which a test result agrees with the actual value
B. Imprecision is a measure of how close the repeat values are to each other
C. The predictive value of a test is not influenced by the prevalence of the disease tested for.
D. Sensitivity refers to positivity in disease
E. Specificity refers to negativity in health

28. Indicate which of the following statements concerning pulmonary emphysema is NOT true:
A. It has a positive association with cigarette smoking
B. It has a positive association with α1-antitrypsin deficiency
C. It has a positive association with chronic bronchitis
D. It is more common in females than in males
E. May produce pneumothoraces

29. Which patient has the worst prognosis or is most likely to die from the melanoma?
A. 12 year old male with malignant melanoma, superficial spreading type, level 2, 0.2mm thick, arising in
association with a compound naevus, cleared from margins.
B. 45 year old female with malignant melanoma in situ, lentigo maligna type, level 3, 0.4mm thick.
C. 70 year old male with malignant melanoma, type unclassified, level 3, 0.5mm thick, with low mitotic
rate and satellite formation.
D. 75 year old female with malignant melanoma, acral lentiginous type, level 4, 1.5mm thick,
intermediate mitotic rate and probable vascular invasion.
E. 25 year old male with malignant melanoma, desmoplastic type, level 5, 3.5mm thick, with perineural
invasion and a low mitotic rate.

30. Which of the following conditions is LEAST likely to play a role in the causation of aneurysms?
A. Atherosclerosis
B. Polyarteritis nodosa
C. Congenital weakness of the arterial wall
D. Syphilis
E. Rheumatic fever

32. Which of the following does NOT exclude the diagnosis of cardiomyopathy?
A. Major disease or abnormality of coronary artery
B. Systemic hypertension
C. Ventricular hypertrophy or dilatation
D. Abnormality of heart valves
E. Congenital abnormality of the heart

33. Indicate which of the following is the most reliable index at post mortem of the presence of chronic
bronchitis during life:
A. Atheroma of pulmonary arteries
B. Enlargement of bronchial mucus glands
C. Enlargement of hilar lymph nodes
D. Peribronchial emphysema
E. Peribronchial fibrosis?

34. Which of the following statements about Kaposi's sarcoma is UNTRUE?

A. It may present in elderly Europeans as red nodules on the legs
B. It occurs in young black African males in Africa
C. It is thought that EBV infection is implicated in its causation
D. It may be associated with HIV infection and AIDS
E. A second malignancy such as lymphoma may develop in some patients with Kaposi's sarcoma
35. Which of the following, if isolated from the oropharynx, would never be considered as a member of
the normal flora?
A. Streptococcus pneumoniae
B. Treponema species
C. Haemophilus parainj/uenzae
D. Mycobacterium tuberculosis
E. Moraxella catarrhalis

36. When the CLOtest is applied to a duodenal biopsy, a yellow colour reaction indicates:
A. the absence of infection with Helicobacter pylori.
B. the absence of infection with
Vibrio cholerae.
C. the presence of infection with
Helicobacter pylori.
D. the presence of infection with
Corynebacterium urealyticum.
E. the presence of infection with
Vibrio cholerae.

44. A 77-year-old female with very low body mass index has a serum creatinine result just outside the
reference range. In the determination of the reference range which of the following is incorrect:
A. Mean +/- 2 standard deviations are usually used to define the upper and lower limits of the reference
range?
B. Generally 5%of the normal population have values outside the reference range
C. Serum creatinine is affected by muscle mass
D. Serum creatinine does not increase with age
E. Serum creatinine may be falsely elevated due to cephalosporin interference

52. A 54-year-old man had a number of blood tests done one afternoon 2 days after being diagnosed
with myocardial infarction. Which of the following statements is untrue?
A. Serum iron may vary with time of the day
B. Serum cholesterol may increase significantly by 24 hours after a MI?
C. Thyroid function tests may be affected by acute illness
D. Time of the last dose is important in serum digoxin measurement
E. Serum triglycerides is affected by recent food intake

61. Of the following which is the third commonest neoplasm of bone?

A. A metastasis
B. Osteosarcoma
C. Giant cell tumour of bone
D. Ewings sarcoma
E. Chondrosarcoma

62. Which patient has the best prognosis?

A. 12 year old male with malignant melanoma, superficial spreading type, level 2, 0.2mm thick, arising in
association with a compound naevus, cleared from margins.
B. 45 year old female with malignant melanoma in situ, lentigo maligna type, level 3, 0.4mm thick.
C. 70 year old male with malignant melanoma, type unclassified, level 3, 0.5mm thick, with low mitotic
rate and satellite formation.
D. 75 year old female with malignant melanoma, acrallentiginous type, level 4, 1.5mm thick,
intermediate mitotic rate and probable vascular invasion.
E. 25 year old male with malignant melanoma, desmoplastic type, level 5, 3.5mm thick, with perineural
invasion and a low mitotic rate.

64. Which patient has the incorrect pathology report?

A. 12 year old male with malignant melanoma, superficial spreading type, level 2, 0.2mm thick, arising in
association with a compound naevus, cleared from margins.
B. 45 year old female with malignant melanoma in situ, lentigo malignant type, level 3, 0.4mm thick.
C. 70 year old male with malignant melanoma, type unclassified, level 3, 0.5mm thick, with low mitotic
rate and satellite formation.
D. 75 year old female with malignant melanoma, acral lentiginous type, level 4, 1.5mm thick,
intermediate mitotic rate and probable vascular invasion.
E. 25 year old male with malignant melanoma, desmoplastic type, level 5, 3.5mm thick, with perineural
invasion and a low mitotic rate.

66. All of the following are likely complications or sequelae of duodenal ulcers EXCEPT:
A. Haemorrhage
B. Perforation
C. Scarring with obstruction
D. Complete healing
E. Malignant change

68. Fine needle aspiration cytology of the breast:

A. Has completely removed the need for intra-operative frozen section diagnosis
B. Generally requires a general anaesthetic
C. Results in tumour cell implants in the needle track in 5-10% of cases
D. Has no role in the diagnosis of impalpable breast lesions
E. May in some instances remove the need for a surgical biopsy to be performed

69. An elderly man who has had several attacks of coronary disease is admitted to hospital for incipient
gangrene of one leg and found on admission to have symptoms of intestinal obstruction. What is the
most probable cause of the latter?
A. Cancer of the colon
B. Intussusception
C. Mesenteric thrombosis
D. Strangulated hernia
E. Volvulus

71. Barrett's epithelium is defined as:

A. Ectopic gastric epithelium in midoesophagus
B. Dysplastic epithelium
C. Metaplasia of oesophageal epithelium to gastric type
D. Adenocarcinoma primary in the oesophagus
E. Regenerating squamous epithelium adjacent to oesophageal ulcer

73. Which one of the following is NOT true of uterine "fibroids"

A. Arise from muscle cells
B. Arise in the myometrium
C. Are frequently multiple
D. Usually give rise to leiomyosarcoma
E. Have a false capsule

75. Histological features of fibrocystic change/disease of the female breast include typically all but which
ONE of the following:
A. Apocrine metaplasia
B. Chronic inflammatory infiltrates
C. Squamous metaplasia
D. Cyst formation
E. Fibrosis

76. Thyroid gland enlargement is associated with all of the following conditions EXCEPT:
A. Ingestion of oral contraceptives
B. Puberty
C. Androgenic steroid therapy
D. Dietary iodine deficiency
E. Pregnancy

78. Myocardial hypertrophy due to direct hormonal action is seen in:

A. Myxoedema
B. Malignant carcinoid tumour
C. Acromegaly
D. Grave's disease
E. Beriberi

81. Type II diabetes mellitus is characterized by:

A. Constituting a majority of all cases of diabetes mellitus
B. Dependence on insulin injections
C. Tendency to ketoacidosis
D. Weight loss
E. Islet cell antibodies

83. Which of the following is CORRECT? Subhyloid haemorrhage is a sign of:

A. Meningitis
B. Encephalitis
C. Hydrocephalus
D. Subarachnoid haemorrhage
E. None of the above

85. The term lacune refers to:

A. A Expansion of the central canal
B. A widening of the subarachnoid space
C. A long standing infarct
D. An aneurysm
E. A cyst