Practice questions: Introduction to pathology and Cellular response to stress

Answer in red or highlighted

Q1. A 4-year old child is brought by his mother to the emergency room with a history of
high fever for 3 days and a running nose. On examination, the doctor notes a skin rash on
the child’s extremities, back and chest. The doctor explains to the mother that the child has
Measles due to a viral infection that enters through the nose and spreads to the skin.

Match the clinical information provided in this example to the terminology used in clinical
practice?

Clinical information Terminology

1. High Fever a. Etiology
(Symptom – patient’s complaints)
2. Skin rash b. Pathogenesis
(Sign – changes observed by physician through
examination)
3. Measles virus infection c. Symptom
(Etiology – cause of disease)
4. Infection entry through nose and spread to skin d. Sign
(Pathogenesis – steps in evolution of disease
affecting normal function/pathways)

Q2. A 60-year old man presents with fever, cough and loss of weight for the past six
months. He has been a heavy smoker for the last 30 years. After examination, based on the
history and clinical examination findings the attending physician requests a blood test for
blood cell counts, and a CT scan of the chest which shows a lesion suspicious for cancer in
the left upper lobe. To confirm the diagnosis, a bronchoscopy is carried out and a bronchial
brushing and biopsy are obtained from the diseased area.
Which of the following diagnostic methods represents a histopathologic diagnosis in this
patient?

a. Bronchial brushing (this isn’t the answer, as it’s a cytopathologic diagnosis)

b. CT scan
c. Bronchial biopsy
d. Blood cell counts

Q3. A patient presented with multiple blisters on the skin of 4 days’ duration accompanied
by fever suspected to be due to a viral infection. The microscopic image of a skin biopsy
performed on the lesion illustrates a type of cell injury to the epidermal cells (arrows).

1. Name the type of cellular response?

a. Apoptosis (this is the answer, because apoptosis doesn’t invite a cell
inflammatory response, as there aren’t any inflammatory cells present)
b. Accumulation
c. Adaptation
d. Necrosis (this isn’t the answer because cell membrane was intact, and usually
an area would be affected, but over here, only a cell was affected, and in
necrosis the cell swells, but here, the cell shrinks)
 2. What is the appearance of the nucleus in these cells described as?
a. Pyknosis (this is the answer because of shrinkage)
b. Karyorrhexis (this isn’t the answer because there weren’t multiple fragments)
c. Karyolysis (this isn’t the answer because no dissolution)
d. Normal
3. What would be the inflammatory response to this change?
a. Neutrophilic
b. Monocytic
c. None
d. Eosinophilic
4. Which one of the following enzymatic mechanisms mediates this type of cell injury?
a. ATPase
b. Caspase
c. Phospholipase
d. Protease

Q4. A 5 year-old child is brought by the mother with history of increasing listlessness and
poor appetite for the last three months. On examination the child has moderate pallor.
Haemoglobin is 6g/dl (N 11-12.5g/dl) and reduced red cell count. A bone marrow
examination shows a marked increase in the number of normal erythroid precursors.

Which adaptive cellular response to stress does this represent?

a. Atrophy
b. Hyperplasia
c. Hypertrophy (this isn’t the answer because hypertrophy is increase in size of cells)
d. Metaplasia
Q5. A 70 year-old man suffers a stroke and is bed-bound for a month in hospital. During
ward rounds in the third week the physician observes that he has developed an ulcer over
the sacral region and illustrates it as a ‘bed sore’ to you as the accompanying intern.

1. Which cellular response to stress does this represent?

a. Atrophy
b. Hypertrophy
c. Hyperplasia
d. Metaplasia
2. Which patho-physiologic mechanism plays the most important role in its
occurrence?
a. Disuse (the patient was bed-bound for a month)
b. Ischemia
c. Neuropathy
d. Undernutrition
3. How can it be prevented?
Keep moving the patient.
Q6. While drinking hot coffee at Starbucks you accidentally knock your friend’s cup
and the coffee spills on his hand.

1. What is the etiology of the injury seen in the picture?

a. Mechanical
b. Thermal
c. Infectious
d. Immune
2. Which of the two arrows would indicate cells that are more likely to suffer
irreversible injury?
The arrow in yellow, because now the area is undergoing repair due to
thermal injury, because of which it’s necrosed and elevated.
Q. 7. A 90-year old man died of heart failure which progressed gradually. At autopsy,
a cross-section of the left ventricle showed the change seen in the picture below at
‘B’. A normal heart is at ‘A’ for comparison.

B
A

1. Which of the following adaptive changes have resulted in the change seen in the
patient’s left ventricle represent?
a. Atrophy
b. Hyperplasia
c. Hypertrophy
d. Metaplasia
2. The accumulation of which pigment gives rise to the altered colour of the
myocardium in this patient?
a. Hemoglobin
b. Lipofuscin
c. Myoglobin
d. Bilirubin
e. Melanin
Practice questions: Acute inflammation (1&2)

Answer in red or highlighted

Q.1 While drinking hot coffee at Zaffarano you accidentally knock your friend’s glass
and the coffee spills on his hand.

1. What is the clinical nature of this injury?

a. Acute
b. Subacute
c. Chronic
2. Match the arrows to one of the five cardinal signs of acute inflammation
a. Red arrow – Redness (Rubor)
b. Yellow arrow – Swelling (Tumor)
3. Name two other cardinal signs of acute inflammation which are not visible in the
picture, but which would be present in this patient.
a. Heat (Calor)
b. Pain (Dolor)
4. Can you suggest two principles of treatment based on your understanding of the
type of injury and its mechanism?

Apply an anti-inflammatory cream, and also apply ice to alleviate pain and
reduce heat.
Q. 2 A 25-year old cyclist slips and falls down sustaining a lacerated wound on his ankle (see
image).

1. Which one of the following cellular inflammatory responses occurs last in response
to this injury?
a. Adhesion
b. Rolling
c. Margination
d. Phagocytosis
2. Which of the following cell types responds first in this type of injury at the site of the
wound?
a. Basophil
b. Eosinophil
c. Lymphocyte
d. Neutrophil

Q.3 A 50-year old man is admitted to hospital for treatment of right-sided bacterial
pneumonia. After three days an X-ray chest shows a collection of fluid in the right pleural
cavity. The aspirated fluid is an exudate.

Which of the following would be most characteristic of this fluid?

a. Clear transparent appearance
b. Specific gravity 1020
c. Numerous polymorphs
d. Proteins 1g/dl
Q.4 A 5-year old child is brought by the mother to the clinic with history of high fever, sore
throat and running nose for the last 2 days. On examination, the throat is congested. Blood
differential counts show 60% lymphocytes (normal 20-40%).

Which of the following is the most likely etiology of the child’s illness?

a. Bacterial rhinitis
b. Immune reaction
c. Viral nasopharyngitis
d. Parasitic infection

Q.5 A 65-year old man has been suffering from diabetes since the last 15 years. He develops
an abscess on his leg which is not responding well to treatment.

Which of the following is an O2-dependant microbial-killing mechanism that is likely to be

defective in this patient?

a. Iron-binding lactoferrin
b. H2O2-MPO-halide system
c. Major basic protein
d. Elastase

Q.6 A 25-year old healthy man develops wound infection after a cut sustained in an
accident. He receives appropriate treatment with wound care and antibiotics.

Activation of which of the following cells in the tissues will terminate the inflammatory
reaction and initiate the process of healing?

a. Neutrophils
b. Lymphocytes
c. M2 macrophages
d. Eosinophils
Practice questions: Acute inflammation (3) and Chronic inflammation 1

Q.1 Nitric oxide is used as a therapeutic gas for its action on the vasculature. Based on your
knowledge of its in vivo role in inflammation which therapeutic action is it likely to
execute?

a. Vasoconstriction

b. Vasodilatation

c. Increased vascular permeability

d. Chemotaxis

Q.2. Low dose aspirin is prescribed to patients with coronary artery disease to prevent
platelet aggregation. Which of the following enzymes in the prostaglandin synthetic
pathway does it inhibit to achieve this action?

a. Phospholipase

b. Cyclooxygenase

c. 5-Lipooxygenase

d. 12-lipooxygenase

Q.3 A 25-year old male suffering from pyogenic (pus-generating) arthritis (of bacterial
origin) complains of fever, loss of appetite and increased sleep.

Name two cytokines produced by macrophages that play an important role in these
reactions.

1. TNF-α (Tumor necrosis factor - alpha)

2. Interleukin I

Q4. Which one of the following clinical conditions predisposes to infections due to defects
in all 4 inflammatory processes: chemotaxis, leucocyte adhesion, phagocytosis and
microbicidal action?
 a. Burns
b. Sepsis
c. Diabetes
d. Malnutrition

Q5. A 60-year old man undergoes abdominal surgery to remove a part of the colon for
cancer. Ten days later the surgeon discovers an opening at the site of the sutured
surgical skin incision. On probing it he finds that it is extruding faecal material.

Which of the following postoperative complication has developed in the patient?

a. Abscess
b. Sinus (abnormal channel that originates or ends in one opening)
c. Ulcer
d. Fistula (abnormal pathway between two anatomic spaces or a pathway that
leads from an internal cavity or organ to the surface of the body)

Q. 6 A 40-year old man has developed a lung infection which has persisted for several
months. On an X-ray chest the area of infection shows a cavity with a well-defined wall.

Which of the following tissue reactions has resulted in development of the wall?

a. Necrosis
b. Acute inflammation
c. Abscess
d. Fibrosis
Q.7 After prolonged treatment of a non-healing ulcer on the foot, healing has started slowly.
The release of which of the following would be most useful in this process?

a. Growth factors (only in chronic inflammatory, and non-healing ulcer is chronic)

b. Reactive oxygen species

c. Proteases

d. Coagulation factors (only in acute inflammatory)

Q. 8. A 4-year old child is brought by the mother to the hospital with complaints of
weakness and poor appetite. The child is anaemic (low Hb) and stool examination shows a
worm infection. A peripheral blood smear of this child is placed below.

Which of the following substances is released by the predominant leucocytes seen in this
smear to target the worm infection.

a. Elastase
b. Major basic protein
c. Histamine (note that basophils and mast cells secrete histamine)
d. Serotonin
Practice questions: Week 4. Chronic inflammation (2) and Repair

Q. 2 A 25-year old cyclist slips and falls down sustaining a lacerated wound on his ankle (see
image).

1. Name three specific factors that would affect wound healing in this patient assuming
he has no other chronic illness?

a) Bacterial infection
b) Medications (like steroids) which might delay healing
c) Blood loss which can lead to anemia, which will compromise healing
d) Gaping open wound

2. List three principles of treatment based on your knowledge of inflammation that

would promote healing in this patient?

A. Apply pressure to stop bleeding and please, clean the wound

B. Prevent infection either by oral antibiotics or apply antiseptic locally

C. The edges of the wound must be sutured together, hence covering the wound
Answer questions 3-7 based on the scenario and image provided below

A 55-year old obese man with history of diabetes for the last five years, presents
with discoloration and disfigurement of the nails of the feet for the last 3 months. He
has mild itching but no pain at the site. The physician diagnoses fungal infection of
the nails (onychomycosis) and advises oral antifungal treatment for the next three
months followed by review and continuation of therapy.

Q3. Is the patient’s disease acute or chronic? Give 3 reasons to support your answer?

It is chronic, because the symptoms took 3 months for it to manifest.

The treatment is also for a longer period of time.

There was no pain at the site.

Q4. Which of the following is the predominant inflammatory cell reaction in the lesion?

a. Basophil
b. Eosinophil
c. Lymphocyte
d. Neutrophil

Q5. List three mechanisms by which diabetes would affect the cellular inflammatory
response and healing in this patient.

Chemotaxis, Adhesion, Phagocytosis and Microbicidal activity

Q6. Why does the physician recommend oral (systemic) therapy for a localised disease?

To prevent the spread of systemic fungal infection, and also injuries that are chronic in
nature are relatively deep in nature, and an ointment will not be sufficient enough.

Q 7. Give 2 reasons why the physician plans to institute therapy for so long?

Since the disease took so long to evolve, the treatment must be longer.

There’s also eosinophil compromise, so persistent treatment is required.

Q 8. The CT scan chest of a patient with pulmonary tuberculosis is placed below.

8. a Which of the following tissue reactions is likely to be seen in a biopsy from these
lesions?

i. abscess (although there are cavities, this isn’t the answer)

ii. coagulative necrosis

iii. granulomas (because there are well-defined wall linings of the granuloma, as the
tuberculopathology doesn’t deal with abscesses)

iv. haemorrhage
8. b Which inflammatory reaction leads to the circumscribed appearance (well-defined
wall lining) of these lesions on radiology?

a. caseous necrosis

b. macrophage response

c. lymphocytic infiltration

d. fibrosis (because this produces the shape of the granuloma and the circumscribed
appearance)

9. Match the following etiologic classes of granulomatous inflammation with the

appropriate disease listed

Etiologic class Correct answer Disease

Infectious Leprosy A. Sarcoidosis
Chemical Gout B. Rheumatic fever
Allergic Rheumatic fever C. Leprosy
Unknown Sarcoidosis D. Gout

Q. 11, The image below is a diagrammatic representation of the cellular components of a

granuloma.

Which type of cell does the cell indicated at the pointer originate from?
a. Macrophage
b. Lymphocyte
c. Plasma cell
d. Mast cell
Practice questions: Week 5. Haemodynamic derangements (1&2)

1. In chronic venous congestion of the lungs, cells laden with hemosiderin are present in
the alveoli.
Which of the following are these cells?
a. Lymphocyte
b. Alveolar pneumocytes
c. Endothelial cells
d. Macrophages [siderophages/heart failure cells (hemosiderin-containing
macrophages)]

2. A 45-year old man presents with anasarca of recent onset. Oedema of which the
following anatomical sites would be most critical to the life of the patient?
a. Lower limbs
b. Abdomen
c. Brain
d. Pleura

3. An 80-year old lady who is in good health for her age is flying from Dubai to the USA
on a 15-hour flight. She is advised to periodically get up and walk around in-flight.
Which of the following haemodynamic derangements will be prevented through this
exercise?
a. Congestion
b. Thrombosis
c. Haemorrhage
d. Infarction

4. The image below is the microscopic section of the lung of a patient who presents
with breathlessness of 2 days duration.
Which of the following breath sounds would be heard on auscultation?
 a. Vesicular
b. Bronchial
c. Crepitation
d. Rales

5. A 35-year old woman is diagnosed to have a disease in which the intima and media of
a medium sized artery are inflamed with a thrombus in the lumen attached to the
intima.
Which of the following pathophysiologic mechanisms could have caused the
thrombus?
a. Endothelial injury
b. Hypercoagulability
c. Change in blood viscosity
d. Turbulence of blood

6. A 25-year old Formula-1 driver has a car crash in a race, resulting in crush injury of
his lower limbs with fracture of both femurs. Six hours after admission to hospital he
develops acute breathlessness. The attending physician suspects the cause to be
pulmonary embolism.
Which of the following is most likely to be the etiology?
a. Fat
b. Thrombus (blood clot)
c. Air
d. Amniotic fluid
Practice questions: Week 6. Embolism, Infarction, Shock

1. An 80-year old man slips and falls while crossing a road. In hospital, he is diagnosed
to have a fracture of the femur and hospitalized for surgery. On the third day of
admission he starts gasping for breath. The alert physician investigates and
diagnoses pulmonary embolism and starts treatment.

List 2 likely sources of embolism in this patient. For each of them indicate which
pathophysiologic mechanisms of Virchow’s triad of thrombosis is the cause?

Source of emboli in this patient Pathophysiologic mechanism(s)

1. Fat Embolism
2. Stasis Reduced venous return

2. A 75-year old man suffering from chronic atrial fibrillation (irregular atrial
contraction due to alteration in rhythm) develops sudden loss of vision in the right
eye. The attending physician diagnoses the cause as embolism from a thrombus in
the left atrium.

Which of the following conditions in the eye is the most important cause of the
sudden blindness?

a. Rich collateral circulation of the eye

b. Block of the single retinal artery
c. Retinal sensitivity to hypoxia
d. Vitamin A deficiency

3. List three differences in appearance of the lower limb if thromboembolism occurs in

the arterial vs. venous side of the circulation
a. Artery = swelling
b. Artery = appears red → vein = appears white
c. Artery causes gangrene
4. The image below illustrates infarction of the lung.
Which ONE of the following anatomic/functional etiology is the most likely cause
for the hemorrhagic appearance of the infarct?

a. Slow circulation in the pulmonary bed

b. High pressure causing capillary rupture
c. Dual blood supply of the pulmonary vascular bed
d. Reduced platelet availability

5. A 65-years old man presents with acute onset pain at the right renal angle. Imaging
reveals a wedge shaped lesion suspected to be an infarct. Study the appearance of
the infarct in the gross picture of the kidney below.
Which of the following is the appropriate explanation for the shape of the infarct?

a. Blockage of end arteries

b. Lipid deposition
c. Shape of the nephron
d. Gradual block of arteries
6. After an earthquake, due to improper sewage disposal there is an outbreak of
cholera. Many patients have profuse diarrhea and are brought in with signs of
shock.

Which of the following principles of therapy will be given the highest priority for
treatment?

a. Medicine to raise BP
b. O2 inhalation
c. Fluid replacement
d. Anti-motility medicine

7. In which of the following etiologic types of shock is disseminated intravascular

coagulation (DIC) most likely to develop?
a. Hypovolemic
b. Cardiogenic
c. Septic
d. Neurogenic

8. A 70-year old man is admitted in shock following a myocardial infarction. At

admission he is alert, has tachycardia, BP is 100/70mmHg and urine output is mildly
decreased.
On follow-up, the physician notices a sign which alerts him to the development of
progressive shock. Which of the following observations did the physician make?
a. BP 140/90 mmHg
b. Temp 990F
c. Patient talks irrelevantly
d. Urine output increases
 9. The condition of the patient referred above rapidly deteriorates and he dies within
the next few hours. On autopsy what would be one characteristic microscopic change
in each of the following organs?
a. Lung → edema
b. Kidney → less urine output

Genetic diseases

1. What is the etiopathogenesis for the vascular lesions in Marfan syndrome

predominantly occurring in the arterial side of the circulation?
Fibrillin issue – Missense Mutations – Skeletal Autosomal Dominant Disorder.
Fibrillin-1 protein, scaffolding for elastic fibres, abnormal TGF-βsignalling
2. Glycogen storage disorders (glycogenosis) often present clinically, as enlargement of
the liver and spleen.
Storage of the substrate in which of the following cells is responsible for this
phenomenon?
a. Parenchymal cell
b. Macrophage
c. Sinusoidal lining cells
d. Fibroblasts
3. Which of the following mechanisms of inheritance is responsible for Down
syndrome?
a. Autosomal dominant
b. Chromosome number
c. Autosomal recessive
d. X-linked recessive
4. Match the etiologic defect to the genetic disease
Disease Defect (protein/enzyme)
Marfan FBN1
Ehlers Danlos Collagen
Tay Sach Hexosaminidase
Gaucher G6P
Myopathic glycogenoses Muscle phosphorylase
Practice questions: Week 9. Infectious and environmental diseases

1. A 25-year old man presents with a non-healing genital sore. A biopsy from the edge
of the ulcer shows an occluded vessel. Its wall is infiltrated by lymphocytes and
plasma cells.
Which of the following sexually-transmitted infections has this patient developed?
a. Gonorrhoea
b. Syphilis (vasculitis)
c. Herpes
d. Hepatitis

2. A 30-year old woman develops high fever accompanied by fluid-filled blisters near
the angle of the mouth. The attached image shows the cytological appearance of an
aspirate from the blister.
Which of the following steps in viral pathogenesis leads to the change seen in the
image?

a. Entry into the cell membrane

b. Residence in the phagolysosome
c. Integration with cellular DNA
d. Intracytoplasmic cytopathic effect
3. A 20-year old male presenting with severe headache and altered consciousness is
suspected to have meningitis. Despite treatment he dies. An image of the brain is
attached.
Which of the following characteristics of the etiologic organism is responsible for the
external appearance of the patient’s brain?

a. Yeast-like shape
b. Slow growth
c. Mucoid capsule
d. Invasive spread

4. The attached image shows the presence of an intracellular parasite inside the
macrophages in a patient’s bone marrow aspirate.
Which of the following alterations in haematology tests would be seen in this
patient?
 a. Leucocytosis
b. Haemolysis
c. Pancytopenia
d. Thrombocytosis

5. An epidemiologist is surveying the paediatric population in developing countries to

design a global health strategy to allocate funds for health care.
Which of the following diseases is he likely to prioritise in the below 5 year age
group?
a. Malnutrition
b. Cancer
c. Storage disorders
d. Genetic disorders

6. In a 6-year old child suspected to have lead poisoning which of the following clinical
signs will indicate a low-dose of toxicity?
a. Delayed milestones
b. Neurological signs (correct but needs a higher sustained toxicity)
c. Anaemia (more advanced stages)
d. Renal failure (more advanced stages)

7. A 40-year old man who has been smoking 30 cigarettes a day for the past 20 years
wants to quit but feels frustrated because he fails to.
Which of the following substances in cigarette smoke is responsible for his failed
effort?
a. Tar
b. Polycyclic hydrocarbons
c. Nicotine
d. Phenol
8. Following the Japanese tsunami a nuclear reactor in Fukushima was flooded which
caused sudden massive release of radiation in the surrounding population.
Which of the following effects would have required treatment in the immediate
aftermath of this exposure?
a. Pulmonary fibrosis (chronic)
b. Pancytopenia
c. Reduced IQ (chronic)
d. Infertility (chronic)
 Practice Questions – Week 9
1. Which of the following species will show this characteristic shape of macrophages?

a) Protozoa
b) Fungi
c) Bacteria
d) Metazoan

2. A 9-year-old student in the local elementary school presents with an itchy head, it seems that
he has been infected by a lice outbreak in his class. Given that Rickettsia is found in lice,
what type of tissue reaction would you expect to see in this child on a microscopic level?
a) Acute vasculitis
b) Suppuration
c) Granuloma
d) Intracellular inclusions

3. A 55-year-old patient with a history of alcohol abuse presented to a doctor complaining of

fatigue, weakness, and loss of appetite for the past six months. The doctor noticed that the
patient looked jaundiced. Upon examination and laboratory testing, it was discovered that
the patient has fat accumulation within the liver and increased oxidative stress. Which of the
following enzymes can be BEST attributed to the increased oxidative stress observed in this
patient?
a) Superoxide Dismutase
b) CYP2E1
c) NOX4
d) Alcohol Dehydrogenase

4. A 2-year-old girl was sleeping in the back of a non-moving car, when she had a seizure.
Upon presentation to the emergency department, it was shown that she had a cherry pink
discoloration of the skin. What is the most likely air pollutant that caused her symptoms?
a) Nitrogen Dioxide
b) Carbon Dioxide
c) Dust
d) Carbon Monoxide
5. A 19-year-old female presented with symptoms of severe muscle pain, headaches and high
fever. The doctor suspected an infection which can be found using the Mucicarmine and
Silver Stains. If the doctor fails to treat this patient within its rapid onset, the infection could
be fatal and affect the brain. What type of infection is this?
a) Trachoma
b) Chagas Disease
c) Cryptococcal Meningitis
d) Poliomyelitis

6. A 22-year-old male who works in a Formula 1 garage in Nottingham is rushed into the
hospital due to hypoxia. As he is being rushed into the ER, the physician notices cyanosis of
the nails and the skin on his forearm has a cherry red discoloration. If a blood sample is
taken from the patient, which type of hemoglobin would be in the highest amount?
a) HbO
b) HbCO2
c) HbCO
d) HbH+

7. A 65-year-old man presented with a chronic headache that has been ongoing for 2 months
and with persistent muscle cramps. Upon history taking, it has been noted that the patient
was homeless and slept in his car. Additionally, physical examination revealed what seems to
be a rash on his skin and cyanosis on his finger nails. What diagnosis does this patient most
likely have?
a) Lead poisoning
b) Carbon monoxide poisoning
c) Caplan syndrome
d) Siderosis

8. A 23-year-old woman comes into your clinic reporting a newly-erupted blister on the border
of her lips. Upon obtaining a fluid aspirate from the blister, the slides revealed
multinucleated cells with eosinophilic inclusions. She was diagnosed with...
a) Canker sores
b) Cold sores
c) Molloscum contagiosum
d) Gingivomatitis
e) Oral thrush
Practice questions: Week 10. Pathology of Immunologic diseases

1. On biopsy of a lymph node a filarial worm is identified with surrounding infiltrates of

eosinophils and plasma cells.
Which of the following Immunoglobulin type would be identified in this plasma cell
reaction?
a. IgG
b. IgA
c. IgM
d. IgE

2. In Goodpasture syndrome circulating antibodies target the basement membranes of

the glomerulus and the lung alveoli.
Which of the following types of hypersensitivity mechanisms is responsible for this
reaction?
a. Immediate
b. Antibody-mediated
c. Immune-complex mediated
d. Cell-mediated

3. Following exposure to pollen a 14-year old girl, known to have bronchial asthma gets
an acute attack.
Which of the following tissue responses is likely to be a delayed reaction during this
episode?
a. Vasodilatation
b. Leakage from vessels
c. Smooth muscle spasm
d. Epithelial damage
4. A 45-year old female patient has been recently diagnosed to have an autoimmune
disorder that has involved the skin, kidneys and eyes.
Which of the following examples of autoimmune diseases is this most likely to be?
a. Myasthenia gravis
b. Autoimmune haemolytic anaemia
c. Systemic lupus erythematosus
d. Autoimmune thrombocytopenia

5. A surgeon has just finished anastomosing a transplant kidney to its vascular pedicle
in a recipient. Within minutes of completing the procedure the surgeon notes that
the kidney has turned blue and does not excrete urine.
Which of the following immunologic reactions is responsible for this change?
a. Hyperacute humoral rejection
b. Cellular rejection Direct pathway
c. Acute humoral rejection
d. Cellular rejection Indirect pathway

6. Which of the following sites of candida infections in a known HIV positive patient will
categorise him as having Class B disease?
a. Esophagus
b. Oropharynx
c. Bronchus
d. Lungs
7. A 66-year old patient was diagnosed to have multiple myeloma one year back and is
on maintenance therapy. He gradually develops renal failure. The renal biopsy shows
amyloid deposition as the cause of renal dysfunction.
Which of the following types of amyloid protein is being deposited in the kidney?
a. AL
b. AA
c. ATTR
d. Ab

8. Which of the following is a typical clinical feature of the disease seen in the image
below in HIV-positive patients, as compared to the same disease in an
immunocompetent individual?

The disease is
a. localised
b. only affects skin
c. aggressive
d. easy to treat
 Practice Questions – Week 10
1. A patient visited the hospital complaining of repeated infections. After taking
his history, it was revealed that he had a surgery recently, in which he had a
kidney transplant. The doctor suggested that the patient developed secondary
immunodeficiency syndrome and decides to perform differential diagnosis.
Which of the following options can the doctor rule out as not the leading cause
of secondary immunodeficiency?
1) Acute Rejection
2) Immunosuppressive drugs
3) Chronic rejection
4) Genetic Mutation of the immune organs

2. Which one of the following diseases has the highest risk if the HLA allele
B27 is found?
a) ankylosing spondylitis
b) acute anterior uveitis
c) chronic active hepatitis
d) postgonococcal arthritis

3. A 45-year-old female presents to a dermatologist with tightening of the skin

and subsequent clawing; red marks on the surface of the skin, increasing ulcers
on the skin, and increased sensation of heart burn and esophageal discomfort.
Upon testing, the physician finds that the disease is autoimmune and
commences the appropriate treatment.
Which of the following disorders is most likely to be the cause of the patient’s
symptoms?
A) Psoriasis
B) Eczema
C) Rosacea
D) Scleroderma
E) Ulcerative colitis
4. A 33-year-old male patient comes in with a bacterial infection and his doctor
prescribes him penicillin antibiotics without taking proper patient history and
allergic history of the patient. The patient reacts with an anaphylactic shock due
to massive vasodilation and unfortunately passes away.
Which of the following types of hypersensitivity reactions is responsible for this
reaction?
A. Immediate
B. Antibody mediated
C. Immune complex mediated
D. Cell mediated

5. For few months now, Annie, a 57-year-old lady, has been complaining of
dry eyes and difficulty with swallowing and recently blurry vision. During
review of system she also complained of experiencing joint pain. With
examination, you see that there are cracks and fissures present on her tongue
and with palpation you feel swelling on her neck. You decided on taking a
biopsy from the lower lip to send to the lab to confirm your diagnosis. The
results show that there is intense plasma infiltration with ductal epithelial
hyperplasia. What could be the diagnosis?

A) Tumor of the parotid gland

B) Rheumatoid arthritis
C) Menopause
D) Sjogren syndrome
E) Extreme case of dehydration

6. A 20-year-old woman presents with a complaint of diarrhea and fever of 39

degrees Celsius for the last 2 months. She tests for HIV positive and her CD4+
T cell count is 340. Which stage of HIV infection is she?

a)category B2
b)category B3
c)category C1
d)category A2
7. Which of the following clinical manifestations is seen in systemic lupus
erythematosus?
a. Skin butterfly rashes over the malar eminences and nose
b. Hypertrophy of collagen fibers of the subcutaneous tissue
c. Triad of xerostomia, parotid enlargement and keratoconjunctivitis sicca
d. Dermatomyositis

8.a. A 30-year-old women came to the clinic complaining of weight loss and
diarrhea. Upon examination, both spleen and liver were found to be enlarged.
The biopsy of the liver revealed deposition of amyloid.
Which stain was used that served as diagnostic for amyloidosis?

A. Congo red stain

B. H and E stain
C. Prussian Blue/ Perls' Prussian blue stain
D. Giemsa stain

8.b. A 55-year-old women comes to the clinic reporting of dry eyes and mouth.
Upon examination, the doctor noticed bilateral swelling of the parotid gland.
The doctor suspects Sjogren’s syndrome. Which of the antibodies will be most
elevated?
A. ss -A and ss-B antibodies.
B. Anti-histones
C. Anti-sm
D. Jo-1
E. Nuclear RNP
9. A 35 year old man, was on an expedition in Eastern North America, where he
came across various plants. After a few moments, he experienced an itchy-
blistering rash. After visiting the doctor, the diagnosis for his condition is
dermatitis. What type of hypersensitivity reaction does this disease classify
under?

a. Hypersensitivity I
B. Hypersensitivity II
C. Hypersensitivity III
D. Hypersensitivity IV
E. None of the above
Practice questions: Week 11. Neoplasia: nomenclature, benign and malignant tumours

1. A 65-year old man presents with weakness and gradual weight loss. On investigation
he is found to have a growth in the rectum. After a biopsy the surgeon informs the
patient that he has a malignant tumor derived from the inner (epithelial) lining of the
colon.
Which of the following types of tumor does this patient have?
a. Lymphoma
b. Sarcoma
c. Adenocarcinoma
d. Squamous cell carcinoma (only in mouth, Esophagus and terminal part of anal
canal)
2. A 40-year old man presents with multiple warty growths on his face displayed in the
image. The dermatologist records in his clinical notes that the patient has multiple
papillomas.
Which of the following growth patterns is responsible for this nomenclature?

a. Flat elevated
b. Depressed ulcerative
c. Rounded nodule
d. Finger-like projections
3. A new-born baby has a large growth in the sacrococcygeal region. It is operated and
shows a mixed composition of mature skin, muscle and lung tissue on microscopic
examination.
What would be the diagnostic term used for this growth?
a. Cystadenoma
b. Teratoma
c. Choristoma
d. Melanoma
4. A 45-year old female patient presented with lower abdominal discomfort for the past
six months. On examination, the uterus is palpable in the hypogastric region. On
ultrasound multiple ‘fibroids’ are diagnosed.
Which of the following diseases does this patient have?
a. Mesenchymal metaplasia
b. Leiomyoma
c. Fibroma
d. Fibrous scar
5. A 35-year old woman presents with a neck swelling on the front of the neck to the
left of the midline. On clinical examination and ultrasound it is a well demarcated
thyroid nodule. The image shows the resected specimen. It was diagnosed
microscopically as a thyroid adenoma.
List two features of this nodule on gross examination which support its benign
nature?

a. Well defined and structured, well circumscribed

b. Non-infiltrative, well encapsulated
6. A resected hepatocellular carcinoma on gross examination shows extensive
haemorrhage and necrosis.
What is the mechanism of development of these two gross features?
a. Necrosis – due to the fast proliferation, not enough O2 and so leads to death.
b. Haemorrhage – release of growth factors helps with the making of new
vessels, but since the tumour vessels tend to be weak and leaky, leads to
haemorrhage.
7. A 65-year old woman presents with a left breast lump in the upper outer quadrant
which on clinical examination and FNAC is diagnosed as a carcinoma.
Which additional anatomical site will the surgeon examine first to determine if the
tumour has spread outside the breast?
a. Lungs
b. Liver
c. Axillary nodes
d. Internal mammary nodes
8. A 70-year old man presents with a rapidly growing left lateral lymph node mass in
the neck. A biopsy of this mass is performed.
Which of these cytological features would best correlate with the patient’s clinical
symptom of rapid growth of the mass?
a. Disordered arrangement
b. Variation in cell size and shape
c. Large nuclei with prominent
d. Numerous mitosis
Students questions for Week 11

Q. A patient came with a finger like outgrowth on the skin. What type of tumor
nomenclature is it considered?

a) Sarcoma
b) Papillary
c) Carcinoma
d) Benign tumor

Q2. A 3-year-old boy presented with severe stomach pain and swelling and came
complaining with loss of appetite. Additionally, the boy's mother observed blood in his urine.
Upon examination, malignant tumors were observed in both of his kidneys. Which of the
following tumors can be diagnosed in this patient?
a) renal tubular adenoma
b) sarcomatoid renal cancer
c) nephroblastoma
d) renal cell carcinoma
Q. 3. A 30-year-old female presents to your clinic after she feels an abnormal lump on the
side of her breast. Upon further examination, you confirm the presence of a lump that does
not have well defined edges. To support your diagnosis, you order a biopsy. The results show
unencapsulated tissue that lacks differentiation. Which of the following is the most suitable
diagnosis?

a) Fibroadenoma
b) Intraductal papilloma
c) Phyllodes tumour
d) Breast lipoma
Q. 4 A biopsy of a suspected tumor is obtained and shows evidence of malignancy. Which of
the following is not expected to be observed?
a) Presence of abnormal mitotic figures
b) Hypochromatic nuclei
c) Enlarged nuclei
d) Pleomorphic cells

Q. 5. A 25-year-old woman presents to the physician with a wart growing on her face, it
appears brown in color and circumscribed. The physician takes a biopsy of the wart, upon the
results of the biopsy he describes this as a:
a) Adenoma
b) Papilloma
c) Papillary adenocarcinoma
d) Cystoma

Q.6. A neonate was noted to have a large sacral mass at birth. After investigations, she was
found to have a sacrococcygeal teratoma. Which of the following layers is not affected in a
teratoma?
a) Ectoderm
b) Mesoderm
c) Epidermis
d) Endoderm
Q7. In which type of carcinoma will you observe the following photomicrograph?

This photomicrograph is showing a

keratin pearl (in the black circle).
 a) basal cell carcinoma
b) adenocarcinoma
c) squamous cell carcinoma
d) medullary carcinoma

Q. 8. A 62 years old male visiting the clinic complained of fatigue, lethargy and feeling down.
For the last 2 months he has been having trouble while passing stool. The doctor ordered
blood tests which showed iron deficiency and positive blood in stool. A colonoscopy was
done.

The next organ mostly the cancer would metastasize is:

a) Brain
b) Small intestine
c) Liver
d) Kidney

Q.9. A 32-year-old woman has experienced dull pelvic pain for the past 2 months. Physical
examination shows a right adnexal mass. An abdominal ultrasound scan shows a 7.5-cm
cystic ovarian mass. The mass is surgically excised. The surface of the mass is smooth, and it
is nonadherent to surrounding pelvic structures. On gross examination, the mass is cystic
and filled with hair. Microscopically, squamous epithelium, tall columnar glandular
epithelium, cartilage, and fibrous connective tissue are present. Which of the following is the
most likely diagnosis?

a) Adenocarcinoma
b) Fibroadenoma
c) Glioma
d) Hamartoma
e) Mesothelioma
f) Rhabdomyosarcoma
g) Teratoma
Practice questions: Week 12. Predisposition to Cancer & Molecular basis of Cancer

1. A health facility is organising a cancer education camp for the community in which
they would like to highlight early detection of the leading cancer among women.
Cancer of which one of the following organs will they select to highlight?
a. Lung
b. Liver
c. Breast
d. Brain

2. Match the mutated gene with the inherited forms of specific tumors.
GENES
1. Rb
2. APC
3. NF-1
4. p53

TUMORS

a. Various tumors in Li Fraumeni syndrome (4) – p53

b. Neurofibromatosis (3) – NF-1
c. Familial adenomatosis polyposis coli (2) – APC
d. Retinoblastoma (1) – Rb

3. Match the chronic inflammatory etiology with the organ in which it increases the risk
of cancer
CHRONIC INFLAMMATORY ETIOLOGY
1. Schistosoma infection
2. Inflammatory bowel disease
3. Chronic Hepatitis B infection
4. Reflux esophagitis
5. Asbestosis
6. Helicobacter pylori infection
 ORGAN AT RISK OF CANCER
a. Stomach (6) – Helicobacter pylori infection
b. Lung (5) – Asbestosis
c. Liver (3) – Chronic Hepatitis B infection
d. Colon and rectum (2) – Inflammatory bowel disease
e. Urinary bladder (1) – Schistosoma infection
f. Esophagus (4) – Reflux esophagitis

4. A 65-year old male presents with cough and weight loss for the past three months.
He has a history of smoking for the past 30 years. Bronchoscopic biopsy reveals a
metaplastic epithelium adjacent to which a cancer has developed.
Which of the following is the most likely histologic type of cancer in this patient?

a. Adenocarcinoma
b. Squamous cell carcinoma
c. Transitional cell carcinoma
d. Lymphoma

5. A 35-year old woman presents with a breast lump which on clinical evaluation is
suspected to be malignant. She also gives a history of breast cancer in her mother at
40 years of age and a sister at 38 years of age. On genetic testing she is found to
have BRCA-1 mutation.
Alteration of which of the following molecular mechanisms is responsible for
development of early breast cancer in this patient and her first degree female
relatives?
a. Cell cycle regulation
b. Activation of growth factors
c. DNA repair
d. Signal transduction
6. A 55-year old female recently confirmed by biopsy to have breast cancer, is
prescribed Herceptin.
Which of the following oncogenes is over-amplified in this patient’s tumor?
a. Her2neu
b. p53
c. Rb
d. p16

7. In the lymph node biopsy of a patient with a follicular lymphoma the pathologist
finds that the protein product of the bcl2 gene is over expressed.
By which mechanism would this promote the growth of the tumor?
a. Increased proliferation
b. Reduced differentiation
c. Prevention of apoptosis
d. Inhibition of cell cycle

8. A 70-year old male undergoes an endoscopy for symptoms of gastritis and recent
weight loss. The gastric biopsy shows a poorly differentiated adenocarcinoma in
which many malignant epithelial cells are seen singly.
Which of the following steps in the development of metastasis do the single
malignant cells represent?
a. Loss of adhesion
b. Increased locomotion
c. Homing
d. Attachment to matrix
Q.1. Telomerase is the enzyme needed for maintaining telomeres, and it is usually found
switched on in cancer cells. Which of the hallmarks of malignant transformation does
telomerase majorly contribute to?

a) Sustained angiogenesis
b) Limitless replication (immortality)
c) Ability to metastasize
d) Insensitivity to inhibitory signals

Q.2. A 30-year-old man who was recently confirmed to have familial adenomatous polyposis is
prescribed COX2 inhibitors. This recently approved treatment has shown to decrease the
incidence of colonic adenomas. Which of the following conditions is the prescribed treatment
meant to target?

a) Colonic infections
b) Tumor-inducing inflammation
c) Tumor suppressor gene regulation
d) Activation of RAS proto-oncogene

Q. 3. A concerned mother presents to the pediatrician with her 1-year-old child when she
noticed that in photographs, her child’s pupil appeared white instead of the normal black. She
also mentions that this white appearance has been gradually increasing over the past 3 weeks.
The doctor made a diagnosis of retinoblastoma. The nature of the mutated gene is similar to
which of the following?

a) Rb
b) P53
c) Myc
d) BCL-2

Q.4. BLANK

Q.5. A 12-year-old female came to the hospital complaining of loss of appetite and has a lump
and a swelling in her right breast. At the age of 3 she was diagnosed with acute leukemia and
was treated. The doctor ordered a genome sequencing and after that diagnosed her with Li
Fraumeni syndrome. Mutation in which gene caused this disease?

a) BRCA-1
b) NF-1
c) Rb
d) p53
Q.6. A 34-year-old male was presented to the clinic with heartburn and difficulty swallowing.
Endoscopy findings showed Barret’s Esophagus. Metaplasia
of which of the following epithelium types caused this?

a) Simple cuboidal → intestinal

b) Transitional → simple squamous
c) Stratified squamous → intestinal
d) Pseudostratified → simple cuboidal
e) intestinal → stratified squamous

Q.7. A 15-year-old boy presented bone pain or tenderness around his left knee. He had limited
movement and walked with a limp. Upon examination he was diagnosed with osteosarcoma. Which
of following conditions would be responsible if the tumor were to metastasize?

a) Over expression of PDGF

b) Genetic mutation of nm23
c) Presence of the Proto-oncogene sis
d) Amplification of EGF

Q.8. Which of the following is not a DNA damaging agent?

a) Chemicals
b) Radiation
c) Viruses
d) Bacteria

Q.9. A 45-year old woman arrives at the hospital complaining of double

vision and severe headaches. The attending asks for an MRI and identifies
the type of tumor. The attending assures the patient that this is the most
common type of brain tumors (accounts for 10% - 15% of brain tumors)
and at this stage requires no immediate treatment. How do tumor
suppressor genes function to prevent the formation of this kind of
tumor? Refer to the image (attached) and the following website to identify
the tumor: https://blkhospitals.wordpress.com/2019/03/25/different-
types-of-brain-tumor/
a) Inhibition of RAS signaling
b) Growth inhibition
c) Cell adhesion
d) Regulation of cell cycle
e) Unknown mechanism
Practice questions: Week 13. Carcinogenesis 1 & 2

Q. 1. A biopsy from a squamous cell carcinoma from the cervix is being evaluated to
understand which biological pathway of carcinogenesis the human papilloma virus
has affected.
The researchers are most likely to find activation of which of the following?
a. Telomerase
b. p53
c. p21
d. Rb2

1. A 15-year old boy from the African continent presents with massive bilateral lymph
node enlargement in the neck. A biopsy from the mass is suspicious for Burkitt
lymphoma.
The detection of which of the following viruses in the tumor cells will be most
consistent with this diagnosis?
a. Human papilloma virus
b. Herpes simplex virus
c. Epstein Barr virus
d. Human herpes virus

2. Name two organs other than breast and prostate which can develop tumors through
the mechanism of hormonal carcinogenesis.
a. thyroid
b. gastrinomas
3. A 45-year old woman presents with a breast lump which on biopsy evaluation is
found to be malignant.
Positivity for which of the following receptors will be evaluated in this tumor to offer
therapy with Tamoxifen.
a. Her-2
b. Oestrogen
c. TSH
d. PDGF

4. In chemical carcinogenesis which of the following biological pathways is the role of

the promoter rather than the initiator carcinogen.
a. Formation of electrophilic intermediates
b. Activation by the body
c. DNA adduct formation
d. Induction of proliferation

5. In the lymph node biopsy of a patient with a follicular lymphoma the pathologist
finds that the protein product of the bcl2 gene is over expressed.
By which mechanism would this promote the growth of the tumor?
a. Increased proliferation
b. Reduced differentiation
c. Prevention of apoptosis
d. Inhibition of cell cycle
6. A 15-year old boy is exposed to sudden massive radiation when a nuclear plant in the
vicinity of his city has a leak.
Which of the following types of cancer is he at the most risk of development in the
early months after exposure?
a. Thyroid carcinoma
b. Breast carcinoma
c. Chronic lymphatic leukemia
d. Acute myeloid leukemia

7. Which of the following is an oncofetal antigen which if elevated can be an indicator of

malignancy of a specific organ?
a. CA 19-9
b. CD-20
c. CEA
d. CA-125
Ans. Malignant melanoma

A 25-year old male visited an ENT specialist complaining of pain while swallowing and
difficulty speaking. Upon examination, the doctor noticed a lesion at the back of the throat,
which when followed by a biopsy showed the presence of koilocytes in the oropharynx.

Which of these viruses would be responsible for the appearance of the koilocytes?
- Epstein Barr virus (EBV)
- Human Herpes virus
- Human Papilloma virus (HPV)
- Hepatitis B virus

After analyzing at a colon biopsy of a 35-year-old female who was suspected to have colon
cancer, the pathologist reported her findings as T1, N0, MX. What does the above
nomenclature indicate?

A. Presence of tumor, no nodules, metastases absent.

B. Absence of tumor, nodules present, metastases observed.

C. Presence of tumor, no nodules, metastases cannot be assessed.

D. Presence of tumor, nodules present, metastases cannot be assessed.

Which type of cancer is most likely caused due to intermittent intense exposure to UV
radiation?

• squamous cell carcinoma

• basal cell carcinoma
• malignant melanoma
• papilloma

Which of the following paraneoplastic syndromes causes pancreatic tumor?

1. Carcinoid
2. Myasthenia
3. Cushing’s
4. Polycythemia

Q. A 48-year-old woman noticed a growing lump on her

breast. She went to the general physician who referred
her to the oncology department. Initial examination
showed signs of breast cancer that include inverted
nipple and dimpling of the skin along with palpable
lymph nodes. The doctor took a biopsy of the tumor. The
following histology slide shows a section of the tumor.
The doctor describes it being “poorly differentiated” and having “a lot of mitotic cells”. The
doctor also notes that the cancer hasn’t spread to any of the organs yet, only the
surrounding lymph nodes. What grade of cancer does that correspond to?

1) Grade 0
2) Grade 1
3) Grade 2
4) Grade 3
5) Grade 4
Q. Which of the following medical condition can be screened with the help of a
Papanicolaou Test?
a) Pancreatic Cancer
b) Cervical Cancer
c) Breast Cancer
d) Blood Cancer
Pathology of diseases of infancy and Childhood

1. A 30-year old woman undergoes treatment for infertility and conceives triplets (3
foetuses). At normal term delivery, one of the three foetuses is found to be grossly
reduced in size while the other two are normal.
Which of the following phenomenon has occurred?
a. Malformation
b. Sequence
c. Deformation
d. Disruption

2. A new born baby, soon after beginning feeding, regurgitates all fluids and aspirates
milk into the lungs. On endoscopy, there is complete blockage at the lower end of the
oesophagus.
Which of the following terms best describes this phenomenon?
a. Atresia
b. Agenesis
c. Aplasia
d. Hypoplasia

3. Which of the following is a foetal factor responsible for foetal growth retardation?
a. Single umbilical artery
b. TORCH infections
c. Chromosomal abnormality
d. Preeclampsia
4. A new born baby develops severe respiratory distress syndrome (RDS) and dies
despite treatment. At autopsy, the lungs show microscopic changes depicted in the
picture attached.
Which of the following is the most likely ethology of RDS in this neonate?

a. Meconium aspiration
b. Diaphragmatic hernia
c. Metabolic acidosis
d. Hyaline membrane disease

5. Identify the gross abnormality displayed in the brain of a newborn child.

a. Haemorrhage
b. Kernicterus
c. Edema
d. Infarction
6. A 2-year old child undergoes surgery for a large adrenal tumor. On microscopic
examination it is diagnosed as neuroblastoma.

Which of the following histologic features will indicate a good prognosis for this
tumor?

a. Neuroblasts
b. Ganglion cells
c. Mitosis
d. Calcification

7. A full term baby has to be delivered by caesarean section as a growth is noticed in

the sacral region on ultrasound examination. An image of the new born baby is
displayed.
Which of the following is the most likely diagnosis?

a. Hamartoma
b. Teratoma
c. Choristoma
d. Lymphoma