Pathology
March 2, 2018
Transcribers: Colasito, Conda, Conejos, Constantino
Editor: Arnesto, Arquines
QUESTIONS
1. The mother of a 10-year-old,
previously healthy infant…
a. Hirschsprung disease
b. Pyloric stenosis
c. Intussusception
d. Meckel’s diverticulum
2. One of the most feared complications
of ulcerative …
a. the risk of dysplasia decreases 8 to
10 years after disease onset.
b. patients with left-sided disease of
the colon are at a greater risk than
those with pancolitis
c. patients with Crohn disease
affecting only the ileum have a
greater risk than those with colonic
movement
d. greater frequency and severity of
active inflammation (presence of
neutrophils)
3. A study of children in a rural area in
Mindanao with a high prevalence of
iron deficiency anemia, with positive
occult blood and pruritic feet
a. Ascaris lumbricoides
b. Necator amercanus
c. Cryptosporidium parvum
d. Enterobius vermicularis
4. A 24-year-old businesswoman
complains of recurrent with episode
of abdominal bloatedness…
a. Cystic fibrosis
b. Diverticular disease
c. Irritable bowel syndrome
d. Inflammatory bowel disease
5. An 18-year-old man has a positive
occult blood test with multiple polyp.
a. MLH 1
b. APC
c. p53
d. NOD2
6. A 52-year-old retired soldier, with a
hx of chronic alcoholism, with
increasing abdominal girth for the
past 6 months
a. Appendicitis
b. Diverticulitis
c. Lymphocytic colitis
ANEK
LE4
RATIONALE d. Spontaneous bacterial peritonitis
Answer: C 7. This is the most common bacterial Answer: B
enteric pathogen in developed
countries Recall question
a. Shigella dysenteriae
b. Campylobacter jejuni
c. Escherichia coli
Answer: D d. Yersinia enterolitica
8. Precursor of the majority of colorectal Answer: C
adenocarcinomas:
a. Hyperplastic polyp Anything that is adenoma is a precursor of
b. Retention polyp CA
c. Adenoma / adenomatous polyp
d. Inflammatory polyp
9. Which of the following statements Answer: A
about colonic adenocarcinoma is
true?
a. The two most important prognostic
factors are depth of invasion and
presence of lymph node metastasis
b. High intake of unabsorbable
Answer: B vegetable fiber and low intake of
refined carbohydrates and fat
This nematode can penetrate the skin increases the risk for colorectal CA
which causes skin pruritus c. tumors in the distal colon often
grow as polypoid, exophytic masses
those in the proximal colon often
produce “napkin-ring” constrictions
10. A 26-year-old woman in her ninth Answer: B
Answer: C month of pregnancy with upon
defecation with bright red blood stain Clinical feature of bleeding hemorrhoids
a. Angiodysplasia
b. Hemorrhoids
c. Intussusception
d. Ischemic colitis
11. A male infant begins to have Answer: C
Answer: B persistent, projectile nonbilious
vomiting what is the pathology A clinical feature of congenital pyloric
The clinical feature here is Familial a. A segment of intestine lacks both stenosis
Adenomatous polyposis Meissner and Auerbach’s myenteric
plexus
b. Gastric heterotopia
Answer: D c. Progressive thickening of the
circular muscle of the pylorus
This is a Clinical feature of parasynthesis d. outpouching of the intestinal
of cloudy yellow acidic peritoneal fluid with segment within 2 feet of the ICV
gram negative bacilli. 12. A 50-year-old woman presented to Answer: D
the clinic with chronic erythrocytic
hypochromic anemia with
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dysphagia… c. Anaplasia
a. Adenocarcinoma of the esophagus d. Atrophy
b. Barrett’s esophagus 20. The presence of which of the Answer: B
c. Esophageal carcinoid following in the mucosa of
d. Squamous cell carcinoma of the esophagitis…
esophagus a. Acanthosis
13. A 60-year-old female sought consult Answer: B b. Intraepithelial eosinophils
at the OPD for abdominal pain with c. mucosal congestion
bleeding after eating small amount. d. intraepithelial lymphocytes
Biopsy shows several proliferations… 21. An incidental finding of a mediastinal Answer: A
a. smooth muscle mass on chest…
b. interstitial cells of Cajal a. foregut cyst X-ray of a 16yr old incidental finding of
c. skeletal muscle b. extralobar sequestration mediastinal mass with histologic finding of
d. glandular epithelium c. pulmonary hypoplasia bronchogenic cyst
14. H. pylori is not involved in the Answer: D d. lymphoma
pathogenesis of which of the 22. A known case of HIV-infected Answer: B
following: individual was admitted…
a. Gastric lymphoma a. Pseudomonas sp. CD count <200 only for P. jiroveci
b. Chronic gastritis b. Pneumocystis jiroveci
c. Peptic ulcer disease c. Klebsiella pneumoniae
d. Hypertrophic gastropathy d. Streptococcus pneumoniae
15. A 55-year-old attorney presents to his Answer: A 23. A 48-year-old male underwent a Answer: A
primary care physician heartburn major abdominal surgery…
symptoms for the past 6 months This is a case of GERD, there is a. resorption Post-op under general anesthesia
a. Presence of goblet cells in the metaplasia in the distal portion of the b. contraction
esophageal mucosa esophagus c. compression
b. Basal zone hyperplasia d. patchy
c. Presence of intraepithelial 24. A52-year-old man known heavy Answer: B
eosinophils smoker, with bilateral black lucency in
d. Presence of neutrophils above the x-ray… Black in x ray means air so this is a
basement membrane a. bronchial smooth muscle clinical feature of emphysema
16. The most frequent complication of Answer: C hypertrophy and proliferation of
gastric ulcers eosinophils
a. Malignant transformation b. dilatation of air spaces with
b. Perforation destruction of alveolar walls
c. Bleeding c. pulmonary congestion of alveolar
d. Obstruction from scarring capillaries and exudations of fluid in
17. A 50 yo/F complaining of epigastric Answer: B the alveoli
pain with shortened gastric pit… d. permanent bronchial dilatation and
a. Hyperplastic polyp destruction of bronchial walls
b. Fundic gland polyp 25. 60-year-old male with a heavy Answer: C
c. Tubular adenoma smoking history with chronic
d. Carcinoid tumor productive cough… Clinical feature of chronic bronchitis
18. A 50-year-old male was admitted for Answer: A a. bronchial smooth muscle
massive hematemesis… hypertrophy and proliferation of A is histologic feature of asthma
a. Alcoholic cirrhosis eosinophils B is histologic feature of emphysema
b. NSAID use b. dilatation of air spaces with
c. Extrahepatic portal vein obstruction destruction of alveolar walls
d. Mallory-Weiss syndrome c. hyperplasia of bronchial mucus-
19. Which of the following adaptive Answer: B secreting submucosal glands
cellular change seen in Barrett’s d. permanent bronchial dilatation and
esophagus… destruction of bronchial walls
a. Dysplasia 26. 50-year-old male chronic smoker Answer: B
b. Metaplasia presents with chronic dyspnea,
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productive cough and easy
fatigability. Attending doctor
diagnosed his condition
emphysema. What is the most likely
type of emphysema?
a. panacinar
b. centrilobular
c. paraseptal
d. irregular
27. 55-year-old male who suffered two
episodes of myocardial infarction with
worsening dyspnea and orthopnea
over the past 6 weeks. (+) crackles
on most basal lung fields. What
pathologic findings is the man most
likely to have?
a. bronchopneumonia
b. pulmonary edema & congestion
c. pulmonary embolism
d. pulmonary fibrosis
28. An ICU patient developed hospital-
acquired pneumonia… Biopsy
revealed hyaline membranes. Which
of the following is most likely
underlying cause?
a. aspiration of oropharyngeal
contents
b. leukocyte-mediated diffuse alveolar
damage
c. release of fibrogenic cytokines by
macrophages
d. reduced production of surfactant
29. A 50-year-old pigeon caretaker for 20
years has been… if lung biopsy is to
be done, what are the most likely
histology findings?
a. interstitial pneumonitis
b. (+) non-caseating granulomas
c. both A and B are correct
d. neither A nor B is correct
30. A 6-year-old woman has noted
increasing dyspnea and non-
productive cough. Bronchial biopsy
reveals interstitial fibrosis, small
caseating granulomas and (+)
asteroid body within a multi-nucleated
giant cell. Most likely condition is?
a. pulmonary tuberculosis
b. sarcoidosis
c. silicosis
d. hypersensitivity pneumonitis
31. A 20-year-old man has a history of
recurrent chronic sinusitis with recent
bouts of pneumonia, bronchial
key word is “smoker“ dilatation with focal atelectasis, heart syndrome which predispose a person to
shadow appearance on the right. bronchiectasis
as Which lung condition is the man
predisposed to?
a. emphysema
b. chronic bronchitis
c. bronchiectasis
d. asthma
32. An autopsy was done on a patient Answer: B
Answer: B who died due to status asthmaticus.
What gross finding is most? Most characteristic gross finding of
A – no, because there was no history of a. dilatation and destruction of asthma
cough or fever alveolar walls
B - symptoms point out cardiogenic sign b. occlusion of bronchioles by mucus
of edema plugs
c. bronchial dilation and destruction of
bronchial walls
d. hyperemic and edematous
bronchial walls
33. A 6-year old girl with measles Answer: C
Answer: B developed fever followed by
productive cough. Based on studies A – more seen in elderly and with COPD
This is a case of Acute Lung the frequent microbial pathogen seen B – not commonly acquired in the
Injury/Acute Respiratory Distress in viral infection… community except in patients with cystic
Syndrome. Hyaline membranes connote a. Moraxella catarrhalis fibrosis
slimy distended alveolar ducts and sacs. b. Pseudomonas aeruginosa
c. Staphylococcus aureus
A – this is for abscess 34. A 65-year-old man, former cement Answer: A
C – more related to restrictive lung worker increasing dyspnea for 5
D – pathogenic mechanism in pediatrics years, increase interstitial markings.
(newborn) The patient had impression of
asbestosis. If bronchial washings
Answer: C were done, what should you look for?
a. golden-brown beaded rods
Clinical scenario of hypersensitivity b. coiled basophilic mucus plugs
pneumonitis where he is exposed to c. asteroid body within giant cells
organic antigens. This falls under d. Charcot-Leyden crystals
restrictive lung disorder. 35. A 13-year-old girl is planning to travel Answer: D
to the USA…
a. inflammatory response is IgE- Case of bronchial asthma
Answer: B mediated in a genetically predisposed
individual
Key phrase is (+) asteroid body within a b. eosinophils play a key role in the
multi-nucleated giant cell. inflammatory response
c. repeated bouts of exposure to the
allergen will result to structural
changes in the bronchial airway
known as “airway remodeling”
d. all of the above are correct
e. only A and B are correct
36. An ICU patient on long-term Answer: D
Answer: C mechanical ventilator predisposes
him/her to pneumonia. The following Most of the isolates in hospital acquired
This is the case of Kartagener’s are the types of organisms you would pneumonia are gram-negative
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most likely isolate from hospital
acquired pneumonia EXCEPT:
a. Pseudomonas aeruginosa
b. Klebsiella pneumoniae
c. Staphylococcus aureus
d. Moraxella catarrhalis
37. A 30-year-old female, non-smoker
has had progressive dyspnea. The
right side of heart is enlarged and she
has elevated pulmonary arterial
pressure and hypertrophy.
a. mutation of the bone
morphogenetic protein receptor 2
(BMPR2)
b. the presence of an antibody to that
alveolar basement membrane
c. mutation of the fibrinillin-1 gene
d. oxidant-antioxidant imbalance
38. A 70-year-old woman, non-smoker
has had increasing…
a. malignant epithelial cells with
keratin pear formation
b. malignant epithelial cells with
glandular differentiation
c. small, dark-staining malignant cells
with (+) nuclear molding
d. uniform, round tumor cells with salt
& pepper nuclei
39. A 70-year-old woman has been
bedridden for 5 weeks…
a. atherosclerosis
b. thromboembolism
c. vasculitis
d. metastatic carcinoma
For nos. 40-41:
40. A 65-year-old male, known heavy
smoker. Biopsy reveals oval, spindle-
shaped nuclear molding indiscernible
cytoplasm. Most likely neoplasm is?
a. squamous cell carcinoma
b. small cell carcinoma
c. adenocarcinoma
d. large cell carcinoma
41. The most likely precursor lesion for
the above neoplasm in #40 is:
a. squamous dysplasia
b. atypical glandular hyperplasia
c. neuroendocrine cell hyperplasia
d. no known precursor lesion
42. A research on renal diseases
identifies patients with nephrotic
syndrome…
a. parietal epithelial cell
b. podocyte
c. basement membrane
d. mesangial cell
For nos. 43-44: Answer: A
43. An 8-year-old boy, passed out dark
brown, cola-colored urine with edema Clinical scenario of post-streptococcal
Answer: A a. in-situ formation of antigen- GN
antibody complexes
Clinical scenario of pulmonary b. elaboration of cytokine-like
hypertension without history of cardiac substance
disorder or chronic lung disease that c. presence of a circulating
might give rise to pulmonary hypertension antineutrophil cytoplasmic antibody
so this is a case of primary pulmonary d. antibody to a renal autoantigen
hypertension which is caused by letter A. found in the phospholipase A2
receptors
44. Which of the following is the most Answer: B
likely outcome of case in #43?
Answer: B a. chronic renal failure Good prognosis
b. complete recovery
Histologic appearance of c. end stage renal disease
adenocarcinoma. d. rapid progressive
glomerulonephritis (RPGN)
45. A 44-year-old man has experienced Answer: D
body malaise, nausea and acute
reduction of urine output for past 5 Rapid onset; clue is proliferation of
days. Urinalysis show (+) hematuria, parietal cells into the Bowman’s space
(-) anuria, (-) dysuria. Biopsy reveals
Answer: B proliferation of parietal cells into the
Bowman’s space.
Immunofluorescence shows linear
pattern. What additional test would
you request?
a. anti-streptolysin O titer
Answer: B b. urine electrophoresis
c. antinuclear antibody
Clinical scenario of paraneoplastic d. anti-glomerular basement
syndrome of Cushing’s. membrane (GBM) antibody
46. In minimal change disease (lipid Answer: C
nephrosis) which of the following
structures is primarily involved?
a. basement membrane
b. cells of Bowman’s capsule
c. visceral epithelial cell
Answer: D d. the mesangial cell
47. A 46-year-old female present with Answer: B
A – for squamous cell carcinoma abrupt onset of nephritic symptoms
B – for adenoma with crescent formation but negative
C – for carcinoma for immunofluorescence. Which of the
following antibody can be seen?
Answer: B a. anti-GBM antibody
b. anti-neutrophil cytoplasmic
Nephrotic syndrome antibody
c. anti-nuclear antibody
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d. anti-DNA antibody
48. A 45-year-old man presented with
generalized edema… poor response
to corticosteroids
a. minimal change disease
b. membranous glomerulopathy
c. membranoproliferative
glomerulopathy
d. rapid progressive GN
For nos. 49-50:
49. A 7-year-old girl was noticed by her
mother to have facial edema. Work-
up done shows normal creatinine and
BUN; elevated cholesterol. Improves
on corticosteroid. What is the most
likely cause of her renal condition?
a. cytokine-mediated visceral
epithelial injury
b. antibody-against an autoantigen to
phospholipase A2 receptor
c. immune complex-mediated
glomerular injury
d. IgA-mediated mesangial injury
50. Which of the following findings by
electron microscopy is the most likely
presenting finding in no. 49?
a. areas of thick and thinned out
basement membrane
b. increased mesangial matrix
c. subepithelial immune complex
deposits along the GBM
d. effacement of foot processes
51. 10-year-old developed gross
hematuria…. (Clinical Scenario of IgA
nephropathy)
a. Berger’s disease
b. Henoch-Schonlein syndrome
c. Goodpasture’s Syndrome
d. Alport syndrome
52. An Autopsy was performed on a 68
yr. old male who died of end stage
renal disease. Gross findings of
chronic glomerulonephritis: small,
contracted, symmetrically with
granular cortical surface. What is the
histologic finding?
a. Hypercellularity
b. Basement membrane thickening
c. Sclerosis
d. Thyroidization
53. A 30 y/o female had fever and
chills… (Clinical Scenario of Acute
Pyelonephritis) urine culture is
requested
Answer: B a. Gram positive cocci
b. Gram negative cocci
Clinical case of membranous GN c. Gram negative bacilli
d. Fungal elements
54. A staghorn calculus is a morphologic
form of lithiasis…most common urine
stone composition
a. Calcium oxalate
Answer: A b. Magnesium ammonium PO4
c. Uric Acid
Clinical scenario of minimal change
disease
55. Thyroidization characterized by
atrophic tubules…
a. Acute pyelonephritis
b. Chronic Pyelonephritis
c. Acute tubular necrosis
d. Amyloidosis
Answer: D
56. 35 y/o man developed fever and chills
with appearance of rashes… (Acute
drug induced interstitial nephritis,
most common renal condition)
a. Analgesic nephropathy
b. IgA nephropathy
Answer: A c. Acute interstitial nephritis
d. Acute pyelonephritis
Answer: C
Chronic Glomerulonephritis Histo:
Hyalinosis + Sclerosis (end stage) 57. 45 y/o man complains of severe
headache and…. BP elevated to
220/120, died and on autopsy,
pinpoint hemorrhages on his cortical
surface of the kidney. What is the
histologic finding?
a. Hyperplastic arteriolitis
b. Fibrinoid necrosis of arterioles
Answer: C c. Both
d. either
Acute Pyelonephritis common agents:
normal flora of the GI tract = Gram (-)
bacilli
Answer: B
Recall question
A – associated with
hypercalcemia/hypercalciuria like
hyperparathyroidism, diffuse bone
disease, sarcoidosis; radiopaque on x-ray
C – seen in 25% of patients with gout;
radiolucent on x-ray
Answer: B
Chronic Pyelonephritis: tubular atrophy,
thyroidization (hallmark)
A – suppurative inflammation (presence of
neutrophils in the tubules) indicating acute
inflammation
C – tubulorrhexis (detachment/rupture of
basement membrane), coagulative
necrosis of tubular epithelial cells w/c are
also karyolitic (loss of nuclei)
Answer: C
A – dose-related disorder due to
analgesic (Aspirin, Paracetamol (Tylenol),
NSAIDs); common in women of
reproductive age; manifesting polyuria &
stone formation
C – which is the answer is not dose-
related associated w/ drugs such as
Synthetic Penicillins, Rifampicin, thiazide
diuretics, NSAIDs, Allopurinol, Cimetidine;
with a clinical triad of fever, eosinophilia,
rash & renal abnormalities (hematuria,
proteinuria, leukocyturia)
Answer: C
This is a case of Malignant
Nephrosclerosis. It is associated with a
malignant hypertension (BP > 200/120
mmHg systolic/diastolic respectively),
with papilledema (funduscopy),
markedly elevated plasma renin levels.
Grossly, kidney appears like a “flea-
bitten” kidney (small, pinpoint petechial
hemorrhages on cortical surface).
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58. 25 y/o man diagnosed with acute
leukemia. Developed renal
symptoms, metabolic disorder of
urate nephropathy, increased uric
acid. What urinalysis finding would
you search for?
a. Presence of cast
b. Presence of crystals
c. Presence of bacteria
d. Bence-Jones protein
59. 50 y/o female complained of right
flank pain… (Case of Ureteropelvc
junction obstruction)
a. Hydronephrosis
b. Pyelonephritis
c. Both
d. Neither
For nos. 60-61:
60. A 70 y/o male sought consult for
gross… (Renal Cell Carcinoma) What
is the most common histologic
feature?
a. Tumor cells with clear cell
cytoplasm and are non-papillary
Pyelonephritis
b. Cuboidal or columnar neoplastic
cells with papillary formation
c. Pale eosinophillic tumor cells in
solid sheets
d. Spindle red sarcomoid pattern.
61. Which of the following predisposing
factors will you ask with strong
association?
a. Family history of renal cancer
b. History of hypertension
c. Cigarette smoking history
d. Alcoholism
62. Which of the following structures of
the tooth… (is involved
periodontitis)
a. Enamel
b. Cementum
c. Dentin
d. Gingiva
63. A 1.5 cm purplish, ulcerated, nodular
lesion is… (Pyogenic granuloma)
a. It usually forms after the history of
trauma
b. It is the most common fibrous
lesion
Histologically, shows fibrinoid necrosis c. It may mature into a peripheral
of arterioles + hyperplastic arteriolitis ossifying fibroma
(onion-skin lesion). d. It may undergo squamous
Answer: B maturation
64. A 15 year old female student
underwent a botched (failed) root
canal operation. What is the most
likely lesion?
a. Dentriginous cyst
b. Eruption Cyst
c. Radicular Cyst
d. Odontogenic Keratocyst
Answer: C 65. True of Ameloblastoma.
a. Majority are located at the posterior
maxilla
b. It is derived from the enamel organ
c. Reccurence rates are low
d. It is a slow growing tumor
Answer: A 66. A 23-year-old male student
complained of a slowly enlarging….
Case of Brachial cyst. Clinical
feature of this lesion EXCEPT:
a. Stratified squamous epithelium
b. Lymphoid tissue with germinal
centers
c. Pseudostratified columnar
epithelium
d. Thyroid follicles
67. Which of the following oral lesions
has the highest probability of
progressing to SCCA?
a. Erythroplakia
Answer: C b. Hairy Leukoplakia
Tobacco smoking is the most significant c. Leukoplakia
risk factor for Renal Cell CA. Most d. Pyogenic granuloma
commonly see in Male than Female (2:1), 68. A 56 yr old male smoker complained
common at 6th or 7th decade of life. of a slowly enlarging, painless,
preauricular mass…. (case of
pleomorphic adenoma)
Answer: B a. Adenoid cystic carcinoma
in b. Benign mixed tumor
Recall question c. Mucocoele
d Mucoepidermoid Carcinoma
Periodontitis – inflammation of 69. A 65 year old male smoker noted
periodontal ligaments, alveolar bone, enlarging bilateral parotid masses…
cementum round encapsulated, cleft like spaces
Answer: C a. Adenolymphoma
b. Adenoid cystic carcinoma
Pyogenic granuloma aka Pregnancy c. Benign mixed tumor
Tumor: d. Mucoepidermoid carcinoma, high
-common in the gingiva of children, young grade
adults and pregnant
-long standing pyogenic granuloma can
give rise to Peripheral ossifying fibroma
-Histology: lobular proliferation of blood
vessels
-Gross: circumscribed, elevated, ulcerated
Answer: C
Radicular Cyst/ Periapical Cyst:
-due to inflammation of dental pulp
-x-ray round or flask shaped
-complete excision should be done
Answer: D
Ameloblastoma/ Adamanthioma
-majority are located in the posterioi
mandible
-derived from ameloblasts/ dental lamina
-high recurrence rate
Answer: D
Brachial Cyst/ Cervical
lymphoepithelial cell
-well circumscribed
-lined by stratified squamous or
pseudostratified columnar epithelium
-wall contains lymphoid tissue w/
prominent germinal centers
Answer: A
Recall question.
Answer: B
Pleomorphic Adenoma/ Benign Mixed
Tumor:
-painless, slow growing, rounded, mobile
discrete masses
-consist of a mixture of ductal/ epithelial
and myoepithelial cells
Answer: A
Warthin’s Tumor/ Papillary
Cystadenoma Lymphomatosum/
Adenolymphoma:
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70. A 75 year old politician has a 5 year
history of a painless palpable mass
on his left ear…with papillary
structures (Warthin’s Tumor) what is
true of this…
a. It is an unlikely diagnosis in cases
of a bilateral parotid gland tumor
b. The oncocytic appearance of
epithelial cells are due to packed
mitochondria
c. It has a high rate of malignant
transformation
d. It is the most common tumor of the
salivary gland
71. A 60 yr old female retiree complains
of a 2.0 cm slow growing…mucosal
mass, microcyst with uniform
cuboidal cells, minor salivary glands.
(Clinical case of Adenoid Cystic
Carcinoma) What feature is true?
a. It is the most common salivary
gland tumor
b. Local recurrence is rare
c. Perineural invasion accounts for
pain symptoms
d. Microcysts are filled with mucinous
material
72. Apoptotic changes in the hepatocytes
in response to injury:
a. Councilman bodies
b. Mallory Denk bodies
c. Ballooning degeneration
d. Ground glass hepatocytes
73. In Acute Liver Failure which of the
following information is most
consistent with the disease?
a. Past hepatitis infection
b. History of previous liver damage
c. Intake of medications like
Acetaminophen
d. Recent radiological procedure with
exposure to contrast media
74. A 45 yr old alcoholic presents with a
massive GI bleeding… presentation?
a. Bleeding peptic ulcer
b. Massive microvesicular steatosis
c. Ruptured esophageal varices
d. Massive Hepatocyte necrosis
75. A 60 yr old male with jaundice and
right upper quadrant pain, liver biopsy
showed ballooned out hepatocytes…
a. Acute hepatitis B
b. Chronic Hepatitis B
c. Hepatitis C
Answer: B d. Hepatitis A
76. Hepatitis profile: Answer: D
Warthin’s Tumor: Anti-HAV: non-reactive, HBsAg: non- Anti-Hbs is a serological marker for HBV
-bilateral in 10% of cases reactive, HbeAg: non:reactive, Anti- vaccination. See trans 4.05 Appendix A1
-presents as lateral neck mass Hbc: non-reactive, Anti-Hbe: non-
-2nd most common benign tumor of the reactive, Anti-Hbs: reactive, Anti-
salivary gland HCV: non-reactive.
With this results what is diagnosis?
a. Acute Hepatitis B infection
b. Chronic active hepatitis
c. Resolved hepatitis B infection with
immunity
d. Immunity from vaccination
77. Progression to Chronic Hepatitis B Answer: B
Answer: C infection can be attributed to? A. should be HbeAg not HbsAg
a. mutant strains of HBV that do not C. it should be CD8 not CD4
Adenoid Cystic Carcinoma: produce HbsAg
-2nd most common malignant salivary b. vaccination induced mutation
gland tumor c. CD4 induced hepatocyte injury
-prone to recurrence d. history of previous damage
-perineural invasion 78. 45-year-old female presents with Answer: A
-well circumscribed, rarely with cystic symptoms of chronic hepatitis. Hepatocyte rosettes are found only in
spaces, small and poorly encapsulated Denied exposure to hepatitis nor autoimmune hepatitis. Trans 4.05a page 6
intake of drugs and alcohol. Liver
biopsy showed interphase hepatitis
with bridging necrosis of hepatocyte
rosettes. These findings are
Answer: A consistent with?
a. Autoimmune hepatitis
b. Chronic hepatitis B infection
c. Primary Sclerosing cholangitis
d. NAFLD
79. If the liver biopsy showed steatosis Answer: A
Answer: C and steafibrosis with chicken wire-
fence pattern. Which of the following
disease is excluded?
a. Chronic Hepatitis B infection
b. Alcoholic Liver disease
c. NAFLD
d. A & B only
80. A solitary liver mass with embryonal Answer: B
cells forming acini…? Embryonal cell = immature cells = blast
Answer: C a. metastatic carcinoma cells
b. hepatoblastoma
c. Fibrolamellar variant of
hepatocellular carcinoma
d. Angiosarcoma
81. This statement/s are correct in the Answer: A
Answer: A pathogenesis in the primary HCC?
a. Chronic liver diseases are the most
common setting
b. early exposure to radiation is a
common risk factor
c. presence of auto-immune disorders
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contribute to its emergence
d. mutations in the APC gene is seen
in most cases
82. The most common malignant tumor
of the adult pancreas is:
a. Acinar adenocarcinoma
b. Ductal Adenocarcinoma
c. Insulinoma
d. VIPoma
83. A two day old infant presented with
progressive projectile vomiting of
congested loop. CT scan encircling
extra luminal mass in the duodenum.
Most consistently in this condition is?
a. Pancreatic divisum
b. Pancreatic heterotopia
c. Annular pancreas
d. Pancreatic agenesis
84. Which one of the following clinical
conditions is not associated with
gallstones or chronic cholelithiasis?
a. Cystic fibrosis
b. hemolytic anemia
c. Hepatitis B infection
d. Parasitic infection
85. A 35-year-old male patient had
severe abdominal epigastric pain.
What of these is inappropriate
laboratory findings?
a. Serum lipase
b. Serum amylase
c. Hypocalcemia
d. Elevated levels of Chloride in the
sweat fluid
86. Yellow stones are recovered from a
gall bladder…
a. Bile crystals
b. Uric acid crystals
c. Cholesterol crystals
d. A national park from the US
87. Main mechanisms of gall stone
formation:
a. Bile stasis
b. Bacterial infection
c. Supersaturation of bile with
cholesterol
d. all of the above
88. A 68-year-old female with long
standing history of gallstone….
a. This is common malignancy in
elderly women
b. Most histologic types are
adenocarcinoma
c. fairly good clinical outcome with
Answer: B
Pancreatic duct where majority of
pancreatic carcinoma are derived
(adenocarcinoma). Trans 4.06a page 7
Answer: C
Annular pancreas. Band-like ring of
normal pancreatic tissue completely
encircles or wraps around the second part
of the duodenum. Trans 4.06a page 4
Answer: C
Answer: D
This is a case of acute pancreatitis.
Findings will include marked elevation of
serum amylase (first 24hrs) followed by
rising serum lipase level (72-96 hours).
Glycosuria also occurs. Hypocalcemia
may result from precipitation of calcium
soaps in necrotic fat. (Robbins page 887)
Answer: C
Answer: D
Answer: B
This is a long case about history of
gallstone recurrent cholecystitis. A clinical
scenario of gallbladder CA
excellent 5 year survival rate
d. frequently associated with co-
existing carcinoma of extrahepatic
bile
89. Finding of fat necrosis, hemorrhages Answer: B
and calcification is seen in?
a. Pancreatic cacinoma
b. Acute pancreatitis
c. pancreaticblastoma
d. pancreatic calculi
90. Complications of cholelithiasis Answer: C
EXCEPT: Complications include Acute cholecystitis,
a. Cholangitis cholangitis, gall stone ileus, empyema,
b. Pancreatitis perforation, fistulas, obstructive
c. Primary biliary cirrhosis cholestatis or pancreatitis. Trans 4.06a
d. empyema page 4
91. Etiologic factors associated with Answer: D
acute pancreatitis is/are: See Trans 4.06 page 5
a. increase levels of gastrin and
enterogastrin
b. mumps virus
c. aspirin
d. all of the above
92. A 2-year-old boy has had recurrent Answer: C
urinary tract infection since birth Intrarenal congenital cause of
reveals hydronephrosis on hydronephrosis or obstructive uropathy is
ultrasound. Surgical repair of the narrowing of uteropelvic junction.
obstruction was performed. Which of Obstructive lesions of the urinary tract
the following pathologic findings is increases susceptibility to the infection
most likely concerned? (UTI). Trans 4.07b page 11
a. saccular outpouchings along the
wall of the ureter
b. inflammation of a double ureter
c. narrowed defect at the uretero-
pelvic junction
d. urachal remnant at the dome of the
bladder
93. A 70-year-old man with urinary Answer: A
frequency hesitancy in diagnosing There is weaking of the bladder wall
large prostate. Pathologic findings on musculature. Occur secondary to increase
the baldder? in intravesical pressure due to distal
a. Diverticulum obstruction like prostatic enlargement.
b. Interstitial cystitis Trans 4.08a page 4
c. Malakoplakia
d. Papilloma
94. A 55-year-old woman with diabetic Answer: B
nephropathy receives a renal The patient is immunocompromised. This
angiogram episodes. She has urinary is a case of Malakoplakia. Histologic
tract infection of E.coli…. Most likely features of malakoplakia is the Michaelis-
histologic feature is: Guttman bodies
a. non-specific chronic inflammation
b. presence of Michaelis-Guttman
bodies
c. presence of eosinophils
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d. presence of Mallory bodies
95. Which of the following pathogens is Answer: B
associated with hemorrhagic cystitis?
a. Schistosoma haematobium Recall question
b. Adenovirus
c. E.coli
d. Mycobacterium tuberculosis
96. A mother noticed dampening of the Answer: B
top-front surface of her newborn baby
girl diaper. What is the most likely Recall question
problem involve?
a. exstrophy of the bladder
b. patent urachus
c. congenital diverticulum
d. vitelline duct remnant
97. A 40-year-old female known to have Answer: D
recurrent episodes of....
a. nephrolithiasis
b. urothelial carcinoma
c. uretero-pelvic junction obstruction
d. retroperitoneal fibrosis
98. A group of medical students will do a Answer: D
descriptive study on the incidence of Bladder tumors most commonly present
urothelial carcinoma. What is the with painless hematuria. Trans 4.08a
most reliable symptom of bladder page 11
CA?
a. palpable mass
b. weight loss
c. flank pain
d. hematuria
99. A 58-year-old male with painless, Answer: B
hematuria. On cystoscopy, Most like this case is a bladder CA
roughened uneven surface of the
bladder mucosa and there’s atypia.
What is the most likely risk factor?
a. urinary tract infection
b. smoking history
c. presence of congenital anomalies
d. drug-induced
100. A pure squamous cell carcinoma of Answer: D
the bladder is most likely to arise Pure squamous cell CA in the bladder is
form? an indication that is due to Schistosoma
a. one who has worked in an aniline haematobium infection. Trans 4.08a page
dye industry for 20 years 11
b. history of chronic bladder infection
resulting to cystitis glandularis
c. history of surgical corrected
bladder exstrophy
d. Saudi Arabian with history of
schistosomal cystitis

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