Pathology 1 - 22

@ toman
1. A 17-year-old male presents with a lesion on his face that measures approximately 1.5 cm in its
greatest dimension. He has a history of numerous similar skin lesions that have occurred mainly in
sun-exposed areas. The present lesion is biopsied and reveals an invasive squamous cell carcinoma.
This patient most probably has one type of a group of inherited diseases associated with unstable DNA
and increased incidence of carcinoma.
What is the diagnosis for this patient?

-
A) Xeroderma pigmentosa
B) Wiskott-Aldrich syndrome
C) Familial polyposis
D) Sturge-Weber syndrome
E) Multiple endocrine neoplasia type I (MEN I)
2. A 76-year-old male farmer presents with a 2-cm mass on the left side of his forehead. A biopsy
reveals squamous cell carcinoma. Which one of the following causes the formation of pyrimidine
dimers in DNA and is associated with the formation of squamous cell carcinoma?

A) α particles
B) x-rays
C) Human Papilloma Virus
-
D) UVB
E) Epstein-Barr virus

3. The product of the p53 antioncogene is a nuclear protein that regulates DNA replication and
prevents the proliferation of cells with damaged DNA by stopping their cell cycle

-
A) Between G1 and S
B) Between G2 and M
C) Between M and G1
D) Between S and G2
E) During G3

4. Point mutations of the oncogene c-ras can result in the inability of the product of this oncogene to
bind with
-

A) GAP (GTPase Activating Protein)

B) p210
C) p53
D) pRb
E) WT1

5. RET is …….
 A) Nuclear regulatory protein
B) Growth factor receptor

:
C) Cell cycle receptor
D) Protein which involved in signal transduction
E) Tumor supressor gene
6. The morphological dissimilarity between malignant tumor cells and the tissue that the tumor cells
originated from is called:

A) differentiation
B) anaplasia
C) polichromasia
D) pleomorphism
E) atypia

7. A 45-year-old female presents with a 0.5cm firm gray lesion on her upper right thigh. Histologic
sections from this lesion are composed of elongated cells have an elongated shape and regular oval
nuclei with cytoplasmic processes are arranged in fascicles. These cells show a mixture of two
growth patterns; fascicles in areas of moderate to high cellularity- Antoni A and less densely
cellular- Antoni B.
What is the correct diagnosis?

A) Dermatofibroma
B) Dermatofibrosarcoma protuberans
C) Schwannoma
D) Pyogenic granuloma
E) Hemangioma

8. Which one of the following factors is assessed in the grading of a malignant tumor?

A) The number of lymph node metastases

B) The size of the primary tumor
C) The extent of invasion of the primary tumor into surrounding structures
D) The degree of cytologic differentiation of the primary tumor
E) The presence or absence of solid organ metastases

9. Which one of listed below is responsible for breaking down of extracellular matriks for tumor
metastasis?

A) Integrin
B) Fibronectine
C) Catepsin D
D) Type IV Collagen
E) E cadherine

10. Which one of the following is not known as tumorlike lesion of the lung?

A) Organizing pneumonia
 B) Cervisitis

:
C) Endometriosis
D) Tumorlet
E) Hyalinizing granuloma

11. Benign mass of disorganized mature specialized cells having aberrant differantion at the same
tissue or organ is termed as

A) hamartoma
B) adenoma
C) choristoma
D) papilloma
E) collision tumor

12. All of the following lesions are preinvasive lesions of lung except one;

A) Squamous dysplasia
B) Atypical adenomatous hyperplasia
C) Carcinoma in situ
-
D) Multifocal micronodular pneumocyte hyperplasia
E) Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia

13-Ten minutes after being stung by a bee ,a 30-year-old male develops multiple patches
of red, irregular skin lesions over his entire body. These lesions (urticaria) are pruritic and
new crops of lesions occur every day.
This response is primarily the result of liberation of specific vasoactive substances
by the action of:

A) Activated T lymphocytes on smooth muscle cells

B) IgA on basophils and mast cells
C) IgA on lymphocytes and eosinophils
-
D) IgE on basophils and mast cells
E) IgE on lymphocytes and eosinophils

14- Minutes after a donor kidney is connected to the recipient’s blood vessels, the transplanted kidney
turns blue becomes flaccid, excretes a few drops of bloody urine, and has to be, removed.
Histologic examination of the kidney reveals neutrophils within arterioles, glomeruli, and
peritubular capillaries. Immunoglobulin and complement are found to be deposited in blood vessel
walls. This type of transplant rejection is due primarily to:

A) Donor cytotoxic T lymphocytes that are directed against host antigens

B) Host cytotoxic T lymphocytes that are directed against donor antigens
C) Donor natural killer cells that are directed against host antigens
D) Preformed donor antibodies that are directed against host antigens
- E) Preformed host antibodies that are directed against donor antigens
15- Which is the best way to assess the cellularity of bone marrow ?

A) Bone marrow aspiration

B) Bone marrow biopsy

÷
C) Bone marrow biopsy touch preparation
D) İmmunofluorescent staining
E) İmmunohistochemical staining

16- In which subtype of Hodgkin’s Disease is Lacunar cell seen most?

A) Mixed cellularity
B) Lymphocyte depleted
C) Lymphocyte predominant
D) Nodular sclerosing
E) Nodular lymphocytic predominant.

17- Which of the components listed below do not belong into innate immunity ?

A) NK cells
B) Neutrophils
C) Macrophages
D) Plasma cells
E) Complement proteins

18- Non-Hodgkin Lymphomas mostly originate from:

A) Spleen
B) Lymph Nodes
C) Liver
D) Small intestine
E) Thymus

19-Which of the listed pair of diseases are associated with AIDS most?

A) Leukemia- Kaposi sarcoma

 B) Kaposi sarcoma-Hodgkin Lymphoma
-
C) Kaposi sarcoma- Non-Hodgkin Lymphoma
D) Lymphoma- Squamous cell carcinoma
E) Leukemia- Lymphoma

20- Which of the morphologic changes listed below is associated with systemic sclerosis?

A) Diffuse subepithelial fibrosis with associated atrophy of epidermis

-

B) Periductal and perivascular lymphocytic infiltration

C) Atrophy of acini,fibrosis and hyalinisation
D) Necrotising vasculitis
E) Malar rash

21- Which of the listed below is incorrect for Littoral Cell Angioma?

A) Originates from specialised endothelial cells of spleen

- B) It is the most frequent malignant vascular tumor of the spleen.
C) It is associated with other organ cancers in 30% of patients.
D) Splenomegaly is allways present.
E) It is often associated with hematologic problems.

22. Which is not correct for T-lymphocytes?

A) They comprise 60% of peripheral lymphocytes

B) They are located in paracortical region of lymph nodes
-
C) CD8/CD4 ratio is: 2
D) They are located in PALS of spleen
E) They play role in cellular immunity

İnternal Medicine 23 - 36
23- Where T cells continue their maturation process

A) Bone marrow
-
B) Thymus
C) Spleen
D) Lymph node
E) Pancreas

24- Which of the followings are the evading mechanisms of tumors from immune system.

I- Production of immunosppressive proteins.

II- Failure to produce tumor antigens
 III- Expressing Fas on the cell
IV- Activation of tumor specific CTL’s

I
A) I and II B) I and III C) II and III D) II and IV E) III and IV

25-Which of the following statement is wrong?

A) Without angiogenesis, tumor size is limitedr

B) Vasculogenesis is the formation of blood vessel de novo from stem cells or by sprouting
during embryogenesis.
C) Angiogenesis is the formation of blood via extension or remodeling from existing capillaries.
duwound healing, menstrual cycle, tumor-angiogenesis r
D) Insufficent angiogenesis is seen in psoriasis and diabetic retinopathy
E) VGEF helps in the formation of new blood vessels that support tumor growth.

26- Which of the following statements are true for stem cells

I- Stem cells have prolonged self-renewal capacity✓

II- Embryonic stem cells are found in the bone marrow and peripheral blood ✓
III- Stem cells have immunomodulatory functions. n

IV- Inducible pluripotent cells (IPS) are exact embryonic stem cells

A) I and II B) I and III C) II and III D) II and IV E) III and IV

27- Which of the following statements are true for Graft vs host disease (GVHD)

I- Chronic GVHD happens early after transplantation,usually within 30-60 days.

II- In acute GVHDs effector/activated T cells of donor attact host tissue cells
III- In acute GVHD effector/activated T cells of host attact the graft.✓
IV- Infections , bleeding and multi organ failure are cause of acute GVHD

A) I and II B) I and III C) II and III D) II and IV E) III and IV

-

28- Which of the following statement is wrong?

A) P53 is one of the tumor suppresor gene

B) Some viruses convert normal cells to the malignant cells
-
C) Mutations, gene amplifications adn chromosomal translocations leads oncogenes to be proto
oncogenes /
D) Chromosomal Translocations is a chromosome abnormality caused by rearrangement of parts
between nonhomologous chromosomes
E) Familial Adenomatosis polyposis (APC) related to high risk for colon cancer

29-Which of the following is wrong for Rh (Rhesus) blood group antigens

ri
A) Rh blood group antigens are proteins.
B) There are more than 50 antigens described in this system.
C) The most important antigens of this system are D-C-c-E-e.
- D) Rh antigens are not antigenic-
E) The term Rh (+) indicates the presence of D antigen

30- Which of the following statements are true.

I- Transfusion of an ABO incompatible unit of blood to a patient, causes fatal acute hemolytic ✓
transfusion reaction.
II- IgM antibodies are cold reacting antibodies that do not cross the placenta and bind ✓
complement.
III- The antibodies with Rh specifity are usually IgE/
IV- ABO blood group antigens are glycolipids /

A) I and II
-
B) I and III C) II and III D) II and IV E) III and IV

31. Son dönemde zayıflama dışında bir yakınması olmayan ve kolesistektomi amacıyla hastaneye
kabul edilen hastanın kan sayımında beyaz küre sayısı 45 000/mm3(veya 45 x109/L) ve
splenomegali saptanmıştır. Hastanın Hb:12 g/dL, trombosit sayısı: 445 x109/L dir. Bu hastada
Kronik Miyelositer Lösemi tanısı için aşağıdaki bulgulardan hangisi gereklidir?

-
A) Kemik iliğinde sitogenetik incelemede Philadelphia kromozomunun görülmesi
B) Periferik kanda hiperploidi saptanması
C) Periferik yaymada lökosit alkalen fosfataz negatifliği
D) Kemik iliğinde hiperploidi varlığı
E) Serumda LDH değerinin artması

32. 65 yaşındaki erkek hasta lenfadenopati ve lökositoz etyolojisi için araştırılırken periferde yapılan
immunofenotipik analizde CD 19, CD5 ve yüzey İmmunglobulin pozitif bulunmuştur. Bu hastada
-

aşağıdaki hangi hastalık düşünülmelidir?

A) Tüylü Hücreli Lösemi

-
B) Kronik lenfositer Lösemi B cell
C) Kronik Miyeloid Lösemi
D) Büyük B hücreli lenfoma
E) Akut Lenfoblastik Lösemi

33. Aşağıdaki nedenler arasında hem arteryel hem de venöz tromboza yatkınlık yapan nedenleri
işaretleyin.

A) Faktör V Leiden mutasyonu

B) Hiperhomositeinemi
C) Antikardiyolipin sendromu
D) Antitrombin eksikliği
- E) Hepsi

34. Multipl Miyelom Hastalığını asemptomatik miyelom (sinsi miyelom) dan ayırt eden
aşağıdakilerden hangisidir?

A) Serumda M protein değerinin 1 gr/dL den fazla olması

B) Serumda M protein değerinin 3 gr/dL den fazla olması
C) Serum Beta2 mikroglobulin değerinin 3.5 mg/mL den fazla olması
D) Kemik iliğinde plazma hücresinin % 10 dan fazla olması
E) Hemoglobin değerinin 10 gr/dL den az olması

35. Which one of the following proteins does mainly play an important role in the inflamation related
anemia?

A) Transferrin

B) Ferroportin
C) Ferritin

D) Hepcidin

E) Transcobalamin

36. Which one of the following causes macrocytic anemia?

A) Iron deficiency anemia
B) Sideroblastic anemia
C) Cobalamin deficiency
D) Thalassemia trait
E) Lead poisoning
Paediatrics 37 - 51
37. Which one of the following is not a B-cell immune deficiency disease?

A) Bruton’s disease
B) Common variable immune deficiency
C) Transient hypogammaglobulinemia
D) Di-George syndrome xxxxxxx
E) IgG subclass deficiency

38. Which one of the following is not a diagnostic test for B-cell immune deficiency diseases?

A) Immunoglobulin isotype (G,M,A,E) measurements

B) CD19, CD20
C) Specific antbody titre in response to pneumoccocus and/or tetanos antigen
D) Isohemaglutinine
E) CH50 xxxxxxxx

39. Which of the following is not a warning sign of “primary immune deficiency” diseases?

A) ≥ 8 ear infections witin one year

B) ≥ 2 pneomonias within one year
C) Family history of primary immune deficiency
D) Failure to gain weight
E) ≥ 3 urinary tract infections within one year XXXX

40.Which one of the following is the most frequent primary immune deficiency” disease?

A) Complement deficiencies
B) Severe combined immune deficiency
C) Phagocytic disorders
D) Antibody deficiencies XXXXX
E) Cellular immune deficiencies

41.Transplantation of tissue between genetically different members of the same species is called:

A) Autogrft
B) Isograft
C) Allograft XXXXX
D) Xenograft
E) Transfusion
 42.Rejection of transplanted organ or tissue within minutes mediated by preformed circulating
antibodies is called :

A) Acute rejection
B) Hyperacute rejection XXXXXX
C) Chronic rejection
D) Graft versus host reaction
E) Tranfusion reaction

43. Which one of the following is wrong about childhood anemias?

A) The normal references of hematologic parameters change by age in childhood.

- B) The lowest Hb level of a 6 month old infant is 12 g/dl

C) The lower limit of MCV value is 70 fl at the age of 6 months.

D) Reticulocyte count is higher in neonatal period.

E) RDW shows anisocytosis of erythrocytes.

44.Which one of the following is not a characteristic finding of Hereditary spherocytosis?

A) Hemolytic anemia
B) Increased reticulocyte
C) Intermittan jaundice

D) Splenomegaly
E) Decreased osmotic fragility

: 45.Which type of Hb is the main Hb found in a healthy adult?

A) Hb A= every healthy adults

B) Hb A2 = thalessemia

C) Hb F= embryonic
st
D) Hb Gower I=1 hb everrrrrr
E) Hb Portland= a new hb that no one gives a fuck about yetttt

46.What is the main cause of death in a beta thalassemia major patient?

A) Osteoporosis
 B) Infection via transfusion

C) Cardiac failure due to iron overload

:
D) Endocrine complications
E) Anemia
47. Which one of the following complications is the early cause of death in homozygous sickle cell
anemia patients younger than 5 years of age?

A) Vaso occlusive crises

B) Splenic sequestration crises
C) Aplastic crises
D) Stroke
E) Avascular necrosis

48.Which one of the following triggers the initiation of extrinsic system of coagulation?
A) Platelets
B) Tissue factor
C) Fibrin
D) Blood vessel
E) Thrombin

49.Which one of the following is a good prognostic marker for childhood acute leukemias?

A) Age younger than 12 months

3
B) White blood cell count higher than 50.000/mm at the time of diagnosis

C) t(9;22) Philadelphia positive acute lymphoblastic leukemia

D) Extramedullary involvement (testis and central nervos system)
3
E) White blood cell count less than 50.000/mm at the time of diagnosis

50.Which one of the following is not one of the roles of platelets in hemostasis plug formation?

A) Adhesion

B) Secretion
C) Aggregation
D) Procoagulant activity

E) Fibrinolytic activity
 51.Which one is incorrect about Physiologic Jaundice of Newborn?

A) Normal newborns develop elevated uncongugated biluribinemia during the first 1 to 2 weeks
of life.
B) Jaundice appears after 24 hours
- C) Serum indirect biluribin level don’t exceed 15 mg/dl in term neonates, 12-13 mg/dl in
premature neonates.
D) Rate of Biluribin increase never exceed 5 mg/dl per day.
E) Conjugated biluribin level is less than 2 mg/dl

Pharmacology 52 - 53
52. Please choose the wrong answer for iron metabolism:

A) In human adults, approximately 1800 mg of iron is incorporated into hemoglobin

2+
B) Nonheme iron in foods must be reduced to ferrous iron (Fe ) before absorption.
-

C) When iron stores are low or iron requirements are high, newly absorbed iron is immediately
stored as ferritin.

D) Correction of anemia reduces the absorption rate of iron.

3+
E) Absorption of ferric iron (Fe ) is increased by ascorbic acid , whereas blocked by antacids,
phosphates and oxalates.

53. Please choose the wrong answer

A) In recombinant DNA technology, human gene transfection into bacteria or mammalian cells
allows desired production yield.

B) Previously used extraction method of erythropoietin carried risks for disease transmission and
immune system rejection.

C) Manufacturing differences of rHuEPO may lead to anti- rHuEPO antibody production which
may result in pure red cell aplasia (PRCA).

D) Darbepoetin alfa is a more heavily glycosylated rDNA product, produced by Chinese Hamster
Ovary (CHO) Cell technology.

E) Glycosylated darbepoetin alfa has a shorter serum half life as compared to rHuEPO.

Biochemistry 54 - 57
54. Which type of anticoagulant is used in the determination of glycolytic intermadiates and products
such as glucose and lactate in blood sample ?

A) Heparin
-

B) Na Fluoride
C) EDTAremoves calcium
D) Oxalate anticoagulant
u

E) Citrate

55. Which of the following sentences about tumor markers is not correct ?

A) Neuron specific enolase is specific for neuroendocrine tumors.

B) Lactate dehydrogenase and creatine kinase are not specific markers for cancer.
C) c-abl/bcr translocation (Philadelphia chromosome) is specific for chronic myelogenous
leukemia (CML).
- D) A clinical laboratyory always uses the same assay kit for a given tumor marker.
E) A combination of tumor markers does not increase the accuracy of diagnosis.

56. Which one of the following sentences is not a characterictic of a cancer cell ?
-
A) It is immortal.
B) It is not affected from contact inhibition.
C) Its lactic acid production is higher than normal cells.
D) It has tendency to apoptosis.
E) It has no cell cycle control.

57. Which one of the followings is not correct about the development and therapy of cancer ?
A) In many cases, promoters of tumor suppressor genes are hypermethylated.
B) Cancers may arise form cancer stem cells.
-

C) A single mutation is enough to cause cancer.

D) Many cancer drugs force the cancer cells to go apoptosis.
E) Adenomatosis polyposis coli (APC) is an excellent example for the multistep carcinogenesis.

Microbiology 58 - 61

58. Which of the following has the highest antigenic value for transplantation ?

A) Heart
 B) Kidney
C) Liver
D) Bone marrow (*)
E) Cornea

59.Immunoganic tumor antigens are effective only if they are attached to :

A) Albumin
B) Heat shock protein (*)
C) Kemokines
D) Polysaccharide
E) Haptoglobuline

60. Which one of these is not involved in the development of central tolerance?
A) Apoptosis of T-cells in respnse to TCR engagement

E B) Survival of T-cells in respnse to TCR engagement

C) Induced Treg cell production
D) Expression of surrogate T-cell receptor alpha chain
E) AIRE gene function

:
61. An autoimmune disease can be caused by
A) Cross reactivity of lymphocytes activated by a pathogen
B) Failure of central tolerance
C) Failure in AIRE gene function
D) Immune complex deposition
E) All of above

Nuclear Medicine 62 - 65

62. Gamma rays are most similar to which one of the following?

A) High speed electrons

-
B) X rays
C) Infrared radiation
D) Sound waves
E) Laser beams

63. The desired effect of I-131 theraphy for thyroid carcinoma is:

A) to block thyroid function

 B) to reduce thyroid function
C) to inhibit iodide oxidation
-

D) ablation of thyroid tissue

E) reduce the chance for hyperthyroidism

64. Sr-89 or Sm-153 can be used to treat which of the following conditions?

A) Neuroendocrine tumors
B) Polycythemia Vera
-

C) Metastatic bone pain

D) Neuroblastoma
E) Malignant effusions

65. According to the Inverse Square Law, doubling the distance from a source:

A) Decreases exposure 2 times

B) Decreases exposure 8 times
C) Decreases exposure 9 times
-
D) Decreases exposure 4 times
E) Decreases exposure 16 times