Page | of 17 SPECIAL PATHOLOGY (MCQs) Model Paper Total No. of MCQs 65 Marks = 65 Time 1 hour 5 minutes 01. A mother brought her infant to the pediatrician for delayed i ;, hepatosplenomegaly and pallor. Another sibling problems for which repeated blood transfusions ed. Confirmation of the diagnosis can be made by: ‘A. Complete blood picture. B. Iron studies. C. Hemoglobin electrophoresis. D. Bone marrow examination. E. Liver biopsy. Key: C Topic: Hematology 02. Young female complains of episodic breath-lessness, cough, wheezing and chest tightness, worse during spring season. Pathological findings will include: A. Permanent enlargement of distal air spaces. B. Mast cell activation. C. Haemoptysis. D. Excessive lysis of elastin. E. a — antiprotease deficiency. Key: B Topic: Respiratory System 03. During a routine pelvic examination, a 25 year old female was found to have an enlarged uterus. Ultrasound showed a multiloculated cystic structure in the uterine cavity. The mass was removed by dilatation curettage of the uterus and it showed placental like tissue. Which tumor marker is helpful in diagnosis and prognosis? A. CEA. B. PSA. C. S-100. D. Beta-HCG. E. CA-125. Key: D Topic: Female Genital Tract 04. In which of the following breast lesions is there a prominent giant cell reaction? A. Acute mastitis. B. Fat necrosis. C. Fibro adenoma D. Fibrocystic changes. E. Sclerosing adenosis. Key: B0s. 06. 7. Page 2 of 17 SPECIAL PATHOLOGY (MCQs) Model Paper Topic: Breast A 41 year old man complained of swollen ankles. Physical examination revealed marked lower extremity edema and periorbital swelling. Urine dipstick was 4+ positive for protein but negative for blood and glucose. 24 hour urine collection showed proteinuria of 6 GM/day. The diagnosis A. Diabetic nephropathy. B. Membranoproliferative glomerulonephritis. C. Membranous glomerulonephritis. D. E . Minimal change disease. . Berger disease. Key: Topic: Urinary System A middle aged man consulted a physician for a lesion on his nose. On examination a flesh-colored lesion about 1 cm in diameter, with a rolled edge and central ulceration was seen. The most likely diagnosis is: A. Eczema. B. Psoriaris. C. Urticaria. D. E. . Verruca vulgaris. . Basal cell carcinoma. Key: E Topic: Skin The leading cause of mortality in ischaemic heart disease is sudden death which is due to: . Atrial fibrillation. . Ventricular fibrillation. A, B. C. Myocardial ischaemia. D. E. . Hypotension. . Coagulation necrosis. Key: B Topic: Cardiovascular System Wedge shaped shadow on chest X-ray indicates: A. Pneumonitis. B. Pulmonary edema. C. Pulmonary infarction. D. Ards. E. Pulmonary hemorrhage. Key: C Topic: Respiratory System09, 10. 11. Page 3 of 17 SPECIAL PATHOLOGY (MCQs) Model Paper A gastroenterologist performs a colonoscopy on a patient with ily history of gastric and color cancer and discovers le polyps. Biopsy of one lesion reveals benign hamartoma. On physical examination the patient is noted to have dark pigmentation of the buccal mucosa and lips. What is the diagnosis: A. Peutz Jeghers syndrome. B, Gardner's syndrome. C. Adenomatous polyposis coli D. Turcot’s syndrome. E. Helicobacter pylori infection. Key: A Topic: GIT An infant presented with mild anemia, jaundice and splenomegaly. CBC revealed spherocytosis with raised reticulocyte count. The condi i defective: A. Clathrin. B. Connexon. C. Spectrin. D. E. . Tubulin. . Dyenin. Key: C Topic: Hematology (Hereditary Spherocytosis) A 54 year old female with an abdominal mass undergoes exploration laparoscopy. Both ovaries are enlarged hence resected. Pathology report is Krukenberg tumor, indicating which of the following: A. Ectopic pregnancy. B. Endometriosis. C. Hyperestrogenic state. . E. . Immunosuppresion. :. Metastatic carcinoma. Key: E Topic: Female Genital Tract12. 13. 14, 15. Page 4 of 17 SPECIAL PATHOLOGY (MCQs) Model Paper A 60 year old man presented with progressive dysphagia. First for solids, then for liquids. Endoscopy revealed a large fungating mass 2 cm above gastroesophageal junction which was malignant on biopsy report. Which condition is associated With this development? A. Carcinoma stomach. B. Scleroderma, C. Esophageal webs. D. E. . Sliding hiatal hernia. Barrett's esophagus Key: E Topic: GIT 70 year old man presented with left ventricular failure and a harsh systolic murmur. Echocardiography revealed stenosis of aortic valve as well as hypertrophy and dilatation of the left ventricle. Which additional change would also be expected: A. Dilatation of ascending aorta. B. Dissection of ascending aorta, C. Calcification of aortic valve. D. Rupture of aortic valve. —. Vegetations on the aortic valve. Key: C Topie: Cardiovascular System A 40 year old man developed gynecomastia. On examination he was found to have enlarged right testicle. Orchiectomy was done and biopsy revealed homogenous population of large polygonal cells with abundant eosinophilic cytoplasm and round central nuclei. Which is the most likely diagnosis: A. Immature teratoma. B. Sertoli cell tumor. C. Spermatocytic seminoma. D. Leydig cell tumor. E, Teratoma with malignant transformation. Key: D Topic: Male Genital System A patient presented with a lump in his neck. Physical examination revealed a solitary firm thyroid nodule on the left side. The nodule does not enhance during 99 mTc imagin Serum 1, T, and TSH are normal, but serum calcitonin is elevated. Biopsy will reveal which of the following: ‘A. Parathyroid adenoma. B, Follicular carcinoma thyroid. C. Medullary carcinoma thyroid. D. gE, . Parathyroid carcinoma. Hashimoto thyroiditis. Key: € Topic: Endocrines16. 17. 18. Page 5 of 17 SPECIAL PATHOLOGY (MCQs) Model Paper Predisposing factors for carcinoma of the urinary bladder include: A, Diabetes. B. Hypertension. C. Smoking. D. Hypercholesterolemia. E. Obesity. Key: C Topic: Urinary System (urinary bladder) A child develops a tumor of the brainstem, which on biopsy demonstrates bizarre, pleomorphic tumor Cells accompanied by necrosis and heamorrage. Which of the following is the most likely diagnosis? A. Glioblastoma Multiforme. B. Ependymoma. C. Astrocytoma. D. Oligodendroglioma. E, Pilocytic astrocytoma, Key: A Topic: CNS A 60 year old male patient presented with bilateral cervical and axillary lymphadenopathy which develop over the last one year. Blood examination revealed TLC of 120 x 10°/I with normal platelet count and hemoglobin 9Gm/dl. Differential count showed 92% lymphocytes. Bone marrow examination will show: Hypocellular fragments with increased lymphocyes. Hypercellular fragments with increased lymphocytes. Hypercellular fragments with increased myeloid cells. Hypercellular fragments with increase in all cell lines. . Moderately cellular fragments with normal lymphocytes. ey: B RMON ee Topic: Hematology19. 20. 21. 22. Page 6 of 17 SPECIAL PATHOLOGY (MCQs) Model Paper A 15 year old girl was brought to the emergency in coma. Her breath smelt like acetone. Diagnosis would be most likely consistent with: A, Alcohol intoxication. B. Heroin overdose. C. Profound hypoglycemia. D. Diabetic ketoacidosis. E. Diazepam overdose. Key: D Topic: Chemistry Physical examination of a 45 year old man revealed thin arms and legs, a swollen abdomen, red tongue, dry and slightly yellow skin, gynecomastia, testicular atrophy, multiple spider angiomas, tremor and short-term memory loss. Which of the following conditions can be associated with thi A. Bronchogenic carcinoma. B. Colon carcinoma. C. Hepatic cirrhosis. D. Glomerulonephritis. E. Congestive heart failure. Key: € Topie: Liver A 47 year old man presented to the emergency with sudden ‘onset of severe upper abdominal pain with vomiting. Pain was in epigastrium radiating to the back. Serum amylase level was 2000 u/I. Which of the following are predisposing factors for his condition? Helicobacter pylori infection and excess gastric acid secretion. Hepatitis B infection and iron overload. Obesity and high serum cholesterol. Stress and cigarette use. . Alcohol use and gallstones. ey: E AMOOD> Topic: GIT Which of the following locations is most likely for the development of carcinoma in a person who has chewed tobacco for 15 years? ‘A. Floor of the mouth, B. Lower lip. C. Tongue. D. E. . Tonsils. . Upper lip. Key: B Topic: Oral Cavity23. 24. 25. 26. Page 7 of 17 SPECIAL PATHOLOGY (MCQs) Model Paper A. 49 year old female presented to her physician with a lump in her breast. Biopsy of the lump showed invasive ductal carcinoma. The connective tissue adjacent to the tumor was densely collagenous. This is an example of: A. Anlaplasia. B. Dysplasia. C. Desmoplasia. D. Carcinoma in SITU. E. Metaplasia. Key: C Topic: Breast A 61 year old male develops severe chest pain. He is diagnosed as a case of myocardial infarction after investigations. One week later he again complains of precordial pain, this time with fever and a loud friction rub. What is the most likely di is? A. Caseous pericarditis. B. Fibrinous pericarditis. C. Hemorrhagic pericarditis. D. Purulent pericarditis. E. Serous pericarditis. Key: B Topic: CVS Which of the following statements is correct for hepatocellular carcinoma: A. Strong tendency for invasion of vascular channels B. Strongly associated with hepatitis A. C. Females are more affected as compared to males. D. Morphology of hepatocellular carcinoma is usually of squamous cell carcinoma. E. Alpha-I antitrypsin deficiency predisposes to hepatocellular carcinoma. Key: A Topic: Heptobiliary System Which of the follo immune mediated vasculitis characterized by p-ANCA antibodies? A. Hepatitis A. B. Hepatitis B. C. Hepatitis C. D. Hepatitis D. E, Hepatitis E. Key: B Topic: Liver27. 28, 29. 30. Page 8 of 17 SPECIAL PATHOLOGY (MCQs) Model Paper e, radiographically dense crystals in the tissues of a knee joint is associated with which of the following types of arthropathy? A, Gonococcal arthritis. B. Gouty arthritis. C. Osteoarthritis. D. Pseudogout. E. Rheumatoid arthritis. Key: D Topic: Bones & Joints. A patient presents to a physician complaining of recurrent episodic diarrhea triggered by eating too much or drinking alcohol. He also starts wheezing and is flushed during the episodes. Chest X-ray shows a lung mass. Biopsy of the mass would reveal: A. Bronchio alveolar carcinoma. B. Squamous cell carcinoma. C. Carcinoid tumor. D E. . Primary tuberculosis. . Recurrent tuberculosis. Key: € Topic: Respiratory System Electron microscopy showing prominent deposits between the podocytes and the basement membrane of the glomerular capillaries are releted to infection with: A, Escherichia B. Klebsiella. C. Neisseria. D. Pseudomonas. E. Streptococcus. Key: E Topic: Kidney Oral examination of a 57 year old woman revealing a icm flat white patch on the buccal mucosa leading to oral malignancy would be: A. Leukoplakia. B. Hairy leukoplakia. C. Lichen planus. D. Oral thrush. E. Squamous papilloma. Key: A Topic: Oral Cavity31. 32. 33. 34, Page 9 of 17 SPECIAL PATHOLOGY (MCQs) Model Paper The testicular tumor occurring in young males and responsive to radiotherapy i A. Teratoma. B, Choriocarcinoma. C. Yolk sac tumor. D. Embryonal carcinoma. E, Seminoma. Key: E Topic: Male Genital System Which of the following CNS tumors has the best progno: Anaplastic astrocytoma (who grade III) Glioblastoma multforme. Well differentiated astrocytoma (who grade II) Medulloblastoma. . Oligodendroglioma Key: E moO Re Topic: CNS Tumors A large fungating mass protruding into the rectal lumen which on biopsy turns out to be an invasive malignant tumor composed of glandular structures is associated with: A. Diverticulitis. B. Diverticulosis. C. Juvenile polyposis syndrome. D. Crohn's disease. E, Ulcerative colitis. Key: E Topic: GIT An 18 year old boy has an automobile accident. Serum enzyme studies reveal a thousand fold increase in creatine kinase. Which tissue is the source of the enzyme? A. Heart. B. Skeletal muscle. C. Bone, D. Brain. E. Kidney. Key: B Topic: Musculoskeletal System35. 36. 37. 38, Page 10 of 17 SPECIAL PATHOLOGY (MCQs) Model Paper A 54 year old man comes to the emergency four hours after the onset of severe chest pain radiating to the left arm. Examination of which serum marker would best help in diagnosis: A. Aspartate aminotransferase. B. Creatine kinase-MB isoenzyme. C. Lactate dehydrogenase-I isoenzyme. D. Troponin. E. Total creatine kinase. Key: D Topic: Chemistry A woman smokes one pack/ day, she drinks at least 5 cups of coffee/ day, she has no children and she takes birth control pills. Her mother died of breast cancer. Which is the greatest risk factor for breast cancer in this patient? A. Birth control pills. B. Cigarette smoking. C. Family history. D. E. . Caffeine intake. . Nulliparity. Key: C Topic: Breast A 62 year old female is evaluated for uterine bleeding. Endometrial biopsy reveals marked endometrial hyperplasia. A left ovarian mass is noted which is solid and about 4cm in meter, The ovarian tumor A. Corpus albicans. B. Endometrioid carcinoma. C. Endometroitic cyst. D. E . Granulosa cell tumor. . Teratoma. key: D Topic: Female Genital Tract A woman with metastatic lung cancer develops profound weakness with alternating diarrhea and constipation. Physical examination shows hyperpigmentation of skin even in areas protected from the sun. Which endocrine organ is involved in the tumor? A. Pituitary gland. B. Adrenal gland. C. Endocrine pancreas. D. Ovaries. E. Thyroid gland. Key: B Topic: Endocrines39. 40. 41. 42. Page 11 of 17 SPECIAL PATHOLOGY (MCQs) Model Paper A 45 year old male patient presented with fever, cough, dyspnoea, sweats and rigors. Chest X-ray "showed parenchymal infiltrate. On auscultation bronchial breath sounds were heard. Diagnosis can be confirmed by: A. CBC. B. Gram stain and culture of sputum. C. Sputum for AFB, D. Blood gases. E. Bronchoscopy. Key: B Topic: Respiratory System A 21 year old girl complained of weakness, exertional dyspnoea and bleeding from the gums. On examination she was pale, febrile and showed gum hypertrophy along with hepatosplenomegaly. CBC showed HB 6.7 Gm/dl, TLC of 35,000/mm;, platelets were 20,000/mm’ and DLC revealed 6% blast cells. Diagnosis is: .. Immune thrombocytopenia. . Factor IX deficiency. A 8. C, Acute lymphoblastic leukemia. D. E. . Acute myeloblastic leukemia, . Chronic myeloid leukemia. Key: D Topic: Hematology Biopsy of a testicular mass revealed different tissues including cartilage, thyroid and neural tissue. A small focus of squamous cell carcinoma is also seen. Which appropriate type of tumor is it? A. Dermoid cyst. B. Embryona carcinoma. C. Immature teratoma. D. Solid mature teratoma. E. Teratoma with malignant transformation. Key: E Topic: Male Genital System A 65 year old man presented with a palpable lymph node below the left clavi Biopsy report was metastatic adenocarinoma. The primary tumor was most probably in: A. Liver. B. Colon. C. Stomach. D E. |. Pancreas. . Bladder.43. 44, 45. 46, Page 12 of 17 SPECIAL PATHOLOGY (MCQs) Model Paper X-ray of a patient show skull thickening with narrowing of foramina. There is bowing of femur and tibia as well and raised alkaline phosphates. Bone biopsy reveals mosaic pattern of bone spicules with prominent osteoid seams. Which neoplasm will it be? A. Astrocytoma. B. Osteosarcoma. C. Meningioma, D. Hodgkin's lymphoma, E. Non-hodgken’s lymphoma Key: B Topic: Musculo-skeletal system A biopsy of a very large neck mass shows a benign thyroid lesion composed of colloid filled follicles separated by fibrous scars. The most likely diagnosis is: A. Multinodular goiter. B. Diffuse non-toxic goiter. C. Subacute thyroiditis. D. Thyroid adenoma, E. Thyroid cyst. Key: A Topic: Endocrines A 65 year old woman presents with a pathologic fracture of the shaft of humerus. Xray shows multiple lytic and blastic bone lesions. Biopsy of lesion reveals adenocarcinoma. Which is the site of primary tumor? A. Breast. B. Thyroid C. Colon. D. Kidney. E. Lung. Key: A Topic: Breast A 60 year old man develops increased frequency of micturation, nocturia, dysuria, and difficulty in starting and stopping the flow of urine. Prostate specific antigen is normal and biopsy reveals benign tissue. The lesion is located i A. Peri-urethral prostate. B. Posterior prostate. C. Penile urethra. D. E. . Bladder neck . Ureter. Key: A Topic: Male Genital System47. 48. 49. 50. 51. Page 13 of 17 SPECIAL PATHOLOGY (MCQs) Model Paper Acute nephritic syndrome is characterized by: A. Proteinuria. B. Haematuria. C. Oedema, D. Hypertension. E. Hypoproteinemia. Key: B Which of the following statements is true for hepatitis A infection: A. Acarrier stat is common following initial i B. Mortality rate is about 10%. C. Infection is transmitted mainly by parenteral route. D. Incubation period is 2 - 4 weeks. . Infective units are called dane particles. Key: D fection. m Topic: Liver Benign prostatic hyperplasia originates in the: A, Transtional zone of prostate. B. Peripheral zone of prostate. C. Central zone of prostate. D. Periurethral zone of prostate. E. Capsule of the prostate, Key: ¢ Topic: Male Genital System ‘The most common tumor of the appendix is: ‘A. Adenoma. B. Mucinous adenocarcinoma. C. Mesothelioma. D. Squamous cell carcinoma, E. Carcinoid tumor. Key: E Topic: GIT The most common cause of abdo! A. Trauma. B. Syphilis. C. Atherosclerosis. D. E al aortic aneurysm is: . Vasculitides. . Hypertension.52. 53. 54, 55. Page 14 of 17 SPECIAL PATHOLOGY (MCQs) Model Paper A 6 year old boy presents with fever, an abdominal mass which has grown rapidly over the last four months accompanied by weight loss. Ultrasound confirms a solid space occupying lesion in the kidney. The diagnosis is: ‘A. Renal cell carcinoma. B. Transitional cell carcinoma of kidney. C. Squamous cell carcinoma of renal pelvis. D. E. . Wilms tumor. : Hydronephrosis. Key: D Topic: Kidney A female patient was operated for breast cancer. During the procedure mobile axillary nodes were found on the same side of the tumor which showed malignant cells. The size of the primary tumor was 2cm and no distant metastases was seen. The tumor will be staged as: A, Stage I. B. Stage II. C. Stage III. D. E. . Stage ITI b. . Stage IV. Key: B Topic: Breast A 55 year old man has persistent cough, weight loss and clubbing of fingers. X-ray of hand shows new bone formation beneath the periosteum. Which of the following condition is associated with it? ‘Ac Chronic renal failure. B. Colon cancer. C. Endocrine adenoma, D. Profound anemia. E, Lung cancer. Key: E Topic: Respiratory System Biopsy of the synovium of the knee joint in rheumatoid arthritis would reveal: A. A nearly normal synovium with scattered inflammatory cells. B. Anon-proliferative synovitis with abscess formation. . A non-proleferative synovitis with many neutrophils. c D. A proliferative synovitis with many eosinophils, neutrophils, plasma cells. E. A proliferative synovitis with many lymphocytes, macrophages, plasma cells. Key: E Topic: Musculoskeletal System56. 57. 58. 59, Page 15 of 17 SPECIAL PATHOLOGY (MCQs) Model Paper A pap-smear is graded as cervical intra-epithelial neoplasia, grade II (CIN II). Which of the following viruses is related to this neoplastic growth? A. Epstein Barr virus. B. Hepatitis B virus. C. Human papilloma virus. D. Human herpes virus 8. E. Human T-cell lymphotropic virus. Key: € Topic: Female Genital Tract nt has enlarged thyroid gland which on needle aspiration showed cell clusters suspicious for papillary carcinoma of the thyroid. Which of the following findings will support the diagnosis? ‘A. Anitschkow cells. B, Psammoma bodies. C. Auer rods. D. Reed Sternberg cells. E. Roth’s spots. Key: B Topic: Endocrines Conjugated hyperbilirubinemia is seen in: A. Hemolytic anemia. B. Physiologic jaundice of the newborn. C. Crigler-Najjar syndrome. D. Dubin-Johnson syndrome, E. Viral hepatitis. Key: D Topic: Hepato! ry System The most sensitive test to assess renal failure is: A. Serum sodium. B. Serum potassium. C, Serum urea. D. Serum creatinine. E. Creatinine clearance. Key: E Topic: Chemistry60, 61, 62. 63. Page 16 of 17 SPECIAL PATHOLOGY (MCQs) Model Paper A young boy presented with petechiae, haematuria, blee from gums and epistaxis. History was given of a snake Blood examination will show decreased level of: A, Platelets. B. Factor VIII. C. Prothrombin time. D. Activated partial thromboplastin time. E. Fibrin degradation products. Key: A Topic: Hematology Aschoff’s nodule shows the presence of: A. Coagulation necrosis. B. Aggregates of lymphocytes. C. Multinucleated giant cells. D. Numerous plasma cells. E. Marked fibrosis. A 61 year old diabetic female patient presents with bleeding per vaginum. On investigation she admitted to being childless and became menopausal at age 58, after which she started taking hormone replacement therapy and has gained weight by 10 kg. Ultrasound revealed a mass which turned out to be malignant. Diagnosis is: A. Carcinoma cervix. B. Carcinoma ovary. C. Carcinoma fallopian tume. D. Granulosa cell tumor. E. Carcinoma endometrium Key: E Topic: Female Genital Tract Gastric ulcers are characterized by: Males are affected more than females. Seen in younger age group. It is not associated with smoking. Common site is lesser curvature of stomach. : Common site is greater curvature of stomach Key: D moO BE Topic: GIT64, 6s. Page 17 of 17 SPECIAL PATHOLOGY (MCQs) Model Paper Cushing disease is a feature of: A. Chromophobe adenoma of pituitary gland. B. Acidophilic adenoma of pituitary gland. C. Basophilic adenoma of pituitary gland. D. Non-secreting adenoma of pituitary gland. E, Microprolactinoma. Key: C Topic: Endocrines A male patient presented with pseudo-hypertrophy of the muscles. Work up of the patient revealed elevated crea kinase levels with disturbance in dystrophin action. Chromosomal studies showed abnormal gene located at Xp21. The most likely diagnosis is: ‘A. Duchenne muscular dystrophy. B. Becker's muscular dystrophy: C. Thyrotoxic myopathy. D. E. . Dermatomyositis. . Polymyositis Key: A Topic: Musculoskeletal System