PATHOLOGY MCQS $J$

SYSTEMIC PATHOLOGY
QUESTION 1
An 80-year-old woman has had no major medical problems, but she has never been
physically active for most of her life. One day she falls out of bed and immediately notes a
sharp pain in her left hip. She is subsequently unable to ambulate without severe pain.
Radiographs show not only a fracture of the left femoral head, but also a compressed
fracture of T10. Which of the following conditions is she most likely to have?
A Vitamin D deficiency
B Acute osteomyelitis
C Osteogenesis imperfecta
D Osteoporosis
E Polyostotic fibrous dysplasia
F Metastatic breast carcinoma
QUESTION 1
An 80-year-old woman has had no major medical problems, but she has never been
physically active for most of her life. One day she falls out of bed and immediately notes a
sharp pain in her left hip. She is subsequently unable to ambulate without severe pain.
Radiographs show not only a fracture of the left femoral head, but also a compressed
fracture of T10. Which of the following conditions is she most likely to have?
A Vitamin D deficiency
B Acute osteomyelitis
C Osteogenesis imperfecta
D Osteoporosis
E Polyostotic fibrous dysplasia
F Metastatic breast carcinoma
QUESTION 2 ADD XRAY AND
HPE
A 51-year-old man has noted constant, dull right hip pain for the past 3 months. On
physical examination he has diminished range of motion of the right hip. A radiograph
reveals a 10 x 13 cm mass involving the right ischium of the pelvis. The mass has
irregular borders and there are extensive areas of bony destruction along with some
scattered calcifications. The lesion is resected, and grossly the mass has a bluish-white
cut surface. Which of the following is the most likely diagnosis?
A Osteosarcoma
B Enchondroma
C Osteoblastoma
D Chondrosarcoma
E Paget sarcoma
QUESTION 2
A 51-year-old man has noted constant, dull right hip pain for the past 3 months. On
physical examination he has diminished range of motion of the right hip. A radiograph
reveals a 10 x 13 cm mass involving the right ischium of the pelvis. The mass has
irregular borders and there are extensive areas of bony destruction along with some
scattered calcifications. The lesion is resected, and grossly the mass has a bluish-white
cut surface. Which of the following is the most likely diagnosis?
A Osteosarcoma
B Enchondroma
C Osteoblastoma
D Chondrosarcoma
E Paget sarcoma
QUESTION 3
A 62-year-old man has had back pain for 4 months. No abnormal findings are noted on physical
examination. Laboratory findings include WBC count of 3700/microliter, hemoglobin 10.3 g/dL,
hematocrit 31.1%, MCV 85 fL, and platelet count 110,000/microliter. His total serum protein is 9.5
gm/dl with an albumin of 4.1 gm/dl. A chest radiograph shows no abnormalities of heart or lung
fields, but there are several lucencies noted in the vertebral bodies. A sternal bone marrow aspirate
is performed and yields a dark red jelly-like material in the syringe. Which of the following cell
types is most likely to be numerous on microscopic examination of this aspirate?
A Giant cells
B Fibroblasts
C Osteoblasts
D Metastatic renal carcinoma cells
E Plasma cells
QUESTION 3
A 62-year-old man has had back pain for 4 months. No abnormal findings are noted on physical
examination. Laboratory findings include WBC count of 3700/microliter, hemoglobin 10.3 g/dL,
hematocrit 31.1%, MCV 85 fL, and platelet count 110,000/microliter. His total serum protein is 9.5
gm/dl with an albumin of 4.1 gm/dl. A chest radiograph shows no abnormalities of heart or lung
fields, but there are several lucencies noted in the vertebral bodies. A sternal bone marrow aspirate
is performed and yields a dark red jelly-like material in the syringe. Which of the following cell
types is most likely to be numerous on microscopic examination of this aspirate?
A Giant cells
B Fibroblasts
C Osteoblasts
D Metastatic renal carcinoma cells
E Plasma cells
QUESTION 4
A 20-year-old woman notes a mass in her left breast after following the directions for breast
self-examination provided by her health clinic. Her physician palpates a firm, 1 to 2 cm mass.
There is no nipple discharge and no pain. No axillary adenopathy is present. The overlying
skin of the breast appears normal. Her left breast is slightly larger than the right, a condition
she says has been present since puberty. Her urine pregnancy test is negative. Mammography
confirms the presence of a rounded density, which has no microcalcifications, and reveals no
lesions of the opposite breast. Which of the following is the most likely diagnosis?
A Focus of fat necrosis
B Fibroadenoma
C Intraductal papilloma
D Invasive breast carcinoma, NST
E Phyllodes tumor
QUESTION 4
A 20-year-old woman notes a mass in her left breast after following the directions for breast
self-examination provided by her health clinic. Her physician palpates a firm, 1 to 2 cm mass.
There is no nipple discharge and no pain. No axillary adenopathy is present. The overlying
skin of the breast appears normal. Her left breast is slightly larger than the right, a condition
she says has been present since puberty. Her urine pregnancy test is negative. Mammography
confirms the presence of a rounded density, which has no microcalcifications, and reveals no
lesions of the opposite breast. Which of the following is the most likely diagnosis?
A Focus of fat necrosis
B Fibroadenoma
C Intraductal papilloma
D Invasive breast carcinoma, NST
E Phyllodes tumor
QUESTION 5
A 19-year-old woman gave birth to a healthy male infant at term following an
uncomplicated pregnancy. She has now been breast feeding the baby for a month,
but notes that her left breast has gradually become swollen and painful to touch over
the past week. On physical examination her temperature is 38.2°C. Which of the
following is the most likely diagnosis?
A Acute mastitis
B Fibrocystic disease
C Fat necrosis
D Intraductal papilloma
E Galactocele
QUESTION 5
A 19-year-old woman gave birth to a healthy male infant at term following an
uncomplicated pregnancy. She has now been breast feeding the baby for a month,
but notes that her left breast has gradually become swollen and painful to touch over
the past week. On physical examination her temperature is 38.2°C. Which of the
following is the most likely diagnosis?
A Acute mastitis
B Fibrocystic disease
C Fat necrosis
D Intraductal papilloma
E Galactocele
QUESTION 6
A 35-year-old woman has noted a palpably firm, irregular mass in her right breast for the
past 3 months. On physical examination there is no tenderness or swelling. By
mammography there is an irregular 2 cm density that contains scattered microcalcifications.
Biopsy of this mass reveals extensive fat necrosis. Which of the following is the most likely
cause for this breast lesion?
A Pregnancy
B Prolactinoma
C Trauma
D Fibrocystic changes
E Lobular carcinoma in situ
F Mastitis
QUESTION 6
A 35-year-old woman has noted a palpably firm, irregular mass in her right breast for the
past 3 months. On physical examination there is no tenderness or swelling. By
mammography there is an irregular 2 cm density that contains scattered microcalcifications.
Biopsy of this mass reveals extensive fat necrosis. Which of the following is the most likely
cause for this breast lesion?
A Pregnancy
B Prolactinoma
C Trauma
D Fibrocystic changes
E Lobular carcinoma in situ
F Mastitis
QUESTION 7
A 30-year-old postpartum woman notes a palpable 'lump' in one of her breasts. The
lump appeared following cessation of breast feeding and has persisted for more than
one month. On examination there is a 1.5 cm movable nodule in her right breast. There
is no axillary lymphadenopathy. Fine needle aspiration is performed and fluid is
obtained. The lesion resolves and does not recur. Which of the following breast lesions
is most likely to fulfill these criteria?
A Papilloma
B Fat necrosis
C Galactocele
D Ductal epithelial hyperplasia
E Sclerosing adenosis
QUESTION 7
A 30-year-old postpartum woman notes a palpable 'lump' in one of her breasts. The
lump appeared following cessation of breast feeding and has persisted for more than
one month. On examination there is a 1.5 cm movable nodule in her right breast. There
is no axillary lymphadenopathy. Fine needle aspiration is performed and fluid is
obtained. The lesion resolves and does not recur. Which of the following breast lesions
is most likely to fulfill these criteria?
A Papilloma
B Fat necrosis
C Galactocele
D Ductal epithelial hyperplasia
E Sclerosing adenosis
QUESTION 8
A 49-year-old woman notes increasing size to her right breast over the past year. This
breast is not painful, but the heaviness causes some discomfort. On physical examination
the overlying skin and nipple appear normal. There is no nipple discharge. There is no
axillary lymphadenopathy. Mammography reveals a solid 12-cm circumscribed mass. The
mass is biopsied, and on microscopic examination shows a cellular stromal component
along with an epithelial component. Which of the following is the most likely diagnosis?
A Fibroadenoma
B Phyllodes tumor
C Sclerosing adenosis
D Hamartoma
E Medullary carcinoma
QUESTION 8
A 49-year-old woman notes increasing size to her right breast over the past year. This
breast is not painful, but the heaviness causes some discomfort. On physical examination
the overlying skin and nipple appear normal. There is no nipple discharge. There is no
axillary lymphadenopathy. Mammography reveals a solid 12-cm circumscribed mass. The
mass is biopsied, and on microscopic examination shows a cellular stromal component
along with an epithelial component. Which of the following is the most likely diagnosis?
A Fibroadenoma
B Phyllodes tumor
C Sclerosing adenosis
D Hamartoma
E Medullary carcinoma
QUESTION 9
A 50-year-old man dies from a sudden stroke. At
autopsy, he has a right basal ganglia hemorrhage.
He is found to have the microscopic appearance in
islets of Langerhans seen here. Which of the
following metabolic complications was he most
likely to have experienced during life?
A Hypoglycemic shock
B Ketoacidosis
C Cardiac arrhythmias
D Pancreatitis
E Hyperosmolar coma
QUESTION 9
A 50-year-old man dies from a sudden stroke. At
autopsy, he has a right basal ganglia hemorrhage.
He is found to have the microscopic appearance in
islets of Langerhans seen here. Which of the
following metabolic complications was he most
likely to have experienced during life?
A Hypoglycemic shock
B Ketoacidosis
C Cardiac arrhythmias
D Pancreatitis
E Hyperosmolar coma
QUESTION 10
A 45-year-old woman has had worsening
orthopnea for the past 3 years. She is unable to
tolerate strenuous exercise. She has had
increasing difficulty with swallowing for the past
year. On physical examination she has a cardiac
murmur. She is afebrile. Based upon the gross
appearances of her heart shown here, which of
the following is the most likely underlying cause
for her illness?
A Group A beta-hemolytic streptococcal
infection
B Uncontrolled diabetes mellitus
C Congenital anomaly
D Staphylococcus aureus infection
QUESTION 10
A 45-year-old woman has had worsening
orthopnea for the past 3 years. She is unable to
tolerate strenuous exercise. She has had
increasing difficulty with swallowing for the past
year. On physical examination she has a cardiac
murmur. She is afebrile. Based upon the gross
appearances of her heart shown here, which of
the following is the most likely underlying cause
for her illness?
A Group A beta-hemolytic streptococcal
infection
B Uncontrolled diabetes mellitus
C Congenital anomaly
D Staphylococcus aureus infection
QUESTION 11
A term male infant is noted to have a heart
murmur on examination soon after birth. The
representative gross appearance of his heart is
depicted here. Which of the following
underlying conditions is this child most likely
to have?
A Congenital syphilis
B Beta-myosin gene mutation
C Erythroblastosis fetalis
D Hypertension
E Endocardial fibroelastosis
F Trisomy 21
QUESTION 11
A term male infant is noted to have a heart
murmur on examination soon after birth. The
representative gross appearance of his heart is
depicted here. Which of the following
underlying conditions is this child most likely
to have?
A Congenital syphilis
B Beta-myosin gene mutation
C Erythroblastosis fetalis
D Hypertension
E Endocardial fibroelastosis
F Trisomy 21
QUESTION 12
A 36-year-old man incurs a traumatic
laceration to his right upper chest. This is
repaired. Over the next 3 months, he notes
the development of the lesion shown here,
which was excised. Microscopic
examination of this lesion is most likely to
show which of the following findings?
A Necrotizing acute inflammation
B Granulomas with caseous necrosis
C Apoptosis
D Dense collagen bundles
E Atypical squamous epithelium
QUESTION 12
A 36-year-old man incurs a traumatic
laceration to his right upper chest. This is
repaired. Over the next 3 months, he notes
the development of the lesion shown here,
which was excised. Microscopic
examination of this lesion is most likely to
show which of the following findings?
A Necrotizing acute inflammation
B Granulomas with caseous necrosis
C Apoptosis
D Dense collagen bundles
E Atypical squamous epithelium
QUESTION 13 ADD
MICROSCOPY
A 70-year-old woman goes to her physician for a routine
check-up. On physical examination she has the lesions seen
here over her face and upper chest. She reports that these
lesions have become larger and more numerous for about 10
years. On microscopic examination of one of these lesions,
which of the following findings is most likely to be present?
A Atypical cells containing melanin pigment
B Thickened squamous epithelium with keratin-filled cysts
C Marked acute and chronic inflammation with abscess
formation
D Small, dark blue cells resembling the basal layer of
epidermis
E Vesicle formation with acantholysis and multinucleated
cells
QUESTION 13
A 70-year-old woman goes to her physician for a routine
check-up. On physical examination she has the lesions seen
here over her face and upper chest. She reports that these
lesions have become larger and more numerous for about 10
years. On microscopic examination of one of these lesions,
which of the following findings is most likely to be present?
A Atypical cells containing melanin pigment
B Thickened squamous epithelium with keratin-filled cysts
C Marked acute and chronic inflammation with abscess
formation
D Small, dark blue cells resembling the basal layer of
epidermis
E Vesicle formation with acantholysis and multinucleated
cells
QUESTION 14
A 38-year-old lifeguard has been working at a
seaside resort for the past 16 years each summer. On
physical examination he has the skin lesion seen here
grossly. The lesion bleeds easily when traumatized. It
has doubled in size in the past 6 months. Which of
the following is the most likely diagnosis?
A Actinic keratosis
B Squamous cell carcinoma
C Nevocellular nevus
D Basal cell carcinoma
E Neurofibroma
F Seborrheic keratosis
G Melanoma
QUESTION 14
A 38-year-old lifeguard has been working at a
seaside resort for the past 16 years each summer. On
physical examination he has the skin lesion seen here
grossly. The lesion bleeds easily when traumatized. It
has doubled in size in the past 6 months. Which of
the following is the most likely diagnosis?
A Actinic keratosis
B Squamous cell carcinoma
C Nevocellular nevus
D Basal cell carcinoma
E Neurofibroma
F Seborrheic keratosis
G Melanoma
QUESTION 15
A 45-year-old woman developed dyspnea with
fever over the past week. Sputum culture
grows Streptococcus pneumoniae and a chest
radiograph shows extensive infiltrates of the right
lower lobe and a nodule with air-fluid level. Her
serum AST is 277 U/L and ALT 183 U/L. This is
the gross appearance of her liver. Which of the
following is most likely to produce this appearance
of her liver?
A Hepatitis A infection
B Colonic adenocarcinoma
C Chronic alcohol abuse
D Oral contraceptive use
E Dominant polycystic kidney disease
QUESTION 15 ADD
EXPLANATION
A 45-year-old woman developed dyspnea with
fever over the past week. Sputum culture
grows Streptococcus pneumoniae and a chest
radiograph shows extensive infiltrates of the right
lower lobe and a nodule with air-fluid level. Her
serum AST is 277 U/L and ALT 183 U/L. This is
the gross appearance of her liver. Which of the
following is most likely to produce this appearance
of her liver?
A Hepatitis A infection
B Colonic adenocarcinoma
C Chronic alcohol abuse
D Oral contraceptive use
E Dominant polycystic kidney disease
QUESTION 16
A 19-year-old man goes to his physician for a
routine check-up. The physical examination is
normal except that his stool is positive for occult
blood. A colonoscopy is performed and there are
over 100 lesions of the colonic mucosa and
biopsy of one shows findings seen here
microscopically. Which of the following is the
most likely diagnosis?
A Hereditary non-polyposis colon carcinoma
B Hyperplastic polyps
C Ulcerative colitis
D Peutz-Jehgers syndrome
E Familial polyposis coli
QUESTION 16
A 19-year-old man goes to his physician for a
routine check-up. The physical examination is
normal except that his stool is positive for occult
blood. A colonoscopy is performed and there are
over 100 lesions of the colonic mucosa and
biopsy of one shows findings seen here
microscopically. Which of the following is the
most likely diagnosis?
A Hereditary non-polyposis colon carcinoma
B Hyperplastic polyps
C Ulcerative colitis
D Peutz-Jehgers syndrome
E Familial polyposis coli
QUESTION 17
A 42-year-old man has had episodes of substernal
burning pain following meals for the past 4 years. He has
no nausea or vomiting. On physical examination his stool
occult blood is negative. An upper GI endoscopy is
performed, and there are regions of the lower esophageal
mucosa 1 to 4 cm above the gastroesophageal junction
that appear erythematous. The microscopic appearance
of a biopsy from his lower esophagus is shown. Which of
the following is the most likely diagnosis?
A Gastroesophageal reflux disease
B Systemic sclerosis
C Helicobacter pylori infection
D Chronic alcoholism
E Corticosteroid therapy
QUESTION 17
A 42-year-old man has had episodes of substernal
burning pain following meals for the past 4 years. He has
no nausea or vomiting. On physical examination his stool
occult blood is negative. An upper GI endoscopy is
performed, and there are regions of the lower esophageal
mucosa 1 to 4 cm above the gastroesophageal junction
that appear erythematous. The microscopic appearance
of a biopsy from his lower esophagus is shown. Which of
the following is the most likely diagnosis?
A Gastroesophageal reflux disease
B Systemic sclerosis
C Helicobacter pylori infection
D Chronic alcoholism
E Corticosteroid therapy
QUESTION 18
A 65-year-old man has had worsening renal failure for the past
10 years. He now requires hemodialysis. An abdominal
ultrasound reveals that both his kidneys are enlarged. Based
upon this gross appearance of his kidneys shown here, which
of the following conditions is he most likely to have?
A Systemic lupus erythematosus
B Renal cell carcinoma
C Urinary tract obstruction
D Dominant polycystic kidney disease
E Chronic glomerulonephritis
QUESTION 18
A 65-year-old man has had worsening renal failure for the past
10 years. He now requires hemodialysis. An abdominal
ultrasound reveals that both his kidneys are enlarged. Based
upon this gross appearance of his kidneys shown here, which
of the following conditions is he most likely to have?
A Systemic lupus erythematosus
B Renal cell carcinoma
C Urinary tract obstruction
D Dominant polycystic kidney disease
E Chronic glomerulonephritis
QUESTION 19
A 35-year-old man notes passing dark urine following a
flu-like illness that has lasted for 10 days. On physical
examination his blood pressure is 140/90 mm Hg.
Urinalysis shows hematuria. A week later his serum
creatinine is 2.9 mg/dL. A renal biopsy is performed and
microscopic examination with immunofluorescence
pattern with antibody against human IgA is shown here.
Which of the following is the most likely diagnosis?
A Lupus nephritis
B Goodpasture syndrome
C Berger disease
D Membranoproliferative glomerulonephritis
E Membranous nephropathy
QUESTION 19
A 35-year-old man notes passing dark urine following a
flu-like illness that has lasted for 10 days. On physical
examination his blood pressure is 140/90 mm Hg.
Urinalysis shows hematuria. A week later his serum
creatinine is 2.9 mg/dL. A renal biopsy is performed and
microscopic examination with immunofluorescence
pattern with antibody against human IgA is shown here.
Which of the following is the most likely diagnosis?
A Lupus nephritis
B Goodpasture syndrome
C Berger disease
D Membranoproliferative glomerulonephritis
E Membranous nephropathy
QUESTION 20
A 32-year-old woman has the acute onset of fever,
cough, and dyspnea as she is preparing to leave her
work and go home. When she gets home the symptoms
have abated. This scenario is repeated on multiple
occasions over the next 6 weeks. On physical
examination she has no abnormal findings. A
transbronchial biopsy is performed after she is
hospitalized with respiratory distress. The microscopic
appearance of the biopsy is shown here. Which of the
following is the most likely diagnosis?
A Influenza viral pneumonia
B Hypersensitivity pneumonitis
C Diffuse alveolar damage
D Miliary tuberculosis
QUESTION 20
A 32-year-old woman has the acute onset of fever,
cough, and dyspnea as she is preparing to leave her
work and go home. When she gets home the symptoms
have abated. This scenario is repeated on multiple
occasions over the next 6 weeks. On physical
examination she has no abnormal findings. A
transbronchial biopsy is performed after she is
hospitalized with respiratory distress. The microscopic
appearance of the biopsy is shown here. Which of the
following is the most likely diagnosis?
A Influenza viral pneumonia
B Hypersensitivity pneumonitis
C Diffuse alveolar damage
D Miliary tuberculosis