PATHOLOGY TERM 3 TEST

MULTIPLE CHOICE QUESTIONS (MCQs). Indicate T for true or F for false in the
separate answer sheet provided for MCQs and 1/4 mark will be deducted for each wrong
answer.

1. Which of the following twin pregnancies can allow Twin to Twin transfusion?

A. Dichorionic diamnionic

B. Monochorionic diamnionic

C. Dichorionic diamnionic fused

D. Monochorionic monoamnionic

2. Extramammary paget disease is?

A. Carcinoma in situ

B. Pruritic

C. Ulcerative

D. Erythematous

3. Verrucous lesions on the vulva, perineum and vagina comprising sessile branching epithelial
proliferations of stratified squamous epithelium due to HPV are called?

A. Condyloma latum

B. Condyloma Acuminatum

C. Squamous papillomas

D. Fibroepithelial polyps

4. A unilateral, painful cystic lesion due to inflammatory occlusion of the draining ducts situated
at the lower vestibule adjacent to the vaginal canal is called?

A. Papillary hidradenoma

B. Squamous papilloma
C. Vulvar papillomatosis

D. Bartholin cyst

5. Partial hydatidiform mole is characterized by?

A. High risk of choriocarcinoma

B. Normal chromosomal profile

C. Abnormal vaginal bleeding

D. Metastasis to the lungs

6. Risk factors for breast cancer include:

A. Cigarette smoking

B. Radiation exposure

C. Prolonged breast feeding

D. Use of contraceptive pills

7. Raised serum levels of HCG is associated with the following except?

A. Complete hydatidiform mole

B. Choriocacinoma

C. Partial hydatidiform mole

D. ovarian cancer

8. Which of the following are true about cancer of the prostate?

A. Is more common in castrated men

B. Arises from the transitional zone

C. May present with acute urinary retention

D. Arises from peripheral zone

9. The differential diagnosis of Extramammary paget disease is?

A. Melanoma vs Carcinoma

B. Melanoma vs Papilloma

C. Carcinoma vs Papilloma

D. Sarcoma vs Teratoma

10. Which of the following are e complications of cryptorchidism?

A. Testicular atrophy

B. Infertility

C. Increased risk for seminoma

D. Increased risk for BPH

11. Focal persistence of columnar epithelium in the upper one third (1/3) of the vagina is called?

A. Adenosis

B. Lichen sclerosus

C. Squamous cell hyperplasia

D. Carcinoma in situ

12. Which of the following are e morphological features of ductal carcinoma in situ?

A. Paget disease

B. Noncomedo DCIS

C. Comedocarcinoma

D. Erythematous eruption

13. The following is true about high risk HPV

A. E6 increases destruction of p53

B. E6 decreases destruction of p53

C. E7 increases destruction of Rb

D. E7 decreases destruction of Rb

14. Which of the following are non-neoplastic epithelial disorders?

A. Papillary hidradenoma

B. Lichen Sclerosus

C. Extramammary Paget disease

D. Squamous cell hyperplasia

15. Which of the following are causes of orchitis?

A. E coli

B. Autoimmune

C. Mumps

D. Chlamydia trachomatis

16. Which of the following are glandular neoplastic lesions?

A. Papillary hidradenoma

B. Lichen Sclerosus

C. Extramammary Paget disease

D. Squamous cell hyperplasia

17. Which type of infarction can Testicular torsion lead to?

A. Hemorrhagic infarction

B. White infarction
C. Red infarction

D. Anemic infarction

18. Extramammary Paget disease is?

A. PAS +

B. Keratin+

C. PAS-

D. Keratin -

19. Chronic endometritis histologically present with?

A. Eosinophils

B. Neutrophils

C. Plasma cells

D. Mast cells

20. Which of the following causes preeclampsia?

A. Endothelial dysfunction

B. Angiogenesis imbalance

C. Antiangiogenesis imbalance

D. Coagulation abnormalities

21. Which of following conditions presents with abnormal uterine bleeding?

A. Anovulatory cycle

B. Polyps

C. Endometrial hyperplasia

D. Leiomyoma
22. Polycystic ovary syndrome or (PCOD) is due to?

A. Increased LH

B. Increased FSH

C. Decreased LH

D. Decreased FSH

23. Which of the following are proliferative diseases without atypia?

A. ADH

B. Adenosis

C. Papilloma

D. Duct ectasia

24. Which of the following are fibrocystic changes of the breast?

A. Cysts

B. Adenosis

C. Apocrine change

D. Fibrosis

25. Which of the following can cause galactorrhea?

A. Drugs

B. Prolactinoma of the posterior pituitary

C. Nipple stimulation

D. Prolactinoma of the anterior pituitary

26. Which of the following are common symptoms of cerebral vascular disease?
a) Sudden confusion or difficulty understanding

b) Unilateral facial drooping

c) Sensory disturbances in the extremities

d) Mood swings and irritability

27. Which of the following are common risk factors for developing osteoporosis?

a) Female gender

b) Advanced age

c) Sedentary lifestyle

d) High calcium intake

28. Which of the following are characteristic features of osteomalacia?

a) Softening of the bones

b) Vitamin D deficiency

c) Impaired bone mineralization

d) Increased bone density

29. Which of the following are potential causes of bone tumors?

a) Genetic mutations

b) Exposure to radiation

c) Chronic osteoporosis

d) chronic osteomyelitis

30. Which of the following are associated with osteochondroma?

a) Benign bone tumor

b) Cartilage overgrowth
c) Risk of malignant transformation

d) Commonly affects long bones

31. Which of the following are potential causes of osteopenia?

a) Hormonal changes (e.g., menopause)

b) Prolonged use of corticosteroids

c) Excessive calcium intake

d) Regular weight-bearing exercise

32. Which of the following are potential complications of osteomyelitis?

a) Bone necrosis

b) Abscess formation

c) Septicemia

d) Osteoarthritis

33.Which of the following are two most common types of bone tumors?

a) Osteosarcoma

b) Chondrosarcoma

c) Ewing's sarcoma

d) Multiple myeloma

34. Which of the following are characteristic features of osteogenesis imperfecta?

a) Fragile bones prone to fractures

b) Blue discoloration of the sclera

c) Thickened and deformed bones

d) Hearing loss
35. Which of the following are associated with osteomalacia?

a) Softening of bones due to vitamin D deficiency

b) Bowing deformities in weight-bearing bones

c) Increased bone density.

d) Impaired bone mineralization

36. Which of the following are common symptoms of osteomyelitis?

a) Bone pain

b) Swelling and redness over the affected area

c) Limited range of motion in nearby joints

d) High bone mineral density

37. Which of the following are associated with osteoarthritis?

a) Degeneration of joint cartilage

b) Formation of bone spurs (osteophytes)

c) Inflammatory autoimmune response

d) Joint stiffness and limited range of motion

38. Which of the following are potential causes of hydrocephalus?

a) Congenital malformations

b) Brain tumors

c) Head trauma

d) Cerebral infarction

39. Which of the following are signs and symptoms of increased intracranial pressure?
a) Severe headache

b) Nausea and vomiting

c) Papilledema (swelling of the optic disc)

d) Hypotension

40. Which of the following are types of traumatic vascular injuries is associated with rapid loss
consciousness, a brief lucid period and again deep loss of consciousness?

a) Epidural hematoma

b) Subdural hematoma

c) Subarachnoid hemorrhage

d) Cerebral aneurysm

41. Which of the following are common symptoms of cerebral vascular disease?

a) Sudden severe headache

b) Weakness or numbness on one side of the body

c) Difficulty speaking or understanding speech

d) Euphoria and hyperactivity

42. Which of the following are potential causes of obstructive hydrocephalus?

a) Tumour blocking the cerebrospinal fluid (CSF) flow

b) Infection in the brain tissue

c) Congenital malformation of the cerebral blood vessels

d) Aqueductal stenosis

43. Which of the following are characteristic features of acute myeloid

leukemia (AML)?
a) Increased blasts in the bone marrow

b) Cytogenetic abnormalities, such as t(15;17)

c) Auer rods in the cytoplasm of leukemic blasts

d) Predominantly affects children and young adults

44. Which of the following are types of myeloproliferative neoplasms (MPNs)?

a) Chronic myeloid leukemia (CML)

b) Polycythemia vera (PV)

c) Myelofibrosis (MF)

d) Acute lymphoblastic leukemia (ALL)

45. Which of the following are true regarding chronic myeloid leukemia (CML)?

a) Presence of the Philadelphia chromosome (t(9;22))

b) Increased levels of the BCR-ABL1 fusion gene

c) Elevated white blood cell count, mainly rbcs

d) Predominantly affects older individuals

46. Which of the following are types of Hodgkin lymphoma?

a) Nodular lymphocyte-predominant Hodgkin lymphoma

b) Diffuse large B-cell lymphoma

c) Classical Hodgkin lymphoma

d) Burkitt lymphoma

47. Which of the following are true regarding chronic lymphocytic leukemia (CLL)?

a) It is characterized by the accumulation of monoclonal B lymphocytes.

b) It commonly presents with lymphadenopathy and splenomegaly.

c) It is typically associated with anemia and thrombocytopenia. d) The presence of the CD5
marker is a diagnostic hallmark.

48. Which of the following subtypes of non-Hodgkin lymphoma are germinal centre B cells?

a) Follicular lymphoma

b) Mantle cell lymphoma

c) Diffuse large B-cell lymphoma

d) Burkitt lymphoma

49. Which of the following are characteristic features of Burkitt lymphoma?

a) Associated with Epstein-Barr virus (EBV) infection

b) Abnormal expression of the c-MYC oncogene

c) Predominantly affects children and young adults

d) Involves extranodal sites such as the jaw and abdomen

50. Which of the following are types of plasma cell neoplasms?

a) Multiple myeloma

b) Waldenström macroglobulinemia

c) Follicular lymphoma

d) Marginal zone lymphoma

SECTION B; ESSAY QUESTIONS. ANSWER ALL QUESTIONS FROM THIS

SECTION, 15 MARKS EACH. REMEMBER QUALITY AND NOT QUANTITY.

1. Write notes on the pathogenesis of Benign Prostate Hyperplasia (BPH) highlighting two main
contributing processes to enlargement.

Benign Prostate Hyperplasia (BPH) is a common condition characterized by noncancerous

enlargement of the prostate gland in aging men. The pathogenesis of BPH involves a complex
interplay of various factors, including hormonal changes, stromal-epithelial interactions, and
growth factors. Two main contributing processes to the enlargement of the prostate in BPH are
as follows:

1. Hormonal Imbalance: Hormonal changes, specifically alterations in androgen and

estrogen levels, play a crucial role in the development of BPH. Testosterone, the primary
androgen, is converted to dihydrotestosterone (DHT) by the enzyme 5-alpha reductase in
the prostate gland. DHT promotes the growth and proliferation of prostatic cells.
However, with aging, the balance between testosterone and estrogen shifts due to
increased estrogen production and decreased testosterone levels. This hormonal
imbalance contributes to prostatic enlargement by stimulating the proliferation of
prostatic stromal and epithelial cells.

2. Stromal-Epithelial Interactions: The prostate gland consists of both stromal and

epithelial cells. In BPH, abnormal interactions between these two cell types contribute to
the enlargement of the prostate. The stromal cells produce growth factors and cytokines
that promote the proliferation of epithelial cells. Similarly, the epithelial cells secrete
factors that influence the stromal cells. This cross-talk between stromal and epithelial
cells leads to an imbalance in cell growth and differentiation, resulting in the excessive
proliferation of prostatic cells and subsequent enlargement of the gland.

2. Discus the causes and pathophysiology of increased intracranial pressure and further write
notes on Uncal (transtentorial) herniation

Increased intracranial pressure (ICP) refers to the elevation of pressure within the skull. It can
occur due to various underlying causes and can have serious implications for brain function and
perfusion. Some common causes of increased ICP include:

1. Brain Trauma: Traumatic brain injury, such as a severe blow to the head or a
penetrating injury, can result in increased ICP. The trauma can cause bleeding, swelling,
or the formation of hematomas within the brain, leading to elevated pressure.

2. Brain Tumors: Tumors within the brain can cause increased ICP by occupying space
and exerting pressure on surrounding tissues. As the tumor grows, it compresses brain
structures and impedes the flow of cerebrospinal fluid (CSF).

3. Cerebral Edema: Swelling or inflammation of the brain, known as cerebral edema, can
increase ICP. This can occur due to various factors, including infections, ischemic injury,
metabolic disturbances, or the presence of toxins.
 4. Hydrocephalus: Hydrocephalus is a condition characterized by the accumulation of
excess CSF within the ventricles of the brain. It can result from an obstruction in the
normal flow or absorption of CSF, leading to increased ICP.

Pathophysiology of Increased Intracranial Pressure:

The skull is a rigid structure that contains the brain, blood vessels, and CSF. Any increase in the
volume of these components, such as bleeding, swelling, or fluid accumulation, leads to an
increase in ICP. The brain has limited space within the skull, and any increase in pressure can
cause compression and displacement of brain tissue, impairing its function and blood flow. This
can result in a cascade of pathological events, including:

1. Impaired Cerebral Blood Flow: Increased ICP can compress cerebral blood vessels,
reducing blood flow to the brain. This compromises oxygen and nutrient delivery, leading
to ischemia and further brain injury.

2. Shift of Brain Structures: As ICP rises, brain structures may shift or herniate, trying to
find space within the rigid skull. This can lead to compression of vital structures and
disruption of normal brain function.

3. Impaired Cerebrospinal Fluid Dynamics: Elevated ICP can affect the normal flow and
absorption of CSF. It can obstruct the pathways through which CSF circulates, leading to
hydrocephalus or increased accumulation of fluid within the brain ventricles.

4. Cerebral Ischemia and Cell Injury: Prolonged elevation of ICP reduces cerebral
perfusion pressure (CPP), which is the pressure needed to maintain blood flow to the
brain. Insufficient CPP results in cerebral ischemia and neuronal injury, further
exacerbating the pathological consequences of increased ICP.

Notes on Uncal (Transtentorial) Herniation:

Uncal herniation is a specific type of herniation that occurs when the uncus, a part of the
temporal lobe, displaces and compresses adjacent structures due to increased ICP. This
herniation pattern is significant because it can lead to severe neurological deficits and is
considered a neurosurgical emergency. Some key features of uncal herniation include:

1. Clinical Presentation: Uncal herniation commonly presents with a triad of symptoms

known as the Kernohan's triad. This triad includes ipsilateral dilated pupil (due to
compression of the oculomotor nerve), contralateral hemiparesis (due to compression of
the cerebral peduncle), and altered mental status.

2. Pathophysiology: Increased ICP causes the medial aspect of the temporal lobe, including
the uncus, to herniate through the tentorial notch, a narrowopening in the tentorium
cerebelli, which is a fold of the dura mater separating the cerebrum from the cerebellum.
 This displacement of the uncus puts pressure on adjacent structures, such as the
oculomotor nerve (cranial nerve III) and the midbrain, leading to the characteristic
symptoms of uncal herniation.

3. Oculomotor Nerve Compression: Compression of the oculomotor nerve results in

pupillary dilation on the same side as the herniation. This occurs because the
parasympathetic fibers within the oculomotor nerve, which control constriction of the
pupil, are affected first.

4. Cerebral Peduncle Compression: The cerebral peduncle, located in the midbrain,

contains descending motor tracts. Compression of the cerebral peduncle due to uncal
herniation leads to contralateral hemiparesis or weakness on the side opposite to the
herniation. This occurs because the motor pathways that control voluntary movement are
affected.

5. Altered Mental Status: As uncal herniation progresses and further compromises brain
function, it can lead to a decline in consciousness and altered mental status. This can
range from confusion to coma, depending on the extent of the herniation and associated
brain injury.