MEDICAL BOARD REVIEW

IN ORGAN SYSTEM PATHOLOGY

JULY 31, 2016
FELIPE S TEMPLO, JR.,MD, FPSP
ANATOMIC & CLINICAL PATHOLOGY
CARDIOVASCULAR PATHOLOGY
 COVERAGE
PART 1 ( 8-9:50) :
SHORT LECTURE AND QUESTIONS
1. VASCULAR PATHOLOGY
2. CARDIAC PATHOLOGY
3. RESPIRATORY PATHOLOGY
4. GALLBLADDER PATHOLOGY
5. LIVER PATHOLOGY
6. CENTRAL NERVOUS SYSTEM PATHOLOGY
 COVERAGE
PART 2 (10:10-12) :
QUESTIONS WITH DISCUSSIONS
1. ENDROCRINE PATHOLOGY
2. MUSCULOSKELETAL PATHOLOGY
3. RENAL PATHOLOGY
4. HEMATOPATHOLOGY
5. PANCREAS/GI PATHOLOGY
VASCULAR PATHOLOGY
 VASCULAR PATHOLOGY
VASCULITIS
• 1. POLYARTERITIS NODOSA
-varied symptoms
- segmental necrotizing vasculitis
-fatal in most cases
 
• 2. CHURG-STRAUSS SYNDROME
(allergic granulomatosis and angiitis)
 
• 3. WEGENERS GRANULOMATOSIS
 
• 4. TEMPORAL ARTERITIS
-associated with HLA-DR4
- segmental granulomatous vasculitis
 VASCULAR PATHOLOGY
5. TAKAYASU ARTERITIS (pulseless disease)
 

• 6.BUERGER DISEASE (thromboangiitis obliterans)

 
• 7. KAWASAKI DISEASE (mucocutaneous lymph node syndrome)
 
 VASCULAR PATHOLOGY
• RAYNAUD DISEASE VERSUS RAYNAUD
PHENOMENON
 
• 1.PRIMARY RAYNAUD PHENOMENON (RAYNAUD DISEASE)
-no underlying disease or pathology
 
• 2. SECONDARY RAYNAUD PHENOMENON
-secondary to scleroderma, SLE, Buerger disease,
atherosclerosis
 VASCULAR PATHOLOGY
• ARTERIOSCLEROSIS 
• 1.MONCKEBERG MEDIAL CALCIFIC SCLEROSIS –medium sized
arteries
• 2. ARTERIOLOSCLEROSIS- small arteries and arterioles
• 3. ATHEROSCLEROSIS- aorta and muscular arteries
• Stages :
a.Fatty streak
b.Uncomplicated atheromatous plaque
c.Complicated atheromatous plaque
d.Clinical complications
 VASCULAR PATHOLOGY
 
HYPERTENSION- > 140/90 mm Hg
A. BENIGN HYPERTENSION-95%

B. MALIGNANT (Accelerated) HYPERTENSION

 VASCULAR PATHOLOGY
ANEURYSMS AND ARTERIOVENOUS FISTULA

• 1.ANEURYSMS-congenital or acquired
• 2.ATHEROSCLEROTIC ANEURYSMS
• 3. SYPHILITIC ANEURYSM
• 4. AORTIC DISSECTING ANEURYSMS
• 5. BERRY ANEURYSMS
• 6. MICROANEURYSMS
• 7. MYCOTIC ANEURYSMS
• 8. ARTERIOVENOUS FISTULA
 VASCULAR PATHOLOGY

• VENOUS DISEASES
A. DEEP VENOUS THROMBOSIS
B. VARICOSE VEINS
Superficial Veins of the Lower Extremities
Esophageal Varices
Hemorrhoids
•
VASCULAR PATHOLOGY
VASCULAR NEOPLASMS

• 1.HEMANGIOMAS-extremely common, benign tumors

-most common in infants

• 2.HEMANGIOBLASTOMAS-associated with Von Hippel-Lindau Disease

 
3.GLOMUS TUMORS (Glomangioma)-painful under the fingernails
 
• 4.KAPOSI SARCOMA- associated with HHV8

– Classic European form

– Transplant Associated form
– African form
– AIDS associated form
 
• 5. ANGIOSARCOMA (Hemangiosarcoma)- malignant
-occur in skin, breast, liver, soft tissue
-associated with vinyl chloride, arsenic and thorotrast
 
CARDIAC PATHOLOGY
 CARDIAC PATHOLOGY
 
• ISCHEMIC HEART DISEASE

• CARDIAC ISCHEMIA
 
• ANGINA PECTORIS
 
A. Stable
B. Prinzmetal
• C.Unstable or Crescendo
 CARDIAC PATHOLOGY
MYOCARDIAL INFARCTION (MI)- Coagulation Necrosis 
• LAD (45%), RCA (35%), LCA (15%)

Type of Infarctions:
Transmural ( >50% of the wall)
Subendocardial (< 50% of the wall)

Clinical Presentation
Serum Markers
Gross Sequence of Changes
No visible changes ( 0-4 h)--------------White,firm scar (months)
Microscopic Changes
(Wavy fibers/contraction bands (1-4 h)---------fibrotic scar (6 weeks)
Complications

SUDDEN CARDIAC DEATH- fatal cardiac arrhythmia ( ventricular fibrillation)

• -80% due to CAD
 CHRONIC ISCHEMIC HEART DISEASE
 
 CARDIAC PATHOLOGY

• CONGESTIVE HEART FAILURE

1. LEFT SIDED FAILURE
2. RIGHT SIDED FAILURE
-most commonly caused by LEFT SIDED FAILURE
 CARDIAC PATHOLOGY
VALVULAR HEART DISEASE
 

1.DEGENERATIVE CALCIFIC AORTIC VALVE STENOSIS

 

2.MITRAL VALVE PROLAPSE

 

3.RHEUMATIC HEART DISEASE/ACUTE RHEUMATIC FEVER

 

Rheumatic fever- Jones Criteria

-Group A Beta-hemolytic streptococci
4. ACUTE RHEUMATIC HEART DISEASE
Aschoff bodies, Anitschkow cells
5. CHRONIC RHEUMATIC HEART DISEASE
 
6 .INFECTIOUS BACTERIAL ENDOCARDITIS
Acute Endocarditis- S. aureus
Subacute Endocarditis- Streptococci group viridians

7. MARANTIC ENDOCARDITIS (Non Bacterial Thrombotic Endocarditis)

 
 CARDIAC PATHOLOGY
CONGENITAL HEART DISEASE 
• 1.COARCTATION OF AORTA
-Preductal
-Postductal
• 2.TETRALOGY OF FALLOT
-Pulmonary outflow obstruction/stenosis
-Right Ventricular Hypertrophy
-Ventricular Septal Defect
-Overriding Aorta
• 3.TRANSPOSITION OF GREAT VESSELS
• 4.TRUNCUS ARTERIOSUS
• 5.TRICUSPID ATRESIA
• 6.VENTRICULAR SEPTAL DEFECT
• 7.ATRIAL SEPTAL DEFECT
• 8.PATENT DUCTUS ARTERIOSUS
 CARDIAC PATHOLOGY
PRIMARY CARDIOMYOPATHIES (DIAGNOSIS OF EXCLUSION)

1. DILATED CARDIOMYOPATHY-most common 

2. HYPERTROPHIC CARDIOMYOPATHY (Asymmetrical Septal Hypertrophy

and
Idiopathic Hypertrophic Subaortic Stenosis
 
3. RESTRICTIVE CARDIOMYOPATHY-uncommon
 

CARCINOID HEART DISEASE

Right sided
Elevated 5-HIAA
 CARDIAC PATHOLOGY
CARDIAC TUMORS

CARDIAC MYXOMA-benign
-tumor emboli/ball valve obstruction of the valves

CARDIAC RHABDOMYOMA- benign, associated with Tuberous

Sclerosis
CARDIAC ANGIOSARCOMA- malignant
 QUESTIONS
Of the following specific causes of hypertrophic
(diastolic disorder) cardiomyopathy, one does not
belong:

A. Valvular heart disease

B. Infants of diabetic mothers
C. Glycogen storage disease
D. Friedrich’s ataxia
 QUESTIONS
Floppy valve syndrome (Barlow’s syndrome) usually
seen in women between the ages of 20 to 40
years most commonly involves the:

A. Tricuspid valve
B. Pulmonic valve
C. Aortic valve
D. Mitral valve
 QUESTIONS
An 18 year old male manifested with a “step ladder” body
temperature pattern for the past 2 days. A cardiac murmur was
auscultated over the aortic area which changed in character just
before death. Post mortem revealed perforated aortic valve cusp, with
friable fibrin deposition. The most likely diagnosis:

A. Polypoid myxoma
B. Subacute bacterial endocarditis
C. Libman-Sack endocarditis
D. Acute bacterial endocarditis
 QUESTIONS
Valvular diseases showing diagnostic friable bulky,
usually bacteria laden vegetations on the heart
valve are those of:

A. Rheumatic heart disease

B. Libman-Sacks disease
C. Non-bacterial endocarditis
D. Infective endocarditis
 QUESTIONS
The only part of the heart which may not be
relatively immune to metastatic malignancy:
A. Aortic valve portion of the interventricular septum
B. Pulmonary outflow tract
C. Pericardium
D. Myocardium
 QUESTIONS
A functional carcinoid tumor metastatic to the
liver leads to endocardial plaque formation in
the heart and results in:
A. Pulmonary valve stenosis
B. Coronary artery occlusion
C. Tricuspid valve stenosis
D. Libman-Sacks endocarditis
 QUESTIONS
• “Bread and Butter ‘ pericarditis so called
because of thick, shaggy fibrin deposits
between the parietal and visceral pericardial
layers is typically seen in :
• A. Granulomatous pericarditis
• B. Systemic lupus erythematosus
• C. Soldier’s plaque
• D. Rheumatic fever
 QUESTIONS
A 30 year old male patient was diagnosed as having
subacute bacterial endocarditis on top of a
rheumatic valvular disease. He developed a sharp
costovertebral pain which subsequently followed by
hematuria. He MOST likely developed:

A.Perirenal hematoma
B.Acute hepatic congestion
C.Embolic infarction
D.Acute cholecystitis
 QUESTIONS
A 75 year old man collapsed suddenly. He died shortly
after reaching the hospital. A ruptured abdominal
aneurysm was found. The MOST common cause of
such an aneurysm is:
A. Atherosclerosis
B. Bacterial infection
C. Development defect
D. Trauma
 QUESTIONS
A 50 year old male with a chronic history of
alcoholism developed progressive congestive heart
failure. Post-mortem examination of the heart
could likely show:

A. Hypertrophic cardiomyopathy
B. Restrictive cardiomyopathy
C. Infiltration cardiomyopathy
D. Dilated cardiomyopathy
 QUESTIONS
Chronic renal disease, pheochromocytoma,
Conn’s syndrome, coarctation of the aorta and
acromegaly are all conditions that may lead to:
A. Venous thrombosis
B. Hypersensitivity angiitis
C. Wegener’s granulomatosis
D. Hypertension
 QUESTIONS
Small vessel vasculitis due to an IgA-dominant
immune complex deposit in the vessel wall is
seen in:
A.Infectious vasculitis
B.Drug-induced angiitis
C.Henoch-schonlein purpura
D.Cryoglobulinemic vasculitis
 QUESTIONS
Libman-Sacks endocarditis is seen in the
tricuspid valve of patients who have:

A.Rheumatic heart disease

B.Advanced diabetic mellitus
C.Systemic lupus erythematosus
D.Stage IV adenocarcinoma
 QUESTIONS
The following congenital heart diseases have
the right to left shunts and characterized
clinically by cyanosis EXCEPT:
A. Patent ductus arteriosus
B. Eisenmerger complex
C. Tetralogy of Fallot
D. Transposition of Great Vessels
 QUESTIONS
Gross identification of myocardial infarction is usually
observed:
A. Four hours after the onset of infarction
B. Twelve hours after the onset of infarction
C. Two hours after the onset of infarction
D. One hour after the onset of infarction
 QUESTIONS
The basic lesion of atherosclerosis is the:

A.fibrofatty plaques within the intima

B.fibrinoid necrosis of the intima
C.hyaline thickening of the tunica media
D. calcifications of the media
 QUESTIONS
An elderly individual died of progressive congestive
heart failure. Microscopic examination of the
cardiac tissues shows amorphous deposits with
“salmon pink” tinctorial reaction to Congo-stains.
Which of the following is the MOST likely diagnosis?

A.Hypertrophic obstructive cardiomyopathy

B. Restrictive cardiomyopathy
• Dilated cardiomyopathy
• Ischemic heart disease
 QUESTIONS
Of the following specific causes of hypertropic
(diastolic disorder ) cardiomyopathy, one does
not belong:
A. Valvular heart disease
B. Infants of diabetic mothers
C. Glycogen storage disease
D. Friedrich’s ataxia
RESPIRATORY PATHOLOGY
 RESPIRATORY PATHOLOGY
ATELECTASIS

1. Obstruction/Resorption Atelectasis
2. Compression Atelectasis
3. Contraction (Scar) Atelectasis
4. Patchy Atelectasis
 RESPIRATORY PATHOLOGY
PULMONARY INFECTIONS
1.BACTERIAL INFECTIONS
A.Lobar pneumonia –caused by Streptococcus pneumonia (95%)/ Klebsiella
Four Phases
Congestion
Red hepatization
Grey hepatization
Resolution
  B.Bronchopneumonia
 2.LUNG ABSCESS
 3.ATYPICAL PNEUMONIA- Mycoplasma, Influenza, Parainfluenza
4.TUBERCULOSIS- Ghon complex, caseating granulomatous inflammation
Primary, Secondary & Progressive
 RESPIRATORY PATHOLOGY
SARCOIDOSIS` - diagnosis of exclusion
- non-caseating granuloma

OBSTRUCTIVE VERSUS RESTRICTIVE LUNG DISEASE

 
OBSTRUCTIVE PULMONARY DISEASE
 
1.CHRONIC BRONCHITIS

2.EMPHYSEMA
 
3.ASTHMA

4.BRONCHIECTASIS
 
 RESPIRATORY PATHOLOGY
INFILTRATIVE RESTRICTIVE LUNG DISEASE
(DIFFUSE INTERSTITIAL LUNG DISEASE)

ACUTE RESPIRATORY SYNDROME

RESPIRATORY DISTRESS SYNDROME OF THE NEWBORN

(Hyaline Membrane Disease of the Newborn)

OCCUPATION ASSOCIATED PNEUMOCONIOSIS

1. Coal workers’s pneumoconiosis-carbon pigment

2. Asbestosis-amphibole/serpentine
-pleural involvement, bronchogenic carcinoma, malignant mesothelioma
  3. Silicosis-silicon oxide
4. Berylliosis-beryllium
 
 RESPIRATORY PATHOLOGY
PULMONARY NEOPLASIA

Adenocarcinoma (35%)
Bronchioloalveolar carcinoma (5%)
Squamous Cell Carcinoma (30%)
Small cell (oat cell) carcinoma (20%)
Large Cell Carcinoma (10%)
Bronchial carcinoids
Laryngeal Squamous Cell Carcinoma
Metastatic Carcinoma-breast, stomach,
pancreas , colon primaries
 
DISEASES OF THE PLEURAL CAVITY

Pleural effusion
Pneumothorax
Mesothelioma
•  
•  
 QUESTIONS
Best describes the morphologic features of
bronchiectasis:

A.edema and inflammatory infiltrates of bronchial

walls with increased size of submucous glands
B.bronchi with mucopurulent secretions and
increased Reid index
C. airways dilated up to 4 or more times the normal
size
D. hypertrophic bronchial walls
 QUESTIONS
FALSE regarding bronchogenic carcinoma:
A. most common visceral malignancy in males
B.80% of cases occur in individuals with a history
of smoking
C. squamous cell carcinoma has the best 5 year
survival rate at 80%
D. small cell carcinoma has the worst prognosis
 QUESTIONS
TRUE regarding restrictive lung disease:

A. neutrophilic infiltrates play a central role in

development of fibrosis
B. desquamated pneumocytes and neutrophilic infiltrates
are predominantly seen
C. diffuse alveolar damage is the major morphologic
feature
D. alveoli are replaced with cystic spaces with thick bands
of connective tissue interspersed with inflammatory
cells
 QUESTIONS
Common etiologic agents for primary atypical
pneumonia include the following EXCEPT:

A. Herpes simplex A
B. Influenza A and B
C. RSV
D. Mycoplasma pneumoniae
 QUESTIONS
Which statement is TRUE regarding asbestosis?
A.amphiboles are fibrogenic while serpentines are
not due to the latter’s curly and flexible nature
B. only amphibole exposure correlates with
mesothelioma
C. pleural plaques, the most common manifestation
of asbestos exposure, contain asbestos bodies
D. mesothelioma is the only lung tumor which
develops in workers exposed to asbestos
 QUESTIONS
A 27 year old male was rushed to the ER for
methamphetamine overdose. He was pale, cold and with
barely audible BP. Over the next few hours his oxygen
saturation fell and he was subsequently hooked to a
ventilator. The lungs at this time would likely show:
A. vascular thrombosis
B. hyaline membrane and intra-alveolar fluid
C. honeycomb lung with increased connective tissue
stroma
D. proliferation of type II pneumocytes
 QUESTIONS

Which of the following pairs of

pneumoconiosis/feature is CORRECT?

A.Chronic berylliosis/tuberculosis
B.Silicosis/Loffler’s syndrome
C. Coal worker’s pneumoconiosis/ferruginous
bodies
D. Anthracosis/city dwelling
 QUESTIONS
A Pulmonary Sequestration is best defined as:

A. a peripheral pulmonary cyst lined with

respiratory epithelium
B. a portion of lung with blood supply directly from
the airways and with no connection to the lung
C. a portion of necrotic lung due to pulmonary
embolism
D. a lobe of lung that never developed from the
fetal state
 QUESTIONS
Alpha-1 antitrypsin deficiency is associated with:

A. PiZZ phenotype
B. Centriacinar emphysema
C. Decreased trypsin deficiency
D. Irregular emphysema
 QUESTIONS

• A 57 y/o male undergoes fine needle aspiration

of a 4.5 cm hilar mass. He has had chronic cough
for six months. The smears showed clusters of
small hyperchromatic round to ovoid cells with
dense chromatin, scant cytoplasmic rim, nucleoli
are not prominent. The most likely diagnosis is:
A. Small cell carcinoma
B. Squamous cell carcinoma
C. Adenocarcinoma
D. Bronchoalveolar carcinoma
 QUESTIONS
Which of the following describes the microscopic
features of TB?
A. caseation necrosis with epithelioid histiocytes,
lymphocytes, Langhan’s giant cells
B. caseation necrosis, epithelial cells, lymphocytes,
giant cells
C. caseation necrosis, epithelial cells, fibroblasts,
foreign body giant cells
D. caseation necrosis, medial hypertrophic,
Langhan’s giant cells
 QUESTIONS
Which of the following is TRUE of pulmonary
hypertension?
A. atheromatous plaques are more prominent and
severe than those seen in systemic hypertension
B. small arteries and arterioles are most
prominently affected
C. the luminal diameter of pulmonary arteries are
markedly increased due to destruction of the
medial wall
D. plexogenic pulmonary arteriopathy is commonly
seen in heart diseases with a right to left shunt
 QUESTIONS
A potent chemoattractant and activator of
eosinophils produced by bronchial epithelial
cells is:
A. Major basic protein
B. Eotaxin
C. Leukotrienes
D. Th2-type T cells
 QUESTIONS
Which of the ff pairs of stage of
pneumonia/description of alveoli content is
CORRECT?
A. congestion/few neutrophils, large amounts of
fibrin
B. red hepatization/ red cells, neutrophils, fibrin
C. gray hepatization/many neutrophils, little fibrin
D. resolution/ necrotic debris, multinucleated giant
cells
 QUESTIONS
The tumor type least associated with smoking
and is the most common type of cancer found in
women and nonsmokers is:
A. Squamous cell carcinoma
B. Small cell carcinoma
C. Adenocarcinoma
D. Large cell carcinoma
 QUESTIONS
Bronchial carcinoid is best described as:
locally invasive tumors with high incidence of
metastasis
A. neuroendocrine tumors derived from Kulchitsky cells
B. benign tumors composed of cartilage and respiratory-
lined cystic spaces
C. benign tumors composed of columnar cells lining
alveolar septa
D. Benign tumors composed of columnar cells lining the
alveolar septa.
 QUESTIONS
Apical lung tumors in the superior sulcus
producing the characteristic Horner’s syndrome
are referred to as:
A.Loffler’s syndrome
B.Eaton-Lambert tumors
C. Pancoast tumors
E. Carcinoid tumorlets
 QUESTIONS
The major morphologic correlate of chronic
rejection in lung transplant patients is:

A. Radiation pneumonitis
B. Cytomegalovirus infection
C. Bronchiolitis obliterans
D. Desquamative pneumonitis
 QUESTIONS
Lipoid pneumonia is best described as:

A.breakdown of surfactant with foreign-body

giant cell reaction
B.aspiration of oils with foamy macrophage
reaction
C. fat embolism to the lungs
D. reaction to pulmonary atherosclerosis
 QUESTIONS
The following are included among the immune-
mediated pulmonary diseases, EXCEPT:
A. Farmer’s lung
B. Silicosis
C. Extrinsic asthma
D. Goodpasture’s syndrome
 QUESTIONS
A 3 pack per day cigarette smoker has had a
hacking cough productive of mucoid sputum for
years. Lung auscultation showed rhonchi and
wheezing. The diagnosis is:

A. Chronic bronchitis
B. Diffuse pulmonary fibrosis
C. Bronchial asthma
D. Chronic pneumonitis
 QUESTIONS
Pulmonary hypertension is seen in all of the
following EXCEPT:
A. Diffuse pulmonary fibrosis
B. Tetralogy of Fallot
C. Mitral stenosis
D. Multiple pulmonary microemboli
 QUESTIONS
The following pulmonary pathology are
complications of gastric content aspiration
EXCEPT:
A. Lung abscess
B. Adult respiratory distress syndrome
C. Pulmonary alveolar proteinosis
D. lipoid pneumonia
 QUESTIONS
Mesothelioma is defined by the following
statements EXCEPT:
A.there is no known effective treatment
B.it has histologic resemblance to
adenocarcinoma
C. it is related to heavy cigarette smoking
D. asbestos exposure
 QUESTIONS
A pleural malignancy that is frequently
associated historically with asbestos or glass
fiber exposure is:
A.Mesothelioma
B. Spindle cell carcinoma
C. Small cell carcinoma
D. Squamous cell carcinoma
 QUESTIONS
The histopathologic description showed hyaline
membrane lining the alveoli with mononuclear
cell infiltration of the alveolar septae. The
diagnosis is:
A. Lobar pneumonia
B. Viral pneumonia
C. Tuberculous pneumonia
D. Bronchopneumonia
 QUESTIONS
At the height of a rainy day, an elderly resident of a
squatter’s colony was brought to the emergency
room with chills and fever, dyspnea, cough and
rusty sputum. Percussion of the chest showed
complete dullness over the left robe.

A. Lobar pneumonia
B. Interstitial pneumonia
C. Tuberculous pneumonia
D. bronchopneumonia
 QUESTIONS
A 70 year old male has been known to be a heavy
cigarette smoker for years. He now complains of
pain in the right chest. On physical examination,
there was Horner’s syndrome on the right side
and a radiologic density on the right upper lobe
of the lungs. The MOST likely diagnosis is:
A. Apical lung abscess
B. Metastatic disease within right cervical lymph
nodes
C. Superior pulmonary sulcus neoplasm
D. Tuberculoma
 QUESTIONS
Because metastases are almost always present by
the time the diagnosis is made, which of the
following histologic forms of lung cancer are
radiotherapy and chemotherapy the mainstays of
treatment:

A. Adenocarcinoma
B. Small cell carcinoma
C. Squamous cell carcinoma
D. Large cell carcinoma
 QUESTIONS
The second stage of a pneumococcal pneumonia
is referred to as:
A. Gray hepatization
B. Edema stage
C. Organization stage
D. Red hepatization
 QUESTIONS
If a lung cancer presents as a cavitary lesion, the
MOST likely histologic type is:

A. Adenocarcinoma
B. Small cell carcinoma
C. Carcinoid
D. Squamous cell carcinoma
 QUESTIONS
The histopathology showed patchy areas of neutrophilic
infiltrates in the alveolar spaces especially in the vicinity
of the bronchioles. The diagnosis is:

A. Lobar pneumonia
B. Viral pneumonia
C. Tuberculous pneumonia
D. Bronchopneumonia
 QUESTIONS
Which of the following is not true of
mesothelioma?
A. there is no known effective treatment
B. it has histologic resemblance to
adenocarcinoma
C. it is related to heavy cigarette smoking
D. it is related to asbestos exposure
GALLBLADDER/BILIARY TRACT
PATHOLOGY
 GALLBLADDER/BILIARY TRACT
PATHOLOGY
GALLSTONES (CHOLELITHIASIS)

1. Cholesterol Stones
2. Pigmented Bilirubinate
 
 
INFLAMMATORY CONDITIONS

1. Acute Cholecystitis
2. Chronic Cholecystitis
3. Ascending Cholangitis
 GALLBLADDER/BILIARY TRACT
PATHOLOGY
MISCELLANEOUS CONDITIONS
Cholestrolosis
Hydrops of the Gallbladder

BILIARY TRACT CANCER

Gallbladder- Adenocarcinoma
Bile duct- Bile duct carcinoma (Extrahepatic bile ducts)
-Cholangiocarcinoma (Intrahepatic bile ducts)
Klatskin tumor
LIVER PATHOLOGY
 LIVER PATHOLOGY
• JAUNDICE

Unconjugated versus Conjugated Bilirubinemia

Increased red blood cells turnover

Physiologic jaundice of the newborn

HEREDITARY HYPERBILIRUBINEMIA
 
Gilbert syndrome
Crigler-Najjar Syndrome
Dubin Johnson Syndrome
Rotor Syndrome
 LIVER PATHOLOGY
BILIARY TRACT OBSTRUCTION
 
PRIMARY BILIARY CIRRHOSIS (PBC)
 
PRIMARY SCLEROSING CHOLANGITIS (PSC)
 
CIRRHOSIS
Causes: alcohol, viral hepatitis, biliary tract diseases, hemochromatosis, Wilson’s
disease and alpha-1 antitrypsin deficiency
 
Pathology: Micronodular cirrhosis (<3mm)
Macronodular cirrhosis ( >3mm)

Consequence: Portal hypertension, Ascites,Splenomegaly,Esophageal varices,

Hemorrhoids, etc.
 
 LIVER PATHOLOGY
VIRAL HEPATITIS
Acute Viral Hepatitis- Lobular disarray, balloon
cells, Councilman bodies

Chronic Viral Hepatitis-Interface hepatitis

(Peacemeal necrosis of Limiting Plates)
Ground Glass hepatocytes

AMEBIC LIVER ABSCESS

-Entamoeba histolytica
 LIVER PATHOLOGY
ALCOHOLIC LIVER DISEASE
Fatty Change ( Steatosis)
Alcoholic Hepatitis
Alcoholic Cirrhosis
  METABOLIC LIVER DISEASES
1. WILSON’S DISEASE (Hepatolenticular Degeneration)
– -decreased serum ceruloplasmin
– -increased tissue copper levels
– -increased urinary copper excretion
– -WD gene (ATP7B on Chromosome 13)
2. HEMOCHROMATOSIS
-HFE gene on chromosome 6p
-C28Y mutation
 3.ALPHA-1 ANTI-TRYPSIN DEFICIENCY –Pi gene

 4.REYE SYNDROME-aspirin

 5.NON-ALCOHOLIC FATTY LIVER DISEASE

 
 LIVER PATHOLOGY
HEMODYNAMIC LIVER DISEASE

1. BUDD-CHIARI SYNDROME (Hepatic Vein Thrombosis)

-Centrilobular congestion and necrosis

2. CHRONIC PASSIVE CONGESTION

-Nutmeg pattern
• -right sided heart failure
 LIVER PATHOLOGY
LIVER TUMORS

HEMANGIOMA-most common primary tumor

 
HEPATIC ADENOMA (LIVER CELL ADENOMA)-oral contraceptive

HEPATOCELLULAR CARCINOMA-
-most common primary MALIGNANT tumor
-risk factors are cirrhosis, Hepatitis B and C,
Alcohol, aflatoxin B1
 
METASTATIC TUMORS-from colon, breast and lung.
 QUESTIONS
The most reliable histopathologic evidence of
chronicity in an inflammatory process in the
liver is the presence of:
A. lymphocytic infiltrates
B. bile duct destruction
C. councilman bodies
D. fibrosis
 QUESTIONS
Fulminant viral hepatitis present with the following
features EXCEPT:

A. between fulminant viral hepatitis and that induced by drugs is a

common histologic appearance

B. the severity of the hepatocellular damage is directly

proportional to the efficiency of the platelet’s immune
response to the virus

C. if a patient survives, he/she is favored with life long immunity

D. from the onset of symptoms, the patient dies within 24 hours

 QUESTIONS
A 45 y/o male presented with jaundice, ascites and
a liver mass. A fine needle aspiration biopsy
revealed hepatocellular carcinoma on liver
cirrhosis. The virus associated with this diagnosis is:

A. Epstein-Barr
B. Human immunodeficiency virus
C. Hepatitis C
D. Human papilloma
 QUESTIONS
Of the four (4) hepatotrophic viruses, enumerated
below, the one apparently least dangerous because
the disease is self-limited, there is no chronic liver
disease or carrier state is:

A. Hepatitis B
B. Hepatitis C
C. Hepatitis A
D. Hepatitis D
 QUESTIONS
The following are established associated risk
factors for hepatocellular carcinoma EXCEPT:

A. Cirrhosis
B. Hepatitis B viral infection
C. Vinyl chloride exposure
D. Aflatoxin exposure
 QUESTIONS
Abundant stromal formation within the tumor is
noted in:
A. Polypoid colonic carcinoma
B. Hepatocellular carcinoma
C. Liver cell adenoma
D. Cholangiocarcinoma
 QUESTIONS
Fatty metamorphosis of the liver which vary from
moderate to severe is seen invariably in the
following conditions EXCEPT:

A. Diabetes mellitus
B. Reye’s syndrome
C. Hepatitis due to type B virus
D. Acute severe alcoholism
 QUESTIONS
Hepatitis B virus is apparently related to the
causation of:
A. Cervical carcinoma
B. Acute T-lymphoblastic leukemia
C. Hepatocellular carcinoma
D. Non-Hodgkin’s lymphoma
 QUESTIONS
A macronodular post-hepatitic cirrhosis from a
hepatitis type C predisposes the patient to the
following EXCEPT:
A. Splenomegaly
B. Cholesterol cholecystolithiasis
C. Hemorrhoids and esophageal varices
D. Hepatocellular carcinoma
CENTRAL NERVOUS SYSTEM
PATHOLOGY
 CENTRAL NERVOUS SYSTEM
PATHOLOGY
INFECTIONS 
1.ACUTE MENINGITIS
a.Acute aseptic (viral) meningitis
b.Acute purulent meningitis
2.MYCOBACTERIAL MENINGOENCEPHALITIS
3.VIRAL ENCEPHALITIDES
a. Arthropod forms
b.HIV
c. Progressive Multifocal Leukoencephalopathy

4. FUNGAL MENINGOENCEPHALITIS
 5.TOXOPLASMOSIS
6.CEREBRAL ABSCESS
7.SUBACUTE SCLEROSING PANENCEPHALITIS
8.CREUTZFELD-JAKOB DISEASE (CJD)-prion disease
-spongiform disease
Kuru,Gertsmann-Straussler,Fatal Familial Insomnia, Scrapie
•  
 CENTRAL NERVOUS SYSTEM
PATHOLOGY
CEREBROVASCULAR DISEASE

Global Cerebral Ischemia

Transient Ischemic Attack
Stroke
Infarction- thrombotic occlusion ,embolic occlusion
Hemorrhage
-Intracerebral (intraprenchymal) hemorrhage
-Epidural hemorrhage
-Subarachnoid hemorrhage
Berry aneurysms
 CENTRAL NERVOUS SYSTEM
PATHOLOGY
CNS TRAUMA

1.CRANIAL CAVITY AND BRAIN

Concussion
Contusions
Diffuse Axonal Injury

2.SPINAL CORD INJURY

3.CEREBRAL HERNIATIONS
Subfalcine (Cingulate Gyrus) Herniation
Transtentorial (Uncal) Herniation
Cerebellar Tonsillar Herniation
 CENTRAL NERVOUS SYSTEM
PATHOLOGY
DEVELOPMENTAL ABNORMALITIES

1.NEURAL TUBE DEFECTS

2.ARNOLD-CHIARI MALFORMATIONS
3.SYRINGOMYELIA
4.PERINATAL BRAIN INJURY
5.DANDY –WALKER MALFORMATION
6. ENCEPHALOCOELE

DEMYELINATING DISORDERS

1.MULTIPLE SCLEROSIS
2.CENTRAL PONTINE MYELINOLYSIS
 
 CENTRAL NERVOUS SYSTEM
PATHOLOGY
DEGENERATIVE/DEMENTING DISORDERS
 
1.PARKINSONS DISEASE AND SYNDROME
2.HUNTINGTON DISEASE
3.ALZHEIMER’S DISEASE
4.LEWY BODY DEMENTIA
5.AMYOTROPHIC LATERAL SCLEROSIS
6.FRIEDREICH ATAXIA
7.WILSON DISEASE
8.ACUTE INTERMITTENT PORPHYRIA
9.VITAMIN B12 DEFICIENCY
10.ALCOHOL DISEASE
 CENTRAL NERVOUS SYSTEM
PATHOLOGY
CNS TUMORS

ASTROCYTOMA
Grade 1 pilocytic astrocytoma
Grade 2 fibrillary astrocytoma
Grade 3 astrocytoma (Anaplastic astrocytoma)
Grade 4 astrocytoma( Glioblastoma multiforme)
-glomeruloiud formations

OLIGODENDROGLIOMA- fried egg appearance

EPENDYMOMA-
ependymal rosettes,
perivascular rosettes
 CENTRAL NERVOUS SYSTEM
PATHOLOGY
MENINGIOMA

PRIMITIVE NEUROECTODERMAL TUMORS

Medulloblastoma
Retinoblastoma

SCHWANNOMA- Antoni A, Antoni B and Verocay bodies

CRANIOPHARYNGOMA-benign and resembles

Adamantinoma
 QUESTIONS
The phenomenon of multiple parasitic cysts in the
brain referred to as cerebral cysticercosis, is
produced by the larvae of:

A. Taenia saginata
B. Echinococcus granulosus
C. Multiceps multiceps
D. Taenia solium
 QUESTIONS
An 50 y/o male was found sleeping on the sidewalk. He had
fever and neck rigidity. He died on the way to the hospital. At
post-mortem, the major findings were those of gelatinous
exudates at the base of the brain and a caseous cavitary lesion
in the upper lobes of both lungs. Your diagnosis of the brain
lesions is:

A. Tuberculous meningitis
B. Viral meningitis
C. Ruptured “berry” aneurysm
D. Alzheimer’s disease
 QUESTIONS
An 8 year old boy gradually developed a staggerin
gate. Hospital consult was eventually made when
he complained of severe headache and vomiting.
An MRI procedure revealed a cerebellar tumor. The
most likely diagnosis is:
A. Medulloblastoma
B. Ependymoma
C. Glioblastoma multiforme
D. Meningioma
 QUESTIONS
A 30 y/o male who was a known case of having
rheumatic
mitral valvulitis in atrial fibrillation suddenly developed a
right-sided hemiplagia. The clinical impression was
cerebral embolism from a detached left atrial embolus.
The cerebral vessel which became occluded was the:
A. Left middle cerebral artery
B. Basilar artery
C. Right anterior cerebral artery
D. Right middle cerebral artery
 QUESTIONS
An increased intracranial pressure with
flattening of the optic disc is part and parcel of
the following conditions EXCEPT:
A. Glioblastoma multiforme
B. Metastatic choriocarcinoma
C. Alzheimer’s disease
D. Hemorrhage in the basal ganglia
 QUESTIONS
A 4 year old girl was noted by her physician to have
“ cat’s eye reflex”. Ophthalmoscopic examination
revealed an intra-ocular tumor. The most likely
diagnosis is:
A. Immature teratoma
B. Angiosarcoma
C. Retinoblastoma
D. Malignant melanoma
 QUESTIONS
In what condition is the classical neurofibrillary
tangLe brain lesion found?
A. Alzheimer’s disease
B. Middle cerebral artery thrombosis
C. Mad cow encepalopathy
D. Multiple sclerosis
 QUESTIONS
An elderly male was found unconscious on the sidewalk. He had fever
and neck rigidity. He died on the way to the hospital. On post-mortem
examination, the major findings were those of exudates localizing at
the base of the brain, as well as cavitary lesions within the apices of
both lungs. Which of the following would be a MOST pertinent
differential ?

A. E. coli meningitis
B. Viral meningo-encephalitis
C. Crytococcal meningitis
D. Protozoal meningo-encephalitis
 QUESTIONS
A 55 year old hypertensive male suddenly
complained of headache followed by loss of
consciousness. Which of the following is the MOST
probable diagnosis?
A. Intraparenchymal hemorrhage
B. Epidural hemorrhage
C. Subarachnoid hemorrhage
D. Subdural hemorrhage
 QUESTIONS
A 50 year old male was admitted because of headache
and seizures. CT scan revealed a large tumor in the
cerebral hemisphere. The MOST likely diagnosis is

A. Fibrillary astrocytoma
B. Medulloblastoma
C. Ependymoma
D. Pilocytic astrocytoma
 QUESTIONS
The MOST common primary malignant tumor of
the central nervous system in adults:
A. Medulloblastoma
B. Glioblastoma multiforme
C. Astrocytoma
D. Meningioma
 QUESTIONS
The MOST common cause of subarachnoid
hemorrhage:
A. Capillary hemangioma
B. Charcot-bouchard microaneurysm
C. Arteriovenous malformation
D. Ruptured berry aneurysm
 QUESTIONS
Herniation of the meninges through defect in
the bony spinal canal is called
A.Budd-Chiari syndrome
B.Meningocele
C. Spina bifida
D. Meningioma
PART 2 : TISSUE/ORGAN PATHOLOGY
 ENDOCRINE PATHOLOGY
1. A 15 y/o male was brought to the hospital because of
inspite of his young age, he was 6 ft tall. An enzyme
immunoassay showed elevated growth hormone level.
Magnetic resonance imaging: examination revealed a tumor
at the region of the sella turcica. The most likely diagnosis is:
A. chromophobe adenoma of the pituitary
B. craniopharyngioma
C. basophilic adenoma of the pituitary
D. eosinophilic adenoma of the pituitary
 ENDOCRINE PATHOLOGY
2. Growth hormone producing adenomas of the anterior
pituitary gland may result in the following
signs and clinical consequences EXCEPT:
A. acromegaly
B. impairment of vision
C. amenorrhea, galactorrhea, and infertility
D. gigantism
 ENDOCRINE PATHOLOGY
3. Hypothyroidism in the adult is clinically called:

A. Sheehan’s syndrome
B. cretinism
C. cachexia
D. myxedema
 ENDOCRINE PATHOLOGY
4. Ketone bodies are formed by:

A. accelerated glycogenolysis
B. excessive fatty acid oxidation
C. cholesterol degradation
D. enzymatic digestion of proteins
 ENDOCRINE PATHOLOGY
5. Ketoacidosis is a common feature of:

A. type I diabetes mellitus

B. type II diabetes mellitus
C. neither type I nor type II diabetes mellitus
D. both type I and type II diabetes mellitus
 ENDOCRINE PATHOLOGY
6. Sudden infarction of the anterior lobe of the
pituitary gland caused by shock would lead to:

A. Waterhouse-Friederichsen syndrome
B. Sheehan’s syndrome
C. acute respiratory distress
D. Addison’s disease
 ENDOCRINE PATHOLOGY
7. Histologic picture most compatible with a
toxic goiter:

A. multiple colloid adenomatous goiter

B. diffuse thyroid hyperplasia
C. Hashimoto’s thyroiditis
D. De Quervain’s thyroiditis
 ENDOCRINE PATHOLOGY
8. The most common cause of spontaneous
hyperthyroidism is:

A. diffuse toxic hyperplasia

B. multinodular colloid goiter
C. toxic adenoma
D. functional thyroid carcinoma
 ENDOCRINE PATHOLOGY
9. Islet cell changes in diabetes mellitus, more in
type I, would be:
A. alpha cell degranulation and fibrosis of the
islets
B. amyloid replacement of the islets and fibrosis
of the islets
C. alpha cell degranulation
D. amyloid replacement of islets
 ENDOCRINE PATHOLOGY
10. The Armani-Ebstein lesion of diabetes
mellitus affects this organ:

A. pancreas
B. kidneys
C. blood vessels
D. eyes
 MUSCULOSKELETAL PATHOLOGY
1. Scoliosis is an abnormal lateral curvature of the
spine common in young females due to:

A. vitamin D deficiency
B. multiple osteochondromas of the vertebral bodies
C. asymmetric cartilage growth of vertebral body end
plates
D. disorder of of procollagen synthesis
 MUSCULOSKELETAL PATHOLOGY
2. A 2 year old boy has blue sclera, misshapen
teeth and diminished hearing in both ears. X
ray of the extremities shows new as well as
healed fractures of the long bones. The most
likely diagnosis is:
A. Osteogenesis imperfecta
B. “Shaken baby” syndrome
C. achondroplasia
D. osteopetrosis
 MUSCULOSKELETAL PATHOLOGY
3. A 5 year old boy experiences head pains and a
skull x-ray was done and shows a destructive bony
lesion of the mastoid. A biopsy shows abundant
histiocytes, eosinophils, numerous lymphocytes
and eosinophils. This is compatible with:
A. eosinophilic granuloma
B. osteitis fibrosa cystica
C. tuberculosis
D. osteoid osteoma
 MUSCULOSKELETAL PATHOLOGY
4. Over time, the articular surfaces of femoral head
become worn or damaged, leading to pain and
decreased mobility. This condition is known as:
A. rheumatoid arthritis
B. osteoporosis
C. osteoarthritis
D. osteitis fibrosa cystica
MUSCULOSKELETAL EPATHOLOGY
5. Irregular or nodular thickening of the palmar
fascia unilaterally or bilaterally is known as:

A. Peyronie’s disease
B. Dupuytren’s contracture
C. Desmoid tumor
D. Myositis ossificans
 MUSCULOSKELETAL PATHOLOGY
6. The most common soft tissue sarcoma of
childhood and adolescence is:
A. Liposarcoma
B. Malignant fibrous histiocytoma
C. Rhabdomyosarcoma
D. Leiomyosarcoma
 MUSCULOSKELETAL PATHOLOGY
7. Individuals with sickle cell disease are more
prone to develop suppurative arthritis
secondary to which of the following micro-
organisms?
A. Staphylococcus
B. Streptococcus
C. Haemophilus
D. Salmonella
MUSCULOSKELETAL PATHOLOGY
8. A 50 year old male presented with back pain
with gradual and progressive limitation of
motion of the spine. Tissue typing showed
positive HLA-B27. The most likely diagnosis is:
A. ankylosing spondylitis
B. spina bifida
C. rheumatoid arthritis
D. multiple myeloma
MUSCULOSKELETAL PATHOLOGY
9. Heberden’s nodes are usually seen in:

A. sarcoidosis
B. rheumatoid arthritis
C. gouty arthritis
D. osteoarthritis
MUSCULOSKELETAL PATHOLOGY
10. The symptoms of multiple myeloma are due
to infiltration of organs by:

A. langerhans cells
B. plasma cells
C. T-lymphocytes
D. fibroblasts
 RENAL PATHOLOGY
1. Adult polycystic kidney is associated with all
EXCEPT:
A. hematuria
B. shrunken cystic kidneys
C. hepatic cysts
D. hypertension
 RENAL PATHOLOGY
3. Renal medullary cystic disease is
characterized by:
A. present with renal failure
B. congenital urethral obstruction
C. infantile polycystic kidney disease
D. present in middle adult life
 RENAL PATHOLOGY
4. Chronic pyelonephritis is characterized by:
A. chronic inflammation in tubulointerstitial area
and calyces
B. symmetrically swollen scarred kidney
C. ongoing renal papillary necrosis
D. disordered mesenchyme, cartilage and
tubules
 RENAL PATHOLOGY
5. A renal biopsy shows the following findings:
hypercellularity due to mesangial and endothelial
cells, neutrophils, subepithelial electron-dense
hump-like deposits; IgG and C3 in the deposits.
The most likely diagnosis is:
A. bacterial endocarditis
B. lupus nephritis
C. rapidly-progressive GN
D. acute post-strep GN
 RENAL PATHOLOGY
• 6. An autopsy is performed in an elderly male
and the kidney shows interstitial fibrosis,
chronic inflammation, papillary necrosis.
Probable causes are the following EXCEPT:
A. analgesic abuse
B. essential HPN
C. sickle cell disease
D. diabetes mellitus
 RENAL PATHOLOGY
7. A patient has abruptio placenta during the third
trimester and eventually dies. Which of the following
kidney findings would most likely show on autopsy?
A. renal cortical necrosis
B. horseshoe kidney
C. renal artery stenosis
D. acute pyelonephritis
 RENAL PATHOLOGY
8. A patient has mental retardation, seizures and
facial angiofibromas. The most likely kidney
finding on autopsy would reveal:
A. renal cell carcinoma
B. nephroblastoma
C. angiomyolipoma
D. transitional cell carcinoma
 RENAL PATHOLOGY
9. The most reliable of the classical clinical features
of renal cell carcinoma is:

A. costovertebral pain
B. palpable mass
C. hematuria
D. weight loss
 RENAL PATHOLOGY
10. All of the following are mediators of
glomerular injury EXCEPT:

A. resident glomerular cells

B. NK cells
C. neutrophils
D. tubular cells
 RENAL PATHOLOGY
11. The most important morphologic feature of rapidly
progressive GN is:
A. small contracted kidneys with petechial cortical
hemorrhages
B. proliferation of epithelial cells with migration of
monocytes, macrophages into the Bowman’s space
C. enlarged hypercellular glomeruli
D. small deposits of fibrin within capillary lumen
 RENAL PATHOLOGY
12. Which statement is NOT TRUE of minimal
change disease?
A. usually occurs in children 2-6 years of age
B. maybe associated with viral respiratory
infections
C. unresponsive to corticosteroid treatment
D. most frequent cause of nephrotic
syndrome in children
 RENAL PATHOLOGY
13. The most common cause of benign familial
hematuria is:

A. Alport’s syndrome
B. Thin membrane disease
C. Minimal change disease
D. IgA nephropathy
 RENAL PATHOLOGY
14. Which of the following associations of
glomerular disease and electron microscopy
findings is CORRECT?
A. lipoid nephrosis: loss of foot processes
B. IgA nephropathy: GBM disruption
C. Goodpasture’s syndrome: paramesangial
dense deposits
D. Post-strep GN: loss of foot processes
 RENAL PATHOLOGY
15. FALSE regarding benign nephrosclerosis:
A. renal vessels show medial and intimal
thickening
B. fibrinoid necrosis of arterioles
C. hyaline deposits in arterioles
D. fibroelastic hyperplasia
 RENAL PATHOLOGY
16. Most common type of renal calculi:

A. uric acid
B. calcium
C. cysteine
D. phosphate
 RENAL PATHOLOGY
17. Most common site of distant metastasis for
renal cell carcinoma is:

A. liver
B. bones
C. lungs
D. brain
 RENAL PATHOLOGY
18. In gout as well as in massive tissue
breakdown such as seen in chemotherapy for
cancer, the formation of urinary calculi may
result and composition is:
A. cysteine crystals
B. uric acid crystals
C. calcium oxalate precipitate
D. magnesium ammonium triple phosphate
 RENAL PATHOLOGY
19. Hypoxic nephrosis could be caused by the
following clinical entities EXCEPT:

A. skeletal muscle trauma

B. severe post-partum hemorrhage
C. hypokalemia
D. Gram negative septicemia
 RENAL PATHOLOGY
20. The serum levels of the following substances are
increased in most forms of end-stage renal disease
(ESRD) EXCEPT:

A. calcium
B. renin
C. phosphate
D. aldosterone
•
 RENAL PATHOLOGY
21. Histologically, the following lesions are seen
in the kidneys in diabetes mellitus EXCEPT:
A. benign nephrosclerosis
B. uric acid nephropathy
C. Kimmelstiel-Wilson disease (intercapillary
glomerulosclerosis)
D. Acute pyelonephritis
 RENAL PATHOLOGY
22. The following abnormalities are associated with
uremia EXCEPT:

A. polycythemia
B. neuropathy
C. intra-alveolar edema
D. pericarditis
 RENAL PATHOLOGY
23. Acting in concert most frequently with
immune complex deposits, the following cells
are involved in the glomerular damage in
glomerulonephritis EXCEPT:

A. mesangial cells
B. neutrophils
C. macrophages
D. mast cells
 RENAL PATHOLOGY
24. Clear cell type renal carcinoma can produce
various hormones which explains why its
presence could manifest as the following
diseases EXCEPT:
A. polycythemia
B. hyperlipidemia
C. Cushing’s syndrome
D. feminization
 RENAL PATHOLOGY
25. A post-renal transplant needle biopsy reported
“acute tubular necrosis”. The most characteristic
clinical feature of this condition is:
A. oliguria
B. proteinuria
C. hematuria
D. pyuria
•
 RENAL PATHOLOGY
26. A 56 year old complained of a low-back pain. A CT-
scan showed a “moth eaten” vertebral body. A
gamma globulin peak on serum electrophoresis
clinched the diagnosis of multiple myeloma. The renal
findings in this disease are the following EXCEPT:
A. necrotizing papillitis
B. tubular metastatic calcifications
C. Bence-Jones protein casts in the tubules
D. plasma cell infiltrates in the interstitium
 RENAL PATHOLOGY
27. The histopathologic findings of a renal biopsy specimen
showed uniform thickening of the glomerular basement
membrane. This was shown to be positive for immunoglobulin
and complement by immunofluorescence. A diagnosis of
membranous glomerulonephritis was made. This condition
may be found in the following clinical situations EXCEPT:

A. hepatitis B
B. lupus erythematosus
C. renal vein thrombosis
D. amyloidosis
 RENAL PATHOLOGY
28. The main cause of chronic rejection of a
kidney transplant is an immunologically
mediated:
A. interstitial lymphocytic infiltrates with
tubular damage
B. acute tubular necrosis
C. pre-formed circulating cytotoxic antibodies
D. chronic vascular damage
 RENAL PATHOLOGY
29. Patients undergoing chemotherapy for
malignancies are at risk for developing urinary
calculi. These calculi usually have the
following composition:
A. cysteine crystals
B. uric acid crystals
C. calcium oxalate precipitates
D. magnesium ammonium triple phosphates
 RENAL PATHOLOGY
30. The term “hepatorenal syndrome” specifically refers to one
of the following statements:
A. synchronized virus-related toxemic damage of the kidney
and the liver
B. massive bleeding from ruptured esophageal varices in a
cirrhotic patient with consequentially ischemic acute tubular
necrosis in the kidney
C. a morphologically remarkable kidney which goes into
functional failure in the presence of severe liver disease
D. membranoproliferative glomerulonephritis secondary to
hyperantigenemia from chronic viral hepatitis
 RENAL PATHOLOGY
31. Virtually pathognomonic of diabetic
nephropathy:

A. fibrin caps and wire loops

B. diffuse glomerulosclerosis
C. nodular glomerulosclerosis
D. papillary necrosis
 RENAL PATHOLOGY
32. Renal papillary necrosis is seen MOST often
in:
A. lupus erythematosus
B. heavy metal poisoning
C. Fanconi’s syndrome
D. diabetes mellitus
 RENAL PATHOLOGY
33. All of these lesions of the kidney appear
yellow grossly EXCEPT:

A. renal cell carcinoma

B. angiolipoma
C. renal oncocytoma
D. xanthogranulomatous pyelonephritis
 HEMATOPATHOLOGY
1. In hemochromatosis, which is characterized by
deposition of iron in various organs, spares one from
those enumerated below:

A. pancreas
B. liver
C. brain
D. skin
•
 HEMATOPATHOLOGY
2. Hypersplenism is a syndrome characterized by
the following EXCEPT:
A. presence of accessory spleen
B. reduction of one of the cellular elements of
blood
C. splenomegaly
D. correction of cytopenia after splenectomy
 HEMATOPATHOLOGY
3. The following condition may be associated
with multiple myeloma EXCEPT:

A. hypercalcemia
B. frequency of viral infection
C. monoclonal gammaglobulin peak by
electrophoresis
D. renal failure
 HEMATOPATHOLOGY
4. The following pathologic findings are seen in
severe erythroblastosis fetalis EXCEPT:

A. anasarca
B. tea-colored urine
C. extramedullary hematopoiesis
D. yellow pigmentation of the brain
 HEMATOPATHOLOGY
5. The formation of urinary stones is related to
the following predisposing conditions EXCEPT:

A. sickle cell nephropathy

B. hyperparathyroidism
C. pyelonephritis due to Proteus
D. gout
 HEMATOPATHOLOGY
6. The main finding in the spleen in patients with
thrombocytopenic purpura is:
A. congestion of the sinusoids and fibrosis of
the Malphiggian follicles
B. massive infarction
C. marked thickening and fibrosis of
trabeculae
D. effacement of splenic corpuscles
 HEMATOPATHOLOGY
7. A bone marrow aspirate was obtained from a 70 year
old woman who complained of weakness, weight loss
and recurrent infections. Laboratory findings showed
anemia, proteinuria and an abnormal component in
serum proteins. The bone marrow aspirate showed
numerous plasma cells. The most probable diagnosis is:
A. monocytic leukemia
B. non-Hodgkin’s lymphoma
C. myelomonocytic leukemia
D. multiple myeloma
 HEMATOPATHOLOGY
8. The peripheral blood smear of a severely
anemic patient reveals oval macrocytes,
hypersegmented neutrophils and decreased
platelets. The MOST likely cause of anemia is:
A. iron deficiency
B. vitamin B12 or folate deficiency
C. marrow hypoplasia
D. red cell membrane protein defect
 HEMATOPATHOLOGY
9. This statement about mycosis fungoides is true:
A. the lesion resembles superficial fungal
infection
B. causative lesion is an atypical mycobacterium

C. Munro’s abcesses are diagnostic

D. hematogenous involvement is termed Sezary
syndrome
 HEMATOPATHOLOGY
10. Osmotic fragility characterizes the
erythrocytes in:
A. Fanconi’s syndrome
B. Glucose-6-phosphate dehydrogenase
deficiency
C. hereditary spherocytosis
D. sickle cell anemia
 HEMATOPATHOLOGY
11. The presence of melanin-laden histiocytes
and Langhan’s cells in an enlarged lymph node
is characteristic of:
A. malignant melanoma metastatic to lymph
nodes
B. tuberculosis
C. histiocytic lymphoma
D. dermatopathic lymphadenitis
 HEMATOPATHOLOGY
12. The normal red blood cell survival time in
humans is approximately:

A. 30 days
B. 60 days
C. 120 days
D. 90 days
 GI PATHOLOGY
1. Cushing’s ulcer of the gastric mucosa
specifically occurs in patients with:
A.Cushing’s syndrome secondary to
adrenocortial adenoma
B. history of non-steroidal anti-inflammatory
drug intake
C. brain tumor
D. greater than 50% body surface burns
 GI PATHOLOGY
2. The following areas in the gastrointestinal
tract may be sites of peptic ulcer EXCEPT:
A. Meckel’s diverticulum
B. Lower esophagus
C. Cecum
D. stomach
 GI PATHOLOGY
3. Varicose veins in the lower esophagus is
almost always caused by:
A. esophagitis
B. hiatal hernia
C. diverticulitis
D. high portal vein system pressure
 GI PATHOLOGY
4. Zollinger-Ellison syndrome is characterized by
the following EXCEPT:
A. excessive acid secretion
B. multiple ulcers in the duodenum
C. gastrin-secreting tumor in the pancreas
D. intestinal metaplasia in the stomach
 GI PATHOLOGY
5. The most major risk factor in the
pathogenesis of a duodenal ulcer:
A. hydrochloric acid hypersecretion from the
stomach
B. presence of gastrin-secreting G cell adenoma
C. decreased duodenal mucosal resistance to
trauma
D. blood type O
 GI PATHOLOGY
6. One of the items enumerated below is not a
feature of squamous cell carcinoma of the
esophagus:
A. epidemiologically common in Northern China
B. invades the respiratory tree and mediastinal
lymph nodes
C. patients develop dysphagia due to obstructing
stricture
D. highly associated with Barrett’s esophagus
 GI PATHOLOGY
7. Reflux esophagitis is causally related to the
following factors EXCEPT:
A. increased gastrin
B. acid production in the stomach is greatly
increased
C. dysfunction of the lower esophageal
sphincter
D. hiatal hernia, sliding type
 GI PATHOLOGY
8. A three month old first born male was brought
to the emergency room for persistent
projectile vomiting. A CT scan revealed
segmental enlargement of the pylorus. MOST
likely diagnosis is:
A.congenital hypertrophic pyloric stenosis
B. fibrosing benign duodenal ulcer
• C. Crohn’s disease
• D. Hirschprung’s disease
 GI PATHOLOGY
9. A 30 year old male patient complained of
recurrent diarrhea with vague abdominal
pain. An upper GI series showed segmental ill
narrowing. The most likely diagnosis is:
A. Crohn’s disease
B. tuberculosis
C. Carcinoid
D. adenocarcinoma
 GI PATHOLOGY
10. A 35 year old female was hospitalized because of
abdominal pain, diarrhea and rectal bleeding. Colonic
endoscopy showed a colonic mucosa which had a
cobblestone appearance. This was due to numerous
mucosal ulcers with intervening intact mucosa. The
MOST likely diagnosis is:
A. multiple familial polyposis
B. regional enteritis
C. amoebic colitis
D. ulcerative colitis
 GI PATHOLOGY
11. Obstruction is common in:
A. right sided carcinoma of the colon
B. carcinoma anywhere in the colon
C. left sided carcinoma of the colon
D. hepatic flexure carcinoma
 GI PATHOLOGY
12. Laceration with bleeding of the lower
esophagus due to gastric content reflux is
seen in:
A. portal cirrhosis
B. Mallory Weiss syndrome
C. Borrhaave’s syndrome
D. diverticulitis
 GI PATHOLOGY
13. Helicobacter pylori infection of the pyloric
gastric mucosa is an etiopathogenetic factor
in:
A. gastric adenocarcinoma
B. acute hemorrhagic gastritis
C. granulomatous gastritis
D. auto-immune gastritis
 GI PATHOLOGY
14. The following esophageal disorders may
result in pulmonary aspiration, EXCEPT:
A. squamous cell carcinoma
B.esophageal diverticula
C. viral esophagitis (herpes simplex)
D. achalasia
 GI PATHOLOGY
15. Benign peptic ulcers of the stomach present
with the following features EXCEPT:
A. the surrounding mucosal folds are puckered
in a radial fashion
B. ulcer base is smooth
C. the lesser curvature is the most frequent
location
D. the margins are irregular
 GI PATHOLOGY
16. Duodenal ulceration associated with a
gastrin-secreting tumor is known as:

A. Banti’s syndrome
B. Curling’s ulceration
C. Zollinger-Ellison syndrome
D. Pancoast syndrome
 GI PATHOLOGY
17. A relatively new entity of inflammatory disorder of
the stomach known as autoimmune gastritis, has the
following features, EXCEPT:
A. chronic hypertrophic gastritis affecting the body
mucosa
B. antibody reaction directed against the chief cells
and parietal cells
C. correlate clinically with pernicious anemia
D. presence of antiparietal cell antibodies in the blood
 GI PATHOLOGY
18. Transperitoneal spread of gastric malignancy
with consequent involvement of the ovary is
known as
A. tubulo-villous tumor
B. Grave’s tumor
C. Zollinger-Ellison syndrome
D. Krukenberg tumor
 GI PATHOLOGY
19. In the older age group, the most common
complications of diverticulosis is:

A. obstruction
B. malignant degeneration
C. perforation
D. diverticulitis
 GI PATHOLOGY
20. A 50-year old male complained of severe epigastric
pain radiating to the back. Serum amylase was
markedly elevated. A diagnose of acute pancreatitis
was made. The following clinical conditions are
associated with pancreatitis EXCEPT:

A. chronic alcoholism
B. hyperparathyroidism
C. hypertension
D. viral pneumonia
THANK YOU AND GOOD LUCK!