MRCPath part 1 Autumn 2009

MCQ

 

1)  A known alcoholic 45 year-old male was found dead outside a pub. Which of the following suggest foul play?

1. Laceration on the inside of lower lip.
2. No alcohol in blood test.
3. Multiple bruises on arms and legs of varying ages.
4. Bruising at the back of the head
5. Skull fracture of occiput

 

2)  A friend of yours is interested in applying for a medical examiner job. He asked you for advice. Who hires the medical examiner?

1. Coroner’s office
2. Primary care trust
3. Ministry of Justice
4. Foundation hospital
5. GP

 

3)  A woman died in the hospital after started on a course of penicillin. Anaphylaxis is suspected. Which of the followings indicate anaphylaxis ?

3. Specific IgE to penicillin
4. Serum Tryptase
5. Mastocytosis
6. Serum IgE Level

 

4)  A child with a lesion composed of cells positive for CD1a and S100.

1. Cat scratch disease

2. Langerhan’s histiocytosis

 

5)  27 yo man from Hong Kong has a neck lump. The cells show large nuclei with prominent nucleoli with a syncytial growth pattern. Which of the following IHC would you perform?

1. S100, MelanA
2. CD15, CD30

 

6)  A man was found dead lying face down on the kitchen floor in his own home with a chair toppled. A pool of blood on the floor.

1. Incision wounds on the inner aspect of the left forearm, stab wound on the left chest and no cut on the overlying T-shirt.
2. Incision wounds on the outer aspect of the left forearm, stab wound on the left chest and cut on the T-shirt.

  

7)  A 32 yo female whose cervical smear was reported as moderate dyskaryosis and referred for colposcopy. However, 6 months later, your department has not received any specimen. You received a letter from the GP saying that this patient has moved. Who is responsible for the cervical cytology result?

4. Central call/recall center
5. PCT
6. GP who took the smear
7. Foundation hospital
8. Pathologist reported the cytology

 

8)  A mechanic who is a part-time bodybuilder admitted with acute renal failure. He admitted to drinking liquid from unlabelled bottle in the Gym. There are birefringent crystals in the urine. Which of the following is the most likely cause?

1. Oxalate – Ethylene Glycol

2. Uric acid – metabolism of Taurin

 

9) An elderly farmer had a dispute with his neighbours. He was found dead at home. PM - his  lungs are solid with hemorrhage and consolidation. What is likely to be the cause?

1. Paraquat

2. Organophosphate

 

10) Lesion from the thigh of a man showing biphasic lesion composed of spindle cells and epithelial cells forming glands.

1. Synovial sarcoma

 

11) A tumour in the small bowel with tumour cells positive for CD34 and CD117, what is it?

1. GIST

 

12) A female patient with breast carcinoma. What is the most important prognostic feature?

1. Lymph node mets

2. Size of tumour
3. Type of tumour

 

13) Suspicious of GIST, CD117 not working, which other immuno would you use?

1. CD34

 

14) A bladder TCC invades deep into the muscularis mucosae, what is the stage?

1. T1a

2. T1b

3. T2
4. T3
5. T4

 
 

15) Post mortem MRI is most useful in which of the following situation?

1. Aortic dissection

2. Pulmonary embolism

16)  Post-mortem of a patient with suspected MI 1 day prior to death, which is the most useful test?

1. Loss of staining of the myocardium with TTC (Triphenyl Tetrazolium Chloride)
2. Histology sections of the myocardium
3. Stain with something??? Blue

 

17) Prostate needle biopsy show areas of small regular glands and areas of gland fusion giving rise to cribriform appearance. Which is the most likely grade?

1. Gl 3+4

 

18) A young pregnant lady who was febrile and had a stillbirth. Which of the following is the most likely sequence of event?

1. Ascending infection – chorioamnionitis

2. Placental previa
3. Placental rupture

 

19) Axillary sentinel lymph node biopsy for breast carcinoma. What is the best practice to process the lymph nodes?

1. Slice 2mm thick, embed all and 1 H&E section.
2. Slice 2mm thick, embed all and panCK on all sections
3. Bisect the LN and embed all with 1 H&E section.
4. Bisect and submit one half of the LN with 1 H&E section.

 

20) Young man with enlarge neck node. LN shows high endothelial venules proliferation and plasma cells. Patient has polyclonal hypergammaglobulinemia. Which is the likely cause?

1. Angio-immunoblast T-cell lymphoma

2. Castleman disease

 

21) Young man with phaechromocytoma and a mass in the ?thyroid. which of the following gene mutation is most likely?

1. RET

2. MEN1
3. RAS

 

22) A man with hypertension, hypokalemia and hypernatremia. (Conn’s syndrome) which is the most likely finding?

1. 1cm yellow tumour in the cortex of adrenal gland.
2. 1cm yellow tumour in the medulla of adrenal gland.

 
 
 

23) A mother with type 1 diabetes. The baby was born with hypoglycaemia immediately, why?

1. The islet cells of the baby continue to produce increased insulin after birth.

 

24) An afro-caribbean female with skin rash. Chest X-ray was done and a diagnosis was made. What is the most likely diagnosis?

1. Sarcoidosis.

 

25)  A 63yo female has a negative cervical smear. She had a borderline smear 5 years ago but since had 3 subsequent negative smear. What action should you take?

1. No further smear

2. Repeat smear 3 months
3. Repeat smear 6 months
4. Repeat smear 12 months

 

26) Renal transplant patient with renal failure. The biopsy showed ‘Decoy cells’. What is the likely cause?

1. BK virus (Polyoma virus)

 

27) Child with recurrent chest infection, failure to thrive and died. What is the underlying disease?

1. Cystic fibrosis

 

28)Young man with ? accident, right arm/leg weakness, 6^th nerve palsy. What is the cause?

1. Transtentorial herniation

2. Hemorrhage on cerebellar surface
3. ? cerebellar herniation

 

29) A miner’s lung with calcified fibrous nodules. Which minerals he was exposed to?

1. Silica

2. Coal
3. Asbestos?

 

30) Elderly man from England travel to visit his son in Scotland. He had COPD. Prior to returning to England, his health deteriorated and he died in the hospital. His body was returned  to England. The coroner asked you to perform a second autopsy. However, you discovered that no autopsy had been done in Scotland. What is the most likely explanation?

1. The autopsy was performed on a wrong body
2. The fiscal has more discretion on patient die of old age

3. The fiscal is satisfied that the patient died of natural causes

 
 
 

31) Frozen section of parathyroid gland, surgeon wants to know whether it is an adenoma. What would you tell the surgeon?

1. We can only tell them this is parathyroid tissue and need to assess the size of the other 3 parathyroid glands.
2. We can only tell them this is parathyroid tissue and need the frozen sections of the other 3 parathyroid glands.

 

32)  Frozen section of a lymph node from neck. The patient was exposed to TB recently. Surgeon wants to rule out TB with frozen section. What would you do?

1. Refuse to do the FS as it is inappropriate

2. Cut the specimen, do the FS and send small piece to microbiology.
3. Ask the surgeon to cut the specimen, send part to microbiology and the other part for FS

 

33)  What is the normal size of parathyroid gland?

1. 5mm, 37mg

2. 1mm, 37mg
3. 10mm, 37mg
4. 5mm, 85mg
5. 10mm, 250mg

 

34)  FNA from neck lump showed 2 small clusters of follicles and debris. Which of the following result is appropriate?

1. Thy 1

2. Thy 2
3. Thy 3
4. Thy 4
5. Thy 0

 

35)  A male patient , post aortic aneurysm repair. Developed left sided abdominal pain and died. Which of the following branch is most likely to have been blocked?

1. Inferior mesentery artery

2. Superior mesentery artery
3. Celiac artery

 

36)  A young man with stomach GIST has a family history of tumours and multiple subcutaneous nodules. Which of the following is the syndrome?

      A) ?? 

37)  In the case of diaphragmatic hernia, what is the most important prognostic factor?

      A) Lung hypoplasia

 
 
 
 
 

38)  Breast cancer axillary node clearance. There is a group of cells in the subcapsular space. Which of the following immunostaining means that this group of cells is likely to be benign.

1. S100

 

39)  When you find that a specimen you are trimming is different from the description on the request form, what would you do?

1. Check label and specimen pots.

 
 

40)  In a liver biopsy, there are PAS positive globules in the hepatocytes, what is the likely diagnosis?

1. á1 antitrysin difficiency.

 

41)  A vulval lesion with large epithelial cells infiltrating the epidermis. These cells are CK7 –ve, CK20+ve, CEA+ve and CDX2-ve. Diagnosis?

1. ?Primary pagetoid disease
2. ?Secondary pagetoid disease

 

42)  What does “p” in pT1N2Mx mean?

1. Resection specimen

 

43)  HOCM morphology, which gene is mutated? 

44)  Female with mastectomy for breast cancer. She also had chemo-radiotherapy.  Presented with a vascular breast lump. What is the likely diagnosis?

1. Post-radiotherapy angiosarcoma

 

45)  20 yo male with multiple skin lesions ? site. Histology shows cup-shaped lesion, intracellular inclusion, extends to surface. What is the likely diagnosis?

1. Molluscum contagiosum

 

46)  IVDU, pleural effusion. “Maltese cross” seen in the effusion. What is the likely substance?

1. Starch

 

47)  A patient with 47 XXY chromosome, what is the commonest ovarian tumour 
 
 
 
 
 
 
 
 

EMQ

 

1)  What is the likely precursor protein for amyloid  deposition in the following conditions?

1. Cardiomegaly with waxy surface and plasma cells.
2. Rheumatoid arthritis
3. Haemodialysis  à â2-microglobulin
4. Dementia.

 

2)  Liver biopsy from following patients, what is the likely diagnosis?

1. IVDU, interface hepatitis, Orcein-positive granules in hepatocytes à Hepatitis B
2. Female with biopsy showing numerous plasma cells infiltration in the portal tract  à Autoimmune hepatitis
3. Middle aged female with biopsy showing lymphocytic infiltrates in the portal tracts with loose granulomas à PBC
4. A man with chronic alcohol excess. Liver biopsy shows macro and microvesicular steatosis and presence of Mallory’s bodies à Alcoholic hepatitis
5. Young patient with PERL’s +ve granules in hepatocytes and non-hepatocytes à ? Hemosiderosis / Hemochromatosis

 

3)  Neurodegenerative disease, what is the likely diagnosis?

1. 72yo, haematology patient, right hand weakness, had a fit, rapidly deteriorated and died.
2. 60yo, myoclonic fit.
3. Old man, dysarthria, poor swallowing, muscle loss à ? Motorneurone disease
4. Old man with memory loss, aggression, then became mute. Autopsy shows temporal atrophy à  ? Pick’s disease
5. Young woman, myoclonic seizure.

 

4)  FNA cytology of neck lump?

1. Bizzare squamous cells
2. Lymphoid cells
3. Sheets of epithelial cells with lymphocytes
4. “Comet-shaped” cells

 
 
 
 
 
 
 
 

5)  Infectious diseases.

1. young patient, been to Africa recently. Fever, loss of consciousness, intracellular parasites. à Plasmodium Falciparum
2. Immunosuppressed patient with diarrhoea and weight loss. Intestinal biopsy shows ZN +ve organisms. à ? Mycobacterium avium intracellulare
3. Can’t remember history à Entaemoeba histolytical
4. Colectomy with cream color membrane like material on the mucosal surface à Clostridium difficile
5. Immunosuppressed patient with cough. Found to have a well circumscribed mass in lung. à Aspergillus

 

6)  Diarrhoea, what is the likely cause?

1. Woman been to Russia, 1 episode of diarrhoea and abdo pain. Then progressive weight loss. Otherwise well. à Giardiasis
2. Old woman had some sort of surgery and started on ciprofloxacin. Watery diarrhoea. à Pseudomembranous colitis
3. HIV +ve patient with chronic diarrhoea, weight loss and skin pigmentation. à Whipples disease
4. Post-op CABG, diarrhoea, laparotomy shows dusky color large intestine à Ischaemic colitis
5. Thin woman with increased appetite, weight loss, hand tremor, diarrhoea. à Hyperthyroidism

 

7)  Polyps from intestine.

1. Pedunculated polyps with a tree like architecture à Peutz-Jeghers polyp
2. 5 yo girl with pedunculated polyp à Juvenile polyp
3. Middle aged man with diarrhoea, ?polyp from the rectum à Solitary rectal ulcer
4. Morphology description ?? Serrated adenoma
5. Can’t remember

 

8)  Bone tumours.

1. Tumour distal femur, with bone covered by cartilage, stalk in continuity with the marrow. à Osteochondroma
2. Lesion in the knee, woke up at night with pain and helped by aspirin. X-ray shows translucent nidus with peripheral sclerosis. à Osteoid Osteoma
3. Can’t remember history à Ewing’s sarcoma
4. Young female patient with lesion in the rib. There is no calcification. Microscopically, there are fish-hook shaped bone trabeculae with interspersed fibrosis. à Fibrous dysplasia
5. Young patient with lytic bone lesion in the jaw. There are multinucleated giant cells and mononuclear cells positive for CD1a. à Langerhan’s cell histiocytosis

 
 
 

9)  Skin IF.

1. Linear IgG  and C3 deposition along basement membrane à Bullous Pemphigoid
2. Focal deposit of IgA at the tips of dermal papillae à Dermatitis herpetiformis
3. IgA depositions in the vessel walls à Henoch-Schonlein Purpura
4. Ig G deposition with the epidermis in ‘Chicken-wire’ pattern à Pemphigus Vulgaris
5. Granular depositions of IgG along dermo-epidermal junction à Discoid Lupus Erythematosus

 

10)  Cardiar anomalies- morphology descriptions, can’t remember, but answers below should be correct, just read the chapter!

      A)  Ebstein anomaly

2. Hypoplastic left heart

3. Tetralogy of Fallot

4. Coarctation of aorta

5. Truncus Arteriosus

 

11)  Cervical cytology – Infections:

1. Pear-shaped organisms à Trichomonas Vaginalis

2. Dordein Bacilli

3. IUCD user, hairy organisms à Actinomyces like organisms
4. Severe dyskaryosis with koilocytes, CIN3, which are the most likely organisms involve? à HPV 16, 18
5. Vaccination for HPV, what would you tell the patients à Virus like particles

 

12)  Insignificant Gynae lesions seen on histology- Please read the books about their morphology.

1. Microglandular hyperplasia

2. Walthard cell rest

3. Rete ovarii

4. Mesonephric remnant

5. Can’t remember

 

13)  Prostate needle biopsy.

1. glands with epithelial cells containing pigments à Seminal vesicle
2. Glands with stratifications of epithelial cells à HG PIN
3. Description of ? Gleason 4 AdenoCA
4. Can’t remember the rest.

 
 
 
 
 
 

14)  Breast pathology- Please read textbook for morphology descriptions:

1. Phyllodes

2. Hamartoma

3. Fibroadenoma

4. Metaplastic tumour

5. ?? Adenoid cystic ca

 

15)  Auto-antibodies.

1. Sjogren’s syndrome à Anti Ro
2. Coeliac disease à Anti TTG
3. Pulmonary hemorrhage and renal failure – Wegener’s à Anti PR3