AP EXAM 1 Flashcards
57/F, gastric biopsy.
The patient most likely has:
A. Increased gastrin production
B. Increased risk for gastric carcinoma
C. Markedly decreased acid production
D. All of the above
B. Increased risk for gastric carcinoma
Which phospholipid is recognized during efferocytosis of dead cells by its inversion from the inner to the outer leaflet of the cell membrane?
A. Phosphatidylserine
B. Phosphatidylcholine
C. Phosphatidylethanolamine
D. Phosphatidylinositol
A. Phosphatidylserine
Merkel cells will stain positive for which of these immunohistochemical markers?
A. Chromogranin
B. CD1a
C. CD38
D. None of the above
A. Chromogranin
Autopsy finding of a 56-year-old male, known smoker and hypertensive. What is the likely histopathologic finding from the specimen shown below?
A. Marked macrovesicular steatosis with dense portal inflammation forming lymphoid aggregates
B. Centrilobular congestion and hemorrhage with hepatocyte necrosis
C. Lobular disarray with ballooning hepatocytes and lymphocytic infiltrates
D. Periportal fibrosis with regenerative hepatocyte nodules
B. Centrilobular congestion and hemorrhage with hepatocyte necrosis
40/M, intracranial mass. Which of the following features is NOT part of the criteria that upgrade this tumour to a WHO Grade II tumour?
A. Geographic necrosis
B. mitotic activity of 4-19 mitotic figures per 10 high power fields
C. secretory variant
D. patternless growth
C. secretory variant
What is the most likely underlying cause of these findings?
A. Squamous cell carcinoma
B. Ocular herpes
C. Pinguecula
D. Vit. A deficiency
D. Vit. A deficiency
This tumour most likely came from:
A. Parotid gland of a 33/F SLE patient
B. Submandibular gland of a 14/M osteosarcoma patient undergoing chemotherapy
C. Sublingual gland of a 67/M betel nut chewer
D. Parotid gland of a 45/M smoker
D. Parotid gland of a 45/M smoker
What is the autopsy method of organ removal shown?
A. Letulle
B. Rokitansky
C. Ghon
D. Virchow
D. Virchow
Which of the following entities will not show a similar histology to the one pictured below?
A. Letterer-Siwe disease
B. Erdheim-Chester disease
C. Eosinophilic granuloma
D. Hand-Schüller-Christian disease
B. Erdheim-Chester disease
Which protein expression is altered leading to this gross finding?
A. Fibrocystin
B. Polycystin-1
C. Nephrin
D. Polycystin-2
A. Fibrocystin
16/F, pre-auricular mass fine needle aspiration biopsy (FNAB).
Diagnosis?
A. Acinic cell carcinoma
B. Mucoepidermoid carcinoma
C. Pleomorphic adenoma
D. Adenoid cystic carcinoma
A. Acinic cell carcinoma
Diagnosis?
A. Conjoined twin
B. Parasitic twin
C. Fetu-in-fetu
D. Fetiform teratoma
D. Fetiform teratoma
Left atrial pedunculated mass.
The constitutional symptoms associated with this tumor is most likely due to the elaboration of which cytokine?
A. Interleukin-3 (IL-3)
B. Interferon-gamma (IFN-γ)
C. Tumor necrosis factor-alpha (TNF-α)
D. Interleukin-6 (IL-6)
D. Interleukin-6 (IL-6)
Diagnosis?
A. Burkitt lymphoma
B. Mantle cell lymphoma
C. T-lymphoblastic lymphoma
D. Follicular lymphoma
D. Follicular lymphoma
47/F, breast mass.
The following are the features used in determining the grade of this tumor, EXCEPT:
A. Necrosis
B. Tubule formation
C. Mitotic activity
D. Nuclear pleomorphism
A. Necrosis
What is the most common congenital anomaly associated with this pathology?
A. Posterior urethral valve
B. Urethral stricture
C. Bladder neck obstruction
D. Primary vesicoureteral reflux
D. Primary vesicoureteral reflux
Biopsy of the skin in Sweet Syndrome would show:
A. Collections of mast cells in the dermal papillae
B. Cutaneous metastasis of neoplastic gustatory cells (taste bud cells), expressing the T1R2 protein which detects sucrose
C. Dense lymphocytic infiltrate with germinal centers
D. Sheets of neutrophilic infiltrate in the dermis without vasculitis
D. Sheets of neutrophilic infiltrate in the dermis without vasculitis
What is the immunophenotypic profile of breast tumors that are associated with BRCA1 mutations, and show medullary or metaplastic features?
A. ER (+), PR (+), HER2 (-)
B. ER (-), PR (-), HER2 (-)
C. ER (+), PR (-), HER2 (+)
D. ER (+), PR (-), HER2 (-)
B. ER (-), PR (-), HER2 (-)
65/F, extrafascial hysterectomy with bilateral salpingooophorectomy for an endometrial mass.
Which of the following statements is/are true regarding this type of tumor?
A. These tumors commonly have TP53 mutations and have aneuploidy.
B. This tumor is graded according to the amount of solid areas, including the squamous components.
C. Obesity and hyperestrogenism are associated with this type of tumor.
D. All of the other statements are true.
C. Obesity and hyperestrogenism are associated with this type of tumor.
Radiograph finding from a 32/F presenting with chronic back pain. The surgeon relays to you that the lesion appears “currant jelly-like”. What is the most likely diagnosis?
A. Hemangioma
B. Metastatic carcinoma
C. Tuberculous spondylitis
D. Paget disease
A. Hemangioma
25/F, forearm soft tissue mass. TFE3 immunostain was positive.
Which of the following is/are true about this tumour?
A. This tumor will also demonstrate INI1 loss.
B. This is a low-grade neoplasm with a good prognosis.
C. It is a translocation sarcoma.
D. All of the above are true
C. It is a translocation sarcoma.
What is the expected histopathologic finding if a skin biopsy was taken from the patient’s nose?
A. Widening of dermal connective tissue septa by edema, fibrin exudation and neutrophilic infiltration
B. Variable infiltrates of lymphocytes and macrophages around hair follicles and microabscess formation
C. Neoplastic infiltration of the dermis with a monoclonal T cell population
D. Hypertrophy of sebaceous glands and follicular plugging by keratotic debris
D. Hypertrophy of sebaceous glands and follicular plugging by keratotic debris
27/F, gravida 2 para 2, status post caesarean section.
Diagnosis?
A. Amniotic fluid embolism
B. Pneumonia
C. Coronavirus Disease-2019 (COVID-19)
D. Hyaline membrane disease
A. Amniotic fluid embolism
Forensic autopsy of a 41/M, utility worker, showed these distinctive hand lesions. What is the most likely cause?
A. Moist thermal injury/scald
B. Blunt penetrating injury
C. Electrical injury
D. Gunshot wound
C. Electrical injury
30/F. Anterior neck mass.
What is/are the nuclear features used to diagnose this tumor?
A. Nuclear pseudoinclusions
B. Nuclear grooving
C. Ground-glass, optically clear nuclei
D. All of the other choices
D. All of the other choices
Which special stain should be requested to determine the underlying etiology?
A. Giemsa
B. Periodic acid-Schiff
C. Fite-Faraco
D. Methenamine silver stain
C. Fite-Faraco
7/M, buttock mass.
The cell of origin of this tumor is:
A. Post-germinal center B cell
B. Mature helper T cells
C. Mature cytotoxic T cells
D. Plasma cells
C. Mature cytotoxic T cells
Diagnosis?
A. Perisplenitis
B. Splenic lymphoma
C. Splenic abscess
D. Metastatic carcinoma to the spleen
A. Perisplenitis
HHV8 is involved in the pathogenesis of the following except:
A. Primary effusion lymphoma
B. Multicentric Castleman disease
C. Epithelioid lymphangioendothelioma
D. Kaposi sarcoma
C. Epithelioid lymphangioendothelioma
This renal mass will typically show what immunophenotypic profile and special staining characteristics?
A. CD117 (-), CK7 (-), Vimentin (+), Hale colloidal iron (+)
B. CD117 (-), CK7 (+), Vimentin (+), Hale colloidal iron (-)
C. CD117 (+), CK7 (+/-), Vimentin (-), Hale colloidal iron (-)
D. CD117 (+), CK7 (+), Vimentin (-), Hale colloidal iron (+)
C. CD117 (+), CK7 (+/-), Vimentin (-), Hale colloidal iron (-)
Pulmonary biopsy showed the following histologic picture:
Aside from Mycobacterium tuberculosis, which of these other organisms will most likely cause this histologic pattern?
A. Paragonimus westermani
B. Streptococcus pneumoniae
C. Aspergillus fumigatus
D. Histoplasma capsulatum
D. Histoplasma capsulatum
46/F with a 5 cm breast carcinoma. Histopathologic evaluation showed extensive lymphovascular space invasion and five (5) lymph node involvement, the largest metastatic deposit measuring 1 cm. What is the most likely TNM stage of the patient with these findings?
A. pT3 pN2a
B. pT4b pN3a
C. pT4d pN2a
D. pT3 pN3a
C. pT4d pN2a
35/F, vulvar nodule.
This most likely came from:
A. Metastatic from the endometrium
B. Metastatic from the breast
C. Anogenital mammary-like glands
D. Metastatic from the ovary
C. Anogenital mammary-like glands
Describe the manner of umbilical cord insertion
A. Tethered
B. Velamentous
C. Battledore
D. Furcuate
D. Furcuate
Anterior neck mass FNAB.
Diagnosis?
A. Bethesda category VI
B. Bethesda category I
C. Bethesda category II
D. Bethesda category IV
A. Bethesda category VI
What is the most common malignant transformation of this tumor?
A. Neuroendocrine carcinoma
B. Adenocarcinoma
C. Sarcoma
D. Squamous cell carcinoma
D. Squamous cell carcinoma
10/M, soft tissue mass.
What genetic abnormality will you most likely find in this tumor?
A. NCOA2 translocation
B. VGLL translocation
C. MYOD1 L122R mutation
D. FOXO1 translocation
D. FOXO1 translocation
What is the most common/important predisposing factor for its development?
A. Intrauterine contraceptive device
B. Pelvic inflammatory disease
C. Endometriosis
D. Previous Surgery
B. Pelvic inflammatory disease
What is the predominant Gleason grade of the prostate tumor shown in this picture?
A. Gleason Grade 4
B. Gleason Grade 2
C. Gleason Grade 5
D. Gleason Grade 3
A. Gleason Grade 4
28 weeks/M, fetal death in utero.
What is the associated genetic abnormality?
A. Gene mutations in Xp11.23
B. Loss-of-function mutations in the AIRE gene
C. Mutations in Xq21.22
D. TBX1 gene deletion in 22q11
D. TBX1 gene deletion in 22q11
25/F, unilateral salpingooophorectomy for an ovarian mass.
Which of the following statements is/are true about this tumor?
A. Majority of the tumors are bilateral.
B. Virilization (defeminization and masculinization) is rare in these tumors.
C. This tumor often harbors DICER1 mutations.
D. All of the above
C. This tumor often harbors DICER1 mutations.
Diagnosis?
A. Arcuate
B. Septate
C. Didelphus
D. Bicornuate
C. Didelphus
40/F, modified radical mastectomy.
The immunohistochemical hallmark of this tumor is:
A. Loss of E-cadherin expression
B. Loss of Her2-neu expression
C. Strong nuclear beta-catenin expression
D. Strong E-cadherin expression
A. Loss of E-cadherin expression
The presence of these findings should warrant an investigation on what organ systems?
A. Thymus, adrenals and lymph nodes to rule out an infectious process
B. Central nervous system and heart for congenital defects
C. Urinary tract and lungs to investigate the oligohydramnios
D. Liver, spleen and bone marrow to assess hematopoiesis
C. Urinary tract and lungs to investigate the oligohydramnios
66/M, intracranial, intraaxial mass.
Which of the following features, when present in this kind of tumor, will upgrade it to WHO Grade IV?
A. Brain invasion
B. IDH mutant status
C. Microvascular proliferation
D. Cytologic atypia
C. Microvascular proliferation
35/M, mandibular mass.
Diagnosis?
A. Calcifying epithelial odontogenic tumor
B. Calcifying cystic odontogenic tumor
C. Adenomatoid odontogenic tumor
D. Ameloblastoma
A. Calcifying epithelial odontogenic tumor
What is the most likely pathophysiologic process associated with the gross finding shown?
A. Rupture of vessel walls affected by β amyloid deposition
B. Vascular basement membrane abnormality secondary to COL4A1 mutation
C. Mutation of NOTCH3 gene acquired in an autosomal dominant pattern
D. Rupture of vessel walls affected by hyaline arteriosclerosis
A. Rupture of vessel walls affected by β amyloid deposition
32/F, ovarian tumor.
For these types of ovarian neoplasms, the main criteria for malignancy is:
A. Invasion
B. Cellular stratification
C. Presence of heterologous elements
D. Loss of mucinous differentiation
A. Invasion
Diagnosis?
A. Joubert syndrome
B. Chiari Type I malformation
C. Arnold-Chiari malformation
D. Dandy-Walker malformation
C. Arnold-Chiari malformation
20/M, sellar mass.
Diagnosis?
A. Ameloblastoma
B. Adamantinoma
C. Adenomatoid odontogenic tumor
D. Craniopharyngioma
D. Craniopharyngioma
Lung resection specimen from a 35/M presenting with recurrent cough and colds, hemoptysis, and finding of obstructive azoospermia. What is the most likely diagnosis?
A. Kartagener syndrome
B. Allergic bronchopulmonary aspergillosis
C. Cystic fibrosis
D. Young syndrome
D. Young syndrome
2/F, renal mass.
Diagnosis?
A. Wilms tumor
B. Renal medullary carcinoma
C. Clear cell sarcoma of the kidney
D. Clear cell renal cell carcinoma
C. Clear cell sarcoma of the kidney
What is the tubular structure involved in this lesion?
A. Pampiniform plexus
B. Testicular artery
C. Cremasteric artery
D. Ductus deferens
A. Pampiniform plexus
Most likely diagnosis?
A. Vegetative endocarditis
B. Myxoma
C. Rhabdomyoma
D. Fibroelastoma
D. Fibroelastoma
10/M, third ventricle mass.
Which of these genetic mutations confer a poorer prognosis for these patients?
A. NF2 mutation
B. RELA fusion
C. 6q deletion
D. YAP1 fusion
B. RELA fusion
Which infectious agent is commonly associated with this pathology?
A. Staphylococcus saprophytics
B. Escherichia coli
C. Pseudomonas aeruginosa
D. Proteus mirabilis
D. Proteus mirabilis
40/M, Uterus.
What are the histologic features one must look at in order to classify these kinds of tumours?
A. Tumor cell necrosis, Mitotic Activity, Presence of Heterologous elements
B. Tumor cell necrosis, Mitotic Activity, Atypia
C. Mitotic Activity, Atypia, Hypercellularity
D. Tumor cell necrosis, Mitotic Activity, Hypercellularity
B. Tumor cell necrosis, Mitotic Activity, Atypia
Which of the following best describes the pathophysiologic process of this lesion?
A. Inflammatory response to microvascular trauma with subsequent deposition of collagen leading to fibrosis
B. Rupture of the tunica albuginea secondary to blunt force trauma to the erect penis
C. Persistent infection of the glans and prepuce due to poor hygiene leading to inflammatory scarring
D. Neoplastic proliferation of the epidermis with subsequent involvement of the underlying connective tissues
A. Inflammatory response to microvascular trauma with subsequent deposition of collagen leading to fibrosis
39/F, anterior neck mass.
Development of this tumor is associated with which familial syndrome?
A. McCune-Albright Syndrome
B. MEN-1
C. MEN-2
D. All of the above
C. MEN-2
Diagnosis?
A. Ectopic pancreas
B. Pancreas divisum
C. Pancreatic head cancer
D. Annular pancreas
D. Annular pancreas
31/F, parotid mass.
This tumor is most related to which part of the salivary gland?
A. Excretory ducts
B. Intercalated duct
C. Striated ducts
D. Salivary gland acini
B. Intercalated duct
Diagnosis?
A. Hairy leukoplakia
B. Aphthous ulcers
C. Geographic tongue
D. Candidiasis
C. Geographic tongue
56/F. Cervical cytology (Pap smear)
Diagnosis?
A. Squamous Metaplasia
B. Squamous cell carcinoma
C. High-Grade Squamous Intraepithelial Lesion (HSIL)
D. Low-Grade Squamous Intraepithelial Lesion (LSIL)
C. High-Grade Squamous Intraepithelial Lesion (HSIL)
Which bacterial infection is commonly associated with this finding?
A. Staphylococcus aureus
B. Streptococcus agalactiae
C. Neisseria meningitidis
D. Haemophilus influenzae
C. Neisseria meningitidis
50/M presenting with massive hematemesis.
What is the most frequent risk factor predisposing the patient to this lesion?
A. Multiple sexual partners
B. Heavy alcoholic beverage intake
C. Living in an area endemic for schistosomiasis
D. Family history of malignancy
B. Heavy alcoholic beverage intake
44/F, Skin biopsy, Fite-Farraco Stain.
Which of the following nerves does the organism have a predilection for?
A. Pudendal nerve
B. Recurrent laryngeal nerve
C. Superficial peroneal nerve
D. Phrenic nerve
C. Superficial peroneal nerve
Maternal age has a positive correlation with the incidence of this karyotype finding, and is only important for which of the following mechanism of chromosomal aberration?
A. Robertsonian translocation
B. Mosaicism
C. Meiotic nondisjunction
D. Mitotic nondisjunction
C. Meiotic nondisjunction
18/M, distal forearm mass.
Immunohistochemistry showed EMA (+), CK (+), PAX8 (-), S-100 (-), desmin (-), CD68 (-); INI-1 is lost.
Diagnosis?
A. Epithelioid sarcoma
B. Metastatic carcinoma
C. Granuloma annulare
D. Chronic granulomatous inflammation
A. Epithelioid sarcoma
Diagnosis?
A. Gallbladder hydrops
B. Porcelain gallbladder
C. Cholecystolithiases
D. Gallbladder carcinoma
B. Porcelain gallbladder
55/M, hepatic mass.
Which of the following conditions is NOT a major risk factor in the pathogenesis of this tumor?
A. Alcoholic liver disease
B. Chronic Hepatitis B infection
C. Hepatitis A infection
D. Aflatoxin consumption
C. Hepatitis A infection
Describe the membrane insertion of this placenta
A. Paracentral
B. Peripheral
C. Circummarginate
D. Circumvallate
D. Circumvallate
24/F, ovarian tumor.
Which of the following statements is/are true regarding this tumor?
A. Majority of cases are associated with hyperestrinism.
B. These tumors harbor a somatic mutation in the FOXL2 gene.
C. These tumors would stain positive for CD99.
D. All of the above
D. All of the above
Which symbiotic bacteria contributes to the development and pathogenesis of the agent producing these lower extremity lesions?
A. Ehrlichia
B. Anaplasma
C. Wolbachia
D. Orientia
C. Wolbachia
9 mo/F with a retroperitoneal mass.
The following features are assessed in subtyping this tumor EXCEPT:
A. Tumor nodularity
B. Amount of necrosis
C. Amount of neuropil
D. Amount of Schwannian stroma
B. Amount of necrosis
Diagnosis?
A. Cowden
B. Turcot
C. Familial adenomatous polyposis
D. Peutz-Jeghers
D. Peutz-Jeghers
Placenta from a 24/F G1P0, status post caesarean section. There is a mass occupying 40% of the placental volume. Histologic sections of the mass show:
Which of these is a risk factor for the development of this tumor?
A. Singleton pregnancy
B. Rh incompatibility
C. Trisomy X in the fetus
D. High-altitude living
D. High-altitude living
Which segment is the most common site of involvement of this pathology?
A. Cecum
B. Sigmoid/Left colon
C. Rectum
D. Transverse colon
B. Sigmoid/Left colon
50/M, renal mass.
In the World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading system, this tumor would be graded based on:
A. Mitotic activity and Ki-67 index
B. Tubule formation and necrosis
C. Nucleoli and nuclear pleomorphism
D. All of the above
C. Nucleoli and nuclear pleomorphism
23/F Lung mass
Along with this finding, the patient presented with several masses, most notably in the kidney, brain, and heart. What is the most likely underlying disease?
A. McCune-Albright syndrome
B. Cowden syndrome
C. Neurofibromatosis type I
D. Tuberous sclerosis
D. Tuberous sclerosis
55/M, soft tissue mass.
Immunohistochemistry shows CK (-), LCA (-), TdT (-), CD5 (-), CD10 (-), CD79a (+), CD 138 (+), monotypic kappa on IHC.
Bone marrow biopsy, serum protein electrophoresis, and skeletal survey was normal. Patient was asymptomatic with no evidence of end-organ damage. This patient most likely has:
A. Plasma cell myeloma
B. Waldenstrom macroglobulinemia
C. Solitary plasmacytoma
D. Lymphoplasmacytic lymphoma
C. Solitary plasmacytoma
Classify the gunshot injury shown:
A. Intermediate
B. Indeterminate/distant
C. Near contact
D. Contact
C. Near contact
44/F, uterus.
The conventional immunophenotype of this tumor is:
A. ER (+), PR (+), CD10 (+)
B. CD117 (+), ER (+), PR (+)
C. PAX8 (+), ER (+), EMA (+)
D. Desmin (+), SMA (+), h-caldesmon (+)
A. ER (+), PR (+), CD10 (+)
Most likely diagnosis?
A. Acrochordon
B. Keloid
C. Hypertrophic scar
D. Dermatofibroma
B. Keloid
26/F, rapidly growing forearm mass.
What bone tumor shows the same chromosomal rearrangements as the above tumor?
A. Bizarre Parosteal Osteochondromatous Proliferaion (Nora’s Lesion)
B. Osteochondroma
C. Aneurysmal Bone Cyst
D. Unicameral Bone Cyst
C. Aneurysmal Bone Cyst
Diagnosis?
A. Follicular cyst
B. Serous cystadenoma
C. Endometriotic cyst
D. Corpus luteum cyst
D. Corpus luteum cyst
60/M, colonic mass.
According to the College of American Pathologist protocols, the following are required elements for reporting EXCEPT:
A. Tumor depth/extension
B. Lymphovascular space invasion
C. Perineural Invasion
D. Tumor-Infiltrating Lymphocytes
D. Tumor-Infiltrating Lymphocytes
This occurs in association with which underlying condition(s)?
A. Diabetes
B. Sickle cell disease
C. Analgesic abuse nephropathy
D. All of the above
D. All of the above
Which vessel is primarily involved with this finding?
A. Basilar artery
B. Middle cerebral artery
C. Meningeal artery
D. Bridging veins
D. Bridging veins
These findings are strongly associated with which antibody?
A. Anti-P155 antibody
B. Anti-P140 antibody
C. Anti-Mi2 antibody
D. Anti-Jo1 antibody
C. Anti-Mi2 antibody
4/M presented with fever and multiple mucocutaneous findings (see image). Workup done showed elevated cardiac troponin and coronary artery disease based on electrocardiography and echocardiography. Which autoantibody precipitated the cardiac findings of this patient?
A. Anti-proteinase-3
B. Anti-myeloperoxidase
C. Antinuclear antibody
D. Anti-endothelial cell
D. Anti-endothelial cell
Most likely diagnosis?
A. Disseminated tuberculosis
B. Solitary fibrous tumor
C. Mesothelioma
D. Pneumoconioses
C. Mesothelioma
Diagnosis? (arrow)
A. Dermolipoma
B. Conjunctival hemangioma
C. Pterygium
D. Pinguecula
C. Pterygium
