Male Genital System
1. A 32-year-old male presents with a
painless, large testicular mass. Orchidectomy specimen reveals s large pale
fleshy mass, 12cm in diameter. Histology consists of nests of uniform cells
separated by fibrous bands showing lymphocyte infiltration. The tumor stains
negative for AFP and HCG and positive for placental alkaline phosphatase. What
germ cell tumor are these features most characteristic of?
a. Seminoma
b. Choriocarcinoma
c. Yolk sac tumor
d. Embryonal carcinoma
e. Teratoma
2. A 32-year-old male presents with
cahexia and hemoptysis. Chest X ray reveal multiple hemorrhagic foci in the
lungs. Colonoscopy and upper GI endoscopy are unremarkable. No testicular mass
is palpable. Serum HCG level is raised; CEA and AFP are within normal range.
Lung biopsy from one of the lesions shows massive hemorrhage with few
cytotrophoblast and syncitiotrophoblast like elements. What is the diagnosis?
a. Lymphoma
b. Squamous cell
carcinoma
c. Metastatic
Yolk sac tumor
d. Metastatic
Choriocarcinoma
e. Metastatic
adenocarcinoma
3. In a patient with mixed germ cell
tumor of the testis, which serum marker/markers are best used to monitor
response to chemotherapy?
a. AFP and HCG
b. LDH and CEA
c. CEA and AFP
d. Ca-125
e. CA-19-9
4. A 55-year-old patient diagnosed to
have nodular hyperplasia of prostate is prescribed a 5 alpha reductase
inhibitor. Which trophic factor responsible for prostatic hyperplasia will this
agent inhibit?
a. Testosterone
b. Estrogen
c. Dihydrotestosterone
d. Epinephrine
e. Epidermal
growth factor
5. While examining a prostatic needle
biopsy a pathologist notices a cluster of small crowded, closely packed glands
lacking the myoepithelial layer; epithelial cells show prominent pink nucleoli.
Adjacent to these are larger glands lined by epithelium and myoepithelium and
showing branching and tufting. How will these two types of glands differ in
behavior?
a. Both are benign
b. Both are malignant
c. The first
cluster is benign
d. The second cluster
is benign
e. The first
cluster is more likely to be malignant
6. Of the major specific inflammatory
conditions of testis, which invariably effects testis before epididymus?
a. Gonorrhoea
b. Tuberculosis
c. Chlamydia
d. Syphilis
e. All Gram
negative bacterial infections
7. Two males each aged 28 years are
diagnosed with Cryptorchidism. One patient has abdominal undescended testis and
the other has inguinal undescended testis, what is the risk of both developing
testicular cancer?
a. The patient with
inguinal testis has the higher risk
b. The patient with
abdominal testis has the higher risk
c. Both have
equal risk
d. Undescended testis
is not related to the risk of testicular cancer
e. Undescended
testis protects against testicular cancer
8. A 25-year-old male presents with a
rapidly enlarging painless testicular mass. Serum HCG is markedly raised. A
diagnosis of mixed germ cell tumor is made on Histopathology of the
orchidectomy specimen. Which component of the mixed tumor is most responsible
for the rise in HCG?
a. Embryonal carcinoma
b. Yolk sac tumor
c. Teratoma
d. Choriocarcinoma
e. Seminoma
9. A 50-year-old male develops acute
urinary retention and is catheterized. The prostate is found moderately
enlarged on digital rectal examination. Later on serum PSA level is found
slightly elevated (8ng/dL). How best will you interpret this result?
a. Diagnostic for
prostatic adenocarcinoma
b. Diagnostic for
nodular hyperplasia
c. May have
resulted from catheterization and digital rectal examination
d. The value is falsely
high due to analytical lab error
e. Normal level
for this age
10. A patient with diagnosis of nodular
prostatic hyperplasia is unresponsive to medical therapy and is anxious about
his risk of developing cancer. What is the most pertinent information you can
give this patient?
a. He has an 80% risk
of developing prostate cancer in the next 5 years
b. He has a 50% risk of
developing prostate cancer in the next 5 years
c. He has a 10%
risk of developing prostate cancer in the next 5 years
d. He has a 100% risk
of developing prostate cancer in the next 5 years
e. He is not at
risk for prostate cancer since nodular hyperplasia is not a premalignant
condition
11. A 25-year-old male presents with
infertility and oligospermia is found on semen analysis. Left scrotal sac is
empty and an undescended testis is palpable in the left inguinal region, which
is excised. The excised testis will most likely show:
a. Active
spermatogenesis
b. Atrophy with no
spermatogenesis
c. Granulomatous
orchitis
d. Hydrocele
e. Leydig cell
tumor
12. A 28-year-old male presents with a
rapidly enlarging painless testicular mass. Serum alpha feto protein is
markedly raised. A diagnosis of mixed germ cell tumor is made on Histopathology
of the orchidectomy specimen. Which component of the mixed tumor is most
responsible for the rise in alpha feto protein?
a. Embryonal carcinoma
b. Yolk sac tumor
c. Teratoma
d. Choriocarcinoma
e. Seminoma
13. H and E sections from testicular mass
of a 24-year-old patient reveal disorganized clusters of glands, cartilage,
smooth muscle, bronchial and bronchiolar epithelium. The junior resident
examining the case seeks the help of a senior colleague about the presence or
absence of immature elements in the teratoma to determine its malignant
potential. He is advised that he does not need to search for the immature
components in this tumor because:
a. In post pubertal
males all teratomas are considered benign
b. All teratomas are benign
irrespective of presence or lack of immature components
c. All teratomas
are malignant irrespective of presence or lack of immature components
d. All teratomas are
considered malignant in post pubertal males
e. Excision is
curative for all testicular teratomas
14. A 55-year-old male presents with low
back pain, dysuria and suprapubic discomfort. Expressed prostatic secretions
contain 15 leukocytes/HPF. Bacterial cultures are negative. What is the
diagnosis?
a. Granulomatous
prostatitis
b. Acute prostatitis
c. Chronic
bacterial prostatitis
d. Chronic abacterial
prostatitis
e. Nodular
hyperplasia
15. For predicting prognosis of prostatic
adenocarcinoma, what is the most important factor besides tumor stage?
a. Perineural invasion
b. Comorbid conditions
c. Tumor grade
d. Immune status
e. Serum PSA
levels
Female genital System
16. Colposcopic biopsy of a 48-year old
woman reveals diffuse Atypia of Squamous epithelium with complete lack of
maturation in all layers and no surface maturation. Basement membrane is
intact. How will you label this lesion?
a. Normal Squamous
metaplasia
b. Invasive Squamous
carcinoma
c. CIN I
d. CIN II
e. CIN III
17. A 68-year-old obese postmenopausal
woman is at a greater risk of developing endometrial carcinoma than a
40-year-old premenopausal woman with normal weight. How best would you explain
this?
a. Advancing age
renders the endometrium genetically unstable
b. Post menopausal
women are more likely to be taking exogenous hormones
c. Progesterone
levels are higher in post menopausal women
d. In post menopausal
women there is a greater synthesis of estrogen from body fat
e. Estrogen levels
are higher in premenopausal women
18. Endometrial hyperplasia is the
forerunner of:
a. Poorly
differentiated endometrial carcinoma
b. Moderately
differentiated endometrial carcinomas
c. Well
differentiated endometrial carcinomas
d. All Endometroid
endometrial carcinomas
e. Serous
endometrial carcinomas
19. H and E stained sections from all
ovarian tumors reported in the past one year are reviewed by a pathology
resident. What histologic features would favor a diagnosis of serous cyst
adenoma?
a. Cyst lined by
columnar epithelium with abundant cilia
b. Cyst lined by
columnar epithelium without mucin or cilia
c. Cyst lined by
transitional epithelium
d. Solid tumor composed
of nests of transitional cells
e. Cyst lined by
stratified Squamous epithelium
20. A cystic mass removed from the right
ovary of a 28-year-old female consists of a cyst wall lined by mature
stratified Squamous epithelium with skin appendages. Mature gut and bronchial
epithelium, cartilage and thyroid tissue are also present. What malignant
transformation is this tumor most likely to undergo?
a. Immature teratoma
b. Squamous cell
carcinoma
c. Thyroid
follicular carcinoma
d. Adenocarcinoma
e. Chondrosarcoma
21. A 45-year-old female having history
of multiple sexual partners is diagnosed as Squamous cell carcinoma of cervix.
Genetic material of which virus is most likely to be detected in the tumor?
a. HPV 16
b. HPV 6
c. EBV
d. HSV type I
e. HSV type II
22. A 28-year-old female presents with
dysmenorrhea, pelvic pain and irregular vaginal bleeding. Ultrasound
examination reveals a partly cystic right adnexal mass. Cystectomy specimen is
filled with thick chocolate colored fluid and histologic sections reveal a cyst
wall lined showing marked hemorrhage, with endometrial glands and stroma along
with hemosiderin-laden macrophages. What is the diagnosis?
a. Mucinous cystadenoma
b. Serous cyst adenoma
c. Endometriotic
cyst
d. Hemangioma
e. Endometrial
carcinoma
23. Papillary serous endometrial
carcinoma is graded as:
a. G1
b. G2
c. G3
d. Grading is not
applicable
e. Grading would
depend on cellular Atypia
24. A 22-year-old female is diagnosed
with a malignant germ cell tumor of the ovary that is metastatic to liver,
lungs and bone at the time of diagnosis. What is this tumor most likely to be?
a. Yolk sac tumor
b. Dysgerminoma
c. Choriocarcinoma
d. Embryonal carcinoma
e. Teratoma
25. A cystic mass removed from the right
ovary of a 28-year-old female consists of a cyst wall lined by mature
stratified Squamous epithelium with skin appendages. Mature gut and bronchial
epithelium and cartilage are also present. What is the expected karyotype of
this tumor?
a. 46XX
b. 46XY
c. 45Y
d. 47XXY
e. 45X
26. While working in a gynecology
department in a remote district of southern Punjab you notice a high number of
patients presenting with advanced cervical cancer. In order to screen for
cervical cancer so that these patients can be detected at an earlier stage of
the disease what test would you request your laboratory to start doing?
a. HPV DNA by PCR
b. HPV DNA by
hybridization
c. p53 staining
on all colposcopic biopsies
d. p16 staining on all
colposcopic biopsies
e. Papanecolaou
cytology for cervical smears
27. A 58-year-old nulliparous woman with
history of functional menstrual abnormalities is most likely to develop:
a.
Endometroid
endometrial carcinoma
b.
Cervical Squamous cell
carcinoma
c.
Cervical
adenocarcinoma
d.
Ovarian
cystadenocarcinoma
e.
Endometrial stromal
tumor
28. An endometrial adenocarcinoma grossly
involving the uterine corpus and extending into cervix hiostologically shows a
well-differentiated and easy recognizable glandular pattern. What is the tumor
grade and stage?
a. Stage I, Grade I
b. Stage II, Grade I
c. Stage I, Grade
II
d. Stage II, Grade II
e. Stage III,
Grade I
29. Struma ovarii is a monodermal
teratoma composed of:
a. Bone
b. Cartilage
c. Thyroid tissue
d. Skin and appendages
e. Skeletal
muscle
30. A 45-year-old female presents with
massive abdominal distension causing respiratory distress. An emergency
laparotomy reveals massive Mucinous ascites and adhesions with a large left
ovarian tumor, which is later, reported as a borderline Mucinous neoplasm. What
is this condition known as?
a. Meigs syndrome
b. Pseudomyxoma
peritonei
c. Krukenberg
tumor
d. Carcinomatosis
e. Mullerian
Mucinous cystadenoma
Diseases of the breast
31. A 32-year-old female presents with a
painless, irregular firm to hard mass in her right breast. She has history of
trauma to the breast. Excised mass consists of foci of necrotic fat cells
surrounded by macrophages and intense inflammatory reaction. What is the
diagnosis?
a. Acute mastitis
b. Invasive carcinoma
c. Fat necrosis
d. Fibroadenoma
e. Lipoma
32. During a mastectomy for invasive
carcinoma of breast, the surgeon injects dye into the tumor, localizes and
resects the first lymph node to take up the dye. The lymph node is reported
negative for metastases on frozen section examination. How will this effect the
management of this patient?
a. The patient must
undergo complete axillary clearance
b. Lumpectomy will be
curative in this patient
c. Quardrantectomy
will be curative in this patient
d. The patient can be
spared complete axillary clearance
e. A negative
result is of no significance
33 48. Two female patients
of the same age are diagnosed with breast cancer. Mastectomy specimen of the
first patient reveals Ductal carcinoma in situ without invasive component; the
other patient has a 2cm invasive component in her tumor. Both are node negative
and have no distant metastases. What does this tell you about the prognosis of
these patients?
a. Prognosis will be
similar in both patients
b. Patient with DCIS is
likely to have a better prognosis
c. Patient with
invasive component is likely to have a better prognosis
d. Prognosis is
determined by response to chemotherapy
e. Prognosis will
depend on the histological type of both tumors
34. A surgeon examines two patients of clinically
suspected breast carcinoma; the palpable tumor size is 2cm in one patient and
4cm in the second patient. What can he deduce about the lymph node status of
these patients?
a. Tumor size does not
predict lymph node status
b. First patient will
have involved axillary lymph nodes
c. Second patient
will have involved axillary lymph nodes
d. Both will have
involved axillary lymph nodes
e. Both will have
uninvolved axillary lymph nodes
35 50. Which breast
lesion carries the greatest risk of developing into an invasive carcinoma?
a. Fibroadenoma
b. Papilloma
c. Atypical
ductal hyperplasia
d. Low grade DCIS
e. High grade
DCIS
36. What is the commonest causative
organism for acute mastitis?
a. Streptococcus aureus
b. Staphylococcus
aureus
c. E coli
d. Pseudomonas
e. Candida
albicans
37. A 35-year old female patient is
diagnosed to have ‘Invasive ductal carcinoma’ of the right breast. Her
grandmother and two maternal aunts have had breast cancer below 40 years of
age. What genetic mutation is she likely to carry?
a. c-Myc
b. K-Ras
c. BRCA 1 or 2
d. p53
e. INK4A
38. A 55-year-old female is found to have
3cm mammographic density with irregular borders and calcification in her left
breast. There is a 90% likelihood that this lesion is a:
a. Benign lesion
b. Invasive carcinoma
c. Insitu
carcinoma
d. Sclerosing condition
e. Sarcoma
39. The designations ‘ductal’ and
‘lobular’ with reference to carcinoma of the breast refer to:
a. Tumor growth
patterns
b. Cell of origin of
the tumor
c. Tumor Grade
d. Degree of invasiveness
e. Anatomic site
of origin of tumor
40. Examination of a mastectomy specimen
in the pathology lab reveals an eczema-like erythematous eruption on the nipple
with scale crust. Underlying this is an invasive ductal carcinoma. H & E
sections from the nipple show presence of large atypical cells in the epidermis
with no breech of the basement membrane of the skin. What is this condition
called?
a. Dermatitis
b. Psoriasis
c. Inflammatory
carcinoma
d. Comedocarcinoma
e. Paget’s
disease
41. A 30-year-old female smoker presents
with a painful subareolar mass in her left breast. On examination the nipple is
found to be inverted. Histology of excised lesion shows squamous metaplasia of
lactiferous duct with abundant keratin trapped in the lumen. Adjacent tissue
shows chronic inflammation. What is the diagnosis?
a.
Paget’s disease
b.
Acute mastitis
c.
Fat necrosis
d.
Periductal mastitis
e.
Mammary duct ectasia
42. The history of a
35-year-old female presenting with menorrhagia shows that she was operated for
a ‘fibroadenoma’ in her left breast five years back. What is this lesion?
a. Inflammatory disease
b. Malignant epithelial
neoplasm
c. Benign
epithelial neoplasm
d. Reactive
fibrohistiocytic lesion
e. Sarcoma
43. Two 60-year-old women are recruited
into a screening program for breast cancer. The first woman (A) gave birth to
her first child at 18 years of age while the second woman (B) had her first
issue at 34 years. If all other factors are considered equal which statement is
most accurate regarding the relative risk of the two women developing breast
cancer?
a. Both have equal risk
b. A has the greater
risk
c. B has the
greater risk
d. Both have no risk
since parity prevents breast cancer
e. Both have no
risk since breast cancer is rare after 60 years of age
44. FDA has banned hormonal replacement
therapy for treatment of postmenopausal symptoms since it was found to be
associated with an increased risk of developing breast cancer. How can this be
best explained?
a. Prolonged exposure
to estrogen increases the risk of breast cancer
b. Prolonged exposure
to progesterone increases the risk of breast cancer
c. All hormones
exogenously administered increase the risk of breast cancer
d. Post menopausal
women are at increased risk of breast carcinoma regardless of hormonal status
e. The relative
excess of androgens in post menopausal women is protective against breast
cancer
45. Of the histological
subtypes of breast carcinoma, which metastasizes most frequently to peritoneum,
reteroperitoneum and leptomeninges?
a. Invasive ductal
carcinoma
b. Lobular carcinoma
c. Mucinous
carcinoma
d. Medullary carcinoma
e. Metaplastic
carcinoma
Musculoskeletal, Bones
and joints
46. A 55-year-old female patient presents
with deep aching pain in the right knee joint. Clinical exam reveal osteophytes
(Heberdon nodes) at distal interphalangeal joints of hands. X ray shows
narrowing of joint space, subchondral sclerosis and osteophytes lipping. Serum
RA factor is negative. This pathological process primarily targets:
a. Hyaline cartilage
b. Subchondral bone
c. Articular
cartilage
d. Synovium
e. Periosteum
47. A 30-year old female presents with
morning stiffness with pain and swelling of metacarpophalangeal joints and
proximal interphalangeal joints of her hands. Serum RA factor is positive. This
condition results from an autoimmune reaction against:
a. Articular cartilage
b. Periosteum of bone
c. Hyaline
cartilage
d. Synovium
e. Unknown
arthritogenic antigen
48. Juvenile rheumatoid arthritis
affects:
a.
Larger joints more
frequently than smaller joints
b.
Smaller joints more
frequently than larger joints
c.
Both large and small
joints equally
d.
Only knee joint
e.
Only small joints of
fingers
49. Several days after an episode of
urethritis a 28 yr old man develops acute pain and swelling of the left knee.
On physical examination the knee is swollen and is warm and tender to touch. No
other joints appear to be affected. Lab exam of fluid aspirated from the left
knee joint shoes numerous neutrophils. A gram stain of the fluid shows gram –ve
intracellular diplococcic. No crystals are seen. Which is the most likely orgasnism?
a. Borrelia burgdorferi
b. Treponema pallidum
c. Neisseria
gonorrhoeae
d. Staphylococcus
aureus
e. Haemophilus
influenza
50. A 47 yr old man sees the physician
because he has had dull constant pain in the mid section of the right thigh for
the past 4 months. On physical exam there is pain on palpation opf the anterior
right thigh which worsens slightly with movement. The right thigh appears to
have a larger circumference than the left thigh. A radiogaraph of the right
upper leg and pelvis shows no fracture but there is an ill defined soft tissue
mass anterior to the femur. MRI shows a 10 × 8 × 7 cm solid mass deep to the
quadriceps but it does not involve the femur. What is the most likely
diagnosis?
a. Nodular
fasciitis
b. Liposarcoma
c. Osteosarcoma
d. Rhabdomysarcoma
e. Haemangioma
f. Chondrosarcoma
No comments:
Post a Comment