PATHOLOGY Board Exam
PATHOLOGY Board Exam
PATHOLOGY Board Exam
6. A 76-year old female developed Staphylococcal pneumonia for which she was given a
course of antibiotic therapy. Ten days later, she no longer had productive cough but
fever persisted. Chest x-ray showed a 3-cm, rounded density in the right lower lobe
whose liquefied contents form a central air-fluid level. Which of the following
outcomes of her pneumonia occurred?
A. abscess formation
B. regeneration
C. progression to chronic inflammation
D. fibrosis
MPL: 65
7. A 58-year old female with congestive heart failure develops fever and pleural effusion.
Pleural fluid examination revealed a specific gravity of 1.032 and many degenerating
neutrophils. The most likely cause of fluid accumulation is an increase in
A. vascular permeability
B. colloid osmotic pressure
C. lymphatic pressure
D. renal retention of sodium and water
MPL: 75
8. A 32-year old female takes aspirin for her arthritis. Her joint pain is reduced and there
is still some degree of swelling and limitation of movements. Aspirin lessens pain
mainly through reduction in the synthesis of which of the following mediators?
A. leukotriene D4
B. nitric oxide
C. prostaglandins
D. histamine
MPL: 80
9. A laceration in the right hand of a 22-year old male was sutured. A week later, the
sutures were removed and healing continued. However, the site of the wound
developed a raised, nodular scar that developed over the following 2 months. What
process occurred?
A. wound dehiscence
B. exuberant granulation
C. organization
D. keloid formation
MPL: 90
10. A 44-year old male underwent laparotomy for a perforated sigmoid colon
diverticulum. A wound infection complicated the postoperative course, and surgical
wound dehiscence occurred. Six weeks later, the wound was only 10% of its original
size. Which of the following processes best accounts for the decrease in wound size?
A. inhibition of metalloproteinases
B. diminished subcutaneous edema
C. myofibroblast contraction
D. greater synthesis of collagen
MPL: 65
11. In which of the following organs is an arterial thromboembolus least likely to produce
an infarct?
A. kidney
B. heart
C. brain
D. liver
MPL: 70
12. A 44-year old female was diagnosed with breast carcinoma. The affected left breast is
covered by thickened, pitted overlying skin and is slightly larger than the uninvolved
right breast. How is the gross appearance of the left breast best explained?
A. chronic passive congestion
B. chronic inflammation
C. lymphatic obstruction
D. venous thrombosis
MPL: 70
13. A section through a branch of the right main pulmonary artery at autopsy reveals a
band of fibrous connective tissue that extends across the lumen. Which of the
following events best explains the presence of this finding?
A. thromboembolism
B. hemorrhage
C. hypertension
D. ischemia
MPL: 95
14. A 24-year old male has a workup for infertility and is found to have oligospermia.
Physical examination findings include bilateral gynecomastia, reduced testicular size,
and reduced body hair. Karyotypic analysis will most likely reveal which of the
following abnormalities?
A. 47,XXY
B. 47,XYY
C. 46,XY,del(22q11)
D. 46XX/47XX,+21
MPL: 50
15. Multifactorial inheritance is most likely to play a significant role in the appearance of
A. Marfan syndrome
B. cleft lip
C. polycystic kidneys
D. Tay-Sachs disease
MPL: 55
16. An 8-year old female can bend her thumb back to touch her forearm. She can pull her
skin out from her abdomen about 8 cm, and a cut to her skin gapes open and is
difficult to repair. Her underlying disease process results from an inherited defect in
A. LDL receptor
B. factor VIII
C. alpha1-antitrypsin
D. collagen
MPL: 70
17. A 22-year old female has pancytopenia, proteinuria and a malar rash. A chest
radiograph reveals bilateral pleural effusions. Which of the following findings is most
likely to be elicited in the history?
A. xerostomia
B. photosensitivity
C. urethritis
D. esophageal dysmotility
MPL: 60
18. In a type I hypersensitivity reaction, which of the following cells secretes cytokines
that stimulate IgE production by B cells, promotes mast cell growth, and recruits and
activates eosinophils?
A. CD4+ lymphocytes
B. macrophages
C. neutrophils
D. NK cells
MPL: 50
19. A 34-year old male known to be infected with HIV begins to have difficulty with
activities of daily living. He has memory problems and decreased ability to perform
functions that require fine motor control, such as writing. Which of the following
cells is most important for the dissemination of the infection into the central nervous
system?
A. neutrophil
B. monocyte
C. NK cell
D. CD8+ lymphocyte
MPL: 65
20. A vasculitis affects arteries in many visceral organs of a 27-year old male. There is
focal fibrinoid necrosis of the small arterial and arteriolar vascular media along with
intravascular microthrombi. Scattered neutrophils are seen in these areas of necrosis.
Which of the following laboratory test findings would you most expect for this
patient?
A. neutropenia
B. increased IgE
C. tuberculin skin test positivity
D. decreased C3 complement
MPL: 60
21. A 38-year old male with a 15-year history of intravenous drug use developed a
chronic watery diarrhea caused by Cryptosporidium parvum. She later developed
oral candidiasis followed by Pneumocystis pneumonia. Which of the following
neoplasms is most likely to develop in this patient?
A. cervical squamous carcinoma
B. non-Hodgkin lymphoma
C. adenocarcinoma of the lung
D. cerebral astrocytoma
MPL: 65
22. A 40-year old male with blood type B+ receives a blood transfusion. Unknowingly,
blood from another patient with blood type A+ was used for compatibility testing
prior to the transfusion. Within 30 minutes after starting the transfusion, the patient
becomes tachycardic and hypotensive and passes tea-colored urine. How is this
reaction mediated?
A. mast cell degranulation
B. antigen-antibody complex deposition in glomeruli
C. complement-mediated lysis of red blood cells
D. antibody-dependent cellular cytotoxicity
MPL: 70
23. A 14-year old female is diagnosed with acute tonsillitis which grows group A betahemolytic Streptococcus. The tonsillitis resolves but 3 weeks later, she develops
chest pain with fever. Her ASO titer is 1:512. By which of the following
immunologic mechanisms has the carditis developed?
A. polyclonal lymphocyte activation
B. release of sequestered antigens
C. breakdown of T-cell anergy
D. molecular mimicry
MPL: 45
24. A 46-year old female has keratoconjunctivitis. She also has oral mucosal atrophy
with buccal mucosal ulceration. A biopsy of her lip reveals marked lymphocytic and
plasma cell infiltrates in minor salivary glands. Which of the following antibodies is
most likely to be found for this patient?
A. anti-centromere antibody
B. SS-B
C. Scl-70
D. anti-dsDNA
MPL: 45
25. A biopsy of an enlarged, nontender posterior cervical lymph node from a 62-year old
female reveals effacement of the nodal architecture by a monomorphous population
of large cells with large, dark blue nuclei and scant cytoplasm. The peripheral blood
smear and bone marrow biopsy are normal. This process is most likely to be a
A. myeloma
B. reactive hyperplasia
C. lymphoma
D. lymphangioma
MPL: 65
26. A 62-year old male who presented with hematuria was recently diagnosed with a
grade IV transitional cell carcinoma that has infiltrated through the bladder wall.
Which of the following statements regarding the findings is true?
A. He has a pooly differentiated tumor.
B. The neoplasm is metastatic.
C. The stage of this tumor is low.
D. A paraneoplastic syndrome is apparent.
MPL: 70
27. Which of the following diagnostic screening tests has had the greatest impact on
reduction of cancer deaths?
A. urinalysis
B. Pap smear
C. stool occult blood
D. prostate-specific antigen
MPL: 90
28. A 68-year old male who is positive for HBsAg has an elevated alpha-fetoprotein
level. There are no palpable masses or lymphadenopathy on physical examination.
Occult blood in stool is negative. Which of the following neoplasms is most likely?
A. pancreatic adenocarcinoma
B. prostatic adenocarcinoma
C. hepatocellular carcinoma
D. multiple myeloma
MPL: 95
29. Annual check-up of a 67-year old male reveals pancytopenia on CBC and a serum
chemistry panel with elevated alkaline phosphatase. After a serum prostate-specific
antigen level is found to be elevated, he has a prostate needle biopsy which reveals a
moderately differentiated adenocarcinoma. Which of the following mechanisms best
accounts for these findings?
A. paraneoplastic syndrome
B. tumor metastases to bone
C. tumor angiogenesis
D. high tumor grade
MPL: 80
30. A watery diarrhea is causing dehydration of a 1-year old infant. The attending
physician eventually diagnosed the case as viral gastroenteritis. Which of the
following mechanisms accounts for the diarrhea?
A. decreased absorption of sodium and water
B. lysis of colonic epithelial cells
C. increased secretion of sodium and water by epithelial cells
D. decreased breakdown of lactose
MPL: 65
31. A 13-year old female developed a rash over her chest that started as 0.5 cm-diameter,
reddish macules. In a day or so, the macules became vesicles. A few days later, the
vesicles ruptured and crusted over. Crops of these lesions spread to involve the face
and extremities over the next 10 days. Decades later, which of the following
manifestations of this infection is most likely to appear?
A. infertility
B. shingles
C. chronic arthritis
D. paralysis
MPL: 75
32. A 48-year old rice farmer becomes infected by cercaria that penetrate the skin of his
feet. The cercaria are released from snails living in the irrigation canals. He develops
progressive ascites. Which of the following disease process is responsible for the
clinical finding?
A. elephantiasis
B. hepatic fibrosis
C. mucocutaneous ulceration
D. hemolysis
MPL: 65
33. A suicidal ingestion of acetaminophen results in symptoms of nausea and vomiting in
a 24-year old female. Within a day, which of the following laboratory test results will
indicate the most severe organ damage?
A. ketonuria
B. hypokalemia
C. elevated serum ALT level
D. elevated serum creatine kinase level
MPL: 65
34. A basal cell carcinoma is excised from the left lower eyelid of a 68-year old male.
Which of the following forms of electromagnetic radiation played the greatest role in
the development of this neoplasm?
A. infrared rays
B. x-rays
C. gamma rays
D. ultraviolet rays
MPL: 70
35. Chronic alcoholics are at increased risk for which of the following disorders?
A. blindness
B. carcinoma of the stomach
C. carcinoma of the esophagus
D. acute renal failure
MPL: 65
36. Soon after birth, a 40-week baby has a heart murmur audible on auscultation of the
chest. On echocardiography there is a membranous ventricular septal defect. Which
of the following events is most likely to have resulted in the appearance of this VSD?
A. erythroblastosis fetalis
B. folate deficiency
C. maternal malnutrition
D. maternal rubella infection
MPL: 65
37. A large port-wine stain involves the right side of the face of a 3-year old child. This
irregular, slightly raised, red-blue area is not painful, but is very disfiguring.
Histologically, this lesion is most likely composed of a proliferation of
A. lymphatics
B. capillaries
C. fibroblasts
D. lymphoblasts
MPL: 65
38. Which of the following is a major risk factor for coronary atherosclerosis?
A. diabetes mellitus
B. obesity
C. type A personality
D. sedentary lifestyle
MPL: 70
39. Several skin lesions on the upper chest of a 45-year old male have central pulsatile
cores. Pressing on a core causes a radially arranged array of subcutaneous arterioles
to blanch. The underlying disease he is most likely to have in association with these
skin lesions is
A. micronodular cirrhosis
B. Wegener granulomatosis
C. Marfan syndrome
D. diabetes mellitus
MPL: 45
40. A 49-year old previously healthy female reports having had several fainting spells in
the last 6 months. In each case, she regained consciousness after only a few minutes.
Her blood pressure is normal. She has good carotid pulses with no bruits. Which of
the following cardiac lesions is most likely to be present?
A. left atrial myxoma
B. pericardial effusion
C. mitral valve stenosis
D. bicuspid aortic valve
MPL: 35
41. The feature most important in distinguishing a malignant from a benign tumor is:
A. high mitotic rate
B. presence of necrosis
C. presence of metastasis
D. nuclear pleomorphism
MPL: 85
42. 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
MPL: 80
43. A 25-year old man who admits to long term use of injection drugs presents to your
office with fatigue and multiple raised, purplish skin and buccal mucosal lesions.
You biopsy one of the skin lesions and the pathologist reports that there is a
vascular proliferation characterized by slit-like vessels lined by very atypical
spindle cells; extravasated RBCs and extracellular hemosiderin deposition are
also noted. Your patient has which of the following?
A. bacillary epithelioid angiomatosis
B. Kaposis sarcoma
C. glomus tumor
D. squamous cell carcinoma
MPL: 75
44. A 20-year old male has a brachial artery blood pressure of 200/140 mm Hg but blood
pressure measured at the anterior tibial artery is 90/50. The best explanation is
which of the following?
A. Tetralogy of Fallot
B. ventricular septal defect
C. coarctation of the aorta
D. patent ductus arteriosus
MPL: 70
45. A 65-year old man with long-standing cigarette smoking history presents with a
cough and weight loss. You order chest x-ray examination and this shows a large
hilar mass. A pulmonologist performs bronchoscopy, and the pathologists report
describes a lesion composed of small round cells, with a very high
nuclear/cytoplasmic ratio, inconspicuous nucleoli, nuclear molding, and no
evidence for gland formation, prominent intercellular bridges or keratinization.
Your patient has which of the following?
A. small cell anaplastic carcinoma
B. squamous cell carcinoma
C. adenocarcinoma
D. hamartoma
MPL: 75
46. Most hereditary spherocytoses are characterized by a decreased amount of which of
the following?
A. alpha globin
B. beta globin
C. spectrin
D. glucose 6-phosphate dehydrogenase
MPL: 75
47. Intestinal intussusception in a middle-aged person is most likely associated with
which of the following?
A. an adenomatous polyp
B. no other intestinal diseases
C. a carcinoid tumor
D. Crohns disease
MPL: 70
54. An 8-year old child is found to have papilledema and a neoplasm within the fourth
ventricle, blocking the outflow of cerebrospinal fluid. It is most likely to be
which of the following?
A. a glioblastoma multiforme
B. an ependymoma
C. a colloid cyst
D. a medulloblastoma
MPL: 65
55. The most specific abnormality in Alzheimers disease is which of the following?
A. senile plaque
B. cerebral amyloid angiopathy
C. intraganglionic neurofibrillary tangle
D. Hirano bodies
MPL: 50
56. The classical clinical presenting complaint for a breast intraductal papilloma is which
of the following?
A. bloody nipple discharge
B. peau dorange skin changes
C. a red, firm, painful mass
D. enlargement of ipsilateral axillary lymph nodes
MPL: 70
57. A 35-year old woman presents to you with substantial abnormal uterine bleeding and
pelvic discomfort. You perform a pelvic examination and note an enlarged uterus
with multiple large nodular masses. This patient most likely has which of the
following lesions?
A. lipoma
B. leiomyomata
C. endometrial adenocarcinoma
D. sarcoma botryoides
MPL: 85
58. The type of primary ovarian cancer with the highest rate of bilaterality is which of the
following?
A. serous cystadenocarcinoma
B. mucinous cystadenocarcinoma
C. clear cell carcinoma
D. endometrioid carcinoma
MPL: 70
59. A 65-year old man presents to your office with increased urinary frequency, nocturia,
urinary dribbling and difficulty starting his urinary stream. This clinical scenario
is most compatible with which of the following underlying diseases?
A. prostate cancer
B. urinary bladder cancer
C. urinary bladder infection
D. prostatic nodular hyperplasia
MPL: 85
73. A patient notices a deeply pigmented, raised nodule with indefinite borders on the
upper extremity. Which of the following lesions can be ruled out on clinical
inspection?
A. basal cell carcinoma
B. seborrheic keratosis
C. blue nevus
D. lentigo simplex
MPL: 30
74. A woman fails to lactate or menstruate after giving birth. Which of the following is
the most likely cause?
A. Sheehans syndrome
B. Empty sella syndrome
C. Hypothalamic glioma
D. prolactinoma
MPL: 45
75. The most common cause of the syndrome of inappropriate antidiuretic hormone
secretion is:
A. subdural hematoma
B. pituitary adenoma
C. oat cell carcinoma of the lung
D. radiation injury to the hypothalamus
MPL: 50
76. A 30-year old female recovering from a bout of influenza suddenly develops a
painful, enlarged thyroid. The most likely diagnosis is:
A. Reidels thyroiditis
B. thyroid abscess
C. subacute granulomatous thyroiditis
D. Hashimotos thyroiditis
MPL: 45
77. The blood vessel most commonly involved in myocardial infarction is:
A. circle of Willis
B. left anterior descending coronary artery
C. lateral circumflex branch of the aorta
D. right coronary
MPL: 99
78. The most common site of lytic lesions in muliple myeloma is the:
A. ribs
B. vertebrae
C pelvis
D. skull
MPL: 70
86. Meningiomas commonly are associated with all of the following pathologic features
EXCEPT:
A. irregular infiltrative borders
B. penetration of adjacent bone
C. psammoma bodies
D. expression of epithelial membrane antigen
MPL: 45
87. Which of the following statements correctly describe plexiform neurofibromas?
A. They are diagnostic of neurofibromatosis type I.
B. They have significant potential for malignant transformation.
C. both are correct
D. both are incorrect
MPL: 45
88. In addition to nephrotoxic injury, the other major cause of acute tubular necrosis is:
A. sepsis
B. ischemia
C. severe hypocomplementenemia
D. immune complex deposition
MPL: 55
89. A malignancy which is apparently virus-related and commonly seen in patients of
Chinese ancestry is:
A. esophagea carcinoma
B. adamantinoma
C. Burkitts lymphoma
D. nasopharyngeal carcinoma
MPL: 55
90. Which of the following does NOT characteristically cause fatty change in the liver?
A. diabetes mellitus
B. Reyes syndrome
C. tetracycline toxicity
D. acute hepatitis B
MPL: 55
91. Which of the following histologic features of hepatocellular injury is prognostically
LEAST favorable?
A. bile lake formation
B. collagen formation
C. ballooning of hepatocytes
D. lobular inflammatory cell infiltrates
MPL: 50
92. All of the following features are characteristic of hepatic encephalopathy EXCEPT:
A. occurs with cirrhotic portal hypertension
B. does not occur when serum ammonia levels are normal
C. characteristically causes asterixis
D. frequently is associated with generalized cerebral edema
MPL: 50
93. Chronic bronchitis is associated with all of the following pathologic changes
EXCEPT:
A. goblet cell hyperplasia in bronchi
B. hypertrophy of bronchial submucosal glands
C. inflammatory infiltration of alveolar walls
D. goblet cell metaplasia in bronchioles
MPL: 50
94. The following statements correctly describe Adult Respiratory Distress Syndrome
EXCEPT?
A. It usually develops suddenly in an otherwise healthy individual.
B. Interstitial infiltrates on chest radiographs precede the onset of dyspnea.
C. The overall mortality rate is very low.
D. The underlying cause usually cannot be determined from biopsy alone.
MPL: 60
95. Mediators of increased vascular permeability in acute inflammatory responses
include all of the following EXCEPT:
A. leukotriene E4
B. bradykinin
C. platelet-activating factor
D. complement complex C5b-9
MPL: 60
96. Generation of free radicals is a major mechanism of membrane damage associated
with all of the following processes EXCEPT:
A. radiation injury
B. acute ischemia
C. acute inflammation
D. oxygen toxicity
MPL: 60
97. HLA DR4 is more prevalent in which of the following autoimmune disorders?
A. SLE
B. rheumatoid arthritis
C. ankylosing spondylosis
D. Sjogrens syndrome
MPL: 60
98. Trichomoniasis causes lesions referred to as:
A. raspberry tongue
B. strawberry mucosa
C. strawberry gallbladder
D. chocolate cysts
MPL: 70
99. Bronchopulmonary dysplasia and necrotizing enterocolitis are most likely to be seen
in a patient with which of the following diseases?
A. cystic fibrosis
B. Down syndrome
C. hyaline membrane disease
D. sudden infant death syndrome
MPL: 60
100. In a 70-year old male, which of the following processes contributes most to the
occurrence of osteoporosis?
A. decreased production of osteoid by osteoblasts
B. increased resorption of bone by osteoclasts
C. synthesis of chemically abnormal osteoid
D. increased sensitivity of bone to the effects of parathyroid hormone
MPL: 55