Patho FEU PGI BCA Exit Exam May 2020

PATHO FEU-NRMF PGI-JI COURSE AUDIT EXIT EXAM MAY 2020
PATHO FEU PGI-JI COURSE AUDIT EXIT EXAM MAY 2020
1.) A 50 year old male was diagnosed with tophaceous gout supported by histopathologic examination. What pattern of
inflammation was seen in the tissue in response to the crystal deposits?
a. Suppurative inflammation c. Serous inflammation
b. Fibrinous inflammation d. Granulomatous inflammation
Correct: D
Ratio:
GRANULOMATOUS PURULENT / SUPPURATIVE INFLAMMATION FIBRINOUS INFLAMMATION
INFLAMMATION Characterized by production of pus. Due to increased vascular permeability, large
Characterized by collections of Pus is an exudate containing neutrophils, liquefied molecules such as fibrinogen pass out the blood
activated macrophages, often T- debris of necrotic cell, and edema fluid. and forms fibrin deposits in the extracellular
lymphocytes and sometimes Most frequent cause is bacterial infection that causes space.
associated with central necrosis. liquefactive necrosis, such as staphylococci which Fibrin appears as an eosinophilic meshwork of
A cellular attempt to contain an pyogenic bacteria (pus-producing). threads or sometimes an amorphous coagulum.
offending agent that is difficult to Abscesses are localized collection of purulent If fibrin is not removed, it stimulates the ingrowth
eradicate. inflammation confined in a space with a central region of fibroblasts and angiogenesis.
Strong lymphocytes lead to that appears as a mass of necrotic leukocytes and tissue Ex: (Left) Fibrinou pericarditis, seen grossly are
macrophage activation and cause cells. fibrin deposits in the pericardium. (Right)
injury to normal tissues. Microscopically, a pink meshwork of fibrin
Epitheloid Cells are activated SEROUS INFLAMMATION exudates (F) overlying the pericardium (P).
macrophages that develop abundant Marked by the exudation of cell-poor fluid into the Granulomatous inflammation is a histologic
cytoplasm and begin to resemble spaces created by cell injury. pattern of tissue reaction which appears
epithelial cells. Fluids in serous exudation are not filled with destructive following cell injury. Granulomatous
Giant Cells are fused, multinucleated organisms and do not contain leukocytes. inflammation is caused by a variety of conditions
activated macrophages. It is usually derived from the plasma or the secretion of including infection, autoimmune, toxic, allergic,
mesothelial cells. drug, and neoplastic conditions.
Accumulation of fluid in the cavities is called an effusion.
X-section of a skin blister showing the separation of the
epidermis from the dermis by a local serous effusion.
FEU-NRMF PGI BATCH 2020. SUPPORT. KINDNESS. ENCOURAGEMENT. TROUBLESHOOT. 1

2.) Which of the statements below best explains the preference of tumor cells for aerobic glycolysis?
a. Metabolic reprogramming occurs that favors production of more ATP per glucose molecule
b. Mitochondria of neoplastic cells are less efficient than normal cells
c. The reaction produces enough ATP with more carbon moieties for building cellular components
d. It allows maximum production of high energy phosphates
Correct: C -Altered cellular metabolism – cells switch to aerobic glycolysis called Warburg effect which enables synthesis of
macromolecules and organelles.
Cellular and Molecular Hallmarks of Cancer

1. Self-sufficiency in growth signals – tumors have the
capacity to proliferate without any external stimuli, as a
consequence of oncogene activation.
2. Insensitivity to growth signals
3. Altered cellular metabolism – cells switch to aerobic
glycolysis called Warburg effect which enables synthesis of
macromolecules and organelles.
4. Evasion of apoptosis
5. Limitless replicative potential (Immortality)
6. Sustained angiogenesis – tumor cells need vascular
supply to bring oxygen and nutrients, and remove waste
products.
7. Ability to invade and metastasize
8. Ability to evade immune response
-These may be accelerated by genomic instability and
cancer-promoting inflammation.
3.) In which age group is testicular torsion most likely associated with bell-clapper abnormality?
a. Pre-school
b. Toddler
c. Neonates
d. Adult
Correct: D
Adult torsion: seen in adolescence, presenting as sudden onset of testicular pain; bilateral anatomic defect in which the testis has
increased mobility (bell-clapper abnormality) -> occurs without any inciting injury; sudden pain heralding the torsion may even occur
during sleep
-If testis is untwisted within 6hours of onset of torsion, testis may remain viable
Torsion
Twisting of spermatic cord cutting of venous drainage of the testis
Leads to infarctions when untreated
Arteries remain patent producing intense vascular engorgement followed by hemorrhagic infarction
Neonatal torsion – occurs in utero or after birth and lacks any associated anatomic defect
- Bell-clapper abnormality – bilateral anatomic defect that leads to increased mobility of the testis
- To prevent torsion of unaffected testis, it is surgically fixed to the scrotum (orchiopexy)
4.) After wounding, continuous excessive deposition of collagen beyond the border of the original wound will result to:
a. Keloid
b. Dehiscence
c. Contracture
d. Ulcer
Correct: A

Excessive formation of the components of the repair process can give rise to hypertrophic scars & keloids
◌ Hypertrophic scar ◌ Keloid

- Raised scar due to accumulation of - Scar tissues that grow beyond the boundaries of the original wound
excessive amount of collagen & does not regress
- Generally develops after thermal or -More common in African Americans
traumatic injury that involves the deep --- Exuberant granulation consisting of the formation of excessive
layers of the epidermis amount of granulation tissue which protrudes above the level of the
surrounding skin & blocks reepithelialization (proud flesh)
- Excessive granulation must be removed

by cautery or surgical excision to permit Dehiscence: Mechanical factors
restoration of the continuity of the Examples: increased local pressure or torsion
epithelium -May cause wounds to pull apart or dehisce
An exaggeration of this process gives rise
to contracture & results in deformities of
the wound & the surrounding tissues
5.) Patient was diagnosed of sepsis and went into DIC. The following laboratory findings are decreased EXCEPT:
a. factor VIII
b. platelets
c. factor VII
d. fibrin degradation product
Correct: D
Diagnosis is based on clinical observation & laboratory studies: Fibrinogen
levels, platelets, PT, PTT, & FDP
DISSEMINATED INTRAVASCULAR COAGULATION (DIC)
Acute, subacute or chronic thromboembolic disorder
Excessive activation of coagulation formation of thrombi in the
microvasculature in the body
Secondary complication of many different disorders
Sometimes localized to specific organ or tissue
Consumption of platelets, fibrin & coagulation factors
Secondary activation of fibrinolysis
Can present with signs & symptoms relating to tissue hypoxia & infarction – Myriad Microthrombi
Depletion of factors for hemostasis, activation of fibrinolysis or both results to hemorrhage
6.) Patient with dysphagia had an esophageal biopsy revealing columnar metaplasia with goblet cells. This condition is high
risk for
a. squamous cell carcinoma
b. lymphoma
c. carcinoid syndrome
d. adenocarcinoma
Correct: D
Barrett Esophagus
Can be recognized as one or several tongues or patches of red, velvety mucosa extending upward the junction.
Intestinal-type metaplasia is seen as replacement of the squamous esophageal epithelium with goblet cells.
A complication of chronic GERD characterized by intestinal metaplasia with esophageal squamous mucosa.
Increased risk for esophageal adenocarcinoma.

These are diagnostic of Barrett Esophagus, and have distinct mucous vacuoles that stain plate blue in H&E and impart the shape of a
wine-goblet.
7.) I am the source of cells’ strength, I help in the capacity of cells to resist shear stress. I am not as big as my big brother and
neither I am small as my little sister. I am….
a. Actin
b. Intermediate filament
c. Myosin
d. Microtubule
Correct: B
Intermediate filament: Actin Microtubules
10-nm diameter fibrils that comprise Are 5- to 9-nm diameter fibrils 25-nm-thick
a large & heterogenous family formed from the globular protein Composed of noncovalently
Impart tensile strength & allow cells actin (G-actin), the most abundant polymerized dimers of - & -tubulin
to bear mechanical strength cytosolic proteins in the cell arrayed in constantly elongating or
Maintains nuclear morphology & The G-actin monomers shrinking hollow tubes with a
regulates normal nuclear noncovalently polymerize into long defined polarity; the ends are
transcription with regards to filaments (F-actin) that interwine to designated with a “+” or “-“
laminins form double-stranded helices with a Determines the position of
Form the major structural proteins of defined polarity membrane enclosed organelles &
skin & hair In non-muscle cells, F-actin directs cellular transports
assembles via an assortment of The “-“ end is typically embedded in
actin-binding proteins into well- a microtubule organizing center
organized bundles & network that (MTOC or centrosome)
control shape & movement “long highways” – preferred track for
What about Myosin?
Myosin- in terms of cellular long distance transport
housekeeping, these are the trucks, “+” ends are pointed out to the
along with kinesin, & dynein periphery & the “-“ ends towards the
center of the cell
These questions are totally SOOOOO Doc Gacasan. There’s tons of questions like this.
8.) Anisocoria associated with brain herniation is consistent with:

a. cingulate
b. transtentorial
c. subfalcine
d. tonsillar

Correct: B
Transtentorial (Uncinate, Uncal, Medial Tonsillar Herniation:

Temporal) Herniation Cerebellar tonsils displaced through the foramen
- Occurs when the MEDIAL aspect of the magnum
Occipital bone surrounding foramen magnum – rigid
TEMPORAL LOBE is compressed against a free
structure
margin of the tentorium (rigid structure) - > Life-threatening – can cause brainstem compression
uncus/hippocampus herniates Compromise respiratory and cardiac centers Central
- Midbrain compression (dec sensorium) RESPIRATORY FAILURE
9.) The paramesonephric duct develops into:

a. Uterus
b. Lower vagina
c. Ovary
d. Vestibule
Correct: A
10.) In the heart that underwent myocardial infarction which of the following is expected to be seen?
a. apoptotic myocytes
b. dead intact cardiac myocytes
c. Dividing cardiac myocytes
d. small proliferating myocytes
Correct: B
Can’t find the exact explanation but:
One-day-old infarct: showing coagulative necrosis and wavy fibers. Widened spaces between the dead fibers contain edema fluid and scattered
neutrophils.
3-4 days old: Dense polymorphonuclear leukocytic infiltrate in an acute myocardial infarction that
7-10 days: Removal of necrotic myocytes by phagocytosis (approximately 7 to 10
days).
-The typical changes of coagulative necrosis become detectable in the first 6 to 12 hours. “Wavy
fibers” may be present at the periphery of the infarct; these changes probably result from the forceful systolic tugs of the viable fibers on immediately
adjacent, noncontractile dead fibers, causing stretching and folding. An additional sublethal ischemic change may be seen in the margins of infarcts: so-
called myocyte vacuolization or myocytolysis, which reflects intracellular accumulations of salt and water within the sarcoplasmic reticulum. The necrotic
muscle elicits acute inflammation (most prominent between 1 and 3 days).

-Thereafter, macrophages remove the necrotic myocytes (most noticeable by 3 to 7 days), and the damaged zone is progressively replaced by the
ingrowth of highly vascularized granulation tissue (most prominent at 1 to 2 weeks); as healing progresses, this is replaced by fibrous tissue. In most
instances, scarring is well advanced by the end of the sixth week, but the efficiency of repair depends on the size of the original lesion, as well as the
relative metabolic and inflammatory state of the host.
Coagulation Necrosis – mechanism of cell MI less 12 hours – NOT apparent in gross The necrotic muscle elicits:
death in MI examination o Acute inflammation – 1-3 days
Frequencies of site of infarction: (areas Triphenyltetrazolium chloride (TTC) stain o Macrophages – 3-7 days (remove the
supplied) o To highlight the area of necrosis necrotic myocytes)
o LAD (40-50%) o Imparts brick-red color to uninfarct area/intact o Granulation tissue – 1-2 wks (this replaces
o RCA (30-40%) Typical coagulative necrosis detectable in the damage zone)
o LCX (15-20%) 6-12 hours o Scarring – 6 wks
Wavy fibers at periphery of infarct Infarct heals from its margins toward its center
Myocytolysis (vacuolar degeneration) at Extensions
margins additional sublethal ischemic change o Process where infarcts may expand beyond
may be seen in the margins of infarcts their original borders over a period of days to
weeks
o In extension, healing in central zone is more
advanced than the periphery of the infarct
11.) Skeletal muscle fiber enlargement in a person doing regular exercise is attributed to which of the following?
a. Adaptation resulting into hyperplasia
b. Adaptation resulting into hypertrophy
c. Metaplastic change
d. Autophagy
Correct: B
Hypertrophy C. Aplasia
1. Hypertrophy is an increase in the size of an organ or tissue 1. Aplasia is a failure of cell production.
due to an increase in the size of 2. During fetal development, aplasia results in agenesis, or
cells. absence of an organ due to
2. Other characteristics include an increase in protein failure of production.
synthesis and an increase in the size 3. Later in life, it can be caused by permanent loss of precursor
or number of intracellular organelles. cells in proliferative tissues,
3. A cellular adaptation to increased workload results in such as the bone marrow.
hypertrophy, as exemplified by the D. Hypoplasia
increase in skeletal muscle mass associated with exercise and 1. Hypoplasia is a decrease in cell production that is less
the enlargement of the left extreme than in aplasia.
ventricle in hypertensive heart disease. 2. It is seen in the partial lack of growth and maturation of
B. Hyperplasia gonadal structures in Turner
1. Hyperplasia is an increase in the size of an organ or tissue syndrome and Klinefelter syndrome.
caused by an increase in the
number of cells. Atrophy
2. It is exemplified by glandular proliferation in the breast 1. Atrophy is a decrease in the size of an organ or tissue and
during pregnancy. results from a decrease in the
3. In some cases, hyperplasia occurs together with mass of preexisting cells (Figure 1-1).
hypertrophy. During pregnancy, uterine 2. Most often, causal factors are disuse, nutritional or oxygen
enlargement is caused by both hypertrophy and hyperplasia of deprivation, diminished
the smooth muscle cells endocrine stimulation, aging, and denervation (lack of nerve
in the uterus. stimulation in peripheral
muscles caused by injury to motor nerves).
3. Characteristic features often include the presence of
autophagic granules, which are
intracytoplasmic vacuoles containing debris from degraded
organelles.
12.) A 6 day old male, preterm, is presenting with pneumonia and has a blood culture result of Group B streptococcus. Which
of the following is not true about his case?
a. Inhalation of amniotic fluid is one of the ways by which the organism reached the fetus
b. The organism is the most common cause of the type of sepsis of the patient
c. The organisms entered the fetal bloodstream through the chorionic villi

d. Pneumonia is a common clinical presentation of early onset sepsis

Correct: C
Transcervical Infections (Ascending Preterm birth is a common SEPSIS
Infections) consequence of infection which may be Grouped based on
- Most bacterial and few viral are acquired via associated with: early onset (first 7 days of life)
this route. Damage and rupture to the amniotic sac o Group B streptococcus - bacterial
- Fetus either acquires this infection either by: as a direct consequence of meningitis
Inhaling the infected amniotic fluid into the inflammation. late onset (from 7 days to 3 months
lungs shortly before birth. Induction of labor by prostaglandins o Infections with Listeria and Candida
By passing through an infected birth canal released from infiltrating neutrophils.
during delivery. Pneumonia, sepsis, and meningitis are
common sequelae of fetus infected by
inhalation of amniotic fluid.
13.) Histologic finding associated with nutmeg liver would be:

a. centrilobular necrosis
b. granuloma formation
c. regenerating pseudolobules
d. bridging fibrosis
Correct: A
In chronic passive hepatic congestion, the centrilobular are grossly red-brown & slightly depressed (because of cell death) & are
accentuated against the surrounding zones of uncongested tan liver (nutmeg liver)
◌ Microscopically, there is centrilobular hemorrhage, hemosiderin-laden macrophages & variable degrees of hepatocyte dropout &
necrosis
BRIDGING FIBROSIS: Porto-central. It occurs after centrolobular necrosis and produces new vascular connections between portal
fields and central veins which may lead to cirrhosis
Primary Biliary Cirrhosis (PBC)

-An autoimmune disease characterized by non-suppurative, inflammatory destruction of small and medium sized intrahepatic bile ducts.
-Interlobular bile ducts are actively destroyed by lymphoplasmacytic inflammation with or without granuloma – florid duct lesion
In Acute Viral Hepatitis:

There is central-portal bridging necrosis followed by parenchymal collapse.
14.) The histologic appearance of C. neoformans infection in Virchow-Robin spaces in the gray matter is:
a. Fungus balls
b. Durck granulomata
c. Fruiting bodies
d. Soap bubble lesion
Correct: D
15.) A 10-year-old female was given a vaccine with adjuvant, intramuscular route, for a re-emerging infectious disease with
the antigen composed of protein. With an intact immune system, the expected immune responses are the following, except:
a. B lymphocyte differentiation into cell that will produce mainly IgM isotype
b. Clonal proliferation of T cells with TCR specific for the antigen
c. Isotype switching following CD40L-CD40 interaction, and IL-4 and IFN- γ action
d. Plasma cell production of antibodies with high affinity
Correct: A
-Can’t find a good explanation -should be IgM and IgD isotype?
IgM and IgD isotypes are present in the surface of naïve B cells, which serves as its antigen-binding component.
After stimulation, it matures to a Plasma Cell which produces Ab

- Antibody-secreting cells detected in the peripheral blood of human are called plasmablasts.
The receptor also contains a heterodimer of two invariant protein Igα (CD79a) and Igβ (CD79b), which are essential for signal
transduction through the antigen receptor.
CR2 or CD21 is a type-2 complement receptor which recognizes complement products during innate immune response to microbes.
CD40 receives signals from Helper T-cells.
CLONAL SELECTION
Lymphocytes express specific receptors for antigens and mature into functionally competent cells before exposure to antigen.
Lymphocytes of the same specificity constitute a CLONE, expressing identical antigen receptors.
16.) What is the most common primary tumor in the heart?

a. Myxoma
b. Carcinoid tumor
c. Lipoma
d. Rhabdomyoma
Correct: A
Cardiac tumors may be primary (benign or malignant) or metastatic (malignant). Myxoma, a benign tumor, is the most common type of
primary cardiac tumor.
Myxomas are the most common. Lipoma Rhabdomyoma
These are benign neoplasm thought to arise Localized well circumscribed benign tumors of Most frequent primary tumor of the pediatric
from primitive multipotent mesenchymal cells. mature fat cells. heart, and commonly discovered in the first
Tumors are usually single, but can rarely be Can occur in subendo-, subepi- or myocardium. years of life because of obstruction of a valvular
multiple. May be asymptomatic or produce ball-valve orifice or heart chamber.
The region of the fossa ovalis in the atrial obstruction. Due to sporadic mutations (50%), the other
septum is the favored site of origin. Most often located in left ventricle, right atrium hand is associated with tuberous sclerosis.
Myxomas range from small (<1cm) to large or the atrial septum. Gray-white myocardial masses that can be
(>10cm) and can be sessile or pedunculated small.
(wrecking-ball appearance) often mobile during Papillary Fibroelastoma Usually multiple and involve the ventricles
systole. Curious, usually incidental, sea-anemone-like preferentially, protruding into the lumen.
lesions often identified at autopsy. Composed of bizarre markedly enlarged
May embolize and become clinically important. myocytes.
Resembles lambl excrescences. Histologic processing reduces the cytoplasm to
80% are located on valves particularly the thin strands that stretch from the nucleus
ventricular surfaces of SL valves and the atrial appearance referred as spider cells.
surface of AV valves.
17.) Which of the following conditions favour thrombus formation?

a. intact endothelium
b. tissue factor
c. heparin like molecules
d. thrombomodulin
Correct: B
Tissue factor
◌ Exposed at the site of injury
◌ Membrane-bound procoagulant glycoprotein that is normally expressed by subendothelial cells in the vessel wall such as smooth
muscle cells & fibroblasts
◌ Capable of binding & activating factor VII → setting in motion a cascade of reactions that culminates in thrombin formation
Platelet aggregation causes microthrombus formation and leads to the release of vasoactive
amines from platelet-dense granules.
Endothelial injury leading to platelet activation almost inevitably underlies thrombus formation in the heart & the arterial circulation
where the high rates of blood flow impede clot formation
- Notably, cardiac & arterial clots are typically rich in platelets
◌ Platelet adherence & activation is a necessary prerequisite for thrombus formation under high shear stress such as exists in arteries

Inflammation & other noxious stimuli also promote thrombosis by shifting the pattern of gene expression in endothelium to
one that is “prothromotic”
18.) A 35-year old woman presents with vague pelvic pain. Transvaginal ultrasound shows left ovarian cyst. Biopsy of the left
ovary shows endometrial glands and stroma as well as old and recent hemorrhages. These findings are compatible with:
a. Serous cystadenoma
b. Adenomyosis
c. Mucinous cystadenoma
d. Endometriosis
Correct: D
Endometriosis: Presence of Adenomyosis Serous cystadenoma -single MUCINOUS TUMOR
endometrial tissue outside of presence of endometrial tissue layer of cells lining the cyst - Less common than serous
the uterus within the uterine wall wall tumor
o commonly consists of both (myometrium) SEROUS TUMOR -mutations in KRAS proto
endometrial glands and remain in continuity with the Lined by tall columnar ciliated oncogene
stroma, rarely consists only of endometrium, signifying and non ciliated cells
endometrial stroma downgrowth of endometrial Cyst cavity filled w/ serous
o can give rise to carcinoma tissue into and between the fluid
smooth muscle fascicles of the Benign/ borderline - 70%;
myometrium malignant - 30%
-Associated w/ BRCA1 and
BRCA2
19.) Which of the following is not true about schistosomiasis?

a. Much of the pathology is caused by tissue destruction by the adult stage of the parasite
b. Urinary schistosomiasis is associated with squamous cell carcinoma of the bladder
c. Presence of the egg in the liver evokes a granulomatous type of inflammation
d. The organism causes pipe-stem fibrosis in the liver
Correct: A
Enter skin: from the larvae of Schistosoma, which releases Squamous cell carcinoma constitutes a minority of urinary tract
enzymes that dissolve adhesive proteins that hold keratinocytes malignancies.
together. 1. This cancer may result from chronic inflammatory processes,
Schistosomiasis is caused by infestation with Schistosoma such as chronic bacterial
mansoni or Schistosoma infection or Schistosoma haematobium infection.
japonicum. The adult worms lodge in the portal vein and its 2. It can also be associated with renal calculi.
branches. The eggs are
highly antigenic and stimulate granuloma formation, with Schistosoma mansoni localizes to the vessels of the portal
resultant tissue destruction, system, and mesentery.
scarring, and portal hypertension. Schistosoma haematobium travels to vessels in the urinary
Pipe-stem fibrosis: Intrahepatic: caused by intrahepatic vascular bladder and causes cystitis.
obstruction, most often by cirrhosis or
metastatic tumor, and more rarely by exotic entities such as Schistosoma: Granulomatous inflammation is a distinctive form
schistosomiasis of mononuclear inflammation usually evoked by infection that
resist eradication and are capable of stimulating strong T-cell
mediated immunity.
20.) The major underlying etiology of intraparenchymal hemorrhage affecting the putamen is:
a. diabetes
b. hypertension
c. atherosclerosis
d. cerebral amyloid angiopathy
Correct: B
Intracerebral (Intraparenchymal) Hemorrhage
- “Primary Brain Parenchymal Hemorrhage”

- 2 major underlying etiologies:

HYPERTENSION (Most common) & CEREBRAL AMYLOID ANGIOPATHY (CAA)
- CHARCOT-BOUCHARD MICROANEURYSMS (minute aneurysm)
- Originate in putamen, thalamus, pons, cerebellar hemisphere-ganglionic, and lobar hemorrhages
- Occur most commonly in middle to late adult life, peak incidence about 60 years old
- Large portions of the brain and extends to ventricular system vs. small regions (clinically silent)
- Acute hemorrhages
- Old hemorrhages show an area of cavitary destruction of brain with a rim of brownish discoloration
In babies: Intraparenchymal Hemorrhage
- Between thalamus and caudate nucleus
- Extend into ventricular system going to the subarachnoid space (SAS) -> hydrocephalus
21.) Giant cell arteritis presents a change which is:

a. Typical of granulomatous inflammation
b. Tunica media calcification
c. Production of anti-endothelial cell antibodies
d. Proliferation of endothelial cells
Correct: A
Giant Cell (Temporal) Arteries Vasculitis
The most common form of vasculitis among Mőckenberg medial sclerosis Vasculitis is a general term for vessel
older individuals in the US and Europe. Calcification of the walls of muscular wall inflammation.
It is a chronic inflammatory disorder of large to arteries, typically involving the -Clinical features are largely dependent
small sized arteries that principally affect the internal elastic membrane. on the vascular bed affected; typically
arteries in the head – especially the temporal Most commonly affected are ages include constitutional signs and
arteries – but also the vertebral and ophthalmic 50 and above. symptoms such as fever, myalgia,
arteries. Calcifications do not encroach on arthralgia and malaise.
May also affect the aorta. the vessel lumen and are usually not ****Non-infectious Vasculitis
Classic lesions exhibit medial granulomatous clinically significant -Immune complex deposition
inflammation centered on the internal elastic -Anti-neutrophil cytotoxic antibody
lamina that produces elastic lamina -Anti-endothelial cell antibody
fragmentation. -Autoreactive T cells
22.) Most common paraneoplastic syndrome

a. hypercalcemia
b. hyperkalemia
c. hypokalemia
d. hypocalcemia
Correct: A
Paraneoplastic syndromes occur in approximately 10% of patients with lung cancer, and two of the most common are humoral
hypercalcemia of malignancy (HHM) in squamous cell carcinoma and the syndrome of inappropriate antidiuretic hormone secretion
(SIADH) in small cell lung cancer.
23.) Hyperadrenal clinical syndromes include

a. Cushing
b. Conn’s
c. Fanconi
d. Addison
Correct: A
Adrenal insufficiency (another way of saying “hypo” adrenal)

–Primary acute adrenocortical insufficiency
–Primary chronic adrenocortical insufficiency (Addison disease)
Conn syndrome

Primary hyperaldosteronism: autonomous over-production of

aldosterone->suppression of renin-angiotensin system ->
decreased plasma renin activity
–Adrenocotical neoplasm: 35%, adenoma)
–Primary adrenocortical hyperplasia –60%
–Glucocorticocid-remediable hyperaldosteronism
Fanconi syndrome is a rare disorder of kidney tubule function that results in excess amounts of glucose, bicarbonate, phosphates
(phosphorus salts), uric acid, potassium, and certain amino acids being excreted in the urine
24.) Complication of hemorrhoids will be the following, except:

a. May undergo malignant transformation
b. A source of bleeding
c. Results to painful ulceration
d. Undergoes inflammatory change
Correct: A
Develop secondary to persistently elevated venous pressure within the hemorrhoidal plexus.
Most frequent predisposing factors are straining on defecation due to constipation, and venous stasis in pregnancy.
Can also occur in portal hypertension.
Often presents with pain and rectal bleeding, particularly bright red blood.
Can be treated by sclerotherapy, rubber band ligation, or infrared coagulation. Severe cases undergo hemorrhoidectomy.
Morphology
Collateral vessels within the inferior hemorrhoidal plexus below the anorectal line are termed external hemorrhoids.
Dilation of the superior hemorrhoidal plexus within the distal rectum is termed internal hemorrhoids.
Consists of thin-walled, dilated, submucosal vessels
While colorectal cancer can cause similar symptoms, hemorrhoids are far more common. As uncomfortable as hemorrhoids can be,
they're easily treatable and don't cause cancer.
25.)Which of the following is the most common primary

benign tumor of salivary glands?
a. mucocele
b. pleomorphic adenoma
c. warthin tumor
d. oncocytoma
Correct:B
PLEOMORPHIC WARTHIN TUMOR (PAPILLARY MUCOEPIDERMOID ADENOID CYSTIC

ADENOMA CYSTADENOMA CARCINOMA CARCINOMA
- Aka mixed tumors LYMPHOMATOSUM) - Variable mixtures of - Uncommon
- 60% in parotid, less - 2nd most common salivary gland squamous cells, mucos- - 50% is found in minor salivary
common in submandibular neoplasm secreting glands(palate), major
glands - Only tumor restricted to the parotid) cells & intermediate cells salivary glands (parotid &
- Benign tumors that consist - More common in males, 5th-7th - Most common primary submandibular)
of a mixture of ductal decade of life, malignant tumor of
epithelia & myoepithelia smokers salivary
cells - 10% multifocal, 10% bilateral gland; 60-70% in parotid
26.)Which of the cells below proliferates continuously throughout life from stem cells?
a. Red blood cell
b. Renal tubular cells
c. Fibroblasts

d. Hepatocytes
Correct: A
LABILE TISSUES STABLE TISSUES PERMANENT
Continuously dividing tissues consistently Quiescent tissues in the G0 phase of the cell cycle. TISSUES
lost and replaced. Only iminimal proliferative activity in their normal state. These are
Proliferates all throughout life. Capable of dividing in response to injury or loss of tissue mass. tissues that are
Hematopoietic cells (Bone Marrow) Parenchyma of solid organs terminally
Stratified Squamous epithelia - Liver, Kidney, Pancreas differentiated and
- Oral cavity, vagina, cervix Endothelial cells non-proliferative.
Cuboidal epithelia Fibroblasts Neurons and
- Ducts of exocrine organs Smooth muscle cells Cardiac Muscles
Columnar epithelia However, they have the limited capacity to regenerate after an are permanent
- Lining of the GIT, uterus, fallopian tube injury, except from the liver. tissues.
Transitional epithelia
- Lining of the urinary bladder.
27.) A 40-year old male with a known pituitary mass complained of sudden onset of excruciating headache and diplopia was
subsequently brought to the hospital for loss of consciousness. Which of the following complications could have possibly
occurred on the pituitary mass?
a. Hemorrhage
b. Necrosis
c. Infection
d. Thrombosis
Correct:A
The word apoplexy is defined as a sudden neurologic impairment, usually due to a vascular process. Pituitary apoplexy is characterized
by a sudden onset of headache, visual symptoms, altered mental status, and hormonal dysfunction due to acute hemorrhage or
infarction of a pituitary gland. An existing pituitary adenoma is usually present. The visual symptoms may include both visual acuity
impairment and visual field impairment from involvement of the optic nerve or chiasm and ocular motility dysfunction from involvement
of the cranial nerves traversing the cavernous sinus.
28.) A 30 year old female who had a one-night stand with a guy she met in a bar in Taguig one week ago now has fever,
malaise, tender inguinal nodes and several vesicles and ulcers on her cervix, vagina and vulva. Samples from the base of the
ulcer were cytologically examined which showed cells with glassy intranuclear inclusion bodies. What do you call the
inclusion bodies?
a. Warthin-Finkeldey cells
b. Owl’s eye cells
c. Koplik spots
d. Cowdry Type A
Correct:D
Warthin–Finkeldey cell - giant multinucleate cell found in hyperplastic lymph nodes early in the course of measles and also in HIV-
infected individuals, as well as in Kimura disease, and more rarely in a number of neoplastic (e.g. lymphoma) and non-neoplastic lymph
node disorders.
Koplik's spots: Little spots inside the mouth that are highly characteristic of the early phase of measles (rubeola). The spots look like a
tiny grains of white sand, each surrounded by a red ring. They are found especially on the inside of the cheek (the buccal mucosa)
opposite the 1st and 2nd upper molars.
Type A (as seen in herpes simplex and VZV)

Type B (as seen in infection with poliovirus and CMV
Owl's eye appearance of entire nucleus - a finding in Reed–Sternberg cells in individuals with Hodgkin's lymphoma
29.) The morphology of the red blood cells of patients with IDA or hemoglobinopathies like thalassemia is:
a. microcytic hypochromic

b. normocytic normochromic
c. microcytic hyperchromic
d. macrocytic normochromic
Correct:A
Thalassemias
■ Autosomal codominant disorders caused by mutations in α- or β-globin
that reduce hemoglobin synthesis, resulting in a microcytic, hypochromic anemia.
■ In β-thalassemia, unpaired α-globin chains form aggregates that damage red cell
precursors and further impair erythropoiesis.
Iron Deficiency Anemia

■ Caused by chronic bleeding or inadequate iron intake; results in insufficient
hemoglobin synthesis and hypochromic, microcytic red cells
30.) Which of the following is TRUE of sinonasal papilloma

a. association with HPV 16 in inverted type of papilloma - Inverted (endophytic) and exophytic type lesions are associated with HPV
DNA type 6 and 11
b. exophytic type is noted for its aggressiveness - Inverted (endophytic) type is aggressive
c. cylindrical type is not associated with HPV infection
d. inverted papilloma is the most common type - Exophytic is most common
Correct: C
Additional Notes:
Sinonasal (Schneiderian) Papilloma
- a benign neoplasm arising from the respiratory or Schneiderian mucosa lining the nasal cavity and paranasal sinus
- These lesions occur in 3 forms: Exophytic, Endophytic (Inverted), cylindrical
31.) Saddle emboli in the lungs is most commonly due to:

a. pulmonary embolism
b. systemic thromboembolism
c. fat embolism
d. air embolism
Correct: A
Saddle pulmonary embolism commonly refers to a large pulmonary embolism that straddles the bifurcation of the pulmonary trunk,
extending into the left and right pulmonary arteries.
32.) Familial hypercholesterolemia is due to which of the following?

a. Lysosomal storage defect
b. Receptor protein defect
c. Structural protein defect
d. Glycogen storage defect
Correct:B
FH results from defects in the hepatic uptake and degradation of LDL via the LDL-receptor pathway, commonly caused by a loss-of-
function mutation in the LDL-receptor gene (LDLR) or by a mutation in the gene encoding apolipoprotein B (APOB)
33.) A 6-month old boy presents with recurrent bacterial infections of the respiratory tract. Examinations show markedly
decreased B-cells in the circulation, absent plasma cells in the bone marrow and underdeveloped germinal centers of the
lymph nodes. What is the most likely diagnosis?
a. Bruton Agammaglobulinemia
b. DiGeorge Syndrome

c. Severe Combined Immunodeficiency

d. Chédiak-Higashi Syndrome
Correct: A
Severe Combined Immunodeficiency (SCID)
Constellation of genetically distinct syndromes, all having common defects in both humoral and cell-mediated immune responses.
Affected infants present with prominent thrush (oral candidiasis), extensive diaper rash, and failure to thrive.
Some patients develop a morbilliform rash shortly after birth because maternal T cells are transferred across the placenta and attack
the fetus, causing GVHD.
DiGeorge Syndrome (Thymic Hyperplasia)

T-cell deficiency that results from failure of development of the third and fourth pharyngeal pouches – the latter gives rise to the thymus,
parathyroids, C cells of the thyroids, and ultimobranchial body.
X-linked Agammaglobulinemia
Failure of B-cell precursors (pro-B cells and pre-B cells) to develop into mature B cells.Caused by mutations in the cytoplasmic tyrosine
kinase called Bruton tyrosine kinase (Btk); the gene that encodes it is located in Xq21.22.
Chédiak-Higashi Syndrome
Defect in Phagolysosome Function
Autosomal Recessive
Defective fusion of the phagosome and lysosome.
Main leukocyte abnormalities are neutropenia, defective degranulation, and delayed microbial killing.
34.) A newborn has developmental failure in the anterior abdominal

and bladder wall with the bladder appearing as an open sac. What
histologic type of bladder malignancy is associated with this
condition?
a. Leiomyosarcoma
b. Adenocarcinoma
c. Squamous cell carcinoma
d. Urothelial carcinoma
Correct:B
Urothelial Tumors
- 90% of all bladder tumors and run the gamut from small benign lesions
that may never recur to aggressive cancers associated with a high risk of death.
There are two distinct precursor lesions to invasive urothelial carcinoma:

-non-invasive papillary tumors
-flat non-invasive urothelial carcinoma.
o The most common precursor lesions are the non-invasive papillary tumors, which originate from papillary urothelial hyperplasia.
o flat non-invasive urothelial carcinoma is referred to as carcinoma in situ or CIS.
-CIS -> epithelial lesions that have cytologic changes of malignancy, but are confined to the epithelium, without basement membrane
invasion (high grade lesion)
o in invasive bladder CA, there are times that there’s no precursor lesions may be detected. It is presumed that the precursor lesion has
been destroyed by the high-grade invasive component, which typically appears as a large frequently ulcerated mass.
35.) The most common malignancy of the esophagus is

a. squamous cell carcinoma
b. MALToma
c. adenocarcinoma
d. GIST
Correct:A

The vast majority of esophageal cancers fall into one of

two types, adenocarcinoma and squamous cell carcinoma.
Squamous cell carcinoma is more common worldwide,
but adenocarcinoma is on the rise in the United
States and other Western countries.
Benign tumors of the esophagus are

generally mesenchymal, and arise within the esophageal
wall, with leiomyomas being most common
Esophageal Adenocarcinoma Esophageal Squamous Cell Carcinoma Leiomyoma
- Most arise from Barrett esophagus, Linked to tobacco and alcohol, nutritional Benign tumors of the esophagus are
increased rates may be partly due to deficiencies (polycyclic hydrocarbons, generally of mesenchymal origin,
increased incidence of obesity related nitrosamines), mutagenic compounds, leiomyoma being the most common.
GERD. HPV.
- H. pylori infection reduces the risk of Molecular pathogenesis is linked to SOX2
esophageal adenocarcinoma due to amplification, overexpression of cyclin D1,
atrophy of the gastric mucosa. and loss-of-function mutations in TP53, E-
- Occurs most frequently in Caucasians cadherin, and NOTCH1.
more commonly in men.
36.)A 55 year old female, non-smoker has cough for 3 months associated with occasional chest pain. Chest CT-scan showed
a lung mass. CT scan-guided biopsy of the mass was done with a cytopathology report of adenocarcinoma. EGFR mutation
testing was positive using the same biopsy specimen. Which of the following is not true about the mutation detected?
a. It is a gain-of-function point mutation

b. There is gene amplification of the receptor tyrosine kinase
c. The protein that will be expressed by mutated gene is constitutively active
d. The mutated gene encodes for a membrane receptor with intrinsic tyrosine kinase activity
Correct: B
Really can’t find the answer to this

Adenocarcinoma
Most common type in women and non-smokers.
EFGR (15%), K-RAS mutation (30%)
p53, RB and p16 mutation and inactivation.
Microscopic findings:
Glandular differentiation
Patterns: nonmucinous, mucinous, lepidic, acinar,
papillary, solid, mucinous adenocarcinoma
Adenocarcinoma is marked by oncogenic gain-of-function

mutations involving components of growth factor
receptor signaling pathways. All are found in a minority
of tumors, but together they make up a substantial fraction
of tumors as a whole. These include gain-of-function
mutations in multiple genes encoding receptor
tyrosine kinases, including EGFR, ALK, ROS, MET, and
RET, which are all also mutated in other forms of cancer.
Tumors without tyrosine kinase gene mutations often
have mutations in the KRAS gene, which you will
remember lies downstream of receptor tyrosine kinases
in growth factor signaling pathways.
Small Cell Carcinoma

Mutation: p53 (50-80%) and RB gene (80-100%)
Large Cell Carcinoma

LCC is a diagnosis of exclusion since it expresses none of the markers associated with adenocarcinoma (TTF-1, Napsin A) and
squamous cell carcinoma (p63, p40),
37.) Scaling of skin plaques result in minute bleeding points when scale is lifted from the plaques. What is the likely
diagnosis?
a. Lichen planus
b. Psoriasis
c. Pemphigus
d. None
Correct:B
PSORIASIS
• Well-demarcated pink to salmon colored Lichen planus is an inflammatory skin Pemphigus vulgaris is a rare, severe
plaque covered by loose condition, characterized by an itchy, non- autoimmune disease in which blisters of
silver white scale infectious rash on the arms and legs. It varying sizes break out on the skin and on
• Increased epidermal cell turnover consists of small, many-sided, flat-topped, the lining of the mouth and other mucous
• acanthosis, with regular downward pink or purple bumps. membranes. Pemphigus vulgaris occurs
elongation of rete ridges when the immune system mistakenly
• stratum corneum is thinned or absent attacks proteins in the upper layers of the
skin.
38.) Which of the following is not true about the most common type of testicular germ cell tumor?
a. The counterpart of the tumor in females is choriocarcinoma
b. Some patients can have elevated HCG
c. It has lobules of uniform cells divided by delicate fibrous septae with lymphocytes
d. Histologically, some cases have syncytiotrophoblasts
Correct:A
-Seminoma
most common type of germinal tumor (50%) and the type most likely to produce a
uniform population of cells
never occur in infants; they peak in the thirties
An identical tumor arises in the ovary (dysgerminoma)
Morphology:
"seminoma" refers to "classic" or "typical" seminoma
Spermatocytic seminoma, despite its nosologic similarity, is actually a
distinct tumor
produce bulky masses, sometimes 10 times the size of the normal testis
typical seminoma has a homogeneous, gray-white, lobulated cut surface,
usually devoid of hemorrhage or necrosis
the tunica albuginea is not penetrated, but occasionally, extension to the
epididymis, spermatic cord, or scrotal sac occurs
Microscopically:
w/ sheets of uniform cells divided into poorly demarcated lobules by delicate septa of fibrous tissue.
Seminoma cell is large and round to polyhedral and has a distinct cell membrane; a clear or watery-appearing cytoplasm; and a large, central
nucleus with one or two prominent nucleoli.
39.)Pathophysiologic cause of edema leading to both increased hydrostatic pressure and decreased plasma osmotic
pressure would be:
a. constrictive pericarditis
b. lymphadenitis
c. nephrotic syndrome
d. liver cirrhosis

Correct:D
liver cirrhosis is both shown on the pictures below. But regardless, we knwo that in Liver cirrhosis, there’s less albumin being
produced, yet the hydrostatic pressure still exists.
40.) Most common cancer in children

a. ALL
b. CLL
c. AML
d. CML
Correct:A
ONE OF THE ONLY SAMPLEX QUESTIONS IN THIS EXAM!
Leukemia is the most common cancer in children and teens, accounting for almost 1 out of 3 cancers. Most childhood leukemias are
acute lymphocytic leukemia (ALL). Most of the remaining cases are acute myeloid leukemia (AML). Chronic leukemias are rare in
children.
AML is the most common type of acute leukemia in adults. Chronic lymphocytic leukemia (CLL). With CLL, the most common chronic
adult leukemia, you may feel well for years without needing treatment. Chronic myelogenous leukemia (CML).
41.) My role in the cellular world is to manage the repair process, for damaged DNA, try I must with the help of others to
correct what is wrong. If things cannot be corrected, I would tap on the apoptosis mechanism to get rid of permanently
damaged genes or just allow certain cells to grow old and die. What am I?
a. golgi apparatus
b. proteasome
c. nucleus
d. mitochondria
Correct: D

42.) This is the dominant intrahepatic cause of portal hypertension

a. Schistosomiasis
b. Malignancy with portal vein invasion
c. Massive fatty change
d. Cirrhosis
Correct:D
The most common cause of portal hypertension is cirrhosis, or scarring of the liver. Cirrhosis results from the healing of a liver injury
caused by hepatitis, alcohol abuse or other causes of liver damage. In cirrhosis, the scar tissue blocks the flow of blood through the
liver and slows its processing functions.
Cirrhosis is a condition marked by disffuse transformation of the entire liver into regenerative parenchymal nodules surrounded by
fibrous bands and variable degrees of vascular shunting (usually portosystemic).
- Narrow, densely compacted fibrous septa separated by large islands of hepatic parenchyma have less portal hypertension.
- Broad bands of dense scar, often with dilated lymphatic spaces, with less intervening parenchyma are likely to be progressing to
portal hypertension and to end-stage disease.
Hepatic Steatosis
-1st stage in alcoholic liver disease Small Portal Vein branch diseases
Lipid droplets accumulate in hepatocytes begins as small Genetically distinct conditions characterized by non-cirrhotic
droplets that coalesce into large droplets which distend the portal hypertension with portal fibrosis and obliteration.
hepatocyte and push the nucleus aside. Most common cause is obstruction by schistosomiasis.
Grossly large (4-6kg), soft, yellow and greasy Eggs of the parasite lodge in and obstruct the smallest branches.
-Alcohol stimulates release of endothelin causes
vasoconstriction and contraction of activated myofibroblastic
stellate cells leading to decrease in hepatic sinusoidal
perfusion (portal hypetension).
43.) How does p53 prevent development of cancer?

a. Through downregulated expression of CDKN1A
b. By maintaining RB in hypophosphorylated state
c. Through upregulated expression of and high affinity binding with MDM2
d. p53 directs the transcription of BCL-2 and BCL-XL
Correct: B
-Can’t find this in transes. I guess you really have to read the book. Lol
-RB and TP53 encode proteins that inhibit G1/S progression.
-Tumor progression is characterized by the accumulation of successive cytogenetic or
molecular abnormalities.
(1) It is exemplified by the progression of changes from normal colonic epithelium
to adenoma to carcinoma to metastasis, with parallel changes in the APC, K-ras,
DCC, p53, and possibly other genes.
(2) Individual neoplastic cells within a tumor may have varying metastatic potential.
-P53 (Tumor suppressor) – G1/S and G2/M, major cause of genetic instability.
-Many tumor suppressors (RB, TP53) are part of a regulatory network that recognizes specific genotoxic stress and shuts down proliferation.
-TP53 (Guardian of the genome)
A tumor suppressor gene that regulates cell cycle progression, DNA repair, cellular senescence, and apoptosis.
Most common target for genetic alteration.
Located on chromosome 17p13.1
Inheritance of a mutated copy of the TP53 predisposes an individual to malignant tumor, only one additional hit is needed for the normal gene to have
loss-of-function mutation of TP53.
44.) Most common type of renal calculi

a. uric acid
b. struvite
c. cysteine
d. calcium containing
Correct: D

The most common type of kidney stone is a calcium oxalate stone. These result when the urine contains low levels of citrate and
high levels of calcium and either oxalate or uric acid. Calcium oxalate stones are linked with foods high in oxalate, which is a naturally
occurring substance in plants and animals.
45.) Aschoff body has the ff. component/s:

a. Collagen
b. Lymphocytes
c. Anitskow cells
d. All of the above
Correct:D
-I can’t really find collagen. But since there’s an All of the above option while B and C are 100% searchable in transes, then go
for D.
-Aschoff bodies - consist of foci of lymphocytes (primarily T cells)
-Anitschkow cells (pathognomonic for RF) - activated macrophages
AKA: caterpillar cells
-Diffuse inflammation & Aschoff bodies maybe found in the 3 layers – causing pericarditis, myocarditis, or endocarditis (pancarditis)
-Verrucae – small vegetations found along lines of closure
-MacCallum plaques – irregular thickenings in LA
-―bread & butter pericarditis
46.) In normal adults, only about _______% of the marrow space is hematopetically active.
a. 25%
b. 10%
c. 75%
d. 50%
Correct: D
It is generally considered that, in the dog, normal bone marrow contains about 50% fat and 50% hematopoietic tissue; approximately 70
to 80% of the marrow being hematopoietic tissue in rats and mice.
I know right? I can’t find it anywhere xD
47.) Characteristically, loss of sensation/movement is DISTAL when this is damaged

a. nerve
b. neuromuscular junction
c. muscle
d. all of these
Correct: A
Nerves are fragile and can be damaged by pressure, stretching, or cutting. Injury to a nerve can stop signals to and from the brain,
causing muscles not to work properly, and a loss of feeling in the injured area.
neuromuscular junction: diseases present within this subset are myasthenia gravis, and Lambert-Eaton syndrome. In each of these
diseases, a receptor or other protein essential to normal function of the junction is targeted by antibodies in an autoimmune attack by
the body.
48.) Which of the following lesion is associated with hyperestrenism?

a. Lactation adenoma
SCLEROSING ADENOSIS
b. Sclerosing Adenosis GYNECOMASTIA
Benign male breast tumor inc acini to 2x
c. Gynecomastia
Unilateral or bilateral compressed centrally
d. All of these dilated at periphery
Proliferation of dense collagenous connective tissue,
Correct: C marked micropapillary hyperplasia of the ductal linings prominent myoepithelial cells
Puberty, very aged, hyperesternism (cirrhosis, other “adenosis” - inc lobules
liver diseases) (+) around and in between lobules
Sclerosis & fibrosis – synonymous
A lactating adenoma is a benign tumor . This type of breast lump usually occurs in
younger, pregnant and lactating women. This tumor is a variant of a class of benign breast
lesions called 'fibroadenomas'

49.) In _______ atelectasis, the mediastinum shifts towards the atelectatic lung.
a. resorption
b. compression
c. contraction
d. None of the above
Correct:A
Resorption Atelectasis Compression Atelectasis Contraction Atelectasis
Stems from complete obstruction of the airways, Results whenever a significant Occurs when focal or generalized
which can be due to excessive secretions, volume of fluid (blood, pulmonary fibrosis prevents full lung
exudates in smaller bronchi (e.g. bronchial asthma, transudate, and exudate), tumor, expansion.
chronic bronchitis, bronchiectasis, post-op) or air (pneumothorax) Atelectasis reduces oxygenation and
Air is resorbed from the dependent alveoli, which accumulates within the pleural predisposes to infection.
collapses. cavity. Except to that caused by contraction,
Lung volume is diminished, mediastinum shifts Mediastinum shifts contralateral / atelectasis is reversible.
ipsilateral or towards to the atelectatic lung. away from the collapsed lung.
50.) Tear in the bridging veins within the cerebral convexities associated with skull fracture can result to:
a. subarachnoid hemorrhage
b. epidural hematoma
c. intraparenchymal hemorrhage
d. subdural hematoma
Correct: D
Bridging veins travel from the convexities of cerebral hemispheres through the subarachnoid space, and the subdural space to empty
into the superior sagital sinus. Similar anatomic relationships exist with other dural sinuses. These vessels are particularly prone to
tearing along their course through the dural layers and are the source of bleeding in most cases of SUBDURAL HEMATOMA.
Older Individuals= bridging veins are stretched*
Infants=> thin-walled bridging veins.

51.) Drugs involved in toxic myopathies EXCEPT

a. Statins
b. corticosteroids
c. Chloroquine
d. NSAID
Correct: D
Toxic myopathies can be caused by prescription or recreational drugs, or by certain hormonal imbalances. Among prescription
drugs, statins are among the leading culprits. Myopathy is the most common complication of statins (e.g., atorvastatin,
simvastatin, pravastatin). It occurs in approximately 1.5% of users, and is unrelated to dose, cumulative dose, or statin
subtype.
Chloroquine and hydroxychloroquine were originally used as antimalarial agents and are currently given as long-term
therapy to some patients with systemic autoimmune diseases. These drugs interfere with normal lysosomal function and can
cause a drug-induced lysosomal storage myopathy that presents with slowly progressive muscle weakness. The muscle tissue
shows myopathic changes including vacuolation that predominantly affects type I fibers. Ultrastructural studies identify
aggregates of whorled, lamellar membranous structures, including curvilinear bodies that mimic those seen in ceroid
lipofuscinoses
52.) “Doube controur or tram track” is the characteristic finding

a. membranoproliferative glomerulonephritis
b. IgA nephropathy
c. crescentic glomerulonephritis
d. acute proliferative glomerulonephritis
Correct:A
BUZZ WORDS!
➔ Tram Track (Thickened split GBM) , Spike and dome appearance -- Membranoproliferative Glomerulonephritis
➔ IgA immune complex deposition - IGA Nephropathy
➔ “Crescents” -- Proliferation of parietal epithelial admized with leukocyte infiltrating the glomerulous; “Lumpy Bumpy”
appearance of GBM due to deposits-- RPGN
➔ “Subepithelial humps” -- PSAGN
Source: Pathoma, Topnotch Sept 2019, NVL3, GD5PT bida-bida ka Nelson di naman to assigned sayo na number buzz words ka pa
53.) A 40-year old woman has a tumor in the right ovary that is composed of sheets of large vesicular cells with clear
cytoplasm, well-defined cell boundaries, and centrally placed regular nuclei. The sheets of tumor cells are separated by thin
fibrous septae. Also seen are mature lymphocytic infiltrates. This tumor expresses:
a. Inhibin
b. HCG
c. AFP
d. NANOG
Correct:D
DYSGERMINOMA - most common malignant germ cell tumor with generally favorable prognosis. Histologically, nests of large
vesicular cells with clear cytoplasm, centrally-located nuclei with lymphocytic infiltration were seen.
Inhibin - Granulosa Cell Tumor
HCG - Ovarian Choriocarcinoma
AFP - Yolk Sac Tumor
54.)A 45-year-old female with slowing of reflexes, weight gain and cold intolerance. T3 and T4 are decreased; TSH: slightly
elevated. Biopsy of the thyroid revealed replacement of the thyroid follicles by lymphoid cells with formation of lymphoid
follicles, presence of Hurthle cells and fibrosis. What is the diagnosis?
a. Subacute lymphocytic thyroiditis
b. Hashimoto thyroiditis
c. Granulomatous thyroiditis
d. Reidel struma

Correct:B
RATIO:
➔ Slowing of reflexes, weight gain, cold intolerance, elevated TSH, decreased T3 and T4: HYPOthyroidism
➔ Microscopic examination (Hashimoto thyroiditis): widespread infiltration of the parenchyma by a mononuclear inflammatory
infiltrate containing small lymphocytes, plasma cells, and well-developed germinal centers. The thyroid follicles are
atrophic and are lined in many areas by epithelial cells distinguished by the presence of abundant eosinophilic, granular
cytoplasm, termed Hürthle, or oxyphil, cells. This is a metaplastic response of the normally low cuboidal follicular epithelium
to ongoing injury; on ultrastructural examination, the Hürthle cells are characterized by numerous prominent mitochondria.
55.) A 56 year old male was diagnosed 10 years ago with viral hepatitis. He now has ascites and signs of liver failure such as
prolonged coagulation studies and decreased plasma protein. What is the expected morphologic change in the liver due to
the inflammatory response to the organism?
a. Chronic inflammation and scarring
b. Suppurative inflammation
c. Granulomatous inflammation
d. Liquefactive necrosis
Correct:A
SCAR FORMATION AND REGRESSION
The principal cell type involved in scar deposition is the hepatic stellate cell, which can become activated and are converted into highly
fibrogenic myofibroblasts when triggered/mediated by platelet-derived growth factor receptor β (PDGFR-β).
● Factors involved:
○ Chronic inflammation/disease (e.g. hepatitis)
○ Release of cytokines & chemokines by Kupffer
cells and lymphocytes
○ Intake of medications like acetaminophen (one
of the most common)
○ Toxins
○ ECM disruption
56.) Cause/s of death in COPD

a. left-sided heart failure
b. Respiratory Alkalosis
c. massive collapse of lungs
d. All of the above
Correct: C
RATIO:
➔ Most patients with emphysema and COPD, however, fall somewhere between these two classic extremes. In all cases,
secondary pulmonary hypertension develops gradually, arising from both hypoxia-induced pulmonary vascular spasm and
loss of pulmonary capillary surface area from alveolar destruction. Death from emphysema is related to either pulmonary
failure, with respiratory acidosis, hypoxia, and coma, or right-sided heart failure (cor pulmonale).
57.) A toddler is mentally retarded, unable to walk and talk, with episodes of seizure and with musty odor urine and sweat. In
majority of patients with similar condition, what is the main biochemical problem?
a. Deficiency of GALT
b. Deficiency of DPHR
c. Deficiency of PAH
d. Deficiency of BH4
ROBBINS p464 Classic phenylketonuria (PKU):

- Most common form of inborn error of metabolism

- AR disorder caused by a deficiency of the enzyme phenylalanine hydroxylase (PAH) and the resultant
hyperphenylalaninemia
- Severe mental retardation at 6 months (d/t excess phenylalanine or its metabolites); unable to walk and talk; seizures, other
neurologic abnormalities, decreased pigmentation of hair and skin (d/t lack of tyrosine, a precursor of melanin), eczema.
- when phenylalanine metabolism is blocked because of lack of PAH enzyme → minor shunt pathways → intermediates that are
excreted in urine & sweat → strong musty or mousy odor.
58.) The type of glomerulonephritis is often seen 1-4 weeks after streptococcal infection of the pharynx or skin
a. rapidly progressive glomerulonephritis
b. minimal change disease
c. acute proliferative glomerulonephritis
d. IgA nephropathy
Correct: C
RATIO:
➔ The classic case of poststreptococcal GN develops in a child 1 to 4 weeks after they recover from a group A streptococcal
infection. Only certain “nephritogenic” strains of β-hemolytic streptococci evoke glomerular disease. In most cases, the initial
infection is localized to the pharynx or skin.
➔ Acute post-streptococcal glomerulonephritis is a non-suppurative sequelae of GABHS infection which appears 1-4 weeks after
pharyngitis or pyoderma and is the most common cause of nephritic syndrome in children.
59.) Patient presented with epistaxis. Bleeding time is prolonged with normal PT & PTT. These findings are compatible with:
a. DIC
b. Vit. K deficiency
c. VWD
d. Hemophilia A
The correct answer is: VWD
Von Willebrand Disease is an autosomal dominant disorder caused by missing or defective von Willebrand factor, a clotting protein. VWF binds factor
VIII, a key clotting protein, and platelets in blood vessel walls, which help form a platelet plug during the clotting process. People with VWD experience
frequent nosebleeds, easy bruising and excessive bleeding during and after invasive procedures, such as tooth extractions and surgery. Women
often experience heavy menstrual bleeding and hemorrhaging after childbirth. Screening coagulation tests reveal a normal platelet count,
normal INR, and sometimes slightly prolonged or normal PTT.
60.) A patient with GIT carcinoma have multiple velvety, round, flat, coin-like and waxy plaques that are tan to dark brown in
color and appear like a “Stuck on” dirt.
a. Greater Trelat sign
b. Sezary syndrome
c. Leser Trelat sign
d. Darier sign
Correct: C
Diagnosis: Seborrheic Keratoses

- Benign epithelial neoplasm
- Activating mutations in the FGFR3
- Appear in large numbers as part of paraneoplastic syndrome (Leser-Trelat Sign), due to stimulation of keratinocytes by
TGFA, most commonly carcinomas of the GIT
- Morphology: round, flat, coinlike, waxy plaques that vary in diameter; uniformly tan to dark brown and usually have a velvety to
granular surface.
● Sezary Syndrome - seen in MYCOSIS FUNGOIDES (CUTANEOUS T CELL LYMPHOMA), characterized as seeding of
malignant T cells accompanied by diffuse erythema and scaling of the entire body surfave (erythroderma)

● Darier sign - seen in MASTOCYTOSIS, characterized as dermal edema and erythema (wheal) when skin is rubbed
61.) Jigsaw puzzle red blood cells are seen in:

a. Thalassemia - Target cells, basophilic stippling, and fragmented red cells
b. Sickle cell disease - irreversibly sickled cells, reticulocytosis, and target cells
c. G6PD deficiency - Heinz bodies (on supravital staining), and bite cells
d. hereditary spherocytosis - spherocytosis: small, dark-staining (hyperchromic) red cells lacking the central zone of pallor
Correct:A
From Mother of Dragons trans (sorry wala talaga sa Robbins pero baka may mahanap kayo sa ibang books �)
In thalassemia, blood smear shows severe red cell abnormalities:

Anisocytosis - change in size
Poikilocytosis – change in shape.
It also shows microcytosis and hypochromia. Target cells, basophilic stippling, and fragmented RBC. Inclusions of aggregated
α chains are efficiently removed by the spleen and not easily seen
Reticulocytosis, with variable numbers of poorly hemoglobinized nucleated cell precursors (Normoblasts).
62.) Retrolental fibroplasia is associated with:

a. sickle cell retinopathy
b. diabetes
c. prematurity
d. Hypertension
Correct: C
RATIO:
Retinopathy of prematurity (retrolental fibroplasia)
➔ Contraction of retinal vascular membrane – drags temporal aspect of retina to temporal zone – retina detaches
➔ Prematures treated with O2 – constriction of temporal retinal vessels – ischemia – stimulates angiogenesis
63.) Councilman bodies are apoptotic hepatocytes seen in

a. infectious mononucleosis
b. yellow fever
c. neonatal hepatitis
d. viral hepatitis
Correct: B

Apoptotic hepatocytes were first clearly described in yellow fever by William Thomas Councilman and therefore have often been referred to as
Councilman bodies; while apoptosis occurs in many forms of liver disease, by convention this eponym is restricted to that disease. In the more frequent
settings in which apoptotic hepatocytes are seen, (e.g., acute and chronic hepatitis), the term acidophil bodies is used, due to their deeply eosinophilic
staining characteristics (Robbins page 823)
64.) Chronic cor pulmonale is characterized by:

a. Stenotic pulmonic valve
b. Tricuspid valve insufficiency
c. Hypertrophic right ventricle
d. Hypertrophic left ventricle
Correct: C
The initial pathophysiologic event in the production of cor pulmonale is an elevation of the pulmonary vascular resistance. As the resistance increases,
the pulmonary arterial pressure rises, and the right ventricular work increases leading to right ventricular enlargement (e.g., thickening, dilation, or
both).
65.) A 70 year old was diagnosed to have prostate adenocarcinoma with vascular invasion, the bone to which the tumor
commonly spread through the mentioned route is:
a. proximal femur
b. ribs
c. pelvis
d. lumbar spine
Correct: D
RATIO:
➔ Metastasis may be through direct local extension to the seminal vesicles and bladder base, or through the hematogenous route
(most common site: lumbar spine > proximal femur > pelvis > thoracic spine > ribs)
66.) The following are characteristics of pinguecula, EXCEPT

a. does not cross papillary axis
b. migrates to the cornea
c. fibrovascular connective tissue new growth
d. caused by actinic damage
Correct: B
RATIO:
67.) I jump from one place to another, I don’t code for proteins but definitely I have a function in the life of a human being. I am
also one of the reasons why humans are quite different from our friendly worms. Who do you think am I?
a. transposon
b. telomere
c. microRNA
d. lncRNA
Correct:A
Ratio:Mobile genetic elements eg Transponons
Comprises more than one third of the human genome
AKA jumping genes
Implicated in gene regulation & chromatin organization

68.) Characteristic immunofluorescence finding is mesangial deposition of IgA

a. Buerger's disease
b. Rapidly progressive GN-
c. Minimal change disease
d. Acute Proliferative GN
Correct:A
Ratio: IgA nephropathy, also known as Berger's disease, is a kidney disease that occurs when an antibody immunoglobulin A (IgA)
builds up in the kidneys. Characterized by presence of prominent IgA deposits in the
mesangial regions and prominent hematuria.
Minimal change disease In Electron microscope, the GBM is normal, principal lesion is in the visceral
epithelial cells, which show a uniform to diffuse effacement of foot processes.
Rapidly progressive GN - Linear deposits of IgG, C3 (Anti-GBM Abs) in the GBM.
Acute Proliferative GN - Diffuse proliferation of glomerular cells with leukocyte influx or

exudation, typically caused by immune complexes.
69.) A baby who has ventricular septal defect, clubfeet and absent left upper extremity was delivered to a mother with
unremarkable pregnancy and genital tract anatomy. The attending physician cannot explain the cause of the congenital
anomalies after exhausting all means. How will you categorize the congenital anomaly?
a. Malformation
b. Malformation syndrome
c. Deformation
d. Sequence
Correct:B
Ratio: Malformation syndrome- constellation of congenital anomalies

pathologically related. In contrast to a sequence, cannot be explained on the
basis of a single localized initiating defect. Often caused by single etiologic agent (viral infection or
chromosomal abnormality)
Malformation- Represent primary errors of morphogenesis in

which there is an intrinsic abnormal developmental process.
Deformation – Localized or generalized compression of the

growing fetus by abnormal biomechanical forces
Sequence- cascade of anomalies triggered by one initiating

aberration
70.) True statement/s regarding benign nephrosclerosis

a. thickening of the blood vessel wall
b. hypertensive patients
c. markedly elevated renin
d. Onion-skin appearance
Correct:A
RATIO:
Nephroclerosis refers to renal pathology associated with
sclerosis of renal arterioles and small arteries, highly associated

with hypertension.
Affected vessels have thickened walls and narrowed lumens,
changes that result from focal parenchymal ischemia.
Ischemia leads to glomerular sclerosis and chronic
tubulointerstitial injury, produces a reduction in renal mass.
hypertensive patients - Malignant Nephrosclerosis

markedly elevated renin- Malignant Nephrosclerosis
Onion-skin appearance - Malignant Nephrosclerosis
71.) Stage of lobar pneumonia where there is progressive disintegration of rbc, persistence of fibrinosuppurative exudate
a. congestion
b. resolution
c. red hepatization
d. gray hepatization
Correct:D
Ratio: Gray Hepatization - Red Hepatization Resolution

Marked by progressive Congestion Massive confluent exudation, Exudate within the alveolar
disintegration of red cells. Lung is heavy, boddy, and red, as neutrophils, red cells, and spaces is broken down by
Persistence of with vascular engorgement. fibrin enzymatic
fibrinosuppurative exudate. Intra-alveolar fluid with few fill the alveolar spaces. digestion. It produces granular,
Grayish brown, dry surface, neutrophils and many bacteria. Lobe is red, firm, and airless, semi-fluid debris, that is
liver-like consistency with a liver-like consistency. reabsorbed, ingested by
macrophages, expectorated,
or
organized by fibroblasts.
72.) Which of the following is required for the initiation of transcription of HIV?
a. Viral Infectivity Factor
b. Long Terminal Repeat
c. Negative Effector
d. Viral Protein U
Correct:B
Ratio: HIV-1 gene expression is driven by the long terminal repeat (LTR), which contains many binding sites shown to interact with
an array of host and viral factors. Selective pressures within the host as well as the low fidelity of reverse transcriptase lead to changes
in the relative prevalence of genetic variants within the HIV-1 genome, including the LTR, resulting in viral quasispecies that can be
differentially regulated and can potentially establish niches within specific cell types and tissues
73.) A 4-year old girl has a polypoid mass protruding from the vagina. Biopsy of the mass shows small malignant cells with
oval nuclei. Some cells have small protrusions of cytoplasm from one end, resembling a tennis racket. These findings are
compatible with:
a. Paget disease
b. Rhabdomyosarcoma
c. Leiomyosarcoma
d. Warty carcinoma
Correct:B
Ratio:
Rhabdomyosarcoma - Soft gray, infiltrative mass.
Mimic skeletal muscle at various embryonic stages.
Sheets of both primitive round and spindle shaped.

Visible cross-striations may be present.

Sarcoma botyroides a variant that develops in the walls of
hollow, mucosa-lined structures.
Pagets - Hallmark is a mosaic pattern of Leimyosarcoma - Eosinophilic spindle Warty carcinoma -
lamellar bone seen in sclerotic cells with blunt-ended hyperchromatic Early: sharply delineated interface
phase, this jigsaw puzzle-like appearance nuclei arranged in interweaving fascicles. between tumor and stroma with no
is produced by Contain bundles of thin filaments with invasion (noninvasive warty carcinoma)
unusually prominent cement lines joining dense bodies and Later: jagged boundary between tumor
haphazard oriented pinocytic vesicles, each cell surrounded and stroma (invasive warty carcinoma)
units of lamellar bone. by basal lamina.
74.)What is the most common histologic pattern of malignancy in the distal urethra?
a. Adenocarcinoma
b. Squamous cell carcinoma
c. Leiomyosarcoma
d. Urothelial carcinoma
Correct:B
Squamous cell carcinoma - Tumors in the distal urethra are more often squamous CA
Urothelial carcinoma- Flat non-invasive urothelial carcinoma – carcinoma in situ
Adeno carcinoma- Most lesions are adenocarcinomas that are well defined,
demonstrable glandular patterns
Lined by single uniform layer of cuboidal or low columnar
epithelium and are more crowded and lack branching and
papillary infolding
75.) A 61 year old female whose husband recently passed away has been suffering from depression and complained of
sudden chest pain. Cardiac enzymes were elevated, CXR showed enlarged heart and the ECG demonstrated ST elevation. If
the injury to the cardiac tissue is due to prolonged vasospasm, what is your diagnosis?
a. Phlebothrombosis
b. Buerger Disease
c. Churg Strauss Syndrome
d. Broken Heart Syndrome
Correct:D
Ratio: Broken Heart syndrome - Outcome of vasospasm can be sudden death due to fatal
arrhythmia or an ischemic dilated cardiomyopathy, also known
as Takotsubo Cardiomyopathy (Broken Heart Syndrome).
Churg strauss syndrome - a rare systemic necrotizing vasculitis associated with granuloma formation and severe blood and tissue
eosinophilia. CSS occurs almost exclusively in patients with asthma. Its pathogenesis remains largely unknown, as triggering factors for
CSS development have not been identified so far
Phlebothrombosis -formation of a blood clot in a vein that is not inflamed. Inactivity, such as bed rest during convalescence, can lead to
the condition, which frequently progresses to thrombophlebitis

76.) A 59 year old male, known hypertensive suddenly complained of excruciating pain from the anterior chest radiating to the
back. After a few minutes the patient suddenly died. Autopsy was done to the patient with a gross finding of transverse sharp
tear measuring 1 cm in length found in the ascending aorta with a localized hematoma. Most probable diagnosis would be:
a. Abdominal aortic aneurysm
b. Type A Aortic dissection
c. Type B Aortic dissection
d. Thoracic aneurysm
Correct:B
Ratio: Type A Aortic dissection More common and dangerous proximal lesions (Type A
dissections), involving either both the ascending and
descending aorta or just the ascending only (Types I and II of
DeBakey classification).
Type B Aortic dissection

Distal lesions not involving the ascending part and usually
begins distal to the subclavian artery (Type B dissections,
DeBakey Type III).
77.) Post partum cardiomyopathy is of this type:

a. Dilated
b. Hypertrophic
c. Restrictive
Correct:A
Ratio: Genetic Influences – familial in at least 30-50%, caused by

mutations in a diverse group of more than 20 genes encoding
proteins involved in cytoskeleton, sarcolemma, and nuclear
envelope (Laminin A/C).
Myocarditis – Coxsackie B and other viruses.
Alcohol and other toxins
Childbirth (Peripartum Cardiomyopathy) – occurs late in
pregnancy or to months postpartum.
Iron Overload
Supraphysiologic Stress – excess catecholamine
HYPERTROPHIC CARDIOMYOPATHY RESTRICTIVE CARDIOMYOPATHY Characterized by a primary
A common clinically heterogeneous, genetic disorder decrease in ventricular compliance,resulting in impaired
characterized by myocardial hypertrophy, poorly compliant left ventricular filling during diastole. Contractile function is usually
ventricular myocardium leading to abnormal diastolic filling and unaffected. Can be idiopathic or associated with diseases or
intermittent ventricular outflow obstruction. processes that affect the myocardium, principally radiation
fibrosis, amyloidosis, sarcoidosis, metastatic tumors or
depositions.
78.) A 50-year old woman presents with itchiness of the eyes, fissures in the mouth and a 5 cm palpable mass at the right
submandibular area. 90% of patients with this condition have detectable antibodies against:
a. RNA polymerase III
b. SS-A
c. Double-stranded DNA
d. MDA5
Correct:B

Rate: SS-A - SSA and La/SSB autoantigens were originally identified in patients with Sjögren's syndrome and systemic lupus
erythematosus (SLE)
Sjogren syndrome - Antibodies against ribonucleoproteins antigens: SS-A (Ro) and
SS-B (La) in as many as 90% of the patients.
79.) The most commonly mutated membrane skeletal protein in Hereditary spherocytosis is:
a. band 4.2
b. ankyrin
c. alpha spectrin
d. band 3
Correct:B
Ratio: HS is caused by diverse mutations that lead to an insufficiency of the membrane skeletal components.
Life span decreases.
Most mutations commonly affect Ankyrin, band3, or band
ankyrin deficiency is probably the most common molecular defect in HS
80.) An elderly woman inhaled air droplets with influenza virus. In the four aspects of disease what describes the sequence of
events in the response of cells or tissues to the virus until the patient begins to have fever and cough?
a. Pathogenesis
b. Clinical Manifestation
c. Etiology
d. Morphologic change
Correct: A
Ratio: Pathogenesis - manner of development of a disease
Clinical manifestation - can be either objective when observed by a physician, or subjective when perceived by the patient
Etiology -cause, set of causes, or manner of causation of a disease or condition
Morphologic change- consists of examination of diseased tissues. These can be recognized with the naked eye or studied by
microscopic examination of tissue.
81.) Normal FEV1/FVC ratio

a. obstructive lung disease
b. restrictive lung disease
c. A & B
Correct: B
Ratio:
Restrictive Lung Diseases Obstructive Lung (Airway) Disease
Reduced expansion of the lung parenchyma and decreased total Increase in resistance to airflow.
lung capacity. Due to a partial or complete obstruction at any level from the
Expiratory rate is normal or proportionately reduced. trachea and larger bronchi to the terminal and respiratory
bronchioles.
Pulmonary function tests show decreased maximal airflow rates
during forced expiration, usually expressed as FEV1/FVC ratio,
a
ratio of less than 0.7 generally indicates airway obstruction.

82.) A 4 year old patient has a renal tumor composed of sheets of round blue cells and abortive tubules surrounded by
fibrocytic stroma. The patient also has organomegaly. Which of the following statements is true about the patient’s case?
a. There is a contiguous deletion of PAX6

b. There is a dominant-negative missense mutation in the zinc-finger region of the WT1
c. The mutated gene is located on the short arm of chromosome 11 band 1 sub-band 3
d. The disease is caused by an epigenetic alteration
Correct:D
Ratio: Epigenetic changes are essential for development and functioning of the kidney, and aberrant methylation, histone modifications, and
expression of microRNA could lead to chronic kidney disease (CKD)
PAX6 gene is associated with the characteristic eye features of WAGR syndrome
Wilms tumor suppressor protein (WT1) is a Cys2-His2 zinc-finger (ZF) transcription
83.) ANCA-vasculitis mechanism would be: Ratio: Mechanism

a. Activated macrophages invade the vessel wall Drugs or cross-reactive microbial antigens induce ANCA
b. Endothelial cell toxicity due to ROS released from formation.
activated neutrophils Subsequent infection, endotoxin exposure, or inflammatory
c. Abscess formation with liquefaction necrosis stimulus elicits cytokines such as TNF that upregulate
d. Antibodies are produced by plasma cells expression
Correct:B or release of PR3 and MPO.
ANCAs react with these cytokine-activated cells, causing either
direct injury or further activation.
ANCA-activated neutrophils cause tissue injury by releasing
granule contents and ROS.
84.) Which of the following is/are feature/s of a Complete Mole?

a. Fertilization of an empty ovum with two sperm
b. 69,XXY or 92, XXXY
c. Presence of fetal parts
d. All of these
Correct:A
[RATIO LETTER A.] The remaining 10% result from the fertilization of an empty egg by two sperm;
[RATIO LETTER B.]these
may have 46,XX or 46,XY karyotype.
[RATIO LETTER C.]In complete moles the embryo dies very early in development and therefore is usually not identified.
(Robbins and Cotran Pathologic Basis of Disease 9 Ed. p.1039)
85.) The most common cause of clinically significant subarachnoid hemorrhage is a ruptured:
a. A-V malformation
b. Charcot-Bouchardt aneurysm
c. Venous angioma
d. Berry aneurysm
Correct:D
The most frequent cause of clinically significant subarachnoid hemorrhage is rupture of a saccular (“berry”)
aneurysm in a cerebral artery. (Robbins and Cotran Pathologic Basis of Disease p.1269)

86.) Which of the statements below is true about mediators of inflammation?

a. Most of the plasma derived mediators are produced by macrophages
b. Cell derived mediators are mostly produced by sentinel cells
c. Mediators are continuously secreted even after offending agents have been eradicated to make sure that the body can easily
activate cells in the next exposure
d. Mediators of inflammation are only produced by cells during inflammatory process
Correct:B
A. Plasma derived mediators are composed of Complement, and Kinins, both are produced in the Liver. Not by macrophages.
C. Inflammation is terminated when the offending agent is eliminated. The reaction resolves because mediators are broken down and
dissipated, and leukocytes have short lifespans in tissues. (Robbins Basic patho)
D. Mediators of inflammation are only produced by cells during inflammatory process
87.) Which among the ff. is the most common congenital defect?
a. VSD
b. Coarctation of aorta
c. Tetralogy of Fallot
d. ASD
Correct:A
VSD - Most common congenital defect :(
88.) A male patient has long face, large mandible, large everted ears and macro-orchidism. What is the most likely diagnosis?
a. Fragile X syndrome
b. Prader-Willi syndrome - mental retardation, hypotonia, profound hyperphagia, obesity, small hands and feet, hypogonadism (deletion
in paternally derived chromosome 15)
c. Angelman’s syndrome - mental retardation, ataxic gait, seizure, inappropriate laughter “happy puppet” (deletion in maternally derived
chromosome 15)
d. Patau syndrome - mental retardation, microcephaly, microphthalmia, brain abnormalities, cleft lip and palate, polydactyly, rocker-
bottom feet, and congenital heart disease (extra copy of chromosome 13)
Correct: A
Ratio: Fragile X Syndrome
Seen as discontinuity of staining or as a constriction in the long
arm of the X-chromosome, and is liable to chromatid breaks.
One of the most common causes of familial mental retardation
in males.
Reduction in FMR protein due to mutation of the FMR1 gene
Long face, large mandible, large everted ears, macro-orchidism.
89.) Etiologic agent of SARS

a. adenovirus
b. coronavirus
c. Influenza
Correct:B
SARS-CoV (the beta coronavirus that causes severe acute respiratory syndrome, or SARS) SARS-CoV-2 (the novel coronavirus that
causes coronavirus disease 2019, or COVID-19)
90.) Tumor cells often are latently infected by EBV in:

a. Burkitt lymphoma
b. Follicular lymphoma
c. Diffuse large B-cell lymphoma
d. SLL/CLL
Correct:A
EBV associated cancer: Nasopharyngeal Ca, Bcell NHL, Burkitt lymphoma

91.) Which of the following is the most common female sex chromosomal disorder?
a. Edward’s syndrome
b. Turner syndrome
c. Klinefelter syndrome
d. Down’s syndrome
Correct:B - Think Tina Turner, while Klinefelter is in boys
92.) I can create new cells but only of a kind, specific to where I am found.
By the way, I mingle with mature differentiated cells. Who am I?
a. Embryonic stem cell
b. CDK
c. Tissue stem cell
d. DNA
Correct:C
Adult stem cells are generally less flexible and versatile than embryonic stem
cells. Embryonic stem cells have a far greater differentiation potential than adult
stem cells simply because embryonic stem cells can develop into almost every
type of cell in the human body.
93.) In which layer of the appendix should the neutrophils be found to be diagnostic of acute appendicitis?
a. mucosa
b. submucosa
c. serosa
d. muscularis propria
Correct:D
Ratio: Early acute appendicitis – subserosal vessels are congested,
modest perivascular neutrophilic infiltrate in all layers.
Diagnosis of acute appendicitis requires neutrophilic infiltration
of the muscularis propria.
Ratio: Phthisis bulbi
94.) Which of the following changes is/are associated with Trauma, inflammation, chronic retinal detachment can give rise
phthisis bulbi? to eyes that is both small (atrophic) and internally disorganized.
a. lens atrophy Appears square than round.
b. thin sclera Exudate or blood between ciliary body and sclera, and the choird
c. retinal detachment and sclera (ciliochoroidal effusion – low intraocular pressure).
d. all of these Chronic retinal detachment.
Correct:C Optic nerve atrophy.
Intraocular bone originating from osseous metaplasia of RPE.
95.) A 3 year old male who has recurrent bacterial infection such as pneumonia was recently diagnosed to have “leukocyte
adhesion deficiency” due to absence of the ligand for E-selectin. Which of the following statements is true about the deficient
molecule?
a. The deficient molecule is an endothelial cell surface molecule
b. The deficient molecule is integral in the initial rolling of leukocytes
c. The molecule is needed for firm adhesion during leukocyte recruitment
d. The molecule is needed for homotypic interaction during transmigration
Correct:B
E-cadherin is one of the most important molecules in cell-cell adhesion in epithelial tissues. It is localized on the surfaces of epithelial
cells in regions of cell-cell contact known as adherens junctions

96.) This condition is characterized by moon facie, buffalo hump and hirsutism. This is most probably due to oversecretion of
a. GnrH
Ratio: Hypercortisolism (Cushing Syndrome) : With time central pattern of adipose tissue
b. POMC
deposition becomes apparent in forms of truncal obesity, moon facies, and
c. prolactin
accumulation of fat in the posterior neck (buffalo hump).
d. cortisol
97.) Metastatic calcification in a tissue can be
Paraneoplastic Syndromes
expected in the following conditions, except:
- Some cancer-bearing individual develop signs and symptoms that can't be
a. hypercalcemia
readily be explained by anatomic distribution of the tumor or by elaboration of
b. hyperparathyroidism
hormones indigenous to the tissue from which the tumor arose
c. tuberculous granuloma
- Ex. PTHRP- hypercalcemia (most common)
d. renal failure
Hyperparathyroidism - increase release of calcium
Correct:C
Renal failure - most common cause of secondary hyperparathyroidism
98.) A young adult was diagnosed of acute bacterial meningitis.

The most probable cause is:
a. Strep pneumoniae
b. H. influenzae
c. N. meningitidis
d. E. coli
Correct: C
99.) Patient a diagnosed case of G6PD deficiency was

accidentally given antimalarial drug. The anemia that
developed as a complication is due to:
a. acute blood loss
b. increased red cell destruction
c. decreased red cell production
d. chronic blood loss
Correct:B It causes red blood cells to hemolyze.
100.) Which of the following morphologic characteristics is present in osteoarthritis and not in rheumatoid arthritis?
a. Pannus formation c. Fibrosing ankylosis
b. Bony ankylosis d. Osteophyte formation
Correct:D
OSTEOARTHRITIS MORPHOLOGY CLINICAL FEATURES
>Most common form of arthritis >Proliferation of chondroctes(cloning)--> >Commonly a disease of elderly;
>Degeneration of articular cartilage and eventual death-->dislodgement(joint oligoarticular, and primary
disordered repair mice)-->exposed subchondral bone >Non-inflammatory pain :pain worsens
>Genetic and environmental factors: most >Eburnation: ivory like; from friction with activity
common environmental: age and applied to exposed subchondral bone >Bones: hips, knees, lower lumbar and
biochemical stress >Osteophytes: Bony outgrowth at margins cervical vertebrae, PIP (Bouchard nodes),
of articular surface DIP (Heberden nodes), 1st CMCJ, 1st
MTPJ
>Joint deformity without fusion
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PATHO FEU-NRMF PGI-JI COURSE AUDIT EXIT EXAM MAY 2020

PATHO FEU PGI-JI COURSE AUDIT EXIT EXAM MAY 2020

FEU-NRMF PGI BATCH 2020. SUPPORT. KINDNESS. ENCOURAGEMENT. TROUBLESHOOT. 1

Cellular and Molecular Hallmarks of Cancer

FEU-NRMF PGI BATCH 2020. SUPPORT. KINDNESS. ENCOURAGEMENT. TROUBLESHOOT. 2

◌ Hypertrophic scar ◌ Keloid

- Excessive granulation must be removed

FEU-NRMF PGI BATCH 2020. SUPPORT. KINDNESS. ENCOURAGEMENT. TROUBLESHOOT. 3

8.) Anisocoria associated with brain herniation is consistent with:

FEU-NRMF PGI BATCH 2020. SUPPORT. KINDNESS. ENCOURAGEMENT. TROUBLESHOOT. 4

Transtentorial (Uncinate, Uncal, Medial Tonsillar Herniation:

9.) The paramesonephric duct develops into:

FEU-NRMF PGI BATCH 2020. SUPPORT. KINDNESS. ENCOURAGEMENT. TROUBLESHOOT. 5

FEU-NRMF PGI BATCH 2020. SUPPORT. KINDNESS. ENCOURAGEMENT. TROUBLESHOOT. 6

d. Pneumonia is a common clinical presentation of early onset sepsis

13.) Histologic finding associated with nutmeg liver would be:

Primary Biliary Cirrhosis (PBC)

In Acute Viral Hepatitis:

FEU-NRMF PGI BATCH 2020. SUPPORT. KINDNESS. ENCOURAGEMENT. TROUBLESHOOT. 7

16.) What is the most common primary tumor in the heart?

17.) Which of the following conditions favour thrombus formation?

FEU-NRMF PGI BATCH 2020. SUPPORT. KINDNESS. ENCOURAGEMENT. TROUBLESHOOT. 8

19.) Which of the following is not true about schistosomiasis?

FEU-NRMF PGI BATCH 2020. SUPPORT. KINDNESS. ENCOURAGEMENT. TROUBLESHOOT. 9

- 2 major underlying etiologies:

21.) Giant cell arteritis presents a change which is:

22.) Most common paraneoplastic syndrome

23.) Hyperadrenal clinical syndromes include

Adrenal insufficiency (another way of saying “hypo” adrenal)

FEU-NRMF PGI BATCH 2020. SUPPORT. KINDNESS. ENCOURAGEMENT. TROUBLESHOOT. 10

Primary hyperaldosteronism: autonomous over-production of

24.) Complication of hemorrhoids will be the following, except:

25.)Which of the following is the most common primary

PLEOMORPHIC WARTHIN TUMOR (PAPILLARY MUCOEPIDERMOID ADENOID CYSTIC

FEU-NRMF PGI BATCH 2020. SUPPORT. KINDNESS. ENCOURAGEMENT. TROUBLESHOOT. 11

Type A (as seen in herpes simplex and VZV)

FEU-NRMF PGI BATCH 2020. SUPPORT. KINDNESS. ENCOURAGEMENT. TROUBLESHOOT. 12

Iron Deficiency Anemia

30.) Which of the following is TRUE of sinonasal papilloma

31.) Saddle emboli in the lungs is most commonly due to:

32.) Familial hypercholesterolemia is due to which of the following?

FEU-NRMF PGI BATCH 2020. SUPPORT. KINDNESS. ENCOURAGEMENT. TROUBLESHOOT. 13

c. Severe Combined Immunodeficiency

DiGeorge Syndrome (Thymic Hyperplasia)

34.) A newborn has developmental failure in the anterior abdominal

There are two distinct precursor lesions to invasive urothelial carcinoma:

35.) The most common malignancy of the esophagus is

FEU-NRMF PGI BATCH 2020. SUPPORT. KINDNESS. ENCOURAGEMENT. TROUBLESHOOT. 14

The vast majority of esophageal cancers fall into one of

Benign tumors of the esophagus are

a. It is a gain-of-function point mutation

Really can’t find the answer to this

Adenocarcinoma is marked by oncogenic gain-of-function

Small Cell Carcinoma

FEU-NRMF PGI BATCH 2020. SUPPORT. KINDNESS. ENCOURAGEMENT. TROUBLESHOOT. 15

Mutation: p53 (50-80%) and RB gene (80-100%)

Large Cell Carcinoma

FEU-NRMF PGI BATCH 2020. SUPPORT. KINDNESS. ENCOURAGEMENT. TROUBLESHOOT. 16

40.) Most common cancer in children

FEU-NRMF PGI BATCH 2020. SUPPORT. KINDNESS. ENCOURAGEMENT. TROUBLESHOOT. 17