Part 1 examination questions from September 2010

EMQ Bladder biopsy:

1.Malakoplakia-lamellar structures pos for von Kossa

2.Granulomatous cystitis-pt treated for severe bladder dysplasia with BCG has now non caseating granulomas in the bladder biopsy

3.Interstitial cystitis – ulcers on cystoscopy, mast cells on biopsy

4.Schistosomasis- man came from Egypt and now biopsy shows fibrosis with strictures

5.Encrusted cystitis-haematuria. pH 8 of urine, cystoscopy calcified plaques with gram pos bacteria
(conditions predisposing to infection, debilitated patients, pre-existing urological procedures, Corynebacterium)

Other options that I remember : SCC, Squamous metaplasia

 EMQ Forensic toxicology

1.Inhaled heroin- died surrounded by lighters and cigarettes and in his pipe was brown residue. He was a drug addict.

2.Ecstasy- girl went clubbing, drank 3 L water within 1.5 h and died

3.Cocaine or solvent sniffing- came from prison, took some drugs, went shoplifting and died when was chased by police

4.Fentanyl patch overdose- sickle cell anaemia took his usual medication and was found dead with multiple rectangular patches on the skin

5. ????????????????????????????????????????????????

EMQ infections:

A 4 year old boy has an enlarged neck lymph node with stellate necrosis and no CXR changes-Mycobacterium fortuitum
Sickle cell anaemia child had anaplastic crisis with low reticulocytes- parvovirus infection
Erythema chronicum migrans- Borrelia burgdorferi
Pregnant woman went to rural France and had stillborn baby, placenta showed abscesses- Listeria
CMV- perforated caecum?

EMQ Head and neck:

Smoker-Warthins tumour
Basal cell adenoma -----------------------------------------------------------------------
Pleomorphic adenoma- with incomplete capsule
Adenoid cystic carcinoma------------------------------
Sialadenitis acini distruction

EMQ Paediatric bowel:

Hirshprung – no ganglia and thickened nerves on AchE staining
Dysplastic ganglions – many bizarre ganglions and thickened nerves on AchE staiing
Pneumatosis Cystoides Intestinorum- normal mucosa and pseudocystic spaces in the submucosa lined by multinucleated giant cels
Pseudomembranous colitis
Cowdry A B inclusions in HSV infection


EMQ Adult bowel:

GI haemorrhage and partial resection of large bowel, received in formalin and did not show any patology-angiodysplasia
Leukaemia and bone marrow transplant ? chemotherapy--------------------------                                                
Bowel ulcers with many neutrophils- ? GVHD
Crohn disease – fat wrapping
Ulcerative colitis – caecal patch
 AAA repair and had ischaemic bowel post op-ischaemic colitis

EMQ Renal:

Minimal change

EMQ Autopsy:

Died of cardiac problems during cystectomy intensive CPR and PM finding was fat with small cells in it in pulmonary arteries-bone marrow embolism

3 day old neonate died and autopsy showed petechial haemorrhages in the liver that on histology were foci of necrosis-?


Pulmonary hypertention

Small cell carcinoma disseminated

EMQ Serology:

Renal failure and pulmonary haemorrhage
Anti-Phospholipid syndrome-anti ds DNA
Sjogren anti Ro
Antiendomysial in coeliac

EMQ Breast:

2. Fat necrosis
3. Mucinous carcinoma
5. Duct ectasia

EMQ Bone:

Ewing sarcoma – pseudorosettes
Osteoid osteoma- NSAIDS help the night pain
Fibrous dysplasia- osteoid with no osteoblasts rimming
Osteochondroma-mashroom lesion with cartilage cap
Langerhans histiocytosis – uniform cells with grooves and a lot of eosinophils in the mandible

EMQ Lymph node:

28 male with ileal mass. There are sheets of moderate size lymphocytes with intracytoplasmic lipid, pos for bcl6 and CD 10, neg for TdT and all the T markers, MIB 90%-Burkitt
NLPHL vs classical Hodgkins- mediastinal lymphadenopathy in 30sth male, many Reed Sternberg like cell pos for CD20, surrounded by rosettes of cells pos for CD57

EMQ Skin:

Bullous Pemphigoid
Pemphigus vulgaris
Dermatitis herpetiformis
Lupus erythematosus vs Discoid lupus

EMQ gynae infections:

1. Teenager got drunk in a pub and ended up with papules and then ulceration on the vulva. Painful inguinal LNs.     HSV2
2. On cervical bx follicular cervicitis   Chlamydia
3. Strawberry cervix     Trichomonas
4. Pregnant woman with DM has itchy white lesion in vagina   Candida
5. CIN3 on cervical biopsy HPV


1.Bilateral pleural effusion in progressive shortness of breath-had dirty background, many macropages bizarre, cholesterol clefts, fat globules, granularity-
A) Rheumatoid arthritis
B) Lupus
C) Bronchopneumonia
D) Pulmonary infarction
E) Bronchial carcinoma

2. Postmenopausal bleeding- a mass 10cm in the ovary. It contains cartilage, bone, rabdomyoblasts, intestine, skin. But the majority of the tumour consists of tubular structures lined with eosinophilic cell. (?or papillary structures lined by tall eosinophilic cells)
A) mature cystic teratoma
B)carcinosarcoma with heterotopic sarcomatous element
C) Sertoli-Leydig tumour
D)epithelial adenocarcinoma
E)granulosa cell tumour

3. Virilism, increased libido, hair loss. Tumour forms microtubular structures lined by cells with nuclear grooves. What stain would you do to confirm the diagnosis:


4. Neck mass in a smoker. Cytology shows lymphocytes and epithelioid cells that show grey granules on Pap. Diagnosis:

B)  carotid body tumour

5.Elipse of skin with melanoma. How would you cut it up:

C)en face

6. FAP with papillary carcinoma of the thyroid which type of ca is it:

A)    cribriform

7.26 male come from Hong Kong with a mass in the neck. Biopsy shows syncytial growth of cells, all of them show prominent nucleoli. There are eosinophils. What immuno would you do to confirm the diagnosis:

A)    S100 HMB
B)    MNF116 EBV
C)    CD15 CD30
D)    CD79

8. p stands for

A)    resection specimen

9. Cushing putting on weight. Dexamethasone test pos. Elevated cortisol. Bilaterally enlarged adrenals.
A)pituitary adenoma
C)adrenal adenoma
D) iatrogenic

10. Breast grade 3 (333) invasive adeno + extensive DCIS+ one microscopic LN axillary node met. What is the most significant prognostic factor  for her local recurrence?
A) micromet
B)extensive DCIS

11.Died at home, male , had depression and hypertenstion. Toxicology shows phenylethylalanin and alcohol. Alc level 480mg%. Bladder was empty. Why phenylethylalanin was not measured?
A) can be measured only in urine
B)it is a metabolite of phenyl sth with ethanol
C)has high fat distribution
D)it is a product of decomposition

12. In caeliac disease the intraepithelial lymphocytes will stain with:

13.Woman has diarrhea because of caeliac disease and gets peripheral oedema. Why?
A)decreased oncocytic pressure
B)increased hydrostatic pressure

14. Bx shows crypt hypertrophy, shortening of villi and intraepithelial lymphocytes and lymphoepithelial lesion and mesenteric lymphadenopathy. On MDT doctors decided that the diagnosis lies between lymphoma and caeliac disease. What feature would favour lymphoma:
A) lymphoepithelial lesion
B) mesenteric lymphadenopathy
15. What features of giant cell tumour of the tendon sheath would the most predict its aggressive/malignant behaviour:
A)mitoses more than 10 per 10hpf-Weiss
C)invasion to soft tissue
D)invasion to bone-p.1247 Robbins
Pathology outlines: Malignant if nodular and solid invasive growth plus large cells with large nuclei, prominent nucleoli, necrotic areas and atypical mitotic figures

16. Lesions on the shins and dorsal palms show saw toothing and lichenoid changes. What type of reaction is it:
B)cytotoxic cellular
C)cytotoxic antibody
D)immuno complexes deposition

17. Lung tumour 1.5cm from carina

18. Caldicott
A)faxing to the reception area

19. HTA
A) can use tissue from living for research without consent if ethical approval and anonymised

20. Pure rt hemiparesis
A)left lacunar infarct in the internal capsule

21. Chemical gastritis due to:
A)acid bile reflux
B)pancreatic enzymes

22. Lymph node with small granulomas monocytoid lymphocytes and follicular hyperplasia

23. Lung and paraneoplstic syndromes
A)small cell ca left side and bilateral ptosis with photosensitivity Lambert eaton

24. Laceration vs incised wound:

25. MRI autopsy:

B) aortic dissection
C) coronary artery thrombosis
D) bronchopneumonia

26. Decoy cells
A) BK virus

27. Berylliosis has granulomas like sarcoidosis

28. Gout has crystals that show negative birefringence

29.Medullary ca thyroid +pchaeochromocytoma:
A)RET gene mutation

30. Woman died of multiple myeloma and the renal section showed:
A) cast nephropathy

31. Synovial sarcoma transformation:

32. Head and neck what the most predicts bad prognosis:
A) extranodal spread

33. Phyllodes tumour description

34. Dysplastic melanoma description

35.Pilocytic astrocytoma description

36. 6th nerve ipsilateral palsy in uncal/subtentorial herniation

37. Cingulate gyrus in subfalcine herniation

38. Cherry red spot,  no hepatosplenomegaly, mental retardation present
A) Tay-Sachs
B)Nieman –Pick

39. Fallot does not include ASD

40. Where to take histology from to look for WPW abnormality:
A) foramen ovale
C)upper intraventricular septum
D) left ventricular apex
E)mitral valve

41. Inadequate thryroid cytology

42. Frame shift mutation in a boy with dilated cardiomyopathy and muscle weakness

43. Choriocarcinoma histology description

44. Kawasaki disease

45. Which artery gets occluded in small bowel necrosis:
A) superior mesenteric artery

46. Burkitt lymphoma description , choose translocation:
A) t(8;14)