In chronic lympholeukemia in the liver can be seen
myeloblasts
mature lymphocytes and single lymphoblasts
focal leukemic infiltrates in the portal spaces
leukemic infiltrates in the sinusoids
Chronic myeloleukemia causes the following changes in liver
effaced lobular structure
hypertrophy and hyperplasia of hepatocytes
atrophy of hepatocytes
In chronic myeloleukemia we observe the following
long remissions even without treatment
extreme hepato-splenomegaly
anemia, hemorrhages, infections
splenic infarctions
Which are the clinical phases of chronic myeloleukemia?
chronic stable phase
accelerated phase
blast crisis
none of the above
In Hodgkin lymphoma, mixed cellularity type
there can be seen numerous eosinophils
we can observe areas with necrosis
intact histological lymph node structure
giant bi-nucleated cells, called ‘mirror image"
Plasmocytoma has the following features:
Reed-Sternberg tumor cells
Jelly-like raspberry red osteolytic bone lesion
The tumor cells have a large vacuolar nucleus with prominent nucleolus
The tumor cells have a round eccentric nucleus with a pale halo around it
Which of the following are examples of pathological processes in the oral cavity that can have an effect of internal organs?
scarlet fever
peritonsilar abscess
epulis
oral squamous cell carcinoma
Which avitaminosis can be associated with changes in the oral cavity?
vit. B6
vit. B12
vit. D
Vitamin B12 deficiency can cause the following changes in the oral cavity
Glossomegaly
Hunter’s tongue ( atrophic glossitis)
Geographic tongue
Fibrinous gingivitis
What type of examination you will suggest to your patient if you diagnose him/her with atrophic glossitis (Hunter’s tongue)?
colonoscopy
dermatoscopy
gastroscopy
hysteroscopy
If a patient with atrophic glossitis is examined with gastroscopy, what can be the findings in gastric mucosa?
Menetrier’s disease
Atrophic autoimmune gastritis
Acute fibrinous gastritsis
None of the above
The risk of which disease does atrophic autoimmune gastritis carry?
acute gastritis
atrophy of the colonic mucosa
rectal cancer
gastric cancer
What are the usual changes in leukoplakia?
the epithelium is hyperkeratotic
acanthosis in the epithelium
chronic inflammation
dysplasia in the epithelium can be observed
What can we observe in leukoplakia?
parakeratosis
dysplasia
carcinoma in situ
diabetes
Which of the following 15 true of pleomorphic adenoma of the parotid gland
it is a benign tumor
it contains hyperplastic fatty tissue
it is firm and lobulated
it is painful and inflamed
In chronic tonsillitis we can observe the following
purulent exudate
hypertrophic tonsillitis
atrophic tonsillitis
it is a predisposing factor for the formation of epulis
The typical histological picture of epulis includes
Langhans giant multinuclear cells
Fresh heamorrhages and hemosiderin
Osteoclast-type multinuclear giant cells
It is a true tumor
Adamantinoma (amelloblastoma) is
a true tumor
an odontogenic tumor
when compressed the sound is described as flapping wings
when it is compressed the sound is described as eggshell cracking
Why is it necessary to comment on the presence or absence of H.pylori in gastric biopsies?
H. pylori is a risk factor for MALT lymphoma
H. pylori is a risk factor for duodenal cancer
H. pylori causes chronic gastritis
H. pylori is a severe fungal infection
Which of the following are possible complications of chronic gastric ulcer?
penetration into the diaphragm
perforation
pyloric stenosis
massive hemorrhage
Which special stain help us determine the presence of H. pylori in gastric biopsies?
Van Gieson
Giemsa
Congo Red
Immunohistochemistry
The following changes can be observed in acute duodenal ulcer
fibrinoid necrosis at the ulcer base
inflammatory infiltrate with lymphocytes and plasma cells
ulceration penetrating through muscularis mucosae, reaching muscularis propria
it often undergoes malignant transformation
What histological types of gastric cancer do you recognize?
adenocarcinoma
signet-ring cell carcinoma
squamous cell carcinoma
mucinous adenocarcinoma
In phlegmonous appendicitis we can observe the following
peri-appendicitis
lymphocytic infiltration in the mucosa
neutrophilic infiltration throughout the thickness of the wall of the appendix
constriction of the blood vessels of the serosa
Phlegmonous appendicitis is characterized by
purulent exudate in the lumen
hypoplasia of the lymph follicles
hyperplastic activated lymph follicles
hyperemic blood vessels of the serosa
Gangrenous appendicitis is characterized by
lymphocytic infiltration of the mucosa
thrombosis of blood vessels
necrosis of the wall of the appendix
severe inflammation through the wall of the appendix
What are the causes which may lead to micro-nodular liver cirrhosis?
acute viral hepatitis
chronic viral hepatitis
cardiogenic shock
chronic alcoholism
Which of the types of necrosis are found in chronic active hepatitis?
piece-meal necrosis
adjacent necrosis
bridging necrosis
caseous necrosis
Why the level of calcium in the blood has prognostic value in acute pancreatitis?
calcium is deposited in the bones
calcium levels in the blood lower with the progression of steato-necrosis
calcium reacts with fatty acids to form soaps
it has no prognostic value
Some of the gross features of acute pancreatitis are
enlarged liver
steatonecrosis of the fatty tissue around and inside the pancreas
hemorrhages in the tissues of the pancreas
fibrosis in the tissues of the pancreas
What histological changes can be observed in chronic hepatitis?
chronic cholecystitis
inflammatory infiltrates
massive necrosis of hepatocytes
fibrotic septa
Chronic cholecystitis is characterized by the following
often it is accompanied by cholelithiasis
it has no association with cholelithiasis
can cause adhesions
it is caused by viral infection
Which of the following can be complications caused by chronic cholecystitis?
peritonitis
obstruction of d. choledochus
cholestasis
pancreatitis
After consuming poisonous mushrooms, a patient shows signs of acute liver failure with progressive reduction of the size of the liver. What process has developed in the liver?
massive hepatic necrosis
hepatocellular carcinoma
After consuming poisonous mushrooms, a patient shows signs of acute liver failure with progressive reduction of the size of the liver. Besides liver failure, what other complication can worsen the patient’s clinical condition?
left sided heart failure
right sided heart failure
pyelonephritis
acute renal failure
Which of the following can occur after a streptococcal tonsillitis?
post-infectious cholecystitis
post-infectious glomerulonephritis
minimal change disease of the kidneys
acute rheumatism
Which types of glomerulonephritis are clinically presented by nephritic syndrome
diffuse endocapillary glomerulonephritis
rapidly progressing glomerulonephritis
minimal change disease
membranous glomerulonephritis
Which types of glomerulonephritis are clinically presented by nephrotic syndrome
What findings can be observed in glomerulonephritis?
Klebsiella
E.coli
Streptococcus
The urine is sterile
Which type of glomerulonephritis is ‘crescentic’?
rapidly progressing glomerulonepbhritis
‘Big white kidney’ can be observed in the following cases
amyloidosis of the kidney
nephrosclerosis glomerulonephritica
Which of the following histological changes are associated with tubal pregnancy?
chorionic villi and decidual changes of the endometrium
monstrous trophoblast, hydropic chorionic villi
hematoma in fallopian tube, chronic villi invading the muscle layer of the tube, decidual changes of the endometrium
cervical intraepithelial lesion, third grade
Which of the following histological changes are associated with mola hydatidosa?
chronic villi and decidual changes of the endometrium
monstrous trophoblast, hydropic chorionic villi without fetal blood capillaries
hematoma in the fallopian tube, chorionic villi invading the muscle layer of the tube, decidual changes of the endometrium
Which of the following histological changes are associated with abortion (miscarriage)?
Specify the associated clinical symptoms in dysplasia and carcinoma in situ of the uterine cervix
no clinical symptoms
scarce contact bleeding
fever
enlarged inguinal lymph nodes
Why if curettage from a suspected pregnancy shows only decidual changes, the gynecologist should be notified immediately?
there is an increased risk for endometrial carcinoma
there is an increased risk of associated mola hydatidosa
there is an increased risk of associated intraepithelial lesion of the cervix
there is a high risk of associated tubal pregnancy
Mola hydatidosa has the following characteristics
grossly it resembles grape-like structures
chronic villi have fetal capillaries
chronic villi are with hydropic edema
chronic villi lack fetal blood vessels
Examples of ovarian cysts are
follicular cyst
cystadenoma papilliferum
mature teratoma (dermoid cyst)
colloid cyst
Which hormones play a role in breast diseases?
somatotropin
oxytocin
estrogen
progesterone
How does the breast cancer metastasize?
primarily via lymphogenic spread
distantly via hematogenous spread
fibro-epithelial spread
apocrine spread
Select the epithelial ovarian tumors
Granulosa cell tumor
Thecoma
Brenner’s tumor
Androblastoma
Which of the following are epithelial ovarian tumors?
Serous cystadenoma
Dysgerminoma
Which of the following are sex-cord stromal ovarian tumors?
granulosa cell tumor
thecoma
dysgerminoma
androblastoma
Which of the following ovarian tumors are benign?
papillary cystadenoma
papillary cystadenocarcinoma
Which of the following ovarian tumors are malignant?
serous cystadenoma
endodermal yolk sac tumor
mucinous cystadenocarcinoma
In fibro-cystic breast disease we find the following
solitary nodule
multiple nodules
cysts
papillary proliferaations
In fibroadenoma of the breast we find
proliferated mammary ducts and stroma
Benign prostate hyperplasia is seen most commonly in
median lobe
subcapsular prostate tissue
lateral lobes
periurethral prostate tissue
Prostate carcinoma is usually seen in
posterior lobe
Which two markers are valuable for the diagnosis of prostate carcinoma?
PSA
HER2
PAP
Estrogen receptors
What pathogenetic mechanism can be used for the therapy of prostate carcinoma?
hormonal therapy - anti-testosterone drugs
hormonal therapy - anti-progesterone drugs
treatment with monoclonal antibodies
Which of the following types of cancer metastasize to bone?
ovarian cancer
renal cancer
breast cancer
thyroid gland cancer
Bone metastases are observed in which
prostate cancer
Which of the following statements are true for Grave’s disease
it is the most common cause for hypothyroidism
exophthalmos in some patients
pretibial myxedema
usually most patients are euthyroid
The following is true for Grave’s disease
it causes hyperthyroidism
autoantibodies against TSH-receptors
affects more men than women
thyroid stimulating IgG is the cause
Histologically in Grave’s disease we can find
nodular colloid goiter
signs of thyroid hyperfunction
small thyroid follicles with small amounts of diluted colloid
many resorbtive vacuoles in the thyroid follicles
In nodular toxic goiter we can observe the following
exophthalmos
there are found autoantibodies against TSH-receptors
colloid nodular goiter
Which of the following are renal complications of diabetes?
arteriolo-hyalinosis of vas afferens and vas efferens
chronic pyelonephritis
diffuse and segmental glomerulosclerosis
diabetic retinopathy
In goiter we observe
cystically dilated thyroid follicles
histological accommodation of the epithelium lining the follicles
papillary folds of the epithelium of the follicles
diluted, scarce colloid
Hashimoto’s thyroiditis is characterized by
the thyroid follicles are dilated, filled with large amounts of concentrated colloid
atypical looking cells called oncocytes
the thyroid follicles are replaced by lymph follicles
these lymphoid follicles have pale germinal centers
Pneumococcus usually causes infections of the CNS in
newboms
adults
teenagers
toddlers
Haemophylus influenze is the most common etiological agent for infections of the CNS in
newborns
Escherichia coli is the most common etiological agent from infections of the CNS in
Neisseria meningitidis is the most common etiological agent from infections of the CNS in
Which of the following statements are true for tumors of the CNS?
metastatic tumors to the brain are more common than the primary
primary tumors of the CNS often metastasize outside the CNS
primary tumors of the CNS almost never metastasize outside the CNS
most important factor for the outcome is the tumor location
Which are the purposes of pathological autopsy?
to accuse the clinicians of medical malpractice
to establish the cause of death and the definitive diagnosis
to help and educate clinicians and to improve their work
to help the-relatives of the deceased to convict the doctors
Which are the conditions for an autopsy to be done?
death occurred in a hospital due to a disease
available medical history of the patient
presence of the treating doctor
all of the listed above
What are the characteristics of a frozen section?
urgent diagnosis given during an operation
the preparation of the tissue samples is done by a paraffin method
the preparation of the tissue samples is done on a freezing microtome
sometimes the diagnosis is not exactly clear because of the preparation method but information like “malignant tumor”, “benign tumor” or “inflammation” is given to the surgeons to know how to proceed with the operation
Which fixative is most commonly used?
Bouin solution
Absolute alcohol
Formalin 10%
Salts of heavy metals
What fixative should be used for a liver biopsy from a baby with a suspected inherited metabolic disease?
Formalin 10
1,5-4% glutaraldehyde
Frozen section
Zenker’s fixative
What is the role of immunohistochemical stains?
to give urgent answers about the diagnosis or at least orientation about the pathological process during surgery
to determine the histogenesis of the tumor especially in highly undifferentiated malignant tumors
to determine the proliferative activity and the hormonal receptors of the tumor that is highly important for the treatment
to help determine the cause of death
Cytokeratin, S-100 protein, Vimentin, Desmin, CD-20 are examples of
special stains to prove different substances
immunohistochemical markers
In which cases a pathological autopsy is performed?
when there is suspicion for diagnostic or therapeutic malpractice
death of a person outside the hospital
when there is suspicion of violent death
death of a patient in the hospital and when the relatives don’t ask the principal to cancel the autopsy
Which of the followings is not a part of performing an autopsy
dissection of organ
opening the body
taking biopsy from organ change
extraction of abdominal and thoracic organs
Size, shape, elasticity, consistency, color and cut surface are characteristics of
microscopic examination of organs
gross examination of organs
ultramicroscopic examination of organs
none of the listed
Indicate correctly the name of the described test. The pericardial sac is cut in Y-like section and filled with water, after that, in the presence of a witness, the right ventricle is punctured with a knife
test for thromboembolism
test for pneumothorax
test for air and gas embolism
test for fat embolism
Indicate correctly the name of the described test. The pulmonary artery is cut at the place of truncus pulmonalis. Tweezers are inserted and the content of the artery is taken out for examinationion
Indicate correctly the name of the described test. A pocket between the skin and the ribs is formed and is filled with water. In the presence of a witness, the thorax is punctured with a thin knife in an intercostal space
Where is the main accumulation of glycogen in patients with diabetes?
in epithelial cells of convoluted tubules and Henle’s loop
in epithelial cells of gastrointestinal mucosa
in the nuclei and in the cytoplasm of the hepatocytes
endothelial cells of the vessels
The abnormal inclusions in the hepatocytes in alpha-1 antitrypsin deficiency are composed of
glycogen
lipids
bile
proteins
PAS reaction with PAS control is used to distinguish
Cholesterol from other lipids
Glycogen from mucus
DNA from RNA
Denaturated intracellular proteins from accumulated extracellular proteins
PAS-control is done using
sulfuric acid
hydrochloric acid
amylase
picric acid
What is the relation between fatty degeneration of the liver and diabetes?
there is no relation between them
patients with diabetes have increased intake of lipids to provide more energy
the fatty liver in diabetes is caused by increased lipolysis and increased delivery of fatty acids in the liver
the fatty liver leads to diabetes mellitus
What is android type of obesity?
also called “male”or “apple” type, it is the accumulation of lipids in the fatty cells around the shoulders, thorax and waist
also called “female” or “pear’’type, it is the accumulation of lipids in the fatty cells around the hips, tights and legs
generalized obesity predominantly on the face, shoulders and thorax
generalized obesity predominantly in the tights, hips and legs
What is gynoid type of obesity?
also called “female”or “pear”type, it is the accumulation of lipids in the fatty cells around the hips, tights and legs
What is upper type of obesity?
also called “male”or “apple” type, accumulation of lipids in the fatty cells around the shoulders, thorax and waist
What is lower type of obesity?
also called “male” or “apple” type, it is the accumulation of lipids in the fatty cells around the shoulders, thorax and waist
also called “female”or “pear”’type - accumulation of lipids in the fatty cells around the hips, tights and legs
Which type of obesity has worse prognosis?
gynoid type
male type
the obesity doesn’t affect the patient’s health
all of the obesity types have the same prognosis
Haemolytic jaundice is characterized by the following laboratory findings:
increased indirect bilirubin in the serum, hypercholic stools and increased urobilinogen in the urine
both types of bilirubin are increased in the serum, normal colour of the stools, both bilirubin and urobilinogen are increased in the urine
increased direct bilirubin in the serum, hypoholic or acholic stool, increased bilirubin in the urine
Mechanical jaundice is characterized by the following laboratory findings
increased direct bilirubin in the serum, hypocholic or acholic stools, increased bilirubin in the urine
