Clinical Pathoanatomy MCQs (Qs 491 - 530)

The upper outer quadrant of the breast shows dense node, well delimited and movable to the surrounding tissue and skin. Histological examination established proliferated and expanded ducts of the breast with spherical shape and the surrounding connective tissues that does not deform them. Breast lobules are not seen. Give the diagnosis of the process!

Autopsy of a 67 year old with cancer of the ascending colon. Skin, mucous membranes and internal organs are pale, the heart is a 'tiger' types, the bone marrow of flat bones is hyperplastic, and in the long bones it is the hyperplastic and 'red'. Point out the correct diagnosis of the hematopoetic system!

At an autopsy, a large part of one of the lungs is soft, grey colour with an unpleasant odor and the surrounding lung tissue is atelectatic. Histologically is seen necrosis with many microorganisms. No inflammatory reactions is seen. Give the correct diagnosis!

18-year old girl is with tumor formation in the abdomen. An operation is done and a cystic tumor of the left ovary with the size of 10cm is removed. Cutting of the tumor shows little protrusion at one pole of the cyst and the contents are fat and hair. Histologically are observed improperly mixed tissues from all three germ laters - ecto - , meso- and endoderm. Determine the type of tumor;

At necropsy the gastric mucosa is strongly hypertophied. Gastric mucosal folds are large, curved, swollen resembling brain gyri. Which of the following is correct

Autopsy of 27 year old woman find in the lungs numerous gray-yellowish nodules in the size of the millet grain and dense texture, In the subarachnoid space of the basal surface of the brain between the cruris cerebri around the optic chiasma is see abundant gelatinous, yellowish exudate and along the blood vessels - nodules with the same characteristic as in the lungs. What is the disease of the nervous system

An elderly with complaints of severe chest pain that spread to the left arm was admitted in emergency cardiac surgery. A surgical intervention with placement of two bypasses was performed and the patient's life was saved. What disease caused the complaints

If thrombosis occurs a few days after surgery of popliteal vein and causes death due to massive pulmonary embolism, the main disease is:

The autopsy of 27 years old woman revealed numerous grayish yellow nodules in the lungs with size of a grain and dense consistency. On the brain was found gelatinous yellowish exudate mainly on the base, around the chiasm and Sylvian fissure. Around the vessels were visible single nodules with the same characteristics as in the lungs. What is the process in the lungs

A 50years old male present with angina pectoris. Coronary angiography reveals a 75% narrowing of the anterior descending branch of the left coronary artery. Which of the following cells is least likely to be involved in the pathogenesis of his coronary artery lesion

*During third trimester of pregnancy, a 28 year old woman discovers a lump in her right breast. It is circumscribed, 2cm, freely movable mass beneath the nipple. After delivery of a term infant the mass appears to decrease slightly in size. This breast lesion is most likely to be a (an): *NB: There is no marked answer in the MCQs book (Q501) so i ticked the one i thought is the correct answer...

A patient was admitted to the surgical department with clinical signs of acute abdomen and died before the surgical intervention. The autopsy revealed bluish to dark red color of the jejunum and part of the ileum. Intestines were inflated and when opened - with leakages of bloody matter. The histological examination of the intestinal wall showed hemorrhagic infarction. In what pathological process can be described the picture observed

The autopsy of 57 years old female revealed papillary formation in the area of the trigonum of the urinary bladder, which significantly narrowed the urethra. Ureters and renal pelvis were highly enlarged and the renal parenchyma was thin. Point out the changes in the kidneys

The autopsy of 67 years old woman revealed carcinoma of the ascending colon with significant size. The skin, mucous membranes and internal organs were pale, the bone marrow in the long bones was red and the heart appeared as ''tiger heart''. Set the correct diagnosis of the changes in the hematopoietic system

At the autopsy of a 29 day old baby with total hypotrophy is observe: diffuse purulent inflammation of the skin (pyoderma), cyanosis of the phalanges and the mucosal membranes, bilateral fibrino-purulent pleuritic and dense subpleural areas in the black parts of the lungs. What is the most probable etiological agent of the infection and how was the baby affected

The autopsy of 41years old man the whole middle lobe of the right lung is firm, greyish, airless. The cut surface is finely granular and the texture resembles that of the liver. The adjacent pleural surface is covered by fibrino-purulent exudate. What is the diagnosis

The autopsy of 41years old man the whole middle lobe of the right lung is firm, greyish, airless. The cut surface is finely granular and the texture resembles that of the liver. The adjacent pleural surface is covered by fibrino-purulent exudate. On which day of the illness did death occur

A 33 year old woman complains of fatigue, night sweats and unilateral enlarged lymph nodes for several months. The biopsy shows effaced lymph node structure with multiple inflammatory cells - small mature lymphocytes, eosinophils, macrophages. Large bean-shaped nuclei, located with its concave parts as in 'mirror'image and 1 or 2 well visible red nucleoli. Lymph nodes are dissected by strands of connective tissue that creates the impression of nested structure of the lymph nodes. CT scan of the abdominal organs and the bone marrow biopsy show no pathological changes. Identify the lymphoma, its form and stage

At autopsy of a 39yers old man was found: enlarged 6kgs spleen, liver - 4.5kgs, greyish (purulent) bone marrow and plenty of post-mortem clots in the blood vessels. In the cleft large brain hemisphere there is a blood clot, which destroy brain tissue. What is the diagnosis and the cause of death

At autopsy of a 39yers old man was found: enlarged 6kgs spleen, liver - 4.5kgs, greyish (purulent) bone marrow and plenty of post-mortem clots in the blood vessels. In the cleft large brain hemisphere there is a blood clot, which destroy brain tissue. What is the reason for the hepato- splenomegaly

The examination of the oral cavity of 42yrs old patient shows slightly elevated pale plaque-like lesion with uneven surface, slit spaces and erosive areas, located on the back surface of the tongue and the mouth floor. It cannot be scrapped off. Two week antibiotic therapy is not helpful. Incisional biopsy is done. The pathologist describes hyperkeratosis, parakeratosiss, acanthosis of the epirthelium, severe chronic inflammation, but also disorganisation and moderate cellular atypia in the basal two thirds of the stratified squamous epithelium. The integrity of the basal membrane is retained. What is the clinical diagnosis

A 53 yrs old woman is diagnosed with malignant lymphoma based on a biopsy of a painless moderately mobile nodule, located on the left, supraclavicularly. She complains of weakness, palpable peripheral lymph nodes. From the laboratory results: iron deficiency anemia, hypo-proteinemia. The biopsy was sent for revision. What conclusion do you expect from the consulting pathologist and how could it be proved

The autopsy of a 28 yrs old male shows expressed changes in the kidneys and lungs. The lungs are enlarged, heavy, with rusty color. Histologically, there are multiple hemorrhages, fibrinoid necrosis of alveolar wall, hemosiderophages in the alveoli. The kidneys are enlarged, the cortex is widened, fleshy, with hemorrhages. The clinical diagnosis is crescentic glromerulonephritis. What is the final pathological diagnosis

The autopsy of a 28 yrs old male shows expressed changes in the kidneys and lungs. The lungs are enlarged, heavy, with rusty color. Histologically, there are multiple hemorrhages, fibrinoid necrosis of alveolar wall, hemosiderophages in the alveoli. The kidneys are enlarged, the cortex is widened, fleshy, with hemorrhages.The final pathological diagnosis is Goodpasture syndrome. Which are the most common clinical symptoms in this disease

The autopsy of a 28 yrs old male shows expressed changes in the kidneys and lungs. The lungs are enlarged, heavy, with rusty color. Histologically, there are multiple hemorrhages, fibrinoid necrosis of alveolar wall, hemosiderophages in the alveoli. The kidneys are enlarged, the cortex is widened, fleshy, with hemorrhages.The final pathological diagnosis is Goodpasture syndrome. What changes can be observed in the heart

A 29yrs old nulluparous has a high grade intraepithelial lesion of the cervix. After the targeted biopsy, conization is done. The entire cervix is received at the laboratory and 16 cut sections are submitted. The biopsy report claims that in situ carcinoma is seen only in the area of the portio vaginalis coli uteri. The gynecologist considers the answer inadequate. Why?

47 yrs old female has been sent to surgery for breast lump, attached to the adjacent tissues, measuring 4cm in diameter, located in the upper breast quadrant. The biopsy of the lump shows distorted breast structure small identical cells arranged in an 'Indian file' pattern. What is the diagnosis

47 yrs old female has been sent to surgery for breast lump, attached to the adjacent tissues, measuring 4cm in diameter, located in the upper breast quadrant. The biopsy of the lump shows distorted breast structure small identical cells arranged in an 'Indian file' pattern. What type of tumor is described

At the autopsy of a 70yrs old male the prostate is enlarged, measuring 85gr, 6-7cm in diameter. The cut surface shows lobular architecture and preserved capsule. The prostate part of the urethra is folded and narrow. The urinary bladder shows hypertrophy of the muscle layer. Bladder mucosa is hyperemic and covered with fibrino-purulent exudate. Both ureters and pyelon are dilated. The kidneys are enlarged, but the parenchyma is thin. What is the diagnosis of the changes in the prostate and kidneys

30yrs old male patient, married with no children is admitted for surgery due to a right sided inguinal hernia. The right testis could not be palpated. The ultrasound reveals hypo-echogenic area measuring 5/5cm behind the urinary bladder. CT scan shows a mass measuring 2/1cm in close proximity to the inguinal canal. The tumor is resected. The histology shows 2 types of cells - large, highly atypical and monstrous, and small spindle shaped cells set among the blood mass. No stroma is seen. The human chorionic gonadotropin is highly elevated. What is the diagnosis

30yrs old male patient, married with no children is admitted for surgery due to a right sided inguinal hernia. The right testis could not be palpated. The ultrasound reveals hypo-echogenic area measuring 5/5cm behind the urinary bladder. CT scan shows a mass measuring 2/1cm in close proximity to the inguinal canal. The tumor is resected. The histology shows 2 types of cells - large, highly atypical and monstrous, and small spindle shaped cells set among the blood mass. No stroma is seen. The human chorionic gonadotropin is highly elevated. Is there any relation between the 'missing' testis and the tumor formation

A 22 yr old female felt a painless nodule on the right side of her neck. She reported she underwent ionizing therapy years ago for a capillary hemangioma. Histologically, 3 lymph nodes structures were identified, entirely replaced by thyroid tissue. Some of the follicles show papillary structures, in which the lining epithelium is with large, vesicular, optically ''empty'' nuclei. Some of the papillae show calcium deposits. After the biopsy, thyroidectomy followed. What is your diagnosis of the findings in the lymph node

A 22 yr old female felt a painless nodule on the right side of her neck. She reported she underwent ionizing therapy years ago for a capillary hemangioma. Histologically, 3 lymph nodes structures were identified, entirely replaced by thyroid tissue. Some of the follicles show papillary structures, in which the lining epithelium is with large, vesicular, optically ''empty'' nuclei. Some of the papillae show calcium deposits. After the biopsy, thyroidectomy followed. What is the expected finding in the thyroid gland

28yr old female complained from facial hair, lower type diabetes, fleshy stretch mark on the lower abdomen and arterial hypertension. CT reveals retroperitoneal tumor measuring 10/5/3cm, set above the kidney. Grossly, the tumor is lobular, tan-yellow, lacking a capsule. Histology shows nested structure. Tumor cells are with pale, vacuolar cytoplasm with centrally located nuclei. Cellular atypia is observed, large 'monstrous' cells are seen. Tumor emboli are found in the veins. What kind of neoplasm is described

28yr old female complained from facial hair, lower type diabetes, fleshy stretch mark on the lower abdomen and arterial hypertension. CT reveals retroperitoneal tumor measuring 10/5/3cm, set above the kidney. Grossly, the tumor is lobular, tan-yellow, lacking a capsule. Histology shows nested structure. Tumor cells are with pale, vacuolar cytoplasm with centrally located nuclei. Cellular atypia is observed, large 'monstrous' cells are seen. Tumor emboli are found in the veins. Specify your diagnosis taking into consideration the given data.

13yrs old boy was sent back home from school due to general weakness, high fever and headache. In the evening a living skin rush appeared on his body. The lost consciousness his blood pressure dropped, the heart rate was rapid and arrhythmic. The boy died 16hrs after onset of the symptoms. The cerebrospinal fluid shows plenty of leucocytes, protein and coccoid flora-Neissria meningitides. The autopsy reveals large suprarenal glands transformed in to hemorrhagic 'pouches'. The brain shows to remarkable changes, mainly edema and small hemorrhages. Which is the main disease

13yrs old boy was sent back home from school due to general weakness, high fever and headache. In the evening a living skin rush appeared on his body. The lost consciousness his blood pressure dropped, the heart rate was rapid and arrhythmic. The boy died 16hrs after onset of the symptoms. The cerebrospinal fluid shows plenty of leucocytes, protein and coccoid flora-Neissria meningitides. The autopsy reveals large suprarenal glands transformed in to hemorrhagic 'pouches'. The brain shows to remarkable changes, mainly edema and small hemorrhages. Which is the complication of the main disease

13yrs old boy was sent back home from school due to general weakness, high fever and headache. In the evening a living skin rush appeared on his body. The lost consciousness his blood pressure dropped, the heart rate was rapid and arrhythmic. The boy died 16hrs after onset of the symptoms. The cerebrospinal fluid shows plenty of leucocytes, protein and coccoid flora-Neissria meningitides. The autopsy reveals large suprarenal glands transformed in to hemorrhagic 'pouches'. The brain shows to remarkable changes, mainly edema and small hemorrhages. What is the cause of death

A well circumscribed nodule attached to dura mater was resected, greyish-white in color, firm, and measuring 4cm in diameter. The tumor is easily detached from the underlying dura and the underlying brain tissue shows a compression 'pit'. Which is the tumor

The biopsy of a recurrent brain tumor shows polymorphous cells in a necrotic background. There are large giant multinucleated tumor cells, some of them highly atypical, called 'monstrous'. The tumor cells from palisades around the necrosis and hemorrhages. Idenfify the tumor