GENERAL PATHOLOGY

REVIEW

John Anthony D. Tindoc, MD

Jonathan P. Rivera, MD
University of the Philippines -PGH
Which of the following cellular adaptations refer to an increase in the
number of cells in an organ or tissue?(p35)

A.Hypertrophy
B.Hyperplasia
C.Atrophy
D.Metaplasia
Answer: B

Hypertrophy: increase in size, increase in protein (myocytes)

Atrophy: decrease in both cell size and number
Types: Pressure/ischemic, denervation, disuse, malnutrition, loss of
endocrine stimulation.
Metaplasia: reversible change from one cell type to another.
What is the most common form of metaplasia? (p37)

A.Columnar to squamous
B.Squamous to columnar
C.Muscle to bone
D.Epithelium to cartilage
Answer: A
Columnar to Squamous Metaplasia: Cervical metaplasia, Irritated Excretory ducts,
Respiratory epithelium during smoking or vitamin A deficiency.

Squamous to columnar: Barrett Esophagus (GERD)

Muscle to bone: myositis ossificans

Epithelium to cartilage: certain uterine neoplasms

Which of the following phospholipids in the cell membrane is normally
restricted in the inner layer but is flipped to the outer layer during
apoptosis and acts as a signal for phagocytosis? (p7)

A.Phosphatidylinositol
B.Phosphatidylserine
C.Sphingomyelin
D.Phosphatidyethanolamine
Light microscopic changes of cell death are seen only after at least how
many hours after onset of ischemia? (p40)

A.1 hour
B.4 hours
C.8 hours
D.12 hours

Light microscopy changes are not visible until

4-12 hours from the onset of ischemia.
At what level of ATP depletion will there be widespread effects on
critical cellular systems? (p46)

A.1-5% of normal levels

B.5-10% of normal levels
C.10-15% of normal levels
D.15-20% of normal levels
Answer: B

With the lack of ATP, sodium potassium pumps fail and there is increased influx of
sodium followed by water and then cell swelling.
Anaerobic glycolysis ensues increasing the acidity of the cytoplasm and the
inactivation of many enzymes.

Failure of Calcium pumps lead to influx of calcium with eventual activation of

phospolipases, proteases, enoducleases and caspases.
Which of the following Reactive Oxygen Species is the major oxygen-
derived free radical and the principal ROS responsible for damaging
lipids, proteins, and DNA? (p48)

A.Superoxide anion
B.Hydrogen peroxide
C.Hydroxyl radical
D.Peroxynitrite
Answer: C
Superoxide anion: acts close to site
H202: can act distant from site of production
Which of the following nuclear changes occur during necrosis? (p42)

A.Karyolysis
B.Pyknosis
C.Karyorrhexis
D.All of the above
Answer: D
Type of Necrosis (p16)?

A.Liquefactive
B.Coagulative
C.Caseation
D.Fibrinoid
Type of Necrosis (p15)?

A.Liquefactive
B.Coagulative
C.Caseation
D.Fibrinoid
Which of the following refers to calcium deposits in areas of dying
tissues? (p65)

A.Heterotrophic bone formation

B.Dystrophic Calcification
C.Metastatic Calcification
D.Endochondral ossification
Answer: B
Heterotrophic bone formation: formation of mature bone in unusual sites

Metastatic calcification: calcium deposition in tissues secondary to increased

serum calcium

Endochondral ossification: formation of bone over a cartilage framework

Which of the following regulate/inhibit the intrinsic pathway of
apoptosis? (p54)

A.BAX
B.BAK
C.BCL-2
D.BIM
What is the initiator caspase in humans, along the mitochondrial
pathway? (p55)

A.Caspase 9
B.Caspase 8
C.Caspase 10
D.Caspase 6
Answer: A

Intrinsic pathway: mitochondrial pathway

Initiator caspase: Caspase 9
Extrinsic pathway: death receptor pathway
Initiator caspase: Caspase 8, and 10 ( in humans)

Executioner caspases: Caspase 3 and 6

Which of the following processes is not programmed cell death? (p52
p59)

A.Apoptosis
B.Necrosis
C.Necroptosis
D.Pyroptosis
Necroptosis: caspase-independent programmed cell death
Pyroptosis: programmed cell death associated with the
release of IL-1
Purulent/Suppurative inflammation primarily is characterized by which
inflammatory infiltrate? (p91)

A.Lymphocytes
B.Monocytes
C.Eosinophils
D.Neutrophils
 Answer: D

Neutrophils: acute inflammatory patterns

Lymphocytes: chronic inflammation, Viral infections
Eosinophils: parasitic infections, allergies
Basophil: significant increase in the accelerated phase of Chronic myelogenous
leukemia and eventual leukemic phase
Leukocyte rolling across the endothelium is mediated by interactions of
the Sialyl Lewis X with which endothelial receptors? (p75)

A.Selectins
B.CD31
C.Proteoglycan
D.ICAM-1/VCAM-1
Which of the following arachidonic acid metabolites inhibit platelet
aggregation? (p84)

A.Prostacyclin
B.Thromboxane A2
C.PGD2
D.PGE2
Answer: A
Which of the following are plasma protein-derived inflammatory
mediators? (p84)

A.Prostacyclin
B.Thromboxane A2
C.Complement proteins
D.Leukotriene
Which of the following cytokines principally mediates febrile reactions?
(p86)

A.TNF
B.IL1
C.IL6
D.IL 17
TNF, IL-1 and IL-6 contribute to systemic effects of inflammation
including fever. But IL-1 has the greatest role in fever induction.
TNF has the greater role in cachexia.
Which of the following processes is mediated by a macrophage activated through
the alternative pathway? (p95)

A. Microbicidal actions
B. Phagocytosis
C. Inflammation
D.Fibrosis
Granuloumatous inflammation in response to tuberculous infection
usually produces epithelioid cells with large cytoplasm and multiple
nuclei arranged in a horseshoe shape? (P98)

A.Foreign Body Type Giant Cell

B.Langhans Type Giant Cell
C.Touton Type Giant Cell
D.Warthin-Finkeldey Cells
1. Foreign body type giant cells:
sutures, ruptured sebaceous
cysts
2. Langhans type: tuberculosis
3. Tuoton giant cell: liposarcoma
4. Warthin finkeldey cells:
measles
WARTHIN FINKELDEY CELLS
Cell junctions provide mechanical links between cells and/or
extracellular matrix. Which of the following maintain an attachment
between cells and the basement membrane? (p11)

A.Tight Junctions
B.Gap Junctions
C.Desmosomes
D.Hemidesmosomes
Answer: D
Which of the following RAS signal transduction pathways is correct?
(p17)

A.Growth Factor -> RAS -> RAF -> MAPK -> MYC protein -> cell cycle
progression
B.Growth Factor -> RAF -> RAS -> MYC protein -> MAPK -> cell cycle
progression
C.RAF ->RAS -> MAPK -> MYC protein -> growth factor -> cell cycle
progression
D.RAS -> RAF -> MAPK-MYC protein -> growth factor -> cell cycle
progression
Answer: A
In wound healing, growth signals secreted by macrophages to fibroblasts
is a form of (p104):

A. Autocrine signaling
B. Paracrine
C. Endocrine
D. Exocrine
 Signaling Mechanisms in Cell Growth

1. Autocrine (hepatic regeneration,

antigen presented lymphs)

2. Paracrine (wound healing)

3. Endocrine (distant sites)

Cyclin dependent kinases can be inhibited by different protein products
by imposing cell cycle checkpoints. Which of the following protein
products broadly inhibit these kinases at different checkpoints? (p26)
A.p21
B.p27
C.p57
D. All of the above
Answer: D
Broad acting CDK inhibitors: P21, P27, P57
Selective CDK inhibitors: p15, p16,p18,p19
During wound repair, neovascularization reaches its peak during which
time frame? (p106)

A.1-2 days
B.3-4 days
C.5-6 days
D.7-8 days
Answer: C
Within 24 hours, neutrophils seen at wound sites.
24-48 hours: migration and proliferation of epithelia along the edges
Day 3: macrophages largely replaced neutrophils
Day 5: peak of neovascularization
Second week: continued collagen accumulation and fibroblast proliferation
First month: normal epidermis covers wound
Third month: maximum wound strength (70-80% of normal).
Maximum wound strength despite healing and repair after 3 months is
only: (p109).

A.30-40% of normal.
B.50-60% of normal.
C.70-80% of normal.
D.90-100% of normal.
Crosslinking of the collagen triple helices is dependent on which
micronutrient? (p23)

A. Vitamin A
B. Vitamin D
C. Vitamin E
D. Vitamin C
Answer: D

Vitamin C is needed for the

hydroxylation of lysine and
proline.
Scurvy
Prothombin time assay assesses which of the following clotting factor
activity: (p119)

A.Factor X
B.Factor IX
C.Factor XI
D.Factor VIII
Answer: A
Prothrombin time: extrinsic and common pathway
-VII, X, II, fibrinogen
Partial thromboplastin time: intrinsic and common pathway
-XII, XI, IX, VIII, X, V, II, fibrinogen

Vitamin K dependent factors: II, VII, IX, X

Note: The extrinsic pathway contributes more to physiologic hemostasis.
Platelet adhesion disorders involving a defect in GpIb is called: (p117)

A.Von Willebrand disease

B.Bernard Soulier Syndrome
C.Glanzmann thrombasthenia
D.Gray Platelet Syndrome
Defects in primary hemostasis show small bleeds on skin and mucus
membranes just slightly larger than or equal to 3mm. These are called:
(p122)

A.Petechiae
B.Purpura
C.Ecchymoses
D.Hematoma
Petechiae: 1-2mm
Purpura: slightly larger than petchiae (>/= 3mm)
Ecchymoses: hemorrhages 1-2cm
Hematoma: palpable mass of blood
The second most common inherited cause of hypercoagulability is:
(p124)

A.Prothrombin mutation
B.Factor V Leiden
C.Cystathione B-synthetase deficiency
D.Protein C deficiency

All the choices contribute to hypercoagulability.

Factor V Leiden is the most common inherited cause of hypercoagulability.
A prothrombin mutation comes in second.
Chronic Heart failure will result to the following findings:

A.Pulmonary congestion with heart failure cells

B.Nutmeg liver
C.Both are seen
D.None of the above
Chronic passive congestion: Liver

Hemorrhagic necrosis around central

vein=“Nutmeg Liver”
http://www.pathguy.com/lectures/liver.html
http://patologia.gabeents.com/data/Pathologic/flh1/record0011.html
http://fblt.cz/en/skripta/ix-travici-soustava/5-jatra-a-biotransformace-xenobiotik/
 Hemosiderin-laden
macrophages
“Heart Failure Cells”
Embolic deposits gaining access to the systemic arterial circulation from
the venous circulation is referred to as (p127)

A.Pulmonary embolus
B.Paradoxical embolus
C.Saddle embolus
D.Cor pulmonale
Answer: B
Paradoxical emboli are from the venous circulation that was able to bypass the
pulmonary circulation through an atrial septal defect or ventricular septal defect
and into the systemic circulation.

Saddle embolus is a large embolus lodged in the pulmonary artery branchpoint.

Cor pulmonale can occur as a sequelae to multiple pulmonary emboli.

60/M patient presented with chest pain followed by lost of consciousness and vital signs. The
patient was coded and revived. Work up showed elevated troponin done after chest
compressions. There was noted multiple rib fractures post cardiac resuscitation. 1-3 days
after the patient presented with tachypnea, dyspnea with delirium. Work up showed
thrombocytopenia and anemia. The patient eventually went into coma and died. What do
you expect to see in the autopsy findings done 2 hours after demise? (p128)

A. Large blood clot lodged in the main pulmonary artery branch point.
B. Liquefactive necrosis of brain tissue.
C. Multiple hyaline deposits with cleared fat vacuoles in the pulmonary circulation.
D. Large ruptured aneurysm on the abdominal aorta near the renal artery branchpoints.
Answer: C
The exact cause for the initial code done for the patient is not elucidated. We do
know that troponin levels were elevated (which might make one think of
myocardial infarction) but remember that this was done post ACLS. A few days
later the patient presented with neurologic, pulmonary and hematologic
symptoms, which when compounded by the fact that there has been multiple
fractures on the rib post-ACLS, point to a fat embolism.

The morphologic correlate of fat embolism on histology are the presence of fat
vacuoles in the circulation.
Divers are prone to decompression sickness when the dissolved oxygen
escapes from the blood. When this occurs over long period of time and
repeated exposures, the gas bubbles may persist in the femoral head,
tibia, and humerus. This is called: (p128)

A.Bends
B.Chokes
C.Grecian bend
D.Caisson Disease
 Answer: D

Bends: rapid formation of gas

bubbles in the joints

Chokes: rapid formation of gas

bubbles in the lung vasculature

“Grecian Bend”= the characteristic

posture of those with bends
(hinting to an old popular women’s
fashion pose)
Which of the following disorders is X-linked dominant? (p142)

A.Duchenne muscular dystrophy

B.Vitamin D resistant rickets
C.Huntington Syndrome
D.Wiskott-Aldrich syndrome

X-linked dominant disorders are rare.

Among them are vitamin D resistant rickets and Rett syndrome.
Autosomal dominant disorders
System Disorder
Nervous Huntington disease
Neurofibromatosis
Myotonic dystrophy
Tuberous sclerosis
Urinary Polycystic kidney disease (ADPKD)
Gastrointestinal Familial polyposis coli
Hematopoietic Hereditary spherocytosis
Von Willebrand disease
Skeletal Marfan syndrome
Ehler-Danlos syndrome (some variants)
Osteogenesis imperfecta
Achondroplasia
Metabolic Familial hypercholesterolemia
Acute intermittent porphyria
Autosomal recessive disorders
System Disorder
Metabolic Cystic fibrosis Phenylketonuria
Galactosemia Homocystinuria
Lysosomal storage diseases
α-1-antitrypsin deficiency Wilson disease
Hemochromatosis Glycogen storage diseases
Hematopoietic Sickle cell anemia
Thalassemias
Endocrine Congenital adrenal hyperplasia
Skeletal Ehler-Danlos syndrome (some variants)
Alkaptonuria
Nervous Neurogenic muscular atrophies
Friedrich ataxia
Spinal muscular atrophy
X-linked recessive disorders
System Disorder
Musculoskeletal Duchenne Muscular Dystrophy (Dystrophin gene)
Blood Hemophilia A and B (Factors 8 and 9)
Chronic granulomatous disease
G6PD deficiency
Immune Agammaglobulinemia
Wiskott-Aldrich syndrome
Metabolic Diabetes insipidus
Lesch-Nyhan syndrome
Nervous Fragile X syndrome
Cherry red retinal spots are not seen in which disorder? (p152)

A.Tay Sachs Disease

B.Niemann-Pick Disease
C.Central retinal artery occlusion
D.Gaucher’s disease

The cherry red spot is seen

In 2 systemic metabolic disorders
and one vascular disorder.
 Lysosomal Storage Disease: Sphingolipidosis
• Tay-Sachs disease
Defect: α-subunit of hexosaminidase A  accumulation of GM2 ganglioside (most
prominent: in neurons and retina)

Neurons (Brain and Spinal cord):

• ballooned with cytoplasmic vacuoles with ganglioside (+) for fat stains (oil red O, Sudan Black B)
• EM: cytoplasmic inclusions, whorled (onion-skin) configuration
• Death in early childhood, seizures, hearing loss, paralysis etc…

Retina: ganglion cells swollen by ganglioside vacuoles: (+) cherry-red spot in retina
Lysosomal storage diseases rest in the fact that lysosomes are organelles/sacs containing
enzymes to digest glycoproteins, lipids and sugars. Without the enzymes, products accumulate
causing cellular toxicity and eventual cell death.
 Lysosomal Storage Disease: Sphingolipidosis
• Niemann-Pick Disease (Types A and B)
Defect: sphingomyelinase deficiency  accumulation of sphingomyelin

Clinically, hepatosplenomegaly, cherry-red spot in macula, CNS

• EM: membranous cytoplasmic inclusions of lamellated myelin figures (zebra bodies)
 Lysosomal Storage Disease:
Sphingolipidosis
• Gaucher disease
Most common lysosomal storage disorder

Defect: glucerebrosidase deficiency (β-glucosidase) causing accumulation of

glucocerebroside “Crumpled tissue
paper” appearance
Distended phagocytic cells (macrophages) of cytoplasm

in spleen, liver, BM, LNs, tonsils, thymus,

and Peyer patches
Which of the following glycogenoses presents with massive
cardiomegaly? (p156)

A.Von Gierke disease (Type I)

B.McArdle disease(Type V)
C.Tarui disease (Type VII)
D.Pompe disease (Type II)
Answer: D
Notable points among glycogenoses:
1.) Type IV (Anderson’s disease): fatal by 5 years of age
2.) Type 0 (Glycogen synthase deficiency): no hepatomegaly

Cardiomyopathy is seen in:

1.) Type II (Pompe disease)
2.) Type IIIa (Cori disease or Forbes disease)
3.) Type IV (Anderson’s disease)
Most common chromosomal disorder: (p160)

A.Down Syndrome
B.Klinefelter’s Syndrome
C.Turners Syndrome
D.Edwards Syndrome
Answer: A

Other trisomies
1.) Patau Syndrome
Trisomy 13
“Puberty”=13
2.) Edwards Syndrome
Trisomy 18
Which of the following chromosomal disorders affect the males and
present with large ears and mandible with macro-orchidism? (p169)

A.CGG trinucleotide repeat disorder

B.CAG trinucleotide repeat disorder
C.GAA trinucleotide repeat disorder
D.CTG trinucleotide repeat disorder

CGG repeats: Fragile X syndrome

CAG repeats: Huntington syndrome
GAA repeats: Friedreich ataxia
CTG repeats: Myogenic dystrophy
Trinucleotide repeat disorders
Which of the following disorders is the prototype for mitochondrial
inheritance associated diseases, presenting with progressive bilateral
loss of vision and cardiac conduction defects? (p172)

A.Prader-Willi Syndrome
B.Huntington disease
C.Myotonic dystrophy
D.Leber’s optic neuropathy
Which of the following methods involves hybridization of radiolabeled
sequence-specific probes to genomic DNA? (p177)

A.Southern Blot
B.Northern Blot
C.Western Blot
D.Eastern Blot Hint: SNoW DRoP
Southern blot: DNA
Northern Blot: RNA
Western Blot: Protein

NO EASTERN BLOT
Southwestern blot: a method described to evaluate
specific DNA-binding proteins.
The only cells in the body capable of producing antibodies? (p191)

A.Helper T lymphocytes
B.Cytotoxic T lymphocytes
C.B lymphocytes
D.Follicular dendritic cells
Answer: C

B lymphocytes or the more mature plasma cells produce antibodies.

T cells are more involved with cell-mediated immunity.

Follicular dendritic cells (and interdigitating dendritic cells) are involved with
antigen presentation.
Which of the following cells are involved in the innate immune
response? (p192)

A.B cells
B.T cells
C.Natural Killer cells
D.Plasma cells
Answer: C

Lymphocytes are usually involved with adaptive immunity.

However, the natural killer cells are a subset which can function in both innate and
adaptive immunity.

Natural killer cells usually detect the absence of MHC class I self-molecules and the
presence of trigger molecules.
The Multihistocompatibility complex HLA-DR present their antigens to:
(p194)

A.CD4+ cells
B.CD8+ cells
C.CD20+cells
D.CD1a+ cells
Answer: A
MHC class I: HLA-A, HLA-B, HLA-C
MHC Class II: HLA-DP, HLA-DQ, HLA-DR

MHC class I: CD8+ lymphocytes

MHC class II: CD4+ lymphocytes

Hint: The product of the class and the lymphocyte type is always 8.
(Ix8 or IIx4.)
Which of the following cytokine responses are mounted against
helminthic parasites? (p198).

A.TH1
B.TH2
C.TH12
D.TH17
Answer: B
Acute rheumatic fever is an example of what type of hypersensitivity?
(p206).

A.Type I
B.Type II
C.Type III
D.Type IV
Answer: B
NOTE:
Possible confusion in memorizing.

Insulin Resistant Diabetes (Type II) vs Type 1 Diabetest Mellitus (Type IV)

Acute Rheumatic Fever (Type II) vs Rheumatoid Arthritis (Type IV).

Which of the following antibodies is almost always positive in Systemic
Lupus Erythematosus? (p219)

A.Anti-Double stranded DNA

B.Anti-Smith
C.Anti-cyclic citrullinated peptide
D.Antibodies to multiple nuclear antigens
Answer: D

ANA: nonspecific but sensitive for SLE (95-100%)

Anti-DSDNA: specific for SLE
Anti-Smith: specific for SLE
Anti-CCP: specific for rheumatoid arthritis
Anti-DNA topoisomerase I: specific for systemic sclerosis
Antihistone: Drug-induced SLE
What is the most common form of lupus nephritis? (p224)

A.Minimal Mesangial Lupus Nephritis

B.Mesangial Proliferative Lupus Nephritis
C.Focal lupus nephritis
D. Diffuse Lupus Nephritis
Answer: D

Classes of Lupus Nephritis

Class I: Minimal mesangial (least common)
Class II: Mesangial Proliferative
Class III: Focal Lupus Nephritis, ≤50% of all glomeruli involved
Class IV: Diffuse Lupus Nephritis, ≥50% of all glomeruli involved (most common,
most severe)

Class V: Membranous Lupus Nephritis

Class VI: Advanced Sclerosing Lupus Nephritis
What is the most common associated disorder of Sjogrens syndrome?
(p227)

A.Keratoconjunctivitis sicca
B.Xerostomia
C.Rheumatoid arthritis
D.Lymphoma

Keratoconjunctivitis sicca and xerostomia are components of

Sjogrens syndrome.

Sjogren’s patients have a 40-fold greater incidence of lymphoma than

the normal population. Despite this rheumatoid arthritis is still the
most common associated disorder of Sjogren Syndrome.
Which of the following is the most common complement protein
deficiency? (p238)

A.C2 deficiency
B.Properdin deficiency
C.Factor D deficiency
D. C3 deficiency
Answer: A

C2 deficiency may be asymptomatic or present with an SLE-like autoimmune

disease.

Deficiency in properdin and factor D (alternative pathway) as well as C3

predisposes to recurrent pyogenic infections.

Deficiency in the terminal components (C5,6,7,8,9) predisposes to recurrent

Neisserial infection.
Which of the following immune deficiency syndromes is associated with
development of severe anaphylactic reactions on blood transfusions?
(p242)

A.X-linked Agammaglobulinemia
B.Hyper IgM syndrome
C.Common variable immune deficiency
D.Isolated IgA deficiency
Answer: D

X-linked agammaglobulinemia: absence of antibodies due to failure of B cell

maturation

Hyper-IgM Syndrome: failure to produce IgE, IgA, IgG

Isolated IgA deficiency: Failure to produce IgA

Common Variable Deficiency: defects in antibody production

Approximately how many CD4+ T cells are destroyed by HIV every day?
(p252)

A.1-2 million cells

B.50-100 million cells
C.500million to 1 billion cells
D.1-2 billion cells

1-2 Billion cells of the CD4+ subtype are lost daily!

The most common neoplasm in patients with AIDS? (p254)

A.Leiomyosarcoma
B.Pleural effusion lymphoma
C.Kaposi Sarcoma
D.Burkitt Lymphoma

Kaposi Sarcoma is a vascular neoplasm

with Human Herpesvirus 8 as the etiologic
agent.
A patient with multiple myeloma presented with a soft tissue mass. Due
to clinical suspicion, a special stain was done on the biopsy of the mass
which showed apple green birefringence on polarizing microscopy. What
is the stain used? (p257)

A. Hematoxylin and Eosin Stain

B. Congo red stain
C. Gram Stain
D. Kinyoun Stain
Answer: B
Congo red stain is a stain for amyloid showing apple green birefringence.

Hematoxylin and Eosin: for tissue staining

Gram Stain: for bacteria

Kinyoun Stain: a modified acid fast staining

technique
Which of the following terms refer to variation in size and shape in cells?
(p270)

A.Pleomorphism
B.Anaplasia
C.Anisocytosis
D.Dysplasia

Pleomorphism: variation in size and shape

Anaplasia: loss of differentiation
Anisocytosis: variation in size
Dysplasia: loss of cell uniformity or loss of normal architectural
orientation
Most common pathway for initial dissemination of carcinomas? (p273)

A. Hematogenous spread
B. Lymphatic spread
C. Direct seeding of body cavities
D.Iatrogenic seeding

It is believed that carcinomas usually prefer lymphatic spread while

sarcomas prefer a hematogenous spread. This is probably why it is rare
for most sarcomas to metastasize to lymph nodes.
Most common cancer in men? (P276)

A.Lung
B.Colon
C.Prostate
D.Liver
Answer: C
Men incidence:
1.) Prostate
2.) Lung
3.) Colon

Women incidence:
1.) Breast
2.) Lung
3.) Colon

Note: Does not include basal cell and squamous cell skin cancers. In situ neoplasia also
not included.
Most common cancer death in women? (p276)

A.Lung
B.Colon
C.Breast
D.Liver
Answer: A
Men Cancer death:
1.) Lung
2.) Prostate
3.) Colon

Women Cancer death:

1.) Lung
2.) Breast
3.) Colon

Note: Does not include basal cell and squamous cell skin cancers. In situ neoplasia also
not included.
Which of the following does not increase risk for lung cancer? (p278)

A.Arsenic
B.Asbestos
C.Beryllium
D.Cadmium
Answer: D

Lung cancer: Arsenic, Asbestos, Beryllium, Chromium, Radon, Nickel

Benzene: Acute Myeloid Leukemia

Cadmium: Prostate Cancer
Vinyl Chloride: Hepatic angiosarcoma
The most common type of abnormality involving proto-oncogenes in
human tumors? (p286)

A.RAS
B.P53
C.RB
D.Myc
Answer: A
P53: most commonly mutated gene in human cancers; also known as guardian of
the genome

RB: directly or indirectly inactivated in most human cancers, also known as the
governor of proliferation

APC: gatekeeper of colonic neoplasia

Which of the following conditions is brought about by germline
mutations in one allele of TP53? (p294)

A.Von Hippel Lindau Syndrome

B.Li-Fraumeni syndrome
C.Peutz Jeghers Syndrome
D.Lynch Syndrome
Answer: B
Li Fraumeni Syndrome predisposes to multiple
cancers and sarcomas at an early age.

Von Hippel Lindau is associated with hemangioblastoma,

bilateral renal cell carcinoma, and retinal angiomas.

Lynch Syndrome is also called Hereditary Nonpolyposis Colorectal carcinoma and thus
increases risk for colon cancer.
What is the chromosomal translocation seen in Chronic myelogenous
leukemia? (p317)

A.Translocation (9:22)
B.Translocation (8:14)
C.Translocation (11:22)
D.Translocation (14:18)
 Answer: A

Translocation (8:14) =
Burkitt Lymphoma
Translocation (11:22)=
Ewing Sarcoma
Translocation (14:18)=
Follicular Lymphoma
Translocation (11:14)=
Mantle Cell Lymphoma
Most common paraneoplastic syndrome: (p331)

A.Cushing syndrome
B.Hypercalcemia
C.Hypoglycemia
D.Polycythemia

Cushing syndrome is the most common endocrinopathy.

Hypercalcemia is the most common paraneoplastic syndrome.
 seen in squamous cell carcinoma of the lung, breast
carcinoma, renal cell carcinoma, adult T-cell leukemia
The most common cause of immunodeficiency worldwide? (p348)

A.Severe combined immunodeficiency syndrome.

B.X-linked Agammaglobulinemia
C.Malnutrition
D.HIV infection

Malnutrition does cause impairment of the immune system

but not always to the point of being immunodeficient.
Reactivation of Varicella Zoster virus can sometimes be accompanied
with facial paralysis when the geniculate nucleus is involved. This is
called: (p359).

A.Ramsay Hunt Syndrome

B.Herpes Zoster
C.Chickenpox
D.Shingles
Answer: A
Chickenpox is the usual presentation during initial infection with varicella.

Shingles or Herpes Zoster is a reactivation of the dormant varicella within nerve

ganglia.

Ramsay-Hunt Syndrome is likewise a reactivation of the varicella but with

involvement of the geniculate nucleus.
Which of the following is in not pointing towards the diagnosis of
Infectious Mononucleosis? (p362).

A. Atypical lymphocytes on peripheral blood smear

B.Positive heterophile antibody reaction (Monospot test)
C.Decreasing titers of specific antibodies for Epstein Barr Virus
D.Lymphocytosis
Middle aged man presented with a tender enlarging papule on the penis
with eventual ulceration into a painful chancroid. What is the expected
organism that can be isolated from the lesion? (p370)

A.Treponema pallidum
B.Chlamydia trachomatis
C.Haemophilus ducreyi
D.Klebsiella granulomatis
Which of the following vitamin A derivatives has the highest affinity for
Retinoic acid receptor? (p437)

A.9 cis retinoic acid

B.11-cis retinal
C.All-trans-retinoic acid
D. 13-cis-retinoic acid

Faggot Cells
Auer Rods
Acute Promyelocytic Leukemia
Which of the following vitamins can bind to its specific nuclear receptor
and then associate accordingly with Retinoic X Receptor? (p439)

A.Vitamin E
B.Vitamin D
C.Vitamin K
D.Vitamin B12

Both PPAR and Vitamin D receptors can associate with RXR.

What is the only orexigenic gut hormone? (P446)

A.Ghrelin
B.PYY
C.Amylin
D.Leptin
During what period of intrauterine growth is the human most resistant
to teratogenesis? (p455)

A.0-3 weeks AOG

B.4-6 weeks AOG
C.7-9 weeks AOG
D.9-16 weeks AOG
Answer: A

At this point it is an
all or none situation.
Either the blastema
fully recovers or dies
from an insult.
Which of the following conditions is protective against Rh
immunization? (p461)

A.Lost of cytotrophoblast layer in the placenta

B.Transplacental bleeding
C.Mother-Child ABO incompatibility
D.Mother-Child RH incompatibility
 Answer: C

The mature placental villi losses the cytotrophoblastic layer

and increases risk of fetal blood exposure.

Mother-child ABO hemolytic disease occurs in infants who are type A or B and born to Type O
mothers. Thae mothers somehow produce antibodies against group A and B without prior
sensitization. This would immediately clear fetal blood cells in an RH negative mother and
prevent Rh sensitization.

RH incompatibility does not affect the first born and requires sensitization.
ABO incompatibility affects the first born and does not require sensitization.
Which of the following features are suggestive of a CFTR mutation?
(p470)

A.Bilateral congenital absence of vas deferens

B.Albinism with immunodeficiency
C.Bilateral renal cell carcinoma
D.Congenital absence of the thumb
 Answer: A

Sometimes the only feature suggestive of an underlying

CFTR mutation.
ENaC are normally inhibited by CFTR.
Thus in cystic fibrosis, ENaC is hyperfunctioning and
thus augments sodium uptake into cells.

Exception: Sweat ducts where CFTR mutation

decreases ENaC activity thus leaving behind salt in
sweat.
What are the histologic components of a Wilms Tumor? (P479)

A.Tubules
B.Stromal
C.Blastemal
D.All of the above

Usually a triphasic tumor