WMBBS 2nd PROF

PATHOLOGY
Sample Paper: PAPER-B, BFUHS
TIME:3 Hours Max Marks: 100

Q1. Multiple Choice Questions, Use OMR sheet to answer, 1x20=20, Time for MCQs-30 min

1. A 49-year woman has had increasing cold intolerance, weight gain of 4 kg, and
sluggishness over the past two years. A physical examination reveals dry, coarse skin and
alopecia of the scalp. Her thyroid is not palpably enlarged. Her serum TSH is 11.7 mU/L
with thyroxine of 2.1 micrograms/dL. A year ago, anti-thyroglobulin and anti-
microsomal autoantibodies were detected at high titer. Which of the following thyroid
diseases is she most likely to have?
A. Papillary carcinoma
B. Hashimoto thyroiditis
C. Multinodular goiter
D. Graves’ disease
2. A 3-year-old child has become more irritable over the past two months and does not want
to eat much at meals. On physical examination the pediatrician notes an enlarged
abdomen and can palpate a mass on the right. An abdominal CT scan reveals a 10 cm
solid mass involving the right kidney. The resected mass has a microscopic appearance
with sheets of small blue cells along with primitive tubular structures. The child receives
chemotherapy and radiation therapy, and there is no recurrence. Which of the following
neoplasms is this child most likely to have?
A. Renal cell carcinoma
B. Urothelial carcinoma
C. Wilms tumor
D. Angiomyolipoma
3. A 50-year man was diagnosed at age 15 with type 1 diabetes mellitus. His disease has
been poorly controlled, as evidenced by elevated hemoglobin A1C levels. He develops a
non-healing ulcer of his foot at age 35. At age 45, he has an increasing serum urea
nitrogen and a urinalysis shows sp gr 1.012, pH 6.5, 1+ protein, no blood, 1+ glucose,
negative nitrite and no ketones. Which of the following renal diseases is he most likely to
have?
A. Nodular glomerulosclerosis
B. Papillary necrosis
C. Crescentic glomerulonephritis
D. Pyelonephritis
4. A 24-year female patient presents with a palpable, painless nodule in the right breast. The
patient has no other significant medical history. A single firm nodule of 2 cm noted on
examination which is freely mobile and non-tender. Pathologic evaluation reveals a well
demarcated lesion composed of proliferating stroma encircling bilayered epithelium lined
ducts and glandular spaces. Which of the following is the most likely diagnosis in this
patient?
A. Ductal carcinoma in situ
B. Medullary carcinoma
 C. Fibroadenoma
D. Phyllodes tumor
5. A 39 year lady presented with palpable nodularity in the right breast. Pathologically, the
lesion is composed of ducts distended by pleomorphic cells with prominent central
necrosis. The lesion does not extend beyond the ductal basal membrane. Which of the
following is the most likely diagnosis in this patient?
A. Comedocarcinoma
B. Medullary carcinoma
C. Sclerosing adenosis
D. Phyllodes tumour.
6. A 65-year man with a history of alcohol abuse has had hematemesis for the past day.
Physical examination reveals mild jaundice, spider angiomas, and gynecomastia. He has
mild pedal edema, normal jugular venous pulsation (JVP), and a massively distended
abdomen. Paracentesis is performed and the fluid obtained shows accumulation of
protein-poor fluid that is free of inflammatory cells. Which of the following factors is
most likely to be responsible for the collection of abdominal fluid in this man?
A. Congestive heart failure
B. Hepatopulmonary syndrome
C. Hyperbilirubinemia
D. Portosystemic shunts
7. A 54-year woman has a long history of chronic hepatitis B infection and has had
increasing malaise for the past year. She was hospitalized 1 year ago because of upper
gastrointestinal hemorrhage. Physical examination now shows a firm nodular liver.
Laboratory findings show a serum albumin level of 2.5 g/dL and prothrombin time of 28
seconds. Which of the following additional physical examination findings is most likely
to be present in this woman?
A. Caput medusae
B. Diminished deep tendon reflexes
C. Distended jugular veins
D. Papilledema
8. A pathologic study of hepatic cirrhosis is performed. There is collapse of reticulin with
bridging fibrosis from deposition of collagen in the space of Disse to form fibrous septae.
Which of the following cell types is activated under the influence of cytokines to give
rise to collagen- producing cells?
A. Bile duct cell
B. Endothelial cell
C. Macrophage
D. Stellate cell
9. A 27-year-old man develops malaise, fatigue, and loss of appetite three weeks after a
meal at the Trucker’s Cafe. He notes passing dark urine. On physical examination, he has
mild scleral icterus and right upper quadrant tenderness. Laboratory studies show serum
AST of 62 U/L and ALT of 58 U/L. The total bilirubin concentration is 3.9 mg/dL, and
the direct bilirubin concentration is 2.8 mg/dL. His symptoms abate over the next 3
weeks. Which of the following serologic test results is most likely to be positive in this
patient?
A. Anti-HAV
 B. Anti-HBc
C. Anti-HBs
D. Anti-HCV
10. Bronchodilators are a class of drug often used in the treatment of asthma and COPD,
which act on β-adrenergic receptors of the airways to induce smooth muscle relaxation.
The anatomic distribution of these receptors is closely correlated to the function of each
structural component of the lungs. What structural component(s) of the airway would be
most affected by the use of a bronchodilator, and in what functional zone(s) are they
found?
A. Lobar bronchi and alveoli would be affected equally, and they are both found in
the respiratory zone
B. Lobar bronchi and alveoli would be affected equally, and they are found in the
conducting and respiratory zones respectively
C. Lobar bronchi, which are found in the conducting zone
D. Alveoli, which are found in the respiratory zone
11. Histological sections of the lung reveal the alveoli to be filled with pale, non-granular
pink fluid. Neither leukocyte nor erythrocytes are present with in the fluid. Which of the
following is the cause of this abnormality?
A. Bacterial pneumonia
B. Congestive heart failure
C. Lymphatic obstruction by tumour
D. Pulmonary embolus
12. Interstitial lung disease (ILD) refers to a set of conditions which affect the pulmonary
interstitium the area of tissue and space which lies between the alveoli and alveolar
capillaries. What factor in the setting of severe ILD, would NOT decrease the extent to
which oxygen passes from the air sacs of the lungs into the blood?
A. Decreased interstitial thickness
B. Decreased lung capacity
C. Increased alveolar surface tension
D. Increased lung elastic recoil
13. 44 year alcoholic febrile man comes with productive cough with copious amount of foul
smelling purulent sputum. Further changing on position paroxysms of coughing are seen.
Which of the following is the most likely cause of this patients sign and symptoms
A. Oesophageal cancer
B. Oesophageal reflux
C. Myocardial infarction
D. Pulmonary abscess
14. A 43 years female with chronic dysphagia undergoes an upper gastrointestinal endoscopy
that reveals massive dilation of the distal oesophagus. The oesophagus is kinked and
tortuous and partly filled with undigested foods. What is most likely diagnosis for this
patient?
A. Achalasia
B. Barrett’s oesophagus
C. Hiatal hernia
D. Plummer Wilson syndrome
15. 52 years man presents with symptoms of gastric pain after eating. During workup a 3 cm
mass is found in the wall of stomach. These cells are having elongated spindle shaped
nuclei. The tumour does not connect to the overlying epithelium and is found only in the
wall of the stomach. Which of the following is the origin of tumour?
A. Adipocytes
B. Endothelial cells
C. Glandular epithelial cells
D. Smooth muscle cells
16. A 2-year male presented with abdominal distension, chronic diarrhea, severe anaemia and
failure to thrive. Which of the following is investigation of choice
A. Anti-milk protein antibody
B. Anti endomysial antibody
C. Anti-nuclear antibody
D. Intestinal biopsy
17. A female patient presented with a firm mass of 2x2 cm in the upper outer quadrant of the
breast. She gives a family history of ovarian carcinoma. The investigation that needs to
be done to assess for mutations is:
A. P53
B. BRCA-2
C. Her2/Neu gene
D. C-myc gene
18. A 54 year female presents for an annual exam. Her right breast is swollen, red and tender.
The physician palpates a firm area in the breast and suspects inflammatory breast cancer.
Which of the following best describes the histological changes observed in this disorder?
A. Acute inflammation in breast carcinoma
B. Chronic inflammation in breast carcinoma
C. Dermal lymphatic invasion by cancer cells
D. Epidermal invasion by cancer cells
19. A 60 years male patient presents with a non-healing ulcer on the leg. Biopsy of which
showed presence of tumor having polygonal cells along with presence of keratin pearls
and individual cell keratinisation. What is the most likely diagnosis?
A. Squamous cell carcinoma
B. Malignant melanoma
C. Basal cell carcinoma
D. Vitiligo
20. A 55 years male comes to the doctor with a nodular lesion present on the face near the
ear. Biopsy of this nodule was taken which showed islands of cells having
Hyperchromatic nuclei and scanty amount of cytoplasm. Peripheral palisading of tumor
cells with retraction artifact was present. Which of the following is the most likely
diagnosis?
A. Squamous cell carcinoma
B. Basal cell carcinoma
C. Melanoma
D. Syringoma
Q2. A 52 years male complains of severe chest pain and sweating. His ECG shows elevation of
ST segment. CT angiography done shows narrowing of coronary arteries. 4+4+4=12
a) Describe the etiopathogenesis of narrowing of the coronary artery.
b) Describe the morphologic spectrum of this disease.
c) Explain the clinical consequences of this disease on various organs.

Q.3.Short answers: 5x4=20

a) Compare & contrast lobar pneumonia & bronchopneumonia.
b) Compare & contrast ulcerative colitis and Crohn’s disease.
c) Describe the morphology of nodular hyperplasia prostate.
d) Explain classification of renal cell carcinoma.

Q.4. Explain why? 3x5=15

a) Esophageal varices are seen in portal hypertension.
b) Cobweb appearance of CSF is seen in case of tubercular meningitis.
c) Typhoid ulcers are parallel to longitudinal axis of intestine
d) PAP smear is used in diagnosis of early cervical cancer.
e) Pink puffers appearances is seen in emphysema.

Q.5. Short answers (applied aspects): 6x3=18

a) Describe the lab diagnosis of acute hepatitis.
b) Describe differential diagnosis of nephrotic syndrome of primary glomerular disease.
c) Explain the lab diagnosis of diabetes mellitus.

Q.6. Short answers: 5x3=15

a) Describe various types of surface epithelial tumors of ovary.
b) Describe pathogenesis and morphology of osteogenic sarcoma.
c) What is empathy? What is the role of empathy in the care of patients?