College of Health Sciences MBChB III Unit Title: General Pathology Continuous Assessment Date: December 2020 Time: 2 Hours SECTION A: MULTIPLE CHOICE QUESTIONS
College of Health Sciences MBChB III Unit Title: General Pathology Continuous Assessment Date: December 2020 Time: 2 Hours SECTION A: MULTIPLE CHOICE QUESTIONS 1. A 67-year-old male long-term smoker presents with weight loss, persistent cough, fever, chest pain, and haemoptysis. Chest x-ray reveals a 3.5 cm hilar region mass. What is the most likely diagnosis? a) Adenocarcinomab) Hamartomac) Large cell undifferentiated carcinomad) Small cell undifferentiated carcinomae) Squamous cell carcinoma Answer: e) Squamous cell carcinoma Explanation: In long-term smokers with a central (hilar) lung mass, squamous cell carcinoma is the most common histologic type. It typically arises from the central bronchi and is strongly associated with smoking. The hilar location and smoking history make squamous cell carcinoma the most likely diagnosis. 2. A condition of the lung characterized by abnormal permanent enlargement of air spaces distal to the terminal bronchiole, with wall destruction but without fibrosis, leading to a "pink puffer": a) Emphysemab) Chronic bronchitisc) Bronchial asthmad) Bronchiectasise) Pleural effusion Answer: a) Emphysema Explanation: This definition perfectly describes emphysema. The key features are permanent enlargement of air spaces distal to terminal bronchioles with alveolar wall destruction but without significant fibrosis. The term "pink puffer" refers to the typical appearance of emphysema patients who maintain normal oxygen saturation (pink) but are dyspneic (puffer). 3. A condition of the lung characterized by productive cough, long-term cigarette smoking, and histologically by enlargement of mucus-secreting glands of trachea and bronchi, leading to a "blue bloater": a) Emphysemab) Chronic bronchitisc) Bronchial asthmad) Bronchiectasise) Pleural effusion Answer: b) Chronic bronchitis Explanation: Chronic bronchitis is defined by persistent productive cough for at least 3 months in each of 2 consecutive years. Histologically, it shows hypertrophy and hyperplasia of mucus-secreting glands. The "blue bloater" appearance reflects chronic hypoxemia (cyanosis) and cor pulmonale (right heart failure with edema). 4. A 60-year-old male develops sudden chest pain and shortness of breath while recovering from ankle fracture surgery. He collapses and dies. Most likely diagnosis: a) Cerebral infarctb) Acute myocardial infarctc) Pulmonary thromboembolismd) Aortic dissectione) Foreign body aspiration Answer: c) Pulmonary thromboembolism Explanation: The clinical scenario describes classic pulmonary embolism. The patient has multiple risk factors: recent surgery, immobilization, and likely advanced age. The sudden onset of chest pain, dyspnea, and rapid collapse followed by death is characteristic of massive pulmonary embolism. 5. A systemic disease of unknown etiology, with non-caseating granulomas in many organs, particularly hilar lymph nodes and lungs: a) Silicosisb) Idiopathic pulmonary fibrosisc) Sarcoidosisd) Asbestosise) Pulmonary tuberculosis Answer: c) Sarcoidosis Explanation: Sarcoidosis is a multisystem granulomatous disease of unknown cause characterized by non-caseating (non-necrotic) granulomas. It commonly affects hilar lymph nodes and lungs, distinguishing it from tuberculosis which typically shows caseating granulomas. 6. A syndrome of necrotizing hemorrhagic interstitial pneumonitis associated with proliferative glomerulonephritis: a) Goodpasture syndromeb) Paraneoplastic syndromec) Kartagener syndromed) Lambert-Eaton myasthenic syndromee) Horner's syndrome Answer: a) Goodpasture syndrome Explanation: Goodpasture syndrome is an autoimmune condition caused by anti-glomerular basement membrane antibodies that cross-react with pulmonary basement membranes. This results in rapidly progressive glomerulonephritis and pulmonary hemorrhage, fitting the description perfectly. 7. Daughters of women who received diethylstilbestrol (DES) during pregnancy are most likely to develop: a) Sarcoma botryoidesb) Clear cell adenocarcinomac) Squamous cell carcinomad) Uterine leiomyomae) Paget disease of the vulva Answer: b) Clear cell adenocarcinoma Explanation: DES exposure in utero predisposes to clear cell adenocarcinoma of the vagina and cervix in female offspring. This association was discovered when young women developed this rare cancer, leading to the recognition of DES as a transplacental carcinogen. 8. High-risk HPV subtypes strongly associated with cervical cancer: a) 6 and 11b) 16 and 18c) Types 1–180d) 3, 10, 28, and 49e) None of the above Answer: b) 16 and 18 Explanation: HPV types 16 and 18 are the most important high-risk oncogenic types, responsible for approximately 70% of cervical cancers worldwide. HPV 16 is associated with squamous cell carcinoma, while HPV 18 is more associated with adenocarcinoma. 9. Vulval condyloma acuminatum in immunosuppressed states is associated with HPV subtypes: a) 6 and 11b) 16 and 18c) Types 1–180d) 3, 10, 28, and 49e) None of the above Answer: a) 6 and 11 Explanation: HPV types 6 and 11 are low-risk types that cause benign genital warts (condyloma acuminatum). In immunosuppressed patients, these lesions can be more extensive and persistent. Types 6 and 11 are responsible for approximately 90% of genital warts. 10. A 25-year-old woman at 15 weeks gestation presents with bleeding, uterine enlargement, and grape-like cystic structures in the uterus, no fetal parts seen. Most likely diagnosis: a) Partial hydatidiform moleb) Complete hydatidiform molec) Invasive moled) Placental site trophoblastic tumore) Choriocarcinoma Answer: b) Complete hydatidiform mole Explanation: The absence of fetal parts with grape-like vesicles is characteristic of complete hydatidiform mole. This occurs when an empty ovum is fertilized by one or two sperm, resulting in only paternal DNA and no fetal development, only abnormal trophoblastic proliferation. 11. A 32-year-old female presents with oligomenorrhea, amenorrhea, loss of secondary characteristics, acne, deep voice, and temporal balding. The most likely ovarian tumor is: a) Epithelial tumorb) Stromal tumorc) Germ cell tumord) Surface tumore) Metastasis Answer: b) Stromal tumor Explanation: The masculinizing features (deep voice, temporal balding, acne) suggest androgen excess from a functioning ovarian stromal tumor, most likely a Sertoli-Leydig cell tumor. These tumors can produce androgens, leading to virilization and defeminization. 12. A 70-year-old female presents with chronic vulval irritation and itching. Vulval exam shows leukoplakia with leathery thick skin. Most likely diagnosis: a) Lichen sclerosisb) Lichen simplex chronicusc) Extramammary Paget's diseased) Acute endometritise) Vulval carcinoma Answer: b) Lichen simplex chronicus Explanation: Lichen simplex chronicus presents with chronic itching and thick, leathery skin (lichenification) due to chronic scratching and rubbing. The leukoplakia (white patches) and thickened appearance in an elderly woman with chronic symptoms is characteristic. 13. A 19-year-old female with pelvic inflammatory disease may suffer which complication despite treatment? a) Primary amenorrheab) Secondary amenorrheac) Squamous cell carcinoma of cervixd) Infertilitye) Uterine hypoplasia Answer: d) Infertility Explanation: PID can cause tubal scarring and adhesions even after successful treatment of the acute infection. This tubal damage is a major cause of infertility and ectopic pregnancy. The inflammatory process can permanently damage the fallopian tube architecture. 14. A 33-year-old female presents with dyspareunia, heavy painful menses, and infertility. Laparoscopy shows blood-filled cysts and small reddish-brown lesions on ovaries and peritoneum. Most likely diagnosis: a) Pelvic inflammatory diseaseb) Polycystic ovarian syndromec) Acute endometritisd) Endometriosise) Endometrial adenocarcinoma Answer: d) Endometriosis Explanation: The triad of dysmenorrhea, dyspareunia, and infertility with laparoscopic findings of blood-fil