Weekly Pathology Exam - March 7, 2026 (Section A: MCQs) – 69 MCQs | Kenya MBChB

69 Year 3: General Pathology exam questions on Weekly Pathology Exam - March 7, 2026 (Section A: MCQs) for medical students. Includes MCQs, answers, explanation

This MCQ set contains 69 questions on Weekly Pathology Exam - March 7, 2026 (Section A: MCQs) in the Year 3: General Pathology unit. Each question includes the correct answer and a detailed explanation for active recall and exam preparation.

Q1: A 45-year-old woman undergoes imaging for unrelated abdominal pain, revealing a 3 cm incidental liver lesion. Given its suspected diagnosis as the most common benign liver tumor, which of the following diagnostic procedures should be avoided?

  1. A. Contrast-enhanced MRI
  2. B. Percutaneous needle biopsy
  3. C. Technetium-99m labeled RBC scan
  4. D. Doppler ultrasound

Correct answer: B – Percutaneous needle biopsy

The most common benign liver tumor is a cavernous hemangioma. Percutaneous biopsy is avoided due to the significant risk of hemorrhage from the vascular channels.

Q2: A 28-year-old woman on oral contraceptive pills presents with sudden onset severe RUQ pain and hypovolemic shock. Imaging reveals a ruptured hepatic mass. Which tumor is most likely?

  1. A. Focal Nodular Hyperplasia
  2. B. Cavernous Hemangioma
  3. C. Hepatic Adenoma
  4. D. Hepatocellular Carcinoma

Correct answer: C – Hepatic Adenoma

Hepatic adenomas are strongly associated with oral contraceptive use and have a high risk of rupture and intraperitoneal hemorrhage, especially during pregnancy or menstruation.

Q3: A liver lesion in a 35-year-old male shows a central stellate scar and radiating fibrous septa containing anomalous arteries and bile ductules. What is the diagnosis?

  1. A. Fibrolamellar HCC
  2. B. Focal Nodular Hyperplasia
  3. C. Cirrhotic nodule
  4. D. Biliary cystadenoma

Correct answer: B – Focal Nodular Hyperplasia

Focal Nodular Hyperplasia (FNH) is characterized by a central stellate scar and is thought to be a hyperplastic response to a pre-existing vascular malformation.

Q4: Which of the following risk factors is most strongly associated with the development of Hepatocellular Carcinoma (HCC) globally?

  1. A. Alcohol consumption
  2. B. Aflatoxin exposure
  3. C. Chronic Hepatitis B Infection
  4. D. Nonalcoholic steatohepatitis (NASH)

Correct answer: C – Chronic Hepatitis B Infection

Globally, chronic Hepatitis B virus infection is the most common risk factor for HCC, particularly in high-prevalence areas like Asia and sub-Saharan Africa.

Q5: A 62-year-old male with chronic Hep C and cirrhosis has a liver mass. Which tumor marker, if significantly elevated ( 1000 ng/ml), is highly suggestive of HCC?

  1. A. CEA
  2. B. CA 19-9
  3. C. Alpha-fetoprotein (AFP)
  4. D. CA-125

Correct answer: C – Alpha-fetoprotein (AFP)

AFP is the primary serum marker for HCC; levels 1000 ng/ml are highly specific for the diagnosis in the context of a liver mass.

Q6: A 70-year-old man with PSC develops jaundice and an intrahepatic mass. His AFP is normal. Which primary liver malignancy is most consistent with this?

  1. A. Hepatocellular Carcinoma
  2. B. Cholangiocarcinoma
  3. C. Angiosarcoma
  4. D. Hepatoblastoma

Correct answer: B – Cholangiocarcinoma

Primary Sclerosing Cholangitis (PSC) is a major risk factor for cholangiocarcinoma. High AFP is usually associated with HCC, not cholangiocarcinoma.

Q7: A 58-year-old female presents with multiple bilateral liver lesions and no history of liver disease. What is the most common diagnosis?

  1. A. Multicentric HCC
  2. B. Metastatic adenocarcinoma
  3. C. Biliary cystadenocarcinoma
  4. D. Angiosarcoma

Correct answer: B – Metastatic adenocarcinoma

Metastatic disease is the most common malignancy of the liver in adults, most frequently originating from the colon, breast, or lung.

Q8: A 2-year-old child presents with a RUQ mass. Biopsy reveals a malignant epithelial tumor with primitive mesenchymal stroma. What is the diagnosis?

  1. A. Hepatocellular Carcinoma
  2. B. Infantile Hemangioma
  3. C. Hepatoblastoma
  4. D. Yolk sac tumor

Correct answer: C – Hepatoblastoma

Hepatoblastoma is the most common primary liver tumor in childhood, typically occurring before age 3.

Q9: Exposure to which of the following substances is a significant risk factor for developing hepatic Angiosarcoma?

  1. A. Aflatoxin B1
  2. B. Vinyl chloride
  3. C. Oral contraceptives
  4. D. Alcohol

Correct answer: B – Vinyl chloride

Hepatic angiosarcoma is specifically associated with exposure to vinyl chloride, Thorotrast, and arsenic.

Q10: Regarding Hepatocellular Carcinoma (HCC), which statement is correct concerning its variant forms?

  1. A. Fibrolamellar HCC is associated with HBV
  2. B. Fibrolamellar HCC typically presents in young adults without cirrhosis
  3. C. The pleomorphic variant has the best prognosis
  4. D. Clear cell variant is always associated with von Hippel-Lindau

Correct answer: B – Fibrolamellar HCC typically presents in young adults without cirrhosis

Fibrolamellar HCC is a distinct variant that occurs in young adults (20-40 years), is not associated with cirrhosis or HBV, and has a slightly better prognosis.

Q11: What percentage of Non-Hodgkin Lymphomas are of B-cell origin?

  1. A. 50%
  2. B. 70%
  3. C. 85%
  4. D. 95%

Correct answer: C – 85%

Approximately 85-90% of NHL cases are B-cell lymphomas; the remainder are T-cell or NK-cell lymphomas.

Q12: Which is the most common subtype of B-cell NHL?

  1. A. Follicular Lymphoma
  2. B. Diffuse Large B-Cell Lymphoma (DLBCL)
  3. C. Burkitt Lymphoma
  4. D. Mantle Cell Lymphoma

Correct answer: B – Diffuse Large B-Cell Lymphoma (DLBCL)

DLBCL is the most common form of NHL, accounting for about 30-40% of adult cases.

Q13: A 60-year-old woman has painless lymphadenopathy. Biopsy shows BCL-2+, CD10+, CD20+ cells. What is the most likely diagnosis?

  1. A. Burkitt Lymphoma
  2. B. Follicular Lymphoma
  3. C. Marginal Zone Lymphoma
  4. D. Mantle Cell Lymphoma

Correct answer: B – Follicular Lymphoma

Follicular lymphoma is characterized by a nodular growth pattern and expression of BCL-2 (due to t(14;18)) and germinal center markers like CD10.

Q14: Which translocation is required for the diagnosis of Mantle Cell Lymphoma?

  1. A. t(14;18)
  2. B. t(8;14)
  3. C. t(11;14)
  4. D. t(11;18)

Correct answer: C – t(11;14)

Mantle Cell Lymphoma is defined by the t(11;14) translocation, which leads to overexpression of Cyclin D1.

Q15: A patient with NHL has CD5+, CD19+, CD22+, CD23− immunophenotype. Which lymphoma does this suggest?

  1. A. Chronic Lymphocytic Leukemia (CLL)
  2. B. Mantle Cell Lymphoma
  3. C. Follicular Lymphoma
  4. D. Marginal Zone Lymphoma

Correct answer: B – Mantle Cell Lymphoma

Mantle Cell Lymphoma is CD5+ and CD23- negative, whereas CLL/SLL is CD5+ and CD23+ positive.

Q16: Which organism is directly implicated in the pathogenesis of gastric MALT lymphoma?

  1. A. Epstein-Barr Virus
  2. B. Helicobacter pylori
  3. C. Human Herpesvirus 8
  4. D. Hepatitis C Virus

Correct answer: B – Helicobacter pylori

H. pylori infection causes chronic inflammation that provides the stimulus for the development of gastric MALT lymphoma.

Q17: What is the first-line treatment for early-stage gastric MALT lymphoma?

  1. A. CHOP chemotherapy
  2. B. Rituximab monotherapy
  3. C. Antibiotic eradication of H. pylori
  4. D. Partial gastrectomy

Correct answer: C – Antibiotic eradication of H. pylori

In many cases of early gastric MALT lymphoma, eradication of H. pylori leads to complete regression of the tumor.

Q18: Serum protein electrophoresis shows a monoclonal IgM spike. Bone marrow shows lymphoplasmacytoid infiltration. What mutation is likely?

  1. A. BRAF V600E
  2. B. MYD88 L265P
  3. C. JAK2 V617F
  4. D. KIT D816V

Correct answer: B – MYD88 L265P

The MYD88 L265P mutation is found in over 90% of patients with Waldenström's Macroglobulinemia.

Q19: Why is plasmapheresis particularly effective in hyperviscosity for Waldenström's compared to IgG myeloma?

  1. A. IgM is smaller and easier to filter
  2. B. IgM is primarily intravascular due to its large size (pentamer)
  3. C. IgG binds to plasma proteins more tightly
  4. D. IgM levels are always higher than IgG

Correct answer: B – IgM is primarily intravascular due to its large size (pentamer)

IgM is a large pentameric molecule that is mostly restricted to the intravascular space, making it easy to remove via plasmapheresis.

Q20: A child from sub-Saharan Africa has a jaw mass with a 'starry sky' pattern on histology. What is the diagnosis?

  1. A. Ewing Sarcoma
  2. B. Burkitt Lymphoma
  3. C. Lymphoblastic Lymphoma
  4. D. Rhabdomyosarcoma

Correct answer: B – Burkitt Lymphoma

Endemic Burkitt lymphoma typically presents as a jaw mass in African children and shows a 'starry sky' pattern (macrophages consuming debris among tumor cells).

Q21: Which oncogene is overexpressed in virtually all cases of Burkitt lymphoma?

  1. A. BCL-2
  2. B. MYC
  3. C. Cyclin D1
  4. D. BCL-6

Correct answer: B – MYC

Burkitt lymphoma is characterized by the t(8;14) translocation (or variants), which places the MYC gene under the control of the Ig heavy chain promoter.

Q22: What is the gold standard investigation for diagnosing NHL?

  1. A. Fine needle aspiration (FNA)
  2. B. Bone marrow aspirate
  3. C. Excisional lymph node biopsy
  4. D. PET/CT scan

Correct answer: C – Excisional lymph node biopsy

Excisional biopsy is required to preserve the architecture of the lymph node, which is essential for classification (e.g., follicular vs. diffuse).

Q23: In lymphoid neoplasms, what molecular event precedes malignant transformation?

  1. A. p53 mutation
  2. B. Antigen receptor gene rearrangement
  3. C. Loss of MHC expression
  4. D. Telomerase inhibition

Correct answer: B – Antigen receptor gene rearrangement

Rearrangement of antigen receptor genes (Ig for B cells, TCR for T cells) occurs early in lymphoid development; monoclonal rearrangements are markers of malignancy.

Q24: A MALT lymphoma does NOT respond to H. pylori therapy. Which translocation explains this?

  1. A. t(11;14)
  2. B. t(11;18)
  3. C. t(14;18)
  4. D. t(8;14)

Correct answer: B – t(11;18)

The t(11;18) translocation in MALT lymphoma is associated with resistance to H. pylori eradication therapy.

Q25: A 14-year-old male with a large mediastinal mass and TdT+ cells most likely has:

  1. A. Follicular Lymphoma
  2. B. Precursor T-cell ALL/Lymphoma
  3. C. Hodgkin Lymphoma
  4. D. Thymoma

Correct answer: B – Precursor T-cell ALL/Lymphoma

Precursor T-ALL often presents in adolescent males as a mediastinal mass (thymic origin) and is TdT positive.

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