Weekly Pathology Exam - March 7, 2026 (Section A: MCQs) – 80 MCQs | Kenya MBChB

80 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 80 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 red cell scintigraphy
  4. D. Triphasic CT scan

Correct answer: B – Percutaneous needle biopsy

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

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 benign liver tumor is most likely?

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

Correct answer: A – Hepatocellular Adenoma

Hepatocellular adenomas are strongly associated with oral contraceptive use and carry a significant risk of spontaneous rupture and life-threatening intraperitoneal hemorrhage.

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

  1. A. Hepatocellular Carcinoma
  2. B. Fibrolamellar Carcinoma
  3. C. Focal Nodular Hyperplasia (FNH)
  4. D. Hepatic Angiosarcoma

Correct answer: C – Focal Nodular Hyperplasia (FNH)

Focal Nodular Hyperplasia is characterized by a central stellate scar and a 'spoke-wheel' vascular pattern. It is a regenerative 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. Alcoholic Liver Disease
  2. B. Aflatoxin exposure
  3. C. Chronic Hepatitis B Infection
  4. D. Nonalcoholic Steatohepatitis (NASH)

Correct answer: C – Chronic Hepatitis B Infection

Globally, chronic infection with HBV is the most common risk factor for HCC, particularly in endemic regions like Asia and sub-Saharan Africa.

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

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

Correct answer: C – Alpha-fetoprotein (AFP)

Markedly elevated levels of Alpha-fetoprotein (AFP) are highly specific for HCC in the setting of chronic liver disease (though its sensitivity varies).

Q6: A 70-year-old man with Primary Sclerosing Cholangitis (PSC) develops jaundice and an intrahepatic mass with normal AFP. Which primary liver malignancy is most consistent?

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

Correct answer: B – Cholangiocarcinoma

Cholangiocarcinoma arises from the bile duct epithelium. Risk factors include PSC, liver flukes, and Caroli disease. AFP is usually normal, but CA 19-9 may be elevated.

Q7: A 58-year-old female presents with multiple bilateral liver lesions. She has no history of chronic liver disease. What is the most common diagnosis for malignant liver tumors in adults?

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

Correct answer: B – Metastatic Carcinoma

Metastatic disease (especially from colon, lung, or breast) is far more common than primary liver cancer in non-cirrhotic livers.

Q8: A 2-year-old child presents with an enlarging abdomen and a malignant epithelial tumor with primitive mesenchymal stroma on biopsy. What is the diagnosis?

  1. A. Hepatocellular Carcinoma
  2. B. Standard Adenoma
  3. C. Hepatoblastoma
  4. D. Infantile Hemangioendothelioma

Correct answer: C – Hepatoblastoma

Hepatoblastoma is the most common liver tumor of early childhood (usually <3 years). Histology often shows epithelial cells and mesenchymal elements.

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

  1. A. Arsenic and Vinyl Chloride
  2. B. Oral Contraceptive Pills
  3. C. Aflatoxin B1
  4. D. Anabolic Steroids

Correct answer: A – Arsenic and Vinyl Chloride

Hepatic angiosarcoma is rare but strongly linked to environmental toxins like vinyl chloride, thorium dioxide (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 only seen in infants

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

Fibrolamellar HCC is a distinct variant that occurs in young adults (males = females), is not associated with cirrhosis or HBV, and has a better prognosis.

Q11: A 30-year-old female smoker on OCPs for 10 years has a 5 cm encapsulated liver mass. Which feature differentiates this (Adenoma) from Focal Nodular Hyperplasia (FNH)?

  1. A. Presence of bile ducts
  2. B. Absence of a central scar
  3. C. Response to OCP cessation
  4. D. Occurrence in women

Correct answer: B – Absence of a central scar

Adenomas lack the central stellate scar and the anomalous bile ductules found in the fibrous septa of FNH.

Q12: A 65-year-old male cirrhotic has an AFP of 1500 ng/ml. Which characteristic differentiates HCC from Cholangiocarcinoma in this context?

  1. A. HCC often shows bile production histologically
  2. B. Cholangiocarcinoma is never seen in cirrhosis
  3. C. AFP is typically elevated in Cholangiocarcinoma
  4. D. HCC usually spreads via lymphatics first

Correct answer: A – HCC often shows bile production histologically

Bile production by tumor cells is a pathognomonic histological feature of HCC. Cholangiocarcinoma is a mucin-producing glandular tumor.

Q13: What percentage of Non-Hodgkin Lymphomas are of B-cell origin?

  1. A. 20-30%
  2. B. 50%
  3. C. 85-90%
  4. D. 99%

Correct answer: C – 85-90%

Approximately 85% to 90% of NHLs are of B-cell origin, with the remainder being T-cell or NK-cell lymphomas.

Q14: Which is the most common subtype of B-cell NHL?

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

Q15: A 60-year-old woman with painless lymphadenopathy has BCL-2+, CD10+, CD20+ cells and a slow progression. What is the diagnosis?

  1. A. Burkitt Lymphoma
  2. B. Mantle Cell Lymphoma
  3. C. Follicular Lymphoma
  4. D. Chronic Lymphocytic Leukemia

Correct answer: C – Follicular Lymphoma

Follicular lymphoma is an indolent B-cell lymphoma characterized by a t(14;18) translocation involving BCL-2 and germinal center markers like CD10.

Q16: 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.

Q17: 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+ but CD23 negative. CLL is typically CD5+ and CD23 positive.

Q18: Which organism is directly implicated in the pathogenesis of gastric MALT lymphoma?

  1. A. Epstein-Barr Virus
  2. B. Helicobacter pylori
  3. C. Hepatitis C Virus
  4. D. Human T-cell Leukemia Virus

Correct answer: B – Helicobacter pylori

Chronic gastrtitis caused by H. pylori provides the antigenic stimulus for B-cell proliferation in the stomach, leading to MALT lymphoma.

Q19: What is the first-line treatment for early-stage gastric MALT lymphoma?

  1. A. CHOP chemotherapy
  2. B. Radiation therapy
  3. C. H. pylori eradication (antibiotics/PPI)
  4. D. Total gastrectomy

Correct answer: C – H. pylori eradication (antibiotics/PPI)

Most cases of early-stage gastric MALT lymphoma regress completely after eradication of H. pylori.

Q20: A 55-year-old man with visual disturbances and IgM spike has a MYD88 mutation. What is the diagnosis?

  1. A. Multiple Myeloma
  2. B. Waldenström’s Macroglobulinemia
  3. C. Burkitt Lymphoma
  4. D. Follicular Lymphoma

Correct answer: B – Waldenström’s Macroglobulinemia

Waldenström’s Macroglobulinemia is a lymphoplasmacytic lymphoma with an IgM paraprotein and high frequency of MYD88 L265P mutations.

Q21: Why is plasmapheresis particularly effective in Waldenström's compared to IgG myeloma?

  1. A. IgM is found primarily in the intravascular space
  2. B. IgG is too small to be filtered
  3. C. IgM binds to the plasmapheresis filters
  4. D. IgG myeloma never causes hyperviscosity

Correct answer: A – IgM is found primarily in the intravascular space

IgM is a large pentameric molecule that stays primarily within the blood vessels, making it easily removable via plasmapheresis to treat hyperviscosity.

Q22: A child from sub-Saharan Africa with a jaw mass and 'starry sky' histology. What is the diagnosis?

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

Correct answer: B – Burkitt Lymphoma

Endemic Burkitt lymphoma often involves the mandible or maxilla and shows the classic 'starry sky' appearance (tingible body macrophages).

Q23: 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 translocations (most commonly t(8;14)) that result in the overexpression of the MYC oncogene.

Q24: What is the gold standard investigation for diagnosing NHL?

  1. A. Peripheral blood film
  2. B. CT scan of chest/abdomen/pelvis
  3. C. Excisional lymph node biopsy
  4. D. Fine needle aspiration (FNA)

Correct answer: C – Excisional lymph node biopsy

An excisional biopsy is required to assess the tissue architecture (nodular vs. diffuse) which is essential for accurate NHL classification.

Q25: What is the incidence of Non-Hodgkin Lymphoma per 100,000 population?

  1. A. 1-2 per 100,000
  2. B. 15-20 per 100,000
  3. C. 50-60 per 100,000
  4. D. 100 per 100,000

Correct answer: B – 15-20 per 100,000

The incidence of NHL is approximately 15-20 per 100,000, making it significantly more common than Hodgkin lymphoma.

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