Pathology MCQs for NEET PG
870 worked Pathology questions across 103 areas. Each one has its own page with the reasoning for every option.
What this set is
Pathology links mechanism to appearance: what the tissue looks like and what that tells you. It is one of the bigger pre-clinical and para-clinical subjects and feeds directly into medicine and surgery.
This page lists the 870 Pathology questions that have a full worked page: 652 application questions that put a fact to use on a patient or a finding, and 218 multi-step questions that combine two or more ideas. Plain one-fact recall items are left out here on purpose. The Pathology practice bank in the app is larger, with 4,001 questions in all, and is where timed tests and daily practice draw from.
How to use it
- Pick an area you are weak in, below.
- Answer first, then read why each wrong option fails.
- Write a three-line note for every miss, and revisit it in a week.
- Move to a timed Pathology test once an area feels steady.
These are original practice items, not recalled exam questions, and they are not yet reviewed by independent faculty. Confirm important facts in a standard textbook.
What Pathology covers in the exam
- Cell injury and adaptation
- Inflammation and repair
- Haemodynamics
- Neoplasia
- Immunopathology
- Haematology
- Systemic pathology: cardiovascular, respiratory, GI, renal, endocrine, CNS, bone and soft tissue
A study map from the standard curriculum; the NBEMS bulletin is the authority. See the Pathology study guide.
Worked questions by area
103 areas, largest first. Open an area to see its questions.
Neoplasia123
- Neoplasia · ApplicationA child has bilateral retinoblastoma and the father had a childhood eye tumour. Which mechanism best explains this?
- Neoplasia: tumour suppressor genes · ApplicationA 25-year-old woman develops a sarcoma. Her brother had adrenocortical carcinoma in childhood and her mother had breast cancer at 35. Which gene is most likely mutated…
- Neoplasia: germ cell tumours of the ovary · ApplicationA 26-year-old woman has a unilateral ovarian cystic mass found on ultrasound. At surgery it contains hair, sebaceous material and a tooth, and histology shows skin with…
- Neoplasia: dysplasia and carcinoma in situ · ApplicationA cervical biopsy from a 34-year-old woman shows squamous epithelium in which atypical cells with high nuclear-to-cytoplasmic ratio and mitoses replace the full thickne…
- Neoplasia: salivary gland tumours · ApplicationA 45-year-old woman had enucleation of a painless parotid mass that had grown slowly for five years. Histology showed epithelial and myoepithelial cells in a chondromyx…
- Neoplasia: soft tissue tumours of the uterus · ApplicationA 48-year-old woman has a rapidly enlarging uterine mass. Histology shows a spindle cell tumour with marked nuclear atypia, 15 mitoses per 10 high-power fields and geog…
- Neoplasia: oncogene activation by amplification · ApplicationA 2-year-old child has an abdominal mass with raised urinary VMA and HVA. Biopsy shows small round blue cells forming Homer-Wright rosettes, and karyotype shows double…
- Neoplasia: synthetic lethality and DNA repair · Multi-stepA 55-year-old woman has high-grade serous ovarian carcinoma with a germline BRCA1 mutation. After a response to platinum chemotherapy, maintenance olaparib is advised.…
- Neoplasia: DNA mismatch repair defects · Multi-stepA 38-year-old man has adenocarcinoma of the caecum. His mother had endometrial carcinoma at 45 and a maternal uncle had colon cancer at 50. Tumour immunohistochemistry…
- Neoplasia: von Hippel-Lindau syndrome · Multi-stepA 32-year-old man has retinal and cerebellar haemangioblastomas and bilateral clear cell renal carcinomas, and his father had similar tumours. How does loss of the prod…
- Neoplasia: p53 and the cell cycle · ApplicationA normal fibroblast with intact p53 is exposed to a low dose of ionising radiation that causes repairable DNA damage. Which sequence best describes the p53 response?
- Neoplasia: occupational carcinogens · ApplicationA 52-year-old man who worked for 25 years in a textile dye factory has painless haematuria. Cystoscopy shows a papillary bladder tumour. Which agent is the most likely…
- Neoplasia: asbestos-related tumours · Multi-stepA 62-year-old retired shipyard worker has progressive dyspnoea, a right pleural effusion and diffuse pleural thickening. A pleural biopsy shows malignant epithelioid ce…
- Neoplasia: premalignant lesions in India · ApplicationA 35-year-old woman from Gujarat has chewed areca nut preparations for 12 years. She has a burning sensation with spicy food, blanched oral mucosa with palpable fibrous…
- Neoplasia: viral oncogenesis · ApplicationA 35-year-old woman has CIN 3 with HPV 16 detected. Which HPV protein promotes carcinogenesis by binding p53 and targeting it for ubiquitin-mediated degradation?
- Neoplasia: Epstein-Barr virus associated tumours · ApplicationA 40-year-old man from Nagaland has a painless upper cervical lymph node and nasal obstruction. Biopsy of a nasopharyngeal mass shows undifferentiated carcinoma cells w…
- Neoplasia: infection-associated lymphoma · Multi-stepA 55-year-old man has dyspepsia. Gastric biopsy shows a dense infiltrate of small centrocyte-like cells invading glands to form lymphoepithelial lesions, and Helicobact…
- Neoplasia: therapy-related malignancy · Multi-stepA 24-year-old man treated for a testicular germ cell tumour with an etoposide-containing regimen develops acute myeloid leukaemia two years later. Cytogenetics shows an…
- Neoplasia: germ cell tumour markers · ApplicationA 19-year-old woman has a rapidly enlarging ovarian mass and a markedly raised serum alpha-fetoprotein. Histology shows perivascular structures in which a central capil…
- Neoplasia: interpreting tumour markers · Multi-stepA 30-year-old man has an orchidectomy for a testicular mass. Histology appears to show pure seminoma, but preoperative serum alpha-fetoprotein is 1200 ng/mL. How should…
- Neoplasia: CEA in colorectal cancer · ApplicationA 60-year-old man had resection of stage III colon adenocarcinoma, with a preoperative CEA of 28 ng/mL. What is the most appropriate use of CEA now?
- Neoplasia: PSA in prostate cancer · Multi-stepA 66-year-old man has a total PSA of 7.5 ng/mL and a normal digital rectal examination. The free-to-total PSA ratio is 8%. How should this be interpreted?
- Neoplasia: paraneoplastic hypercalcaemia · ApplicationA 64-year-old smoker has a cavitating central lung mass with squamous cell carcinoma on biopsy. Serum calcium is 13.8 mg/dL with a suppressed PTH level and no bone meta…
- Neoplasia: paraneoplastic polycythaemia · ApplicationA 58-year-old man has haematuria, a flank mass and a haemoglobin of 18.9 g/dL with normal arterial oxygen saturation. CT shows a large renal mass invading the renal vei…
- Neoplasia: neuromuscular paraneoplastic syndromes · ApplicationA 60-year-old male smoker has proximal leg weakness, dry mouth and diminished reflexes. Strength improves transiently after sustained contraction. A chest film shows a…
- Neoplasia: cancer-associated thrombosis · ApplicationA 63-year-old man with weight loss and epigastric pain has had repeated episodes of migratory superficial thrombophlebitis without other risk factors. CT shows a mass i…
- Neoplasia: sentinel lymph node · Multi-stepA 52-year-old woman has a 2-cm invasive ductal carcinoma of the breast with a clinically node-negative axilla. A sentinel lymph node biopsy is planned. What does the te…
- Neoplasia: invasion and metastasis · Multi-stepIn the invasion-metastasis cascade, carcinoma cells must cross the extracellular matrix to reach vessels. Which sequence correctly describes the steps of local invasion?
- Neoplasia: metastasis to the ovary · ApplicationA 40-year-old woman has bilateral solid ovarian masses. Histology shows mucin-filled signet-ring cells scattered in a cellular, spindle-cell stroma. Which is the most l…
- Neoplasia: pattern of metastasis · ApplicationA 70-year-old man has back pain and sclerotic vertebral lesions on radiograph, with PSA of 220 ng/mL. Chest imaging is normal. By which route are vertebral metastases f…
- Neoplasia: immunohistochemistry of undifferentiated tumours · ApplicationA 55-year-old man has an axillary lymph node replaced by large pleomorphic cells with prominent nucleoli. Cytokeratin, LCA and desmin are negative. Which set of markers…
- Neoplasia: HER2 testing · Multi-stepA 48-year-old woman has an ER-negative invasive ductal carcinoma of the breast. HER2 immunohistochemistry is reported as 2+ (equivocal). What is the next step?
- Neoplasia: gastrointestinal stromal tumour · ApplicationA 60-year-old man has a gastric submucosal mass. Histology shows spindle cells that are positive for CD117 and DOG1. From which cell does this tumour arise, and which d…
- Neoplasia: predictive molecular markers in lung cancer · ApplicationA 50-year-old non-smoking woman has stage IV lung adenocarcinoma. Which molecular finding best predicts a response to the tyrosine kinase inhibitors erlotinib or gefiti…
- Neoplasia: tumour immunity and checkpoint inhibitors · ApplicationA 62-year-old man with metastatic melanoma receives pembrolizumab. After 8 weeks he has watery diarrhoea, and colonoscopy shows diffuse colonic inflammation. What is th…
- Neoplasia: oncologic emergencies · Multi-stepA 7-year-old child with Burkitt lymphoma receives chemotherapy. After 24 hours, urine output falls, with potassium 6.8 mEq/L, high phosphate, low calcium and uric acid…
- Neoplasia: paediatric renal tumours · ApplicationA 3-year-old boy has aniridia, genitourinary anomalies and developmental delay. He is at increased risk of which tumour, and which chromosomal region is deleted?
- Neoplasia: skin cancers · ApplicationA 45-year-old man has a non-healing ulcer with raised everted edges on a burn scar on his leg that dates back 30 years. What is the most likely diagnosis?
- Neoplasia: thyroid carcinomas · ApplicationA 28-year-old woman has a thyroid nodule with an enlarged cervical lymph node. FNAC shows overlapping, optically clear nuclei with grooves and intranuclear pseudoinclus…
- Neoplasia: AIDS-associated tumours · ApplicationA 34-year-old man with HIV infection and a CD4 count of 80 per microlitre has violaceous plaques on both legs. Biopsy shows spindle cells forming slit-like vascular spa…
- Neoplasia: carcinoid syndrome · Multi-stepA 55-year-old man with an ileal carcinoid tumour and multiple liver metastases has flushing, watery diarrhoea and wheeze. Echocardiography shows tricuspid regurgitation…
- Neoplasia: neuroblastoma · ApplicationA 2-year-old child has an abdominal mass crossing the midline, periorbital ecchymoses and opsoclonus-myoclonus. Urinary VMA and HVA are raised. Which finding indicates…
- Neoplasia: cell cycle control and Rb · Multi-stepA 55-year-old woman with hormone receptor-positive metastatic breast cancer is started on palbociclib, a CDK4/6 inhibitor. What is the intended effect at the level of t…
- Neoplasia: neurofibromatosis type 2 · ApplicationA 22-year-old man has progressive bilateral hearing loss and tinnitus. MRI shows bilateral cerebellopontine angle masses, and his mother had a similar problem. Which ge…
- Neoplasia: granulosa cell tumour · ApplicationA 55-year-old postmenopausal woman has vaginal bleeding. Endometrial biopsy shows hyperplasia, and imaging shows a solid adnexal mass. Histology shows cells with groove…
- Neoplasia: seminoma immunophenotype · Multi-stepA 30-year-old man has a painless testicular mass. The orchidectomy specimen shows sheets of uniform round cells with clear cytoplasm and distinct borders, divided by fi…
- Neoplasia: complete hydatidiform mole · Multi-stepA 24-year-old woman at 11 weeks of amenorrhoea has a uterus of 16 weeks size, serum beta-hCG of 250,000 IU/L and a snowstorm pattern on ultrasound with no fetal parts.…
- Neoplasia: phyllodes tumour · Multi-stepA 45-year-old woman has a rapidly enlarging, mobile 8 cm breast mass. Core biopsy shows leaf-like architecture and markedly hypercellular, atypical stroma with frequent…
- Neoplasia: fibrolamellar carcinoma · Multi-stepA 19-year-old woman has an abdominal mass. She has no cirrhosis or viral hepatitis, and serum AFP is normal. CT shows a large lobulated liver mass with a central scar.…
- Neoplasia: urinary bladder carcinoma · ApplicationA 38-year-old farm worker from an endemic area has terminal haematuria. Cystoscopic biopsy shows calcified eggs with a terminal spine in the bladder wall and an ulcerat…
- Neoplasia: immunohistochemistry panel · ApplicationA 50-year-old has an undifferentiated tumour in a lymph node. It is positive for S-100 and HMB-45 and negative for cytokeratin and leukocyte common antigen. What is the…
- Neoplasia: MEN syndromes · Multi-stepA 25-year-old has a medullary thyroid carcinoma, mucosal neuromas and a marfanoid habitus. Which additional lesion is expected?
- Neoplasia: Gleason grading · ApplicationA prostate biopsy shows adenocarcinoma where the most common pattern is Gleason 3 and the next most common is Gleason 4. How is this reported?
- Neoplasia: WHO neuroblastoma prognosis · Multi-stepA 2-year-old has an abdominal mass and opsoclonus-myoclonus. The tumour biopsy shows small round blue cells with Homer-Wright rosettes. Which finding indicates the wors…
- Neoplasia · ApplicationA 62-year-old woman with weight loss and early satiety has a firm 2 cm nodule at the umbilicus, and biopsy shows adenocarcinoma. What is the eponym for this finding?
- Neoplasia · ApplicationA 52-year-old man with weight loss has abrupt onset of velvety, hyperpigmented skin thickening in the axillae and neck, with thickened palms. Which malignancy should be…
- Neoplasia · Multi-stepA teenager has hundreds of colonic polyps and a cerebellar medulloblastoma. A germline APC mutation is found. What is the syndrome?
- Neoplasia · Multi-stepA woman has macrocephaly, facial trichilemmomas, multiple hamartomatous gastrointestinal polyps, breast cancer and follicular thyroid carcinoma. Which gene is mutated?
- Neoplasia: infectious agents and cholangiocarcinoma · ApplicationA 60-year-old man from a region where raw freshwater fish is commonly eaten has obstructive jaundice and a hilar mass. Biopsy shows adenocarcinoma of the bile duct. Chr…
- Neoplasia: dermatofibrosarcoma protuberans · Multi-stepA 35-year-old man has a slowly growing firm plaque on the trunk that has recurred twice after narrow excision. Histology shows uniform spindle cells in a storiform patt…
- Neoplasia: chondroblastoma · Multi-stepA 16-year-old boy with open growth plates has knee pain. Radiographs show a well-defined lytic lesion with a sclerotic rim in the proximal tibial epiphysis. Histology s…
- Neoplasia: ductal carcinoma in situ of the breast · ApplicationA 52-year-old woman has linear branching pleomorphic calcifications on screening mammography. Core biopsy shows ducts distended by sheets of high-grade malignant cells…
- Neoplasia: post-transplant lymphoproliferative disorder · Multi-stepA 30-year-old renal transplant recipient on tacrolimus and mycophenolate develops cervical lymphadenopathy 8 months after transplantation. Node biopsy shows a polymorph…
- Neoplasia: primary CNS lymphoma · Multi-stepA 34-year-old man with advanced HIV infection (CD4 count 40 per microlitre) has headache and confusion. MRI shows a single periventricular ring-enhancing lesion, CSF PC…
- Neoplasia: haemangioblastoma in von Hippel-Lindau disease · Multi-stepA 32-year-old man with a family history of renal cell carcinoma and retinal angiomas has a cerebellar cystic lesion with a mural nodule. Histology of the nodule shows f…
- Neoplasia: glomus tumour · ApplicationA 40-year-old woman has a bluish nodule under the fingernail that is exquisitely tender and sensitive to cold. Excision shows nests of uniform round cells around vascul…
- Neoplasia: granular cell tumour · Multi-stepA 35-year-old woman has a painless firm nodule on the tongue. The overlying epithelium shows pseudoepitheliomatous hyperplasia, and the nodule contains sheets of large…
- Neoplasia: keratoacanthoma · Multi-stepA 65-year-old man has a dome-shaped nodule with a central keratin-filled crater on the sun-exposed cheek. It grew to 2 cm in six weeks. Histology shows a symmetrical, w…
- Neoplasia: solid pseudopapillary neoplasm of the pancreas · Multi-stepA 22-year-old woman has a large, well-circumscribed mass in the tail of the pancreas with solid and haemorrhagic cystic areas. Histology shows poorly cohesive monomorph…
- Neoplasia: pulmonary hamartoma · ApplicationA 50-year-old asymptomatic man has a 2 cm well-circumscribed solitary pulmonary nodule with popcorn calcification on chest imaging. The resected nodule consists of diso…
- Neoplasia: HTLV-1 and adult T-cell leukaemia · ApplicationA 45-year-old man from southern Japan has skin lesions, generalised lymphadenopathy, hypercalcaemia and lymphocytes with multilobed 'flower' nuclei. Which oncogenic vir…
- Neoplasia: thyroglobulin as tumour marker · ApplicationA woman has undergone total thyroidectomy and radioiodine ablation for follicular thyroid carcinoma. Which serum marker is most useful for detecting recurrence during f…
- Neoplasia: neuroendocrine immunohistochemistry · ApplicationA bronchial biopsy from a smoker shows sheets of small cells with scant cytoplasm, nuclear moulding and finely granular chromatin. Which immunohistochemical pair best c…
- Neoplasia: carcinoma of unknown primary · Multi-stepA 62-year-old man has multiple liver metastases from adenocarcinoma with no known primary. Tumour cells are CK20 positive, CK7 negative and CDX2 positive, and TTF-1 neg…
- Neoplasia: acanthosis nigricans as a paraneoplastic sign · ApplicationA 58-year-old man has had rapidly spreading velvety dark thickening of the axillae and neck over two months, with thickened palms showing exaggerated ridges. He is not…
- Neoplasia: tumour lysis syndrome · Multi-stepTwelve hours after the first cycle of chemotherapy for Burkitt lymphoma, a boy develops oliguria, tetany and arrhythmia. Which set of laboratory findings is expected?
- Neoplasia: neurofibromatosis type 1 molecular basis · Multi-stepA 12-year-old has multiple café-au-lait macules, axillary freckling, Lisch nodules and cutaneous neurofibromas. Loss of function of which gene product explains the tumo…
- Neoplasia: tuberous sclerosis pathway · Multi-stepA child with seizures, ash-leaf macules and facial angiofibromas has a cardiac rhabdomyoma and renal angiomyolipomas. Mutations in TSC1 or TSC2 lead to excessive activi…
- Neoplasia: mature cystic teratoma · ApplicationA 25-year-old woman has a unilocular ovarian cyst containing hair and sebaceous material. Histology shows skin with adnexa, cartilage, respiratory epithelium and neural…
- Neoplasia: alveolar rhabdomyosarcoma · Multi-stepA 14-year-old has a rapidly growing mass in the forearm. Biopsy shows small round blue cells in a nested pattern with fibrous septa and myogenin positivity, and a trans…
- Neoplasia: myxoid liposarcoma · Multi-stepA 40-year-old has a deep thigh mass. Histology shows uniform round cells, a delicate plexiform capillary network and abundant myxoid stroma with lipoblasts. Which trans…
- Neoplasia: microRNA in CLL · Multi-stepIn many cases of chronic lymphocytic leukaemia there is deletion of 13q14, the site of the genes for miR-15a and miR-16-1, which normally act on the transcript of an an…
- Neoplasia: p16 as HPV surrogate · Multi-stepA biopsy from a tonsillar squamous carcinoma in a non-smoker shows strong, diffuse nuclear and cytoplasmic p16 staining. What is the molecular explanation for this over…
- Neoplasia: osteoblastic metastases · ApplicationA 72-year-old man has back pain and a markedly raised serum alkaline phosphatase. Spine radiographs show multiple dense sclerotic vertebral lesions. Which primary tumou…
- Neoplasia: arsenic carcinogenesis · ApplicationVillagers drinking groundwater contaminated with arsenic for years develop hyperkeratotic palms and raindrop-pattern pigmentation. Which malignancy are they at greatly…
- Neoplasia: DES exposure · ApplicationA 19-year-old woman whose mother took diethylstilboestrol during pregnancy is diagnosed with a vaginal tumour. What is the expected histological type?
- Neoplasia: desmoid tumour and APC · Multi-stepA man with familial adenomatous polyposis who underwent colectomy develops a firm infiltrating abdominal wall mass. Biopsy shows bland spindle cells in fascicles, with…
- Neoplasia: tumour doubling and detection · ApplicationA tumour begins from a single transformed cell. Roughly how many doublings are needed before it reaches about 1 g (around 10^9 cells) and becomes clinically detectable?
- Neoplasia: renal cell carcinoma spread · ApplicationA renal cell carcinoma in the right kidney is found at nephrectomy to have grown as a solid plug into the renal vein and beyond. Which further spread is characteristic…
- Neoplasia: hypertrophic osteoarthropathy · ApplicationA 62-year-old smoker has painful swollen wrists and ankles, digital clubbing and periosteal new bone on radiographs of the long bones. What is the most likely cause?
- Neoplasia: Merkel cell carcinoma · Multi-stepA 78-year-old man has a rapidly growing painless violaceous nodule on the cheek. Biopsy shows small blue cells with salt-and-pepper chromatin, and cytokeratin 20 stains…
- Neoplasia: initiation and promotion · ApplicationIn a skin carcinogenesis experiment, a single low dose of a mutagen is applied, followed by repeated application of a phorbol ester that is not itself mutagenic. Tumour…
- Neoplasia · ApplicationWhich feature best indicates malignancy?
- Neoplasia · ApplicationWhat term describes loss of differentiation in malignant cells?
- Neoplasia · ApplicationWhich property allows tumor cells to grow indefinitely?
- Neoplasia · ApplicationWhat allows tumor invasion?
- Neoplasia · ApplicationWhat describes spread to distant site?
- Neoplasia · ApplicationWhat feature best defines a malignant neoplasm?
- Neoplasia · ApplicationWhat term describes spread of cancer to distant sites?
- Neoplasia · ApplicationWhat is the role of TP53 in normal cells?
- Neoplasia · ApplicationActivation of which gene class can drive uncontrolled cell proliferation?
- Neoplasia · ApplicationWhat term describes abnormal disordered growth that can precede malignancy?
- Neoplasia · ApplicationWhat characteristic describes poorly differentiated malignant cells?
- Neoplasia · ApplicationWhat tumor suppressor gene is commonly altered in retinoblastoma?
- Neoplasia · ApplicationWhat term describes a benign gland-forming tumor?
- Neoplasia · ApplicationWhat process allows malignant cells to enter lymphatic or blood vessels?
- Neoplasia · ApplicationWhat is angiogenesis in cancer biology?
- Neoplasia · ApplicationWhich feature most strongly supports a malignant epithelial neoplasm rather than a benign one?
- Neoplasia · ApplicationWhich feature distinguishes malignant from benign neoplasms?
- Neoplasia · ApplicationWhat does dysplasia mean in epithelial tissue?
- Neoplasia · ApplicationWhat is a tumour suppressor gene's normal role?
- Neoplasia: p53 · ApplicationLoss of p53 promotes cancer chiefly because cells fail to do what after DNA damage?
- Neoplasia: RB protein · ApplicationThe retinoblastoma protein normally restrains cell proliferation by binding which transcription factor?
- Neoplasia: metastasis · ApplicationReduced expression of E-cadherin in a carcinoma most directly facilitates which step of invasion?
- Neoplasia · ApplicationWhat does anaplasia indicate in a tumour?
- Neoplasia · ApplicationWhat is carcinoma in situ?
- Neoplasia · ApplicationWhat route is most typical for sarcoma metastasis?
- Neoplasia: anaplasia · ApplicationWhich feature is most characteristic of anaplasia in malignant tumors?
- Neoplasia: metastasis · ApplicationWhich property most directly distinguishes a malignant neoplasm from a benign neoplasm?
- Neoplasia: grading and staging · ApplicationWhat does tumor staging primarily describe?
- Neoplasia: dysplasia · ApplicationWhat is epithelial dysplasia?
- Neoplasia: invasion · ApplicationWhich enzyme facilitates tumor invasion by degrading extracellular matrix and basement membrane?
- Neoplasia: paraneoplastic syndromes · ApplicationWhich tumor is classically associated with ectopic ACTH production causing Cushing syndrome?
Haematology87
- Haematology: hereditary spherocytosis · Multi-stepA 12-year-old boy has intermittent jaundice, splenomegaly and pigment gallstones. His father had a splenectomy in childhood. The smear shows spherocytes, MCHC is raised…
- Haematology: G6PD deficiency · ApplicationAn 8-year-old boy develops dark urine, jaundice and a fall in haemoglobin 2 days after eating fava beans. Supravital staining of his blood shows inclusions attached to…
- Haematology: sickle cell anaemia treatment · ApplicationA 9-year-old child with sickle cell anaemia has frequent painful crises and two episodes of acute chest syndrome in a year. Which drug reduces the frequency of these co…
- Haematology: thalassaemia trait · Multi-stepA 24-year-old woman has haemoglobin 10.5 g/dL, red cell count 5.8 million per microlitre, MCV 62 fL, normal RDW and normal serum ferritin. What is the Mentzer index and…
- Haematology: vitamin B12 deficiency · Multi-stepA 62-year-old woman has MCV 118 fL, hypersegmented neutrophils, tingling of the feet and loss of vibration sense. Which biochemical pattern would be expected, and would…
- Haematology: aplastic anaemia · ApplicationA 22-year-old man has fatigue, bruising and infections. Counts show pancytopenia with low reticulocytes, and there is no splenomegaly or lymphadenopathy. Marrow biopsy…
- Haematology: anaemia of chronic disease · Multi-stepA 48-year-old woman with long-standing rheumatoid arthritis has haemoglobin 9.5 g/dL and MCV 78 fL. Serum iron is low, TIBC is low and ferritin is 320 ng/mL. Which mech…
- Haematology: lead poisoning · ApplicationA 30-year-old man who recycles old batteries has abdominal colic, constipation and anaemia. He has a bluish line on the gums, and the smear shows coarse basophilic stip…
- Haematology: paroxysmal nocturnal haemoglobinuria · ApplicationA 30-year-old woman has episodes of dark urine on waking, mild pancytopenia and a recent hepatic vein thrombosis. The direct Coombs test is negative. Which test is the…
- Haematology: cold agglutinin haemolysis · ApplicationA 25-year-old man recovering from Mycoplasma pneumoniae infection develops pallor and jaundice, and his fingers turn blue on exposure to cold. Which antibody and test r…
- Haematology: immune thrombocytopenia · ApplicationA 6-year-old child develops petechiae and gum bleeding two weeks after a viral illness. Platelet count is 12,000 per microlitre with normal haemoglobin and leukocyte co…
- Haematology: von Willebrand disease · Multi-stepA 20-year-old woman has menorrhagia and recurrent epistaxis, and her mother has similar problems. Platelet count is normal, bleeding time is prolonged, PT is normal and…
- Haematology: Glanzmann thrombasthenia · ApplicationA 7-year-old boy of consanguineous parents has recurrent epistaxis and gum bleeding. Platelet count and smear are normal and bleeding time is prolonged. Platelet aggreg…
- Haematology: antiphospholipid syndrome · Multi-stepA 29-year-old woman has had three first-trimester miscarriages and an earlier deep vein thrombosis. Her aPTT is prolonged and does not correct when mixed 1:1 with norma…
- Haematology: factor V Leiden · ApplicationA 24-year-old woman taking an oral contraceptive pill develops left leg deep vein thrombosis. Her mother also had venous thrombosis at a young age. Which defect is the…
- Haematology: vitamin K deficiency bleeding · ApplicationA 5-day-old exclusively breastfed baby born at home, who received no injections, has melaena and oozing from the umbilical stump. Platelet count is normal, and PT is pr…
- Haematology: heparin-induced thrombocytopenia · Multi-stepA 60-year-old man is on unfractionated heparin after hip surgery. On day 7 his platelet count falls from 250,000 to 90,000 per microlitre, and he develops a new deep ve…
- Haematology: acute lymphoblastic leukaemia · ApplicationA 5-year-old child has pallor, bone pain, hepatosplenomegaly and lymphadenopathy. The smear shows blasts with scant cytoplasm and no granules that are negative for myel…
- Haematology: CLL complication · Multi-stepA 68-year-old man with known chronic lymphocytic leukaemia has new fatigue and jaundice. Haemoglobin has fallen from 12 to 7.5 g/dL, reticulocytes are 9 percent, the sm…
- Haematology: hairy cell leukaemia · ApplicationA 55-year-old man has pancytopenia and massive splenomegaly without lymphadenopathy, and marrow aspiration gives a dry tap. Flow cytometry shows CD25 and CD103 positive…
- Haematology: follicular lymphoma · ApplicationA 55-year-old woman has painless, waxing and waning lymphadenopathy for 2 years. Lymph node biopsy shows closely packed neoplastic follicles that lack tingible-body mac…
- Haematology: polycythaemia vera · ApplicationA 58-year-old man has headache, itching after a hot bath and a plethoric face. Haemoglobin is 19 g/dL, platelets 480,000 and leukocytes 13,000 per microlitre, with sple…
- Haematology: mantle cell lymphoma · ApplicationA 65-year-old man has generalised lymphadenopathy and splenomegaly. A node biopsy shows small to medium cleaved lymphocytes in a mantle zone pattern, positive for CD5 a…
- Haematology: sickle cell anaemia and hyposplenism · ApplicationA 7-year-old with sickle cell anaemia has had two episodes of pneumococcal septicaemia. A blood film shows Howell-Jolly bodies and target cells. What is the mechanism b…
- Haematology: folate versus vitamin B12 deficiency · Multi-stepA 30-year-old woman with chronic alcohol use has macrocytic anaemia and hypersegmented neutrophils. She has no neurological signs. Serum folate is low and vitamin B12 i…
- Haematology: isoniazid-induced sideroblastic anaemia · Multi-stepA 40-year-old man on antituberculosis treatment develops fatigue. Haemoglobin is 8 g/dL with a microcytic hypochromic picture. Serum iron and ferritin are high, and a m…
- Haematology: Fanconi anaemia · Multi-stepA 7-year-old boy has short stature, café-au-lait macules, absent thumbs and progressive pancytopenia. Which investigation is most likely to confirm the diagnosis?
- Haematology: warm autoimmune haemolytic anaemia · ApplicationA 40-year-old woman with systemic lupus erythematosus has fatigue and jaundice. Haemoglobin is 6.8 g/dL, reticulocytes are 12%, the film shows spherocytes, and the dire…
- Haematology: haemolytic uraemic syndrome · Multi-stepA 4-year-old child had bloody diarrhoea 5 days ago and now has pallor and oliguria. Haemoglobin is 7 g/dL, platelets 40,000 per microlitre, creatinine is raised, schist…
- Haematology: acquired haemophilia · Multi-stepA 60-year-old man with no previous bleeding history develops large spontaneous muscle haematomas. Platelets and PT are normal and aPTT is 78 seconds. When mixed 1:1 wit…
- Haematology: Bernard-Soulier syndrome · Multi-stepA 6-year-old boy has had mucocutaneous bleeding since infancy. Platelet count is 60,000 per microlitre and the film shows giant platelets. Ristocetin-induced aggregatio…
- Haematology: acute myeloid leukaemia cytochemistry · ApplicationA peripheral smear from a 50-year-old man shows 60% blasts, some containing needle-shaped cytoplasmic rods. Which cytochemical or immunophenotypic pattern is expected i…
- Haematology: myelodysplastic syndrome with del(5q) · Multi-stepA 70-year-old woman has macrocytic anaemia (Hb 8 g/dL) and thrombocytosis. B12 and folate are normal. The smear shows macro-ovalocytes, the marrow is hypercellular with…
- Haematology: Waldenstrom macroglobulinaemia · Multi-stepA 68-year-old man has fatigue, epistaxis, blurred vision and dilated retinal veins. Serum IgM is 5 g/dL, and marrow shows lymphoplasmacytic infiltration with a MYD88 L2…
- Haematology: essential thrombocythaemia · ApplicationA 55-year-old woman has burning pain and redness of the fingers that is relieved by cooling. Platelet count is 900 x 10^9/L, haemoglobin is normal, and BCR-ABL testing…
- Haematology: mycosis fungoides · ApplicationA 58-year-old man has had scaly patches on the buttocks for years, which have thickened into plaques. A biopsy shows atypical lymphocytes with cerebriform nuclei infilt…
- Haematology: transfusion-related acute lung injury · Multi-stepA 60-year-old man with a bleed receives fresh frozen plasma. Within an hour he has fever, hypotension and severe dyspnoea. His JVP is not raised, chest radiograph shows…
- Haematology: beta thalassaemia major · ApplicationAn 8-month-old child has progressive pallor, hepatosplenomegaly and frontal bossing and needs regular transfusions. The smear shows severe microcytic hypochromic anaemi…
- Haematology: haemophilia A inheritance · ApplicationA man with severe haemophilia A and a woman with no family history of bleeding plan to have children. What outcome is expected?
- Haematology: sickle cell disease · Multi-stepA 9-year-old boy with sickle cell disease has pallor, tiredness and fever after a viral illness with a slapped-cheek rash in a sibling. Haemoglobin has fallen from 8 to…
- Haematology: chronic lymphocytic leukaemia · ApplicationA 68-year-old man has asymptomatic lymphocytosis of 60,000/microlitre. The blood film shows mature small lymphocytes with many smudge cells. Flow cytometry would most l…
- Haematology: chronic myeloid leukaemia · ApplicationA 45-year-old man has massive splenomegaly and a total leukocyte count of 240,000/microlitre with myelocytes, metamyelocytes and basophilia. The leukocyte alkaline phos…
- Haematology: beta thalassaemia trait · Multi-stepA 22-year-old has Hb 10.5 g/dL, MCV 62 fL, RBC count 5.8 x 10^12/L, normal ferritin and normal RDW. Which finding would confirm the diagnosis?
- Haematology: autoimmune haemolysis · ApplicationA 22-year-old has jaundice and anaemia after a recent pneumonia with Mycoplasma. The direct Coombs test is positive for C3 only, and agglutination is seen on cooling th…
- Haematology: Waldenstrom macroglobulinaemia · Multi-stepA 70-year-old has headache, blurred vision, epistaxis and lymphadenopathy. Serum electrophoresis shows an IgM spike, and the marrow has lymphoplasmacytic cells. Which f…
- Haematology: polycythaemia vera · Multi-stepA 58-year-old has facial plethora, pruritus after a hot bath and splenomegaly with Hb 19 g/dL. Which test result is expected and supports primary rather than secondary…
- Haematology: AML genetics · Multi-stepA 45-year-old has acute myeloid leukaemia with normal karyotype. Which mutation indicates a favourable prognosis if FLT3-ITD is absent?
- Haematology · ApplicationA routine smear from a healthy 30-year-old shows many neutrophils with bilobed, spectacle-like nuclei and coarse clumped chromatin. He has no infections and his neutrop…
- Haematology · Multi-stepA 25-year-old man has an isolated, slowly growing cervical node. Biopsy shows scattered large cells with multilobated nuclei in a nodular background of small B lymphocy…
- Haematology · Multi-stepA 70-year-old man has splenomegaly and a persistent absolute monocyte count of 3,000 per microlitre. The smear shows dysplastic neutrophils, blasts are 4%, and BCR-ABL1…
- Haematology · Multi-stepA 55-year-old woman has a platelet count of 900 x 10^9/L. Marrow shows large hyperlobated megakaryocytes. BCR-ABL1 and JAK2 V617F are both negative. Which driver mutati…
- Haematology · Multi-stepBiopsy of a mediastinal mass shows small, regressed germinal centres with concentric onion-skin mantle zones, and a vessel penetrating radially into a follicle. What is…
- Haematology: cytogenetics of childhood ALL · Multi-stepA 4-year-old child is diagnosed with B-lymphoblastic leukaemia. Cytogenetics is awaited. Which of the following abnormalities would carry the most favourable prognosis?
- Haematology: systemic mastocytosis · ApplicationA 45-year-old man has brown macules that urticate when stroked, episodic flushing, abdominal cramps and bone pain. Bone marrow shows aggregates of spindle-shaped mast c…
- Haematology: fetomaternal haemorrhage test · ApplicationAn Rh-negative woman delivers an Rh-positive baby after a placental abruption. A large fetomaternal haemorrhage is suspected and the dose of anti-D immunoglobulin must…
- Haematology: methaemoglobinaemia · Multi-stepA 25-year-old man on dapsone has dyspnoea and cyanosis not corrected by oxygen. Pulse oximetry reads 85 percent, arterial PaO2 is normal and the blood sample is chocola…
- Haematology: Plummer-Vinson syndrome · ApplicationA 45-year-old woman with long-standing iron deficiency anaemia has dysphagia for solids. Barium swallow shows a thin web in the upper oesophagus. Which malignancy is sh…
- Haematology: Evans syndrome · Multi-stepA 30-year-old woman has jaundice and petechiae. Haemoglobin is 7 g/dL, reticulocytes are raised, platelets are 20,000 per microlitre and the smear shows spherocytes wit…
- Haematology: factor XIII deficiency · Multi-stepA neonate bleeds from the umbilical stump after the cord has separated, and later shows poor wound healing. Platelet count, PT, aPTT and bleeding time are normal. Which…
- Haematology: haemoglobin H inclusions · ApplicationA 20-year-old man has mild jaundice, splenomegaly and haemoglobin 8.5 g/dL with microcytic hypochromic red cells. Electrophoresis shows a fast-migrating band. After inc…
- Haematology: delayed haemolytic transfusion reaction · Multi-stepA multiparous 60-year-old woman receives two units of red cells. Her pretransfusion antibody screen was negative. Eight days later she has fever, jaundice and a fall in…
- Haematology: febrile non-haemolytic transfusion reaction · ApplicationA 12-year-old with thalassaemia major develops fever of 38.8 C and chills during a transfusion. Blood pressure is normal, there is no urticaria, urine is clear, the dir…
- Haematology: red cell storage lesion · ApplicationA trauma patient receives many units of red cells stored for more than three weeks. Which pair of changes in the stored units contributes to the metabolic disturbance?
- Haematology: aPTT mixing study · ApplicationA 6-year-old boy has recurrent haemarthroses. PT is normal and aPTT is 70 seconds against a control of 30 seconds. When his plasma is mixed 1:1 with normal plasma, the…
- Haematology: AML with maturation and myeloid sarcoma · Multi-stepA 25-year-old man has pancytopenia and 35 percent marrow blasts with Auer rods and large salmon-pink granules. Biopsy of a greenish orbital mass shows the same blasts.…
- Haematology: acute megakaryoblastic leukaemia in Down syndrome · ApplicationA 2-year-old child with Down syndrome has pancytopenia. Marrow aspiration is a dry tap and the trephine is fibrotic. Blasts with cytoplasmic blebs are myeloperoxidase n…
- Haematology: adult T-cell leukaemia/lymphoma · ApplicationA 45-year-old man from an area of southwestern Japan has skin lesions, hypercalcaemia and lytic bone lesions. His smear shows lymphocytes with multilobated, clover-leaf…
- Haematology: spur cell haemolytic anaemia · Multi-stepA 55-year-old man with alcoholic cirrhosis develops a haemolytic anaemia. His smear shows dense red cells with a few irregular, spiky projections of unequal length. Wha…
- Haematology: imatinib resistance in CML · Multi-stepA 40-year-old man with chronic myeloid leukaemia in chronic phase initially responded to imatinib. After 2 years his BCR-ABL transcript level rises and the white count…
- Haematology: Richter transformation · Multi-stepA 70-year-old man with long-standing chronic lymphocytic leukaemia develops fever, weight loss and a rapidly enlarging inguinal node with raised LDH. Excision of the no…
- Haematology: gastric MALT lymphoma · ApplicationA 58-year-old man with dyspepsia has a gastric biopsy showing small lymphoid cells infiltrating and destroying glands, forming lymphoepithelial lesions. Helicobacter py…
- Haematology: anaplastic large cell lymphoma · ApplicationA 17-year-old boy has lymphadenopathy and skin nodules. Node biopsy shows cohesive sheets of large cells with horseshoe-shaped nuclei that are strongly CD30 positive. W…
- Haematology: mixed cellularity Hodgkin lymphoma · ApplicationA man with advanced HIV infection is diagnosed with Hodgkin lymphoma. Reed-Sternberg cells lie in a mixed background of eosinophils, plasma cells and histiocytes, and E…
- Haematology: T-lymphoblastic lymphoma · Multi-stepA 16-year-old boy has cough, facial swelling and a large anterior mediastinal mass. Biopsy shows small to medium blasts with scant cytoplasm that express TdT and cytopl…
- Haematology: pyruvate kinase deficiency · Multi-stepA 4-year-old child of consanguineous parents has chronic haemolytic anaemia since the neonatal period, splenomegaly. The G6PD assay and the smear for spherocytes are no…
- Haematology: haemophagocytic lymphohistiocytosis · Multi-stepA 3-year-old boy has persistent fever, splenomegaly and cytopenias. Ferritin is markedly raised, triglycerides are high and fibrinogen is low. Marrow shows macrophages…
- Haematology: monoclonal gammopathy of undetermined significance · ApplicationA 72-year-old woman has an incidental IgG M-protein of low concentration on electrophoresis. Marrow plasma cells are fewer than 10 percent, and she has no anaemia, hype…
- Haematology: antithrombin deficiency · ApplicationA 28-year-old man has had two episodes of deep vein thrombosis, one in an unusual mesenteric vein. During treatment with intravenous unfractionated heparin, the aPTT st…
- Haematology: Diamond-Blackfan anaemia · Multi-stepA 3-month-old girl has pallor, macrocytic anaemia and a very low reticulocyte count. White cells and platelets are normal. She has a triphalangeal thumb, and marrow sho…
- Haematology: atypical lymphocytes in infectious mononucleosis · ApplicationA 19-year-old student has fever, exudative pharyngitis, posterior cervical lymphadenopathy and splenomegaly. The blood film shows lymphocytosis with large cells having…
- Haematology: hereditary haemochromatosis pathogenesis · Multi-stepA 45-year-old man homozygous for the C282Y variant of HFE has a ferritin of 2,500 ng/mL and transferrin saturation of 90 percent. Which mechanism explains his iron over…
- Haematology: aspirin and platelet function · ApplicationA 50-year-old woman on daily low-dose aspirin has frequent nosebleeds and easy bruising. Platelet count, PT and aPTT are normal, but bleeding time is prolonged. Which m…
- Haematology: transfusional siderosis in thalassaemia · ApplicationA 14-year-old with beta thalassaemia major on regular transfusions, who has not been taking chelation, develops arrhythmias and heart failure. Cardiac MRI shows a marke…
- Haematology: iron deficiency anaemia · ApplicationWhich iron study pattern best fits uncomplicated iron deficiency anaemia?
- Haematology: megaloblastic anaemia · ApplicationHypersegmented neutrophils and macro-ovalocytes result from impaired synthesis of which macromolecule?
- Haematology: chronic myeloid leukaemia · ApplicationThe BCR-ABL fusion in chronic myeloid leukaemia encodes a constitutively active what?
- Haematology: multiple myeloma · ApplicationA patient has bone pain, anaemia, renal dysfunction and a narrow monoclonal spike on serum electrophoresis. Which urinary finding is most likely?
Systemic pathology64
- Systemic pathology: cardiovascular, respiratory, GI, renal, endocrine, CNS, bone and soft tissue: myocardial infarction histology · ApplicationA man dies 5 days after an anterior myocardial infarction. Which histological finding is expected in the infarct at this time?
- Systemic pathology: cardiovascular, respiratory, GI, renal, endocrine, CNS, bone and soft tissue: cardiomyopathy · Multi-stepA 17-year-old athlete dies suddenly during exertion. Autopsy shows an asymmetrically thickened septum with myocyte disarray and interstitial fibrosis. Which gene group…
- Systemic pathology: cardiovascular, respiratory, GI, renal, endocrine, CNS, bone and soft tissue · Multi-stepA previously healthy 45-year-old develops fever and cough, and within two weeks needs mechanical ventilation. CT shows bilateral ground-glass opacities. Lung biopsy sho…
- Systemic pathology: cardiovascular, respiratory, GI, renal, endocrine, CNS, bone and soft tissue · ApplicationA 78-year-old diabetic man has a hand X-ray showing pipe-stem calcification of the radial arteries. A biopsy shows calcium deposits in the muscular wall, with the intim…
- Systemic pathology: cardiovascular, respiratory, GI, renal, endocrine, CNS, bone and soft tissue · ApplicationColonoscopy in a 62-year-old shows multiple outpouchings in the sigmoid colon. Histology shows mucosa and submucosa herniating through the muscularis at sites where vas…
- Systemic pathology: cardiovascular, respiratory, GI, renal, endocrine, CNS, bone and soft tissue · ApplicationA 35-year-old man has gynaecomastia and a testicular mass with a golden-brown cut surface. Histology shows polygonal cells with eosinophilic cytoplasm containing rod-sh…
- Systemic pathology: cardiovascular, respiratory, GI, renal, endocrine, CNS, bone and soft tissue · Multi-stepA 65-year-old woman has a firm, solid, unilateral ovarian mass found incidentally. Histology shows nests of transitional-type epithelial cells with grooved, coffee-bean…
- Systemic pathology: cardiovascular, respiratory, GI, renal, endocrine, CNS, bone and soft tissue · ApplicationA multiparous woman with a previous caesarean section and placenta praevia needs a hysterectomy after the placenta fails to separate. The specimen shows chorionic villi…
- Systemic pathology: cardiovascular, respiratory, GI, renal, endocrine, CNS, bone and soft tissue · ApplicationA 50-year-old woman has a periareolar mass, nipple retraction and thick green-brown nipple discharge. Biopsy shows ducts distended with inspissated secretions, periduct…
- Systemic pathology: cardiovascular, respiratory, GI, renal, endocrine, CNS, bone and soft tissue · Multi-stepA stellate mammographic lesion mimics carcinoma. Core biopsy shows a central fibroelastotic core with ducts radiating outwards. The ducts show hyperplasia and entrapped…
- Systemic pathology: cardiovascular, respiratory, GI, renal, endocrine, CNS, bone and soft tissue · Multi-stepA 40-year-old woman has calcifications on mammography. Biopsy shows a lobulocentric proliferation of small acini compressed by stroma, with the lobular outline preserve…
- Systemic pathology: cardiovascular, respiratory, GI, renal, endocrine, CNS, bone and soft tissue · ApplicationOn day 12 after bone marrow transplant with busulfan and cyclophosphamide conditioning, a patient has weight gain, painful hepatomegaly and bilirubin of 6 mg/dL. What i…
- Systemic pathology: cardiovascular, respiratory, GI, renal, endocrine, CNS, bone and soft tissue · Multi-stepTwo years after bilateral adrenalectomy for Cushing disease, a patient develops headaches, bitemporal field loss and darkening of the skin. What is the cause?
- Systemic pathology: cardiovascular, respiratory, GI, renal, endocrine, CNS, bone and soft tissue · Multi-stepA 55-year-old man has sacral pain and constipation. Imaging shows a destructive midline sacral mass. Histology shows lobules of large vacuolated cells in a myxoid strom…
- Systemic pathology: cardiovascular, respiratory, GI, renal, endocrine, CNS, bone and soft tissue · ApplicationA 30-year-old has a rapidly growing, tender 2 cm nodule on the volar forearm of 3 weeks' duration. Excision shows plump spindle cells in a feathery tissue-culture patte…
- Systemic pathology: infective endocarditis lesions · ApplicationA 32-year-old man with infective endocarditis has non-tender erythematous macules on his palms and soles. Biopsy of a lesion shows neutrophilic microabscesses containin…
- Systemic pathology: stress cardiomyopathy · Multi-stepA 66-year-old woman develops chest pain and ST-segment elevation after the sudden death of her husband. Coronary angiography is normal, and echocardiography shows apica…
- Systemic pathology: endomyocardial fibrosis · Multi-stepA 20-year-old from coastal Kerala has dyspnoea, ascites and a raised jugular venous pressure. Echocardiography shows fibrous obliteration of the ventricular apices with…
- Systemic pathology: syphilitic aortitis · ApplicationA 55-year-old man has aortic regurgitation and a dilated aortic root. The aortic intima has a wrinkled tree-bark appearance, and histology shows obliterative endarterit…
- Systemic pathology: cardiac biomarkers · ApplicationA 58-year-old man had an inferior myocardial infarction six days ago and develops fresh severe chest pain with new ST elevation. Troponin is still raised from the first…
- Systemic pathology: chronic beryllium disease · Multi-stepA 38-year-old man who worked in an electronics and alloy factory has cough, dyspnoea and bilateral hilar lymphadenopathy. Lung biopsy shows non-caseating granulomas, cl…
- Systemic pathology: achalasia · ApplicationA 35-year-old man has progressive dysphagia for both solids and liquids with regurgitation of undigested food. Barium swallow shows a dilated oesophagus tapering to a b…
- Systemic pathology: eosinophilic oesophagitis · ApplicationA 20-year-old man with asthma and eczema has recurrent food impaction and dysphagia. Endoscopy shows concentric rings and longitudinal furrows in the oesophagus, and he…
- Systemic pathology: oesophageal rupture · ApplicationA 40-year-old man has severe retrosternal pain and subcutaneous emphysema in the neck after forceful vomiting following binge drinking. A chest radiograph shows a left…
- Systemic pathology: ischaemic colitis · Multi-stepA 75-year-old man with atrial fibrillation has left iliac fossa pain and bloody diarrhoea after a hypotensive episode during surgery. Colonoscopy shows segmental mucosa…
- Systemic pathology: hepatocellular adenoma · ApplicationA 28-year-old woman on long-term oral contraceptives has sudden right upper quadrant pain and hypotension. CT shows a 7 cm liver mass with haemorrhage. Histology of the…
- Systemic pathology: autoimmune hepatitis · ApplicationA 32-year-old woman has fatigue, jaundice and raised transaminases with hypergammaglobulinaemia and anti-smooth muscle antibodies. What would liver biopsy show?
- Systemic pathology: renal papillary necrosis · ApplicationA 55-year-old man with diabetes and obstructive uropathy has flank colic, haematuria and passes sloughed tissue fragments in his urine. CT urography shows a ring-shaped…
- Systemic pathology: chromophobe renal cell carcinoma · Multi-stepA 55-year-old man has a tan-brown renal mass. Histology shows large polygonal cells with prominent cell membranes, perinuclear clearing and wrinkled raisinoid nuclei. C…
- Systemic pathology: renal oncocytoma · Multi-stepA 60-year-old man has an incidental 5 cm well-circumscribed mahogany-brown renal mass with a central stellate scar. Histology shows nests of round cells with intensely…
- Systemic pathology: tuberculous meningitis · Multi-stepA 6-year-old child has a subacute illness with headache, vomiting and a cranial nerve palsy. CSF shows lymphocytic pleocytosis, markedly raised protein, low glucose and…
- Systemic pathology: hypertensive intracerebral haemorrhage · ApplicationA 62-year-old hypertensive man collapses with sudden right hemiplegia. CT shows a haemorrhage in the left putamen. Which vascular lesion is responsible?
- Systemic pathology: Wernicke encephalopathy · ApplicationA 48-year-old chronic alcoholic is confused and ataxic and has nystagmus with ophthalmoplegia. He dies, and the brain is examined. Which lesion is found?
- Systemic pathology: Krabbe disease · Multi-stepA 4-month-old infant is irritable and hypertonic with peripheral neuropathy and optic atrophy. Brain white matter shows loss of myelin and multinucleated globoid cells.…
- Systemic pathology: psoriasis histology · ApplicationA 30-year-old man has well-demarcated silvery scaly plaques on the elbows and knees, with pinpoint bleeding on scraping the scale. Which histological feature is charact…
- Systemic pathology: tenosynovial giant cell tumour · Multi-stepA 30-year-old man has recurrent haemorrhagic knee effusions. MRI shows blooming from haemosiderin, and the synovium is villous and rusty brown. Histology shows sheets o…
- Systemic pathology: achondroplasia · ApplicationA child has short limbs with a normal-sized trunk and frontal bossing. The condition results from a gain-of-function mutation in FGFR3. Which process is primarily distu…
- Systemic pathology: Rosai-Dorfman disease · Multi-stepA 12-year-old boy has massive painless bilateral cervical lymphadenopathy with fever and polyclonal hypergammaglobulinaemia. A node biopsy shows dilated sinuses filled…
- Systemic pathology: cystic hygroma · ApplicationA second-trimester ultrasound shows a large septated cystic swelling at the back of the fetal neck. After birth, histology shows dilated lymphatic channels. Which karyo…
- Systemic pathology: mitral valve prolapse · ApplicationA 28-year-old woman has a mid-systolic click and late systolic murmur. A valve excised years later for regurgitation shows ballooned, floppy leaflets. Which histologica…
- Systemic pathology: pulmonary alveolar proteinosis · Multi-stepA 35-year-old smoker has progressive dyspnoea. Bronchoalveolar lavage returns milky fluid. Biopsy shows alveoli filled with granular, PAS-positive eosinophilic material…
- Systemic pathology: bronchial carcinoid · ApplicationA 35-year-old non-smoking woman has recurrent haemoptysis and a polypoid endobronchial mass. Histology shows uniform cells in nests and ribbons with finely stippled chr…
- Systemic pathology: Zollinger-Ellison syndrome · ApplicationA 45-year-old man has multiple ulcers in the duodenum and proximal jejunum with diarrhoea. Endoscopy shows prominent gastric folds, and fasting serum gastrin is markedl…
- Systemic pathology: Menetrier disease · Multi-stepA 50-year-old man has epigastric pain, weight loss and peripheral oedema with low serum albumin. Endoscopy shows giant cerebriform gastric folds in the body and fundus.…
- Systemic pathology: oesophageal carcinoma risk factors · ApplicationA 62-year-old man with long-standing reflux has a distal oesophageal tumour that is a gland-forming adenocarcinoma. Compared with squamous carcinoma of the oesophagus,…
- Systemic pathology: non-alcoholic steatohepatitis · ApplicationA 48-year-old obese woman with type 2 diabetes has mildly raised ALT. Viral and autoimmune markers are negative and she drinks no alcohol. Biopsy shows macrovesicular f…
- Systemic pathology: focal nodular hyperplasia · Multi-stepA 30-year-old woman has an asymptomatic liver mass found incidentally on ultrasound. The resected, unencapsulated lesion shows a central stellate scar with radiating fi…
- Systemic pathology: mucinous cystic neoplasm of pancreas · Multi-stepA 42-year-old woman has a 6 cm multiloculated cyst in the pancreatic tail. The cyst fluid is thick and mucinous, and the wall is lined by columnar mucin-secreting epith…
- Systemic pathology: insulinoma · ApplicationA 40-year-old woman has episodes of confusion relieved by sugar. During a fast, glucose is low with inappropriately high insulin and C-peptide. A 1.5 cm pancreatic tumo…
- Systemic pathology: renal calculus composition · ApplicationA 35-year-old woman with recurrent urinary tract infections has a staghorn calculus filling the renal pelvis. Urine pH is alkaline and culture grows Proteus mirabilis.…
- Systemic pathology: reflux nephropathy · Multi-stepA 25-year-old woman with vesicoureteral reflux since childhood has hypertension and renal impairment. Her kidneys are shrunken with coarse, U-shaped cortical scars over…
- Systemic pathology: craniopharyngioma · ApplicationAn 8-year-old boy has headaches, bitemporal visual field loss and short stature. Imaging shows a calcified, cystic suprasellar mass containing dark oily fluid. Histolog…
- Systemic pathology: stalk effect hyperprolactinaemia · Multi-stepA 50-year-old man has headaches and bitemporal hemianopia. MRI shows a large pituitary macroadenoma compressing the stalk. Serum prolactin is mildly raised, and immunos…
- Systemic pathology: subdural haematoma · ApplicationA 65-year-old alcoholic man has increasing drowsiness and confusion two weeks after a minor fall. CT shows a crescent-shaped collection over the cerebral convexity that…
- Systemic pathology: berry aneurysm structure · ApplicationA 45-year-old woman has a sudden thunderclap headache and neck stiffness. CT shows blood in the subarachnoid space, and angiography reveals a saccular aneurysm at a bif…
- Systemic pathology: amyotrophic lateral sclerosis · ApplicationA 58-year-old man has progressive limb weakness with muscle wasting and fasciculations, together with brisk reflexes and extensor plantar responses. Sensation and eye m…
- Systemic pathology: Reye syndrome · ApplicationA 6-year-old child given aspirin for influenza develops persistent vomiting and then confusion and seizures, with raised ammonia and transaminases and no jaundice. What…
- Systemic pathology: osteochondroma malignant change · Multi-stepA 40-year-old man with multiple hereditary exostoses has had painless bony outgrowths since adolescence. One lesion near the pelvis has recently begun to enlarge and be…
- Systemic pathology: aneurysmal bone cyst · Multi-stepA 12-year-old girl has pain and swelling over the proximal tibia. Radiograph shows an eccentric, expansile lytic lesion with a thin shell, and MRI shows multiple fluid-…
- Systemic pathology: undifferentiated pleomorphic sarcoma · ApplicationA 62-year-old man has a deep thigh mass. Histology shows storiform spindle cells and bizarre multinucleated giant cells. Immunostains for desmin, S100, cytokeratin and…
- Systemic pathology: Pick disease · ApplicationA 58-year-old man develops disinhibition, apathy and language disturbance with relatively preserved memory early on. MRI shows severe, knife-edge atrophy of the frontal…
- Systemic pathology: central pontine myelinolysis · Multi-stepA malnourished alcoholic man with sodium 108 mEq/L is given hypertonic saline, and sodium rises to 128 mEq/L within a day. Three days later he develops flaccid quadripa…
- Systemic pathology: lacunar infarct · ApplicationA 65-year-old hypertensive man has a sudden pure motor hemiparesis with no cortical signs. Years later, autopsy shows a small cavity 1 cm wide in the internal capsule.…
- Systemic pathology: juvenile polyp · ApplicationA 4-year-old boy has painless rectal bleeding. Colonoscopy shows a single smooth, pedunculated 1.5 cm red polyp. Histology shows cystically dilated, mucus-filled glands…
Inflammation39
- Inflammation: leukocyte adhesion deficiency · ApplicationA 3-week-old infant still has an unseparated umbilical stump with surrounding erythema. There is no pus at the site, yet the blood count shows a total leukocyte count o…
- Inflammation: leukocyte extravasation · ApplicationA patient with relapsing multiple sclerosis receives natalizumab, a monoclonal antibody against the alpha-4 integrin subunit. Which step in leukocyte extravasation is p…
- Inflammation: vascular permeability · ApplicationA farmer is stung by a wasp and develops local swelling within minutes, which subsides over about an hour. Which mechanism is responsible for the increased vascular per…
- Inflammation: arachidonic acid metabolites · ApplicationA 35-year-old man with chronic rhinosinusitis, nasal polyps and asthma develops severe bronchospasm after taking aspirin. Which mediators are overproduced because of th…
- Inflammation: complement deficiencies · ApplicationA 19-year-old man has his second episode of meningococcal meningitis within two years. He has no splenic abnormality and normal immunoglobulin levels, but total haemoly…
- Inflammation: kinin system and hereditary angioedema · ApplicationA 22-year-old woman has recurrent episodes of non-pitting facial and laryngeal swelling and colicky abdominal pain without urticaria. Her father had similar symptoms, a…
- Inflammation: acute phase response · ApplicationA 30-year-old woman has three weeks of fever, and her erythrocyte sedimentation rate is 95 mm in the first hour. Which change underlies the raised sedimentation rate in…
- Inflammation: exudate and transudate · Multi-stepA 55-year-old man with fever and cough has a pleural effusion. Pleural fluid protein is 4.2 g/dL (serum 6.0 g/dL) and pleural fluid LDH is 350 U/L (serum 450 U/L, upper…
- Inflammation: fibrinous exudate · ApplicationA 52-year-old man with end-stage renal disease has chest pain and a pericardial friction rub. At autopsy the pericardial surfaces are covered with a shaggy, 'bread and…
- Inflammation: myeloperoxidase deficiency · ApplicationA 55-year-old man with poorly controlled diabetes has had recurrent Candida infections. A nitroblue tetrazolium test is normal, but his neutrophils fail to generate hyp…
- Inflammation: macrophage polarisation · Multi-stepIn the late phase of a healing wound, macrophages exposed to IL-4 and IL-13 differ from those activated by interferon-gamma. Which property characterises the IL-4 and I…
- Inflammation: fever pathogenesis · ApplicationA 25-year-old woman with pneumonia has a temperature of 39.5 degrees Celsius, which falls after she takes paracetamol. Which mediator, produced in response to IL-1 and…
- Inflammation: chronic osteomyelitis · ApplicationA 9-year-old boy had fever and pain in the distal femur treated late. Six weeks later a radiograph shows a dense fragment of devitalised bone lying within a cavity, sur…
- Inflammation: familial Mediterranean fever · Multi-stepA 12-year-old girl of Arab descent has had recurrent 2-day episodes of fever with severe abdominal pain, pleuritic chest pain and an erysipelas-like rash on the shin, w…
- Inflammation: phagocytosis · ApplicationA child has recurrent pyogenic infections with encapsulated bacteria. Neutrophils are normal in number and kill well in vitro, but ingestion of bacteria is poor unless…
- Inflammation · ApplicationWhich mediator causes vasodilation and pain?
- Inflammation · ApplicationWhich leukocyte is prominent in parasitic infection?
- Inflammation · ApplicationWhat is pus predominantly composed of?
- Inflammation · ApplicationWhat is the earliest vascular change in acute inflammation?
- Inflammation · ApplicationWhich mediator increases vascular permeability?
- Inflammation · ApplicationWhat cells dominate early bacterial infection?
- Inflammation · ApplicationWhat cell dominates chronic inflammation?
- Inflammation · ApplicationWhich white cell predominates early in acute bacterial inflammation?
- Inflammation · ApplicationWhich cell type is prominent in chronic inflammation?
- Inflammation · ApplicationWhat is a granuloma composed principally of?
- Inflammation · ApplicationWhich mediator causes vasodilation and increased vascular permeability early in inflammation?
- Inflammation · ApplicationWhat is pus primarily composed of?
- Inflammation · ApplicationWhat does chemotaxis mean in inflammation?
- Inflammation · ApplicationWhat mediator causes pain in acute inflammation?
- Inflammation · ApplicationWhich cells are prominent in allergic inflammation and helminth infection?
- Inflammation · ApplicationWhat is the main role of macrophages in chronic inflammation?
- Inflammation · ApplicationWhich cell is usually the first major leukocyte recruited in acute bacterial inflammation?
- Inflammation · ApplicationWhich chemokine is a major signal recruiting neutrophils to acute inflammatory sites?
- Inflammation: leukocyte adhesion · ApplicationRolling of neutrophils along activated endothelium is principally mediated by which molecules?
- Inflammation: complement · ApplicationWhich complement fragment is a potent chemotactic factor for neutrophils?
- Inflammation: exudate · ApplicationWhat distinguishes an inflammatory exudate from a transudate?
- Inflammation: chemotaxis · ApplicationWhich mediator is a major chemoattractant for neutrophils in acute inflammation?
- Inflammation: leukocyte defect · ApplicationA child has delayed separation of the umbilical cord, recurrent bacterial infections without pus, and persistent neutrophilia. What defect is likely?
- Inflammation: macrophage activation · ApplicationWhich cytokine is most important for classical activation of macrophages by T helper 1 cells?
Immunopathology37
- Immunopathology · ApplicationA man is given horse-derived antivenom after a snakebite. Eight days later he develops fever, urticarial rash and painful joints, and serum C3 is low. Which type of hyp…
- Immunopathology: granuloma and TNF · Multi-stepA 48-year-old woman with rheumatoid arthritis begins infliximab. Six months later she develops fever, weight loss and miliary shadows on chest radiograph, and biopsy sh…
- Immunopathology: AA amyloidosis · ApplicationA 45-year-old man with chronic osteomyelitis for 15 years develops nephrotic-range proteinuria and hepatosplenomegaly. A renal biopsy stained with Congo red shows apple…
- Immunopathology: IgG4-related disease · Multi-stepA 58-year-old man has painless obstructive jaundice, a diffusely enlarged sausage-shaped pancreas and bilateral submandibular gland swelling. Pancreatic biopsy shows de…
- Immunopathology: rheumatoid arthritis · ApplicationA 45-year-old woman has symmetrical swelling of the metacarpophalangeal and proximal interphalangeal joints with morning stiffness lasting 2 hours. Which finding is the…
- Immunopathology: HIV · ApplicationA researcher studies why a small number of people with a homozygous deletion in a chemokine co-receptor remain uninfected despite repeated HIV exposure. Which interacti…
- Immunopathology: hypersensitivity types · Multi-stepA farmer develops cough and dyspnoea 6 hours after cleaning a mouldy hay store. His serum has precipitating IgG against thermophilic actinomycetes. Which hypersensitivi…
- Immunopathology: mixed connective tissue disease · ApplicationA 38-year-old woman has Raynaud phenomenon, puffy fingers, inflammatory arthritis and proximal myositis, with features overlapping lupus and scleroderma but no severe r…
- Immunopathology: pemphigus vulgaris · ApplicationA 45-year-old woman has flaccid blisters that rupture easily to leave painful erosions in the mouth and skin, and the Nikolsky sign is positive. Direct immunofluorescen…
- Immunopathology: bullous pemphigoid · ApplicationA 75-year-old man has tense itchy blisters on the flexures. Biopsy shows a subepidermal blister with eosinophils, and the roof of the blister is intact. Antibodies are…
- Immunopathology: dermatitis herpetiformis · ApplicationA 30-year-old man has intensely itchy grouped vesicles on the elbows and knees. His serum tissue transglutaminase antibody is raised. Direct immunofluorescence of uninv…
- Immunopathology: lupus band test · ApplicationA 28-year-old woman with arthralgia, malar rash and proteinuria has a skin biopsy from an area of normal, non-sun-exposed skin. Direct immunofluorescence shows granular…
- Immunopathology: positive crossmatch · Multi-stepBefore a kidney transplant, the recipient's serum is incubated with donor lymphocytes and complement, and the donor cells are lysed. The surgeon asks what the result pr…
- Immunopathology: adenosine deaminase deficiency · Multi-stepAn 8-month-old infant has failure to thrive, oral candidiasis, Pneumocystis pneumonia and very low lymphocyte counts, with absent thymic shadow. The condition is autoso…
- Immunopathology: IPEX syndrome · Multi-stepA 4-month-old boy has severe watery diarrhoea, eczema, and neonatal-onset type 1 diabetes. His maternal uncle died in infancy. Mutation of which gene is most likely?
- Immunopathology: early classical complement deficiency · Multi-stepA 20-year-old woman has a malar rash, arthritis and glomerulonephritis, with undetectable total haemolytic complement activity. Genetic testing shows homozygous C1q def…
- Immunopathology: HLA and type 1 diabetes · ApplicationA 12-year-old child develops polyuria, weight loss and ketoacidosis. Islet autoantibodies are positive. Which HLA haplotypes are most strongly associated with this dise…
- Immunopathology: p24 antigen in HIV testing · ApplicationA man presents 3 weeks after a high-risk exposure with fever, sore throat and a maculopapular rash. A rapid antibody-only test is negative. A fourth-generation assay de…
- Immunopathology: immune reconstitution inflammatory syndrome · Multi-stepA man with HIV and a CD4 count of 40 cells per microlitre is started on antiretroviral therapy. Six weeks later, with a rising CD4 count and falling viral load, he deve…
- Immunopathology: transthyretin amyloidosis · Multi-stepAn 82-year-old man has heart failure with thickened ventricular walls and low-voltage ECG. Serum free light chains and immunofixation are normal. Endomyocardial biopsy…
- Immunopathology: AIRE and central tolerance · Multi-stepA 10-year-old girl has chronic mucocutaneous candidiasis, hypoparathyroidism and then Addison disease. The autosomal recessive gene responsible normally drives thymic e…
- Immunopathology: autoimmune lymphoproliferative syndrome · Multi-stepA 6-year-old has chronic non-malignant lymphadenopathy, splenomegaly and autoimmune haemolytic anaemia. Lymphocytes are resistant to apoptosis, and double-negative T ce…
- Immunopathology: mixed cryoglobulinaemia · Multi-stepA 55-year-old woman with chronic hepatitis C has palpable purpura, arthralgia, low C4 and membranoproliferative glomerulonephritis. The serum precipitates in the cold.…
- Immunopathology: neonatal lupus · Multi-stepA newborn is found to have a slow heart rate of 50 per minute and complete heart block, with a transient rash. The mother is well but has anti-Ro antibodies. What is th…
- Immunopathology: mendelian susceptibility to mycobacterial disease · Multi-stepA 3-year-old develops disseminated infection with a weakened mycobacterium after BCG vaccination, with poorly formed granulomas. T and B cell numbers and immunoglobulin…
- Immunopathology: sympathetic ophthalmia · ApplicationTwo weeks after a penetrating injury to one eye, a man develops inflammation in the uninjured eye. Which mechanism best explains this?
- Immunopathology · ApplicationWhich hypersensitivity reaction is mediated by IgE?
- Immunopathology · ApplicationWhat is an autoimmune mechanism in Graves disease?
- Immunopathology · ApplicationWhat hypersensitivity reaction is mediated by immune complexes?
- Immunopathology · ApplicationWhat hypersensitivity reaction is mediated predominantly by T cells?
- Immunopathology · ApplicationWhat mechanism underlies type II hypersensitivity?
- Immunopathology · ApplicationWhat is the pathologic hallmark of rheumatoid arthritis?
- Immunopathology · ApplicationWhich hypersensitivity type is mediated by IgE and mast-cell activation?
- Immunopathology · ApplicationWhat mechanism causes type IV hypersensitivity?
- Immunopathology: systemic lupus erythematosus · ApplicationGlomerulonephritis in systemic lupus erythematosus is classically caused by which hypersensitivity mechanism?
- Immunopathology: Goodpasture syndrome · ApplicationA patient has haemoptysis and rapidly progressive glomerulonephritis. Linear IgG staining along glomerular basement membranes indicates antibodies against what?
- Immunopathology · ApplicationWhat is the mechanism of type II hypersensitivity?
Haemodynamics36
- Haemodynamics · ApplicationWhich of the following is NOT a component of Virchow's triad for thrombosis?
- Haemodynamics: thrombosis · ApplicationAt autopsy a large vessel contains a dark red mass that is gelatinous, smooth, shiny and not adherent to the wall. A second mass is dry and friable, and adherent, with…
- Haemodynamics: paradoxical embolism · ApplicationA 30-year-old woman with a recent calf deep vein thrombosis develops sudden right-sided weakness and aphasia. CT shows an acute left middle cerebral artery territory in…
- Haemodynamics: septic shock · Multi-stepA 55-year-old man with pyelonephritis has blood pressure 80/50 mmHg, warm flushed skin, bounding pulses, raised cardiac output and a serum lactate of 5 mmol/L despite a…
- Haemodynamics: infarction · ApplicationA 16-year-old boy has sudden severe scrotal pain. At orchidectomy the testis is enlarged and dark red-black, with the spermatic cord twisted twice on itself. What expla…
- Haemodynamics: fat embolism syndrome · Multi-stepA 25-year-old man sustains a closed femoral shaft fracture in a road accident. Forty-eight hours later he becomes breathless and confused, and has petechiae over the ch…
- Haemodynamics: pulmonary embolism and infarction · Multi-stepA medium-sized pulmonary artery embolus in a previously healthy adult usually does not cause lung infarction, but the same embolus in a patient with chronic left heart…
- Haemodynamics: lymphatic oedema · ApplicationA 40-year-old man from coastal Odisha has had chronic swelling of the right leg for 6 years. The skin is thickened and rough, and pressing leaves no pit. Which mechanis…
- Haemodynamics: Trousseau syndrome · ApplicationA 62-year-old man with weight loss and epigastric pain develops recurrent migratory superficial venous thrombosis at different sites. Which mechanism best explains the…
- Haemodynamics: interpreting shock profiles · Multi-stepAfter a road accident a 30-year-old man has cold clammy skin and a heart rate of 130 per minute. Pulmonary artery catheter readings show a cardiac output of 2.1 L/min/m…
- Haemodynamics: Budd-Chiari syndrome · Multi-stepA 32-year-old woman with polycythaemia vera develops painful hepatomegaly and rapidly accumulating ascites. Doppler shows no flow in the hepatic veins. Which histologic…
- Haemodynamics: decompression sickness · ApplicationA commercial diver who ascended rapidly has acute joint pain. Years later he develops progressive hip pain, and radiographs show a subchondral lucent crescent in the fe…
- Haemodynamics: chronic passive congestion · ApplicationA 60-year-old man with chronic right heart failure has a tender enlarged liver. The cut surface shows alternating dark red and pale brown areas. Where is the dark red z…
- Haemodynamics: pulmonary embolism · Multi-stepA 45-year-old woman collapses and dies 6 days after a hip replacement. Autopsy shows a large coiled thrombus straddling the bifurcation of the main pulmonary trunk. Whe…
- Haemodynamics: paradoxical embolism · Multi-stepA 30-year-old with calf swelling suddenly develops hemiparesis. Echocardiography with bubble study shows a patent foramen ovale. Through which mechanism did the stroke…
- Haemodynamics: pulmonary infarct · ApplicationA 55-year-old dies after a pulmonary embolism that occluded a peripheral branch. At autopsy, the lung shows a wedge-shaped, dark red lesion with its base at the pleura.…
- Haemodynamics: Budd-Chiari syndrome · Multi-stepA young woman with polycythaemia vera develops painful hepatomegaly, ascites and rapid weight gain. Imaging shows non-visualisation of the hepatic veins. What does live…
- Haemodynamics: shock mechanism · ApplicationA 45-year-old with fever, hypotension and warm flushed extremities has a normal central venous pressure and a bounding pulse. Which mechanism underlies this shock?
- Haemodynamics: arterial thrombus · ApplicationA 62-year-old smoker has an occlusive thrombus overlying a ruptured atheromatous plaque in the left anterior descending artery. Which description best fits this thrombus?
- Haemodynamics: pulmonary hypertension · ApplicationA 28-year-old woman has progressive exertional dyspnoea, a loud pulmonary second sound and right ventricular hypertrophy. Her mother died of a similar illness. Lung bio…
- Haemodynamics: cerebral venous sinus thrombosis · ApplicationA 26-year-old woman taking combined oral contraceptives has three days of worsening headache, then a generalised seizure. MR venography shows a filling defect in the su…
- Haemodynamics: Waterhouse-Friderichsen syndrome · ApplicationA 7-year-old boy dies within 14 hours of fever, headache and a spreading purpuric rash. Blood culture grew Gram-negative diplococci. What is the expected finding in the…
- Haemodynamics: cholesterol atheroembolism · Multi-stepA 68-year-old man with severe atherosclerosis develops a bluish mottled rash on both feet, eosinophilia and a rising creatinine two weeks after coronary angiography. Pa…
- Haemodynamics: homocystinuria and thrombosis · ApplicationA tall 19-year-old with long limbs, downward lens subluxation and learning difficulty presents with a deep vein thrombosis. Urine cyanide-nitroprusside test is positive…
- Haemodynamics: irreversible stage of shock · ApplicationA man in haemorrhagic shock is resuscitated with fluids and blood, and his blood pressure returns to normal. Over the next day he develops oliguric renal failure, lung…
- Haemodynamics: hepatic changes in shock · ApplicationA 60-year-old man develops a sudden fall in blood pressure after massive myocardial infarction. Two days later aminotransferases are over 3000 U/L. Which pattern of hep…
- Haemodynamics: serum-ascites albumin gradient · ApplicationA 50-year-old man with long-standing alcohol use has abdominal distension. Paracentesis shows a clear fluid with serum-ascites albumin gradient 1.6 g/dL and ascitic pro…
- Haemodynamics: renal contribution to cardiac oedema · ApplicationA man with chronic right heart failure has pitting leg oedema that worsens despite normal albumin. Which process in the kidney most directly sustains the generalised oe…
- Haemodynamics: warfarin-induced skin necrosis · Multi-stepOn day 4 of warfarin started without heparin cover, a 55-year-old woman develops painful, well-demarcated areas of skin necrosis on the thighs and breasts. Biopsy shows…
- Haemodynamics: antithrombin deficiency · Multi-stepA 30-year-old woman with extensive iliofemoral thrombosis has an aPTT that barely rises despite escalating intravenous unfractionated heparin doses. Her father also had…
- Haemodynamics: hereditary haemorrhagic telangiectasia · ApplicationA 35-year-old man has recurrent nosebleeds, mucocutaneous red spots on his lips and fingertips, and a father with the same findings. Platelet count, PT and aPTT are nor…
- Haemodynamics: Virchow triad · ApplicationA patient develops deep-vein thrombosis after prolonged immobilisation in hospital. Which component of Virchow triad is most directly responsible?
- Haemodynamics: disseminated intravascular coagulation · Multi-stepA patient with placental abruption has oozing from venepuncture sites, thrombocytopenia, prolonged PT and aPTT, and low fibrinogen. What process best explains this?
- Haemodynamics: shock · ApplicationWhich shock state typically has warm extremities and reduced systemic vascular resistance early in its course?
- Haemodynamics · ApplicationWhich haemodynamic process makes inflamed tissue red and warm through active arteriolar dilation?
- Haemodynamics · ApplicationWhat mechanism causes oedema in nephrotic syndrome?
Cell injury and adaptation34
- Cell injury and adaptation: telomere biology · ApplicationA 12-year-old has premature greying, nail dystrophy and oral leukoplakia, followed by bone marrow failure. The underlying defect is in maintenance of which structure?
- Cell injury and adaptation: metaplasia mechanism · ApplicationA 40-year-old with chronic reflux has columnar epithelium with goblet cells replacing the distal oesophageal squamous lining. What best explains this change?
- Cell injury and adaptation: lysosomal glycogen storage · Multi-stepA 4-month-old hypotonic infant has macroglossia and marked cardiomegaly. A muscle biopsy shows vacuolated fibres filled with PAS-positive material that is abolished by…
- Cell injury and adaptation: Tay-Sachs disease · ApplicationA 7-month-old infant of Ashkenazi Jewish descent has lost the ability to sit, startles excessively to sound and has a cherry-red spot at the macula. The liver and splee…
- Cell injury and adaptation: Niemann-Pick disease · Multi-stepAn 8-month-old infant has feeding difficulty, hepatosplenomegaly and progressive neurological regression. Fundoscopy shows a cherry-red macula and a marrow aspirate sho…
- Cell injury and adaptation: Fabry disease · ApplicationA 17-year-old boy has episodes of burning pain in the hands and feet, clusters of dark red papules around the umbilicus and proteinuria. His maternal uncle died of rena…
- Cell injury and adaptation: Hurler syndrome · ApplicationA 2-year-old has coarse facies, corneal clouding, hepatosplenomegaly, a thoracolumbar gibbus and developmental delay. Which pair of glycosaminoglycans accumulates in th…
- Cell injury and adaptation: Dubin-Johnson pigment · ApplicationA 20-year-old man has mild fluctuating jaundice. Liver enzymes are normal, the bilirubin is predominantly conjugated, and at laparoscopy the liver is uniformly black. W…
- Cell injury and adaptation: ochronosis · ApplicationA 45-year-old man has urine that turns dark on standing, bluish-black pigmentation of the ear cartilage and sclerae, and degenerative arthritis of the spine. Which enzy…
- Cell injury and adaptation: molecular basis of cardiac hypertrophy · ApplicationA 62-year-old man with long-standing severe aortic stenosis has a concentrically thickened left ventricle. Which molecular change in his cardiac myocytes contributes to…
- Cell injury and adaptation: proteolysis in cachexia · ApplicationA 58-year-old man with advanced lung cancer has marked wasting of skeletal muscle and a raised TNF level. Which proteolytic system is chiefly responsible for the loss o…
- Cell injury and adaptation: metaplasia in schistosomiasis · ApplicationA 40-year-old farmer from the Nile delta has had terminal haematuria for years. Cystoscopy shows granular mucosa, and a biopsy of the chronically inflamed bladder shows…
- Cell injury and adaptation: Werner syndrome · Multi-stepA 32-year-old man has premature greying, bilateral cataracts, thin tight skin over the limbs, type 2 diabetes and has just been treated for a sarcoma. Growth was normal…
- Cell injury and adaptation: peroxisomal disorder · ApplicationA neonate has profound hypotonia, a high forehead with flat facial profile, hepatomegaly, seizures and jaundice. Liver biopsy shows an absence of peroxisomes. Which sub…
- Cell injury and adaptation: paracetamol hepatotoxicity · ApplicationA 22-year-old woman is admitted after ingesting a large quantity of paracetamol. Two days later transaminases are in the thousands and a liver biopsy shows confluent ce…
- Cell injury and adaptation: radiation injury · ApplicationA child receiving therapeutic ionising radiation develops damage to rapidly dividing cells in the irradiated field. What is the principal mechanism by which the radiati…
- Cell injury and adaptation: peroxynitrite · ApplicationIn injured and inflamed tissue, nitric oxide reacts with another reactive species to form a powerful oxidant that damages lipids, proteins and DNA. Which species combin…
- Cell injury and adaptation: pyroptosis · ApplicationA form of programmed cell death depends on activation of caspase-1 within an inflammasome, forms membrane pores through gasdermin and releases IL-1 beta. Which process…
- Cell injury and adaptation: inflammasome in gout · ApplicationA 55-year-old man has an acutely painful, red first metatarsophalangeal joint, and polarised microscopy of the aspirate shows needle-shaped crystals. Which cytosolic co…
- Cell injury and adaptation: annexin V detection of apoptosis · Multi-stepIn flow cytometry of a culture exposed to a cytotoxic drug, one population of cells binds annexin V but excludes propidium iodide. Which state are these cells in?
- Cell injury and adaptation: ultrastructure of irreversible injury · ApplicationElectron microscopy of ischaemic myocardium is examined to decide whether injury has become irreversible. Which finding indicates the point of no return?
- Cell injury and adaptation: hypoxic injury and HIF-1 · Multi-stepA tumour cell in a poorly vascularised region survives on anaerobic glycolysis and stimulates new vessel growth. Which transcription factor, stabilised under low oxygen…
- Cell injury and adaptation: extrinsic apoptosis · ApplicationCytotoxic T cells induce apoptosis in a virus-infected hepatocyte by binding Fas on its surface. Which adaptor protein recruited to the receptor's death domain directly…
- Cell injury and adaptation: clearance of apoptotic cells · ApplicationApoptotic cells are cleared by macrophages without triggering inflammation. Which membrane change on the dying cell acts as the main 'eat me' signal?
- Cell injury and adaptation: acquired pigmentation · ApplicationA retired coal miner has a blackened lung and hilar nodes. Macrophages laden with black granules are seen along lymphatics. Which pigment is this?
- Cell injury and adaptation: hypertrophy and hyperplasia in pregnancy · ApplicationThe uterus enlarges many-fold during pregnancy. Which process explains this under oestrogen stimulation?
- Cell injury and adaptation: disuse atrophy mechanism · Multi-stepA limb immobilised in plaster for six weeks shows reduced muscle bulk. Which cellular mechanism contributes most to the loss of cell mass?
- Cell injury and adaptation: metachromatic leukodystrophy · Multi-stepA toddler regresses in gait and speech, and nerve biopsy shows metachromatic granules in myelin-forming cells. Which enzyme is deficient?
- Cell injury and adaptation: Hunter syndrome · Multi-stepA boy with coarse facies, hepatosplenomegaly and mental decline has no corneal clouding. The disorder is X-linked. Which enzyme is deficient?
- Cell injury and adaptation: von Gierke disease · Multi-stepAn infant has hepatomegaly, severe fasting hypoglycaemia, lactic acidosis and hyperuricaemia, with glycogen and fat in hepatocytes. Which enzyme is deficient?
- Cell injury and adaptation: Zenker degeneration · Multi-stepIn a patient with severe typhoid fever, the rectus abdominis shows waxy, glassy, hyalinised muscle fibres with loss of striations. What is this change called?
- Cell injury and adaptation: gas gangrene toxin · Multi-stepAfter a contaminated road-traffic wound, a limb develops crepitus and rapidly spreading muscle necrosis. Which bacterial toxin is chiefly responsible for the tissue des…
- Cell injury and adaptation: markers of myocyte necrosis · ApplicationSix hours after chest pain, a rise in a serum protein indicates irreversible myocyte injury. What is the pathological basis for this rise?
- Cell injury and adaptation: argyria · Multi-stepA man who used silver-containing nasal drops for years has diffuse slate-grey skin discolouration, worse in sun-exposed areas. What is the nature of the discolouration?
Inflammation and repair30
- Inflammation and repair: sarcoidosis hypercalcaemia · ApplicationA 35-year-old woman with bilateral hilar lymphadenopathy and non-caseating granulomas has a serum calcium of 12.5 mg/dL. What is the mechanism of the hypercalcaemia?
- Inflammation and repair: keloid versus hypertrophic scar · ApplicationA 22-year-old develops a raised scar after ear piercing that grows well beyond the original wound margin and recurs after excision. Which histological feature is charac…
- Inflammation and repair: acute phase response · ApplicationA patient with chronic inflammation has a low serum iron and a high serum ferritin. Which acute-phase protein, induced by IL-6, accounts for the low iron?
- Inflammation and repair · Multi-stepA diabetic woman has recurrent E. coli urinary infection. Cystoscopy shows soft yellow-brown bladder plaques. Biopsy shows sheets of foamy macrophages with laminated, c…
- Inflammation and repair: stages of lobar pneumonia · ApplicationAt autopsy of a man who died of pneumococcal lobar pneumonia, one lobe is red, firm and airless with a dry granular cut surface. Alveoli are packed with neutrophils, re…
- Inflammation and repair: pseudomembranous colitis · ApplicationA 70-year-old woman develops profuse watery diarrhoea 8 days after a course of clindamycin. Colonoscopy shows yellow-white plaques, and biopsy shows a volcano-like erup…
- Inflammation and repair: PECAM-1 and transmigration · ApplicationAfter firm adhesion to the endothelium, leukocytes squeeze between endothelial cells in postcapillary venules to enter the tissue. Which molecule on both leukocytes and…
- Inflammation and repair: P-selectin mobilisation · ApplicationWithin minutes of exposure to histamine, venular endothelium shows a marked increase in leukocyte rolling. Which change at the endothelial surface explains this rapid r…
- Inflammation and repair: leukocyte adhesion deficiency type 2 · Multi-stepAn infant has recurrent bacterial infections, a marked neutrophilia and an absence of pus at infection sites. Red cells are of the rare Bombay phenotype and the neutrop…
- Inflammation and repair: Hageman factor · ApplicationWhich plasma protein, activated on contact with exposed collagen or basement membrane, initiates the kinin, clotting and fibrinolytic systems at a site of injury?
- Inflammation and repair: bradykinin and ACE inhibitors · ApplicationA 55-year-old hypertensive man taking an angiotensin-converting enzyme inhibitor develops a persistent dry cough and an episode of lip swelling. Accumulation of which m…
- Inflammation and repair: lipoxins and resolution · ApplicationDuring the resolution of acute inflammation, a class of arachidonic acid derivatives formed by transcellular biosynthesis inhibits neutrophil chemotaxis and adhesion. W…
- Inflammation and repair: exuberant granulation tissue · ApplicationA chronic leg wound has a raised, beefy-red, friable mass of granulation tissue projecting above the level of the surrounding skin and preventing the edges from epithel…
- Inflammation and repair: Wallerian degeneration · ApplicationA peripheral nerve is completely transected in an accident. Which sequence of events occurs in the segment distal to the cut?
- Inflammation and repair: limbal stem cells · ApplicationCorneal epithelium renews itself continuously and heals small abrasions without scarring. Where do the stem cells that regenerate it reside?
- Inflammation and repair: fracture callus · ApplicationAt four weeks after a closed femoral shaft fracture, radiographs show bridging callus. Which tissue forms the hard callus before it is remodelled?
- Inflammation and repair: gumma of syphilis · ApplicationA 50-year-old man has a rubbery nodule in the liver. Histology shows a central area of coagulative necrosis surrounded by epithelioid histiocytes, lymphocytes and numer…
- Inflammation and repair: neutrophil granule contents · Multi-stepNeutrophils contain two main granule types. Which constituent is found in the azurophil (primary) granules?
- Inflammation and repair: eotaxin · ApplicationIn allergic inflammation of the airway, which chemokine acts through CCR3 to recruit eosinophils selectively?
- Inflammation and repair: delayed prolonged vascular leakage · Multi-stepA fair-skinned man develops swelling and redness of his shoulders about 8 hours after severe sunburn. The oedema persists for several days. Which pattern of vascular le…
- Inflammation and repair: Dohle bodies · ApplicationA blood smear of a patient with sepsis shows neutrophils with coarse dark granules, vacuoles and small pale-blue cytoplasmic inclusions. What are these inclusions?
- Inflammation and repair: IL-8 in neutrophil chemotaxis · ApplicationA chemokine secreted by activated macrophages and endothelium binds receptors on neutrophils and attracts them along a gradient into infected tissue. Which is it?
- Inflammation and repair: complement and PNH · Multi-stepA man has episodic haemoglobinuria and venous thrombosis. His red cells lyse excessively through complement because they lack GPI-anchored regulators. Which are the mis…
- Inflammation and repair: C3 deficiency · Multi-stepA child has repeated severe pyogenic infections with encapsulated bacteria and an immune complex disease. Which complement component deficiency fits best?
- Inflammation and repair: hypertrophic scar versus keloid · Multi-stepA raised scar appears over a sternotomy wound within weeks, stays within the margins of the original incision and regresses partly over a year. How does this differ fro…
- Inflammation and repair: wound dehiscence · ApplicationTen days after abdominal surgery, an obese diabetic patient on long-term prednisolone has the wound open up with a coughing fit. Which factor most directly weakens the…
- Inflammation and repair: diphtheria pseudomembrane · Multi-stepA child with sore throat has a grey, adherent membrane over the tonsils that bleeds when peeled. What is the membrane composed of?
- Inflammation and repair: spreading cellulitis · ApplicationA leg develops a diffuse, rapidly spreading, warm red swelling without a localised pus collection. Which bacterial enzyme most readily explains the lack of localisation?
- Inflammation and repair: pentraxins · ApplicationA patient with bacterial pneumonia shows markedly raised C-reactive protein. How does this acute phase protein help host defence?
- Inflammation and repair: serotonin as mediator · ApplicationPlatelet dense granules release a preformed amine that increases vascular permeability and is a vasoconstrictor. Which mediator is this?
Cell injury29
- Cell injury: fatty change · ApplicationA 44-year-old man who has consumed alcohol heavily for 15 years has a smooth, enlarged, yellow liver on ultrasound. A biopsy shows macrovesicular fat in hepatocytes. Wh…
- Cell injury: free radical injury · ApplicationA worker in a chemical plant is exposed to carbon tetrachloride vapour and later develops centrilobular hepatic necrosis with fatty change. What is the principal mechan…
- Cell injury: ischaemia-reperfusion · Multi-stepA 58-year-old man with an acute anterior myocardial infarction undergoes primary angioplasty 90 minutes after onset. Hours later a biopsy of the reperfused zone shows c…
- Cell injury: Fenton reaction and iron · Multi-stepA 16-year-old with beta-thalassaemia major on regular transfusions without chelation develops cardiac dysfunction. Free iron in the myocardium is thought to damage cell…
- Cell injury: gangrene · ApplicationA 62-year-old diabetic man has a swollen, black, foul-smelling foot with blisters and poorly defined demarcation. There is no crepitus and a radiograph shows no soft-ti…
- Cell injury: fat necrosis · ApplicationA 45-year-old man with severe epigastric pain and raised serum lipase undergoes laparotomy and has chalky white foci scattered over the omentum. What is the mechanism b…
- Cell injury: fibrinoid necrosis · ApplicationA 38-year-old man with blood pressure 240/140 mmHg has headache and retinal haemorrhages. A renal biopsy shows afferent arterioles with a bright pink, smudged wall and…
- Cell injury: lipofuscin · ApplicationAn 85-year-old woman dies of cancer cachexia. At autopsy the heart is small, firm and brown. Microscopy shows perinuclear golden-brown granules in myocytes that do not…
- Cell injury: dystrophic calcification · Multi-stepCalcium deposits are found in the following specimens. Which specimen shows dystrophic calcification?
- Cell injury: haemosiderin · ApplicationA 42-year-old woman with long-standing rheumatic mitral stenosis has breathlessness and rusty sputum. Bronchoalveolar lavage shows macrophages with golden-brown cytopla…
- Cell injury: autophagy · ApplicationIn a starved cell, electron microscopy shows double-membrane vacuoles enclosing organelles that fuse with lysosomes. Which process is this, and what signals it?
- Cell injury: carbon tetrachloride toxicity · ApplicationA worker in a dry-cleaning unit accidentally inhales a large amount of carbon tetrachloride vapour. Over the next three days he develops centrilobular hepatic necrosis…
- Cell injury: necroptosis · Multi-stepIn cultured hepatocytes infected with a virus that expresses a caspase-8 inhibitor, TNF still causes cell death with swelling, membrane rupture and release of inflammat…
- Cell injury: cyanide poisoning · Multi-stepA worker is found collapsed after drinking an electroplating solution. He has cherry-red skin and severe lactic acidosis, venous blood is bright red, and PaO2 is normal…
- Cell injury: cellular ageing · ApplicationA researcher compares fibroblasts from a young donor and an elderly donor in culture. The older cells stop dividing after fewer passages. Which mechanism most directly…
- Cell injury: reversible injury · ApplicationA hepatocyte exposed briefly to a mitochondrial toxin appears swollen and pale, with small cytoplasmic vacuoles, and recovers when the toxin is removed. Which primary b…
- Cell injury · ApplicationCaseous necrosis is classically associated with what infection?
- Cell injury · ApplicationWhat is reversible cell swelling called?
- Cell injury · ApplicationWhat is the reversible cellular swelling caused by failure of ionic pumps called?
- Cell injury · ApplicationWhat type of necrosis is typical of cerebral infarction?
- Cell injury · ApplicationWhat form of programmed cell death occurs without marked inflammation?
- Cell injury · ApplicationWhat necrosis pattern is common after myocardial infarction?
- Cell injury · ApplicationWhat type of necrosis occurs in acute pancreatitis?
- Cell injury · ApplicationWhat cellular change is typical of reversible hypoxic injury?
- Cell injury · ApplicationWhich cellular change is a classic reversible response to acute hypoxic injury?
- Cell injury · ApplicationWhat is the defining feature of necrosis?
- Cell injury · ApplicationWhich feature is most typical of apoptosis?
- Cell injury: necrosis in cerebral infarction · ApplicationAn occlusion of the middle cerebral artery produces an infarct that becomes soft and cystic over time. Which pattern of necrosis is expected in the brain?
- Cell injury: reversible injury · ApplicationWhich cellular change is typical of reversible cell injury?
Cell adaptation18
- Cell adaptation · ApplicationIncrease in cell size from increased workload is what?
- Cell adaptation · ApplicationIncrease in cell number from hormonal stimulation is what?
- Cell adaptation · ApplicationReplacement of one mature cell type by another is what?
- Cell adaptation · ApplicationDecreased cell size from reduced workload is what?
- Cell adaptation · ApplicationWhat is an increase in cell size in response to increased workload called?
- Cell adaptation · ApplicationWhat is an increase in cell number due to a stimulus called?
- Cell adaptation · ApplicationWhat is replacement of one mature cell type by another called?
- Cell adaptation · ApplicationWhat is a decrease in cell size due to reduced workload called?
- Cell adaptation · ApplicationWhat adaptation occurs when bronchial epithelium becomes squamous in smokers?
- Cell adaptation · ApplicationWhich term describes an increase in the number of cells within an organ in response to a stimulus?
- Cell adaptation · ApplicationWhich example best illustrates metaplasia caused by chronic cigarette smoking?
- Cell adaptation · ApplicationWhat does epithelial dysplasia signify in a biopsy specimen?
- Cell adaptation: Barrett oesophagus · ApplicationChronic gastro-oesophageal reflux causes replacement of distal oesophageal squamous epithelium by intestinal-type columnar epithelium. This adaptation is called what?
- Cell adaptation · ApplicationWhich adaptive change replaces bronchial ciliated columnar epithelium with squamous epithelium in smokers?
- Cell adaptation · ApplicationWhat cellular adaptation explains increased left-ventricular wall thickness in chronic hypertension?
- Cell adaptation: hypertrophy · ApplicationWhich example best illustrates physiologic hypertrophy?
- Cell adaptation: metaplasia · ApplicationChronic cigarette smoke exposure causes replacement of ciliated columnar epithelium in bronchi by stratified squamous epithelium. What is this adaptation?
- Cell adaptation: Barrett esophagus · ApplicationIn Barrett esophagus, normal stratified squamous epithelium is replaced by which type?
Wound healing15
- Wound healing · ApplicationWhich cells synthesize collagen in healing wounds?
- Wound healing · ApplicationWhich vitamin deficiency impairs wound healing?
- Wound healing · ApplicationWhich cells synthesize collagen during repair?
- Wound healing · ApplicationWhat is granulation tissue composed of during repair?
- Wound healing · ApplicationWhat vitamin deficiency can impair collagen hydroxylation and wound healing?
- Wound healing · ApplicationWhat type of collagen predominates in an early healing wound?
- Wound healing · ApplicationWhat complication is caused by excessive scar formation beyond wound borders?
- Wound healing · ApplicationWhich phase of wound healing is characterized by new capillary formation and fibroblast proliferation?
- Wound healing · ApplicationWhich cell synthesizes collagen during tissue repair?
- Wound healing · ApplicationWhat does granulation tissue contain?
- Wound healing: granulation tissue · ApplicationWhich histologic combination best defines granulation tissue in a healing wound?
- Wound healing · ApplicationWhat vitamin deficiency impairs wound healing by disrupting collagen synthesis?
- Wound healing · ApplicationWhat is wound contraction primarily mediated by?
- Wound healing: granulation tissue · ApplicationWhich feature is characteristic of granulation tissue in a healing wound?
- Wound healing: keloid · ApplicationWhat distinguishes a keloid from a hypertrophic scar?
Respiratory14
- Respiratory: primary ciliary dyskinesia · ApplicationA 24-year-old man has chronic productive cough since childhood, recurrent sinusitis and infertility with normal sperm counts but immotile sperm. Chest imaging shows bro…
- Respiratory: silicosis · ApplicationA 45-year-old man who has worked for 20 years cutting sandstone has progressive breathlessness. Chest radiograph shows small nodular opacities in the upper zones and th…
- Respiratory: lung adenocarcinoma · Multi-stepA 58-year-old Indian woman who has never smoked has metastatic peripheral lung adenocarcinoma on biopsy. Which molecular test should be requested on the tissue before c…
- Respiratory: squamous cell carcinoma and hypercalcaemia · Multi-stepA 62-year-old smoker has a central cavitating lung mass. Serum calcium is 13.4 mg/dL with a suppressed parathyroid hormone, and a skeletal survey shows no bone metastas…
- Respiratory: neonatal respiratory distress syndrome · ApplicationA neonate born at 30 weeks develops grunting, cyanosis and chest wall retractions within hours of birth. Radiograph shows a ground-glass pattern with air bronchograms.…
- Respiratory: stages of lobar pneumonia · ApplicationA 50-year-old alcoholic man has high fever and rusty sputum. On the third day of illness, a lung specimen is airless, red-purple and firm like liver. Microscopy shows a…
- Respiratory: usual interstitial pneumonia · Multi-stepA 65-year-old man has progressive breathlessness, dry cough, finger clubbing and fine bibasal crackles. HRCT shows subpleural basal honeycombing with traction bronchiec…
- Respiratory: hypersensitivity pneumonitis · ApplicationA 45-year-old farmer develops fever, cough and dyspnoea about 6 hours after handling mouldy hay, which settles in a few days and recurs on re-exposure. Biopsy shows lym…
- Respiratory: malignant mesothelioma · Multi-stepA 66-year-old retired insulation worker has pleural effusion, chest pain and rind-like pleural thickening encasing the lung. Biopsy shows epithelioid malignant cells. W…
- Respiratory: bronchopneumonia · ApplicationA 78-year-old bedridden man after a stroke develops fever and purulent sputum. A chest radiograph shows patchy opacities in both lower zones. At autopsy, what is the ch…
- Respiratory: Caplan syndrome · ApplicationA 55-year-old coal miner with seropositive rheumatoid arthritis has several well-defined peripheral lung nodules of 1 to 4 cm on chest radiography. On section the nodul…
- Respiratory: emphysema · ApplicationA 62-year-old man with a 40 pack-year smoking history has progressive dyspnoea. Autopsy shows enlarged airspaces in the upper lobes, with the walls of respiratory bronc…
- Respiratory: chronic bronchitis · ApplicationA 55-year-old man who smokes has had a productive cough on most days for the last 3 months in each of 2 consecutive years. A bronchial biopsy would most likely show whi…
- Respiratory: lung tumours · ApplicationA 62-year-old smoker has shoulder pain radiating down the inner arm, weakness of the hand muscles, and a drooping eyelid with a constricted pupil on the right. A chest…
Hematopathology13
- Hematopathology · ApplicationWhat red-cell finding is typical of iron deficiency anemia?
- Hematopathology · ApplicationWhat red-cell pattern is common in folate deficiency?
- Hematopathology · ApplicationWhat cell fragment on blood film suggests microangiopathic hemolysis?
- Hematopathology · ApplicationWhat translocation is associated with chronic myeloid leukemia?
- Hematopathology · ApplicationWhat cell is characteristic of Hodgkin lymphoma?
- Hematopathology · ApplicationWhat is a common peripheral smear feature of megaloblastic anemia?
- Hematopathology · ApplicationWhat type of anemia is associated with reduced erythropoietin in chronic kidney disease?
- Hematopathology · ApplicationWhat platelet disorder is characterized by low platelet count?
- Hematopathology · ApplicationWhat is a common blood-film feature in iron deficiency anemia?
- Hematopathology · ApplicationWhat is a common feature of acute leukemia?
- Hematopathology · ApplicationWhat finding is characteristic of multiple myeloma?
- Hematopathology: Hodgkin lymphoma · ApplicationWhich cell is characteristic of classical Hodgkin lymphoma?
- Hematopathology: multiple myeloma · ApplicationA patient has bone pain, lytic lesions, anemia, renal impairment, and high total protein. Which malignancy is most likely?
Hemodynamic disorders13
- Hemodynamic disorders · ApplicationWhat does edema represent?
- Hemodynamic disorders · ApplicationWhat process forms a thrombus in an uninjured vein during stasis?
- Hemodynamic disorders · ApplicationWhat is a common source of pulmonary emboli?
- Hemodynamic disorders · ApplicationDuring exercise, arteriolar dilation produces an active increase in blood flow to skeletal muscle; what is this called?
- Hemodynamic disorders · ApplicationIn chronic right-sided heart failure, impaired venous outflow produces passive blood accumulation in the liver; what is this called?
- Hemodynamic disorders · ApplicationWhat term describes an embolus that travels from a venous source to pulmonary arteries?
- Hemodynamic disorders · ApplicationA patient with heart failure develops dependent pitting swelling because fluid accumulates outside blood vessels in tissues; what process is this?
- Hemodynamic disorders · ApplicationWhat is Virchow triad a risk framework for?
- Hemodynamic disorders · ApplicationFollowing sudden arterial occlusion, a wedge-shaped region of tissue dies from loss of perfusion; what lesion has formed?
- Hemodynamic disorders: edema · ApplicationWhich mechanism most directly causes edema in nephrotic syndrome?
- Hemodynamic disorders: hyperemia · ApplicationWhat distinguishes active hyperemia from passive congestion?
- Hemodynamic disorders: chronic congestion · ApplicationWhich histologic finding is expected in chronic passive congestion of the liver from right-sided heart failure?
- Hemodynamic disorders: disseminated intravascular coagulation · ApplicationWhat is the central pathophysiologic feature of disseminated intravascular coagulation?
Necrosis11
- Necrosis · ApplicationFat necrosis is classically seen in what?
- Necrosis · ApplicationFibrinoid necrosis is typical of what process?
- Necrosis · ApplicationWhat necrosis is typical of brain infarct?
- Necrosis · ApplicationWhat necrosis is typical of TB?
- Necrosis · ApplicationWhich type of necrosis is most typical of myocardial infarction?
- Necrosis · ApplicationWhich pattern of necrosis is expected in a cerebral infarct?
- Necrosis · ApplicationWhich infectious disease is classically associated with caseous necrosis in granulomas?
- Necrosis · ApplicationWhat type of necrosis can follow leakage of pancreatic enzymes into peripancreatic adipose tissue?
- Necrosis: coagulative necrosis · ApplicationWhich organ most commonly shows coagulative necrosis after ischemic infarction?
- Necrosis: liquefactive necrosis · ApplicationWhat type of necrosis is characteristic of cerebral infarction?
- Necrosis: caseous necrosis · ApplicationWhich setting is most associated with caseous necrosis?
Chronic inflammation10
- Chronic inflammation: eosinophilic response · ApplicationA 9-year-old boy from a rural area has cough, abdominal discomfort and an absolute eosinophil count of 2,500 per microlitre. Stool examination shows Ascaris lumbricoide…
- Chronic inflammation: TNF and granulomas · Multi-stepA 50-year-old woman with rheumatoid arthritis has been taking infliximab for six months. She now has fever, night sweats, weight loss and a chest radiograph showing mil…
- Chronic inflammation: cat-scratch disease · ApplicationA 7-year-old child has had a tender axillary lymph node for 2 weeks, after being scratched by a kitten. A node biopsy shows stellate necrotising granulomas with central…
- Chronic inflammation: spectrum of leprosy · Multi-stepA 30-year-old man has a single anaesthetic, hypopigmented, sharply demarcated plaque. A skin biopsy shows well-formed epithelioid granulomas with Langhans giant cells t…
- Chronic inflammation: actinomycosis · ApplicationAfter a dental extraction, a 40-year-old man develops a firm swelling of the lower jaw with multiple draining sinuses discharging yellow granules. Crushed granules show…
- Chronic inflammation: Whipple disease · ApplicationA 45-year-old man has weight loss, steatorrhoea, migratory arthralgia and low-grade fever. A small bowel biopsy shows a lamina propria packed with foamy macrophages con…
- Chronic inflammation · ApplicationWhich cell type is central to chronic inflammation and tissue repair signaling?
- Chronic inflammation: granuloma · ApplicationWhich cytokine from Th1 lymphocytes activates macrophages and promotes formation of a tuberculous granuloma?
- Chronic inflammation · ApplicationWhich cells predominate in chronic inflammation?
- Chronic inflammation · ApplicationWhich cell is the principal effector cell in chronic inflammation and antibody production?
Endocrine10
- Endocrine: Graves disease · ApplicationA 32-year-old woman has heat intolerance, weight loss, palpitations, a diffuse non-tender goitre, exophthalmos and pretibial myxoedema. Which mechanism explains her hyp…
- Endocrine: Hashimoto thyroiditis · ApplicationA 40-year-old woman has a diffusely enlarged, firm, painless goitre and high anti-thyroid peroxidase antibodies. Fine-needle aspiration is performed. Which cytological…
- Endocrine: type 1 diabetes mellitus · ApplicationA 12-year-old girl presents in diabetic ketoacidosis a few weeks after a viral illness. If a pancreatic biopsy had been taken early in the disease, what would it have s…
- Endocrine: primary hyperparathyroidism · Multi-stepA 50-year-old woman has recurrent renal stones, bone pain and constipation. Serum calcium is 12.2 mg/dL, phosphate is low and parathyroid hormone is raised. Which skele…
- Endocrine: Sheehan syndrome · Multi-stepA 28-year-old woman had severe postpartum haemorrhage with hypotension. She later cannot breastfeed, has amenorrhoea, fatigue and cold intolerance. What is the underlyi…
- Endocrine: papillary thyroid carcinoma · ApplicationA 30-year-old woman has a firm thyroid nodule with cervical lymph node metastasis. Histology shows papillae with optically clear nuclei and nuclear grooves. Which genet…
- Endocrine: subacute granulomatous thyroiditis · Multi-stepA 38-year-old woman has a painful tender thyroid with fever two weeks after a viral illness. ESR is high, T4 is raised, TSH is suppressed and radioiodine uptake is very…
- Endocrine: congenital adrenal hyperplasia · Multi-stepA 10-day-old genetically female infant has ambiguous genitalia, vomiting, hypotension, hyponatraemia and hyperkalaemia. Which enzyme is deficient and which precursor is…
- Endocrine: thyroid carcinoma · ApplicationA 72-year-old woman has a rapidly enlarging, hard neck mass for 3 weeks with hoarseness and dysphagia. Biopsy shows pleomorphic spindle and giant cells with numerous mi…
- Endocrine: adrenal · ApplicationA 6-year-old boy has fever, a spreading purpuric rash and hypotension unresponsive to fluids. He dies within hours, and autopsy shows bilateral massive adrenal haemorrh…
Immunodeficiency10
- Immunodeficiency: X-linked agammaglobulinaemia · ApplicationAn 8-month-old boy has recurrent otitis media and pneumonia with encapsulated bacteria. Examination shows absent tonsils and no palpable nodes. Serum IgG, IgA and IgM a…
- Immunodeficiency: DiGeorge syndrome · ApplicationA 3-day-old neonate has seizures with a serum calcium of 6.2 mg/dL, a cleft palate and a conotruncal cardiac defect. The chest radiograph shows no thymic shadow. Which…
- Immunodeficiency: severe combined immunodeficiency · Multi-stepA 4-month-old boy has persistent oral candidiasis, chronic diarrhoea, failure to thrive and Pneumocystis pneumonia. Lymphocyte count is low and no thymic shadow is seen…
- Immunodeficiency: chronic granulomatous disease · Multi-stepA 3-year-old boy has recurrent liver and lung abscesses caused by Staphylococcus aureus and Aspergillus, and biopsy shows granulomas. Which investigation best demonstra…
- Immunodeficiency: Wiskott-Aldrich syndrome · ApplicationA 1-year-old boy has eczema, petechiae and recurrent otitis media. His platelet count is 30,000 per microlitre, and the platelets are small on the smear. Which defect e…
- Immunodeficiency: leukocyte adhesion deficiency · ApplicationA newborn has delayed separation of the umbilical cord beyond 3 weeks, omphalitis without pus formation and a neutrophil count of 40,000 per microlitre. Which defect is…
- Immunodeficiency: selective IgA deficiency · Multi-stepA 30-year-old man with recurrent sinusitis and giardiasis develops urticaria, wheeze and hypotension within minutes of starting a red cell transfusion. Which blood prod…
- Immunodeficiency: common variable immunodeficiency · Multi-stepA 28-year-old man has had recurrent sinusitis and pneumonia since adolescence, chronic Giardia diarrhoea and nodular lymphoid hyperplasia of the gut. All immunoglobulin…
- Immunodeficiency: hyper-IgM syndrome · Multi-stepA 3-year-old boy has recurrent pyogenic sinopulmonary infections and Pneumocystis jirovecii pneumonia. Serum IgG, IgA and IgE are low, IgM is normal to high, B-cell num…
- Immunodeficiency: Chediak-Higashi · ApplicationA child has recurrent pyogenic infections, partial albinism, peripheral neuropathy, and giant granules in leukocytes. What defect is likely?
Shock10
- Shock · ApplicationWhich shock type follows severe blood loss?
- Shock · ApplicationWhich shock follows acute MI with pump failure?
- Shock · ApplicationWhat is a hallmark of shock?
- Shock · ApplicationWhat is the central problem in shock?
- Shock · ApplicationWhat type of shock follows major blood loss?
- Shock · ApplicationWhat type of shock can result from severe infection and vasodilation?
- Shock · ApplicationWhat is cardiogenic shock caused primarily by?
- Shock · ApplicationWhat type of shock follows severe allergic reaction with vasodilation?
- Shock · ApplicationWhat is the defining problem in septic shock?
- Shock · ApplicationWhich finding is most characteristic of early septic shock compared with hypovolemic shock?
Autoimmunity9
- Autoimmunity: lupus nephritis · Multi-stepA 26-year-old woman with malar rash and arthralgia has haematuria, proteinuria of 4 g per day, hypertension and low C3 and C4. Renal biopsy shows endocapillary prolifer…
- Autoimmunity: drug-induced lupus · ApplicationA 60-year-old man who has taken hydralazine for hypertension for 8 months develops arthralgia, fever and pleuritic chest pain. Renal and central nervous system function…
- Autoimmunity: Sjogren syndrome · ApplicationA 52-year-old woman with dry eyes, dry mouth and anti-SSA (Ro) antibodies develops persistent parotid enlargement, palpable purpura and low C4. Which malignancy is she…
- Autoimmunity · ApplicationWhich mechanism causes Graves disease?
- Autoimmunity · ApplicationMyasthenia gravis is caused by antibodies to what?
- Autoimmunity · ApplicationWhat antibody target causes Graves disease?
- Autoimmunity · ApplicationWhat autoantibody is highly specific for systemic lupus erythematosus but not highly sensitive?
- Autoimmunity: type II hypersensitivity · ApplicationAutoimmune hemolytic anemia caused by antibodies against red-cell surface antigens is which type of hypersensitivity?
- Autoimmunity: type III hypersensitivity · ApplicationSerum sickness after foreign protein exposure is primarily mediated by which mechanism?
Cardiovascular9
- Cardiovascular: infective endocarditis · ApplicationA 28-year-old man who injects drugs has high fever and pleuritic chest pain. Chest radiograph shows multiple peripheral cavitating nodules, and echocardiography shows a…
- Cardiovascular: Libman-Sacks endocarditis · ApplicationA 26-year-old woman with a malar rash, arthritis and proteinuria has a new murmur. Echocardiography shows small sterile verrucous vegetations on both surfaces of the mi…
- Cardiovascular: hypertrophic cardiomyopathy · ApplicationA 19-year-old footballer collapses and dies during a match. His father had died suddenly at 40. Autopsy shows a heavy heart with asymmetric septal hypertrophy and a sma…
- Cardiovascular: giant cell arteritis · Multi-stepA 72-year-old woman has a new temporal headache, scalp tenderness, jaw pain on chewing and an ESR of 95 mm in the first hour. She reports a transient episode of visual…
- Cardiovascular: polyarteritis nodosa · ApplicationA 40-year-old man with chronic hepatitis B has fever, weight loss, new hypertension, abdominal pain and mononeuritis multiplex. Mesenteric angiography shows multiple mi…
- Cardiovascular: cardiac amyloidosis · Multi-stepA 68-year-old man has exertional dyspnoea, ankle oedema and a raised jugular venous pressure with a prominent y descent. His ECG shows low voltage, but echocardiography…
- Cardiovascular: nonbacterial thrombotic endocarditis · Multi-stepA 66-year-old woman with metastatic mucin-secreting pancreatic adenocarcinoma and migratory thrombophlebitis develops a cerebral embolic stroke. Echocardiography shows…
- Cardiovascular: early atherosclerosis · ApplicationAn 18-year-old man dies in a road traffic accident. At autopsy the thoracic aorta shows flat, yellow, non-obstructing streaks on the intimal surface. Which histological…
- Cardiovascular: aneurysms · Multi-stepA 70-year-old smoker and a 30-year-old man with Marfan syndrome are both found to have aortic aneurysms. Which statement correctly pairs each patient with the underlyin…
Haematopathology9
- Haematopathology · ApplicationBinucleate 'owl-eye' cells that stain for CD15 and CD30 are characteristic of which condition?
- Haematopathology · Multi-stepA 62-year-old man has fatigue and massive splenomegaly. Marrow aspiration is a dry tap, and the blood film shows teardrop red cells, nucleated red cells and immature gr…
- Haematopathology: DIC · Multi-stepA woman with placental abruption develops bleeding from venepuncture sites. Laboratory results show prolonged PT and aPTT, low platelets, low fibrinogen, raised D-dimer…
- Haematopathology: Hodgkin lymphoma · ApplicationA young woman has painless cervical lymphadenopathy, with broad collagen bands dividing the lymph node into nodules and lacunar cells on biopsy. Which is the most likel…
- Haematopathology: plasma cell neoplasms · ApplicationAn elderly woman has bone pain, anaemia, hypercalcaemia and renal failure. Serum electrophoresis shows an M spike. Which finding is expected on the peripheral smear and…
- Haematopathology: thrombotic microangiopathy · ApplicationA 28-year-old woman has fever, confusion, microangiopathic haemolytic anaemia with schistocytes, severe thrombocytopenia and mild renal impairment. Coagulation tests ar…
- Haematopathology: acute leukaemia · ApplicationA 30-year-old woman has bruising, a prolonged PT and aPTT with low fibrinogen, and a marrow full of abnormal promyelocytes containing multiple Auer rods. Which transloc…
- Haematopathology: diffuse large B cell lymphoma · ApplicationA 62-year-old man has a rapidly enlarging cervical lymph node mass and a raised LDH. Biopsy shows diffuse sheets of large lymphoid cells with nuclei larger than twice a…
- Haematopathology · ApplicationWhich peripheral-blood finding should raise concern for acute leukaemia and prompt urgent haematology evaluation?
Renal pathology9
- Renal pathology · ApplicationWhat is the most common cause of nephrotic syndrome in children?
- Renal pathology: anti-GBM disease · ApplicationA 24-year-old smoker has haemoptysis and rapidly progressive renal failure. Renal biopsy immunofluorescence shows smooth, linear IgG staining along the glomerular basem…
- Renal pathology: acute pyelonephritis · ApplicationA 28-year-old woman has fever, flank pain and dysuria. Which urinary finding most specifically localises the infection to the kidney rather than the bladder?
- Renal pathology: focal segmental glomerulosclerosis · Multi-stepA 30-year-old man has nephrotic syndrome that does not respond to eight weeks of prednisolone. Light microscopy shows sclerosis in part of the tuft in some glomeruli, a…
- Renal pathology · ApplicationWhat finding is characteristic of nephritic syndrome?
- Renal pathology: nephritic syndrome · ApplicationWhich urinary sediment finding most strongly indicates glomerular bleeding in acute nephritic syndrome?
- Renal pathology: diabetic nephropathy · ApplicationNodular glomerulosclerosis in long-standing diabetes mellitus is known by which eponym?
- Renal pathology · ApplicationWhat is the typical lesion in acute tubular injury?
- Renal pathology · ApplicationWhat mechanism causes post-renal acute kidney injury?
Gastrointestinal8
- Gastrointestinal: Hirschsprung disease · ApplicationA newborn has not passed meconium in 48 hours and has abdominal distension. Rectal examination reveals a tight, empty rectum followed by explosive passage of stool and…
- Gastrointestinal: hereditary diffuse gastric cancer · ApplicationA 32-year-old woman's mother and maternal aunt both died of gastric cancer in their thirties. Endoscopy of the patient shows pale mucosal patches, and biopsy shows sign…
- Gastrointestinal: Lynch syndrome · Multi-stepA 38-year-old man has a caecal adenocarcinoma. His father and paternal uncle had colon cancer in their forties. Immunohistochemistry on the tumour shows loss of MSH2 an…
- Gastrointestinal: gastrointestinal stromal tumour · ApplicationA 55-year-old man has gastrointestinal bleeding. Endoscopic ultrasound shows a submucosal gastric mass. Biopsy shows spindle cells positive for CD117 and DOG1. Which tr…
- Gastrointestinal: pancreatic ductal adenocarcinoma · ApplicationA 66-year-old man has weight loss and painless jaundice with a palpable, non-tender gallbladder. He has also had recurrent migratory superficial thrombophlebitis. Which…
- Gastrointestinal: Crohn disease · Multi-stepA 24-year-old man has chronic diarrhoea, a right iliac fossa mass and a perianal fistula. An ileal resection shows skip lesions and mesenteric fat wrapping the bowel. W…
- Gastrointestinal: carcinoid syndrome · Multi-stepA 55-year-old man has flushing, watery diarrhoea, wheezing and right-sided valvular fibrosis. An ileal carcinoid tumour with multiple liver metastases is found. Why doe…
- Gastrointestinal: chronic gastritis · Multi-stepA 58-year-old woman has fatigue and glossitis with macrocytic anaemia. Endoscopy shows atrophic gastric body mucosa with a normal antrum. Serum gastrin is markedly rais…
Hypersensitivity8
- Hypersensitivity: type I · ApplicationA 34-year-old woman develops urticaria, wheeze and hypotension 10 minutes after a wasp sting and recovers after treatment. Which blood test drawn within a few hours bes…
- Hypersensitivity: type II haemolysis · Multi-stepA 22-year-old woman recovering from Mycoplasma pneumonia has pallor, jaundice and bluish discolouration of the fingers and ears in cold weather. The direct antiglobulin…
- Hypersensitivity: Arthus reaction · ApplicationA farmer who has had several tetanus toxoid boosters is given another dose. Six hours later the injection site is red, indurated and painful, and over the next day it b…
- Hypersensitivity: type IV and patch testing · ApplicationA 28-year-old woman has an itchy eczematous rash on her earlobes and under her jeans button that appeared two days after wearing new jewellery. Which test is used to co…
- Hypersensitivity · ApplicationSerum sickness is what hypersensitivity type?
- Hypersensitivity · ApplicationContact dermatitis is which type?
- Hypersensitivity · ApplicationWhat type is IgE-mediated allergy?
- Hypersensitivity · ApplicationWhich mechanism underlies immediate anaphylaxis after exposure to a previously sensitizing allergen?
Renal8
- Renal: post-streptococcal glomerulonephritis · ApplicationA 7-year-old boy has cola-coloured urine and periorbital oedema two weeks after a skin infection. Serum C3 is low. Which finding is expected on electron microscopy of t…
- Renal: IgA nephropathy · ApplicationA 20-year-old man has recurrent episodes of macroscopic haematuria one to two days after each sore throat. Serum C3 and C4 are normal. What would immunofluorescence of…
- Renal: membranous nephropathy · Multi-stepA 45-year-old man has nephrotic-range proteinuria. Light microscopy shows uniformly thickened glomerular capillary walls without hypercellularity, and silver stain show…
- Renal: Alport syndrome · ApplicationA 10-year-old boy has persistent haematuria and a high-frequency sensorineural hearing loss. An ophthalmologist notes anterior lenticonus, and his maternal uncle needed…
- Renal: renal cell carcinoma · ApplicationA 60-year-old smoker has haematuria, a flank mass and a haemoglobin of 18 g/dL. Nephrectomy shows a golden-yellow tumour composed of cells with clear cytoplasm extendin…
- Renal: collapsing glomerulopathy · ApplicationA 30-year-old man with untreated HIV infection has nephrotic-range proteinuria and rapidly progressive renal failure. Biopsy shows collapse of the glomerular capillary…
- Renal: autosomal dominant polycystic kidney disease · ApplicationA 40-year-old man with hypertension has bilateral palpable flank masses and haematuria. He suddenly develops a thunderclap headache. Which gene is most commonly mutated…
- Renal: membranoproliferative glomerulonephritis · Multi-stepA 14-year-old girl has haematuria, proteinuria and persistently low serum C3 with normal C4. Light microscopy shows lobulated glomeruli with a tram-track basement membr…
Gastrointestinal pathology7
- Gastrointestinal pathology · ApplicationFamilial adenomatous polyposis is caused by a germline mutation in which gene?
- Gastrointestinal pathology: malabsorption · ApplicationA woman with iron deficiency anaemia and chronic diarrhoea has positive anti-tissue transglutaminase antibodies. What is the expected duodenal biopsy finding?
- Gastrointestinal pathology: stomach · ApplicationChronic Helicobacter pylori gastritis with intestinal metaplasia is the precursor of which carcinoma?
- Gastrointestinal pathology: inflammatory bowel disease · ApplicationA 28-year-old man has bloody diarrhoea. Colonoscopy shows continuous inflammation starting at the rectum, extending proximally, with no skip areas. Biopsy shows crypt a…
- Gastrointestinal pathology: colorectal adenoma · ApplicationA 55-year-old man has rectal bleeding, and colonoscopy shows a 2.5 cm sessile polyp. Which histological features of an adenoma carry the greatest risk of containing inv…
- Gastrointestinal pathology: inflammatory bowel disease · Multi-stepTransmural inflammation with skip lesions, fissures and noncaseating granulomas most strongly supports which diagnosis?
- Gastrointestinal pathology · ApplicationWhat is the defining lesion in ulcerative colitis?
Hepatic pathology7
- Hepatic pathology: metabolic liver disease · ApplicationA 45-year-old man has diabetes, bronze skin pigmentation and hepatomegaly. A liver biopsy shows abundant hepatocyte pigment that stains blue with Perls stain. What is t…
- Hepatic pathology: genetic liver disease · ApplicationA 35-year-old man has early-onset basal-predominant emphysema and cirrhosis. A liver biopsy shows periportal hepatocytes containing pink globules that are PAS positive…
- Hepatic pathology: Wilson disease · Multi-stepA 17-year-old boy has tremor, dysarthria and chronic hepatitis. Slit-lamp examination shows Kayser-Fleischer rings. Serum ceruloplasmin is low, while 24-hour urinary co…
- Hepatic pathology: ascites in cirrhosis · Multi-stepA 52-year-old man with alcoholic cirrhosis has tense ascites, splenomegaly and oesophageal varices. Which combination best explains the accumulation of ascitic fluid?
- Hepatic pathology: hepatocellular carcinoma · Multi-stepA 58-year-old hepatitis B carrier with cirrhosis has a new 6 cm liver mass and an alpha-fetoprotein of 2400 ng/mL. Contrast CT is likely to show which pattern, allowing…
- Hepatic pathology · ApplicationWhich structural change defines established cirrhosis of the liver?
- Hepatic pathology · ApplicationWhat is the common mechanism of alcoholic steatosis?
Thrombosis7
- Thrombosis · ApplicationWhich triad includes endothelial injury, stasis, and hypercoagulability?
- Thrombosis · ApplicationWhich condition causes hypercoagulability?
- Thrombosis · ApplicationWhat Virchow factor occurs with immobility?
- Thrombosis · ApplicationWhich element of Virchow triad is illustrated by prolonged bed rest after surgery?
- Thrombosis · ApplicationWhat is the usual outcome when a thrombus is incorporated into a vessel wall?
- Thrombosis: Virchow triad · ApplicationWhich factor is part of Virchow triad for thrombosis?
- Thrombosis: embolism · ApplicationMost pulmonary emboli originate from thrombi in which location?
Transplant pathology7
- Transplant pathology: hyperacute rejection · ApplicationDuring a renal transplant, within minutes of releasing the vascular clamps the kidney turns mottled and cyanotic and stops producing urine. The recipient had received m…
- Transplant pathology: acute cellular rejection · Multi-stepA renal transplant recipient is 4 weeks after surgery with rising creatinine and a fever. Graft biopsy shows interstitial lymphocytic infiltrate and lymphocytes within…
- Transplant pathology: transfusion-associated GVHD · Multi-stepA 62-year-old man treated with fludarabine for chronic lymphocytic leukaemia develops fever, a maculopapular rash, diarrhoea and pancytopenia 10 days after a non-irradi…
- Transplant pathology: chronic rejection · ApplicationA kidney transplant recipient two years after transplant has a slowly rising creatinine. Biopsy shows interstitial fibrosis and tubular atrophy with vascular changes. W…
- Transplant pathology: graft versus host disease · ApplicationThree weeks after allogeneic bone marrow transplantation for leukaemia, a patient develops a maculopapular rash, watery diarrhoea and raised bilirubin. Which cells medi…
- Transplant pathology: rejection · ApplicationWhat mechanism underlies hyperacute organ-transplant rejection occurring minutes to hours after reperfusion?
- Transplant pathology: chronic rejection · ApplicationWhich finding best characterizes chronic allograft rejection?
Acute inflammation6
- Acute inflammation · ApplicationWhich leukocyte predominates during the first 24 hours of a typical acute bacterial inflammation?
- Acute inflammation: fibrinous inflammation · ApplicationA shaggy fibrin-rich exudate on the pericardial surface after myocardial infarction represents which pattern of inflammation?
- Acute inflammation · ApplicationWhat is the main vascular effect of histamine?
- Acute inflammation: vascular changes · ApplicationWhich vascular change is responsible for early redness and heat in acute inflammation?
- Acute inflammation: leukocyte migration · ApplicationWhich adhesion molecule mediates firm neutrophil attachment to endothelium during acute inflammation?
- Acute inflammation: complement · ApplicationWhich complement fragment is a powerful neutrophil chemotactic factor?
Anemia6
- Anemia · ApplicationTarget cells are common in which disorder?
- Anemia · ApplicationSpherocytes are typical of what process?
- Anemia · ApplicationMicrocytic anemia with high RDW suggests what?
- Anemia · ApplicationMacrocytosis with neuropathy suggests what?
- Anemia · ApplicationWhat anemia is microcytic?
- Anemia · ApplicationWhat anemia is macrocytic?
Apoptosis6
- Apoptosis: morphology · Multi-stepA liver biopsy from a patient with acute viral hepatitis shows scattered shrunken, intensely eosinophilic hepatocytes with condensed nuclear fragments lying free in sin…
- Apoptosis: extrinsic pathway · ApplicationA 6-year-old boy has persistent lymphadenopathy, splenomegaly and autoimmune haemolytic anaemia. Blood shows increased TCR alpha-beta T cells that express neither CD4 n…
- Apoptosis: BCL-2 family · ApplicationA 55-year-old man has painless generalised lymphadenopathy and a lymph node biopsy shows a nodular proliferation of small cleaved cells. Cytogenetics show t(14;18). Wha…
- Apoptosis: cytotoxic T-cell killing · ApplicationA virus-infected hepatocyte is destroyed by a CD8+ cytotoxic T lymphocyte. Which mechanism triggers apoptosis of the target cell?
- Apoptosis · ApplicationWhich enzyme family executes apoptosis?
- Apoptosis · ApplicationWhat occurs in apoptosis?
Calcification6
- Calcification · ApplicationDystrophic calcification occurs in what setting?
- Calcification · ApplicationMetastatic calcification occurs with what?
- Calcification · ApplicationWhat occurs in damaged tissue with normal calcium?
- Calcification · ApplicationWhat type of calcification occurs in damaged tissue despite normal serum calcium?
- Calcification · ApplicationWhat type of calcification occurs in normal tissue with elevated serum calcium?
- Calcification · ApplicationWhat is metastatic calcification?
CNS6
- CNS: meningioma · ApplicationA 55-year-old woman has new-onset seizures. MRI shows a well-circumscribed, extra-axial, dural-based mass that enhances avidly with a dural tail. What is the expected h…
- CNS: medulloblastoma · ApplicationA 5-year-old child has morning vomiting, unsteady gait and papilloedema. MRI shows a midline cerebellar vermis mass with hydrocephalus. Biopsy shows sheets of small blu…
- CNS: multiple sclerosis · ApplicationA 28-year-old woman has had optic neuritis followed by an internuclear ophthalmoplegia. MRI shows ovoid periventricular white matter lesions. What is the pathological h…
- CNS: Huntington disease · ApplicationA 42-year-old man has chorea, depression and cognitive decline. His father developed similar illness at 35 and his grandfather in his fifties. Which genetic abnormality…
- CNS: Creutzfeldt-Jakob disease · Multi-stepA 62-year-old woman has had rapidly progressive dementia over four months, with myoclonic jerks and periodic sharp wave complexes on EEG. What would brain histology show?
- CNS: oligodendroglioma · ApplicationA 38-year-old man presents with seizures. MRI shows a calcified frontal lobe tumour. Histology shows uniform round nuclei with perinuclear halos and a delicate chicken-…
Endocrine pathology6
- Endocrine pathology · ApplicationA thyroid nodule shows sheets of polygonal cells in a stroma containing amyloid, and serum calcitonin is raised. A mutation in which gene is associated with the heredit…
- Endocrine pathology: adrenal medulla · ApplicationA 35-year-old woman has episodic headache, palpitations and sweating with a blood pressure of 210/120 mmHg during attacks. A 4 cm adrenal mass is found. Histology is ex…
- Endocrine pathology: Addison disease · ApplicationA 34-year-old woman has fatigue, weight loss, postural hypotension, sodium 126 mEq/L, potassium 5.8 mEq/L and darkening of the palmar creases. What explains the pigment…
- Endocrine pathology · ApplicationWhat is a common histological feature of Hashimoto thyroiditis?
- Endocrine pathology: papillary thyroid carcinoma · ApplicationA thyroid nodule biopsy shows optically clear 'Orphan Annie eye' nuclei and nuclear grooves. Which malignancy is most likely?
- Endocrine pathology · ApplicationWhat is the pathological mechanism of Graves disease?
Infectious pathology6
- Infectious pathology · ApplicationWhich cellular arrangement best characterizes a granuloma in persistent inflammation?
- Infectious pathology · ApplicationWhich pattern of necrosis is classically associated with tuberculosis?
- Infectious pathology · ApplicationWhat does a suppurative inflammatory response contain predominantly?
- Infectious pathology: tuberculosis · ApplicationWhich histologic pattern is most typical of tuberculosis?
- Infectious pathology: acute bacterial inflammation · ApplicationWhich type of inflammatory infiltrate predominates in acute pyogenic bacterial infection?
- Infectious pathology: viral cytopathic effect · ApplicationWhich histologic finding is characteristic of herpesvirus infection?
Neuropathology6
- Neuropathology · ApplicationEosinophilic intracytoplasmic inclusions in the pigmented neurons of the substantia nigra are called:
- Neuropathology: brain tumours · ApplicationAn elderly man has a ring-enhancing, butterfly-pattern lesion crossing the corpus callosum. Histology shows pleomorphic astrocytes, necrosis surrounded by palisading tu…
- Neuropathology: progressive multifocal leukoencephalopathy · Multi-stepA 35-year-old man with HIV and a CD4 count of 40 per microlitre has progressive hemiparesis and visual loss over several weeks. MRI shows non-enhancing white matter les…
- Neuropathology: vestibular schwannoma · ApplicationA 30-year-old woman has progressive bilateral sensorineural hearing loss and tinnitus. MRI shows bilateral cerebellopontine angle masses. Which gene is involved, and wh…
- Neuropathology: ependymoma · ApplicationA 6-year-old child has morning headaches, vomiting and obstructive hydrocephalus. MRI shows a mass arising from the floor of the fourth ventricle. Which histological fe…
- Neuropathology: Guillain-Barre syndrome · ApplicationA 28-year-old man develops symmetrical ascending weakness with absent reflexes two weeks after an episode of diarrhoea. Which cerebrospinal fluid result is expected?
Bone5
- Bone: postmenopausal osteoporosis · Multi-stepA 62-year-old woman has lost 5 cm in height and has a wedge fracture of a lumbar vertebra. Serum calcium, phosphate, alkaline phosphatase and parathyroid hormone are no…
- Bone: Paget disease · ApplicationA 68-year-old man reports an increase in hat size, hearing loss and bone pain. Serum alkaline phosphatase is markedly raised, while calcium and phosphate are normal. Wh…
- Bone: osteoid osteoma · Multi-stepA 14-year-old boy has tibial pain that is worse at night and dramatically relieved by aspirin. Radiograph shows a small radiolucent nidus less than 2 cm across, surroun…
- Bone: chronic osteomyelitis · ApplicationA 9-year-old boy in rural India had fever and distal femoral pain that was inadequately treated. Weeks later, radiographs show a fragment of dead bone surrounded by new…
- Bone: McCune-Albright syndrome · Multi-stepA 9-year-old girl has precocious puberty, large café-au-lait macules with irregular borders and polyostotic bone lesions. Radiographs show ground-glass lesions and a sh…
Gynaecological pathology5
- Gynaecological pathology: cervical intraepithelial neoplasia · ApplicationA 32-year-old woman has a high-grade squamous intraepithelial lesion on cytology, and colposcopic biopsy shows CIN 3. At which site did the lesion most likely arise, an…
- Gynaecological pathology: gonadal dysgenesis and tumour risk · Multi-stepA 16-year-old girl has primary amenorrhoea, absent breast development and streak gonads, and her karyotype is 46,XY. What is the major risk, and what is the recommended…
- Gynaecological pathology: endometrial carcinoma · ApplicationA 58-year-old obese, diabetic nulliparous woman has postmenopausal bleeding. Biopsy shows crowded glands with endometrioid carcinoma. Which molecular alteration is most…
- Gynaecological pathology: mucinous tumours and pseudomyxoma · Multi-stepA 48-year-old woman has a large multiloculated ovarian mass, and at laparotomy the peritoneal cavity contains abundant gelatinous mucin. What should be examined to find…
- Gynaecological pathology: gestational trophoblastic disease · Multi-stepFour months after a molar pregnancy was evacuated, a 26-year-old woman has haemoptysis and rising serum beta-hCG. Chest radiograph shows multiple cannonball opacities.…
Vasculitis5
- Vasculitis · ApplicationA 3-year-old child has had fever for six days with conjunctival injection, cracked red lips, a strawberry tongue, cervical lymphadenopathy and peeling of the fingertips…
- Vasculitis: Takayasu arteritis · ApplicationA 24-year-old woman has fatigue, absent left radial pulse, a difference in blood pressure between the arms, carotid bruits and transient visual blurring. What is the ch…
- Vasculitis: granulomatosis with polyangiitis · Multi-stepA 40-year-old man has chronic sinusitis with nasal crusting, haemoptysis with cavitating lung nodules and rapidly progressive glomerulonephritis. Which pairing of serol…
- Vasculitis: eosinophilic granulomatosis with polyangiitis · ApplicationA 38-year-old man with long-standing asthma develops mononeuritis multiplex, a peripheral eosinophil count of 2,500 per microlitre and palpable purpura. Which antibody…
- Vasculitis: thromboangiitis obliterans · ApplicationA 32-year-old man who smokes beedis heavily has calf claudication, painful ulcers on the fingertips and recurrent superficial thrombophlebitis. Angiography shows segmen…
Adaptation4
- Adaptation: hypertrophy · ApplicationA 55-year-old man with long-standing hypertension has a left ventricle that is thick-walled, with increased heart weight. Why does the heart enlarge by hypertrophy rath…
- Adaptation: metaplasia · ApplicationA 3-year-old malnourished child with night blindness has Bitot spots. Biopsy of respiratory mucosa in such vitamin A deficiency shows keratinising squamous epithelium r…
- Adaptation: atrophy · ApplicationA 30-year-old man has his leg in plaster for 8 weeks after a tibial fracture. The thigh circumference is reduced, but strength recovers with physiotherapy. What is the…
- Adaptation: endometrial hyperplasia · ApplicationA 50-year-old obese woman with anovulatory cycles has prolonged heavy bleeding. Endometrial biopsy shows crowded glands with a high gland-to-stroma ratio and nuclear at…
Amyloidosis4
- Amyloidosis: reactive systemic amyloid · ApplicationA 50-year-old man with long-standing bronchiectasis develops nephrotic-range proteinuria and hepatosplenomegaly. A rectal biopsy shows Congo red-positive deposits with…
- Amyloidosis · ApplicationWhat stain demonstrates amyloid with apple-green birefringence?
- Amyloidosis · ApplicationWhat property is demonstrated by amyloid on Congo red staining?
- Amyloidosis · ApplicationWhat histologic stain shows apple-green birefringence under polarized light in amyloid deposits?
Embolism4
Haemodynamic disorders4
- Haemodynamic disorders · ApplicationWhich mechanism can produce peripheral oedema in a patient with heart failure?
- Haemodynamic disorders · ApplicationWhich component of Virchow triad contributes to thrombosis?
- Haemodynamic disorders · ApplicationWhen can an intravascular thrombus be classified as an embolus?
- Haemodynamic disorders · ApplicationWhat pathological outcome follows prolonged interruption of arterial blood supply to tissue?
Tissue repair4
- Tissue repair: keloid · ApplicationA 22-year-old woman of dark complexion develops a raised, firm, shiny scar at an ear-piercing site. Over months it has grown well beyond the original wound margins, and…
- Tissue repair: wound contraction · ApplicationA 60-year-old man has a large full-thickness burn that is left to heal by secondary intention. Over three weeks the open wound area shrinks by more than half before epi…
- Tissue repair: copper and collagen cross-linking · Multi-stepA 4-month-old boy has sparse, kinky, depigmented hair, hypotonia, seizures and tortuous arteries on imaging. Serum copper and ceruloplasmin are low. Which step of conne…
- Tissue repair: hepatic fibrosis · ApplicationA 45-year-old man with 15 years of chronic hepatitis C has a liver biopsy showing bridging fibrosis. Which cell is the main source of the excess collagen, and what is i…
Bone tumours3
- Bone tumours · ApplicationA 15-year-old boy has knee pain and a firm mass at the distal femur. Radiograph shows a destructive metaphyseal lesion with a sunburst periosteal reaction and Codman tr…
- Bone tumours · ApplicationA 28-year-old woman has pain near the knee. Radiograph shows an eccentric lytic lesion in the epiphysis reaching the subchondral bone. Histology shows numerous multinuc…
- Bone tumours: chondrosarcoma · ApplicationA 55-year-old man has a slowly growing painful mass in the iliac bone. Radiograph shows a lytic lesion with stippled calcification, and histology shows atypical cells i…
Cardiac pathology3
- Cardiac pathology · ApplicationAschoff bodies are characteristic of which condition?
- Cardiac pathology: myocardial infarction · ApplicationOn autopsy of a patient who died 5 days after a myocardial infarction, the infarct is soft and yellow, with a hyperaemic border. Which microscopic finding is expected?
- Cardiac pathology: complications of infarction · Multi-stepA 62-year-old man is recovering from an anterior myocardial infarction. On day 5 he suddenly collapses with distended neck veins, muffled heart sounds and electromechan…
Cardiovascular pathology3
Cell death3
Granulomatous inflammation3
- Granulomatous inflammation: sarcoid hypercalcaemia · Multi-stepA 32-year-old woman has cough and bilateral hilar lymphadenopathy. Serum calcium is 11.8 mg/dL, PTH is suppressed, 25-hydroxyvitamin D is normal and 1,25-dihydroxyvitam…
- Granulomatous inflammation · ApplicationWhat is the defining cellular arrangement in a granuloma?
- Granulomatous inflammation · ApplicationWhich cellular arrangement best defines a granuloma in chronic inflammation?
Infection pathology3
Leukemia3
Lymphoma3
Oncogenes3
Pulmonary pathology3
Amyloid2
Autoimmune disease2
Breast pathology2
- Breast pathology · ApplicationA woman has an ill-defined breast mass. Histology shows small discohesive cells infiltrating the stroma in single files, with some signet ring cells. Which molecular ab…
- Breast pathology · ApplicationA woman has a persistent scaly, eczema-like lesion of the nipple. Biopsy shows large cells with abundant pale cytoplasm lying singly and in nests within the epidermis.…
Cancer genetics2
Carcinogenesis2
Cytogenetics2
- Cytogenetics · ApplicationThe Philadelphia chromosome, t(9;22), is characteristic of which condition?
- Cytogenetics: Down syndrome · Multi-stepA neonate with typical features of Down syndrome is born to a 24-year-old woman. Karyotype shows a Robertsonian translocation between chromosomes 14 and 21 together wit…
Edema2
Granuloma2
Granulomatous disease2
- Granulomatous disease · ApplicationNon-caseating granulomas with Schaumann bodies and asteroid bodies are typical of:
- Granulomatous disease: primary tuberculosis · ApplicationAn 8-year-old child with household contact with a case of tuberculosis has a positive tuberculin test. Where is the parenchymal focus of primary pulmonary tuberculosis…
Hepatobiliary2
- Hepatobiliary: brown pigment stones · Multi-stepA 62-year-old man has recurrent episodes of fever, jaundice and right upper quadrant pain. ERCP shows soft, greasy brown stones in dilated bile ducts with a stricture.…
- Hepatobiliary: primary biliary cholangitis · Multi-stepA 50-year-old woman has pruritus, fatigue, xanthelasma and a raised alkaline phosphatase. Antimitochondrial antibody is positive. A liver biopsy would most likely show…
Infarction2
Joint pathology2
- Joint pathology: rheumatoid arthritis · ApplicationA 45-year-old woman has symmetrical swelling of the metacarpophalangeal joints with morning stiffness lasting more than an hour. Which tissue is directly responsible fo…
- Joint pathology: osteoarthritis · ApplicationA 65-year-old obese woman has knee pain worse on walking, crepitus and bony enlargement of distal interphalangeal joints. Which findings are expected on examination of…
Laboratory pathology2
Muscle pathology2
- Muscle pathology: dermatomyositis · ApplicationA 38-year-old woman has a violaceous periorbital rash, scaly papules over the knuckles and progressive proximal limb weakness. Serum creatine kinase is markedly raised.…
- Muscle pathology: Duchenne and Becker dystrophy · Multi-stepA 5-year-old boy has calf pseudohypertrophy, a Gowers sign and creatine kinase of 15,000 U/L. His muscle biopsy shows absent dystrophin staining. Why does Becker muscul…
Skin pathology2
- Skin pathology · ApplicationA middle-aged patient has flaccid blisters, painful oral erosions and a positive Nikolsky sign. What does direct immunofluorescence of perilesional skin show?
- Skin pathology: squamous cell carcinoma · ApplicationA 70-year-old farmer has a crusted nodule on the dorsum of the hand. Biopsy shows invasive nests of atypical squamous cells with keratin pearls and intercellular bridge…
Soft tissue2
- Soft tissue: embryonal rhabdomyosarcoma · ApplicationA 3-year-old girl has vaginal bleeding and a grape-like polypoid mass protruding from the vagina. Biopsy shows small round cells beneath the epithelium, with some strap…
- Soft tissue: well-differentiated liposarcoma · ApplicationA 60-year-old man has a 25 cm retroperitoneal fatty mass. Histology shows mature adipocytes of varying size with atypical hyperchromatic stromal cells and occasional li…
Transfusion medicine2
- Transfusion medicine · Multi-stepWithin minutes of starting a red cell transfusion a patient develops fever, flank pain, hypotension and red urine. Which mechanism underlies this reaction?
- Transfusion medicine · Multi-stepOn cell grouping, a patient's red cells show no agglutination with anti-A or anti-B. The serum agglutinates group A, group B and group O reagent cells. What is the most…
Tumor suppressors2
Vascular pathology2
Cell injury and apoptosis1
Coagulation disorders1
Complement1
Hemodynamics1
Hemostasis1
Oedema1
Protein deposition disorders1
Reactive lymphadenopathy1
Respiratory pathology1
Common questions
How many Pathology questions are there?
870 original questions across 655 topics, and the bank grows over time.
Which Pathology topics are covered?
Haematopathology, Neuropathology, Haemodynamics, Granulomatous disease, Cytogenetics, Renal pathology, Cardiac pathology, Gastrointestinal pathology, Cell injury and apoptosis, Immunopathology, Breast pathology, Anaemia, and more.
How difficult are these Pathology questions?
0 are recall, 652 are application and 218 are multi-step. The tags are our own editorial judgement, not an official difficulty rating.
Are these Pathology questions from past papers?
No. They are original practice items. NBEMS does not publish its paper or an official key, and we do not use recalled or leaked questions.
Can I practise Pathology for free?
Yes. The free plan includes 20 practice questions a day across all subjects, and the free 20-question assessment covers every subject. A paid term removes the daily limit.
Is there a timed Pathology test?
Yes. The Pathology subject test is included with a paid term, with a countdown and a question palette.
How should I use these Pathology questions?
Answer before you look, read the reason for every option, and write a three-line note for each mistake. A few questions you fully review are worth more than many you skim.
Have these Pathology questions been reviewed by faculty?
Not yet. They are original and drafted with AI assistance, then edited by our team. Independent faculty review is planned, and each item shows its status. Confirm important facts in a standard textbook.