Pathology questions GUT and ENDO Final

Which pathologic feature is seen in paraneoplastic Cushing syndrome lung cancer/ ectopic ACTH?

(Hyperplasia)

Young female non pregnant increased intracranial pressure headache missed menstrual cycles noticed secretion of milk?

(Hyperprolactinemia)

Which increases in primary adrenal insufficiency?

(Serum potassium levels)

Female thyroid mass increased t3 t4 levels low tsh what type of goiter?

(toxic nodular goiter)

A patient's X-ray revealed an enlarged Sella turcica, what is the possible diagnosis?

Acromegaly

50-year-old female presents with acute renal insufficiency. She treated his garden last week with number of herbicides and insecticides, some of which contained heavy metals. Laboratory studies confirm oliguria, and increased serum urea and creatinine levels. A renal biopsy is shown. What is the most likely diagnosis?

Acute tubular necrosis

18PSA, normal size prostate, nodule on palpation, no problem in urine samples, diagnosis?

Adenocarcinoma

62-year-old childless, last menstrual period was 10 years ago, she has vaginal bleeding twice in the last month, examination showed normal uterus, no scars on cervix, no adnexal masses...what's the most likely diagnosis -

Adenocarcinoma

A 29 yr old patient had severe pelvic pain and dysmenorrea she undergone hysterectomy. The biopsy of the uterus reveals endometrial glands and stromal cells that lie deeper about 4mm till the endomyometrial junction just above the myometrium, what is the most likely diagnosis?

Adenomyosis

Case of patient suffering from Medullary thyroid Carcinoma which arises parafollicular cells or C cells, Microscope immunofluorescence => apple green, while red congo stain => orange - red, what substance is found in the stroma of medullary thyroid carcinoma?

Amyloid laden deposits

A 40-year- old woman notices that her gloves from the previous winter no longer fits her hands. Her friends remark that her facial features have changed in the past year and her voice seems deeper. On physical examination, she is afebrile, her BP is 140/90 mm Hg. She has coarse facial features. There is decreased sensation to pin-prick over the palms in the distribution of her thumb and first two fingers. A radiograph of the foot shows an increased amount of soft tissue beneath the calcaneus. A chest radiograph shows cardiomegaly. Laboratory studies indicate a fasting serum glucose level of 138 mg/dl. Which part is affected?

Anterior pituitary

A 40-year-old woman has had increasing lethargy and weakness over the past 3 years. She has cold intolerance and wears a sweater in the summer. One year ago, she had menorrhagia, but now she has oligomenorrhea. She has difficulty concentrating,and her memory is poor. She has chronic constipation. On physical examination, her pulse is 54/min,respirations are 13/min, and blood pressure is 110/70 mm Hg. Her skin appears coarse and dry. Her face, hands, and feet appear puffy, with dough like skin. The representative microscopic appearance of her causative disease is shown in the figure. Which of the following serologic test findings is most likely to be positive in this woman?

Anti-thyroid peroxidase antibody

Patient with hyperpigmentation of gingiva and palmar creases. Most common cause?

Autoimmune

45-year-old man complains of nausea, vomiting and cramping abdominal pain. His temperature is 38°C (101°F)» blood pressure 90/60 mm Hg and pulse rate 90/minute. On physical examination, the patient appears dehydrated with dry tongue and poor skin turgor. Hyperpigmentation is noted in the palmar creases and the gingival margins. Laboratory findings include hypoglycemia, hyponatremia and hyperkalemia. Which of the following is the most likely cause of this patient 'symptoms?

Autoimmunity

A 40-year-old man presents with flank pain and blood clots in urine. Physical examination reveals bilateral flank masses. Urinalysis reveals hematuria, proteinuria and oliguria. CT scan shows bilateral, massive enlarged kidney. The patient develops end stage kidney disease. The gross picture of kidneys removed is shown. What is the diagnosis?

Autosomal dominant polycystic kidney disease

Hashimoto's disease associated with increased risk of which disease?

B-cell non-Hodgkin's lymphoma

PE rectal examination Mass, double layers intact epithelium glands and stromal, diagnosis?

BPH (benign prostatic hyperplasia)

A 44 year old male underwent a digital rectal examination. He had nocturia, dribbling and urination frequency. While doing the rectal examination. It was hard, firm and rubbery prostate gland. While doing the needle biopsy, results showed granular enhancement and stromal tissue. The gland had two layers (granular tissue and stromal cells) with intact basement membrane. What is the most likely diagnosis?

Benign prostatic hyperplasia

A 14-year-old girl noticed gradual neck enlargement during the past 8 months. On physical examination her thyroid gland is diffusely enlarged. Her serum TSH level is normal. A dietary history is most likely to reveal that she has begun eating more of which of the following foods?

Cabbage

How will you differentiate between a follicular adenoma and a follicular carcinoma based on histology?

Capsular invasion

A 54-year-old man has had dysuria with increased frequency and urgency of urination for the past 6 months. He has sometimes experienced mild lower back pain (pelvic pain). On physical examination, he is afebrile. The prostate gland feels normal in size; no nodules are palpable. Laboratory studies show that expressed prostatic secretions contain 30 leukocytes per high- power field. What is the most likely diagnosis?

Chronic abacterial prostatitis

A 40-year-old man presents with repeated episodes of flank pain, fever and dysuria for 1 year. Imaging of the kidneys showed contracted, asymmetrical kidneys with many scars. Urine analysis showed 1+ proteinuria, many pus cells but no RBCs. Which of the following is the MOST LIKELY diagnosis in this patient?

Chronic pyelonephritis

A 60-year-old bed ridden man complains of severe headache and dizziness. He has paralysis of lower limbs and is having suprapubic catherization. The patient has history of repeated urinary infections. His blood pressure is 180/110 mmHg. Laboratory findings shows elevated BUN and creatinine. A CT scan shows small irregularly shaped kidneys with deep coarse scars. Percutaneous renal biopsy shows thyroidization and inflammatory cell infiltration. Which of the following is the appropriate diagnosis?

Chronic pyelonephritis

BP, 150/100, GFR is less than 25%, what's the diagnosis?

Chronic renal failure

40-year-old woman presented to the clinic with palpation , anxiety, excessive sweating and abnormal protrusion of the eyes(exophthalmos). She also have a diffused mild thyroid enlargement. Which of the most findings is most likely to be present?

Decrease in TSH

A 20-year-old woman and her twin sister both experience increasing diplopia. Their conditions develop within 3 years of each other. On physical examination,they have exophthalmos and weak extraocular muscle movement. The thyroid gland is diffusely enlarged but painless in each sister, and there is no lymphadenopathy in either woman. Which of the following serum laboratory findings is most likely to be reported in these sisters?

Decreased thyroid-stimulating hormone level (Decreased TSH)

Cytogenetic examination of complete mole will most likely demonstrate which of the following genetic patterns?

Diploidy (46,XX) (46,XY)

Which disease produces the above microscopic picture?

Dysgerminoma

The 5-year-old boy diagnosed to have nephrotic range proteinuria and edema. Renal biopsy was performed and light microscopy reveals normal glomeruli. Which of the following feature you can expect in this patient on electron microscopy in order to confirm the diagnosis of minimal change disease?

Effacement of foot process

A 41-year-old G5, P5 woman has noticed lower abdominal pain with fever for the past 2 days. She delivered a normal term infant 1 week ago. On examination, she has a temperature of 37.4° C. There is a foul-smelling vaginal discharge. Which of the following pathologic findings is she most likely to have?

Endometrial neutrophilic infiltrates

A study of patients with postmenopausal uterine bleeding reveals that some of them have malignant neoplasms that arise from prior atypical hyperplastic lesions. The peak incidence is between 55 and 65 years of age in women who have obesity, hypertension, and/or diabetes mellitus. Molecular analysis reveals mutations of the PTEN tumor suppressor gene in most of them. Their malignancies tend to remain localized for years before spread to local lymphatics. Which of the following neoplasms is most likely to have these characteristics? -

Endometrioid carcinoma

Brown nodular lesions, ranging from 0.3-0.5 cm seen in Fallopian tube, ovary and appendix: stroma and glandular cells/tissue of endometrium is seen, what is the diagnosis?

Endometriosis

Prominent recorded Feature of Grave's disease?

Exophthalmos (ophthalmopathy

On Endoscopic examination of a women with a history of PID, pre hepatic adhesions are seen. What is the most likely diagnosis?

Fitz Hugh Curtis syndrome

32-year-old African American woman presents to the office with complaints of frothy urine and swing (hat started 4 days ago She noticed the swelling first in the face and then gradually invoked other parts of her body the frequency of urination is the same without noticeable change In the appearance of the urine She is human immunodeficiency virus (HV) positive and is currently under treatment with abacavir, dolutegravir, and lamivudine. On physical examination, there is generalized pitting edema. Urinalysis shows: 4+ protein, No RBCs, 1-2 HPF WBCs. There are casts of fat globules Renal biopsy was performed and image given. Diagnosis?

Focal segmental glomerulosclerosis

Most common cause of acute pyelonephritis is:

Gram-negative bacteria

A 58-year-old woman has noted irregular vaginal bleeding for the past 2 months.On pelvic examination, no cervical lesions are present and Pap smear shows no abnormal cells. An endometrial biopsy shows evidence for endometrial hyperplasia. An abdominal ultrasound reveals a solid right ovarian mass. Which of the following neoplasms is this woman most likely to have?

Granulosa cell tumor

A 40 year old female shown in the picture presents with palpitations, anxiety, excessive sweating, abnormal protrusion of the eyeball and pretibial myxedema. On examination she had mild enlargement of the thyroid. Which one of the following disorders of thyroid is she MOST likely to suffer?

Graves disease

Size of hat and glove increases. Which hormone is elevated?

Growth hormone

Remaining follicles untouched by hormonal changes which are small and many are lined by Hurthle or oxyphil cells seen in which disease?

Hashimotos

Picture of renal cysts given, she's most likely to develop what?

Hepatic cysts

Patient with nodular enlargement of prostate, microscopy hyperplasia of glands of prostate. Dude has urgency to urinate and etc. (all symptoms of BPH) what's are BPH's complications?

Hydroureter and hydronephrosis

A 25-year-old woman has noted breast secretions (found lactating) for the past month. She is not breast-feeding and has never been pregnant. She has not menstruated for the past 5 months. (amenorrhea) Physical examination yields no abnormal findings. MR imaging of the brain shows a 0.7 cm mass in the adenohypophysis. Diagnosis?

Hyperprolactinemia

A 55-year-old woman is seen in the outpatient clinic because of chronic headache. Radiological tests showed a non-secreting brain tumor blocking the hypothalamo-hypophyseal portal circulation. Which of the following endocrine abnormalities is expected in this patient?

Hyperprolactinemia

Lady has milk secretions:

Hyperprolactinemia

Patient with toxic multinodular goiter. What is the state of thyroid hormone?

Hyperthyroidism

10-year-old boy presents with headache and bilateral hemianopia, as well asevidence of increased intra-cranial pressure and diabetes insipidus. The patient'scondition is most likely caused by a primary lesion in:

Hypothalamus

Patient with diabetes insipidus. Where is the lesion?

Hypothalamus

Patient with diabetes mellitus, high intracranial pressure organ affected

Hypothalamus

young middle aged woman presented with puffy face, hoarse voice she complaints and her TSH levels are low, but it increases when she was administered with TRH, what could be the possible cause for this?

Hypothyroidism with an abnormality in the pituitary gland.

32.Which one of the following is not true about Gestational trophoblastic disease?

Hysterectomy is the best treatment with invasive mole

Guy with gynecomastia-

Leydig cell tumor/carcinoma (Sex cord stromal tumor)

A 45-year-old man undergoes renal biopsy for evaluation of chronic renal failure. Physical examination reveals a blood pressure of 190/110 mm Hg. A renal biopsy discloses pathologic changes in small renal arteries, including "onion-skinning" and fibrinoid necrosis. Which of the following is the most likely underlying cause of chronic renal failure in this patient?

Malignant hypertension

Dude with history of smoking 3 packs every day, onion skinning seen in histology, high bp, what's the condition co existing in this patient?

Malignant hypertension

Case given about BPH; person is unable to urinate/void the urine pee/ basically asking about complication of BPH why that happens?

Median lobe hypertrophy leads to pinching of internal urethral sphincter

Tumor arising from c cells, amyloid deposits stained by Congo red stain?

Medullary thyroid carcinoma (MTC)

Pitting edema, proteinuria 4.5, no rbc, renal biopsy done picture given?

Mesangiocapillary glomerulonephritis

A 30-year-old woman is evaluated for an abnormal Pap smear. A cervical biopsy shows atypical squamous cells in lower third of epithelium with koilocytotic changes in superficial epithelial layers. The basal membrane appears intact. What is the appropriate diagnosis?

Mild dysplasia (cervical intraepithelial neoplasia [CIN]-1

A 12-year-old boy complains of swelling of his feet for the past 3 weeks. He is otherwise healthy, with no known previous illness. Vital signs are normal. Physical examination reveals pitting edema of the lower legs and a swollen abdomen. 24 hours urine analysis shows urinary protein more than 3.5gm, no RBCs or WBCs. Which of the following is the most likely diagnose to consider in your evaluation of this patient?

Minimal change disease

A 10-year-old boy complains of periorbital, abdominal and peripheral swelling for few months. Urinalysis showed 8 gm/24 hours proteinuria and no RBCs. A percutaneous kidney biopsy of the kidney shows no morphological abnormality on light microscopic examination. Which of the following best describes the patient's medical condition?

Minimal change glomerulonephritis

28-year-old man has noticed increasing enlargement and a feeling of heaviness in his scrotum for the past year. On physical examination, the right testis is twice its normal size, and it is firm and slightly tender. An ultrasound examination shows a 3.5-cm solid right testicular mass. Abdominal CT scan shows enlargement of the para- aortic lymph nodes. Multiple lung nodules are seen on a chest radiograph. Laboratory findings include markedly increased serum levels of chorionic gonadotropin and α- fetoprotein. Which of the following neoplasms is the most likely diagnosis?

Mixed germ cell tumor

32-year-old woman is evaluated for an abnormal Pap smear. A cervical biopsy shows atypical squamous cells extends to the middle third of epithelium with delayed keratinocyte maturation. The basal membrane appears intact What is the appropriate diagnosis?

Moderate dysplasia (cervical intraepithelial neoplasia [CIN]-2)

A (50) year old sexually active woman had undergone a regular checkup and there were no physical symptoms and the uterus was normal. The physician recommended a pap smear test and the results had shown HSIL (high grade squamous intraepithelial lesion). Which of the following risk factors is the cause?

Multiple Sexual partners

A 19-year-old, previously healthy woman collapsed after complaining of a mild sore throat the previous day. On examination she is hypotensive and febrile with purpuric skin lesions. Her peripheral blood smear shows schistocytes.Imaging studies show her adrenal glands are enlarged, and there are extensive bilateral cortical hemorrhages. Infection with which of the following organisms best accounts for these findings?

Neisseria meningitidis

six year boy with symptoms of post strep glomerulonephritis, history of sore throat, what's the diagnosis?

Nephritic syndrome

65-year-old obese known hypertensive male presents with 4-month history of chronic renal failure. The patient subsequently suffers a massive stroke and expire. Examination of the kidneys at autopsy reveals reduced size of both kidneys and gross photograph is shown. Which of the following is the appropriate diagnosis? (y3ni atrophy)

Nephrosclerosis

Which of the following tumor marker is used for the diagnosis and management of prostate cancer?

PSA

A 35-year-old female was found to have a solitary nodule in the right side of her neck along with enlarged cervical lymph node. A biopsy showed thyroid tissue tumor within the lymph node. The most likely diagnosis is?

Papillary carcinoma

A 44-year-old, otherwise healthy woman feels a small lump on the left side of her neck. A firm, painless, 1.5-cm cervical lymph node is palpable. The thyroid gland is not enlarged. A chest radiograph is unremarkable. The hemoglobin is 14 g/dL,platelet count is 240,400/mm3, and WBC count is 5830/mm3. A fine-needle aspiration biopsy of the thyroid gland is done. What is the most likely diagnosis?

Papillary carcinoma

Most common thyroid malignancy that carries good prognosis?

Papillary thyroid carcinoma

Psammomma bodies' picture given =

Papillary thyroid carcinoma

55-year-old man, smoker presents with complaint of painless hematuria, frequency and dysuria for 2 months. Endoscopy shows a 3 cm exophytic growth on posterior wall of urinary bladder. Biopsy is performed and picture is shown. What is the diagnosis?

Papillary urothelial carcinoma, high grade

Lady complains from infertility, both fallopian tubes where blocked what is the most likely to cause this?

Pelvic inflammatory disease (PID)

A 10-year-old boy presents with headaches, dizziness and malaise. He has sore throat 2 weeks ago. He has facial edema and blood pressure of 180/110 mmHg. A 24-hour urine collection shows of oliguria and urinalysis shows hematuria. Which of the following best describes this patient's medical condition?

Post-infectious glomerulonephritis

A 50-year-old male presents with right costovertebral pain, palpable mass and painless hematuria. The mass is excised and microscopy picture is shown here. From which epithelium, this tumour is likely to arise from?

Proximal tubular epithelium

A 50-year-old man is found to have blood in his urine during routine checkup. A CT scan shows an irregular right renal mass of 7 cm. Histopathological examination reveals trabecular pattern of cells with clear cytoplasm and irregular nuclei with intervening delicate blood vessels. This malignant neoplasm is most likely originates from which of the following tissues in the kidney?

Proximal tubules

Hypertension secondary to renal artery stenosis is due to which of the following?

Renin

20 year old male had a biopsy what is true about the condition and transabdominal phase of this condition is controlled by which hormone? The picture is shown below:

Right side in most cases, müllerian-inhibiting substance.

+ve PLAP, copious nucleoli, septa, clear cytoplasm:

Seminoma

Biopsy taken from a patient shows papillary complexity, thin clear fluid, stromal invasion as seen in the picture. What is your diagnosis?

Serous cystadenocarcinoma

Picture of Bilateral ovaries, psammomma bodies:

Serous cystadenocarcinoma

Sis wants to get pregnant, but fails, biopsy shows atypical squamous hyperplasia throughout the entire length of endometrium though the endometrium appears normal. Diagnosis?

Severe dysplasia (cervical intraepithelial neoplasia [CIN]-3)

45-year-old woman has had a small amount of vaginal bleeding and a brownish, foul- smelling discharge for the past month. On pelvic examination, there is a 3-cm lesion on the ectocervix, shown in the figure. Microscopic examination of the lesion is most likely to show which of the following?

Squamous cell carcinoma

A 37-year-old woman has had difficulty swallowing and a feeling of fullness in the anterior neck for the past week. She is recovering from a mild upper respiratory tract infection 1month ago. On physical examination,her temperature is 37.4° C,pulse is 74/min,respirations are 16/min, and blood pressure is 122/80 mm Hg. Palpation of her diffusely enlarged thyroid elicits pain. Laboratory studies show an increased serum T4 level and a decreased TSH level. Two months later, she no longer has these complaints. The T4 level is now normal. Which of the following conditions is most likely to have produced these findings?

Subacute granulomatous thyroiditis

All features of hyperthyroidism in graves' disease?

TSH reduced (Low Thyroid stimulating hormone in graves disease)

Testis in inguinal region in 25 yr old man. When one of them is removed what is true?

The risk of malignancy in the contralateral testis is higher

A 3-year-old child has failure to thrive since infancy. Physical examination shows that the child is short and has coarse facial features, a protruding tongue, and an umbilical hernia. As the child matures, profound intellectual disability becomes apparent. A deficiency of which of the following hormones is most likely to explain these findings?

Thyroxine

Case of Disseminated intravascular coagulation (DIC), has increased PROTHROMBIN TIME (TO KNOW THAT THIS IS DIC), + gram negative diplococci in gram stain (Neisseria meningitidis) diagnosis?

Waterhouse-friderichsen syndrome

Incorrect about hypopituitarism?

Weight gain

The mother of 12-month-old boy palpates a mass in the right side of infant's abdomen. The surgical specimen is shown. Microscopically, the tumor is composed of multiple elements, including blastemal, stromal, and epithelial tissues. Which of the following is the most likely diagnosis?

Wilm's tumour

2-year-old kid brought to the ER by his parents when they noticed a mass on his testicle, serum analysis/biopsy showed Schiller Duvall bodies, what's the enzyme most likely to be elevated

alpha fetoprotein 2 (or alpha anti trypsin) => yolk sac tumor

Most gestational choriocarcinomas are preceded by -

complete hydatidiform mole

Routine examination of new born baby showed testes 2 cm above the inguinal ring, what's the diagnosis

cryptorchidism

26-year-old comes to ER with vaginal bleeding, sudden pain, and she masses some stuff with blood and decidual substance but no chorionic villi, what's the diagnosis

ectopic pregnancy

Triploidy-

fetal parts partial mole

30 year female with left renal stenosis, what's the most likely etiology?

fibromuscular dysplasia

Anti-thyro peroxidase antibody positive?

hashimoto's thyroiditis

Woman with bilateral adnexal unilocular cysts in the ovaries what is the diagnosis?

serous cystadenoma

Sis has mild pelvic discomfort for the past 3 months, bilateral adnexal masses, unilocular masses 8- 10cm in size -

serous cystadencarcinoma

Which is the most important useful criterion for the differential diagnosis between borderline ovarian tumor and frank carcinoma

stromal invasion