General Pathology Q&A

**College of Health Sciences****MBChB III** **Unit Title:** General Pathology**Continuous Assessment****Date:** December 2020**Time:** 2 Hours ## SECTION A: MULTIPLE CHOICE QUESTIONS **1.** A 67-year-old male long-term smoker presents with weight loss, persistent cough, fever, chest pain, and haemoptysis. Chest x-ray reveals a 3.5 cm hilar region mass. What is the most likely diagnosis? a) Adenocarcinomab) Hamartomac) Large cell undifferentiated carcinomad) Small cell undifferentiated carcinomae) Squamous cell carcinoma **Answer: e) Squamous cell carcinoma** **Explanation:** In long-term smokers with a central (hilar) lung mass, squamous cell carcinoma is the most common histologic type. It typically arises from the central bronchi and is strongly associated with smoking. The hilar location and smoking history make squamous cell carcinoma the most likely diagnosis. **2.** A condition of the lung characterized by abnormal permanent enlargement of air spaces distal to the terminal bronchiole, with wall destruction but without fibrosis, leading to a "pink puffer": a) Emphysemab) Chronic bronchitisc) Bronchial asthmad) Bronchiectasise) Pleural effusion **Answer: a) Emphysema** **Explanation:** This definition perfectly describes emphysema. The key features are permanent enlargement of air spaces distal to terminal bronchioles with alveolar wall destruction but without significant fibrosis. The term "pink puffer" refers to the typical appearance of emphysema patients who maintain normal oxygen saturation (pink) but are dyspneic (puffer). **3.** A condition of the lung characterized by productive cough, long-term cigarette smoking, and histologically by enlargement of mucus-secreting glands of trachea and bronchi, leading to a "blue bloater": a) Emphysemab) Chronic bronchitisc) Bronchial asthmad) Bronchiectasise) Pleural effusion **Answer: b) Chronic bronchitis** **Explanation:** Chronic bronchitis is defined by persistent productive cough for at least 3 months in each of 2 consecutive years. Histologically, it shows hypertrophy and hyperplasia of mucus-secreting glands. The "blue bloater" appearance reflects chronic hypoxemia (cyanosis) and cor pulmonale (right heart failure with edema). **4.** A 60-year-old male develops sudden chest pain and shortness of breath while recovering from ankle fracture surgery. He collapses and dies. Most likely diagnosis: a) Cerebral infarctb) Acute myocardial infarctc) Pulmonary thromboembolismd) Aortic dissectione) Foreign body aspiration **Answer: c) Pulmonary thromboembolism** **Explanation:** The clinical scenario describes classic pulmonary embolism. The patient has multiple risk factors: recent surgery, immobilization, and likely advanced age. The sudden onset of chest pain, dyspnea, and rapid collapse followed by death is characteristic of massive pulmonary embolism. **5.** A systemic disease of unknown etiology, with non-caseating granulomas in many organs, particularly hilar lymph nodes and lungs: a) Silicosisb) Idiopathic pulmonary fibrosisc) Sarcoidosisd) Asbestosise) Pulmonary tuberculosis **Answer: c) Sarcoidosis** **Explanation:** Sarcoidosis is a multisystem granulomatous disease of unknown cause characterized by non-caseating (non-necrotic) granulomas. It commonly affects hilar lymph nodes and lungs, distinguishing it from tuberculosis which typically shows caseating granulomas. **6.** A syndrome of necrotizing hemorrhagic interstitial pneumonitis associated with proliferative glomerulonephritis: a) Goodpasture syndromeb) Paraneoplastic syndromec) Kartagener syndromed) Lambert-Eaton myasthenic syndromee) Horner's syndrome **Answer: a) Goodpasture syndrome** **Explanation:** Goodpasture syndrome is an autoimmune condition caused by anti-glomerular basement membrane antibodies that cross-react with pulmonary basement membranes. This results in rapidly progressive glomerulonephritis and pulmonary hemorrhage, fitting the description perfectly. **7.** Daughters of women who received diethylstilbestrol (DES) during pregnancy are most likely to develop: a) Sarcoma botryoidesb) Clear cell adenocarcinomac) Squamous cell carcinomad) Uterine leiomyomae) Paget disease of the vulva **Answer: b) Clear cell adenocarcinoma** **Explanation:** DES exposure in utero predisposes to clear cell adenocarcinoma of the vagina and cervix in female offspring. This association was discovered when young women developed this rare cancer, leading to the recognition of DES as a transplacental carcinogen. **8.** High-risk HPV subtypes strongly associated with cervical cancer: a) 6 and 11b) 16 and 18c) Types 1–180d) 3, 10, 28, and 49e) None of the above **Answer: b) 16 and 18** **Explanation:** HPV types 16 and 18 are the most important high-risk oncogenic types, responsible for approximately 70% of cervical cancers worldwide. HPV 16 is associated with squamous cell carcinoma, while HPV 18 is more associated with adenocarcinoma. *