BCSE Anatomic and Clinical Pathology 3 — Questions and Answers
Question 1: A 45-year-old patient's urine sediment shows waxy casts with low-power refractility and broad diameter. These casts are most indicative of which condition?
- Advanced chronic renal failure (Correct answer)
- Acute tubular necrosis
- Nephrotic syndrome
- Urinary tract infection
Correct answer: Advanced chronic renal failure
Broad waxy casts form in dilated, damaged tubules and indicate end-stage renal disease with markedly reduced urine flow.
Question 2: On a bone marrow biopsy, you find sheets of plasma cells with eccentrically placed nuclei and 'clock-face' chromatin comprising 40% of marrow cellularity. Which additional laboratory finding would confirm multiple myeloma?
- Monoclonal protein (M-spike) on serum protein electrophoresis (Correct answer)
- Elevated ESR alone
- Hypochromic microcytic anemia
- Polyclonal hypergammaglobulinemia
Correct answer: Monoclonal protein (M-spike) on serum protein electrophoresis
Multiple myeloma is confirmed by identifying a monoclonal immunoglobulin (M-protein) on serum or urine protein electrophoresis in conjunction with clonal plasma cell proliferation.
Question 3: A 30-year-old woman has a thyroid nodule. Fine needle aspiration cytology shows follicular cells arranged in a papillary configuration with nuclear features including ground-glass nuclei, nuclear grooves, and pseudoinclusions. What is the diagnosis?
- Papillary thyroid carcinoma (Correct answer)
- Follicular thyroid carcinoma
- Medullary thyroid carcinoma
- Hashimoto thyroiditis
Correct answer: Papillary thyroid carcinoma
Papillary thyroid carcinoma is diagnosed by its characteristic nuclear features: Orphan Annie eye nuclei (ground-glass), nuclear grooves, and intranuclear pseudoinclusions.
Question 4: Flow cytometry of a lymph node biopsy from a 60-year-old shows a B-cell population co-expressing CD5 and CD23 with weak surface immunoglobulin. What is the most likely diagnosis?
- Chronic lymphocytic leukemia/small lymphocytic lymphoma (Correct answer)
- Mantle cell lymphoma
- Follicular lymphoma
- Diffuse large B-cell lymphoma
Correct answer: Chronic lymphocytic leukemia/small lymphocytic lymphoma
CLL/SLL is characterized by co-expression of CD5 and CD23 with dim surface Ig, distinguishing it from mantle cell lymphoma which is CD5+ but CD23-.
Question 5: A 25-year-old male presents with a mediastinal mass. Biopsy shows large cells with bilobed nuclei and prominent eosinophilic 'owl-eye' nucleoli in a background of lymphocytes, eosinophils, and plasma cells. What is the diagnosis?
- Nodular sclerosis Hodgkin lymphoma (Correct answer)
- Diffuse large B-cell lymphoma
- T-lymphoblastic lymphoma
- Primary mediastinal large B-cell lymphoma
Correct answer: Nodular sclerosis Hodgkin lymphoma
Reed-Sternberg cells with owl-eye nucleoli in an inflammatory background define classical Hodgkin lymphoma, with nodular sclerosis being most common in young adults with mediastinal involvement.
Question 6: A 40-year-old with history of ulcerative colitis undergoes colectomy. The specimen shows dysplastic crypts with complex back-to-back glands and nuclear stratification confined to the mucosa. What is the most appropriate diagnosis?
- High-grade dysplasia (Correct answer)
- Adenocarcinoma
- Low-grade dysplasia
- Reactive atypia
Correct answer: High-grade dysplasia
High-grade dysplasia in inflammatory bowel disease is characterized by complex architectural distortion and marked nuclear atypia without invasion through the muscularis mucosae.
Question 7: A CBC shows hemoglobin of 7.2 g/dL with MCV of 115 fL, and the peripheral smear reveals hypersegmented neutrophils (>5 lobes). What is the most likely underlying cause?
- Vitamin B12 or folate deficiency (Correct answer)
- Iron deficiency anemia
- Thalassemia
- Sickle cell disease
Correct answer: Vitamin B12 or folate deficiency
Macrocytic anemia with hypersegmented neutrophils is the hallmark of megaloblastic anemia caused by vitamin B12 or folate deficiency impacting DNA synthesis.
BCSE Anatomic and Clinical Pathology 3
A 45-year-old patient's urine sediment shows waxy casts with low-power refractility and broad diameter.
These casts are most indicative of which condition?