BCSE Anatomic and Clinical Pathology 3

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?

Accepted Answer

Advanced chronic renal failure

Answer

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?

Accepted Answer

Monoclonal protein (M-spike) on serum protein electrophoresis

Answer

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?

Accepted Answer

Papillary thyroid carcinoma

Answer

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?

Accepted Answer

Chronic lymphocytic leukemia/small lymphocytic lymphoma

Answer

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?

Accepted Answer

Nodular sclerosis Hodgkin lymphoma

Answer

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.

BCSE - Basic and Clinical Sciences Examination Practice Test

BCSE - Basic and Clinical Sciences Examination Practice Test

BCSE Anatomic and Clinical Pathology 3