BCSE Pathology 2 — Questions and Answers
Question 1: A 55-year-old man presents with progressive dysphagia. Biopsy shows squamous cell carcinoma of the esophagus. Which risk factor is most strongly associated with this tumor in the US?
- Barrett esophagus
- Alcohol and tobacco use (Correct answer)
- H. pylori infection
- Achalasia
Correct answer: Alcohol and tobacco use
Alcohol and tobacco use are the strongest risk factors for esophageal squamous cell carcinoma, particularly in the US.
Question 2: Which type of necrosis is characteristically seen in caseous granulomas of tuberculosis?
- Coagulative necrosis
- Liquefactive necrosis
- Caseous necrosis (Correct answer)
- Fat necrosis
Correct answer: Caseous necrosis
Caseous necrosis is the hallmark of tuberculosis granulomas, appearing as soft, cheese-like amorphous debris.
Question 3: A patient develops a pulmonary embolism 5 days after orthopedic surgery. The embolus most commonly originates from which site?
- Pelvic veins
- Deep veins of the lower extremity (Correct answer)
- Axillary veins
- Superior vena cava
Correct answer: Deep veins of the lower extremity
Deep veins of the lower extremity (particularly the femoral and iliac veins) are the most common source of pulmonary emboli.
Question 4: A 40-year-old woman with SLE develops diffuse glomerulonephritis. Immunofluorescence shows a 'full-house' pattern. Which class of lupus nephritis does this represent?
- Class I
- Class II
- Class III
- Class IV (Correct answer)
Correct answer: Class IV
Class IV (diffuse proliferative) lupus nephritis shows the most severe histologic changes and the 'full-house' immunofluorescence pattern with IgG, IgA, IgM, C3, and C1q.
Question 5: Metaplasia of the esophageal squamous epithelium to intestinal-type columnar epithelium secondary to chronic GERD is called:
- Dysplasia
- Barrett esophagus (Correct answer)
- Achalasia
- Mallory-Weiss tear
Correct answer: Barrett esophagus
Barrett esophagus is the replacement of normal esophageal squamous epithelium with specialized intestinal columnar epithelium due to chronic acid reflux.
Question 6: Which oncogene is characteristically amplified in neuroblastoma and correlates with poor prognosis?
- RET
- N-MYC (Correct answer)
- BCR-ABL
- HER2/NEU
Correct answer: N-MYC
N-MYC (MYCN) amplification in neuroblastoma is associated with rapid tumor progression and poor prognosis.
Question 7: A 65-year-old man with chronic alcoholism develops painful gynecomastia and testicular atrophy. Liver biopsy shows micronodular cirrhosis. The gynecomastia is most likely due to:
- Decreased testosterone synthesis
- Impaired hepatic estrogen metabolism (Correct answer)
- Zinc deficiency
- Direct alcohol toxicity on breast tissue
Correct answer: Impaired hepatic estrogen metabolism
Cirrhosis impairs hepatic metabolism of estrogens, leading to elevated circulating estrogen levels and gynecomastia.
BCSE Pathology 2
A 55-year-old man presents with progressive dysphagia.
Biopsy shows squamous cell carcinoma of the esophagus.
Which risk factor is most strongly associated with this tumor in the US?