Home/Quiz/Pathology MCQs – Hematology, Genetic Disorders & Systemic Pathology Pathology MCQs – Hematology, Genetic Disorders & Systemic Pathology Welcome to your Pathology MCQs – Hematology, Genetic Disorders & Systemic Pathology 1. A woman with heavy menstrual bleeding has microcytic hypochromic anemia and low ferritin. What is the diagnosis? Iron deficiency anemia Anemia of chronic disease Thalassemia Aplastic anemia Sickle cell disease None Hint 2. A man with rheumatoid arthritis has low serum iron but increased ferritin. What mechanism is most likely? Absolute iron depletion Hepcidin-mediated iron sequestration Vitamin B12 deficiency Globin mutation Hemolysis None Hint 3. A patient has macrocytosis and hypersegmented neutrophils. What process causes these findings? Defective DNA synthesis Excess iron absorption Platelet destruction Increased globin synthesis Membrane cholesterol loss None Hint 4. A patient has macrocytic anemia, paresthesias, and impaired vibration sense. Which deficiency is most likely? Folate Vitamin B12 Iron Vitamin K Vitamin C None Hint 5. A pregnant woman develops macrocytic anemia without neurologic findings. Which deficiency is most likely? Vitamin B12 Folate Iron Vitamin D Vitamin K None Hint 6. A young adult has recurrent painful crises and chronic hemolytic anemia. Which hemoglobin is responsible? HbA HbA2 HbF HbS HbH None Hint 7. A patient with sickle cell disease develops severe pain after dehydration. What causes the crisis? Vaso-occlusion by sickled cells Platelet destruction Iron overload B12 deficiency Excess erythropoietin None Hint 8. A child has severe microcytic anemia, target cells, and hepatosplenomegaly. Which disorder reduces globin-chain synthesis? Thalassemia Spherocytosis G6PD deficiency Autoimmune hemolysis Aplastic anemia None Hint 9. A child has anemia, jaundice, splenomegaly, and spherocytes. What defect is most likely? RBC membrane protein defect Globin mutation Iron deficiency DNA synthesis defect Factor deficiency None Hint 10. A man develops hemolysis after an oxidant drug. Which smear finding is characteristic? Heinz bodies Auer rods Reed-Sternberg cells Target cells only Howell-Jolly bodies only None Hint 11. A patient has anemia, spherocytes, and a positive direct antiglobulin test. What mechanism is likely? Antibody-mediated RBC destruction Defective beta-globin Iron deficiency Mechanical fragmentation Marrow aplasia None Hint 12. A patient has pancytopenia and a markedly hypocellular bone marrow. What is the diagnosis? Aplastic anemia Iron deficiency Polycythemia vera Myeloma Spherocytosis None Hint 13. A child has fever, bruising, bone pain, and marrow lymphoblasts. What is the diagnosis? Acute lymphoblastic leukemia CML Multiple myeloma Hodgkin lymphoma Polycythemia vera None Hint 14. An adult has myeloblasts containing Auer rods. Which diagnosis is most likely? Acute myeloid leukemia ALL CLL Myeloma Hodgkin lymphoma None Hint 15. A patient with acute promyelocytic leukemia develops DIC. Which abnormality is classic? t(15;17) t(9;22) t(8;14) t(11;14) del(5q) None Hint 16. A patient has marked leukocytosis and splenomegaly. Which molecular abnormality is characteristic? BCR-ABL PML-RARA MYC translocation BCL2 rearrangement RB deletion None Hint 17. An older adult has persistent lymphocytosis of small mature-appearing lymphocytes. Which diagnosis is likely? Chronic lymphocytic leukemia AML ALL Polycythemia vera Aplastic anemia None Hint 18. An older patient has bone pain, anemia, renal dysfunction, and hypercalcemia. Which malignancy is likely? Multiple myeloma Hodgkin lymphoma CML ITP Iron deficiency None Hint 19. A patient with multiple myeloma has a monoclonal spike on serum electrophoresis. What does it represent? Monoclonal immunoglobulin Reduced albumin only Polyclonal Ig Increased fibrinogen Free hemoglobin None Hint 20. A young adult has painless cervical lymphadenopathy and Reed-Sternberg cells. What is the diagnosis? Hodgkin lymphoma Myeloma CML AML Thymoma None Hint 21. A young woman has isolated thrombocytopenia and mucocutaneous bleeding with normal coagulation tests. What is likely? Immune thrombocytopenia Hemophilia A DIC TTP Aplastic anemia None Hint 22. A boy has recurrent hemarthroses and prolonged aPTT with normal platelet count. Which deficiency is likely? Factor VIII Factor VII Factor XIII vWF Fibrinogen None Hint 23. A patient has recurrent mucosal bleeding due to impaired platelet adhesion. Which protein is deficient? von Willebrand factor Factor II Factor VII Fibrinogen Protein C None Hint 24. A patient with hyperlipidemia develops a coronary plaque. Which cells form foam cells? Macrophages Neutrophils Eosinophils Platelets Fibroblasts None Hint 25. A patient has an acute coronary occlusion. Which necrosis occurs in myocardium? Liquefactive Coagulative Caseous Fat Fibrinoid None Hint 26. A chronic smoker has enlarged distal airspaces and destruction of alveolar walls. What is the diagnosis? Emphysema Pulmonary edema Bronchiectasis Lobar pneumonia Sarcoidosis None Hint 27. A patient has fever, productive cough, and focal lung consolidation. Which process is most likely? Acute bacterial pneumonia Emphysema Pulmonary hypertension Pneumothorax Interstitial fibrosis None Hint 28. A patient taking NSAIDs develops epigastric pain and a gastric ulcer. What mechanism contributes? Reduced prostaglandin synthesis Increased mucus Increased bicarbonate Increased mucosal blood flow Enhanced epithelial repair None Hint 29. A patient with chronic liver disease develops fibrosis with regenerative nodules and distorted architecture. What is this called? Cirrhosis Infarction Steatosis only Acute hepatitis Cholestasis None Hint 30. An obese patient has hepatomegaly and triglyceride accumulation in hepatocytes. What is the histologic change? Steatosis Caseous necrosis Amyloidosis Granuloma Fibrinoid necrosis None Hint 31. A patient develops acute kidney injury after prolonged hypotension. Which renal lesion is common? Acute tubular injury Minimal change disease Polycystic disease Renal carcinoma Chronic glomerulonephritis None Hint 32. A patient has heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia. Which syndrome is present? Nephrotic syndrome Nephritic syndrome Pyelonephritis Renal infarction Fanconi syndrome None Hint 33. A patient has hematuria, red-cell casts, hypertension, and reduced GFR. Which syndrome is likely? Nephrotic syndrome Nephritic syndrome Diabetes insipidus Fanconi syndrome Renal tubular acidosis None Hint 34. A patient with long-standing diabetes develops mesangial expansion and glomerular basement membrane thickening. What complication is present? Diabetic nephropathy Minimal change disease Interstitial nephritis Renal infarction Polycystic disease None Hint 35. A woman has weight loss, tremor, heat intolerance, and diffuse thyroid enlargement. What is likely? Hyperthyroidism Hypothyroidism Cushing syndrome Hyperaldosteronism Pheochromocytoma None Hint 36. A patient has fatigue, cold intolerance, weight gain, and bradycardia. Which disorder is likely? Hyperthyroidism Hypothyroidism Cushing syndrome Pheochromocytoma Hyperaldosteronism None Hint 37. A woman develops cervical carcinoma associated with persistent high-risk HPV. Which viral proteins promote tumor development? E6 and E7 HBsAg and HBeAg gp120 and gp41 NS1 and NS2 VP1 and VP2 None Hint 38. A smoker has a central lung mass and hypercalcemia caused by tumor secretion of PTH-related peptide. Which tumor is classically associated? Squamous cell carcinoma Adenocarcinoma Small-cell carcinoma Mesothelioma Hamartoma None Hint 39. A patient with cirrhosis develops a liver mass and elevated alpha-fetoprotein. Which tumor is likely? Hepatocellular carcinoma Cholangiocarcinoma Hemangioma Hepatic adenoma Metastatic melanoma None Hint 40. A renal mass contains cells with abundant clear cytoplasm from lipid and glycogen. Which tumor is likely? Clear cell renal cell carcinoma Wilms tumor Urothelial carcinoma Oncocytoma Angiomyolipoma None Hint 41. A patient develops painless progressive jaundice and a mass in the pancreatic head. What complication is likely? Biliary obstruction Nephrotic syndrome Pulmonary embolism Hyperthyroidism Splenic infarction None Hint 42. A renal biopsy shows extracellular Congo-red-positive deposits with apple-green birefringence. What is the diagnosis? Amyloidosis Fibrinoid necrosis Caseous necrosis Steatosis Hyaline change None Hint 43. A 6-year-old child has recurrent respiratory infections, pancreatic insufficiency, and very high sweat chloride. Which molecular abnormality best explains the disorder? Defective dystrophin production Defective CFTR chloride transport Defective fibrillin synthesis Defective collagen type I synthesis Defective beta-globin synthesis None Hint 44. A newborn has hypotonia, a single transverse palmar crease, and characteristic facial features. Which chromosomal abnormality is most likely? 45,X 47,XXY Trisomy 21 Trisomy 18 5p deletion None Hint 45. A child with multiple café-au-lait macules and neurofibromas is diagnosed with neurofibromatosis type 1. Which gene is classically involved? NF1 RB1 APC RET VHL None Hint 46. A young adult develops bilateral renal tumors, retinal vascular lesions, and cerebellar hemangioblastomas. Which syndrome is most likely? Li-Fraumeni syndrome Von Hippel-Lindau syndrome Lynch syndrome Peutz-Jeghers syndrome Gardner syndrome None Hint 47. A child develops numerous adenomatous polyps throughout the colon and has a strong family history of colorectal carcinoma. Which gene is commonly mutated? APC BRCA1 NF2 RB1 WT1 None Hint 48. A woman develops breast and ovarian carcinomas at a young age, with several affected relatives. Which inherited defect is most strongly associated? BRCA1/BRCA2 dysfunction CFTR dysfunction FBN1 dysfunction DMD dysfunction G6PD deficiency None Hint 49. A child with severe combined immunodeficiency has profound lymphocyte dysfunction due to an inherited purine metabolism defect. Which enzyme deficiency is classically associated? Adenosine deaminase Phenylalanine hydroxylase Glucose-6-phosphatase Hexosaminidase A Ornithine transcarbamylase None Hint 50. A child has developmental delay, seizures, and a characteristic cry caused by deletion of the short arm of chromosome 5. What is this syndrome? Cri-du-chat syndrome Edwards syndrome Patau syndrome Turner syndrome DiGeorge syndrome None Hint 51. A male infant has severe developmental impairment, a distinctive facial appearance, and a characteristic high-pitched cry. Which genetic mechanism is most relevant to many cases of this condition? Trisomy 21 Deletion of 5p Monosomy X Trisomy 13 47,XXY None Hint 52. A patient has Marfan syndrome with aortic root dilation and lens displacement. Which protein is primarily affected? Type IV collagen Fibrillin-1 Dystrophin Spectrin Elastin only None Hint 53. A boy develops progressive proximal muscle weakness and calf pseudohypertrophy. Which protein is deficient in Duchenne muscular dystrophy? Dystrophin Fibrillin Spectrin Collagen IV Neurofibromin None Hint 54. A patient has recurrent infections, eczema, and thrombocytopenia with small platelets. Which inherited disorder is most likely? Wiskott-Aldrich syndrome DiGeorge syndrome Chronic granulomatous disease Bruton agammaglobulinemia Ataxia-telangiectasia None Hint 55. A child has recurrent bacterial infections and absent mature B cells due to an X-linked signaling defect. Which disorder is most likely? Bruton agammaglobulinemia Selective IgA deficiency Wiskott-Aldrich syndrome DiGeorge syndrome Hyper-IgE syndrome None Hint 56. A newborn has hypocalcemia, recurrent infections, and congenital cardiac abnormalities due to abnormal development of the pharyngeal pouches. Which syndrome is most likely? DiGeorge syndrome Turner syndrome Klinefelter syndrome Marfan syndrome Huntington disease None Hint 57. A patient with progressive choreiform movements and a family history of a similar neurologic disease has an autosomal dominant disorder caused by trinucleotide repeat expansion. Which disease is most likely? Huntington disease Cystic fibrosis Tay-Sachs disease Phenylketonuria Duchenne muscular dystrophy None Hint 58. A 28-year-old woman has fatigue, pica, low ferritin, and microcytic hypochromic anemia. Which laboratory finding is expected? Increased ferritin Decreased total iron-binding capacity Increased total iron-binding capacity Increased transferrin saturation Increased mean corpuscular volume None Hint 59. A patient with chronic inflammatory disease has anemia with low serum iron but increased ferritin. What mechanism best explains the iron restriction? Increased hepcidin activity Absent erythropoietin production Increased intestinal iron absorption Excess globin synthesis Reduced ferritin storage None Hint 60. A patient with macrocytosis, paresthesias, and impaired vibration sense has low vitamin B12. Which biochemical abnormality supports the diagnosis? Low methylmalonic acid High methylmalonic acid Low homocysteine High ferritin only Low bilirubin None Hint 61. A patient with sickle cell disease develops severe bone pain after dehydration. What is the primary pathologic event? Intravascular platelet destruction Hemoglobin S polymerization causing red-cell sickling Autoimmune destruction of neutrophils Iron deposition in marrow Vitamin B12 malabsorption None Hint 62. A patient has anemia, jaundice, splenomegaly, and increased osmotic fragility. Which inherited disorder is most likely? Hereditary spherocytosis Thalassemia major Aplastic anemia Iron deficiency anemia Pernicious anemia None Hint 63. A patient develops hemolysis after taking an oxidant medication. Blood smear shows bite cells and Heinz bodies. Which enzyme deficiency is most likely? Pyruvate kinase Glucose-6-phosphate dehydrogenase Adenosine deaminase Hexokinase Myeloperoxidase None Hint 64. A young adult has pancytopenia and a hypocellular bone marrow without significant fibrosis or malignant infiltration. Which diagnosis is most likely? Aplastic anemia Polycythemia vera Multiple myeloma Acute leukemia Iron deficiency anemia None Hint 65. A child presents with fever, bone pain, lymphadenopathy, and circulating lymphoblasts. Which leukemia is most common in children? Acute lymphoblastic leukemia Acute myeloid leukemia Chronic myeloid leukemia Chronic lymphocytic leukemia Hairy cell leukemia None Hint 66. An adult has fatigue, gingival enlargement, and myeloblasts containing Auer rods. Which diagnosis is most likely? Acute myeloid leukemia Acute lymphoblastic leukemia Chronic lymphocytic leukemia Multiple myeloma Hodgkin lymphoma None Hint 67. A patient with acute promyelocytic leukemia is at high risk of disseminated intravascular coagulation. Which genetic abnormality is classically associated? t(9;22) t(15;17) t(8;14) t(11;14) t(14;18) None Hint 68. A patient has marked leukocytosis, splenomegaly, and a low leukocyte alkaline phosphatase score. Which abnormality is characteristic? BCR-ABL fusion JAK2 deletion APC mutation BRCA1 mutation MYC deletion None Hint 69. A patient has painless cervical lymphadenopathy and a lymph node biopsy showing Reed-Sternberg cells. Which diagnosis is most likely? Hodgkin lymphoma Multiple myeloma Burkitt lymphoma Chronic lymphocytic leukemia Acute leukemia None Hint 70. An older adult has bone pain, recurrent infections, anemia, renal dysfunction, and an M-protein spike. Which diagnosis is most likely? Multiple myeloma Hodgkin lymphoma Aplastic anemia Iron deficiency anemia CML None Hint 71. A child develops petechiae after a viral illness. Platelet count is markedly reduced, but hemoglobin and leukocyte counts are normal. Which diagnosis is most likely? Immune thrombocytopenia Aplastic anemia Hemophilia A Disseminated intravascular coagulation TTP None Hint 72. A patient has recurrent hemarthroses and prolonged activated partial thromboplastin time with a normal platelet count. Which deficiency is most likely? Factor VIII Factor VII Fibrinogen Platelet glycoprotein IIb/IIIa Vitamin C None Hint 73. A patient with long-standing hypertension develops concentric thickening of the left ventricular wall. What is the principal cellular adaptation? Cardiomyocyte hypertrophy Cardiomyocyte hyperplasia Fatty replacement Coagulative necrosis Metaplasia None Hint 74. A patient presents with crushing chest pain and ST-segment elevation. Myocardial infarction is suspected. Which necrosis pattern is expected in the early infarct? Liquefactive necrosis Coagulative necrosis Caseous necrosis Fat necrosis Fibrinoid necrosis None Hint 75. A patient develops a thrombus over an atherosclerotic plaque and then sudden limb ischemia. Which process best describes the arterial event? Embolization or thrombosis causing acute ischemia Chronic venous congestion only Lymphatic obstruction Granulomatous inflammation Arteriovenous malformation None Hint 76. A chronic smoker has progressive dyspnea and enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls. Which diagnosis is most likely? Emphysema Asthma Bronchiectasis Pulmonary edema Lobar pneumonia None Hint 77. A patient has chronic productive cough and permanently dilated bronchi with recurrent infections. Which condition is most likely? Bronchiectasis Emphysema Pulmonary embolism Sarcoidosis Pneumothorax None Hint 78. A patient with asthma has recurrent reversible airflow obstruction and eosinophil-rich airway inflammation. Which mediator is strongly associated with bronchoconstriction? Leukotrienes Insulin Erythropoietin Calcitonin Troponin None Hint 79. A patient develops fever, productive cough, and lobar consolidation. Histology shows alveoli filled with neutrophils and fibrin. Which diagnosis is most likely? Lobar pneumonia Emphysema Pulmonary fibrosis Sarcoidosis Pleural mesothelioma None Hint 80. A patient with chronic reflux develops intestinal-type epithelium in the distal esophagus. What is this change called? Dysplasia Barrett esophagus Squamous metaplasia Hyperplasia Atrophy None Hint 81. A patient with peptic ulcer disease has a gastric biopsy showing curved gram-negative organisms in the mucus layer. Which organism is most likely? Helicobacter pylori Escherichia coli Salmonella typhi Clostridioides difficile Vibrio cholerae None Hint 82. A patient with chronic hepatitis B develops cirrhosis and later hepatocellular carcinoma. Which viral protein is associated with oncogenic effects? HBx protein Hemagglutinin Neuraminidase NS1 protein Capsid protein only None Hint 83. A patient has chronic alcohol use, hepatomegaly, steatosis, and elevated aminotransferases. Which microscopic finding is characteristic of alcoholic hepatitis? Mallory-Denk bodies Aschoff bodies Councilman bodies only Psammoma bodies Negri bodies None Hint 84. A patient has recurrent right upper quadrant pain after fatty meals. Imaging shows gallstones. Which stone type is most common in developed countries? Cholesterol stones Pure bilirubin stones Struvite stones Cystine stones Uric acid stones None Hint 85. A patient has progressive renal failure, enlarged kidneys, and multiple cysts affecting both kidneys. Which inherited disorder is most likely? Autosomal dominant polycystic kidney disease Minimal change disease Goodpasture syndrome Membranous nephropathy Acute tubular injury None Hint 86. A child develops edema and heavy proteinuria after a recent respiratory infection. Renal biopsy is normal by light microscopy, while electron microscopy shows podocyte foot-process effacement. Which diagnosis is most likely? Minimal change disease Focal segmental glomerulosclerosis Membranous nephropathy IgA nephropathy Poststreptococcal glomerulonephritis None Hint 87. A patient develops cola-colored urine and periorbital edema after a recent streptococcal throat infection. Which renal lesion is most likely? Poststreptococcal glomerulonephritis Minimal change disease Diabetic nephropathy Amyloidosis Membranous nephropathy None Hint 88. A patient with long-standing diabetes develops albuminuria followed by progressive renal dysfunction. Which glomerular change is characteristic? Nodular glomerulosclerosis Crescent formation Diffuse foot-process effacement only Linear IgG deposition Amyloid-free glomeruli None Hint 89. A patient has fatigue, weight loss, heat intolerance, tremor, and diffuse thyroid enlargement. Histology shows scalloped colloid. Which diagnosis is most likely? Graves disease Hashimoto thyroiditis Subacute thyroiditis Papillary thyroid carcinoma Medullary thyroid carcinoma None Hint 90. A woman has a firm thyroid nodule. Histology shows papillary architecture and nuclei with clearing and grooves. Which tumor is most likely? Papillary thyroid carcinoma Follicular adenoma Medullary thyroid carcinoma Anaplastic carcinoma Parathyroid adenoma None Hint 91. A woman has a breast mass with malignant epithelial cells forming ducts and a desmoplastic stromal response. Which diagnosis is most likely? Invasive ductal carcinoma of breast Fibroadenoma Phyllodes tumor Fat necrosis Mastitis None Hint 92. A patient has a slowly enlarging uterine mass composed of intersecting bundles of benign smooth muscle cells. Which diagnosis is most likely? Leiomyoma Leiomyosarcoma Endometrial carcinoma Adenomyosis Endometrial polyp None Hint 93. A 62-year-old patient has fatigue, recurrent infections, and painless generalized lymphadenopathy. The blood film shows many small mature-appearing lymphocytes and smudge cells. Which diagnosis is most likely? Chronic lymphocytic leukemia Acute lymphoblastic leukemia Acute myeloid leukemia Multiple myeloma Hodgkin lymphoma None Hint 94. A patient with chronic lymphocytic leukemia develops autoimmune hemolytic anemia. Which immunoglobulin-mediated mechanism is most likely? IgG-mediated extravascular hemolysis IgE-mediated mast-cell activation IgA-mediated mucosal injury IgM-mediated complement-independent hemolysis T-cell destruction of erythrocytes None Hint 95. A patient with fatigue, bruising, and pancytopenia has a bone marrow packed with blasts that are positive for myeloperoxidase. Which lineage is represented? Myeloid B lymphoid T lymphoid Megakaryocytic only Plasma-cell None Hint 96. A child with acute leukemia has lymphoblasts that express terminal deoxynucleotidyl transferase (TdT). What does this marker indicate? Immature lymphoid precursor cells Mature neutrophils Plasma cells Mature erythrocytes Megakaryocytes None Hint 97. A patient with multiple myeloma has recurrent bacterial infections. Which immunologic abnormality contributes most directly? Suppression of normal polyclonal immunoglobulin production Marked eosinophilia Excess platelet production Increased complement synthesis Severe neutrophil hypersegmentation None Hint 98. A patient with multiple myeloma develops renal dysfunction. Which substance commonly contributes to tubular injury? Monoclonal light chains Fibrinogen Hemoglobin S IgE Albumin only None Hint 99. A patient has prolonged bleeding after minor procedures, frequent epistaxis, and a normal platelet count. Which inherited disorder is most likely? Von Willebrand disease Hemophilia A Factor V Leiden Polycythemia vera Hereditary spherocytosis None Hint 100. A patient with von Willebrand disease has impaired primary hemostasis. Which platelet interaction is primarily affected? Platelet adhesion to exposed subendothelial collagen Platelet synthesis of hemoglobin Platelet destruction in the spleen Platelet binding to erythropoietin Platelet production in marrow None Hint 101. A patient develops widespread bleeding, prolonged PT and aPTT, thrombocytopenia, and elevated D-dimer during severe sepsis. Which condition is most likely? Disseminated intravascular coagulation Immune thrombocytopenia Hemophilia A Von Willebrand disease Factor XII deficiency None Hint 102. A patient has fever, neurologic symptoms, renal dysfunction, thrombocytopenia, and microangiopathic hemolytic anemia. Which finding is expected on the blood smear? Schistocytes Spherocytes Target cells only Sickle cells only Howell-Jolly bodies None Hint 103. A patient develops thrombocytopenia and thrombosis several days after exposure to heparin. Which mechanism is responsible? Antibodies against heparin-PF4 complexes Direct platelet toxicity by heparin IgE-mediated platelet destruction Vitamin K deficiency Factor VIII autoantibodies None Hint 104. A patient has recurrent deep venous thrombosis and a family history of thrombosis. Testing demonstrates resistance to activated protein C. Which inherited abnormality is most likely? Factor V Leiden mutation Prothrombin deficiency Factor VIII deficiency Antithrombin excess Protein C overactivity None Hint 105. A patient with a chronic myeloproliferative neoplasm has markedly elevated hemoglobin and low erythropoietin. Which diagnosis is most likely? Polycythemia vera Secondary erythrocytosis Iron deficiency anemia Aplastic anemia Essential thrombocytopenia None Hint 106. A patient has persistent thrombocytosis with large mature megakaryocytes in the bone marrow and recurrent thrombosis. Which disorder is most likely? Essential thrombocythemia Hemophilia A Immune thrombocytopenia Aplastic anemia CML only None Hint 107. A patient with CML progresses to an aggressive phase with increasing blasts. Which event is being described? Blast crisis Remission Iron deficiency Hemolytic crisis Aplastic crisis None Hint 108. A child with beta-thalassemia major requires repeated blood transfusions. Which complication can develop because of chronic transfusional iron accumulation? Secondary hemochromatosis Vitamin B12 deficiency Autoimmune hemolysis only Factor VIII deficiency Neutropenia from folate deficiency None Hint 109. A patient with hereditary spherocytosis undergoes splenectomy. Which peripheral blood finding may persist after splenectomy? Howell-Jolly bodies Auer rods Hypersegmented neutrophils Schistocytes only Rouleaux only None Hint 110. A patient with severe anemia has increased reticulocyte count, elevated LDH, indirect hyperbilirubinemia, and low haptoglobin. Which process is most likely? Hemolysis Iron deficiency Marrow aplasia Acute blood loss only Renal erythropoietin excess None Hint 111. A patient with sickle cell disease develops recurrent episodes of severe bone pain and avascular necrosis. Which underlying property of HbS is responsible? Polymerization when deoxygenated Failure to bind oxygen at all Excessive iron binding Increased globin degradation only Defective platelet adhesion None Hint 112. A patient with thalassemia has severe microcytosis with a relatively preserved red-cell count. Which mechanism best explains the anemia? Reduced globin-chain synthesis Reduced iron absorption only Autoimmune platelet destruction Loss of factor VIII Increased vitamin B12 breakdown None Hint 113. A patient with acute leukemia develops severe neutropenia and recurrent bacterial infections. Which component of the blood is primarily responsible for defense against most extracellular bacteria? Neutrophils Erythrocytes Platelets Plasma cells only Basophils None Hint 114. A patient has a monoclonal IgM paraprotein, hyperviscosity symptoms, and lymphoplasmacytic infiltration of bone marrow without lytic bone lesions. Which diagnosis is most likely? Waldenström macroglobulinemia Multiple myeloma Hodgkin lymphoma CML Aplastic anemia None Hint 115. A patient with Hodgkin lymphoma has painless cervical lymphadenopathy and systemic fever, night sweats, and weight loss. Which clinical category describes these systemic symptoms? B symptoms C symptoms M symptoms Aplastic symptoms Hemolytic symptoms None Hint 116. A patient has a bleeding disorder caused by deficiency of a vitamin K-dependent clotting factor. Which factor is NOT vitamin K dependent? Factor VIII Factor II Factor VII Factor IX Factor X None Hint 117. A patient with liver disease develops prolonged PT and aPTT due to reduced synthesis of clotting proteins. Which laboratory finding may accompany the coagulopathy? Low fibrinogen in severe disease Markedly increased factor VIII from liver synthesis High platelet production Low bilirubin in all cases Increased vitamin K absorption None Hint 118. A patient with severe hypertension develops small, granular kidneys. Microscopy shows arteriolar wall thickening with glassy eosinophilic material. What is this lesion? Hyaline arteriolosclerosis Fibrinoid necrosis Caseous necrosis Amyloid deposition Granulomatous inflammation None Hint 119. A patient develops acute kidney injury after prolonged hypotension. Urinalysis shows muddy brown granular casts. Which lesion is most likely? Acute tubular injury Minimal change disease Membranous nephropathy Rapidly progressive glomerulonephritis Chronic pyelonephritis None Hint 120. A patient develops nephritic syndrome with hematuria shortly after an upper respiratory infection. Renal biopsy shows mesangial IgA deposition. Which diagnosis is most likely? IgA nephropathy Poststreptococcal glomerulonephritis Minimal change disease Membranous nephropathy Diabetic nephropathy None Hint 121. A patient has nephrotic syndrome and diffuse thickening of glomerular capillary walls. Immunofluorescence shows granular IgG along the basement membrane. Which diagnosis is most likely? Membranous nephropathy Minimal change disease IgA nephropathy Poststreptococcal glomerulonephritis Alport syndrome None Hint 122. A patient with rapidly progressive renal failure has crescents involving many glomeruli. Which pathologic pattern is present? Rapidly progressive glomerulonephritis Minimal change disease Simple cystic disease Chronic pyelonephritis Diabetic nephropathy None Hint 123. A patient with recurrent urinary tract infections develops irregular cortical scars involving the upper and lower poles of the kidney. Which condition is most likely? Chronic pyelonephritis Acute tubular injury Membranous nephropathy Renal cell carcinoma Minimal change disease None Hint 124. A smoker presents with hematuria and a renal mass. Histology shows nests of clear cells with a delicate vascular network. Which tumor is most likely? Clear cell renal cell carcinoma Papillary renal cell carcinoma Urothelial carcinoma Wilms tumor Oncocytoma None Hint 125. A child presents with an abdominal mass and hematuria. Histology shows primitive blastema, epithelial structures, and stromal elements. Which tumor is most likely? Wilms tumor Clear cell renal cell carcinoma Oncocytoma Urothelial carcinoma Angiomyolipoma None Hint 126. A patient with long-standing reflux develops urinary obstruction and bladder wall thickening. Which type of epithelial malignancy is most common in the urinary bladder? Urothelial carcinoma Squamous cell carcinoma in all cases Adenocarcinoma Small-cell carcinoma Renal cell carcinoma None Hint 127. A patient with chronic smoking develops painless hematuria. Cystoscopy shows a papillary bladder lesion. Which exposure is a major risk factor? Cigarette smoking High dietary calcium Vitamin C supplementation Low salt intake Iron deficiency None Hint 128. A patient has central obesity, hypertension, hyperglycemia, and dyslipidemia. Which endocrine abnormality is central to the pathogenesis? Insulin resistance Complete insulin absence in all cases Excess parathyroid hormone Low cortisol Excess thyroid hormone None Hint 129. A patient with type 1 diabetes develops ketoacidosis. Which metabolic abnormality drives ketone production? Increased lipolysis due to insulin deficiency Increased glycogen synthesis Decreased fatty-acid delivery to liver Increased insulin signaling Reduced glucagon activity None Hint 130. A patient has recurrent renal stones, bone pain, and elevated serum calcium with elevated parathyroid hormone. Which diagnosis is most likely? Primary hyperparathyroidism Hypoparathyroidism Secondary adrenal insufficiency Graves disease Pheochromocytoma None Hint 131. A patient has episodic headache, sweating, palpitations, and severe hypertension. A catecholamine-producing adrenal tumor is suspected. Which diagnosis is most likely? Pheochromocytoma Adrenocortical adenoma Cortical carcinoma Aldosteronoma Thyroid adenoma None Hint 132. A patient has hypertension, hypokalemia, and suppressed renin due to excessive aldosterone production from an adrenal cortical adenoma. What is this syndrome called? Primary hyperaldosteronism Cushing syndrome Addison disease Pheochromocytoma Graves disease None Hint 133. A patient has weight gain, proximal muscle weakness, purple abdominal striae, and hyperglycemia due to excess cortisol. Which syndrome is present? Cushing syndrome Addison disease Conn syndrome Pheochromocytoma Graves disease None Hint 134. A patient has fatigue, hyperpigmentation, hypotension, hyponatremia, and hyperkalemia from primary adrenal insufficiency. Which diagnosis is most likely? Addison disease Cushing syndrome Primary hyperaldosteronism Pheochromocytoma Hyperthyroidism None Hint 135. A patient has chronic autoimmune thyroiditis with a firm, enlarged thyroid and hypothyroidism. Which antibody is commonly associated? Anti-thyroid peroxidase antibody Anti-dsDNA antibody Anti-CCP antibody Anti-GBM antibody Anti-mitochondrial antibody None Hint 136. A patient with thyroid cancer has lymphatic spread to cervical lymph nodes. Histology shows psammoma bodies. Which tumor is most likely? Papillary thyroid carcinoma Follicular thyroid carcinoma Medullary thyroid carcinoma Anaplastic thyroid carcinoma Parathyroid carcinoma None Hint 137. A patient has a thyroid tumor producing calcitonin and associated with endocrine tumors in multiple family members. Which carcinoma is most likely? Medullary thyroid carcinoma Papillary thyroid carcinoma Follicular thyroid carcinoma Anaplastic carcinoma Hurthle cell adenoma None Hint 138. A patient has chronic cough, weight loss, and a central lung mass. Histology shows malignant cells with neuroendocrine features and extensive necrosis. Which tumor is most likely? Small-cell carcinoma Adenocarcinoma Squamous cell carcinoma Hamartoma Mesothelioma None Hint 139. A peripheral lung mass in a nonsmoker shows gland formation and mucin production. Which primary lung cancer is most likely? Adenocarcinoma Small-cell carcinoma Squamous cell carcinoma Large-cell carcinoma Carcinoid tumor only None Hint 140. A smoker has a central bronchial mass showing malignant squamous cells and keratin pearls. Which tumor is most likely? Squamous cell carcinoma Adenocarcinoma Small-cell carcinoma Mesothelioma Carcinoid tumor None Hint 141. A patient develops pleuritic chest pain and sudden dyspnea after prolonged immobilization. Which vascular event is most likely? Pulmonary thromboembolism Lobar pneumonia Pleural effusion from cirrhosis Emphysema Pulmonary hypertension from chronic hypoxia only None Hint 142. A patient has progressive dyspnea, dry cough, and bilateral interstitial opacities. Histology shows patchy fibrosis with temporal heterogeneity and fibroblastic foci. Which pattern is most likely? Usual interstitial pneumonia Diffuse alveolar damage Lobar pneumonia Emphysema Asthma None Hint 143. A patient with chronic inflammatory bowel disease develops bloody diarrhea and continuous mucosal inflammation beginning in the rectum. Which diagnosis is most likely? Ulcerative colitis Crohn disease Diverticulitis Celiac disease Ischemic colitis None Hint 144. A patient has abdominal pain, diarrhea, weight loss, and skip lesions with transmural inflammation. Which diagnosis is most likely? Crohn disease Ulcerative colitis Peptic ulcer disease Celiac disease Acute appendicitis None Hint 145. A patient with chronic diarrhea and weight loss has villous atrophy of the small intestine and anti-tissue transglutaminase antibodies. Which diagnosis is most likely? Celiac disease Crohn disease Ulcerative colitis Whipple disease Lactase excess None Hint 146. A patient develops acute pancreatitis after gallstone obstruction. Which pancreatic enzyme activation is central to the initiating injury? Premature trypsinogen activation to trypsin Premature insulin activation Suppression of lipase Activation of hemoglobin Inhibition of all proteases None Hint 147. A patient with chronic pancreatitis has recurrent abdominal pain, malabsorption, and pancreatic calcifications. Which long-term consequence is most likely? Exocrine pancreatic insufficiency Increased bile production Polycythemia Hyperthyroidism Nephrotic syndrome None Hint 148. A patient with cirrhosis develops hematemesis from dilated veins in the lower esophagus. What is the underlying mechanism? Portal hypertension Systemic hypertension alone Hyperthyroidism Renal artery stenosis Pulmonary hypertension None Hint 149. A patient with chronic liver disease develops ascites, splenomegaly, and thrombocytopenia. Which mechanism contributes to the thrombocytopenia? Splenic sequestration from portal hypertension Increased erythropoietin Excess platelet production Vitamin B12 excess Increased thrombopoietin clearance only None Hint 150. A patient has progressive jaundice and a painless enlarged gallbladder. Imaging reveals a mass in the head of the pancreas. Which malignancy is most likely? Pancreatic ductal adenocarcinoma Pancreatic neuroendocrine tumor Acute pancreatitis Chronic cholecystitis Hepatocellular carcinoma None Hint 151. A patient with long-standing inflammatory bowel disease develops a colon carcinoma. Which histologic precursor lesion is commonly involved in the conventional adenoma-carcinoma sequence? Dysplastic adenomatous polyp Hyperplastic polyp only Inflammatory fibroid polyp Lipoma Hamartoma only None Hint 152. A woman has postmenopausal bleeding. Endometrial biopsy shows malignant glands with atypical cells. Which symptom is most characteristic of endometrial carcinoma? Postmenopausal bleeding Hemoptysis Hematuria Jaundice Dysphagia None Hint 153. A young woman has an irregular cervical lesion. Histology shows invasive nests of malignant squamous cells with keratinization. Which malignancy is most likely? Cervical squamous cell carcinoma Endometrial carcinoma Ovarian serous carcinoma Leiomyoma Hydatidiform mole None Hint 154. A woman has an ovarian mass composed of complex papillary structures and malignant epithelial cells. Which ovarian malignancy is most likely? High-grade serous carcinoma Mature cystic teratoma Fibroma Endometrioma Granulosa cell tumor None Hint 155. A woman has infertility and severe cyclical pelvic pain. Laparoscopy reveals endometrial-type glands and stroma outside the uterus. Which diagnosis is most likely? Endometriosis Adenomyosis Leiomyoma Endometrial carcinoma Cervicitis None Hint 156. A patient with long-standing rheumatoid arthritis develops renal dysfunction and proteinuria. Biopsy demonstrates extracellular deposition of amorphous eosinophilic material that is Congo-red positive. Which diagnosis is most likely? Amyloidosis Acute tubular injury Minimal change disease IgA nephropathy Focal segmental glomerulosclerosis None Hint 157. A patient has restrictive cardiomyopathy and nephrotic-range proteinuria. Biopsy shows extracellular Congo-red positive deposits with apple-green birefringence under polarized light. What is the diagnosis? Amyloidosis Sarcoidosis Hemochromatosis Gout Fibrinoid necrosis None Hint 158. A patient with prolonged severe hypoxia develops cellular swelling followed by membrane damage. Which intracellular change is an early consequence of ATP depletion? Failure of the sodium-potassium pump Increased oxidative phosphorylation Increased protein synthesis Increased lysosomal stability Reduced intracellular calcium None Hint 159. A patient has chronic gastroesophageal reflux with replacement of distal esophageal squamous epithelium by intestinal-type columnar epithelium. What cellular adaptation is present? Metaplasia Hypertrophy Hyperplasia only Dysplasia only Atrophy None Hint 160. A patient develops acute inflammation after a skin injury. Which leukocyte is normally the predominant cell during the first 24 hours? Neutrophil Eosinophil Plasma cell Macrophage Lymphocyte None Hint 161. A patient with chronic inflammation has a tissue biopsy dominated by macrophages, lymphocytes, and plasma cells. Which process best describes the inflammation? Chronic inflammation Acute suppurative inflammation Immediate hypersensitivity Physiologic repair only Transient vasoconstriction None Hint 162. A patient has a deep wound that heals with abundant granulation tissue and later develops a dense collagenous scar. Which cell is primarily responsible for collagen synthesis during repair? Fibroblast Neutrophil Platelet only Eosinophil Mast cell None Hint 163. A hospitalized patient develops a deep venous thrombus after prolonged immobilization. Which factor from Virchow's triad is most directly involved? Stasis of blood flow Hypercalcemia Neutropenia Increased arterial oxygenation Reduced platelet adhesion None Hint 164. A patient develops sudden dyspnea after a large deep venous thrombus embolizes to the pulmonary circulation. What is the immediate vascular event? Pulmonary arterial obstruction Left ventricular rupture Aortic dissection Portal vein thrombosis Coronary artery vasospasm only None Hint 165. A patient in septic shock develops hypotension, warm skin initially, and widespread inflammatory mediator release. Which type of shock is present? Septic shock Hypovolemic shock Cardiogenic shock Obstructive shock from tamponade Neurogenic shock only None Hint 166. A patient has a rapidly enlarging mass. Histology shows marked cellular pleomorphism, numerous atypical mitoses, and invasion of surrounding tissue. Which feature most strongly supports malignancy? Invasion of surrounding tissue Uniform mature cells Low mitotic activity Well-organized architecture Absence of necrosis None Hint 167. A patient with a solid tumor undergoes staging. Imaging demonstrates metastases to distant organs. Which characteristic of cancer is being demonstrated? Metastatic spread Benign encapsulation Local hyperplasia Reversible metaplasia Physiologic hypertrophy None Hint 168. A patient develops urticaria, wheezing, and hypotension within minutes of receiving a drug. Which immunologic mechanism is most likely? IgE-mediated mast-cell activation IgG-mediated cytotoxicity Immune-complex deposition T-cell delayed hypersensitivity Direct complement deficiency None Hint 169. A patient develops hemolytic anemia after receiving an incompatible blood transfusion. Which hypersensitivity mechanism is involved? IgG or IgM antibody-mediated cytotoxicity IgE-mediated mast-cell activation T-cell delayed reaction Immune-complex deposition only Granuloma formation None Hint 170. A patient with systemic lupus erythematosus develops glomerulonephritis due to deposition of circulating antigen-antibody complexes. Which hypersensitivity type is involved? Type III Type I Type II Type IV Type V only None Hint 171. A patient develops an itchy skin reaction 48 hours after contact with a plant allergen. Which immune mechanism is responsible? T-cell-mediated delayed hypersensitivity IgE-mediated immediate hypersensitivity IgM-mediated hemolysis Immune-complex deposition Complement deficiency None Hint 172. A patient has severe anemia with low serum ferritin and increased total iron-binding capacity. Which diagnosis is most likely? Iron deficiency anemia Anemia of chronic disease Sideroblastic anemia Hemolytic anemia Aplastic anemia None Hint 173. A patient with anemia has macro-ovalocytes and hypersegmented neutrophils. Which diagnosis is most likely? Megaloblastic anemia Iron deficiency anemia Hereditary spherocytosis Sickle cell disease Aplastic anemia None Hint 174. A patient with chronic kidney disease develops normocytic anemia. Which deficiency most directly contributes? Erythropoietin Vitamin K Factor VIII Thyroxine Insulin None Hint 175. A patient with chronic hepatitis develops portal hypertension and splenomegaly. Which finding may result from hypersplenism? Thrombocytopenia Marked thrombocytosis Polycythemia Increased neutrophil count Increased erythropoietin None Hint 176. A patient develops a unilateral breast mass with malignant epithelial cells and a desmoplastic stromal response. Which route is commonly used for spread of breast carcinoma to regional nodes? Lymphatic spread Direct spread through the ureter Portal venous spread first CSF dissemination Transplacental spread None Hint 177. A patient has progressive dysphagia and a biopsy showing malignant squamous cells of the esophagus. Which major risk factor is strongly associated with esophageal squamous cell carcinoma? Tobacco and alcohol exposure Low-fat diet alone Iron supplementation Hyperthyroidism Vitamin D excess None Hint 1 out of 89 Time's up
