1. A 30-year-old woman presents with a 2-month history of fatigue, mild fever, and an
erythematous scaling rash. She also notes some joint pain and swelling, primarily
involving the small bones of her fingers. Physical examination reveals erythematous
plaques with adherent silvery scales that induce punctate bleeding points when
removed. Biopsy of lesional skin shows thickening of the epidermis (left panel; compare
to normal in right panel). Which of the following best accounts for the pathologic
findings in the skin of this patient with psoriasis?
A) Abnormal pattern of cellular maturation
B) Increased numbers of otherwise normal cells
C) Invasiveness through the basement membrane
D) Transformation of one differentiated cell type to another
E) Ulceration and necrosis of epithelial cells
2. A 32-year-old woman has an abnormal cervical Pap smear. A cervical biopsy is
obtained. This section of endocervix shows normal columnar epithelium at both margins
and a focus of squamous epithelium in the center (biopsy shown). Which of the
following terms best describes this adaptation to chronic injury?
A) Atrophy
B) Dysplasia
C) Hyperplasia
D) Hypertrophy
E) Metaplasia
Page 1
,3. A routine cervical Pap smear taken during a gynecologic examination of a 31-year-old
woman shows numerous, loosely arranged cells with high nuclear-to-cytoplasmic ratio.
Colposcopy shows white epithelium, punctation, and a mosaic pattern in the
transformation zone. A cervical biopsy shows an epithelium lacking normal polarity
(biopsy shown). Which of the following best describes the pathologic findings observed
in the uterine cervix of this patient?
A) Abnormal pattern of cellular maturation
B) Increased numbers of otherwise normal cells
C) Invasiveness through the basement membrane
D) Transformation of one differentiated cell type to another
E) Ulceration and necrosis of epithelial cells
Page 2
,4. A 36-year-old man presents with a 2-week history of fatigue, fever, yellow skin and
sclerae, tenderness below the right costal margin, and dark urine. Physical examination
reveals jaundice and mild hepatomegaly. Laboratory studies show elevated serum levels
of bilirubin, decreased albumin, and prolonged prothrombin time. The serum is positive
for hepatitis B surface antigen. A liver biopsy is shown. Which of the following proteins
most likely plays a key role in triggering the formation of the acidophilic body in the
center of the field?
A) Hageman factor (clotting factor XII)
B) P53
C) Phospholipase CA2
D) Phospholipase D
E) RNA polymerase
Page 3
, 5. A 68-year-old coal miner is admitted for evaluation of shortness of breath. The patient
was a heavy smoker of cigarettes over the past 50 years. His face is puffy and red, and
physical examination reveals edema of the lower extremities. The patient subsequently
dies of respiratory insufficiency. A section of a mediastinal lymph node is examined at
autopsy (shown). The black material observed in this specimen most likely represents
which of the following intracellular storage materials?
A) Carbon
B) Hemosiderin
C) Lipofuscin
D) Melanin
E) Silica
6. A 70-year old woman presents with a 1-hour history of crushing substernal chest pain.
Shortly after admission, the patient expires. An autopsy reveals calcium deposits in the
intima of coronary arteries affected by atherosclerosis. Which of the following terms
best describes this autopsy finding?
A) Dystrophic calcification
B) Hyperplastic calcification
C) Hypertrophic calcification
D) Metastatic calcification
E) Physiologic calcification
Page 4
erythematous scaling rash. She also notes some joint pain and swelling, primarily
involving the small bones of her fingers. Physical examination reveals erythematous
plaques with adherent silvery scales that induce punctate bleeding points when
removed. Biopsy of lesional skin shows thickening of the epidermis (left panel; compare
to normal in right panel). Which of the following best accounts for the pathologic
findings in the skin of this patient with psoriasis?
A) Abnormal pattern of cellular maturation
B) Increased numbers of otherwise normal cells
C) Invasiveness through the basement membrane
D) Transformation of one differentiated cell type to another
E) Ulceration and necrosis of epithelial cells
2. A 32-year-old woman has an abnormal cervical Pap smear. A cervical biopsy is
obtained. This section of endocervix shows normal columnar epithelium at both margins
and a focus of squamous epithelium in the center (biopsy shown). Which of the
following terms best describes this adaptation to chronic injury?
A) Atrophy
B) Dysplasia
C) Hyperplasia
D) Hypertrophy
E) Metaplasia
Page 1
,3. A routine cervical Pap smear taken during a gynecologic examination of a 31-year-old
woman shows numerous, loosely arranged cells with high nuclear-to-cytoplasmic ratio.
Colposcopy shows white epithelium, punctation, and a mosaic pattern in the
transformation zone. A cervical biopsy shows an epithelium lacking normal polarity
(biopsy shown). Which of the following best describes the pathologic findings observed
in the uterine cervix of this patient?
A) Abnormal pattern of cellular maturation
B) Increased numbers of otherwise normal cells
C) Invasiveness through the basement membrane
D) Transformation of one differentiated cell type to another
E) Ulceration and necrosis of epithelial cells
Page 2
,4. A 36-year-old man presents with a 2-week history of fatigue, fever, yellow skin and
sclerae, tenderness below the right costal margin, and dark urine. Physical examination
reveals jaundice and mild hepatomegaly. Laboratory studies show elevated serum levels
of bilirubin, decreased albumin, and prolonged prothrombin time. The serum is positive
for hepatitis B surface antigen. A liver biopsy is shown. Which of the following proteins
most likely plays a key role in triggering the formation of the acidophilic body in the
center of the field?
A) Hageman factor (clotting factor XII)
B) P53
C) Phospholipase CA2
D) Phospholipase D
E) RNA polymerase
Page 3
, 5. A 68-year-old coal miner is admitted for evaluation of shortness of breath. The patient
was a heavy smoker of cigarettes over the past 50 years. His face is puffy and red, and
physical examination reveals edema of the lower extremities. The patient subsequently
dies of respiratory insufficiency. A section of a mediastinal lymph node is examined at
autopsy (shown). The black material observed in this specimen most likely represents
which of the following intracellular storage materials?
A) Carbon
B) Hemosiderin
C) Lipofuscin
D) Melanin
E) Silica
6. A 70-year old woman presents with a 1-hour history of crushing substernal chest pain.
Shortly after admission, the patient expires. An autopsy reveals calcium deposits in the
intima of coronary arteries affected by atherosclerosis. Which of the following terms
best describes this autopsy finding?
A) Dystrophic calcification
B) Hyperplastic calcification
C) Hypertrophic calcification
D) Metastatic calcification
E) Physiologic calcification
Page 4
