PATHOLOGY HIGH YIELD NBME ELABORATED QUESTIONS AND REVIEWED ANSWERS 2023/2024

PATHOLOGY HIGH YIELD NBME ELABORATED QUESTIONS AND REVIEWED ANSWERS 2023/2024 Anticentromere antibodies - CORRECT ANSWER-Scleroderma (CREST) Antidesmoglein (epithelial) antibodies - CORRECT ANSWER-Pemphigus vulgaris (blistering) Anti-glomerular basement membrane antibodies - CORRECT ANSWER-Goodpasture's syndrome (glomerulonehpritis and hemoptysis) Antihistone antibodies - CORRECT ANSWER-Drug-induced SLE (hydralazine, isoniazid, phenytoin, procainamide) Anti-IgG antibodies - CORRECT ANSWER-Rheumatoid arthritis (systemic inflammation, joint pannus, boutonniere deformity) Antimitochondrial antibodies (AMAs) - CORRECT ANSWER-Primary biliary cirrhosis (female, cholestasis, portal hypertension) Antineutrophil cytoplasmic antibodies (ANCAs) - CORRECT ANSWER-Vasculitis (cANCA: Wegener's; p-ANCA: microscopic polyangiitis, Churg-Strauss syndrome) Antinuclear antibodies (ANAs: anti-Smith and anti-dsDNA) - CORRECT ANSWER-SLE (type III hypersensitivity) Antiplatelet antibodies - CORRECT ANSWER-Idiopathic thrombocytopenic purpura (ITP) Anti-topoisomerase antibodies - CORRECT ANSWER-Diffuse systemic scleroderma Anti-transglutamniase/anti-gliadin/anti-endomysial antibodies - CORRECT ANSWERCeliac disease (diarrhea, distension, weight loss) "Apple core" lesion on abdominal x-ray - CORRECT ANSWER-Colorectal cancer (usually left-sided) Azurophilic granular needles in leukemic blasts - CORRECT ANSWER-Auer rods (acute myelogenous leukemia, especially the promyelocytic [M3] type) Bacitracin response - CORRECT ANSWER-Sensitive: Streptocococcus pyogenes (group A) Resistant: Streptococcus agalactiae (group B) "Bamboo spine" on x-ray - CORRECT ANSWER-Ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27) Basophilic nuclear remnants in RBCs - CORRECT ANSWER-Howell-Jolly bodies (due to splenectomy or nonfunctional spleen) Basophilic stippling of RBCs - CORRECT ANSWER-Lead poisoning or sideroblastic anemia Bloddy tap on LP - CORRECT ANSWER-Subarachnoid hemorrhage "Boot-shaped" heart on x-ray - CORRECT ANSWER-Tetralogy of Fallot, RVH Branching gram-positive rods with sulfur granules - CORRECT ANSWER-Actinomyces israelii Bronchogenic apical lung tumor - CORRECT ANSWER-Pancoast tumor (can compress sympathetic ganglion and cause Horner's syndrome) "Brown" tumor of bone - CORRECT ANSWER-Hemorrhage (hemosiderin) causes brown color of osteolytic cysts. Due to: 1. Hyperparathyroidism 2. Osteitis fibrosa cystica Cardiomegaly with apical atrophy - CORRECT ANSWER-Chagas' disease (Trypanosoma cruzi) Cellular crescents in Bowman's capsule - CORRECT ANSWER-Rapidly progressive crescentic glomerulonephritis "Chocolate cyst" of ovary - CORRECT ANSWER-Endometriosis (frequently involves both ovaries) Circular grouping of dark tumor cells surrounding pale neurofibrils - CORRECT ANSWER-Homer Wright rosettes (neuroblastoma, medulloblastoma, retinoblastoma) Colonies of mucoid Pseudomonas in lungs - CORRECT ANSWER-Cystic fibrosis (AR mutation to CFTR resulting in fat-soluble vitamin deficiency and mucous plugs) Decreased alpha-fetoprotein in amniotic fluid/maternal serum - CORRECT ANSWERDown syndrome or other chromosomal abnormality Degeneration of dorsal column nerves - CORRECT ANSWER-Tabes dorsalis (tertiary syphilis) Depigmentation of neurons in substantia nigra - CORRECT ANSWER-Parkinson's disease (basal ganglia disorder: rigidity, resting, tremor, bradykinesia) Desquamated epithelium casts in sputum - CORRECT ANSWER-Curschmann's spirals (bronchial asthma; can result in whorled mucous plugs) Disarrayed granulosa cells in eosinophilic fluid - CORRECT ANSWER-Call-Exner bodies (granulosa-theca cell tumor of the ovary) Dysplastic squamous cervical cells with nuclear enlargment and hyperchromasia - CORRECT ANSWER-Koilocytes (HPV: predisposes to cervical cancer) Enlarged cells with intranuclear inclusion bodies - CORRECT ANSWER-"Owl's eye" appearance of CMV Enlarged thyroid cells with ground-glass nuclei - CORRECT ANSWER-"Orphan Annie" eye nuclei (papillary carcinoma of the thyroid) Eosinophilic cytoplasmic inclusion in liver cell - CORRECT ANSWER-Mallory bodies (alcoholic liver disease) Eosinophilic cytoplasmic inclusion in nerve cell - CORRECT ANSWER-Lewy body (Parkinson's disease) Eosinophilic inclusion bodies in cytoplasm of hippocampal nerve cells - CORRECT ANSWER-Rabies virus (Lyssavirus) Extracellular amyloid deposition in gray matter of brain - CORRECT ANSWER-Senile plaques (Alzhemier's disease) Giant B cells with bilobed nuclei with prominent inclusions ("owl's eye") - CORRECT ANSWER-Reed-Sternberg cells (Hodgkin's lymphoma) Glomerulus-like structure surrounding vessel in germ cells - CORRECT ANSWERSchiller-Duval bodies (yolk sac tumor) "Hair-on-end" (crew cut) appearance on x-ray - CORRECT ANSWER-Beta-thalassemia, sickle cell anemia (marrow expansion) hCG elevated - CORRECT ANSWER-Choriocarcinoma, hydatidiform mole (occurs with and without embryo) Heart nodules (granulomatous) - CORRECT ANSWER-Aschoff bodies (rheumatic fever) Heterophile antibodies - CORRECT ANSWER-Infectious mononucleosis (EBV) Hexagonal, double-pointed, needle-like crystals in bronchial secretions - CORRECT ANSWER-Bronchial asthma (Charcot-Leyden crystals: eosinophilic granules) High level of D-dimers - CORRECT ANSWER-DVT, pulmonary embolism, DIC Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify) - CORRECT ANSWER-Ghon complex (primary TB: Mycobacterium bacilli) "Honeycomb lung" on x-ray - CORRECT ANSWER-Interstitial fibrosis Hypersegmented neutrophils - CORRECT ANSWER-Megaloblastic anemia (B12 deficiency: neurologic symptoms; folate deficiency: no neurologic symptoms) Hypochromic microcytic anemia - CORRECT ANSWER-Iron deficiency anemia, lead poisoning, thalassemia (HbF sometimes present) Increased alpha-fetoprotein in amniotic fluid/maternal serum - CORRECT ANSWERDating error, anencephaly, spina bifida (neural tube defects) Increased uric acid levels - CORRECT ANSWER-Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics Intranuclear eosinophilic droplet-like bodies - CORRECT ANSWER-Cowdry type A bodies (HSV or CMV) Iron-containing nodules in alveolar septum - CORRECT ANSWER-Ferruginous bodies (asbestosis: increased chance of mesothelioma) Large lysosomal vesicles in phagocytes, immunodeficiency - CORRECT ANSWERChediak-Higashi disease (congenital failure of phagolysosome formation) "Lead pipe" appearance of colon on x-ray - CORRECT ANSWER-Ulcerative colitis (loss of haustra) Linear appearance of glomeruli on immunofluorescence - CORRECT ANSWERGoodpasture's syndrome Low serum ceruloplasmin - CORRECT ANSWER-Wilson's disease (hepatolenticular degeneration) "Lumpy-bumpy" appearance of glomeruli on immunofluorescence - CORRECT ANSWER-Poststerptococcal glomerulonephritis (immune complex deposition of IgG and C3b) Lytic ("hole-punched") bone lesions on x-ray - CORRECT ANSWER-Multiple myeloma Mammary gland ("blue-domed") cyst - CORRECT ANSWER-Fibrocystic change of the breast Monoclonal antibody spike - CORRECT ANSWER-1. Multiple myeloma (called the M protein; usually IgG or IgA) 2. Monoclonal gammopathy of undetermined significance (MGUS); normal consequence of aging) 3. Waldenstrom's (M protein = IgM) macroglobulinemia 4. Primary amyloidosis Monoclonal globulin protein in blood/urine - CORRECT ANSWER-Bence Jones proteins (multiple myeloma [kappa or lambda Ig light chains in urine]), Waldenstrom's macroglobinemia (IgM) Mucin-filled cell with peripheral nucleus - CORRECT ANSWER-Signet ring (gastric carcinoma) Narrowing of bowel lumen on barium radiograph - CORRECT ANSWER-"String sign" (Crohn's disease) Needle-shaped, negatively birefringent crysytals - CORRECT ANSWER-Gout (monosodium urate crystals) Nodular hyaline depostis in glomeruli - CORRECT ANSWER-Kimmelstiel-Wilson nodules (diabetic nephropathy) Novobiocin response - CORRECT ANSWER-Sensitive: Staphylococcus epidermidis Resistant: Staphylococcus saprophyticus "Nutmeg" appearance of liver - CORRECT ANSWER-Chronic passive congestion of liver due to right heart failure "Onion-skin" periosteal reaction - CORRECT ANSWER-Ewing's sarcoma (malignant round-cell tumor) Optochin response - CORRECT ANSWER-Sensitive: Streptococcus pneumoniae Resistant: Viridans streptococcus Periosteum raised from bone, creating triangular area - CORRECT ANSWER-Codman's triangle on x-ray (osteosarcoma, Ewing's sarcoma, pyogenic osteomyelitis