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Board Review Questions

Revised: 19 June 2013
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

View previous questions below
2013:   Jan   Feb  
2012:   Jan  

Recently Added Questions

  1. A 64-year old African American male with history of hypertension and COPD presents for evaluation of an itchy skin rash of several years’ duration. He has been evaluated for this rash several times, and has previously had many inconclusive biopsies. He has failed treatment with multiple courses of steroids as well as other topical medications. On physical examination, there are multiple patches and, plaques, as well as generalized erythroderma located in the bathing trunk distribution. The patient undergoes biopsy of one of the skin lesions, which can be seen below. Which of the following immunophenotypes is most consistent with this diagnosis?
 

  1. CD2+, CD3+, CD5+, and CD7-
  2. CD2-, CD3-, CD5 -, and CD7-
  3. CD2+, CD3+, CD5-, and CD7+
  4. CD2-, CD3+, CD5+, and CD7+
  5. CD2+, CD3-, CD5+, and CD7+
Correct answer: a. CD2+, CD3+, CD5+, and CD7-

Citation: Hoppe, Richard T., and Youn H. Kim. "Clinical Manifestations, Pathologic Features, and Diagnosis of Mycosis Fungoides." Clinical Manifestations, Pathologic Features, and Diagnosis of Mycosis Fungoides. UpToDate, 15 Aug. 2012. Web. 14 Dec. 2012., click here to view article.

Source: BoardVitals, 6/18/2013


  1. Which of the following is true regarding renal cell carcinoma?
  1. Collecting duct carcinoma is more common than chromophobe renal carcinoma
  2. Chromophobe carcinoma is more common than papillary carcinoma
  3. Papillary carcinoma is more common than collecting duct carcinoma
  4. All of the above
  5. None of the above
Correct answer: c. Papillary carcinoma is more common than collecting duct carcinoma

Citation: Robbins and Cotran Pathologic Basis of Disease

Source: BoardVitals, 6/18/2013


  1. A 21-year-old male with no significant past medical history presents with fatigue, shortness of breath, weight loss, and leg pain. He had previously been diagnosed with “growing pains,” six months ago, but the pain has failed to remit since that time. Plain radiographs of the chest as well as a subsequent CT scan of the chest are abnormal. A lung biopsy is performed and is seen in the image below. Alkaline phosphatase, vimentin, variable smooth muscle actin and desmin are positive; EMA and keratin are negative. Which of the following histologic characteristics are typical for this diagnosis?
 

  1. Osteoid composed of fine, lacelike pink matrix
  2. Spaces separated by septa composed of highly malignant cells
  3. Purely spindle cell growth with only a small foci of matrix
  4. Malignant-appearing cartilage with hyperchromasia and hypercellularity with spindling at the periphery of cartilage lobules
  5. Predominance of benign giant cells
Correct answer: c. Purely spindle cell growth with only a small foci of matrix

  1. Incorrect. This is the microscopic appearance of osteoblastic osteosarcoma.
  2. Incorrect. This is the microscopic appearance of telangiectatic osteosarcoma. Telangiectatic osteosarcoma differs from classic osteosarcoma in that radiographically appears as a purely lytic destructive lesion resembling and aneurismal bone cyst.
  3. Correct. This patient presents with signs, symptoms, and radiologic findings of metastatic osteosarcoma. The three primary types of osteosarcoma are osteoblastic, fibroblastic, and chondroblastic, which are classified based upon the predominant matrix.
  4. Incorrect. This is the classic microscopic appearance of chondroblastic osteosarcoma.
  5. Incorrect. This is another possible microscopic appearance of chondroblastic osteosarcoma. The finding of a giant cell tumor n the metaphysis of a young patient should suggest osteosarcoma.
Citation: Sternberg, Stephen S., Stacey E. Mills, and Darryl Carter. "Malignant Osteogenic Tumors." Sternberg's Diagnostic Surgical Pathology. 4th ed. Vol. 1. Philadelphia: Lippincott Williams & Wilkins, 2004. 287-293. Print., link to 5th edition

Source: BoardVitals, 6/18/2013


  1. Which of these methods can reduce the incidence of transfusion transmitted disease?
  1. Donor selection
  2. Infectious disease testing
  3. Leukocyte reduction
  4. Diverting the first 8 ml of blood at venipuncture
  5. All of the above
Correct answer: e. All of the above

  1. Correct. Criteria for donor selection are laid down by regulatory bodies and aim to protect both donor and recipient. Strict compliance with these regulations can limit the transmission of infectious diseases.
  2. Correct. Improvements in infectious disease testing has significantly reduced the transfusion-transmitted disease risk over the past 2 decades.
  3. Correct. Although leukocyte reduction is done to reduce the incidence of HLA immunization, it has been shown that leukocyte reduced blood components are as effective as seronegative components in reducing the risk of CMV transmission.
  4. Correct. Diverting the first 8 ml of blood at venipuncture reduces the risk of bacterial contamination by skin flora by 50%.
Citation: McPherson: Henry’s Clinical Diagnosis and Management by Laboratory Medicine, 22nd ed., 2011, Chapter 36, link

Source: BoardVitals, 6/18/2013


  1. Blood centers and transfusion services are regulated by the U.S.Food and Drug Administration. Criteria for acceptance of blood donors are all defined by the FDA. In which of the following clinical situations, a donor must avoid donating blood for 3 years?
  1. Malaria
  2. Pregnancy
  3. Recipient of blood transfusion
  4. Clinical laboratory evidence of HIV
  5. Recipient of toxoid vaccine
Correct answer: a. Malaria

  1. Correct- In a confirmed diagnosis of malaria, deferment for donating blood is for 3 years after becoming asymptomatic.
  2. Deferred for 6 months in pregnancy.
  3. If a donor had received blood transfusion recently, donating blood should be deferred for 12 months.
  4. Clinical evidence of HIV infection indicates an indefinite deferral.
  5. There is no deferral with toxoid vaccine.
Citation: McPherson: Henry’s Clinical Diagnosis and Management by Laboratory Medicine, 22nd ed., 2011, Chapter 36, link

Source: BoardVitals, 6/18/2013


End of Recently Added Questions


Questions from February 25, 2013

  1. A 25-year-old female with no significant past medical history presents with progressive pain and swelling of her left shin. She is concerned because she has been trying to lose weight for some time, but is unable to keep a regular exercise routine because of the pain. She denies a history of trauma and constitutional symptoms. Plain x-rays reveal a large lesion in the shaft of the tibia, which appears to be composed of areas of both sclerosis and lucency. Further imagining studies reveal no additional skeletal, intra-abdominal, or intra-thoracic lesions. Biopsy of the lesion is seen below. A biopsy of this diagnosis is most likely to reveal which of the following pathologic findings?

  1. Well-circumscribed lesion composed of anastomosing bony trabeculae
  2. Hypocellular proliferation of plump spindle cells with metaplastic bone formation
  3. Clusters of spindle cells with focal squamous differentiation
  4. High-grade spindle cells producing a fine, pink osteoid matrix
  5. Doubly nucleated cells and moderate areas of atypia permeating preexisting trabecular bone and filling the marrow space
Correct answer: c. Clusters of spindle cells with focal squamous differentiation

  1. Incorrect: This is the histologic appearance of osteoid osteoma. Osteoid osteoma typically occurs in the second decade of life with a male predominance and involves the metaphysis of long bones. Its appearance on plain x-ray is that of a radiolucent nidus surrounded by an extensive sclerotic zone.
  2. Incorrect: This is the microscopic appearance of fibrous dysplasia. Fibrous dysplasia is developmental defect of bone formation that appears as a well-defined area of rarefaction with a sclerotic rim on plain x-rays. It is usually seen in patients less than 30 years of age, and affects the jawbones, skill, ribs, or proximal femur. It may be associated with Albright syndrome (skin pigmentation, endocrine dysfunction, and precocious puberty) or Mazabraud syndrome (intramuscular myxomas).
  3. Correct: This is the microscopic appearance of adamantinoma. Adamantinoma is an epithelial-appearing neoplasm of bone with predilection for the tibia that affects young men and woman equally. Patients often present with pain and swelling that may progress over a period of years. X-rays demonstrate large areas of sclerosis interspersed with areas of lucency in the shaft of the bone affecting both the cortex and medullary cavity.
  4. Incorrect: This is the histologic appearance of conventional osteoscarcoma. Conventional osteosarcoma is a high-grade malignant neoplasm that occurs in the metaphysis of the long bones of adolescents and young adults. Patients present with pain and swelling of the affected area, which appears as an area of destruction with extension into soft tissues and reactive new bone formation, known as Codman Triangle.
  5. Incorrect: This is the appearance of conventional chondrosarcoma. Conventional chondrosarcoma is the most common variant of a malignant bone neoplasm, which predominantly affects the axial skeletons of adult patients. Patients present with swelling and pain, and plain x-ray demonstrates erosion of markedly thickened cortices.
Citation: Sternberg, Stephen S., Stacey E. Mills, and Darryl Carter. "Bone Tumors." Sternberg's Diagnostic Surgical Pathology. 4th ed. Vol. 1. Philadelphia: Lippincott Williams & Wilkins, 2004. 265-320. Print., link to 5th edition

Source: BoardVitals, 2/25/2013


  1. A 65-year old man with hypertension and emphysema presents for the results of a recent biopsy of the “lump under my jaw.” He has a long history of smoking, chewing tobacco, and working outside as a farmer. He is concerned because a neighbor recently developed skin cancer, and he would like to “stick around to see my grandkids run around on the farm.” The biopsy results are consistent with adenoid cystic carcinoma. Which of the following statements most correctly describe the means of prognosticating this man’s diagnosis?
  1. Predominant Ki-67 antigen activity indicates a greater likelihood of responding to treatment
  2. C-kit activity is demonstrated in both malignant and benign salivary glands and is not useful in prognosis of adenoid cystic carcinoma
  3. The p53 oncogene is found more frequently in recurrent tumors, and indicates the presence of a late-stage tumor
  4. Lung metastasis indicate aggressive, end-stage disease
  5. Clinical staging is a unreliable indicator of response to treatment
Correct answer: c. The p53 oncogene is found more frequently in recurrent tumors, and indicates the presence of a late-stage tumor

  1. Incorrect: Ki-67 antigen activity is seen most frequently in cases of adenoid cystic carcinoma that have failed to respond to treatment.
  2. Incorrect: C-kit expression is demonstrated in the majority of malignant cases of adenoid cystic carcinoma, but not normal glands. It has been implicated in the development of malignancy.
  3. Correct: The p53 oncogene is a marker of late-stage disease, and can this be used as an adverse prognostic factor.
  4. Incorrect: The most common site of metastasis of adenoid cystic carcinoma is the lung. Although lung metastases affect clinical staging of adenoid cystic carcinoma, they may remain stable for years.
  5. Incorrect: The clinical staging of adenoid cystic carcinoma, including tumor size and presence of metastases, is the most reliable prognostic factor.
Citation: Sternberg, Stephen S., Stacey E. Mills, and Darryl Carter. "Salivary Glands." Sternberg's Diagnostic Surgical Pathology. 4th ed. Vol. 1. Philadelphia: Lippincott Williams & Wilkins, 2004. 933-62. Print., link to 5th edition

Source: BoardVitals, 2/25/2013


  1. A 3 year old boy with developmental delay presents to a clinical geneticist with the following dysmorphic features: microcephaly, epicanthal folds, arched eyebrows, long nose, and micrognathia. Neurological history is significant for seizures and physical exam for hypotonia. Chromosome analysis reveals a karyotype of 46, XY, del(4)(p16). What is the diagnosis?
  1. Wolf-Hirschorn syndrome
  2. Cri du chat syndrome
  3. Angelman syndrome
  4. Miller-Dieker syndrome
  5. Langer-Giedion syndrome
Correct answer: a. Wolf-Hirschorn syndrome

  1. Correct: This clinical presentation and karyotype are consistent with Wolf-Hirschorn syndrome, also known as 4p- syndrome.
  2. Incorrect: This syndrome is associated with a deletion at 5p15.
  3. Incorrect: This syndrome is most commonly associated with a deletion at 15q11.2.
  4. Incorrect: This syndrome is associated with a deletion at 17p13.3.
  5. Incorrect: This syndrome is associated with a deletion at 8q24.11-24.13.
Citation: McPherson: Henry’s Clinical Diagnosis and Management by Laboratory Medicine, 22nd ed., link

Source: BoardVitals, 2/25/2013


  1. A 29-year-old male with history of asthma presents with a painless swelling in the back of his thigh. On examination, the area is soft, non-erythematous, and a bruit is heard over the area. Excisional biopsy grossly reveals a soft, “shelled out” tumor, which microscopically demonstrates a thin microvasculature surrounding nests of PAS-positive polygonal cells with prominent nuclei and abundant cytoplasm. Which of the following chromosomal abnormalities has been implicated in the development of this tumor?
  1. t(1:22)
  2. +8, +12
  3. t(12:22)(q13;q12)
  4. t(12;14)
  5. t(11:22); +1q
Correct answer: b. +8, +12

  1. Incorrect: This is the chromosomal mutation responsible for neurofibroma, an unencapsulated nerve sheath lesion, which appears microscopically as uniformly cellular and slightly myxoid with an undulating fibrillar background and nuclear atypia.
  2. Correct: This vignette describes the typical presentation and pathologic appearance of alveolar soft part sarcoma.
  3. Incorrect: This is the chromosomal mutation responsible for clear cell sarcoma, which microscopically forms nests of clear cells that are surrounded by pink collagen bands, which stain with reticulin.
  4. Incorrect: This is the chromosomal mutation responsible for leiomyosarcoma, a malignant smooth muscle tumor that histologically appears as an alternating fascicle pattern with blunt-ended nuclei and a prominent mitotic rate.
  5. Incorrect: This is the chromosomal mutation responsible for neuroepithelioma (PNET), which microscopically demonstrates sheets of small, uniform cells with a bubbly appearance; it may be PAS-positive.
Citation: Sternberg, Stephen S., Stacey E. Mills, and Darryl Carter. "Disorders of Soft Tissues." Sternberg's Diagnostic Surgical Pathology. 4th ed. Vol. 1. Philadelphia: Lippincott Williams & Wilkins, 2004. 137-222. Print., link to 5th edition

Source: BoardVitals, 2/25/2013


  1. A previously healthy 15-year-old male presents with recurrent fevers, weight loss, and an enlarging, painless lump in his groin for the last six months. Blood work reveals pancytopenia, and a reflex smear demonstrates large, pleomorphic cells with lobulated nuclei, prominent nucleoli and basophilic, vacuolated cytoplasm. Imaging reveals diffuse lymphadenopathy, with no obvious primary lesions. The lymph node biopsy is seen in the image below. Presence of which of the following is both diagnostic and prognostic for this condition?

  1. Epstein-Barr Virus positivity
  2. CD30 positivity
  3. Keratin positivity
  4. Anaplastic lymphoma kinase positivity
  5. Leukocyte common antigen positivity
Correct answer: d. Anaplastic lymphoma kinase positivity

  1. Incorrect: Epstein-Barr virus positivity would be expected if in lymphomatoid graulomatosis.
  2. Incorrect: CD30 positivity may be expected in both typical Hodgkin’s Lymphoma and Anaplastic Large Cell Lymphoma (ALCL). However, although present in ALCL, it cannot be used to guide treatment or to prognosticate.
  3. Incorrect: Keratin positivity would be expected in a pleomorphic carcinoma. This patient’s imaging studies did not reveal any primary tumor, nor is the cytologic appearance typical for carcinoma. It cannot be used for prognostication.
  4. Correct: This is the typical presentation of Anaplastic Large Cell Lymphoma (ALCL). The presence of anaplastic lymphoma kinase can be used to distinguish cutaneous from systemic ALCL, guide treatment, and also corresponds with a higher likelihood of response to chemotherapy.
  5. Incorrect: Leukocyte common antigen is a non-specific marker for conditions that may histologically mimic Hodgkin’s Lymphoma in bone marrow aspirates. It cannot be used for prognostication.
Citation: Sternberg, Stephen S., Stacey E. Mills, and Darryl Carter. "Disorders of Bone Marrow." Sternberg's Diagnostic Surgical Pathology. 4th ed. Vol. 1. Philadelphia: Lippincott Williams & Wilkins, 2004. 699-776. Print., link to 5th edition

Source: BoardVitals, 2/25/2013


Questions from January 30, 2013

General Surgical Pathology

1. What lymphomas are common in the stomach?

A) Follicular Lymphoma and T cell lymphoma
B) Diffuse Large B Cell Lymphoma and MALT lymphoma
C) Hodgkin’s Lymphoma and Burkitt’s lymphoma
D) Lymphoplasmacytic Lymphoma and Anaplastic lymphoma

Answer: Diffuse Large B Cell Lymphoma and MALT lymphoma
Source: Ann Oncol 2008;19:1992, also Stomach chapter of PathologyOutlines.com
Contributor: Crystal L. Rose MD, MS, Ball Memorial Hospital, Indiana

2. What is the most common hereditary kidney abnormality?

A) Autosomal dominant polycystic kidney disease
B) Autosomal recessive polycystic kidney disease
C) Renal manifestions of tuberous sclerosis
D) Caroli's syndrome

Answer: Autosomal dominant polycystic kidney disease. It primarily affects adults, and has an incidence of 1-2 per 1000 live births, compared to 1 per 6,000 to 20,000 live births for autosomal recessive polycystic kidney disease, 1 per 10,000 for tuberous sclerosis (with or without renal disease, Neurology 1985;35:600) and 1 per 1,000,000 for Caroli’s disease, which primarily affects the intrahepatic bile ducts (eMedicine)
Source: Rosai (9th edition), page 959, Kidney tumor chapter of PathologyOutlines.com
Contributor: Crystal L. Rose MD, MS, Ball Memorial Hospital, Indiana

3. Tuberous sclerosis is associated with all of the following tumors except:

A) Clear cell sarcoma of soft parts
B) Angiomyolipoma of the kidney
C) Lymphangiomyomatosis of the lung
D) Cortical tuber of the brain

Answer: Clear cell sarcoma of soft parts. Tuberous sclerosis is caused by mutations in the TSC1 or TSC2 genes, although many cases are sporadic. It is associated with tubers of the brain cortex and lymphangiomyomatosis of the lung. It is also associated with renal angiomyolipoma and renal clear cell carcinoma, but not with renal clear cell sarcoma of soft parts, which is due to the t(12;22)(q13;q12) translocation.
Source: Kidney tumor chapter of PathologyOutlines.com
Contributor: Crystal L. Rose MD, MS, Ball Memorial Hospital, Indiana



Questions from January 2012

Transfusion Medicine

1. What is the shelf life of platelets?

A) 5 days
B) 6 days
C) 7 days
D) 8 days
E) 10 days

Answer: 5 days
Source: AABB Technical Manual
Contributor: Crystal L. Rose MD, MS, Ball Memorial Hospital, Indiana

2. How soon must a full written report regarding a transfusion related death be submitted to the FDA?

A) 24 hours
B) Five business days
C) Seven business days
D) Seven days
E) One month

Answer: Seven Days
Source: AABB Technical Manual
Contributor: Crystal L. Rose MD, MS, Ball Memorial Hospital, Indiana

3. What are Howell-Jolly bodies composed of?

A) RNA
B) DNA
C) Ribosomes
D) Keratin
E) All of the above

Answer: DNA
Source: Robbins (7th ed); image
Contributor: Crystal L. Rose MD, MS, Ball Memorial Hospital, Indiana

4. What are Pappenheimer bodies composed of?

A) RNA
B) DNA
C) Microtubules
D) Iron
E) Keratin

Answer: Iron
Contributor: Crystal L. Rose MD, MS, Ball Memorial Hospital, Indiana

5. Hereditary hemochromatosis is inherited in what pattern and physiologic disruption:

A) Autosomal Dominant, inability to excrete iron adequately
B) Autosomal Recessive, inability to excrete iron adequately
C) Autosomal Dominant, excess iron absorption
D) Autosomal Recessive, excess iron absorption
E) Mitochondrial, inability to excrete iron adequately

Answer: Autosomal Recessive, excess iron absorption
Source: PathologyOutlines.com-Liver nontumor chapter, also Foundations in Diagnostic Pathology: Gastrointestinal and Liver Pathology, page 503
Contributor: Crystal L. Rose MD, MS, Ball Memorial Hospital, Indiana

6. What is the most common mutation for hereditary hemochromatosis?

A) S65C
B) H63D
C) C282Y
D) H85Y
E) HFE

Answer: C282Y
Source: PathologyOutlines.com-Liver nontumor chapter, also Foundations in Diagnostic Pathology: Gastrointestinal and Liver Pathology, page 503. Up to 85% of clinically recognized cases in Northern and Western Europeans are homozygotes for the C282Y mutation, a missense mutation. S65C and H63D are other HH mutations but are not the most common. HFE is the gene located on chromosome 6p.
Contributor: Crystal L. Rose MD, MS, Ball Memorial Hospital, Indiana

7. What is the most common genetic disorder in Caucasians?

A) Cystic fibrosis
B) Hereditary hemochromatosis
C) Tuberous sclerosis
D) Sickle Cell Anemia
E) Tay Sachs

Answer: Hereditary hemochromatosis
Source: PathologyOutlines.com-Liver nontumor chapter, also Foundations in Diagnostic Pathology: Gastrointestinal and Liver Pathology, page 503; also Human Genome Project
Prevalence in homozygous state is 1 in 200 whites with carrier frequency between 1 in 10 and 1 in 20.
Contributor: Crystal L. Rose MD, MS, Ball Memorial Hospital, Indiana

End of Board Review Questions