67 Multiple Choice Questions (MCQS) - Pathology & tumors.doc

67 Multiple Choice Questions (MCQS) - Pathology & tumors

1. Select the ONE best response to each question.
1. The histopathology of vernal conjunctivitis shows that
(A) eosinophils are usually present in the epithelium
(B) mast cells are rare in the stroma
(C) elastotic degeneration of the stroma occurs
(D) subepithelial neovascularization is a common feature
(E) mononuclear cell infiltration rarely occurs
2. Which of the following histopathologic descriptions best characterizes phacolytic glaucoma?
(A) Granulomatous infiltration of the uveal tract
(B) Macrophages on the surface of the iris and within the trabecular meshwork
(C) Granulomatous inflammation surrounding a ruptured lens capsule
(D) Plasma cell infiltration of the iris
(E) Peripheral anterior synechiae
3. All the following statements regarding conjunctival nevi are correct EXCEPT
(A) conjunctival nevi are rarely found on the palpebral conjunctiva
(B) epithelial cyst formation is common in conjunctival nevi
(C) nevus cells are confined to the substantia propria
(D) the diagnosis of conjunctival nevus in a 40-year-old patient with a new, pigmented
lesion of the bulbar conjunctiva is unlikely to be accurate
(E) the bulbar hyperpigmentation associated with oculodermal melanocytosis is due to
episcleral melanosis rather than a true nevus of the conjunctiva
4. Which of the following is the most common primary malignant tumor of the orbit in a 6-year-
old?
(A) Optic nerve glioma
(B) Rhabdomyosarcoma
(C) Malignant lymphoma
(D) Neuroblastoma
(E) Meningioma
5. Pleomorphic adenomas of the lacrimal gland
(A) are usually malignant, but may be benign
(B) are prone to recur after removal, even in the benign form
(C) are well encapsulated with little tendency for local invasion unless there is malignant
transformation
(D) often cause erosion of the adjacent orbital bones
6. The pathologist's report of a mass from the region of the lacrimal gland reads as follows:
"Most of the normal lacrimal gland tissue is replaced by well-defined, scattered aggregations
of epithelioid cells. Around each of these aggregates is a mantle of lymphocytes. Giant cells
are present. No necrosis is seen." The most likely diagnosis is
(A) tuberculosis
(B) amelanotic melanoma
(C) idiopathic orbital inflammation
(C) sarcoidosis
(E) Wegener's granulomatosis
4-7. Tumors associated with von Hippel-Lindau disease include all the following EXCEPT
(A) renal cell carcinoma
(B) pheochromocytoma
(C) retinal hemangioblastoma
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2. (D) cerebellar hemangioblastoma
(E) hepatocellular carcinoma
8. Which of the following is characteristic of the histopathology of sympathetic ophthalmia?
(A) Focal accumulations of epithelioid cells in the subretinal space
(B) Diffuse nongranulo~atous inflammatory infiltration of the choroid
(C) Zonal granulomatous inflammation of the sclera
(D) Inflammation that spares the choriocapillaris
(E) Proliferation of histiocytes in the iris stroma with Touton giant cells
9. Findings consistent with Peter's anomaly include all the following EXCEPT
(A) keratolenticular adhesion
(B) prominent, elongated ciliary processes
(C) central absence of Descemet's membrane
(D) association with trisomy 13 and partial deletion of the long arm of chromosome 11
(E) angle closure glaucoma
10. Touton giant cells may be noted on histopathologic examination of each of the following
EXCEPT
(A) Erdheim-Chester disease
(B) fibrous xanthoma
(C) tuberculosis
(D) fibrous histiocytoma
(E) juvenile xanthogranuloma
11. Which of the following is true of sebaceous cell carcinoma of the eyelid?
(A) It is rarely multicentric
(B) It tends to invade locally but rarely metastasizes to regional lymph nodes
(C) Intraepithelial spread is a feature of this tumor
(D) Biopsy specimens from suspected cases must be placed in alcohol-based fixatives to
allow for proper processing
(E) It may originate in the glands of Moll
12. All the following may involve the anterior segment of the eye in the first decade of life
EXCEPT
(A) juvenile xanthogranuloma
(B) medulloepithelioma
(C) retinoblastoma
(D) large cell lymphoma
(E) acute myelogenous leukemia
13. All the following are true of the pseudoexfoliation syndrome EXCEPT
(A) the disease may be unilateral or bilateral
(B) pseudoexfoliation material ceases to be deposited in the anterior chamber after lens
extraction
(C) dense pigmentation is often noted in the trabecular mesh work
(D) pseudoexfoliation material has been demonstrated in the conjunctiva
(E) this material is periodic acid-Schiff positive
14. The features of paving stone degeneration of the retina include an the following EXCEPT
(A) a pocket of vitreous liquefaction overlying the lesion
(B) a circumscribed area of retinal and RPE atrophy
(C) pale, flat lesions in the retinal periphery
(D) adherence of the inner nuclear layer to Bruch's membrane
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3. (E) occlusion of the choriocapillaris as a causative mechanism
15. Regarding uveal melanoma, which of the following is TRUE?
(A) Orbital lymphatics are a common route for tumor dissemination
(B) Tumors of the epithelioid type are associated with the best prognosis for survival
(C) Tumors of the iris have a poorer prognosis than those of the ciliary body or the choroid
(D) Uveal melanomas can cause glaucoma by several different mechanisms
(E) The orange pigment associated with choroidal melanomas is a breakdown product of
melanin
16. a biopsy obtained from the bulbar conjunctiva shows the epithelium and substantia propria
invaded by large, atypical melanocytes. The diagnosis is
(A) conjunctival melanoma
(B) pigmented squamous cell carcinoma
(C) oculodermal melanocytosis
(D) ochronosis
(E) use of topical epinephrine
17. With regard to retinoblastoma; which of the following statements is TRUE?
(A) Flexner- Wintersteiner and homer Wright rosettes are unique to this tumor
(B) The most common route for extension of this disease from the eye is through the
optic nerve
(C) There is a family history of this disease in the great majority of cases
(D) The constituent cells of this lesion stain negatively for S antigen and rhodopsin
(E) An exuberant immune response is responsible for large areas of necrosis seen within
these lesions
18. A lesion removed from the right upper lid of a 32-year-old woman. It was identified as
keratoacanthoma. The lesion appeared 2 months ago and rapidly increased in size. Which of
the following statements regarding this lesion is correct?
(A) A viral etiology for this tumor has been confirmed
(B) This tumor is often aggressively invasive locally
(C) Antibodies to epithelial basement membrane are commonly found in this condition
(D) This lesion stains positively with Congo red
(E) The clinical course of this lesion is commonly self-limited with spontaneous regression

19. All the following statements regarding choroidal hemangioma are true EXCEPT
(A) scan ultrasonography of these lesions typically reveals high internal reflectivity
(B) serous detachment of the overlying retina is a common complication
(C) it may occur in a localized or diffuse form
(D) these lesions are usually readily visible on CT scan of the orbit
(E) cystoid degeneration of the outer layers of adjacent retina can be seen
20. A biopsy, from the left orbit of a 55-year-old man with 2 months of painful, downward and
inward proptosis, revealed a characteristic swiss-cheese pattern. The diagnosis is
(A) neurilemoma
(B) sclerosing dacryoadenitis
(C) adenoid cystic carcinoma
(D) malignant lymphoma
(E) fibrous histiocytoma
21. Histologic features of seborrheic keratosis include all the following EXCEPT
(A) acanthosis
(B) dyskeratosis
(C) hyperkeratosis
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4. (D) papillomatosis
(E) pseudo-horn cysts

22. A lesion excised from the orbit of a 10-year-old boy with a 2-year history of mild proptosis
that worsened markedly after the child developed an upper respiratory infection. The lesion
contains large serum-filled spaces lined by thin endothelial cells without pericytes or smooth
muscles. Scattered lymphoid tissue is located in the stroma of the lesion. The diagnosis is
(A) idiopathic orbital inflammation
(B) cavernous hemangioma
(C) rhabdomyosarcoma
(D) mucocele
(E) lymphangioma
23. All the following statements are true regarding the intraocular tumor medulloepithelioma
EXCEPT
(A) hyaluronic acid is commonly secreted by this tumor
(B) it may arise from the optic nerve, iris, or ciliary body
(C) it is associated with glaucoma
(D) heteroplastic tissue elements such as cartilage and striated muscle may be present
(E) it is usually bilateral
24. Which of the following characteristics is typical of basal cell carcinoma?
(A) It is found on the lower eyelid
(B) It has a flat, smooth surface
(C) It is pigmented
(D) It has erythematous margins
(E) None of the above
25. Which type of eyelid cancer should be suspected in patients with chronic blepharitis,
chalazion formation, and evidence of pagetoid spread?
(A) Basal cell carcinoma
(B) Squamous cell carcinoma
(C) Sebaceous cell carcinoma
(D) Malignant melanoma
(E) Seborrheic keratosis
26. The prognosis of patients with eyelid melanomas correlates with depth of invasion. Which of
the following statements about eyelid melanoma is correct?
(A) Melanomas that penetrate the skin less than 0.76 mm are associated with 100 percent
5-year survival
(B) Eyelid melanomas most commonly metastasize to the liver
(C) Nodular melanomas are associated with the best prognosis for survival
(D) After the diagnosis is made by biopsy, residual tumor is usually treated with
radiotherapy
(E) Melanomas of the eyelid constitute 5 percent of all eyelid cancers
27. A 60-year-old man comes to the emergency room complaining of chronic conjunctivitis and
recently decreased visual acuity in his right eye. Ophthalmic examination reveals a
conjunctival thickening along the nasal limbus containing fronds of corkscrew-shaped
vessels. A semi transparent gray membrane is noted to extend onto the cornea and into the
visual axis. A physical examination reveals that he would tolerate an ophthalmic procedure.
You would advise this gentleman that
(A) he must have computed tomography to rule out orbital extension
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5. (B) The tumor on his eye has been associated with a 90 percent cure rate after surgical
excision and cryotherapy
(C) his tumor commonly invades the eye and orbit
(D) his tumor is likely to metastasize
(E) he has conjunctivitis and must be treated with topical antibiotic therapy

28. If a middle-aged white patient presents with new-onset coniunctival pigmentation involving
one eye, the most likely diagnosis is
(A) racial melanosis
(B) primary acquired melanosis
(C) Addison's disease'
(D) conjunctival nevus
(E) Ota's nevus
29. Almost all patients with unilateral retinoblastoma are treated by
(A) observation
(B) radiation
(C) enucleation
(D) exenteration
(E) none of the above
30. All the following statements about choroidal melanoma are true EXCEPT
(A) charged-particle therapy (proton beam and helium ion) has been associated with more
dry eye and anterior segment complications than has plaque radiotherapy
(B) metastatic choroidal melanoma is usually discovered in the liver
(C) we know that enucleation is better for survival than irradiation
(D) patients with uveal melanoma are more likely to have blue eyes and an outdoor
occupation
(E) risk factors indicating that a choroidal melanoma may grow include thickness greater
than 2 mm, orange pigment, and subretinal fluid
31. The most significant indication for removal of an iris melanoma is
(A) ectropion uveae
(B) hypervascularity
(C) melanomalytic glaucoma
(D) documented growth
(E) sector cataract
32. The most common site of origin for metastatic uveal tumors is the
(A) kidney
(B) colon
(C) prostate
(D) lung
(E) breast
33. What percentage of patients with eccentric disciform chorioretinopathy will have macular
degeneration in the fellow eye?
(A) <25 percent
(B) 37 percent
(C) 67 percent
(D) >85 percent
(E) None of the above
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6. 34. Retinoblastomas most commonly metastasize
(A) by invasion of the perineural subarachnoid space
(B) by invasion of the intraocular lymphatic system
(C) by invasion of the choroid
(D) through extrascleral extension
(E) through emissary veins
35. The most common primary malignant intraocular tumor in adults is
(A) medBlloepithelioma
(B) melanoma
(C) metastatic carcinoma
(D) retinoblastoma
(E) adenocarcinoma of the retinal pigment epithelium
36. What is the most common primary intraocular malignancy in children?
(A) Medulloepithelioma
(B) Melanoma
(C) Retinoblastoma
(D) Melanocytoma
(E) Leiomyoma
37. A common feature of traumatic recession of the anterior chamber angle is
(A) hypertrophy of the oblique and circular muscles of the ciliary body
(B) disinsertion of the longitudinal ciliary muscle from the scleral spur
(C) posterior and external displacement of the first ciliary process relative to a line drawn
through the scleral spur parallel to the visual axis
(D) rupture of the iris insertion into the ciliary body
(E) a triangular 'cross-sectional appearance of the ciliary body

DIRECTIONS: Each group of questions below consists of lettered headings followed by a set of
numbered items. For each numbered item select the one lettered heading with which it is
most closely associated. Each lettered heading may be used once, more than once, or not
at all.
Questions 38-47
Match each disease with an associated finding.
(A) Positive immunofluorescence for antibasement membrane antibodies
(B) Positive Gomori methenamine silver stain
(C) Positive calcofluor white stain
(D) Positive oil red O stain
(E) Metachromasia with crystal violet
(F) Presence of asteroid and Schaumann bodies
(G) Koilocytes
(H) Dutcher bodies
(I) Positive alcian blue and colloidal iron stains
(J) Elastosis of collagen
(K) Granulomatous reaction to Descemet's membrane
(L) Fibrous metaplasia of corneal endothelium
38. Crystalline corneal dystrophy of Schnyder D
39. Sarcoidosis F
40. Herpes simplex keratitis K
41. Spheroidal corneal degeneration J
42. Benign cicatricial ocular pemphigoid A
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7. 43. Macular corneal dystrophy I
44. Malignant lymphoma of the orbit H
45. Acanthamoeba keratitis C
46. Fungal endophthalmitis B
47. Lattice corneal dystrophy E
Questions 48-51
Match each description with the correct eyelid tumor.
(A) Eyelid nevus
(B) Hidrocystoma
(C) Seborrheic keratosis
(D) Xanthelasma
48. A subcutaneous fluid-filled cyst B
49. Microcysts within its stroma A
50. Fat-laden histiocytes within the dermis D
51. A lobulated surface that appears to be adherent to rather than arising within the eyelid skin
C
Questions 52-56
Match the patients below with the probability that their next child will develop a retinoblastoma.
(A) 1 percent
(B) 6 percent
(C) 25 percent
(D) 50 percent
52. A patient with bilateral retinoblastoma due to a germinal mutation D
53. Parents without history of retinoblastoma, but with one affected child with unilateral disease
A
54. Parents without a history of retinoblastoma, but with two affected children D
55. A patient with unilateral retinoblastoma, but no family history B
56. A healthy patient without retinoblastoma, but with a parent with bilateral disease B
DIRECTIONS: Each question below contains four suggested responses of which one or more is
correct. Select
Aif the item is associated with(A) only
Bif the item is associated with(B) only
Cif the item is associated withboth (A) and (B)
Dif the item is associated withneither (A) nor (B)
Each lettered heading may be used once, more than once, or not at all.
Questions 57-61
(A) Choroidal nevus
(B) Choroidal melanoma
(C) Both
(D) Neither
57. Extrascleral extension B
58. Collar-button configuration B
59. Low internal reflectivity on ultrasound C
60. Retrobulbar edema D
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8. 61. Nonrhegmatogenous serous retinal detachment C
Questions 62-65
(A) Circumscribed choroidal hemangioma
(B) Choroidal melanoma
(C) Both
(D) Neither
62. Evidence of choroidal filling on fluorescein angiography C
63. Coarse vascular pattern A
64. Mottled, irregular hyperfluorescence B
65. Late diffuse leakage of fluorescein C
Questions 66-67
(A) Choroidal osteoma
(B) Choroidal hemangioma
(C) Both
(D) Neither
66. High internal reflectivity on A-scan ultrasonography C
67. Tendency to be located posterior to the equator C
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