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PA7.1,PA22.1-5 | Diagnostic Cytology & Clinical Pathology — Practice Quiz
Practice
12 questions · Untimed · Unlimited attempts
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A 45-year-old woman presents with a 2 cm solitary thyroid nodule. Fine needle aspiration cytology (FNAC) is performed. Which of the following best describes the key advantage of FNAC over exfoliative cytology for this lesion?
A
FNAC samples cells directly from a deep-seated mass inaccessible to surface shedding
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B
FNAC requires no special staining techniques, unlike exfoliative cytology
C
FNAC provides a superior histological core with preserved tissue architecture
D
FNAC is preferred because it requires general anaesthesia, ensuring patient compliance
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A cervical Pap smear shows cells with nuclear enlargement, hyperchromasia, irregular nuclear membrane, and a nuclear-to-cytoplasmic (N:C) ratio of approximately 1:1. Nucleoli are prominent. Which Bethesda 2014 category best fits, and which cytological criterion is MOST specific for malignancy?
A
ASCUS; koilocytic change (perinuclear halo) is the most specific criterion for malignancy
B
LSIL; hyperchromasia alone is the most specific criterion for malignancy
C
Squamous cell carcinoma; prominent nucleoli are the most specific criterion
D
HSIL; irregular nuclear membrane (nuclear contour irregularity) is the most specific criterion
✓
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In a Papanicolaou-stained cervical smear, which statement about staining characteristics is CORRECT?
A
Superficial squamous cells stain blue-green (cyanophilic) with the Pap stain
B
Giemsa stain is preferred over Pap stain for identifying nuclear detail in alcohol-fixed cervical smears
C
The Papanicolaou stain uses haematoxylin for nuclear staining and EA-50/OG-6 for cytoplasmic differentiation, with superficial cells staining pink-orange (eosinophilic)
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D
Giemsa stain gives superior nuclear detail compared to Pap stain for alcohol-fixed smears
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A 28-year-old man presents with haematuria and proteinuria. Urine microscopy shows dysmorphic red blood cells (acanthocytes). Urine protein is 1+ on dipstick. Blood pressure is 160/100 mmHg. Which combination of findings best supports a glomerular origin of haematuria?
A
Fatty casts + oval fat bodies + heavy proteinuria (>3.5 g/day)
B
WBC casts + granular casts + moderate proteinuria
C
Isomorphic RBCs + RBC casts + heavy proteinuria (>3.5 g/day)
D
Dysmorphic RBCs (acanthocytes >5%) + RBC casts + mild proteinuria + hypertension
✓
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Urine microscopy from a patient with suspected renal tubular injury shows coarsely granular brown casts. Urine dipstick is positive for blood but urine microscopy shows no RBCs. Serum creatinine is acutely elevated. Which is the MOST likely diagnosis and cast composition?
A
ATN due to myoglobinuria; muddy-brown granular casts with dipstick positive for haem pigment but no RBCs on microscopy
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B
Nephrotic syndrome; casts composed of lipid-laden tubular cells
C
ATN from ischaemia only; muddy-brown granular casts composed of degenerating tubular epithelial cells
D
Post-streptococcal glomerulonephritis; RBC casts and dysmorphic red cells with haematuria
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CLINICAL VIGNETTE: A 6-year-old boy presents with fever, neck stiffness, and photophobia for 18 hours. LP is performed. CSF: opening pressure 280 mmH₂O; appearance — turbid; WBC 2,400/mm³ (95% neutrophils); protein 320 mg/dL; glucose 18 mg/dL (simultaneous blood glucose 90 mg/dL; CSF:blood glucose ratio = 0.20). Gram stain: Gram-positive diplococci. Which interpretation is MOST accurate?
A
Clear CSF, lymphocytic pleocytosis, normal glucose, mildly elevated protein = viral (enteroviral) meningitis
B
Turbid CSF, neutrophilic pleocytosis, markedly low glucose (CSF:blood ratio 0.20), markedly high protein, Gram-positive diplococci = bacterial meningitis due to Streptococcus pneumoniae
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C
Turbid CSF, lymphocytic pleocytosis, moderately low glucose, fibrin web = TB meningitis due to Mycobacterium tuberculosis
D
Xanthochromic CSF, RBCs, lymphocytes, normal glucose = subarachnoid haemorrhage, not meningitis
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CLINICAL VIGNETTE: A 60-year-old man with known heart failure presents with increasing breathlessness. Right-sided pleural tap yields 800 mL of straw-coloured fluid. Biochemistry: pleural fluid protein 18 g/L, serum protein 72 g/L (ratio 0.25); pleural fluid LDH 90 IU/L, serum LDH 280 IU/L (ratio 0.32; upper limit of normal serum LDH = 280 IU/L, so 2/3 = 187 IU/L). How should this effusion be classified using Light's criteria?
A
Exudate; protein ratio 0.25 exceeds the Light's threshold, confirming exudate from inflammatory pleuritis
B
Exudate; pleural fluid LDH 90 IU/L exceeds 2/3 of serum LDH upper limit, confirming exudate
C
Transudate; all three Light's criteria are negative — protein ratio <0.5, LDH ratio <0.6, pleural LDH <2/3 upper limit — consistent with cardiac failure raising hydrostatic pressure
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D
Transudate; serosanguinous appearance and low glucose confirm transudate from cardiac failure
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A 35-year-old woman has fatigue, cold intolerance, weight gain, and constipation. TFTs: TSH 42 mIU/L (normal 0.4–4.0), free T4 4.2 pmol/L (normal 9–25), free T3 2.1 pmol/L (normal 3.5–7.8). Anti-TPO antibodies are markedly elevated. Which pattern is present and what is the most likely diagnosis?
A
High TSH, low free T4/T3 = primary hypothyroidism; most likely Graves' disease with anti-TSH receptor antibodies
B
Primary hypothyroidism (high TSH + low fT4/fT3) due to autoimmune destruction; markedly elevated anti-TPO antibodies are the serological hallmark of Hashimoto's thyroiditis
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C
High TSH, low free T4/T3 = primary hypothyroidism; most likely Hashimoto's thyroiditis confirmed by markedly elevated anti-TPO antibodies
D
Low TSH, low free T4/T3 = secondary (pituitary) hypothyroidism; anti-TPO elevation is coincidental
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A 52-year-old alcoholic presents with jaundice and abdominal pain. LFTs: ALT 2,100 IU/L (normal <40), AST 1,800 IU/L, ALP 130 IU/L (normal 30–120), GGT 310 IU/L, total bilirubin 85 μmol/L (conjugated 60, unconjugated 25). Urine is dark; stools are pale. Which LFT pattern and jaundice type is present?
A
Cholestatic pattern (ALP/GGT-dominant rise); intrahepatic obstructive jaundice with pale stools
B
Hepatocellular pattern (aminotransferase-dominant rise); conjugated (hepatocellular) jaundice with conjugated bilirubin predominating, dark urine, and pale stools
✓
C
Mixed hepatocellular-cholestatic pattern; haemolytic (pre-hepatic) jaundice with unconjugated bilirubin predominating
D
Hepatocellular pattern; unconjugated (pre-hepatic) jaundice from alcohol-induced haemolysis
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CLINICAL VIGNETTE: A 70-year-old diabetic man with hypertension presents with oliguria for 3 days after severe diarrhoea and vomiting. Serum creatinine 6.8 mg/dL (baseline 0.9 mg/dL six months ago), urea 168 mg/dL, potassium 6.1 mEq/L. Urine output 200 mL/day. Renal ultrasound shows bilaterally small kidneys (8 cm) with increased echogenicity. What does the urea:creatinine ratio indicate, and how do the ultrasound findings modify the diagnosis?
A
Urea:creatinine ratio 24.7:1 with small echogenic kidneys = AKI-on-CKD; small kidneys establish pre-existing CKD, and raised urea:creatinine suggests prerenal component from volume depletion
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B
Urea:creatinine ratio <10:1 indicating intrinsic (parenchymal) AKI; small kidneys are incidental
C
Urea:creatinine ratio >20:1 with normal-sized kidneys = pure prerenal AKI; volume depletion alone explains all findings
D
Urea:creatinine ratio >40:1 = postrenal obstruction; bilateral hydronephrosis expected on ultrasound
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A 22-year-old man and his partner are being investigated for 18 months of infertility. Semen analysis (WHO 2021): volume 1.4 mL (normal ≥1.5 mL), sperm concentration 8 million/mL (normal ≥16 million/mL), total motility 28% (normal ≥42%), progressive motility 18% (normal ≥30%), normal morphology 2% (Kruger strict, normal ≥4%). Which statement about terminology and the most predictive parameter is CORRECT?
A
OAT syndrome (oligozoospermia + asthenozoospermia + teratozoospermia); Kruger strict morphology <4% most strongly predicts fertilisation failure in conventional IVF
B
Hypospermia + OAT syndrome; sperm concentration below 5 million/mL is the single strongest predictor of IVF failure
C
Oligospermia + asthenospermia + teratospermia (using older WHO terminology); total motility most strongly predicts fertilisation failure
D
Hypospermia + OAT syndrome (oligozoospermia + asthenozoospermia + teratozoospermia); Kruger strict morphology <4% is the strongest independent predictor of natural fertilisation and conventional IVF success because morphology reflects acrosome integrity required for zona pellucida penetration
✓
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A urine sample from an afebrile 19-year-old woman on a routine health check-up shows on microscopy: envelope-shaped crystals (square with central X-mark), 2+ glycosuria on dipstick, mild ketonuria, no proteinuria, no casts, no RBCs, WBC 3/hpf. Which is the MOST accurate interpretation?
A
Coffin-lid (triple phosphate) crystals in alkaline urine; glycosuria indicates diabetes mellitus
B
Uric acid crystals (rhomboid/diamond-shaped) in acid urine; glycosuria indicates diabetes mellitus
C
Calcium oxalate dihydrate (envelope/octahedral) crystals — often incidental; glycosuria with ketonuria warrants blood glucose measurement to exclude uncontrolled type 1 diabetes or renal glycosuria
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D
Cystine crystals (hexagonal flat plates) indicating cystinuria; glycosuria is unrelated and likely a laboratory error
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