Directions: Each question below contains five suggested answers.

Choose the one best response to

each question.

1. A 16-year-old girl with a family history of hereditary spherocytosis enters the hospital for
splenectomy as primary therapy for her disease. Surgery is most likely to disclose which of the
following findings?
A. Chronic pancreatitis
B. Duodenal ulcer
C. Cholelithiasis
D. Chronic cholecystitis
E. None of the above
The answer is C

2. Which of the following features is characteristic of acute cholecystitis?

A. Male predominance
B. Association with cholelithiasis in 20% to 30% of cases
C. Gallbladder perforation in most cases
D. An enlarged and discolored gallbladder
E. A prominent infiltrate of lymphocytes and plasma cells
The answer is D

3. Which of the following statements concerning gallbladder cancer is true?

A. Curable cases usually involve a tumor that is an incidental finding at cholecystectomy
B. The tumors typically are found in patients in the fifth decade
C. Most gallbladder cancers are squamous cell carcinomas
D. Patients are asymptomatic in most cases
E. Men are affected more often than women
The answer is A

4. All of the following statements accurately describe pancreatic carcinoma EXCEPT

A. The tumors nearly always are adenocarcinomas
B. They most frequently involve the pancreatic head
C. Patients with hereditary pancreatitis appear to be at increased risk
D. Perineural invasion is a frequent microscopic finding
E. The tumors usually are detected at an early stage
The answer is E

5. All of the following pathologic features may be found in pancreatic pseudocysts EXCEPT
A. Hemorrhage
B. Fistulization into the stomach
C. Amylase-rich fluid
D. Mucinous epithelial lining
E. Fibrous tissue in its wall
The answer is D

6. A 58-year-old man is hospitalized for evaluation of recent intermittent upper abdominal pain. History
and physical examination reveal a 15-lb weight loss over recent months and upper abdominal
tenderness without evidence of a mass or ascites. The best diagnostic approach and most likely
preliminary diagnosis would be
A. Oral cholecystography for the diagnosis of chronic cholecystitis with cholelithiasis
B. Serum bilirubin measurement for the diagnosis of chronic cholecystitis with cholelithiasis
 C. Endoscopy for the diagnosis of carcinoma of the ampulla of Vater
D. Celiotomy for the diagnosis of carcinoma of the head of the pancreas
E. Computed tomography for the diagnosis of carcinoma of the body of the pancreas
The answer is E

Directions: Each question below contains four suggested answers of which one or more is correct.
A. if 1, 2, and 3 are correct
B. if 1 and 3 are correct
C. if 2 and 4 are correct
D. if 4 is correct
E. if 1, 2, 3, and 4 are correct

7. True statements regarding pigment gallstones include which of the following?

1. Pigment stones usually are multiple and multifaceted
2. Pigment stones have a cholesterol content that exceeds 70% by weight
3. Black stones are the most common type seen in the United States
4. Brown stones are associated with cirrhosis
The answer is B

8. True statements regarding chronic cholecystitis include which of the following?

1. Emphysematous cholecystitis refers to dystrophic calcification within the gallbladder wall of
affected patients
2. Rokitansky-Aschoff sinuses are common microscopic findings
3. Men are more commonly affected than women
4. An association with cholelithiasis is typical
The answer is C

9. Primary sclerosing cholangitis has which of the following characteristics?

1. It frequently is seen in patients with ulcerative colitis
2. It usually occurs in young females
3. It is characterized by fibroinflammatory strictures separated by normal or slightly dilated bile
duct segments
4. It can result from operative trauma to the biliary tract
The answer is B

10. In most cases, acute (hemorrhagic) pancreatitis is associated with

1. Hyperparathyroidism or drug toxicity
2. Normal serum amylase levels
3. Autodigestion of the pancreatic parenchyma by activation of disaccharidases and pepsinogen
4. Ductal obstruction or direct toxicity to pancreatic acinar cells
The answer is D

Directions: The group of questions below consists of lettered choices followed by several
numbered items. For each numbered item select the one lettered choice with which it is most
closely associated. Each lettered choice may be used once, more then once, or not at all.

Questions 11-15
 Match each pathologic feature to the biliary tract disorder with which it is most likely to be
associated
A. Rokitansky-Aschoff sinus
B. Porcelain gallbladder
C. Hydrops of the gallbladder
D. Cholesterol polyp
E. Primary sclerosing cholangitis

11. Fibrotic, strictured bile duct

12. Foamy, lipid-laden macrophages in the lamina propria
13. Diverticulum-like invaginations of epithelium into and beyond the smooth muscle layer
14. Mural calcification and fibrosis
15. Distended viscus containing cloudy or mucoid fluid
The answers are: 11-E, 12-D, 13-A, 14-B, 15-C.

Questions 16-20

Match each pathologic feature to the pancreatic disorder with which it is most likely to be
associated.
A. Annular pancreas
B. Pancreatic pseudocyst
C. Acute pancreatitis
D. Chronic pancreatitis
E. Pancreatic carcinoma

16. Fat and parenchymal necrosis

17. Fibrosis and ductal calcifications
18. Amylase-rich fluid
19. Perineural invasion
20. Duodenal stenosis
The answers are: 16-C, 17-D, 18-B, 19-E, 20-A.