Dysplasia US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Dysplasia. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Dysplasia US Medical PG Question 1: A 38-year-old woman makes an appointment with her family physician for a routine check-up after being away due to travel for 1 year. She recently had a screening Pap smear, which was negative for malignancy. Her past medical history is significant for a Pap smear 2 years ago that reported a low-grade squamous intraepithelial lesion (LSIL). A subsequent colposcopy diagnosed high-grade cervical intraepithelial neoplasia (CIN2). The patient is surprised by the differences in her diagnostic tests. You explain to her the basis for the difference and reassure her. With this in mind, which of the following HPV serotypes is most likely to be present in the patient?
- A. HPV 33
- B. HPV 16 (Correct Answer)
- C. HPV 6
- D. HPV 31
- E. HPV 18
Dysplasia Explanation: ***HPV 16***
- HPV 16 is the most common **high-risk HPV serotype**, responsible for approximately 50-60% of all **cervical cancers** and a high percentage of **high-grade cervical intraepithelial neoplasia (CIN2/3)**. The progression from LSIL to CIN2 in this patient suggests infection with a high-risk type, making HPV 16 the most likely candidate.
- Given the patient's history of CIN2, a lesion of high-grade dysplasia, it is highly probable that she is infected with one of the most oncogenic HPV types, of which HPV 16 is paramount in prevalence.
*HPV 33*
- HPV 33 is a **high-risk HPV type** but is less prevalent than HPV 16 and 18 in causing cervical lesions. While it can cause CIN2, it is not the *most likely* serotype.
- It accounts for a smaller proportion of cervical cancers and high-grade dysplasias compared to HPV 16.
*HPV 6*
- HPV 6 is a **low-risk HPV type** primarily associated with **genital warts (condyloma acuminata)** and **low-grade squamous intraepithelial lesions (LSIL)** that typically do not progress to CIN2 or cervical cancer.
- Its presence would be inconsistent with the development of CIN2, as low-risk types are rarely implicated in high-grade dysplasia or malignancy.
*HPV 31*
- HPV 31 is another **high-risk HPV type** capable of causing **CIN2** and cervical cancer. However, it is less common than HPV 16.
- While plausible, HPV 16 remains statistically the most probable cause of CIN2.
*HPV 18*
- HPV 18 is a **high-risk HPV type** and is the second most common cause of **cervical cancer**, particularly **adenocarcinoma**. It is also associated with high-grade squamous lesions.
- While HPV 18 is a strong contender for high-grade lesions like CIN2, HPV 16 is still more frequently implicated in squamous cell carcinoma precursors.
Dysplasia US Medical PG Question 2: A 65-year-old man comes to the physician for a routine health maintenance examination. He has a strong family history of colon cancer. A screening colonoscopy shows a 4 mm polyp in the upper sigmoid colon. Which of the following findings on biopsy is associated with the lowest potential for malignant transformation into colorectal carcinoma?
- A. Branching tubules embedded in lamina propria
- B. Tree-like branching of muscularis mucosa
- C. Regenerating epithelium with inflammatory infiltrate
- D. Hyperplastic epithelium at the base of crypts (Correct Answer)
- E. Finger-like projections with a fibrovascular core
Dysplasia Explanation: ***Hyperplastic epithelium at the base of crypts***
- This description corresponds to a **hyperplastic polyp**, which is the classic **benign colonic polyp** with **negligible malignant potential**.
- Hyperplastic polyps are characterized by a **serrated (saw-toothed) architecture** with delayed maturation of epithelial cells in the lower third of the colonic crypt.
- These polyps are **non-neoplastic** and represent the polyp type with the **lowest risk of malignant transformation** in traditional classification.
- Note: Sessile serrated adenomas/polyps (SSA/Ps) are a distinct entity with malignant potential, but traditional small hyperplastic polyps are considered benign.
*Branching tubules embedded in lamina propria*
- This morphology is characteristic of a **tubular adenoma**, which is a **neoplastic polyp** with definite malignant potential.
- Tubular adenomas have approximately **5% risk of malignancy** when small (<1 cm), but this increases with size and degree of dysplasia.
- These are **precancerous lesions** that require surveillance.
*Tree-like branching of muscularis mucosa*
- This description suggests a **villous growth pattern** characteristic of adenomas with villous architecture.
- **Villous adenomas** have a **higher risk of malignant transformation** (up to 40%) compared to pure tubular adenomas.
- The villous architecture indicates greater neoplastic potential.
*Regenerating epithelium with inflammatory infiltrate*
- This describes an **inflammatory (pseudo)polyp**, which arises from cycles of **inflammation and repair** in inflammatory bowel disease or other mucosal injury.
- **Inflammatory polyps** are **non-neoplastic** and have **no direct malignant potential** themselves.
- However, hyperplastic polyps are the traditional answer for "lowest malignant potential" polyp in screening contexts, as inflammatory polyps are typically associated with underlying inflammatory conditions rather than routine screening findings.
*Finger-like projections with a fibrovascular core*
- This is the classic histological description of a **villous adenoma**, showing finger-like projections of epithelium covering fibrovascular cores.
- **Villous adenomas** have the **highest malignant potential** among adenomatous polyps, with up to **40% risk of harboring carcinoma** depending on size.
- They often contain high-grade dysplasia and are at significant risk for progression to adenocarcinoma.
Dysplasia US Medical PG Question 3: A 10-month-old boy is brought to the physician by his mother for evaluation of abnormal growth and skin abnormalities. His mother has also noticed that his eyes do not fully close when sleeping. He is at the 24th percentile for height, 17th percentile for weight, and 29th percentile for head circumference. Physical examination shows wrinkled skin, prominent veins on the scalp and extremities, and circumoral cyanosis. Genetic testing shows a point mutation in a gene that encodes for a scaffold protein of the inner nuclear membrane. The mutation causes a deformed and unstable nuclear membrane, which leads to premature aging. Which of the following is most likely to be the defective protein?
- A. Vimentin
- B. Lamin (Correct Answer)
- C. Plectin
- D. Nesprin
- E. Desmin
Dysplasia Explanation: ***Lamin***
- The clinical presentation with **accelerated aging** symptoms (wrinkled skin, prominent veins, abnormal growth percentiles, lagophthalmos/difficulty closing eyes) combined with a defect in a **scaffold protein** of the **inner nuclear membrane** is diagnostic of **Hutchinson-Gilford Progeria Syndrome (HGPS)**.
- **Lamins** (specifically Lamin A/C) are intermediate filaments that form the **nuclear lamina**, the primary structural scaffold underlying the inner nuclear membrane, and mutations in the **LMNA gene** cause progeria and other laminopathies.
- The mutation typically produces progerin, an abnormal lamin protein that destabilizes the nuclear envelope leading to premature cellular senescence.
*Vimentin*
- **Vimentin** is an intermediate filament primarily found in **mesenchymal cells** and plays a role in cell shape, integrity, and motility within the **cytoplasm**.
- Defects in vimentin are not associated with disorders of the nuclear membrane or premature aging syndromes.
*Plectin*
- **Plectin** is a **cytoskeletal linker protein** that cross-links intermediate filaments to each other, to microtubules, and to actin filaments, reinforcing cellular stability.
- While important for cellular integrity, plectin is a **cytoplasmic protein**, not a component of the inner nuclear membrane scaffold.
*Nesprin*
- **Nesprins** (Nuclear Envelope Spectrin-repeat Proteins) are components of the **Linker of Nucleoskeleton and Cytoskeleton (LINC) complex**, bridging the nuclear lamina to the cytoskeleton at the **outer nuclear membrane**.
- While nesprins interact with the nuclear envelope, they are not the primary scaffold protein of the **inner nuclear membrane** itself (that role belongs to lamins), and mutations in nesprins are associated with muscular dystrophies, not progeria.
*Desmin*
- **Desmin** is an intermediate filament found predominantly in **muscle cells** (cardiac, skeletal, and smooth muscle), forming a scaffold that connects myofibrils to each other and to the sarcolemma.
- Mutations in desmin are associated with **myopathies** and **cardiomyopathies**, not with defects in the inner nuclear membrane or premature aging.
Dysplasia US Medical PG Question 4: A 42-year-old man comes to the physician because of a 6-week history of intermittent fever, abdominal pain, bloody diarrhea, and sensation of incomplete rectal emptying. He also has had a 4.5-kg (10-lb) weight loss over the past 3 months. Abdominal examination shows diffuse tenderness. Colonoscopy shows circumferential erythematous lesions that extend without interruption from the anal verge to the cecum. A biopsy specimen taken from the rectum shows mucosal and submucosal inflammation with crypt abscesses. This patient is most likely at risk of developing colon cancer with which of the following characteristics?
- A. Low-grade lesion
- B. Unifocal lesion
- C. Non-polypoid dysplasia (Correct Answer)
- D. Late p53 mutation
- E. Early APC mutation
Dysplasia Explanation: ***Non-polypoid dysplasia***
- The patient's symptoms (bloody diarrhea, abdominal pain, crypt abscesses, continuous inflammation extending to the cecum) are highly suggestive of **ulcerative colitis (UC)**.
- In UC, the chronic inflammation causes a field defect across the colonic mucosa, leading to a higher risk of **non-polypoid (flat) dysplasia** and subsequent colon cancer (colitis-associated cancer).
*Low-grade lesion*
- While dysplasia can be low-grade, the primary characteristic of colon cancer development in UC is the **type of growth** (flat/non-polypoid) rather than simply its grade.
- The presence and progression of **dysplasia** (regardless of initial grade) are critical for risk stratification in UC.
*Unifocal lesion*
- Colitis-associated cancer in UC often arises from widespread field changes due to chronic inflammation, making **multifocal or diffuse dysplasia** more common than a single, isolated lesion.
- The diffuse nature of UC inflammation across the colon makes a unifocal cancerous change less typical compared to sporadic colon cancer.
*Late p53 mutation*
- **p53 mutations** are commonly found in colitis-associated colon cancer and are generally considered an **early event** in the progression from dysplasia to invasive carcinoma, rather than a late one.
- Mutations in tumor suppressor genes like **p53** contribute to genomic instability early in the neoplastic process.
*Early APC mutation*
- **APC mutations** are a hallmark of **sporadic colorectal cancer** and familial adenomatous polyposis (FAP), where they typically initiate the adenoma-carcinoma sequence.
- In **colitis-associated cancer**, APC mutations are less frequently the initiating event and often occur later, with other pathways (e.g., p53, microsatellite instability) being more prominent in early carcinogenesis.
Dysplasia US Medical PG Question 5: A 32-year-old nulliparous woman with polycystic ovary syndrome comes to the physician for a pelvic examination and Pap smear. Last year she had a progestin-releasing intrauterine device placed. Menarche occurred at the age of 10 years. She became sexually active at the age of 14 years. Her mother had breast cancer at the age of 51 years. She is 165 cm (5 ft 5 in) tall and weighs 79 kg (174 lb); BMI is 29 kg/m2. Examination shows mild facial acne. A Pap smear shows high-grade cervical intraepithelial neoplasia. Which of the following is this patient's strongest predisposing factor for developing this condition?
- A. Polycystic ovary syndrome
- B. Obesity
- C. Family history of cancer
- D. Early menarche
- E. Early onset of sexual activity (Correct Answer)
Dysplasia Explanation: ***Early onset of sexual activity***
- **Early onset of sexual activity** increases the risk of exposure to **human papillomavirus (HPV)**, the primary cause of cervical intraepithelial neoplasia (CIN).
- The developing **cervical transformation zone** in adolescents is more vulnerable to HPV infection and subsequent neoplastic changes.
*Polycystic ovary syndrome*
- PCOS is associated with **hormonal imbalances** (e.g., hyperandrogenism, insulin resistance) that typically increase the risk of endometrial hyperplasia and cancer, not directly cervical neoplasia.
- While it may be associated with obesity, PCOS itself is not a direct predisposing factor for **high-grade cervical intraepithelial neoplasia**.
*Obesity*
- **Obesity** is an independent risk factor for various cancers, including endometrial, breast, and colorectal cancer, often due to altered hormone metabolism (e.g., increased estrogen).
- However, its direct link to **cervical intraepithelial neoplasia** is not as strong or direct as HPV infection.
*Family history of cancer*
- A family history of **breast cancer** (mother at 51 years) indicates a genetic predisposition to breast cancer, but not necessarily cervical cancer.
- Cervical cancer is predominantly linked to **HPV infection**, with genetic factors playing a lesser, indirect role.
*Early menarche*
- **Early menarche** is associated with a longer lifetime exposure to estrogen, which increases the risk for hormone-sensitive cancers like **breast** and **endometrial cancer**.
- It does not directly predispose an individual to **cervical intraepithelial neoplasia**, which is mainly caused by HPV.
Dysplasia US Medical PG Question 6: A 65-year-old African-American man presents to your office with dysphagia. He reports that he has found it progressively more difficult to swallow food over the past year. At the time of presentation, he is able to eat only soup. Social history is significant for asbestos exposure, multiple daily drinks of hard alcohol, and a 70 pack-year smoking history. What would you most expect to see on an esophageal biopsy of this patient?
- A. Esophageal varices
- B. Ferruginous bodies
- C. Keratin nests and pearls (Correct Answer)
- D. Glandular metaplasia
- E. Mucosal abrasions
Dysplasia Explanation: ***Keratin nests and pearls***
- This patient's significant **smoking history** and **alcohol consumption** are major risk factors for **esophageal squamous cell carcinoma**, which is characterized microscopically by **keratin nests and pearls** on biopsy.
- The progressive **dysphagia** (difficulty swallowing) over a year, especially progressing to difficulty with solids, is a classic symptom of **esophageal cancer**.
*Esophageal varices*
- Esophageal varices are typically caused by **portal hypertension**, most commonly due to cirrhosis from chronic alcohol abuse.
- While alcohol abuse is present, varices would present with **hematemesis** or melena due to rupture, not progressive dysphagia as the primary symptom.
*Ferruginous bodies*
- These are indicative of **asbestos exposure** in the lungs, typically seen in conditions like asbestosis or mesothelioma.
- They are found in the **lungs**, not in the esophagus, although asbestos exposure is noted in the history.
*Glandular metaplasia*
- **Glandular metaplasia** of the esophagus, also known as **Barrett's esophagus**, is a precursor to **esophageal adenocarcinoma**.
- This typically results from chronic **gastroesophageal reflux disease (GERD)** symptoms, which are not mentioned in this patient.
*Mucosal abrasions*
- Mucosal abrasions would suggest trauma or inflammation but would not explain the **progressive, obstructive dysphagia** over a year.
- Abrasions are generally acute findings and not consistent with the underlying pathology suggested by this patient's long history and risk factors.
Dysplasia US Medical PG Question 7: A 34-year-old G2P2 undergoes colposcopy due to high-grade intraepithelial neoplasia detected on a Pap smear. Her 2 previous Pap smears showed low-grade intraepithelial neoplasia. She has had 2 sexual partners in her life, and her husband has been her only sexual partner for the last 10 years. She had her sexual debut at 16 years of age. She had her first pregnancy at 26 years of age. She uses oral contraceptives for birth control. Her medical history is significant for right ovary resection due to a large follicular cyst and cocaine abuse for which she completed a rehabilitation program. Colposcopy reveals an acetowhite lesion with distorted vascularity at 4 o'clock. Which of the following factors present in this patient is a risk factor for the detected condition?
- A. Age of sexual debut (Correct Answer)
- B. Ovarian surgery
- C. History of cocaine abuse
- D. Patient age
- E. Age at first pregnancy
Dysplasia Explanation: ***Age of sexual debut***
- An early **age of sexual debut** (before 17 years old) is a significant risk factor for **HPV infection** and subsequently, cervical dysplasia. This patient's sexual debut at 16 years old falls within this high-risk category.
- Early sexual activity, especially with multiple partners, increases the likelihood of exposure to **human papillomavirus (HPV)**, the primary cause of cervical cancer and its precursor lesions.
*Ovarian surgery*
- **Ovarian surgery**, such as a right ovary resection for a follicular cyst, is not a known risk factor for **cervical intraepithelial neoplasia (CIN)** or **cervical cancer**.
- This aspect of her medical history is unrelated to the development of cervical dysplasia.
*History of cocaine abuse*
- While **cocaine abuse** can be associated with other health complications and risky behaviors, it is not a direct or independent **risk factor** for **cervical intraepithelial neoplasia (CIN)**.
- There is no established physiological link between cocaine use and the development of cervical dysplasia.
*Patient age*
- Although the incidence of HPV infection peaks in younger women, the risk of developing **high-grade cervical intraepithelial neoplasia (HGSIL)** and invasive cancer increases with age, particularly after 30 due to persistent HPV infection.
- However, at 34, her age is not as strong a contributing risk factor as an early **age of sexual debut** for the initial development of the underlying condition.
*Age at first pregnancy*
- **Early age at first pregnancy** (before 20) can increase the risk of cervical cancer in some studies, possibly due to hormonal changes in the cervix making it more vulnerable to **HPV infection**.
- This patient's first pregnancy at 26 is not considered an early age at first pregnancy and therefore is not a significant risk factor in this context.
Dysplasia US Medical PG Question 8: A 48-year-old man has smoked approximately 3 packs of cigarettes per day for the past 12 years. Which of the following pathologic changes is most likely to occur in his bronchial epithelium?
- A. Metaplasia (Correct Answer)
- B. Hyperplasia
- C. Hypertrophy
- D. Dysplasia
- E. Atrophy
Dysplasia Explanation: ***Metaplasia***
- Chronic irritation from **cigarette smoking** can cause the **bronchial epithelium** to change from ciliated columnar to stratified squamous, a process known as **metaplasia**.
- This adaptation makes the tissue more resistant to injury but results in the loss of important protective functions like **mucociliary clearance**.
*Hyperplasia*
- **Hyperplasia** involves an increase in the number of cells in a tissue or organ, often in response to increased demand or chronic stimulation.
- While smoking can cause hyperplasia of goblet cells and mucous glands in the bronchi, the direct epithelial change in response to chronic irritation is more specifically **metaplasia**.
*Hypertrophy*
- **Hypertrophy** is an increase in the size of individual cells, leading to an increase in the size of the organ or tissue.
- This is not the primary adaptive change seen in the bronchial epithelium in response to chronic smoking; instead, cells change their type.
*Dysplasia*
- **Dysplasia** refers to disorderly cell growth, often characterized by variations in cell size, shape, and organization; it is considered a precursor to cancer.
- While chronic smoking can eventually lead to dysplasia and then carcinoma, the initial and most common adaptive change in the bronchial epithelium is **metaplasia**.
*Atrophy*
- **Atrophy** is a decrease in cell size or number, leading to a reduction in the size of an organ or tissue, usually due to decreased workload, nutrition, or blood supply.
- This is not a typical response of the bronchial epithelium to chronic irritation from smoking, which tends to induce proliferative or adaptive changes.
Dysplasia US Medical PG Question 9: A 34-year-old man presents to the office for evaluation of a lesion on his upper arm that appeared a few months ago and has not healed. The patient appears healthful but has a history of cardiovascular disease. He states that his friend at the industrial ammunition factory where he works told him he should "get it looked at." The patient admits to some nausea, vomiting, and diarrhea over the past year, but he states that he "feels fine now." On physical examination, the lesion is an erythematous, scaly, ulcerated plaque on the flexor surface of his upper arm. The rest of the exam is within normal limits. What is the most likely diagnosis?
- A. Squamous cell carcinoma (SCC) (Correct Answer)
- B. Erythema multiforme
- C. Actinic keratosis
- D. Erysipelas
- E. Contact dermatitis
Dysplasia Explanation: ***Squamous cell carcinoma (SCC)***
- The patient's occupational exposure to chemicals at an **ammunition factory**, along with chronic non-healing, **ulcerated, scaly plaque**, raises suspicion for SCC, particularly **arsenic-induced SCC**.
- His history of vague **gastrointestinal symptoms** (nausea, vomiting, diarrhea) over the past year is also consistent with **chronic arsenic exposure**, which is a known carcinogen.
*Erythema multiforme*
- This is an **acute, self-limiting hypersensitivity reaction** to medications or infections, characterized by target lesions, not a chronic, non-healing ulcerated plaque.
- It would not typically present with a history of chronic GI symptoms related to occupational exposure.
*Actinic keratosis*
- This is a **precancerous lesion** caused by chronic sun exposure, typically presenting as a rough, scaly patch on sun-exposed areas.
- While it has malignant potential to transform into SCC, the description of an **ulcerated, non-healing lesion** with a history of probable chemical exposure makes SCC a more likely *current* diagnosis.
*Erysipelas*
- Erysipelas is a **superficial bacterial infection** of the skin characterized by a rapidly spreading, bright red, well-demarcated, and painful rash, often accompanied by fever and systemic symptoms.
- It would not manifest as a chronic, non-healing ulcerated plaque over several months.
*Contact dermatitis*
- This is an **inflammatory skin reaction** due to direct contact with an allergen or irritant, typically presenting as an itchy, erythematous rash with vesicles or papules.
- It would not typically result in a chronic, ulcerated, non-healing plaque and is not associated with the systemic symptoms or occupational exposure history presented.
Dysplasia US Medical PG Question 10: As part of a clinical research study, microscopic analysis of tissues obtained from surgical specimens is performed. Some of these tissues have microscopic findings of an increase in the size of numerous cells within the tissue with an increase in the amount of cytoplasm, but the nuclei are uniform in size. Which of the following processes shows such microscopic findings?
- A. Liver following partial resection
- B. Female breasts at puberty
- C. Ovaries following menopause
- D. Uterine myometrium in pregnancy (Correct Answer)
- E. Cervix with chronic inflammation
Dysplasia Explanation: ***Uterine myometrium in pregnancy***
- During pregnancy, the uterine myometrial cells undergo significant **hypertrophy** (increase in cell size) in response to hormonal stimulation, primarily *estrogen* and *progesterone*.
- This leads to a marked increase in the amount of **cytoplasm** and overall cell size, while maintaining relatively **uniform nuclei**, which precisely matches the microscopic findings described.
- The smooth muscle cells can increase **10-40 fold** in size, making this the classic example of physiologic hypertrophy.
- Note: Hyperplasia (increased cell number) also occurs but is less prominent; the microscopic findings described emphasize the hypertrophic changes.
*Liver following partial resection*
- The liver primarily undergoes **hyperplasia** (increase in cell number) to regenerate following partial resection.
- While some hypertrophy occurs, the dominant microscopic finding is an increase in hepatocyte **number** through proliferation rather than a marked increase in individual cell size and cytoplasm as the primary feature.
*Female breasts at puberty*
- Breast development at puberty involves both **hyperplasia** of the glandular epithelium and ductal structures and **adipose tissue deposition**, driven by *estrogen* and *progesterone*.
- The findings described (marked increase in cell size and cytoplasm with uniform nuclei) are more characteristic of the extreme cell hypertrophy seen in the gravid uterus rather than the mixed growth and differentiation patterns of pubertal breast development.
*Ovaries following menopause*
- Following menopause, the ovaries undergo **atrophy**, meaning a decrease in size and cellular activity due to declining hormonal production.
- This process involves a **decrease in cell size** and number, which is the opposite of the microscopic findings described in the question.
*Cervix with chronic inflammation*
- Chronic inflammation in the cervix can cause various changes, including **squamous metaplasia** (transformation of columnar epithelium to squamous epithelium) or an influx of inflammatory cells.
- While there might be some reactive cellular changes, it does not typically involve a widespread, uniform increase in cell size and cytoplasm within existing cells as described, but rather a change in cell type or infiltration by inflammatory cells.
More Dysplasia US Medical PG questions available in the OnCourse app. Practice MCQs, flashcards, and get detailed explanations.
