AJCP Journal CME/SAM
The ASCP is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The ASCP designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ per article. Physicians should claim only
the credit commensurate with the extent of their participation in the activity. This activity qualifies as an American Board of Pathology Maintenance
of Certification Part II Self-Assessment Module.
To complete an exam, go to www.ascp.org/ajcpcme. Call 800.267.2727 for ASCP Customer Service.
Reisenbichler (page 767)
1. Which of the following histologic features is most useful in distinguishing
benign intraductal papillomas from papillomas involved by atypical ductal
hyperplasia or ductal carcinoma in situ (DCIS)?
A. Thickness of papillary cores
B. Amount and distribution of myoepithelial cells
C. Degree of hyalinization
D. Cytoarchitectural features of the epithelial proliferation
2. Which of the following immunohistochemical expression patterns would be
most supportive for the diagnosis of a benign intraductal papilloma on breast
needle core biopsy?
A. Lack of p63 expression
B. A mixed CK8/18 and CK5 expression pattern
C. CK8/18 expression in the majority of lesional cells
D. CK5 expression in the majority of lesional cells
3. Which of the following immunohistochemical expression patterns would be
most supportive for the diagnosis of a papillary carcinoma on breast needle
core biopsy?
A. Markedly reduced p63 expression
B. Homogeneous CK5 expression in the majority of lesional cells
C. CK8/18 expression in the majority of lesional cells
D.CK8/18 expression in the majority of lesional cells and markedly reduced p63
expression
4. Other than high- and low-molecular-weight cytokeratins and p63, which of
the following immunostains have also been proposed for combined use in the
evaluation of breast papillary lesions?
A. CK5 and ER
B. CK8/18 and estrogen receptor
C. CD44 and CK5
D. a-methylacyl-CoA racemase and p63
5. One exception to the staining pattern usually seen in atypical/malignant
epithelial proliferations is “basal-like” DCIS. What staining pattern would be
expected in such a case?
A. CK8/18 expression in the majority of lesional cells
B. Mixed CK8/18 and CK19 expression in lesional cells
C. Diffuse CK5 expression in lesional cells
D. Mixed CK5 and CK8/18 expression in lesional cells
Aggarwal (page 787)
1. Using flow cytometric immunophenotyping, which of the following cell
surface antigens can be used to distinguish normal T and natural killer (NK)
cells?
A.CD3
B.CD2
C.CD7
D.CD56
4. Flow cytometric immunophenotyping performed on a splenectomy
specimen demonstrates a small population of lymphoid cells with brighter CD3
staining than the other CD3+ cells. This population likely represents
A. CD4+ T cells.
B. CD8+ T cells.
C. NK cells.
D. γδ T cells.
2. Immature and mature NK cells can be distinguished using staining for
which of the following?
A.CD5
B.CD8
C.CD45
D.CD56
5. An 18-year-old man presented with splenic rupture following a motor
vehicle accident. Flow cytometric immunophenotyping performed on a portion
of the spleen demonstrated a population of cells with the following phenotype:
CD2+, CD3+, CD5–, CD7+, CD8+. A similar population was identified in flow
cytometric studies performed on the peripheral blood. The spleen weighed
150 g and no abnormal infiltrate was identified in histologic sections. The CBC
count was unremarkable. Which of the following is the most likely explanation
for this unusual phenotype?
A. Normal lymphoid subset
B. Hepatosplenic T-cell lymphoma
C. Large granular lymphocyte leukemia
D. T lymphoblastic leukemia
3. CD5 positive B cells are
A. indicative of a B-cell lymphoid neoplasm.
B. only found during fetal development.
C. seen in normal healthy individuals.
D. decreased in autoimmune conditions.
Zhang (page 795)
1. What is the hallmark genetic abnormality of mantle cell lymphoma (MCL)?
A.t(8;14)(q24;q32)
B.t(11;14)(q13;q32)
C.t(9;14)(p13;q32)
D.t(11;18)(q21;q21)
C. Polyclonal antibody can recognize many kinds of epitopes, which may cause false
positives and may mislead the diagnosis. In addition, SOX11 is homologous to SOX4,
which is widely expressed in B- and T-cell lymphomas.
D. The immunohistochemical method of using polyclonal antibody targeting SOX11
wis complicated.
2. In our study, there were 138 diffuse large B-cell lymphomas, 58 MCLs, 34
follicular lymphomas, 26 Burkitt lymphomas, 20 chronic lymphocytic leukemia/
small cell lymphomas, 20 lymphoplasmacytic lymphomas, 16 marginal zone
lymphomas, and 37 B-lymphoblastic lymphomas. The only one type of B-cell
non-Hodgkin lymphoma that failed to show nuclear staining with polyclonal
antibody to SOX11 was:
A. diffuse large B-cell lymphoma.
B. follicular lymphoma.
C. chronic lymphocytic leukemia/small cell lymphoma.
D. lymphoplasmacytic lymphoma.
4. The application of monoclonal antibody (SOX11-C1) is supposed to improve
the sensitivity and specificity of immunohistochemistry, as 100% of MCL cases
showed bright nuclear staining. Previous reports of weak SOX11 staining
in many types of B-cell non-Hodgkin lymphoma were not confirmed using
SOX11-C1, except in which?
A. Burkitt lymphoma
B. Follicular lymphoma
C. Chronic lymphocytic leukemia/small cell lymphoma
D. B-lymphoblastic lymphoma
3. Why was polyclonal antibody targeting SOX11 not able to identify MCL from
B-cell non-Hodgkin lymphomas?
A. SOX11 was not expressed on the on the nuclei of MCL.
B. SOX11 was really expressed on the nuclei of other B-cell non-Hodgkin lymphomas.
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5. The specimen was regarded as positive when the percentage of SOX11
staining cells was more than how much?
A.5%
B.10%
C.15%
D.0%
© American Society for Clinical Pathology
11/5/13 3:56 PM
AJCP Journal CME/SAM
The ASCP is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The ASCP designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ per article. Physicians should claim only
the credit commensurate with the extent of their participation in the activity. This activity qualifies as an American Board of Pathology Maintenance
of Certification Part II Self-Assessment Module.
To complete an exam, go to www.ascp.org/ajcpcme. Call 800.267.2727 for ASCP Customer Service.
Melanson (page 801)
1. Which of the following should be performed as best practice for obtaining
accurate trough levels of vancomycin?
A. Blood should be drawn from the patient shortly after the previous dose and after the drug
has reached a steady state.
B. Blood should be drawn from the patient shortly after the previous dose and before the
drug has reached a steady state.
C. Blood should be drawn from the patient shortly before the next dose and after the drug
has reached a steady state.
D. Blood should be drawn from the patient shortly before the next dose and before the drug
has reached a steady state.
2. If a specimen used to determine vancomycin trough level was drawn 2 hours
earlier than the correct time, what would be the most likely outcome?
A.The obtained vancomycin concentration would be 20% higher than the true trough
concentration.
B. The obtained vancomycin concentration would be 20% lower than the true trough concentration.
C. The obtained vancomycin concentration would be falsely high.
D. The obtained vancomycin concentration would be falsely low.
3. Which of the following describes the minimum data necessary to evaluate the
timing of specimens for vancomycin levels in relation to dosing?
A. Patients’ dosing regimen, time of initial dose administration, and time of specimen collection
B. Patients’ dosing regimen, time of last dose, and time of specimen collection
C Patients’ dosing regimen, time of next dose, and concentration of vancomycin
D. Patients’ dosing regimen, time of specimen collection, and concentration of vancomycin
4. Which of the following situations in the study was indicated to be correlated
with the highest error rate?
A. Instances when the physicians did not specify a collection time for vancomycin tests
B. Instances when the vancomycin tests were performed at times of the day other than
between 4:00 am and 10:00 am
C. Instances when the vancomycin doses were administered at the scheduled time
D. Instances when the phlebotomists collected the vancomycin test
5. Which of the following interventions would likely produce the most favorable
results concerning mistimed vancomycin levels?
A. Implementing an incident reporting system that ensures that nurses and phlebotomists
who mistime draws receive corrective action
B. Requiring physicians to document the proper scheduling of draws for vancomycin levels
C. Educating nurses on the proper scheduling of draws for vancomycin levels
D. Implementing an integrated computerized solution that links provider orders, medication
administration, specimen collection, and the laboratory information system
Booth (page 807)
1. Which of the following statements is true regarding the current approach to
handling of routine tonsillectomy specimens in the United States?
A. Gross examination is used only for all benign-appearing specimens.
B. Histologic examination is limited to grossly asymmetric tonsils.
C. Both gross and histologic examination is done of all removed tonsils.
D. There is currently no standardized approach to processing tonsillectomy specimens in the
United States.
2. The incidence of occult malignancies in benign-appearing tonsillectomy
specimens in children, as assessed by current study, is approximately how much?
A.0.2%-0.5%
B.1%
C.2%
D.3%
3. What is the most reliable means for identifying occult malignancy in the
benign-appearing tonsillectomy specimen?
A Gross examination
B. Histologic examination
C. Physical and clinical examination
D. Radiological examination
4. What is the most common occult malignancy detected in the histologic study of
both adult and pediatric tonsils?
A.Carcinoma
B.Lymphoma
C. Sarcoma (such as rhabdomyosarcoma)
D. Germ cell malignancy
5. Why is ancillary testing, such as immunohistochemistry or genetic studies,
often needed when there is an unexpected tonsillar malignancy?
A. Although staging work-up most often shows tumor in other locations as well, ancillary
testing is best performed on the site of original diagnosis.
B. The types of malignancy found are often unique to the tonsil and require special testing
for recognition and/or confirmation of the diagnosis.
C. Due to the small size and localized nature of these lesions, morphology alone may be
inadequate to confirm the malignant nature.
D. The use of ancillary testing allows for a higher billing code to be applied to the case, one
that more accurately reflects the complexity of the diagnosis.
Tembhare (page 813)
1. How is the number of antibodies bound per cell (ABC) in chronic lymphocytic
leukemia (CLL) cells quantified using the flow cytometric Quantibrite method?
A. Using precalibrated standard beads with known levels of phycoerythrin (PE) molecules
bound/bead, a daily standard curve is generated, based on the mean fluorescent intensity of the beads. Using this standard curve, the mean fluorescence of stained CLL cells
is then used to determine the ABC value.
B. The whole B-cell population is gated, and the mean fluorescent intensity is measured to
provide a general estimation of the ABC value of the CLL cells, because CLL is a B-cell
lymphoproliferative disorder.
C. Gating is performed to include cells that are immunophenotypically consistent with CLL,
and the mean fluorescent intensity of these cells is compared to the mean fluorescent
intensity of Quantibrite beads that are acquired that week.
D. Quantibrite beads are acquired on flow cytometry with unique instrument settings that
differ from the individual patient specimens. The mean fluorescence of the CLL cells
from patients require special settings to optimize the detection of the CLL cells, which
characteristically show dim expression of antigens.
2. What does the ABC value represent?
A. A flow cytometric measurement that represents the mean value of the maximum capacity of a cell to bind monoclonal antibody
B. A standard curve that is generated from Quantibrite beads
C. A formula that is calculated from the slope of the several geometric mean fluorescence
values
D. A value that can only be generated for malignant/neoplastic cells and cannot be generated for normal/nonneoplastic cell populations
© American Society for Clinical Pathology
CME Questions_Dec13.indd 913
3. Which statement is true regarding levels of therapeutic antigen expression in
CLL patients?
A. The positive correlation between CD20 and CD52 expression was such that expression
of CD20 would reliably predict expression of CD52.
B. CD25 was consistently expressed on all CLL cases.
C. Expression of CD22 and CD20 was consistent and did not vary.
D.The levels of expression of therapeutic antigen correlated directly with the reported
response rates to single agent therapy.
4. You are asked to give a treatment recommendation for a patient with CLL who
is a 67-year-old woman with ABC of 35,946 for CD20, 3,066 for CD22, negative for
CD 25, and 18,051 for CD52. Based on the ABC values, which single agent would
you prefer for treatment?
A.LMB-2
B.HA22
C.Rituximab
D.Alemtuzumab
5. In which case would LMB2 be a possible treatment choice?
A.62-year-old woman with ABC of 9,133 for CD20, 2,726 for CD22, 412 for CD25, and
10,458 for CD52
B. 31-year-old man with ABC of 12,827 for CD20, 1,364 for CD22, negative for CD25, and
12,225 for CD52
C. 44-year-old man with ABC of 3,928 for CD20, 1,624 for CD22, 206 for CD25, and 1,464
for CD52
D. 75-year-old man with ABC of 4,717 for CD20, 1,287 for CD22, 1,472 for CD25, and 9,828
for CD52.
Am J Clin Pathol 2013;140:912-916
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11/5/13 3:56 PM
AJCP Journal CME/SAM
The ASCP is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The ASCP designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ per article. Physicians should claim only
the credit commensurate with the extent of their participation in the activity. This activity qualifies as an American Board of Pathology Maintenance
of Certification Part II Self-Assessment Module.
To complete an exam, go to www.ascp.org/ajcpcme. Call 800.267.2727 for ASCP Customer Service.
Zhao (page 819)
1. Downregulated expression of p21 expression is associated with which of
the following?
A. Higher-risk myelodysplastic syndromes (MDS)
B. Lower-risk MDS
C. Healthy controls
D. Acute myeloid leukemia (AML)
4. What is the clinical outcome for patients with lower p21 expression
compared to patients with normal expression levels of p21?
A.Good
B.Poor
C.Intermediate
D.Great
2. Which locus is located upstream of p21 gene?
A.p73
B.p27
C.p57
D.p15
5. p73 promoter methylation is more common in which of the following?
A. Higher-risk MDS
B. Lower-risk MDS
C. Healthy controls
D. All subsets of AML
3. S-phase cells are significantly increased in which of the following?
A. Higher-risk MDS
B. Lower-risk MDS
C. Healthy controls
D. All MDS
Wang (page 831)
1. Which of the following is true with respect to the Clostridium difficile
organism?
A. It is an anaerobic, gram-positive spirochete.
B. It produces enterotoxic toxin A and cytotoxic toxin B.
C. It is an aerobic, gram-negative bacillus.
D. All strains of C difficile are toxigenic.
2. In this study, which histologic feature was more frequent in ulcerative
colitis (UC) patients with C difficile infection than in those without?
A. Microscopic pseudomembranes
B. Severe activity
C. Neutrophils in the lamina propria
D. Ischemic changes
3.Amongst C difficile–positive patients, which histologic feature was more
common in UC compared with non–irritable bowel disease patients?
A. Ischemic changes
B. Signs of chronicity
C.Pseudomembranes
D. Mild activity
4. Which of the following statements about diagnosis of C difficile infection is
most true?
A. Stool enzyme immunoassay is a highly reliable test with few false positives or
negatives.
B. Histologic or gross pseudomembranes are present in the vast majority of cases.
C. Pseudomembranes can be associated with other infections or with ischemia.
D. Pseudomembranous colitis cannot be reliably diagnosed without colonoscopy.
5. Which statement is most accurate about the role of histology in diagnosing
C difficile infection?
A. Pseudomembranes are diagnostic for C difficile.
B. Absence of histologic pseudomembranes reliably rules out C difficile.
C. All suspected C difficile patients must undergo biopsy.
D. Histopathology should be accompanied by clinical information and stool testing.
Stetsenko (page 838)
1. What does immunohistochemistry for p63 detect?
A. Membrane marker associated with desmosomes
B. Cytoplasmic marker associated with actin in squamous epithelium
C. Transcription factor associated with alternate splice products expressed in the basal
layer of the epidermis
D. Keratin-associated nuclear membrane protein expressed in epidermis
2. The expression of p63 has been reported to be associated with better
prognosis in which of the following?
A. Estrogen receptor–positive breast cancer
B. B-cell lymphoma
C. Merkel cell carcinoma (MCC)
D. Squamous cell carcinoma of head and neck
3. p63 expression in MCC is correlated with what?
A. Male gender
B. Older age at diagnosis
C. Site of the primary tumor
D. Advanced stage at diagnosis
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4. Which statement is true about p63 expression in MCC?
A. p63-negative tumors are associated with twofold increase in disease specific
mortality.
B. Five-year cumulative mortality is higher in patients with p63-positive tumors.
C. There is no association between p63 expression and prognosis.
D. The outcome of treatment improves with increase in percentage of cells expressing
p63.
5. Which statement is correct about prior studies of p63
immunohistochemistry in MCC?
A.Several prior studies have shown that p63 expression is associated with better
prognosis.
B. Prior studies have included multivariate analysis that considers stage at presentation.
C. The smaller sample sizes in earlier studies may be responsible for observing a stronger correlation between p63 and prognosis in MCC.
D.Prior studies used a different antibody clone for p63, potentially leading to differences in study outcomes.
© American Society for Clinical Pathology
11/5/13 3:56 PM
AJCP Journal CME/SAM
The ASCP is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The ASCP designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ per article. Physicians should claim only
the credit commensurate with the extent of their participation in the activity. This activity qualifies as an American Board of Pathology Maintenance
of Certification Part II Self-Assessment Module.
To complete an exam, go to www.ascp.org/ajcpcme. Call 800.267.2727 for ASCP Customer Service.
Freud (page 853)
1. Which of the following immunophenotypical profiles is most accurate and
specific for most human peripheral blood natural killer (NK) cells?
A. Surface CD3+, cytoplasmic CD3+, CD56+, CD16–, CD335+
B. Surface CD3–, cytoplasmic CD3–, CD56+, CD16+, CD335+
C. Surface CD3–, cytoplasmic CD3+, CD56+, CD16+, CD335+
D. Surface CD3–, cytoplasmic CD3+, CD56+, CD16–, CD335+
2. A senior clinical pathology resident previews the dot plots from a clinical
flow cytometry study performed on a pediatric tonsil specimen and astutely
notes that of the few NK cells detectable in the specimen, most show
relatively bright CD56 expression. Which of the following features are also
likely to be features of this NK cell population?
A. High production of monokine-induced cytokines
B. Strong and uniform expression of CD16
C. Higher capacity for cell killing in an in vitro cytotoxicity assay than would be seen
with dim CD56 expression
D. Heterogeneous (dim to strong) expression of CD335
3. Which of the following is true of CD335?
A. It is rarely detectable on T cells.
B. Uniform surface expression is detectable by flow cytometry on peripheral blood NK
cells.
C. It binds bacterial derived lipopolysaccharide to activate NK cells.
D. The receptor is human-specific (ie, the gene does not exist in rodents).
4. Loss of CD335 staining by flow cytometry or immunohistochemistry
A. is diagnostic of an NK cell neoplasm.
B. may be reactive.
C. is highly sensitive and specific for myeloid neoplasia.
D. is commonly observed on reactive T cells.
5. Immunohistochemical staining of a pleomorphic, large cell, dermal infiltrate
in the skin of a 17-year-old boy demonstrates the following immunophenotype:
CD3–, CD56–, CD335+, CD20–, Epstein-Barr virus–encoded small RNA
negative. What is the most likely diagnosis?
A. Mycosis fungoides
B. ALK+ anaplastic large cell lymphoma
C. Plasma cell myeloma
D. Blastic plasmacytoid dendritic cell neoplasm
Jean Louis (page 867)
1. An external quality assurance (EQA) program is critical to which of the
following?
A. To assign responsibilities to each technician at a laboratory
B. To decrease the cost of laboratory tests
C. To ensure accuracy and reliability of laboratory tests
D. To inspect 100% of all reagents and instruments used in the laboratory
2. In reviewing errors in laboratory testing for human immunodeficiency virus
(HIV) rapid tests, which statement is most accurate?
A. If your internal control is okay, your result is error-free.
B. Errors are less likely to occur when you use an algorithm with two sequential rapid
tests.
C. Errors occur only when your test kit is expired.
D.Errors can occur at any stage of the testing process: preanalytical, analytical, and
postanalytical.
3. The process of implementing an EQA program for quality assurance of HIV
rapid testing requires what?
A.Assessment of laboratory infrastructure by an external agency followed by recommendations on adequate testing environment and training to address biosafety
weaknesses
B. Periodic check on testing process followed by technical assistance and training to
address low proficiency
C. Regular site visits and stepwise automation of laboratory testing to ensure reliable
results
D. Uninterrupted distribution of laboratory reagents and patients’ satisfaction survey
4. A proficiency testing (PT) program is
A.key to identifying laboratories that perform below standard, allowing regulatory
agencies to forbid future testing activities at those sites to protect patients.
B. the distribution by the EQA scheme organizer of small panels of well-characterized
test samples comprising 6-10 specimens.
C. the retesting of selected sample of specimens in a laboratory to assess the quality of
testing.
D. the only way to ensure quality of laboratory testing.
5. The impact of training and technical assistance in Haiti after
implementation of the EQA process
A. was not significant, because of the decrease in PT scores in 2008 and 2010.
B. was negative, since the curve plateaued from 2007 to 2011 in Figure 4.
C. was significant, since laboratories failing the PT in 2006 increased significantly their
scores in following years.
D. was difficult to evaluate, since the results of PT were overall very high (93%).
Gailey (page 872)
1. A 65-year-old man presents with a lung mass, liver masses, and cervical
adenopathy. Excision of the cervical lymph node reveals nests of large
polygonal cells with abundant eosinophilic cytoplasm. Tumor cells express
glypican-3, p63, and CK5/6 but not TTF-1 or Hep Par 1. What is the most likely
diagnosis?
A. Hepatocellular carcinoma
B. Squamous cell carcinoma
C. Urothelial carcinoma
D.Melanoma
2. A squamous cell carcinoma reacts with antibodies to glypican-3, PAX8,
p40, and p63. Reactivity for which of the following suggests a uterine cervical
origin?
A.Glypican-3
B.PAX8
C.p40
D.p63
3. Which of the following is the most sensitive marker of squamous cell
carcinoma?
A.Glypican-3
B.PAX8
C.p40
D.p16
© American Society for Clinical Pathology
CME Questions_Dec13.indd 915
4. p63 consists of a mixture of isotypes containing or lacking a transactivation
domain, referred to as TAp63 and ΔNp63, respectively. Which of the following
antibodies reacts exclusively with ΔNp63?
A.p63
B.4A4
C.p40
D.1G12
5. Biopsy of a primary lung tumor reveals a poorly differentiated non–small
cell carcinoma for which your primary differential diagnosis is a solid
adenocarcinoma vs a high-grade squamous cell carcinoma. Neither mucin
production nor keratinization is readily apparent. The tumor does not react
with antibodies to TTF-1, CK5/6, chromogranin, or synaptophysin, while p63
is weakly expressed by 10% of cells. Follow up p40 immunohistochemistry is
negative. What is the most likely diagnosis and why?
A. Squamous cell carcinoma; p63 is incredibly specific for that diagnosis
B. Squamous cell carcinoma; TTF-1 is incredibly sensitive for lung adenocarcinoma
C. Adenocarcinoma; TTF-1 is only reasonably sensitive for lung adenocarcinoma, and
the pattern of p63 reactivity in this case is nonspecific
D. Adenocarcinoma; the tumor lacks keratinization
Am J Clin Pathol 2013;140:912-916
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915
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11/5/13 3:56 PM
AJCP Journal CME/SAM
The ASCP is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The ASCP designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ per article. Physicians should claim only
the credit commensurate with the extent of their participation in the activity. This activity qualifies as an American Board of Pathology Maintenance
of Certification Part II Self-Assessment Module.
To complete an exam, go to www.ascp.org/ajcpcme. Call 800.267.2727 for ASCP Customer Service.
Godfrey (page 881)
1. In diagnosing cervical disease, which of the following limitations of
cytology screening need to be recognized?
A. A single Pap test only detects high-grade squamous intraepithelial lesions between
55% and 87% of the time.
B. Cytology screening cannot be improved by incorporating human papillomavirus (HPV)
testing.
C. Cytology is better than visual inspection methods alone.
D. Cytology screening programs require minimal infrastructure and are widely available
in resource-limited settings.
2. Immediate improvements in the quality of cytology and histology in
resource-limited countries can be effected by which of the following?
A. Real-time telepathology
B. A systematic evaluation of specimen preparation and examination
C. Training courses for pathologists
D. Support of education of local pathologists in resource-limited settings
3. External quality assurance programs
A. currently are an integral part of international cytology and histopathology laboratory
quality management infrastructure.
B.will improve the diagnostic capabilities and thus decrease mortality from cervical
cancer.
C. are required and regulated in most laboratories globally.
D. have a necessary punitive component to be effective.
4. How might diagnostic accuracy in HPV-related cervical dysplasia be
improved?
A. Participation in commercially available continuing professional development
programs alone
B. Participation in external quality assurance sponsored testing schemes alone
C. Using commercially available reagents alone
D. Adequate specimen collection, processing, and participation in external quality
assurance activities
5. Which statement is correct?
A. HPV testing is highly sensitive and specific for cervical dysplasia in human immunodeficiency virus–infected women.
B. Visual inspection with cryotherapy reduces the incidence of cervical intraepithelial
neoplasia 2+.
C. HPV testing is recommended as a primary screen for cervical dysplasia.
D.Cytologic screening of cervical smears is the gold standard by which to evaluate
screening modalities.
Kim (page 898)
1. Which statement is correct regarding clinicopathologic features of
traditional serrated adenoma (TSA)?
A. TSA is characterized by the abnormal architecture of the crypt bases.
B. Most TSAs show conventional epithelial dysplasia.
C. TSA is heterogeneous in terms of its gross appearance and anatomic distribution.
D. The nondysplastic hyperplastic polyp (HP) or sessile serrated adenoma/polyp (SSA/P)
precursor lesions are rarely accompanied with TSAs.
2. What is the most frequent genetic alteration found among all TSAs,
including those with mixed polyp features?
A. KRAS point mutations
B. BRAF-V600E point mutation
C. EGFR point mutations
D. PIK3CA point mutations
3. Which of the following endoscopic findings indicates a nondysplastic HP
or SSA/P lesion accompanied with TSAs?
A. Flat, elevated growth and type II pit patterns
B. Sessile configuration and type IIIL pit pattern
C. Pedunculated configuration and type IIIL pit pattern
D. Pedunculated configuration and type IV pit pattern
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4. What is the main pit pattern of TSA lesions?
A. Type II
B. Type IIIL
C. Type IV, pinecone-like or fern-like appearance
D. Type V
5. According to this study, which statement is correct regarding
nondysplastic HP or SSA/P precursor lesions accompanied with TSAs?
A. HP or SSA/P precursor lesions are not common in TSAs.
B. It is hard to detect HP or SSA/P precursor lesions accompanied with TSAs by
endoscopy.
C. TSAs with precursor lesions display a higher frequency of KRAS mutation compared
with those with no precursor lesions.
D. The clinicopathologic and molecular features of TSAs are associated with the status
or type of precursor lesions.
© American Society for Clinical Pathology
11/5/13 3:56 PM