Answers to ABP sample questions

[deschutes]

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Some of you must have done these by now. I find myself second-guessing my answers so I'm putting them up here.

I didn't see anything on the website saying I couldn't reproduce the questions, so I'm reposting them till someone says I can't.


Spoilers ahead!


Virtual Slide exam:

1) Malignant melanoma
2) LCH (though since there are no special stains I wouldn't be surprised if you told me it was eosinophilic pneumonia...)
3) Angiomyolipoma

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AP Written:

Question 1.
A pathologist was asked to assess the margins on a 3 x 1.5 cm skin specimen removed for suspected basal cell carcinoma. Separate frozen sections were performed on each of the four margins. Which of the following does not represent correct CPT coding for these services?
A) 88305.
B) 88331 x 4.
C) 88331 x 1 and 88332 x 3.

Ans: B

Question 2.
Which of the following statements regarding the 100 slide per day screening limit imposed by CLIA is correct?
A) It applies only to gynecologic slides.
B) Previously examined abnormal gynecologic cases are included in the 100-slide limit.
C) Slides prepared by liquid-based techniques with cells dispersed over half the slide count as one-half slide.
D) The CLIA workload limit does not apply to CLIA licensed and CAP accredited laboratories.

Ans: It seems like either B or C would be correct. But B is a little less definitive so I'd pick C. (Here's a CAP Today review)

Question 3.
Each of the following statements regarding carcinoma of the prostate gland is correct except:
A) Stage and Gleason sum are the most important prognostic factors in prostate carcinoma.
B) In high grade carcinomas, p53 is likely to be present.
C) Prostate-specific antigen stains the majority of prostatic carcinomas.
D) Stage T1c indicates tumor beyond the prostate capsule.
E) Invasion of small vesicles indicates at least stage T3.

Ans: D (T1c -tumor identified by needle biopsy due to elevated PSA, but not palpable, not visible)

Question 4.
Adverse prognostic factors in colon cancer include each of the following except:
A) a tumor nodule greater than 3 mm in size in the pericolonic fat without histologic evidence of a lymph node.
B) a conspicuous peritumoral lymphoid reaction.
C) lymphatic invasion.
D) perineural invasion.
E) radial margin involvement.

Ans: B

Question 5.
The major morphologic manifestation of chronic rejection of a lung allograft is:
A) perivascular mononuclear infiltrates.
B) interstitial fibrosis.
C) nonspecific interstitial pneumonitis.
D) bronchiolitis obliterans.

Ans: D

Question 6.
Histologic findings that are supportive of a primary myopathic process include each of the following except:
A) centralized nuclei.
B) endomysial fibrosis.
C) myophagocytosis.
D) group atrophy.
E) rounded, atrophic myocytes.

Ans: D

Question 7.
Primary hyperparathyroidism is usually caused by:
A) chronic renal disease.
B) primary parathyroid hyperplasia.
C) malabsorption syndrome.
D) parathyroid carcinoma.
E) parathyroid adenoma.

Ans: E

Question 8.
A melanoma is most likely to arise in a:
A) blue nevus.
B) Spitz nevus.
C) compound nevus in a fair skinned, blue eyed redhead.
D) giant congenital nevus.
E) pigmented spindle cell nevus.

Ans: C

=======
AP Practical (see website for pix)

Question 1.
The patient received a bone marrow transplant for acute leukemia. The most likely diagnosis is:
A) leukemic infiltration of the skin.
B) lymphoma cutis.
C) graft-versus-host reaction.
D) junctional nevus.

Ans: C

Question 2.
The 2001 Bethesda System category most appropriate for this cervicovaginal cytology specimen from a 32-year-old patient is:
A) high grade squamous intraepithelial lesion.
B) low grade squamous intraepithelial lesion.
C) atypical squamous cells of undetermined significance.
D) reactive cellular changes associated with inflammation.
E) negative for intraepithelial lesion or malignancy.

Ans: B

Question 3.
These Gomori methenamine silver stained (x400) structures indicate:
A) Cryptococcus neoformans.
B) Pneumocystis carinii cysts.
C) yeasts of Candida species.
D) Blastomyces dermatitidis.
E) trophozoites of Entamoeba histolytica.

Ans: B

Question 4.
The most likely diagnosis for this H&E stained section from a 4 cm tumor in the neck of a 51-year-old male is:
A) metastatic renal carcinoma.
B) malignant melanoma.
C) mucoepidermoid carcinoma.
D) carotid body tumor.
E) granular cell tumor.

Ans: D

Question 5.
This section of a normal kidney, stained with patient serum for IgG, is from a person with:
A) minimal change disease.
B) systemic lupus erythematosus.
C) acute poststreptococcal glomerulonephritis.
D) Goodpasture syndrome.
E) Wegener granulomatosis.

Ans: D

Question 6.
The most likely diagnosis is:
A) infarction.
B) glioblastoma multiforme.
C) pilocytic astrocytoma.
D) arteriovenous malformation.
E) radiation necrosis.

Ans: B

Question 7.
The most likely diagnosis for this H&E stained section of a 3 cm nodule from the parotid gland of a 45-year-old female is:
A) normal parotid tissue.
B) pleomorphic adenoma.
C) Warthin tumor.
D) acinic cell carcinoma.
E) adenoid cystic carcinoma.
E) mycosis fungoides.

Ans: D

Question 8.
The most likely diagnosis for this core needle biopsy specimen from the breast of a 52-year-old female is:
A) chronic mastitis.
B) myeloma.
C) infiltrating lobular carcinoma.
D) fat necrosis.
E) metastatic small cell carcinoma.

Ans: A

Question 9.
This was the driver of a car that overturned and caught fire after a head-on collision. The injuries shown are due to:
A) falling on gravel.
B) steering wheel impact.
C) postmortem burns caused by gasoline.
D) the body’s dragging on the ground.
E) second degree burns caused by heat.

Ans: D

Up next - CP.

 

[dodobird13]

hey thanks deschutes. i can't get the stupid virtual slide thing to work on my computer. does anyone know if it is the same type of program that uscap uses for their virtual slides? is it really necessary to practice before the test? what a pain in the ass.

 

[deschutes]

What, nobody questioning my diagnoses?? I only guessed at some of those (like for CPT coding frozens). Everyone stuck in the last-ditch Osler course?

dodobird13, it was recommended that I practice, so I did. It takes some getting used to. You have to right-click, and select from a drop-down menu to zoom. And you can only zoom 5x and above on selected green-bordered areas of the slide. The program is called WebSlide, not Aperio ImageScope which is what USCAP uses.

Oh and I didn't manage to view the virtual slides with Firefox, only with IE.

The scopes provided have non-removable clips. And apparently some of them might give you Michelle Obama arms by the end of the day.

I'll get to CP eventually. I'm just afraid of embarrassing myself if I post my answers.

 

[mcfaddens]

What, nobody questioning my diagnoses?? I only guessed at some of those (like for CPT coding frozens). Everyone stuck in the last-ditch Osler course?

dodobird13, it was recommended that I practice, so I did. It takes some getting used to. You have to right-click, and select from a drop-down menu to zoom. And you can only zoom 5x and above on selected green-bordered areas of the slide. The program is called WebSlide, not Aperio ImageScope which is what USCAP uses.

Oh and I didn't manage to view the virtual slides with Firefox, only with IE.

The scopes provided have non-removable clips. And apparently some of them might give you Michelle Obama arms by the end of the day.

I'll get to CP eventually. I'm just afraid of embarrassing myself if I post my answers.

You can do it! Post CP!! We are behind you 100% deschutes!

 

[Toochie]

This might be a silly question--I only saw the virtual microscopy slides. Yes the viewer only works with IE and not Firefox.

Where did you see the other questions?

Thanks for the post.

 

[dodobird13]

well I'm not afraid of looking stupid after you all pointed out the obvious - use IE for the slide viewer as opposed to FF. Drrrr...... so in the interest of continuing the theme here is my take on the CP written practice test.

Question 1.
A serum urea nitrogen/creatinine ratio of less than 10 may suggest each of the following except:
A) acute tubular necrosis.
B) severe liver disease.
C) starvation.
D) severe tissue breakdown.
E) low protein intake.

A. ATN one of these is not like the other.

Question 2.
A 77-year-old male with severe peripheral vascular disease presented at the emergency department with severe abdominal pain of several hours’ duration. There was no history of trauma or chest pain. Laboratory studies included:

Patient Result Reference Interval
Total creatine kinase (CK) 275 IU/L 21–232 IU/L
CK-MB 3 ng/mL 0–5 ng/mL

The most likely source of the elevated CK activity is:

A) a myocardial infarction.
B) rhabdomyolysis.
C) a renal infarction.
D) an infarcted bowel.
E) hepatic congestion.

B. rhabdo ? abd pain hx threw me off

Question 3.
Which of the following myelodysplastic syndromes is most likely to transform to acute leukemia?
A) refractory anemia.
B) refractory anemia with ringed sideroblasts.
C) refractory anemia with excess blasts, type 1.
D) refractory anemia with excess blasts, type 2.
E) chronic myelomonocytic leukemia.

D. RAEB-2

Question 4.
Each of the following statements regarding automated blood counts is correct except:
A) MCV is calculated from the hematocrit and RBC count.
B) The red cell distribution width is a statistical parameter, which reflects anisocytosis when abnormal.
C) They accurately count RBCs, WBCs, and platelets.
D) The MCH is calculated from the hemoglobin and RBC count.

A. HCT is calculated

Question 5.
A patient with recurrent episodes of venous and arterial thrombosis was given therapeutic doses of heparin, but the heparin failed to exert an anticoagulant effect. The patient probably has a deficiency of:
A) protein C.
B) factor VIII.
C) plasminogen.
D) antithrombin.
E) platelets.

D. antithrombin

Question 6.
The most common type of allogeneic transfusion reaction from packed red blood cells is:
A) allergic.
B) acute hemolytic.
C) delayed hemolytic.
D) transfusion-related acute lung injury.
E) febrile, nonhemolytic.

E. febrile non hemo

Question 7.
The most common cause of fatal hemolytic transfusion reactions is:
A) laboratory technical or testing mistakes.
B) clerical errors related to misidentification of patients.
C) the emergency transfusion of uncrossmatched blood.
D) transfusing red blood cells too rapidly.
E) failure to premedicate patients with acetaminophen.

B. clerical error

Question 8.
A patient with necrotizing granulomatous inflammation in the lungs, leukocytoclastic angiitis in the dermis, and necrotizing and crescentic glomerulonephritis in the kidneys would most likely test positive on which of the following serologic tests?
A) antinuclear antibodies.
B) anti-neutrophil cytoplasmic antibodies.
C) anti-phospholipid antibodies.
D) IgA fibronectin aggregates.
E) hepatitis C virus antibodies.

C. c-ANCA (WG)

Question 9.
The oncogene that becomes activated in the t(14;18) that is often associated with follicular lymphoma is:
A) bcr/abl.
B) ets-1.
C) myc.
D) mos.
E) bcl-2.

E bcl-2

Question 10.
A blood agar plate has small, nonhemolytic colonies isolated from an intra-abdominal abscess. The isolate is catalase negative, bile esculin positive, pyrrolidonyl positive, and it grows in 6.5% sodium chloride. The most likely identification is:
A) Enterococcus species.
B) Pneumococcus.
C) group B streptococcus.
D) Staphylococcus species.

A. entero

 

[dodobird13]

This might be a silly question--I only saw the virtual microscopy slides. Yes the viewer only works with IE and not Firefox.

Where did you see the other questions?

Thanks for the post.

https://www.abpath.org/SampleQuestions.htm

 

[dodobird13]

CP practical

Question 1.
Antigens from which of the following organisms may be associated with the acquired B phenomenon?
A) Candida albicans.
B) Treponema pallidum.
C) Escherichia coli O 86.
D) Mycoplasma pneumoniae.
E) Legionella pneumophila.

C. E coli

Question 2.
The concentration of an analyte is measured in nondiseased and diseased populations, and cut-off point Q is chosen. The number of false positives is represented by area:
A) W.
B) X.
C) Y.
D) Z.

C. Y – see image on website

Question 3.
Data obtained during the evaluation of a diagnostic test for a disease with a prevalence of 10% is shown.

Patient Status Positive Result Negative Result Total
Disease 100 0 100
No disease 200 700 900
Total 300 700 1,000

Which of the following statements regarding the data is correct?

A) The diagnostic sensitivity is 100%.
B) The diagnostic specificity is 70%.
C) The predictive value of a positive test is 100%.
D) The predictive value of a negative test is 70%.
E) The efficiency of the test is 43%.

Sens = TP/TP+FN = 100/(100+0) = 100%
Spec = TN/TN+FP = 700/(700+200) = 77.8%
PPV = TP/(TP+FP) = 100/(100+200) = 33%
NPV = TN/(TN+FN) = 700/700 = 100%
Efficiency? WTF I have no idea how to calc.

Answer – A

Question 4.
This is a flow cytometric dot plot of peripheral blood lymphocytes stained for CD3 and CD8 from a patient with a reduced absolute number of lymphocytes. The most likely diagnosis is:
A) infectious mononucleosis.
B) large granular lymphocytic leukemia.
C) cytomegalovirus infection.
D) AIDS.
E) no pathologic change.

Flow shows virtually all CD3+ cells to also be CD8+ so D) AIDS

Question 5.
When 200 mL of whole blood is to be withdrawn from an autologous donor, how much anticoagulant (in mL) must be removed from a regular blood collection bag containing 63 mL of CPD or CPDA-1 anticoagulant to prepare red cells?
A) none.
B) 15.
C) 25.
D) 35.
E) 45.

A. none

Question 6.
This peripheral blood film is most consistent with:
A) acute myeloid leukemia with maturation.
B) acute promyelocytic leukemia.
C) acute myelomonocytic leukemia.
D) acute myeloid leukemia with inv(16)(p13q22).
E) mast cell leukemia.

B. APL

Question 7.
The appearance of this hand suggests that the infant has:
A) a short fourth metacarpal.
B) holoprosencephaly.
C) rocker-bottom feet.
D) a chromosomal abnormality.
E) a cleft lip and palate.

Image of simian crease → D

Question 8.
The most likely interpretation for this serum electrophoresis and immunofixation data from an 85-year-old female is:
A) normal study.
B) acute phase reactant pattern.
C) IgA monoclonal gammopathy.
D) Waldenström macroglobulinemia.

C. IgA mono

Question 9.
The most likely diagnosis for this bile duct brush specimen from a 45-year-old female is:
A) degenerated epithelial cells.
B) Cryptosporidium.
C) Giardia.
D) normal epithelial cells.
E) amoebae.

D. Giardia

Question 10.
The most likely diagnosis for this H&E stained (x400) subcutaneous tissue from a patient who suffered a firecracker injury is:
A) aspergillosis.
B) phaeohyphomycosis.
C) zygomycosis.
D) botryomycosis.
E) sporotrichosis.

I went back and forth on this one. Going to guess C…. too lumpy & irreg for aspergillus, not pigmented (not B), clearly not bacterial (not D) and I thought you weren’t supposed to be able to see sporo in tissue.

 

[deschutes]

Ha, I'd just finished and was about to post but you beat me to it.

CP Written

Question 1.
A serum urea nitrogen/creatinine ratio of less than 10 may suggest each of the following except:
A) acute tubular necrosis.
B) severe liver disease.
C) starvation.
D) severe tissue breakdown.
E) low protein intake.

Ans: D - increased tissue breakdown gives high ratio with normal Cr, according to Henry.

Question 2.
A 77-year-old male with severe peripheral vascular disease presented at the emergency department with severe abdominal pain of several hours' duration. There was no history of trauma or chest pain. Laboratory studies included:

Patient Result Reference Interval
Total creatine kinase (CK) 275 IU/L 21–232 IU/L
CK-MB 3 ng/mL 0–5 ng/mL

The most likely source of the elevated CK activity is:

A) a myocardial infarction.
B) rhabdomyolysis.
C) a renal infarction.
D) an infarcted bowel.
E) hepatic congestion.

Ans: I picked D - CK-BB in bowel, plus the abdo pain and PVD


Question 4.
Each of the following statements regarding automated blood counts is correct except:
A) MCV is calculated from the hematocrit and RBC count.
B) The red cell distribution width is a statistical parameter, which reflects anisocytosis when abnormal.
C) They accurately count RBCs, WBCs, and platelets.
D) The MCH is calculated from the hemoglobin and RBC count.

I thought MCV = Hct/RBC, A is out
MCH = Hgb/RBC, D is out
I thought B and C were both correct. I was stumped.

CP Practical:

Question 4.
You said AIDS since flow shows virtually all CD3+ cells to also be CD8+... you're right, I selected "NPC" without thinking. Gah.

Question 5.
When 200 mL of whole blood is to be withdrawn from an autologous donor, how much anticoagulant (in mL) must be removed from a regular blood collection bag containing 63 mL of CPD or CPDA-1 anticoagulant to prepare red cells?
A) none.

Where did you find the answer for this? I picked A, but it was purely guessing.

Q6 - you said APL. Really?? I thought it was mast cell leukemia since they weren't very butterfly...

Q10 - I picked zygo by exclusion.

My brain is mush.

 

[dodobird13]

yes........ mush

clearly as i misread the whole blood/additive situation.
AABB standards --> 63 ml CPDA-1 for 450 ml whole blood under normal circumstances, if <300 ml whole blood is collected then anticoag should be proportionally decreased to maintain ratio of 1:7 for anticoag:blood volumes. should try to have ~25 ml CPDA then, so answer D is closest.

as for the APL vs mast cell leukemia, i dunno, the granules look really small... and right or wrong i don't necessarily associate bilobed/butterfly nuclei w/ APL.

for the automated blood counter question, I still think A is the correct answer because the instrument uses its measured indices RBC and MCV to calculate the hematocrit not the other way around like that answer states. you're right HCT = MCV x RBC.

i think the biggest problem for me is going to be reading the actual question and all of the frigging choices before leaping to an answer.....

 

[mcfaddens]

i think the biggest problem for me is going to be reading the actual question and all of the frigging choices before leaping to an answer.....

I second that, after doing tons of practice questions the eyes seem to wander to the answers prematurely. Its gonna be hard to be totally focused on the wording of the question when you know the clock is ticking. But I keep hearing over and over that you have to read the question carefully, would hate to loose easy points from being careless.

 

[NKcell]

Question 1.
A serum urea nitrogen/creatinine ratio of less than 10 may suggest each of the following except:
A) acute tubular necrosis.
B) severe liver disease.
C) starvation.
D) severe tissue breakdown.
E) low protein intake.

A) ATN. ATN is an intrarenal disease, and so the BUN/Cr ratio should be 10/1, and not less?

Question 2.
A 77-year-old male with severe peripheral vascular disease presented at the emergency department with severe abdominal pain of several hours’ duration. There was no history of trauma or chest pain. Laboratory studies included:

Patient Result Reference Interval
Total creatine kinase (CK) 275 IU/L 21–232 IU/L
CK-MB 3 ng/mL 0–5 ng/mL

The most likely source of the elevated CK activity is:

A) a myocardial infarction.
B) rhabdomyolysis.
C) a renal infarction.
D) an infarcted bowel.
E) hepatic congestion.

D) Infarcted bowel. Not looking like an MI, I just went with the clinical.

Question 3.
Which of the following myelodysplastic syndromes is most likely to transform to acute leukemia?
A) refractory anemia.
B) refractory anemia with ringed sideroblasts.
C) refractory anemia with excess blasts, type 1.
D) refractory anemia with excess blasts, type 2.
E) chronic myelomonocytic leukemia.

D) RAEB-2

Question 4.
Each of the following statements regarding automated blood counts is correct except:
A) MCV is calculated from the hematocrit and RBC count.
B) The red cell distribution width is a statistical parameter, which reflects anisocytosis when abnormal.
C) They accurately count RBCs, WBCs, and platelets.
D) The MCH is calculated from the hemoglobin and RBC count.

A) For automated methods, MCV is measured. But for manual methods, MCV is calculated.

Question 5.
A patient with recurrent episodes of venous and arterial thrombosis was given therapeutic doses of heparin, but the heparin failed to exert an anticoagulant effect. The patient probably has a deficiency of:
A) protein C.
B) factor VIII.
C) plasminogen.
D) antithrombin.
E) platelets.

D) Antithrombin

Question 6.
The most common type of allogeneic transfusion reaction from packed red blood cells is:
A) allergic.
B) acute hemolytic.
C) delayed hemolytic.
D) transfusion-related acute lung injury.
E) febrile, nonhemolytic.

E) Febrile, nonhemolytic

Question 7.
The most common cause of fatal hemolytic transfusion reactions is:
A) laboratory technical or testing mistakes.
B) clerical errors related to misidentification of patients.
C) the emergency transfusion of uncrossmatched blood.
D) transfusing red blood cells too rapidly.
E) failure to premedicate patients with acetaminophen.

B) Clerical error

Question 8.
A patient with necrotizing granulomatous inflammation in the lungs, leukocytoclastic angiitis in the dermis, and necrotizing and crescentic glomerulonephritis in the kidneys would most likely test positive on which of the following serologic tests?
A) antinuclear antibodies.
B) anti-neutrophil cytoplasmic antibodies.
C) anti-phospholipid antibodies.
D) IgA fibronectin aggregates.
E) hepatitis C virus antibodies.

C) ANCA

Question 9.
The oncogene that becomes activated in the t(14;18) that is often associated with follicular lymphoma is:
A) bcr/abl.
B) ets-1.
C) myc.
D) mos.
E) bcl-2.

E) bcl-2

Question 10.
A blood agar plate has small, nonhemolytic colonies isolated from an intra-abdominal abscess. The isolate is catalase negative, bile esculin positive, pyrrolidonyl positive, and it grows in 6.5% sodium chloride. The most likely identification is:
A) Enterococcus species.
B) Pneumococcus.
C) group B streptococcus.
D) Staphylococcus species.

A) Enterococcus

 

[NKcell]

Question 1.
Antigens from which of the following organisms may be associated with the acquired B phenomenon?
A) Candida albicans.
B) Treponema pallidum.
C) Escherichia coli O 86.
D) Mycoplasma pneumoniae.
E) Legionella pneumophila.

C) Escherichia coli O 86.

Question 2.
The concentration of an analyte is measured in nondiseased and diseased populations, and cut-off point Q is chosen. The number of false positives is represented by area:
A) W.
B) X.
C) Y.
D) Z.

C) Y.

Question 3.
Data obtained during the evaluation of a diagnostic test for a disease with a prevalence of 10% is shown.

Patient Status Positive Result Negative Result Total
Disease 100 0 100
No disease 200 700 900
Total 300 700 1,000

Which of the following statements regarding the data is correct?

A) The diagnostic sensitivity is 100%.
B) The diagnostic specificity is 70%.
C) The predictive value of a positive test is 100%.
D) The predictive value of a negative test is 70%.
E) The efficiency of the test is 43%.

A) The diagnostic sensitivity is 100%.

Question 4.
This is a flow cytometric dot plot of peripheral blood lymphocytes stained for CD3 and CD8 from a patient with a reduced absolute number of lymphocytes. The most likely diagnosis is:
A) infectious mononucleosis.
B) large granular lymphocytic leukemia.
C) cytomegalovirus infection.
D) AIDS.
E) no pathologic change.

D) AIDS. A) and B) would give you lymphocytosis.

Question 5.
When 200 mL of whole blood is to be withdrawn from an autologous donor, how much anticoagulant (in mL) must be removed from a regular blood collection bag containing 63 mL of CPD or CPDA-1 anticoagulant to prepare red cells?
A) none.
B) 15.
C) 25.
D) 35.
E) 45.

D) 35. Stupid question. I looked up this in the Technical Manual.
A. Volume to be drawn
B. Amount of anticoagulant needed = (A/100) x 14
C. Amount of anticoagulant to be removed from bag = 63 ml - B
So, 63 - (200/100) x 14 = 35 ml

Question 6.
This peripheral blood film is most consistent with:
A) acute myeloid leukemia with maturation.
B) acute promyelocytic leukemia.
C) acute myelomonocytic leukemia.
D) acute myeloid leukemia with inv(16)(p13q22).
E) mast cell leukemia.

B) Mast cell leukemia.

Question 7.
The appearance of this hand suggests that the infant has:
A) a short fourth metacarpal.
B) holoprosencephaly.
C) rocker-bottom feet.
D) a chromosomal abnormality.
E) a cleft lip and palate.

D) A chromosomal abnormality. Simian crease?

Question 8.
The most likely interpretation for this serum electrophoresis and immunofixation data from an 85-year-old female is:
A) normal study.
B) acute phase reactant pattern.
C) IgA monoclonal gammopathy.
D) Waldenström macroglobulinemia.

C) IgA monoclonal gammopathy

Question 9.
The most likely diagnosis for this bile duct brush specimen from a 45-year-old female is:
A) degenerated epithelial cells.
B) Cryptosporidium.
C) Giardia.
D) normal epithelial cells.
E) amoebae.

D) Giardia

Question 10.
The most likely diagnosis for this H&E stained (x400) subcutaneous tissue from a patient who suffered a firecracker injury is:
A) aspergillosis.
B) phaeohyphomycosis.
C) zygomycosis.
D) botryomycosis.
E) sporotrichosis.

C) Zygomycosis. Looked like aseptated ribbon like hyphae to me.

 

[deschutes]

Don't know what I was thinking last night, but yeah, Q1 from the written should be A) ATN. I keep having to train my brain to focus on the word "except".

Question 1.
A serum urea nitrogen/creatinine ratio of less than 10 may suggest each of the following except:
A) acute tubular necrosis.
B) severe liver disease.
C) starvation.
D) severe tissue breakdown.
E) low protein intake.

 

[dodobird13]

Don't know what I was thinking last night, but yeah, Q1 from the written should be A) ATN. I keep having to train my brain to focus on the word "except".

i know... i picture my brain as looking very much like a plate of soft scrambled eggs right about now..... bleh

 

[smellycat]

Anyone know if they will give us paper and pen during the non-calculation sections? I was hoping to write down some mnemonics instead of trying to visualize them in my small head.

 

[yaah]

Anyone know if they will give us paper and pen during the non-calculation sections? I was hoping to write down some mnemonics instead of trying to visualize them in my small head.

I believe you get paper and pencil for all sections, just in case you need it. I may be wrong about that, maybe others remember differently. But to my recollection with every section you received a paper handout with instructions for that section and some blank space for writing.

Of course, all of the written and practical sections may potential have some calculation-related questions on them.

 

[dodobird13]

Anyone know if they will give us paper and pen during the non-calculation sections? I was hoping to write down some mnemonics instead of trying to visualize them in my small head.

i'm with you. the website says you get a pen/pencil and paper. i sure hope so!

 

[deschutes]

Okay did no one else think the first virtual slide could have been some funky pleomorphic breast ca? Of course it could have rapidly been sorted out with stains, but we don't get that luxury.

How does the exam day work with regards to snacks - can I bring a snack stash for re-fueling during break times?

 

[Whetherby]

Okay did no one else think the first virtual slide could have been some funky pleomorphic breast ca? Of course it could have rapidly been sorted out with stains, but we don't get that luxury.

How does the exam day work with regards to snacks - can I bring a snack stash for re-fueling during break times?

I agree, I thought the first virtual slide was breast CA. The pattern of invasion didn't look typical of melanoma to me, and it looks like there is mucin in the cells.

Question 8 of the written, I think the answer might be giant congenital nevus rather than compound nevus in light-skinned redhead. Melanomas can definitely arise in giant congenital nevi, and although fair skinned red-head people have an increased risk of melanoma in general, the chance of it developing directly out of a compound nevus is pretty low (some would argue that it doesn't happen).

Question 8 of the practical, I had no idea what the answer was, and I've never heard of chronic mastitis. Maybe I missed that lecture. The picture just looked like a couple inflammatory cells including PMNs trickling through the fat.

 

[NKcell]

I agree, I thought the first virtual slide was breast CA. The pattern of invasion didn't look typical of melanoma to me, and it looks like there is mucin in the cells.

Question 8 of the written, I think the answer might be giant congenital nevus rather than compound nevus in light-skinned redhead. Melanomas can definitely arise in giant congenital nevi, and although fair skinned red-head people have an increased risk of melanoma in general, the chance of it developing directly out of a compound nevus is pretty low (some would argue that it doesn't happen).

Question 8 of the practical, I had no idea what the answer was, and I've never heard of chronic mastitis. Maybe I missed that lecture. The picture just looked like a couple inflammatory cells including PMNs trickling through the fat.

I agree. If you look at high-power at the first virtual slide, the cells look like they have mucin, even signet ring appearing.

 

[deschutes]

So... ugly Pagetoid spread and not melanoma? I've just never seen Pagetoid spread that nasty.

Re: chronic mastitis - I convinced myself rightly or wrongly that some of the inflammatory cells were plasma cells (also explained the inclusion of myeloma in the answer choices).

http://pathologyoutlines.com/breast.html#plasmacellmastitis

And you're right about the giant congenital nevus. I totally forgot about that association.

 

[BierstiefelAndy]

I agree, I thought the first virtual slide was breast CA. The pattern of invasion didn't look typical of melanoma to me, and it looks like there is mucin in the cells.

Question 8 of the written, I think the answer might be giant congenital nevus rather than compound nevus in light-skinned redhead. Melanomas can definitely arise in giant congenital nevi, and although fair skinned red-head people have an increased risk of melanoma in general, the chance of it developing directly out of a compound nevus is pretty low (some would argue that it doesn't happen).

Question 8 of the practical, I had no idea what the answer was, and I've never heard of chronic mastitis. Maybe I missed that lecture. The picture just looked like a couple inflammatory cells including PMNs trickling through the fat.

I agree about the first virtual slide question...first of all, it is a crappy slide that looks like a counterstain for a negative impox stain Anyways, the presence of malignant cells in the epithelium makes one think of melanoma at first glance but a close look at some of the nests of cells show attempts at gland formation. So I am favoring some kind of adenocarcinoma.

Giant congenital nevus and melanoma...I'll trust you on that one since derm is not a strength of mine. Sounds right though.

As for Question 8 of the practical, sure there are a few plasma cells along with other inflammatory cells. Classic example of cancer fakeout on boards because mentally, one may be tempted to call it myeloma based on seeing plasma cells.

 

[Whetherby]

So... ugly Pagetoid spread and not melanoma? I've just never seen Pagetoid spread that nasty.

Re: chronic mastitis - I convinced myself rightly or wrongly that some of the inflammatory cells were plasma cells (also explained the inclusion of myeloma in the answer choices).

http://pathologyoutlines.com/breast.html#plasmacellmastitis

And you're right about the giant congenital nevus. I totally forgot about that association.

I think you're right about there being plasma cells in that breast one, but I've always thought of plasma cell mastitis as being a peri-ductal process that is essentially a form of duct ectasia (which that link you gave seems to confirm), rather than a synonym of chronic mastitis...which I've still never heard of. Whatever, I'm probably wrong.

I do think that one with Pagetoid spread was just really ugly pagetoid spread of breast CA rather than melanoma. Fortunately in real life this wouldn't be an H&E issue.

 

[Patrick O]

[

Question 8 of the written, I think the answer might be giant congenital nevus rather than compound nevus in light-skinned redhead. Melanomas can definitely arise in giant congenital nevi, and although fair skinned red-head people have an increased risk of melanoma in general, the chance of it developing directly out of a compound nevus is pretty low (some would argue that it doesn't happen).


I completely agree with this answer. Had the question stated a dysplastic compound nevus in a red haired blue eyed sun worshipper with a p16INK4a mutation ...etc, the risk of melanoma would be much higher than a plain jane compound nevus, although it probably would be difficult to give a definitive %risk. Being that I consider myself a derm person, I had to look up the risk of developing melanoma in a giant congenital nevus. According to McKee, the risk is 12% overall.

I too am struggling with looking at the fine wording of these practice questions that I am doing.... I just want to be done with these boards already..... There is no way the recert for CP can be like this in 10 years..... if so I'm doomed.[/I]

 

[LoaLoa]

..

 

[LoaLoa]

Deschutes, I think your first answer to Question 1 was correct:
A serum urea nitrogen/creatinine ratio of less than 10 may suggest each of the following except:
A) acute tubular necrosis.
B) severe liver disease.
C) starvation.
D) severe tissue breakdown.
E) low protein intake.

In ATN you can have a low BUN:Cr ratio (typically 10:1, right?). In severe liver disease, starvation, and low protein intake you have low nitrogen due to a low protein state. Severe tissue breakdown (it seems) should have increased amino acid byproducts and should cause a relative increase in the BUN.

Gah, I hate this freaking test. Ten people with Henry open can't figure out the answer. Oh, and what's with the CPT codes on the AP questions. . . . .One more thing to cram.

 

[mango fly]

AP Written # 2 - I think the answer should be "B"

Question 2.
Which of the following statements regarding the 100 slide per day screening limit imposed by CLIA is correct?
A) It applies only to gynecologic slides.
B) Previously examined abnormal gynecologic cases are included in the 100-slide limit.
C) Slides prepared by liquid-based techniques with cells dispersed over half the slide count as one-half slide.
D) The CLIA workload limit does not apply to CLIA licensed and CAP accredited laboratories.

B - CORRECT
For answer C = non-gyn slides in which the cellular material covers 1/2 or less of the slide surface is counted as 1/2 a slide

 

[deschutes]

mango fly, re: AP Written # 2 - I think the answer is C.
I'm looking in Cibas 2e p.471 and it says "non-gyn slides in which the cellular material covers one-half or less of the slide surface are counted as a half slide". And in the table below that it says "Slides that typically count as half slides: cytocentrifuge preps, ThinPrep slides, SurePath slides. Note this applies only to non-gyn cases"

Also, "The maximum number of slides is 100 per 24-hour period. This applies to anyone who does primary screening". The rest of the section also talks about the rule as applied to screening, as opposed to lookbacks.

Loaloa thanks for pointing that out. I think the lesson I'm taking from all this is that I need 8 hours of sleep before each exam. Henry 20e p.181: "For a normal adult on a normal diet, the reference interval for the C/C ratio is about 10 to 20... Low B/C ratios are seen in conditions associated with decreased production of urea, such as low protein intake, starvation, or severe liver disease, and in acute tubular necrosis".

 

[mango fly]

Deschutes - Thanks for the info! All this studying has me looking way to far into these questions. Like when the question said "over half of the slide," I was thinking "more" than half.....Will be glad when all of this is over!

Mango🙂

 

[dodobird13]

ha ha!! wait till you are done with that stupid test. two full days of crap like that. bring your crystal balls, friends!

 

[TJMAXX]

Did anybody think the answer of Q6 is D?

CP practical

Question 1.
Antigens from which of the following organisms may be associated with the acquired B phenomenon?
A) Candida albicans.
B) Treponema pallidum.
C) Escherichia coli O 86.
D) Mycoplasma pneumoniae.
E) Legionella pneumophila.

C. E coli

Question 2.
The concentration of an analyte is measured in nondiseased and diseased populations, and cut-off point Q is chosen. The number of false positives is represented by area:
A) W.
B) X.
C) Y.
D) Z.

C. Y – see image on website

Question 3.
Data obtained during the evaluation of a diagnostic test for a disease with a prevalence of 10% is shown.

Patient Status Positive Result Negative Result Total
Disease 100 0 100
No disease 200 700 900
Total 300 700 1,000

Which of the following statements regarding the data is correct?

A) The diagnostic sensitivity is 100%.
B) The diagnostic specificity is 70%.
C) The predictive value of a positive test is 100%.
D) The predictive value of a negative test is 70%.
E) The efficiency of the test is 43%.

Sens = TP/TP+FN = 100/(100+0) = 100%
Spec = TN/TN+FP = 700/(700+200) = 77.8%
PPV = TP/(TP+FP) = 100/(100+200) = 33%
NPV = TN/(TN+FN) = 700/700 = 100%
Efficiency? WTF I have no idea how to calc.

Answer – A

Question 4.
This is a flow cytometric dot plot of peripheral blood lymphocytes stained for CD3 and CD8 from a patient with a reduced absolute number of lymphocytes. The most likely diagnosis is:
A) infectious mononucleosis.
B) large granular lymphocytic leukemia.
C) cytomegalovirus infection.
D) AIDS.
E) no pathologic change.

Flow shows virtually all CD3+ cells to also be CD8+ so D) AIDS

Question 5.
When 200 mL of whole blood is to be withdrawn from an autologous donor, how much anticoagulant (in mL) must be removed from a regular blood collection bag containing 63 mL of CPD or CPDA-1 anticoagulant to prepare red cells?
A) none.
B) 15.
C) 25.
D) 35.
E) 45.

A. none

Question 6.
This peripheral blood film is most consistent with:
A) acute myeloid leukemia with maturation.
B) acute promyelocytic leukemia.
C) acute myelomonocytic leukemia.
D) acute myeloid leukemia with inv(16)(p13q22).
E) mast cell leukemia.

B. APL

Question 7.
The appearance of this hand suggests that the infant has:
A) a short fourth metacarpal.
B) holoprosencephaly.
C) rocker-bottom feet.
D) a chromosomal abnormality.
E) a cleft lip and palate.

Image of simian crease &#8594; D

Question 8.
The most likely interpretation for this serum electrophoresis and immunofixation data from an 85-year-old female is:
A) normal study.
B) acute phase reactant pattern.
C) IgA monoclonal gammopathy.
D) Waldenström macroglobulinemia.

C. IgA mono

Question 9.
The most likely diagnosis for this bile duct brush specimen from a 45-year-old female is:
A) degenerated epithelial cells.
B) Cryptosporidium.
C) Giardia.
D) normal epithelial cells.
E) amoebae.

D. Giardia

Question 10.
The most likely diagnosis for this H&E stained (x400) subcutaneous tissue from a patient who suffered a firecracker injury is:
A) aspergillosis.
B) phaeohyphomycosis.
C) zygomycosis.
D) botryomycosis.
E) sporotrichosis.

I went back and forth on this one. Going to guess C…. too lumpy & irreg for aspergillus, not pigmented (not B), clearly not bacterial (not D) and I thought you weren’t supposed to be able to see sporo in tissue.

 

[Kilgoretrout 65]

Not that anybody would ever use remembrances but.... whatever you do, don't carry them into the ABP building, you will be keel hauled.

 

[pathstudent]

Some of you must have done these by now. I find myself second-guessing my answers so I'm putting them up here.

I didn't see anything on the website saying I couldn't reproduce the questions, so I'm reposting them till someone says I can't.


Spoilers ahead!


Virtual Slide exam:

1) Malignant melanoma
2) LCH (though since there are no special stains I wouldn't be surprised if you told me it was eosinophilic pneumonia...)
3) Angiomyolipoma

---
AP Written:

Question 1.
A pathologist was asked to assess the margins on a 3 x 1.5 cm skin specimen removed for suspected basal cell carcinoma. Separate frozen sections were performed on each of the four margins. Which of the following does not represent correct CPT coding for these services?
A) 88305.
B) 88331 x 4.
C) 88331 x 1 and 88332 x 3.

Ans: B

Question 2.
Which of the following statements regarding the 100 slide per day screening limit imposed by CLIA is correct?
A) It applies only to gynecologic slides.
B) Previously examined abnormal gynecologic cases are included in the 100-slide limit.
C) Slides prepared by liquid-based techniques with cells dispersed over half the slide count as one-half slide.
D) The CLIA workload limit does not apply to CLIA licensed and CAP accredited laboratories.

Ans: It seems like either B or C would be correct. But B is a little less definitive so I'd pick C. (Here's a CAP Today review)

Question 3.
Each of the following statements regarding carcinoma of the prostate gland is correct except:
A) Stage and Gleason sum are the most important prognostic factors in prostate carcinoma.
B) In high grade carcinomas, p53 is likely to be present.
C) Prostate-specific antigen stains the majority of prostatic carcinomas.
D) Stage T1c indicates tumor beyond the prostate capsule.
E) Invasion of small vesicles indicates at least stage T3.

Ans: D (T1c -tumor identified by needle biopsy due to elevated PSA, but not palpable, not visible)

Question 4.
Adverse prognostic factors in colon cancer include each of the following except:
A) a tumor nodule greater than 3 mm in size in the pericolonic fat without histologic evidence of a lymph node.
B) a conspicuous peritumoral lymphoid reaction.
C) lymphatic invasion.
D) perineural invasion.
E) radial margin involvement.

Ans: B

Question 5.
The major morphologic manifestation of chronic rejection of a lung allograft is:
A) perivascular mononuclear infiltrates.
B) interstitial fibrosis.
C) nonspecific interstitial pneumonitis.
D) bronchiolitis obliterans.

Ans: D

Question 6.
Histologic findings that are supportive of a primary myopathic process include each of the following except:
A) centralized nuclei.
B) endomysial fibrosis.
C) myophagocytosis.
D) group atrophy.
E) rounded, atrophic myocytes.

Ans: D

Question 7.
Primary hyperparathyroidism is usually caused by:
A) chronic renal disease.
B) primary parathyroid hyperplasia.
C) malabsorption syndrome.
D) parathyroid carcinoma.
E) parathyroid adenoma.

Ans: E

Question 8.
A melanoma is most likely to arise in a:
A) blue nevus.
B) Spitz nevus.
C) compound nevus in a fair skinned, blue eyed redhead.
D) giant congenital nevus.
E) pigmented spindle cell nevus.

Ans: C

=======
AP Practical (see website for pix)

Question 1.
The patient received a bone marrow transplant for acute leukemia. The most likely diagnosis is:
A) leukemic infiltration of the skin.
B) lymphoma cutis.
C) graft-versus-host reaction.
D) junctional nevus.

Ans: C

Question 2.
The 2001 Bethesda System category most appropriate for this cervicovaginal cytology specimen from a 32-year-old patient is:
A) high grade squamous intraepithelial lesion.
B) low grade squamous intraepithelial lesion.
C) atypical squamous cells of undetermined significance.
D) reactive cellular changes associated with inflammation.
E) negative for intraepithelial lesion or malignancy.

Ans: B

Question 3.
These Gomori methenamine silver stained (x400) structures indicate:
A) Cryptococcus neoformans.
B) Pneumocystis carinii cysts.
C) yeasts of Candida species.
D) Blastomyces dermatitidis.
E) trophozoites of Entamoeba histolytica.

Ans: B

Question 4.
The most likely diagnosis for this H&E stained section from a 4 cm tumor in the neck of a 51-year-old male is:
A) metastatic renal carcinoma.
B) malignant melanoma.
C) mucoepidermoid carcinoma.
D) carotid body tumor.
E) granular cell tumor.

Ans: D

Question 5.
This section of a normal kidney, stained with patient serum for IgG, is from a person with:
A) minimal change disease.
B) systemic lupus erythematosus.
C) acute poststreptococcal glomerulonephritis.
D) Goodpasture syndrome.
E) Wegener granulomatosis.

Ans: D

Question 6.
The most likely diagnosis is:
A) infarction.
B) glioblastoma multiforme.
C) pilocytic astrocytoma.
D) arteriovenous malformation.
E) radiation necrosis.

Ans: B

Question 7.
The most likely diagnosis for this H&E stained section of a 3 cm nodule from the parotid gland of a 45-year-old female is:
A) normal parotid tissue.
B) pleomorphic adenoma.
C) Warthin tumor.
D) acinic cell carcinoma.
E) adenoid cystic carcinoma.
E) mycosis fungoides.

Ans: D

Question 8.
The most likely diagnosis for this core needle biopsy specimen from the breast of a 52-year-old female is:
A) chronic mastitis.
B) myeloma.
C) infiltrating lobular carcinoma.
D) fat necrosis.
E) metastatic small cell carcinoma.

Ans: A

Question 9.
This was the driver of a car that overturned and caught fire after a head-on collision. The injuries shown are due to:
A) falling on gravel.
B) steering wheel impact.
C) postmortem burns caused by gasoline.
D) the body’s dragging on the ground.
E) second degree burns caused by heat.

Ans: D

Up next - CP.

The answer to number 1 is C unless each of the four margins were submitted separately in their own containers than it would be B.

 

[TJMAXX]

These are not remembrances😍

Not that anybody would ever use remembrances but.... whatever you do, don't carry them into the ABP building, you will be keel hauled.

 

[pathstudent]

I'd say 6 is right

Some of you must have done these by now. I find myself second-guessing my answers so I'm putting them up here.

I didn't see anything on the website saying I couldn't reproduce the questions, so I'm reposting them till someone says I can't.


Spoilers ahead!


Virtual Slide exam:

1) Malignant melanoma
2) LCH (though since there are no special stains I wouldn't be surprised if you told me it was eosinophilic pneumonia...)
3) Angiomyolipoma

---
AP Written:

Question 1.
A pathologist was asked to assess the margins on a 3 x 1.5 cm skin specimen removed for suspected basal cell carcinoma. Separate frozen sections were performed on each of the four margins. Which of the following does not represent correct CPT coding for these services?
A) 88305.
B) 88331 x 4.
C) 88331 x 1 and 88332 x 3.

Ans: B

Question 2.
Which of the following statements regarding the 100 slide per day screening limit imposed by CLIA is correct?
A) It applies only to gynecologic slides.
B) Previously examined abnormal gynecologic cases are included in the 100-slide limit.
C) Slides prepared by liquid-based techniques with cells dispersed over half the slide count as one-half slide.
D) The CLIA workload limit does not apply to CLIA licensed and CAP accredited laboratories.

Ans: It seems like either B or C would be correct. But B is a little less definitive so I'd pick C. (Here's a CAP Today review)

Question 3.
Each of the following statements regarding carcinoma of the prostate gland is correct except:
A) Stage and Gleason sum are the most important prognostic factors in prostate carcinoma.
B) In high grade carcinomas, p53 is likely to be present.
C) Prostate-specific antigen stains the majority of prostatic carcinomas.
D) Stage T1c indicates tumor beyond the prostate capsule.
E) Invasion of small vesicles indicates at least stage T3.

Ans: D (T1c -tumor identified by needle biopsy due to elevated PSA, but not palpable, not visible)

Question 4.
Adverse prognostic factors in colon cancer include each of the following except:
A) a tumor nodule greater than 3 mm in size in the pericolonic fat without histologic evidence of a lymph node.
B) a conspicuous peritumoral lymphoid reaction.
C) lymphatic invasion.
D) perineural invasion.
E) radial margin involvement.

Ans: B

Question 5.
The major morphologic manifestation of chronic rejection of a lung allograft is:
A) perivascular mononuclear infiltrates.
B) interstitial fibrosis.
C) nonspecific interstitial pneumonitis.
D) bronchiolitis obliterans.

Ans: D

Question 6.
Histologic findings that are supportive of a primary myopathic process include each of the following except:
A) centralized nuclei.
B) endomysial fibrosis.
C) myophagocytosis.
D) group atrophy.
E) rounded, atrophic myocytes.

Ans: D

Question 7.
Primary hyperparathyroidism is usually caused by:
A) chronic renal disease.
B) primary parathyroid hyperplasia.
C) malabsorption syndrome.
D) parathyroid carcinoma.
E) parathyroid adenoma.

Ans: E

Question 8.
A melanoma is most likely to arise in a:
A) blue nevus.
B) Spitz nevus.
C) compound nevus in a fair skinned, blue eyed redhead.
D) giant congenital nevus.
E) pigmented spindle cell nevus.

Ans: C

=======
AP Practical (see website for pix)

Question 1.
The patient received a bone marrow transplant for acute leukemia. The most likely diagnosis is:
A) leukemic infiltration of the skin.
B) lymphoma cutis.
C) graft-versus-host reaction.
D) junctional nevus.

Ans: C

Question 2.
The 2001 Bethesda System category most appropriate for this cervicovaginal cytology specimen from a 32-year-old patient is:
A) high grade squamous intraepithelial lesion.
B) low grade squamous intraepithelial lesion.
C) atypical squamous cells of undetermined significance.
D) reactive cellular changes associated with inflammation.
E) negative for intraepithelial lesion or malignancy.

Ans: B

Question 3.
These Gomori methenamine silver stained (x400) structures indicate:
A) Cryptococcus neoformans.
B) Pneumocystis carinii cysts.
C) yeasts of Candida species.
D) Blastomyces dermatitidis.
E) trophozoites of Entamoeba histolytica.

Ans: B

Question 4.
The most likely diagnosis for this H&E stained section from a 4 cm tumor in the neck of a 51-year-old male is:
A) metastatic renal carcinoma.
B) malignant melanoma.
C) mucoepidermoid carcinoma.
D) carotid body tumor.
E) granular cell tumor.

Ans: D

Question 5.
This section of a normal kidney, stained with patient serum for IgG, is from a person with:
A) minimal change disease.
B) systemic lupus erythematosus.
C) acute poststreptococcal glomerulonephritis.
D) Goodpasture syndrome.
E) Wegener granulomatosis.

Ans: D

Question 6.
The most likely diagnosis is:
A) infarction.
B) glioblastoma multiforme.
C) pilocytic astrocytoma.
D) arteriovenous malformation.
E) radiation necrosis.

Ans: B

Question 7.
The most likely diagnosis for this H&E stained section of a 3 cm nodule from the parotid gland of a 45-year-old female is:
A) normal parotid tissue.
B) pleomorphic adenoma.
C) Warthin tumor.
D) acinic cell carcinoma.
E) adenoid cystic carcinoma.
E) mycosis fungoides.

Ans: D

Question 8.
The most likely diagnosis for this core needle biopsy specimen from the breast of a 52-year-old female is:
A) chronic mastitis.
B) myeloma.
C) infiltrating lobular carcinoma.
D) fat necrosis.
E) metastatic small cell carcinoma.

Ans: A

Question 9.
This was the driver of a car that overturned and caught fire after a head-on collision. The injuries shown are due to:
A) falling on gravel.
B) steering wheel impact.
C) postmortem burns caused by gasoline.
D) the body’s dragging on the ground.
E) second degree burns caused by heat.

Ans: D

Up next - CP.