Free CYP Practice Questions

Question 1

Ultrasound-guided aspiration of a 2.8-cm thyroid nodule produces several highly cellular smears dominated by crowded microfollicles and dispersed follicular cells. Colloid is scant. The nuclei are round with smooth contours, without grooves, pseudoinclusions, or chromatin clearing. No significant lymphocytic infiltrate is present. Which Bethesda diagnosis is justified by these findings?

Accepted Answer

Follicular neoplasm (Bethesda IV)

Answer

Benign (Bethesda II)

Answer

Atypia of undetermined significance (Bethesda III)

Answer

Malignant (Bethesda VI)

Question 2

A pleural-fluid cell block contains atypical cells with two-tone cytoplasm and intercellular windows. The cells express calretinin and D2-40 but not claudin-4. BAP1 nuclear staining is absent in the atypical cells and retained in admixed lymphocytes. No pleural tissue is present. What conclusion can the pathologist draw from this combination?

Accepted Answer

Mesothelial malignancy, with stromal invasion not assessable in this specimen

Answer

Reactive mesothelial proliferation with nonspecific BAP1 loss

Answer

Invasive mesothelioma proven by loss of BAP1 expression

Answer

An indeterminate proliferation requiring loss of MTAP for classification

Question 3

An asymptomatic, immunocompetent 37-year-old undergoes cervical cotesting. Cytology is unsatisfactory because of insufficient squamous cellularity; high-risk HPV testing from the same vial is negative. Previous screening was normal, and there is no history of CIN2 or worse. This is the first unsatisfactory result. The clinician asks whether the negative HPV result permits a routine screening interval. What follow-up should be recommended?

Accepted Answer

Repeat cytology and HPV testing promptly, no later than four months.

Answer

Resume routine cotesting in five years.

Answer

Proceed directly to colposcopy.

Answer

Repeat cytology alone within four months, accepting the negative HPV result.

Question 4

PD-L1 22C3 staining is performed on a lung adenocarcinoma FNA cell block using a method validated for that preparation. Controls are satisfactory. Of 300 viable tumor cells, 90 show partial or complete membrane staining, 30 additional tumor cells show cytoplasmic staining only, and the remaining tumor cells are unstained. There are also 90 strongly membrane-positive macrophages. Which tumor proportion score (TPS) should be reported?

Accepted Answer

30%, in the TPS 1-49% range

Answer

40%, in the TPS 1-49% range

Answer

60%, in the TPS 50% or greater range

Answer

46%, in the TPS 1-49% range

Question 5

A parotid aspirate contains loosely cohesive cells with round nuclei, conspicuous cytoplasmic vacuoles, and abundant proteinaceous background material. Zymogen granules are not identified. The tumor is diffusely positive for S100 and mammaglobin and negative for nuclear NR4A3. Which salivary carcinoma best fits this profile?

Accepted Answer

Secretory carcinoma

Answer

Acinic cell carcinoma

Answer

Mucoepidermoid carcinoma

Answer

Epithelial-myoepithelial carcinoma

Question 6

A cytopathologist receives notification of an 85% score on the annual 10-slide gynecologic cytology proficiency test. This is the physician's first unsuccessful testing event. Under the federal CLIA proficiency-testing rule, which action is required at this stage?

Accepted Answer

Arrange a second 10-slide test within 45 days of notification.

Answer

Immediately suspend gynecologic slide examination and require 35 hours of formal education.

Answer

Require a 20-slide retest and documented reexamination of all intervening gynecologic slides.

Answer

Schedule another 10-slide test 60 days after notification.

Question 7

Endoscopic ultrasound-guided sampling of a pancreatic mass yields uniform cells with stippled chromatin and moderate cytoplasm, arranged in nests and delicate trabeculae. Synaptophysin and chromogranin are diffuse. The accompanying core shows well-differentiated architecture and a mitotic rate of 6 per 2 mm². The cell-block Ki-67 index is 28%, based on 800 tumor cells in a hotspot. How should differentiation and grade be integrated?

Accepted Answer

Well-differentiated neuroendocrine tumor, grade 3

Answer

Well-differentiated neuroendocrine tumor, grade 2

Answer

Poorly differentiated small cell neuroendocrine carcinoma

Answer

Poorly differentiated large cell neuroendocrine carcinoma

Question 8

Urine cytology from a kidney transplant recipient shows numerous cells with enlarged smooth-contoured nuclei, ground-glass inclusions, and a thin peripheral chromatin rim. SV40 large T-antigen staining is positive in the inclusion-bearing nuclei. The remaining urothelial cells are bland, and the specimen is adequately cellular and well preserved. Select the appropriate primary Paris System category.

Accepted Answer

Negative for high-grade urothelial carcinoma

Answer

Atypical urothelial cells

Answer

Suspicious for high-grade urothelial carcinoma

Answer

High-grade urothelial carcinoma

Question 9

Before planned CT-guided aspiration of a new adrenal mass in a patient with previously treated lung adenocarcinoma, the pathologist learns of episodic headaches, palpitations, and diaphoresis. The lesion is indeterminate on imaging, and no adrenal hormonal evaluation has been performed. Confirmation of metastasis would change treatment. Which investigation takes priority in addressing the immediate procedure-related safety concern?

Accepted Answer

Plasma free or urinary fractionated metanephrines

Answer

Overnight dexamethasone suppression testing

Answer

FDG PET/CT assessment of the adrenal lesion

Answer

Repeat CT with an adrenal contrast-washout protocol

Question 10

Routine flow cytometry on an axillary-node aspirate identifies polytypic B cells and no aberrant T-cell population. On the smears, however, rare very large mono- and binucleate cells with prominent nucleoli lie among eosinophils, plasma cells, and small lymphocytes. The large cells are strongly CD30-positive and weakly PAX5-positive. Which diagnosis best reconciles the morphology, immunostains, and flow findings?

Accepted Answer

Classic Hodgkin lymphoma

Answer

Anaplastic large cell lymphoma

Answer

Diffuse large B-cell lymphoma

Answer

Reactive follicular hyperplasia

Free CYP Practice Questions

Domain 1: Cervical/vaginal cytology

Question 1

Domain 5: Pleural and Pericardial effusions

Question 2

Domain 11: The Urinary Tract

Question 3

Domain 13: Lung FNA

Question 4

Domain 19: Pancreas

Question 5

Domain 20: Salivary Gland FNA

Question 6

Domain 21: Thyroid and Parathyroid FNA

Question 7

Domain 22: Lymph Node FNA

Question 8

Domain 27: Adrenal glands

Question 9

Domain 31: Cytopathology Laboratory Administration, Management, Techniques and Procedures

Question 10

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