A 40-year-old woman has a soft thyroid nodule. TSH is 2.1 mIU/L (reference 0.4-4.0). FNAC shows abundant thin colloid, flat honeycomb sheets of small follicular cells with round nuclei and some macrophages. How should it be reported?

Bethesda IV, follicular neoplasm

Histological staining and cytology

45 Lab technician recruitment practice questions on Histological staining and cytology, part of Histopathology and Cytology. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Easy
Before aqueous haematoxylin is applied, a paraffin section must first be:
1. ADewaxed and taken to water
2. BDipped in Scott's tap water
3. CTreated with acid alcohol
4. DCleared and coverslipped
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Answer: A · Dewaxed and taken to water
Paraffin wax repels water-based dyes, so the section is dewaxed in xylene and passed through absolute and graded alcohols to water. Only then can aqueous haematoxylin reach the tissue. Wax left on the section gives pale, unstained patches. Acid alcohol and bluing come after the haematoxylin step.
- B: Bluing in Scott's tap water substitute follows differentiation.
- C: Acid alcohol differentiates the section after haematoxylin.
- D: Clearing and mounting are the final steps, after staining.
Question 2 · Hard
A 40-year-old woman has a soft thyroid nodule. TSH is 2.1 mIU/L (reference 0.4-4.0). FNAC shows abundant thin colloid, flat honeycomb sheets of small follicular cells with round nuclei and some macrophages. How should it be reported?
1. ABethesda I, nondiagnostic
2. BBethesda IV, follicular neoplasm
3. CBethesda VI, malignant
4. DBethesda II, benign
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Answer: D · Bethesda II, benign
Plenty of colloid with flat, evenly spaced follicular cells and macrophages is typical of a benign colloid (follicular) nodule, Bethesda category II. A normal TSH fits a non-functioning goitre. Category I would need too few follicular cells, and IV needs a crowded microfollicular pattern with little colloid. No papillary nuclear features are present, so VI does not apply.
- A: Nondiagnostic means too few follicular cells; here they are adequate.
- B: Follicular neoplasm shows crowded microfollicles and scanty colloid.
- C: Malignant needs features such as papillary nuclei, which are absent.
Question 3 · Hard
A renal biopsy shows dark crystalline deposits in tubules. Von Kossa stains them black, but the pathologist wants proof that the deposit contains calcium itself. Which stain is the logical next step?
1. AGrocott methenamine silver
2. BPerls' Prussian blue
3. CAlizarin red S
4. DMasson-Fontana
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Answer: C · Alizarin red S
Von Kossa detects phosphate and carbonate anions, so strictly it does not prove calcium is present. Alizarin red S chelates calcium ions and gives an orange-red colour, confirming calcium specifically. Using both gives a firm answer. The other stains detect iron, melanin or fungi.
- A: GMS shows fungal walls by silver; it is not a calcium stain.
- B: Perls detects ferric iron, not calcium.
- D: Masson-Fontana detects argentaffin substances such as melanin.
Question 4 · Medium
FNAC of a rubbery neck node in a 22-year-old man shows large binucleate cells with mirror-image nuclei and huge nucleoli, among lymphocytes and eosinophils. These findings suggest:
1. ATuberculous lymphadenitis
2. BHodgkin lymphoma
3. CMetastatic squamous carcinoma
4. DReactive hyperplasia
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Answer: B · Hodgkin lymphoma
Large cells with two mirror-image nuclei and big, inclusion-like nucleoli are Reed-Sternberg cells. In a background of small lymphocytes, eosinophils and plasma cells they point to classic Hodgkin lymphoma. FNAC raises the diagnosis, but an excision biopsy is needed for subtyping and immunohistochemistry. The young age fits the common nodular sclerosis type.
- A: Tuberculosis shows epithelioid granulomas and caseous necrosis.
- C: Squamous carcinoma shows keratinised malignant squamous cells.
- D: Reactive nodes show a mixed lymphoid population without Reed-Sternberg cells.
Question 5 · Easy
Nuclei that take up haematoxylin in an H&E section are described as:
1. ABasophilic
2. BEosinophilic
3. CArgyrophilic
4. DMetachromatic
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Answer: A · Basophilic
Haematoxylin, as an aluminium-haematein lake, carries a positive charge and binds the phosphate groups of nuclear DNA, behaving as a basic dye. Structures that stain with it are called basophilic and appear blue to purple. Cytoplasm and collagen that take up the acid dye eosin are called eosinophilic. The terms describe staining behaviour, not cell type.
- B: Eosinophilic structures take up the acid dye eosin and appear pink.
- C: Argyrophilic means binding silver that must then be reduced, as with reticulin.
- D: Metachromatic means staining a colour different from the dye itself.
Question 6 · Easy
A frozen section of liver from an obese diabetic man is stained with Oil Red O. The fat droplets in the hepatocytes appear:
1. ABlue
2. BUnstained
3. CRed
4. DBlack
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Question 7 · Medium
Ehrlich's haematoxylin is traditionally ripened by:
1. AAdding mercuric oxide while boiling
2. BHeating it with potassium alum
3. CAdding sodium iodate to the solution
4. DExposure to air and light over weeks
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Question 8 · Easy
Under ordinary light, amyloid stained with Congo red appears:
1. AApple green
2. BPink to red
3. CDeep blue
4. DJet black
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Question 9 · Medium
In the Pap stain, why are smears taken through 95% alcohol before OG-6?
1. AAlcohol blues the haematoxylin in nuclei
2. BAlcohol fixes cytoplasm for orange staining
3. CAlcohol removes the excess haematoxylin
4. DOG-6 and EA are dissolved in 95% alcohol
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Question 10 · Medium
Which stain shows amyloid by metachromasia, colouring it purple-red against a blue background?
1. ASirius red
2. BCrystal violet
3. CThioflavin T
4. DCongo red
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Question 11 · Medium
After eosin, why should H&E sections pass quickly through 70% and 95% alcohol?
1. AThey make the section lift off the slide
2. BThey remove the remaining haematoxylin
3. CThey react with eosin to form a precipitate
4. DThese alcohols extract eosin from the tissue
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Question 12 · Easy
Verhoeff's iron haematoxylin method is a special stain for:
1. AReticulin fibres
2. BElastic fibres
3. CFibrin
4. DGlycogen
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Question 13 · Medium
A quick check on Schiff's reagent is to add a few drops to 37-40% formaldehyde. A good reagent:
1. AStays colourless for an hour
2. BTurns red-purple at once
3. CTurns deep blue at once
4. DForms a white precipitate
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Question 14 · Medium
In the von Kossa method, which part of the calcium deposit actually reacts with silver nitrate?
1. AThe phosphate and carbonate anions
2. BThe calcium ions themselves
3. CThe iron trapped in the deposit
4. DThe protein matrix around the deposit
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Question 15 · Medium
In a liver biopsy, how does the reticulin stain help to diagnose hepatocellular carcinoma?
1. AThe reticulin framework is lost or reduced
2. BReticulin forms a ring around single cells
3. CReticulin fibres become thicker and denser
4. DTumour cells take up silver in the cytoplasm
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Question 16 · Easy
In Perls' Prussian blue stain, haemosiderin deposits appear:
1. ABright Prussian blue
2. BJet black
3. CGolden brown
4. DOrange-red
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Question 17 · Medium
Why is a small amount of glacial acetic acid added to Harris haematoxylin?
1. ATo make nuclear staining sharper and more selective
2. BTo act as the mordant that binds dye to DNA
3. CTo ripen the haematoxylin into haematein faster
4. DTo stop the solution from growing moulds
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Question 18 · Medium
Breast FNAC from a 55-year-old woman shows many single atypical ductal cells with large irregular nuclei, loss of cohesion and no bare bipolar nuclei. The most likely diagnosis is:
1. AInvasive ductal carcinoma
2. BFibrocystic change
3. CFibroadenoma
4. DFat necrosis
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Question 19 · Medium
FNAC of a parotid swelling in a 60-year-old male smoker yields brown fluid. Smears show sheets of oncocytic cells and many lymphocytes in a granular background. The likely lesion is:
1. APleomorphic adenoma
2. BWarthin tumour
3. CAcute sialadenitis
4. DMucoepidermoid carcinoma
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Question 20 · Medium
FNAC of a soft neck node in a 14-year-old boy with a sore throat shows small and large lymphocytes in a mixed population with many tingible body macrophages. The most likely report is:
1. AMetastatic carcinoma
2. BReactive lymphoid hyperplasia
3. CHodgkin lymphoma
4. DTuberculous lymphadenitis
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Question 21 · Medium
A Perls' stain on the bone marrow aspirate of a 65-year-old anaemic man shows blue granules forming a ring around the nucleus of many erythroblasts. These cells are:
1. ANormal sideroblasts
2. BIron-laden macrophages
3. CSiderocytes
4. DRing sideroblasts
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Question 22 · Medium
A pleural fluid for cytology arrives with a large fibrin clot and little free fluid. The best way to use the clot is to:
1. AFix it and process it as a cell block
2. BShake it hard to free the cells
3. CDiscard it and smear only the fluid
4. DDissolve it in saline before smearing
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Question 23 · Hard
A 45-year-old man has a hard thyroid nodule and raised serum calcitonin. FNAC shows dispersed plasmacytoid and spindle cells with salt-and-pepper chromatin, plus clumps of pink amorphous material. Which result would confirm the most likely diagnosis?
1. AColloid that is PAS-diastase sensitive
2. BThyroglobulin-positive immunostain on the cells
3. CNuclear grooves in many of the cells
4. DCalcitonin-positive immunostain on the cells
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Question 24 · Easy
How many diagnostic categories does The Bethesda System for Reporting Thyroid Cytopathology use?
1. ASeven
2. BSix
3. CFour
4. DFive
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Question 25 · Medium
Spiral, coiled mucus casts with a dark central core are seen in sputum. What are they called?
1. ACreola bodies
2. BCurschmann spirals
3. CFerruginous bodies
4. DPsammoma bodies
Answer and explanation in LearnFree account

20 more Histological staining and cytology questions

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Study Histopathology and Cytology

Histological staining and cytology

Before aqueous haematoxylin is applied, a paraffin section must first be:

A 40-year-old woman has a soft thyroid nodule. TSH is 2.1 mIU/L (reference 0.4-4.0). FNAC shows abundant thin colloid, flat honeycomb sheets of small follicular cells with round nuclei and some macrophages. How should it be reported?

A renal biopsy shows dark crystalline deposits in tubules. Von Kossa stains them black, but the pathologist wants proof that the deposit contains calcium itself. Which stain is the logical next step?

FNAC of a rubbery neck node in a 22-year-old man shows large binucleate cells with mirror-image nuclei and huge nucleoli, among lymphocytes and eosinophils. These findings suggest:

Nuclei that take up haematoxylin in an H&E section are described as:

A frozen section of liver from an obese diabetic man is stained with Oil Red O. The fat droplets in the hepatocytes appear:

Ehrlich's haematoxylin is traditionally ripened by:

Under ordinary light, amyloid stained with Congo red appears:

In the Pap stain, why are smears taken through 95% alcohol before OG-6?

Which stain shows amyloid by metachromasia, colouring it purple-red against a blue background?

After eosin, why should H&E sections pass quickly through 70% and 95% alcohol?

Verhoeff's iron haematoxylin method is a special stain for:

A quick check on Schiff's reagent is to add a few drops to 37-40% formaldehyde. A good reagent:

In the von Kossa method, which part of the calcium deposit actually reacts with silver nitrate?

In a liver biopsy, how does the reticulin stain help to diagnose hepatocellular carcinoma?

In Perls' Prussian blue stain, haemosiderin deposits appear:

Why is a small amount of glacial acetic acid added to Harris haematoxylin?

Breast FNAC from a 55-year-old woman shows many single atypical ductal cells with large irregular nuclei, loss of cohesion and no bare bipolar nuclei. The most likely diagnosis is:

FNAC of a parotid swelling in a 60-year-old male smoker yields brown fluid. Smears show sheets of oncocytic cells and many lymphocytes in a granular background. The likely lesion is:

FNAC of a soft neck node in a 14-year-old boy with a sore throat shows small and large lymphocytes in a mixed population with many tingible body macrophages. The most likely report is:

A Perls' stain on the bone marrow aspirate of a 65-year-old anaemic man shows blue granules forming a ring around the nucleus of many erythroblasts. These cells are:

A pleural fluid for cytology arrives with a large fibrin clot and little free fluid. The best way to use the clot is to:

A 45-year-old man has a hard thyroid nodule and raised serum calcitonin. FNAC shows dispersed plasmacytoid and spindle cells with salt-and-pepper chromatin, plus clumps of pink amorphous material. Which result would confirm the most likely diagnosis?

How many diagnostic categories does The Bethesda System for Reporting Thyroid Cytopathology use?

Spiral, coiled mucus casts with a dark central core are seen in sputum. What are they called?