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DPAT 5002 - Final Exam

Terms in this set (115)

Which of the following represents Barrett's esophagus?

A. Anaplasia
B. Metaplasia
C. Neoplasia
D. Hyperplasia
E. Aplasia
B
An infarct is seen in which of the following conditions?
a. lung abscess
b. heart attack
c. tb granuloma
d. rheumatoid arthritis
e. following axillary lymph node resection with mastectomy
B
Which of the following shows "non-necrotizing granuloma"?
a. gonorrhea
b. syphilis
c. tuberculosis
d. sarcoidosis
e. periapical granuloma
D
A nutmeg liver is a term used in which of the following?
a. alcoholic cirrhosis
b. Wilson disease
c. hepatitis B
d. chronic passive congestion of the liver
e. hepatocellular carcinoma
D
Which of the following diseases is characterized by high levels of alkaline phosphatase, normal levels of calcium and phosphorus, with enlargement of skull bones?
a. osteoporosis
b. multiple myeloma
c. fibrous dysplasia
d. osteogenesis imperfecta
e. paget's disease of bone
E
A 40 year old woman presents with ptosis, diplopia and dysarthria, which worsens as the day progresses. Edrophonium (an acetyl-cholinesterase inhibitor) is administered and after a minute, there is a striking improvement in muscle strength. Which of the following is characteristic of this disorder
a. tangles of small rod shaped granules in type I muscle fibers
b. autoantibodies to acetylcholine receptors
c. paraneoplastic manifestation of small cell lung cancer
d. hypothalamic dopamine-mediated inhibition
e. none of the above
B
Left sided-heart failure is generally associated with
a. pneumoconiosis
b. bronchiectasis
c. pulmonary edema
d. pulmonary emboli
e. all of the above
C
A 23 year old man undergoes surgery for fractures of the pelvis and left femur resulting from a high speed motor vehicle accident. The next day he develops dyspnea, speech difficulties, and petechial skin rash. Which of the following types of embolism is the likely cause of these findings?
a. air/gas embolization
b. thromboembolization
c. IV fluid embolization
d. fat embolization
e. none of the above
D
The renal lesion typically associated with benign hypertension is termed:
a. fibrinoid necrosis
b. kimmelstiel-wilson bodies
c. wire-loop lesions
d. hyaline arteriosclerosis
e. diffuse mesangial sclerosis
D
. Transudate results from which of the following disorders?
a. loss of fluid from GIT through severe vomiting and diarrhea
b. non-inflammatory edema fluid results from altered intravascular hydrostatic or osmotic pressure
c. high protein containing inflammatory edema with specific gravity exceeding 1.020 due to increased vascular permeability
d. pus-forming or pyogenic infection
e. accumulation of intraluminal cystic fluid
B
Which of the following serum values is likely to be elevated in patients with hyperparathyroidism
a. calcium
b. chloride
c. potassium
d. phosphorous
e. acid phosphatase
A
Fluid is aspirated from the grossly distended abdomen of a 47 year old chronic alcoholic man. The fluid is straw color and clear. Which of the following is a major contributor to the fluid accumulation of this patient.
a. blockage of lymphatics
b. decreased oncotic pressue
c. decreased sodium retention
d. increased capillary permeability
e. inflammatory exudation
B
The most likely diagnosis for a patient with dysphonia, weight loss and a history of heavy smoking is:
a. laryngitis
b. tonsilities
c. laryngeal polyps
d. carcinoma of the lungs
e. carcinoma of the larynx
E
Chronic passive congestion of the lungs is characterization by:
a. hyaline membranes
b. chronic bronchitis
c. giant cell arteritis
d. interstitial infiltration of PMNs
e. heart failure cells within the alveolar spaces
E
A 38 year old female suffering from progressive weakness, hypotension, craving for salty food, and generalized bronzing of the skin. Lab test showing low blood cortisol. Which of the following is the most likely diagnosis.
a. graves disease
b. waterhouse-friderichsen disease
c. myasthenia gravis
d. addison's disease
e. cushing's disease
D
A 4-year old boy is brought to the pediatric unit because of the concern about progressive bowing of the legs and the costochondral junctions. The underlying defect in this child is a defect in:
a. calcification of osteoid matrix
b. formation of osteoid matrix
c. hydroxylation of proline residue in collagen
d. type 1 collagen
e. none of the above
A
Which of the following laboratory results is a diagnostic of acute pancreatitis?
a. decrease albumin
b. elevated serum lipase, amylase
c. decrease serum amylase
d. elevated alkaline phosphatase
e. elevated acid phosphatase
B
A 21-year old man was referred to the oral surgery department for evaluation of a progressively enlarging submandibular mass and to rule out dental etiology. The patient's PMH is insignificant. After careful clinical and radiographic examination, dental infection was ruled out as a cause. A trial course of antibiotic did not resolve the swelling. An open biopsy was performed. Based on the clinical and histopathologic features, what is your diagnosis?
a. parotitis
b. lymphadenitis due to occult dentoalveolar absecess
c. benign mixed tumor of the tail of the parotid
d. Hodgkin lymphoma
e. Multiple myeloma
D
A 50 year old woman has been immobilized in bed for several days after a motor vehicle accident. She had been improving, but this morning she suffered the sudden onset of chest pain, hemoptysis, tachypnea, tachycardia, and dyspnea. What is the likely basis of this set of findings?
a. arterial thrombus originating in pulmonary blood vessels
b. arterial thrombus originating in the lower extremities with migration to the pulmonary veins
c. deep venous thrombus of the lower extremities with embolization to branches of the pulmonary artery
d. mural thrombus originating in the left heat with migration to pulmonary blood vessels
e. venous thrombus originating in pulmonary blood vessels
C
Which of the following histopathological findings during autopsy suggests that the person had rheumatic carditis
a. russell bodies
b. periarteritis nodosa
c. aschoff bodies in the heart muscle
d. monckeberg's sclerosis of the aorta
e. Mallory bodies
C
The chest radiograph of a 23- year old student reveals a calcified pulmonary lesion. The tuberculin test is positive, but sputum smears and cultures are negative for Mycobacterium tuberculosis. A presumptive diagnosis of secondary TB is made. If further studies, including biopsy were performed, which of the following findings would justify the diagnosis of secondary TB as contrasted to primary TB.
a. calcification
b. caseating granulomas
c. cavitation
d. Langerhans giant cells
e. positive Tb test results
C
The most common clinical consequence of benign prostatic hyperplasia is:
a. pain
b. jaundice
c. urinary tract obstruction
d. red blood cell casts in urine
e. progression to prostatic carcinoma
C
A periapical granuloma consists of the following except:
a. fibroblasts
b. collagen fibrils
c. endothelial cells
d. epitheliod cells
e. monocytes/macrophages
D
A 60 year old man with a 5 year history of GERD presents with persistent heartburn (pyrosis) and acid regurgitation. Because this patient has a long history of GERD, an esophagogastroduodenoscopy is performed to screen for Barrett esophagus, which confirmed disease. Which of the following is true of Barrett's esophagus?
a. a biopsy will show a histological finding of columnar to squamous metaplasia
b. it is a known precursor of adenocarcinoma of the esophagus
c. it is a known precursor of carcinoma of the stomach
d. it is a known precursor of squamous cell carcinoma of the esophagus
e. the most common location is the proximal (upper) third of the esophagus
B
Which of the following is the most common skin cancer?
a. malignant melanoma
b. basal cell carcinoma
c. squamous cell carcinoma
d. sebaceous cell adenocarcinoma
e. transitional cell carcinoma
B
Peptic ulcer of the stomach is characterized etiologically by.
a. bleeding
b. perforation
c. association with H. pylori
d. malignant transformation
e. none of the above
C
A 25 year old man presents with a low grade fever, weight loss, fatigue, abdominal pain, episodic diarrhea, and postprandial bloating. Right lower quadrant tenderness is elicited on palpation of the abdomen. A capsule endoscopy reveals thickening of the terminal ileum, edema, marked luminal narrowing, and a cobblestone appearance of the mucosa. Which of the following is characteristic of this condition.
a. additional typical findings include crypt abscess and pseudopolyps
b. inflammation and ulceration limited to mucosa and submucosa
c. it can affect any portion of the GIT, but proximal jejunum is most common site of involvement
d. it can cause fistula formation between loops of affected bowel
e. it is benign, self-limited disorder with no complicating sequelae
D
The following are characteristics features of Waterhouse-Friderichsen Syndrome except:
a. massive adrenal destruction and hemorrhage due to bacteremia
b. rapid onset and fast clinical course
c. death often occurs
d. hypertension
e. typically associated with Neisseria meningitides septicemia
D
Right sided heart failure affects the kidneys by causing
a. renal hypozia
b. venous congestion
c. retention of H2O and NaCl
d. decreased glomerular filtration rate
e. all of the above
E
The majority of pulmonary emboli originate from
a. coronary artery thrombus
b. deep vein thrombosis
c. renal artery thrombus
d. pulmonary artery thrombus
e. cerebral vessel
B
Which of the following is a significant effect of pheochromocytoma?
a. myxedema
b. acromegaly
c. glycosuria
d. hypertension
e. hypotension
D
Which of the following has been associated with ingestion of food contaminated with aflatoxin B1-inducing Aspergillus?
a. salivary gland adenocarcinoma
b. lung carcinoma
c. hepatocellular carcinoma
d. colon adenocarcinoma
e. breast carcinoma
C
A 45 year old man complains of heartburn and burning epigastric pain, relieved by antacids and triggered by eating spicy or acidic foods or by assuming a recumbent position. The patient smokes two packs of cigarettes a day and consumes several alcoholic drinks each evening. Which of the following is the usual cause of this patient's condition?
a. columnar "intestinal" metaplasia of the esophageal squamous epithelium
b. excessive acid production in the stomach
c. excessive non-steroidal anti-inflammatory drug use
d. helicobacter pylori infection
e. hiatal hernia and incompetent lower esophageal sphincter
E
. Ascites, which is a complication of alcoholic liver disease, develops a s a result of the following except:
a. cirrhosis
b. esophageal varices
c. portal hypertension
d. decreased protein synthesis by the liver
e. tumor producing portal hypertension
B
The most common cause of massive hematemesis in alcoholics is
a. peptic ulcer
b. acute gastritis
c. esophageal varices
d. Mallory-weis syndrome
e. acute hemorrhagic pancreatitis
D
A 45 year old female with lower neck symmetric swelling and clinical signs and symptoms of hypothyroidism. This condition is referred to as:
a. graves disease
b. hashimotos disease
c. cushing syndrome
d. sjogren's syndrome
e. systemic lupus erythematosus
B
The classic "wire loop" lesion seen microscopically in the glomeruli of the kidney are most likely associated with which of the following diseases?
a. diabetes mellitus
b. chronic renal failure
c. systemic lupus erythematosus
d. acute glomerulonephritis
e. acute tubular necrosis
C
The histopathologic feature of thyroidization in the kidney sections is primarily seen in:
a. acute pyelonephritis
b. acute glomerulonephritis
c. chronic pyelonephritis
d. membranous glomerulonephritis
e. kimmelstiel-wilson disease
C
Hypertension is typically associated with which of the following?
a. aortic stenosis
b. tricuspid stenosis
c. pericardial effusion
d. left ventricular hypertrophy
e. myocarditis
D
The most common characteristic finding in intestinal malabsorption syndrome is:
a. pain
b. melena
c. anorexia
d. diarrhea
e. steatorrhea
E
T wo weeks after recovery from a severe bout of pharyngitis an 11 year old girl is seen because of the acute onset of periorbital edema, hematuria, malaise, nausea and heachace.
a. Hypotension
b. Increased anti-streptolysin O titer
c. marked hypoalbuminemia
d. polyuria
e. positive urine culture for beta-hemolytic streptococci
B
. A 36 year old man presents to his primary care physician complaining of painless enlargement of the testis. Further laboratory studies reveal an increase in serum human chrionic gonadotropin. Which of the following is the most likely diagnosis?
a. dysgerminoma
b. embryonal carcinoma
c. seminoma
d. teratoma
e. yolk sac tumor
C
a 35 year old woman is seen 6 months after giving birth to a normal infant. She now complains of continued amenorrhea, fatigue, loss of weight and muscle strength. Further investigation might be expected to demonstrate which of the following?
a. Sheehan syndrome (Postpartum hypopituitary necrosis)
b. hyperglycemia
c. Hashimoto thyroiditis
d. diabetes insipidus
e. cushing syndrome
A
An 8 year old boy is referred to the dermatologist for numerous 'suspicious' pigmented lesions on the face and neck. Further history reveals that the patient has had difficulty seeing out of his right eye; he is referred to the opthamologist, who diagnosis an ocular melanoma. Which of the following is the most likely diagnosis?
a. basal cell nevus syndrome
b. lentigines
c. Xeroderma pigmentosum
d. tuberous sclerosis
e. none of the above
C
This condition results from:
a. aberrant expression of a receptor tyrosine kinase
b. an inborn defect in DNA repair genes
c. chemical carcinogens
d. DNA viral infection
e. retroviral infection
B
'Krukenberg tumor' of the ovary is which of the following?
a. metastatic stomach carcinoma
b. serous cystadenocarcinoma
c. endometriosis
d. ovarian teratoma
e. fibroids
A
A 2 year old boy presents with his third bone fracture within the past several months. There is no evidence of trauma. His older sibling has a similar history. The boy is small for his age, and his sclerae are tinged a bluish color. Radiographs reveal generalized osteopenia and evidence of multiple fractures, both old and new. Which of the following is the usual mode of inheritance of this disorder?
a. autosomal dominant
b. autosomal recessive
c. x-linked dominant
d. x-linked recessive
e. mitochondrial
A
A 35 year old female presents with amenorrhea and weight loss despite increased appetite. The history and physical examination reveal exophthalmos, fine resting tremor, tachycardia, and warm moist skin. Laboratory tests for thyroid function would be expected to yield which of the following?
a. decreased T3 & T4
b. lack of radioactive iodine uptake
c. elevated TSH
d. thyroid stimulating immunoglobulin (TSI)
e. none of the above
D
. A 20 year old man is evaluated for recurrent peptic ulcer disease, apparently refractory to pharmacologic intervention. Serum gastrin is markedly elevated. These findings are most characteristic of which of the following?
a. cushing syndrome
b. glucagnoma
c. zollinger-ellison syndrome
d. acromegaly
e. Addison disease
C
A 10 year old boy presents with frequent headaches, constant feeling of thirst, and polyuria. He was found to have bilateral hemianopia. A skull film shows a suprasslar mass with evidence of calcification. A computer-guided stereotactic biopsy revealed a lesion exhibiting features microscopically resembling the enamel organ of a developing tooth. What is the most likely diagnosis?
a. germinoma
b. craniopharyngioma
c. metastatic carcinoma
d. wilm's tumor
e. leiomyoma
B
Ten days after hospitalization for a large, incapacitating myocardial infarction, a 58 year old man suddenly develops paralysis of the right side of his body. The best explanation for this hemiparalysis is:
a. rupture of congenital aneurysm of the circle of willis
b. brain abscess from necrosis of myocardium
c. detachment of a bacterial embolus from pulmonic valve
d. detachment of a mural thrombus from the right ventricle
e. detachment of a mural thrombus from the left ventricle
E
During a yearlong training program, a 23 year old female Air Force officer falls in class rank from first place to last place. She has a lower pitch to her voice and corsening of her hair, along with increased tendency toward weight gain, and increasing intolerance to cold. Which of the following laboratory abnormalities is expected?
a. Decreased serum T3 and T4
b. increased serum cortisol level - cushing
c. increased serum parathyroid hormone levels - renal failure
d. decreased serum vasopressin hormone levels - diabetes insipidus
e. decreased serum ACTH levels - Addison disease, secondary
A
During a routine health maintenance examination of a 40 year old man, a s tool guaiac test result was positive. A follow-up sigmoidoscopy showed a 1.5 cm circumscribed, pedunculated mass on a short stalk, located in the upper rectum. Which of the following best describes this lesion?
a. adenoma
b. teratoma
c. sarcoma
d. choristoma
e. melanoma
A
. A 17 year old boy presents with pain and swelling about the left knee for the past month. He thought that this resulted from an old football injury and that it would resolve without incident. However, the pain has persisted and is severe enough to cause him to limp. Radiographs of the knee demonstrate a lifting of the periosteum and a speculated 'sunburst' pattern in the distal femur. Which of the following is the most likely diagnosis?
a. knee sprain
b. chrondrosarcoma
c. osteosarcoma
d. giant cell tumor
e. ewing sarcoma
C
The following statements regarding invasive ductal carcinoma of the breast are correct except:
a. early lesion is generally a solitary painless lump
b. mammograms exhibit microcalcification
c. prominent angiogenesis and erb-B2 amplification are seen
d. commonly occurring in upper outer quadrant
e. hypoesterism is a major etiologic factor
E
. A 1 year old male infant is hospitalized for pneumonia. The baby has been hospitalized twice before for severe respiratory infections. His mother pointed out that when she kisses her child, he tasted 'salty'. The child has weight loss that the mother attributes to frequent vomiting and diarrhea with bulky, foul-smelling fatty stools. Which of the following is the most likely diagnosis?
a. Gaucher disease
b. cretinism
c. cystic fibrosis
d. phenylketonuria
e. tuberous sclerosis
C
An 88 year old woman with marked kyphosis and loss of height that has been gradually progressive over many years experiences sudden onset of acute back pain following a sudden change in position. Radiographic examination demonstrates generalized osteopenia nad a fracture of lower thoracic vertebra. Which of the following is an association or characteristic of the patient's generalized bone disorder?
a. increased serum Ca and Phosphate
b. postmenopausal state and estrogen deficiency
c. physical inactivity
d. hypothyroidism
e. excessive Ca intake
B
A 50 year old woman of Eastern European Jewish descent presented with a history of recurrent fractures, and easy bruising and is found to have hepatosplenomegaly and anemia. Serum assays revealed elevation of the angiotensin-converting enzyme. Which of the following will also be found as 'deficient' in further investigation?
a. glucocerebrosidase
b. a-1,4-glucosidase
c. Hexosaminidase A
d. sphenomyelinase
e. phenylalanine hydroxylase
A
Gross and microscopic changes in injured liver or kidneys occur earlier than any other identifiable alterations. Biopsies of injured liver or kidneys are more reliable than blood tests for early diagnosis of damage
a. statement 1 is true, but statement 2 is false
b. statement 1 is false but statement 2 is true
c. both statements are false
d. both statements are true and related
e. both statements are true, but not related
B
A 17 year old male sustained blunt trauma to the abdomen in a MVA. A portion of his liver had to be removed. A CT during follow up several weeks later showed that the liver nearly regained its normal size. Which of the following processes best explains the CT results.
a. apoptosis
b. dysplasia
c. fatty change
d. hyperplasia
e. metaplasia
f. hypertrophy
D
A 51 year old man present with blood pressure of 150/95. The physician explained if this man's blood pressure remains elevated for years, there will be important alterations in the myocardium. Which alterations are most likely?
a. atrophy
b. hyperplasia
c. metaplasia
d. hemosiderosis
e. hypertrophy
E
A 25 year old female breaks the left femur in a skiing accident. After several weeks of immobilization in a cast, the diameter of the left calf decreased. What is the explanation for the change in the muscles of the cell?
a. aplasia
b. hypoplasia
c. atrophy
d. necrosis
e. metaplasia
C
A 43 yo male with a month history of heartburn and gastric acid reflux. Upper GI endoscopy with esophageal biopsy revealed changes in the epithelial lining. What are these changes?
a. squamous metaplasia
b. epithelial hypertrophy
c. columnar metaplasia
d. mucosal atrophy
e. fatty change
c
The term "hyperplasia" means the exact opposite of the term "metaplasia". Both metaplasia and hyperplasia are reversible tissue adaptations to non-lethal injury.
a. statement 1 is true, but statement 2 is false
b. statement 1 is false but statement 2 is true
c. both statements are false
d. both statements are true and related
e. both statements are true, but not related
B
A myocardial or renal infarct is characterized by what type of necrosis?
a. fatty necrosis
b. caseous necrosis
c. gangrenous necrosis
d. coagulative necrosis
e. liquefactive necrosis
D
A 65 yo woman suddenly lost consciousness, and an hour later, when she woke up, could not move her right arm or leg. A few weeks later, a CT scan of her head showed a large cyst like space in the left parietal lobe. The most likely pathologic process that occurred in the brain is called:
a. fatty necrosis
b. caseous necrosis
c. gangrenous necrosis
d. coagulative necrosis
e. liquefactive necrosis
E
A 45 year old male receives chemotherapy from lung adenocarcinoma. There is reduction in the size of the primary tumor, however, the patient dies due to complications of therapy. Histopathologic features of the primary tumor show foci shrunken tumor cells with condensed nuclear chromatin and deeply eosinophilic cytoplasm. What is the most likely trigger of the changes seen in the tumor cells?
a. release of cytochrome c
b. activation of telomerase
c. catalase activity
d. BCL-2 activty
e. lipofuscin accumulation
A
Which subjective findings are most likely to be reported by individuals receiving COX-2 inhibitors relative to those receiving placebo in a 6-mo trial? Note that the two groups show no significant differences in WBC count, platelet count, hemoglobin, or creatinine.
a. Swelling of ankles
b. Increase in bruising
c. Increase in episodes of fever
d. Decrease in skin rashes
e. Decrease in arthritis pain
E
A 19-year-old female gets her nose pierced and the skin becomes infected with bacteria. Leukocytes respond by exiting the vasculature and migrating into the infected site. Which of the listed substances is the most likely mediator of leukocyte migration?
a. bradykinin
b. Serotonin
c. Histamine
d. Chemokines
e. Prostaglandins
D
A patient presents with pain and swelling of 2 days duration adjacent to a carious mandibular first molar with a non-viable pulp. Incision and drainage of the swelling produces tan-yellow, viscous fluid. Which host cells are most significantly represented in this fluid?
a. Plasma cells
b. Neutrophils
c. B and T lymphocytes
d. Macrophages
e. Mast cells
B
A 39 year-old patient presents with pain, erythema and swelling of the left cheek present for one day. The swelling developed after a bee sting. The earliest event in the acute inflammatory response to the bee sting is
a. Angiogenesis
b. Edema
c. Recruitment of monocytes
d. Recruitment of PMN
e. Hemorrhage
B
After extraction of a carious tooth, incision and drainage of the associated swelling and a course of antibiotics, the patient's condition improves and the area begins to heal. Which of the listed leukocytes are most important for this repair process?
a. Langerhan cells
b. Plasma cells
c. Macrophages
d. Neutrophils
e. Eosinophils
C
A 20 year old male presents with pain and swelling of 2 days duration associated with carious mandibular first molar and a non-viable pulp. He takes aspirin because of the pain. Which aspect of the inflammatory response is most affected by acetylcalicylic acid (aspirin)?
a. Vasodilation
b. Leukocyte chemotaxis
c. Phagocytosis
d. release of leukocytes from bone marrow
A
A biopsy specimen was obtained from a gastric lesion in a 32-year-old patient with abdominal pain of 2 months duration. Histopathologic examination revealed loss of surface epithelium with underlying loose fibrous tissue, angiogenesis, and infiltrates of lymphocytes, macrophages and plasma cells. The best term(s) for this process is/are
a. Granulomatous inflammation
b. Ulcer and chronic inflammation
c. Ulcer and acute inflammation
d. Coagulation necrosis and ulcer
e. Abscess and caseous necrosis
B
A 16 year-old female presents with recent onset of butterfly rash on her face after intense sun exposure. She also complains of stiffness in her joints, mostly in the mornings. Blood tests reveal high ANA titers and low complement C3 levels. What is the meaning of "high ANA titers"?
a. The patient has circulating antibodies against acetylcholine and nicotine receptors
b. High levels of antibodies against neutrophils
c. Poor kidney function
d. High level of arthritis-related rheumatoid factor
e. High concentrations of antibodies against nuclear antigens
E
Jaundice is a clinical manifestation of
a. Sickle cell anemia
b. Hereditary hemorrhagic telangiectasia
c. Agranulocytosis
d. Iron deficiency
e. Aplastic anemia
A
Megaloblastic anemia occurs as a result of
a. Vitamin K deficiency
b. Vitamin B12 deficiency
c. Folic acid deficiency
d. Iron deficiency
e. beta-globin chain gene mutations
B, C
A patient with spontaneous bleeding, petechiae, purpura and ecchymoses
A. Is likely to have 10,000-20,000 plts/mm3
B. As a consequence, may develop microcytic anemia
C. Should not be taking non-steroidal anti-inflammatory drugs
D. Can have invasive surgical procedures
C
Microcytic anemia is
A. Usually a result of insufficient hemoglobin production
B. Is characteristic of iron deficiency
C. Is seen in patients with thalassemia
D. Is a feature of pernicious anemia
E. Is a feature of sickle cell anemia
B
. What is the correct term for peripheral blood absolute neutrophil count of 500 cells per microliter?
A. Anemia
B. Pancytopenia
C. Leukocytosis
D. Agranulocytosis
E. Reticulocytopenia
D
Immediate patient management should include:
A. A referral to an oral surgeon for surgical excision of the lesion
B. A referral to the primary care pediatrician for management of an infection
C. Dental management of the carious molar
D. A referral to an oncologist for treatment of the mandibular lesion
E. A prescription for antibiotics
D
The most likely diagnosis is
A. Odontogenic infection
B. Plasmacytoma
C. Acute lymphoblastic leukemia (ALL)
D. Hodgkin lymphoma
E. SLL/CLL
F. Burkitt lymphoma (8;14)
F
Select the characteristics of Hodgkin lymphoma
A. Presents with cervical lymph node enlargement in 70-75% of cases
B. Bimodal presentation with peaks in the 2-3rd decades and around 6th decade, respectively
C. The neoplastic Reed-Sternberg cells and Hodgkin cells are typically associated with numerous non-neoplastic reactive white blood cells
D. Advanced cases usually involve the spleen
E. Progression occurs via contiguous lymph nodes
A,B,C,D,E
Which of the following is (are) true of the Philadelphia chromosome?
A. It is diagnostic for aplastic anemia
B. It is a translocation t(9;22)
C. It is characteristic of CML
D. It is detected in approximately 25% of adult cases of acute lymphoblastic leukemia
B,C,D
Which of the following is (are) TRUE of oral manifestations in patients with AML or CML?
A. Gingival enlargement is very common in these patients
B. The gingival enlargement is due to infiltration of the gingival by malignant cells of the myeloid lineage
C. Petechiae and purpura are often present in addition to the gingival enlargement
D. The gingival enlargement may be misinterpreted as manifestation of disorders unrelated to leukemia
E. Both are disorders of myeloid precursors
A,B,C,D,E
A 53-year-old man presents with a lump near his left shoulder. There is an enlarged, nontender, supraclavicular lymph node, and enlargement of the lymphoid tissue in the Waldeyer ring. There is no hepatosplenomegaly. CBC shows mild anemia, otherwise WNL. Lymph node biopsy show monotonous sheets of large lymphoid cells replacing the lymph node structure. The cells large nuclei and prominent nucleoli and express B cell markers. The most likely diagnosis is
A. Chronic lymphadenitis
B. Diffuse large B cell lymphoma
C. Hodgkin lymphoma
D. Small lymphocytic lymphoma/chronic lymphocytic leukemia (types of NHL)
E. Acute lymphoblastic leukemia
D
61 year-old man with a 5-mo history of back pain developed a cough with yellow sputum and a fever. There are no lymphadenopathy or splenomegaly. Sputum culture was positive for Strep. Pneumoniae. There is evidence of kidney damage (creatinine and urea nitrogen are increased). The skull radiograph is shown. A bone marrow biopsy will show which of the following?
A. Scattered granulomas
B. Numerous plasma cells
C. Aggregates of small mature lymphocytes
D. Occasional Reed-Sternberg cells
E. Hypercellularity with many blasts
B
a 20 year old male presents with pain and swelling of 2 days duration associated with mandibular first molar and non-viable pulp. he takes aspirin because of the pain. Incision and drainage of the swelling prodcues tan-yellow, viscious fluid. Which host cells are most signficantly represented in this fluid?

a. plasma cells
b. neutrophils
c. b&t lymphocytes
d. macrophages
B
Every spring for the past five years, this 30-year-old female has been developing tearing, sneezing, runny nose, and congestion, the severity of which correlates with high pollen counts. What is the best explanation of the pathologic process?

A. Complications of the common cold
B. IgE and mast cell-mediated hypersensitivity
C. Contact hypersensitivity to environmental triggers
D. Antigen IgG immune complex deposition in mucosal vessels
E. Macrophage and T cell mediated response
B
A 25 year old female reports seasonal allergy to spring pollen. She describes rapidly
developing congestion, runny nose, and sneezing when going outside. Which of the listed
substances is most important for producing these problems?
A. Interleukin-1
B. Bradykinin
C. Histamine
D. Chemokine
E. Complement C5a
C
Serous inflammation is most characteristic of which of the following scenarios?
A. Nodular, firm, erythematous lesions of the skin in a patient with acne
B. Clear fluid-filled blisters developing after a burn
C. Tissue reaction to a suture
D. Response in the lung to M. tuberculosis
E. Abscess
B
Purulent inflammation is most characteristic of which of the following scenarios?
A. Nodular, firm erythematous lesions of the skin in a patient with acne
B. Clear fluid-filled blisters developing after a burn
C. Tissue reaction to a suture
D. Response in lung to M. tuberculosis
E. Abscess
E
A 70 year old woman has increasing shortness of breath x 1 wk and a fever of 38.3 degrees C.
There is cloudy yellow fluid in the left pleural cavity containing WBC (98% neutrophils) and Gram
+ cocci in clusters. Which of the following is the best description of the process in the pleural
cavity?
A. Abscess
B. Chronic inflammation
C. Edema
D. Fibrinous inflammation
E. Purulent exudate
E
A 30-year-old woman receives corticosteroid therapy for an autoimmune disease. She develops an abscess on her face which requires incision and drainage. The wound heals poorly over the next month. Which of the aspects of wound healing is most likely to be deficient in this patient?

A. Re-epithelialization
B. Production of fibroblast growth factor
C. Collagen deposition
D. production of serine proteinase
E. Infiltration of neutrophils
C
A 68 year old female patient with rheumatoid arthritis recently switched from standard
anti-inflammatory treatment to an anti-TNF-alpha agent. Subsequently, she has developed
pulmonary tuberculosis. This is an example of which kind of problem? Select the BEST answer.

A. This is an example of M. tuberculosis reactivation due to accumulation of rheumatoid factor
B. This is an example of iatrogenic immunodeficiency
C. This is an example of a secondary immunodeficiency due to loss of TNF-alpha-mediated
activation of macrophages
D. Both B and C are correct
D
Vasculitis is a key feature of which of the conditions listed below?
A. Anaphylaxis
B. A positive PPD test
C. Hives induced by penicillin
D. Pemphigus
E. Systemic lupus erythematosus
E
Within minutes after exposure to latex, an 18 year old girl develops difficulty breathing. Her
tongue and soft palate begin to swell, and the skin develops urticaria. The best pharmacologic
agent to treat these signs and symptoms is?
A. Cyclosporine
B. Glucocorticoids
C. Penicillin
D. Epinephrine
E. Methotrexate
D
All of the following autoimmune diseases are more prevalent in females than in males except
one. Which one is the exception?
A. Myasthenia gravis
B. Scleroderma
C. Diabetes mellitus
D. Sjogren syndrome
E. Autoimmune thyroid disease
C
In a patient with Wegener's granulomatosis, activated neutrophils become the target of the
autoimmune IgG antibodies directed at a cytoplasmic antigen of neutrophils (anti-neutrophil
cytoplasmic antibodies, ANCA). Which of the following statements regarding Wegener's
granulomatosis is NOT TRUE?
A. The ANCA are produced by auto-reactive B cells with the help of auto reactive CD4+ T cells
B. The tissue damage will be pronounced at sites where activated neutrophils accumulate,
such as blood vessels in the area of an infection
C. Acute inflammation in response to infections is likely to trigger active episodes of the
autoimmune disease
D. Necrotizing granulomatous inflammation is characteristic of this disorder
E. Phagocytes do not contribute to tissue damage
E
A 31 year old female gets a rash on her face when spending more than 1 hr in the sun. Her lab
values: Hb 10.9 g/dl, Hct 32.9% (normal=37), platelets 157,000/mm cubed (normal 150-450,000),
WBC 4200/mm cubed (WNL). There is also proteinuria, and ANA test is positive with a titer
1:2048 (High). Which of the listed complications is most characteristic of this disorder? (Lupus)
A. Hyperthyroidism
B. Sclerodactyly
C. Lymphoma
a
pot or
soft
D. Keratoconjunctivitis
E. Hemolytic anemia
E
A 45 year old woman has had a chronic dry cough for about 5 years and blurred vision has
been increasingly problematic for about a year. Examination reveals severe xerostomia and
angular cheilitis. There is enlargement of the parotid glands. Which of the following positive tests
is most compatible with the diagnosis?
A. Anti Jo-1 antibodies
B. Anti-histone antibodies
C. Anti-TSHR antibodies
D. Anti-SS-A and -SS-B antibodies
E. Anti-mumps antibodies
D
A 34 year old woman with severe psoriasis of several years' duration has increasing pain in
her hip and hands for 6 months. There is decreased motion in the affected joints. Blood test is
negative for ANA and rheumatoid factor. She has not traveled outside of Maine in years. Which of
the listed complications is the most characteristic of the patient's condition?
A. Sclerodactyly
B. Chickungunia-related joint pain
C. Psoriatic arthritis
D. Rheumatoid arthritis
E. Parvovirus-related polyarthropathy
C
Direct immunofluorescence test on a mucosal biopsy specimen confirms a diagnosis of mucous
membrane pemphigoid. The positive result would have revealed the presence of which of the
following along/near the basement membrane?
A. IgE and mast cells
B. IgG antibody and complement C3
C. Coagulation necrosis
D. Vasculitis with immune complexes
E. Granulomatous inflammation
B
What do Graves disease and mucous membrane pemphigoid have in common?
A. Nothing, as the two diseases affect completely different cells and mechanisms
B. The mechanism of tissue damage involves soluble antigen-antibody immune complexes
C. Macrophages and T cells are the key effector cells
D. Binding of IgG auto-antibodies to cells
E. Activation of cytotoxic T cells
D
45 year old man with several days history of cough, fever, and worsening dyspnea. He has a 39
degrees C fever, decreased breath sounds over lung fields, and Pneumocystis carinii is found in the
bronchoalveolar lavage fluid. Blood work: CD4+ cell count = 135/ul, WBC 7800/mm3, 75%
neutrophils, 6% lymphocytes, 10% monocytes. Which of the following lab tests is likely to be
positive?
A. ANCA
B. Rheumatoid factor
C. Antistreptolysin O
D. Anti-HIV antibodies
E. ANA
d
A 37 year old man with HIV has noticed multiple, gradually enlarging plaque like and nodular,
reddish- purple, 0.5-1.2cm skin lesions. The spindle cells in these lesions would most likely be
positive for
A. A. Cytomegalovirus
B. Epstein-Barr virus
C. Herpes Simplex virus 1
O
D. Human herpesvirus-8
E. HIV-1
D
A 12 year old girl has had a sore throat for 3 days and a fever of 38.5 degrees C with marked
pharyngeal erythema. Throat culture is a positive for group A beta-hemolytic strep. Three weeks
after the pharyngitis resolves, the patient develops fever and chest pain. The titer of the
anti-streptolysin O antibodies is 1:512. Select the most likely mechanism responsible for the new
symptoms.
A. Activation of cytotoxic T cells
B. Failure of T cell mediated suppression
C. Molecular mimicry
D. Neutrophil dysfunction
E. Bacteria dissemination
C
What do Sjogren syndrome and insulin-dependent diabetes mellitus have in common?
A. IgE + mast cell mediated tissue damage
B. Type 4 mechanism of tissue damage
C. Both are hypersensitivity reactions to exogenous antigens
D. Delaye
E
A 54 year-old woman has had nausea with vomiting and early satiety for several months. She
has no fever, lymphadenopathy or hepatosplenomegaly. CBC: Hb 12.9 g/dL, Hct 41.5%, Plt
263,000/mm3, WBC 8430/mm3. GI endoscopy shows loss of rugae in a 4x8 cm area the stomach
lining. Biopsy of this area shows H. pylori along the epithelial surface. There is a monotonous
infiltrate of small B lymphocytes in the mucosa and submucosa. After treatment of the H. pylori
infection, her condition improves. What is the most likely diagnosis?
A. A. Acute lymphoblastic leukemia
B. B. Chronic lymphocytic leukemia
C. C. Diffuse large B cell lymphoma
D. D. Follicular lymphoma
E. E. MALT lymphoma
E
A 2-year-old girl developed a skin rash in the past 3 months. She has had recurrent strep
infections in the past year. There is hepatosplenomegaly and generalized lymphadenopathy. There
is hearing loss in the right ear, and a 2 cm radiolucent lesion of the right temporal bone. There is
no anemia, thrombocytopenia, or leukopenia. The mass of the temporal bone most likely consists
of which of the following?
A. A. Histiocytes with Birbeck granules
B. B. Lymphoblasts
C. C. Plasma cells
D. D. Reed-Sternberg cells
E. E. Neutrophils
A
A 34-year-old man has had multiple nosebleed and spontaneous gingival bleeding for the past
month. There are multiple oral and cutaneous purpura and ecchymoses. CBC: HB 8.5 g/dL, Hct
25.7%, Plt 13,000/mm3, WBC 52,100/mm3 with 5% neutrophils, 2% myelocytes, 83% blasts, 3%
lymphocytes, 2% monocytes. The smear shows blasts with azurophilic granules. Which of the
following are likely to also be present in the smear?
A. A. Auer rods
B. B. Hairy projections
C. C. Heinz bodies
D. D. Sickle cells
E. E. Birbeck granules
A
Translocation t(9;22) leading to BCR-ABL rearrangement is characteristic of which of the
following conditions?
A. A. Sickle cell anemia
B. B. Chronic lymphocytic leukemia
C. C. Burkitt lymphoma
D. D. Chronic myeloid leukemia
E. E. Follicular lymphoma
D
A patient with crater-like ulcers that are heavily colonized by bacteria, gingival petechiae and
purpura, fever, pallor and fatigue, and CBC that includes 400 WBC/uL, 18,000 platelets/uL and
9,000 reticulocytes/uL is MOST likely to have
A. A. Agranulocytosis
B. B. Aplastic anemia
C. C. Leukocyte adhesion deficiency
D. D. Acute leukemia
E. E. Diffuse large B cell lymphoma
B
Erythrocytes in patients with vitamin B12-deficiency are larger and less mature than normal,
because B12 is important for normal differentiation of blood cells.
A. A. The statement and the reason are both correct and related.
B. B. Both the statement and the reason are correct but NOT related.
C. C. The statement is correct but the reason is NOT.
D. D. The statement is NOT correct, but the reason is correct.
E. E. NEITHER the statement NOR the reason is correct
A
Autosplenectomy is a complication of sickle cell anemia, because the spleen in such patients
performs extramedullary hematopoiesis.
A. A. The statement and the reason are both correct and related.
B. B. Both the statement and the reason are correct but NOT related.
C. C. The statement is correct but the reason is NOT.
D. D. The statement is NOT correct, but the reason is correct.
E. E. NEITHER the statement NOR the reason is correct
B
THIS SET IS OFTEN IN FOLDERS WITH...