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39 Cards in this Set

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A 17 yo girl develops an acute syndrome characterized by low grade fever, lassitude, pharyngitis, generalized lymphadenopathy, and a palpable liver and spleen. A peripheral blood smear reveals the presence of "atypical lymphocytes." A heterophil test for abs reacting with sheep erythrocytes is neg. Infection with which one of the following viruses is most likely?
The scenario is strongly suggestive of infectious mononucleosis, a benign , self-limited lymphproliferative diosrder that is most often c/b EBC infection. However, the heterophil test for sheep red cell agglutinins is neg, and so-called heterophil-neg infectious mononucleosis is most often c/b cytomegalovirus
A 70 yo man is found to have a papilomatous neoplasm of the bladder. Even though the lesion is extremely well-differentiated, the patholgist makes a diagnosis of transitional cell carcinoma grade I. The distincion of the "malignant" from "benign" in this instance was most likely bsed on which of the following known general characteristics of this type of lesion?
Clinical behavior
The clinical behavior of neoplasms is the underlying basis for all other indicators that distinguish maliganant form benign lesions. For example, some extremely well-differentiated, otherwise benign-appearing lesions are known to metastiasize and thus are classified as malignant
A 60 yo man was seen because of progressive bone deformity and pain, progressive hearing loss, and increasing skull size. Workup revealed generalized increased bone density with cortical thickening, normal serum calcium and phosphorus, and markedly elevated serum alkaline phosphatase. Biopsy revealed a characteristic "mosaic" pattern. Which one of the following tumors is a known complication of the disorder suggested by this scenario?
The hx is suggstive of Page disease of bone, which is also marked by bone pain, anterolateral bowing of long bones, and seomtimes high-output heart failure. This disorder is complicated by osteosarcoma in bout 1% of cases. Paget disease of bone should not be confused with Paget disease of the breast, which is closely assoc with an underlying ductal carcinoma
At autopsy, both lungs from a 45 yo woman are found to have colapsed or distended alveoli, many of which are lined with fibrin-rich hyaline membranes. The finding of hyaline membranes is assoc with all of the following EXCEPT: a. high-concentration oxygen therapy, b. infection with Mycoplasma pneumoniae, c. long-standing pulmonary emphysema, d. shock, e. uremia
long-standing pulmonary emphysema
Emphysema has no assoc with hyaline membrane formation. Alveolar hyaline membrane formation is a characteristic finding in both the neonatal and adult rep distress syndromes. The common factor is diffuse alveaolar damage induced y a nubmer of agents or conditions
After being picked up by the police, a run away adolescent girl became increasingly somnolent, lapsing into a deep coma 72 hours later. Her resps were rapid and deep, and she appeared to be severely dehydrated. Lab studies revealed a marked reduction in serum bicarbonate and a signifticatn anion gap, as well as neutrophilic leukocytosis. The most likely additional lab abnormality is:
increaed serum glucose
Progressive somnolence leading to metabolic acidosis, coma, and severe dehydration, often with prerenal azotemia, are all strongly suggestive of diabetic ketoacidosis. Expected findings in this condition include increased serium urine glucose and ketones
All of the following item pairs are correct effects or assocs EXCEPT: a. Duffy blood group ag - susceptibility to malarin; b.folate deficiency - hypochromic erythrocytes, c. hereditary spherocytosis - increased mean corpuscular hgb concentration, d. increased plasma volume - decreased hematocrit in pregnancy, e. suppressed B chain synthesis - thalasemia
folate deficiency - hypochromic erythrocytes
Folate deficiency leads to megaloblasatic anemia. The red cells are macrocytic andnormochromic. Since the thickened red cells appear more dense on peripheral blood smears, these cells aer often erroneously thought to be hyperchromic; however the MCHC is normal
A 56 yo man collapsed at work and died 20 mins later in the ER while blood was being drawn. The PTs hx revealed an episode of prolonged chest discomfort 3 mos earlier. Which of the following is LEAST likely? A. death from arrythmia, b. fibrotic scare in the ventricular septum, c. loss of myocardial striations and beginning infiltration with neutrophils, d. normal values for serum creatin kinase, troponin I, and Mgb.; e. severe atherosclerotic narrowing of the anterior descending branch of the L coronary artery with overlying thrombus formation
loss of myocardial straiations and beginning infiltration with neutrophils
In the first several hours after MI, the most common cause of death is arrhythmia. Although evidence of actue coronary artery obsruction may be found, morphologic myocardial changes an serum myocardial merker protein elevations are most often delayed for several hours. A myocardial fibrotic scar is evidence of old prior MI.
Cytologic findings consisten with carcinoma of the endometrium are found during diagnostic eval of a 65 yo woman with uterine bleeding. The pathogenesis of the lesion is assoc with all the following EXCEPT: a. adenomatoous hyperplasia of the endometrium, b. coexisting granulosa cell tumor of the ovary, c. diabetes mellitus, d. endometriosis, e. obesity
Endometriosis is not a neoplasm and has no relation to malignancy. The most IMP factor in the pathogenesis of endomaetrial carcinoma appears to be prolonged estrogen stimulation such as that assoc with estrogen therapy or with estrogen-secrteing tumors. Adenomatous hyperplasia, itself a result of estrogen stimulation, is a freq precursor to endometrial carcinoma. Obesity and conditions assoc with it, such as diabetes mellitus or hypertension, may contribute to hyperestrinism because estrone can be synthesized in perpheral fat cells.
A 32 yo woman was seen because of sever watery diarrhea. Diagnostic eval revealed achlorhydria and reduced concentration of serum potassium. Imaging studies revealed the presecne of a pancereatic tumor. Special stains will most likely reveal the pancreatic tumor to be a(an):
The VIPoma is an islet cell tumor of the pancreas that is assoc with Watery Diarrhea, Hypokalemia, and Achlorhydri (WDHA), all c/b the secretion of vasoactive intestinal peptide by the tumor.
A 56 yo man I found to have amerkedly elevated values for total serum cholesterol and for LDL. Which of the following is the LEAST likely complication of the common vascular disorder that is assoc with these lab abnormalities? A. aneurysm of asacending aorta, b. cerbral infarct, c. gangrene of small bowel, d. mural thormbosis, e. MI
aneurysm of ascending aorta
Markedly elevated values for total serum cholesterol and for LDL cholesterol are major predictors of atherosclerosis. Although atherosclerosis can affect all portions of the aorta, aneurysm of the thoracic aorta, aespecailly the ascending portion, is unusual. Most atherosclerotic aortic aneurysms involve the abdominal damage.
All of the following procedures are useful in distinguishing iron deficiency anemia from B-thalassemia minor EXCEPT: a. bone marrow Prussian blue stain, b. hematocrit, c. serum ferritin, d. serum iron., e. total iron-building capacity
The hematocrit does not distinguish one form of anemai from another. In iron deficiency anemia, serum iron is decreased, TIBC is incrased, and storage iron is depleted, as indicated by decreased serum ferritin and absent bone marrow hemosiderin on Prussian blue stain.
Which form of Hodgkin disease has the poorest prognosis?
Lymphocyte depletion
Among the variants of Hodgkin disease, lymphcyte depletion has the poorest prognosis. Besides lymphocytic depletion, this form of Hodgkin disease is characterized by the presence of numerous Reed-Sternberg cells; both are indicators of poor prognosis.
Which one of the following disordrs is often c/b T cell-mediated hypersensitivity?
contact dermatitis
Contact dermatitis can be c/b T cell-mediated hypersensitivity or by direct chemical injury to the skin. Graves disesae, hemolytic disease of the newborn, polyarteritis nodosa, andurticaria are all ab-mediated disorders
A 67 yo man, a 2-pack-a-day smoker since age 18, has had a productive cough over the past 20 yrs. Although continuous through the years, there have been episodic exacerbations of these symptoms, which have worsened during the past 4 or 5 years, lasting 3 mos or 4 mos at a time. Arterial p02 is decreased and pC02 is increased. Total lung capacity measurements are normal. These findings are most suggestive of which of the following pulmonary disorders?
chronic bronchitis
Chronic bronchitis, which is clearly linked to smoking, is defined as productive cough occurring during at least 3 consectutive months over a t least 2 consectutive years.
Multiple cutaneous punctate hemorrhages are characteristic of all of the following contions EXCEPT: a. ascorbic acid deficiency, b. christmas disease, c. disseminated intravascualar coagulation, d. Rocky Mtn spotted fever, e. thrombocytopenia
Christmas disease
Punctate cutaneous bleeding is an indicator of primary hemostatic bleeding, as seein in defects the microvasculature or the platelets. Platelet disorders include thrombocytopenia, which may either primary or secondary. Christmas disease, a disorder of the intrinsic pathway of coagulation clinically indistinguishable from classic hemophilia, is characterized by secondary hemostatic bleeding.
All of the following characteristics of Hashimoto thyroiditis are suggestive of an autoimmune etiology EXCEPT: a. antihyroglobulin and antimicrosomal abs; b. assoc with other autoimmune disorders; c. atrophy of thyroid follicles; d. increased incidence in HLA-DR5 and HLA-B5 pos persons; e. presence of lymphid follicles iwthing hte thyroid gland
atrophy of thyroid follicles
Autoabs, assoc with certain HLA types, and incrased incidence in persons with other autoimmune disorders are freq occurrences in autoimmune disorders. In additoin, Hashimoto thyroiditis is charcterized by dense lymphcytic infiltrates with germinal center formation, striking morpholgic eveidence of immun cell participation
Agnogenic myeloid metaplasia is characterized by all of the following EXCEPT: a. depletion of bone marrow megakaryocytes, b. hepatosplenomegaly; c. myelofibrosis; d. nucleated red cells in peripheal blood smear; e. teardrop-shaped erythrocytes
depletion of bone marrow megakaryocytes
Agnogenic myeloid metaplasia is characterized by extensive myelofibrosis and extramedullary hematopoieses resluting in hepatosplenomegaly. Myeloid and erythroid precursor cells are depleted. Megakaryocytes are not only spared but are most often increased in number.
An autopsy is performed on a 35 yo black man who died after a brief illness characterized by papilledema, severe hypertension, L ventricular hypertrophy and failure, and renal dysfunction. The most likely findings in the kidney are:
surface covered with multiple petechial hemorrhages, hyperplastic arteriolosclerosis, and necrotizing glomerulitis
A rapidly fatal course with sever hypertension, L ventricular hypertrophy and failure, papilledema, and reanl dysfunction is charcaterisitc of malignant hypertension. This syndrome is most freq seen in relatvely young black men. The defining renal arteriolar lesion, malignant nephrosclerosis, and the assoc necrotizing glomerular lesion reslut in capillary rupture and the consequent "flea-bitten" kidney appearnace due to petechial hemorrhages covering the surfcaes of the kidneys.
Which of the following statements is NOT true of maternal-fetal rubella infection? A. associated fetal defects are not limited to the cariovascular system; b. the fetus is most vulnerable during the first trimester of pregnancy; c. the majority of cases of congenital heart disease are c/b rubella or other intrauterine infections; d. patent ductus arteriosus and septal defects are the most freq congenital cardiac abnormalities assoc with rubella infection; e. a predominant IgM ab response indicates recent primary infection
the majority of cases of congenital heart disease are c/b rubella or other intrauterine infections
The cause of congenital heart disease is most often unknown. Only a small minority of cases are clearly asooc with maternal-fetal infections
A bone marrow aspiration from a 65 yo man with long-standing profound anemia shows megaloblastic erythroid hyperplasia. Which of the folliwing is the most likely diagnosis?
pernicious anemia
The hallmark of the megaloblastic anemias is the finding of megaloblastic erythroid hyperplasia in the bone marrow; pernicious anemia is a megaloblastic anemia
Which of the following is NOT a characteristic of multiple sclerosis? A. assoc with certain HLA haplotypes;b. axonal degeneration; c. differing incidence according to geographic location; d. multiple cerebrospinal fuid oligoclonal immunoglubulin bands; e. optic nerve, brain stem, and paraventricular areas are favored sites
axonal degeneration
Mulitple sclerosis is the most commoon of the demyelinating disease, a group of disorders charcaterized by destruction of myelin with perservation of axons.
All of the following are well-known causes of megaloblastic anemia EXCEPT: a. hookworm infestation, b. intestinal blind loops; c. pregnancy; d. severe malnutrition; e. strict vegetarian diet
hookworm infestation
Hookworm infestation causes crhonic blood loss with resultant iron deficiencty anemai and should not be confused with fish tapeworm infestation, which causes megaloblastic anemia. Folate deficiency with megaloblastic anemia can occur in severely malnourishe persons and in assoc with increased emand for folate in pregancy. Cobalamin deficeiency megaloblastic anemia can occur in strcit vegetarians and is assoc with surgically induce intestinal blind loops overgrown with mircorogs with high avidity for cobalamin
A 62 yo man is seen because of change in bowel habits. A lesion similar to that illustrated below is resected from the sigmoid colon. The diagnosis is:
The illustaration demonstrates an adenocarcinoma diffusely infiltrating the wall of the colon, with amrked constriction of the lumen and ulceration of the mucosa
A 20 yo man is hospitalized with fever, shaking chills, and widespread cutaneous hemorrhages. He complains of sever headache, a nucal rigidity is noted on physical exam. Exam of the peripheral blood and CSF reveals gram neg diplococci within neutrophils. A well-known complication of this disorder is hemorrhage into the
adrenal cortex
The findings are characteristic of meningococcemia with meningococcal meningitis. A well-recognized complication of meningococcemia is the Wtaerhous-Friderichesen syndrom, which is catastrophic adrenal insufficency and cascular collapse c/b hemmorhagic necrosis of hte adrenal cortex, often with assoc dissmeinated intravascular coagulation.
Membranous glomerulonephritis is found at autopsy in a 25 yo woman who died in renal failure. Other autopsy findings include pleuritis, diffuse interstitial fibrosis of the lungs, concetnric rings of collagen surrounding spjlenic arterioles, and warty vegetations of the mitral and tricuspid valves affecting the surfaces behind the cusps as well as the srufaces exposed to the forward flow of blodd. Which of the following is an expected lab finding?
peripheral rim pattern of antinuclear ab fluorescence
The combo of membranous glomerulonephritis, plerutitis, and Libman-Sacks endocarditis as well as proliferative spleni arteriolitis is characterisit of systemic lupus erytematosus. Diffuse interstitial plulmonary fibrosis also occurs in SLE. A variety of antinuclear abs are found; the most specific are abs to the Sm ag, abs to dsDNA, and the abs that result in a peripheral rim pattern of nulcaer immunofluorescence.
Recurrent intractable peptic ulcer disease suggests an underlying:
islet cell tumor of the pancrease
The Zollinger-Ellison syndrom, charcterized by markedly incrased gastric acid production and intractable peptic ulcer, is c/b hypersecretion of a gastrin-producing islet cell tumor.
Conjugated hyperbilirubinemia, pos urine tests for bilirubin, and total absence of urobilinogen in the urine and stools suggest:
adenocarcinoma of the pancreas
Conjugated hyperbilirubinemia and pos urine testes for bilirubin are indicative of obstructive jaundice. The complete absence of urine and stool urobilinogen further indicates total common bile ducte obstruction and strongly suggests that the etiology is a malignant tumor such as adenocarcinoma of the pancreas.
Autophagic granules are characteristic findings in:
skeletal muscle cells after prolonged immobilization
Autopagic granules are intracytoplasmic vacuoles containing debris from degraded organelles such as mitochongdreia. The yaer especially prominent in cells that have become atrophic, such a ssskeletal muscle cells after prolonged immobiliation.
All of the following are true of fatty change EXCEPT: a. it is observed most freq in the liver; b. it often occurs as a result of decreased apoprotien synth; c. it can be assoc with starvation; d. it can result from incrased triglyceride synthesis; e. it is characterized by triglyceride deposition within adipocytes
it is characterized by triglyceride deposition within adipocytes
Fatty change is defined as deposition of triglyecerides within parenchymal cells. The liver is most often affected, but it also can occur in myocardial and renal tubular cells.
All of following are assoc with lead poisoning EXCEPT: a. dark precipitate along gingival margins; b. degeneration of the optic nerve; c. punctate basophilic stippling of erythrocytes; d. radiopaque deposits in epiphyses;, e. urinary excretion of delta-aminolevulinic acid
degeneration of the optic nerve
Although led poisoning is assoc with peripheral neruopathy and a variety of CNS changes, degenration of the optic nerve is not observed. Classic features of lead opisoning include a gingival lead line consiting of precipitated lead sulfie, basophilic stipling of erythrocytes, radiopaquye deposits in epiphyses, and increased urinary delta-aminolevulinic acid.
All of the following conditions are assoc with increased hCG EXCEPT: a. gestational carcinomas; b. granulosa cell tumor; c. hydatidiform tumor; d. pregnancy; e. seminoma
granulosa cell tumor
Granulosa cell tumors typically secret estrogen and are independent of hCG stimulation
All of the following features are assoc with carcinoma of the cervix EXCEPT: a. eraly sexual activity, b. freq origin at the squamocolunar junction; c. a hx of estrogen therapy; d. infection with human papilloma virus; e. squamous cell morphology
hx of estrogen therapy
Hyperestrinism from estrogen therapy or tother causes is assoc with endometiral carcinoma, not carcinoma of the crevix
All of the following toxic agents are correctly paired with the appropriate disease process EXCEPT: a. CCl4 - hepatic centrilobular fatty change and necrosis; b. CO - neuronal loss in the basal ganglia; c. ethanol - coronary artery disease; d. phenacetin - renal papillary necrosis; e. polychlorinated biphenyls - chloracne
ethanol - coronary artery disease;
Ethanol intake is unrelated to coronary artery disease. Moderate ethanol intake may induce a beneficial rise in HDL cholesterol. CCl4 poisoning leads to centrilobular fatty change in the liver and sometimes to liever cell necrosis. CO interferes with 02 transport by hgb, leading to system hypoxia. Neurons, particulary those of the basal ganglia and lenticular nuclei, are especially susceptibel to CO-mediated hypoxic damage. The therapeutic use of pheacetin has been largely discontinued because of its nephrotoxicity, whcih is manifest by renal papillar ynecrosis and chronic tubulointerstitial nephritis. Indestructible PCBs have been banned from manufacturing because of their association with chloracne, impaired vision, and impotence.
Which of the following statements concerning benign nodular ehyperplasia and adenocarcinoma of the prostate is NOT true? A. adenocarcinoma is ofte nresponsive to orchiectomy or endocrine therapy;b. endoncarcinoma tends to arise in the peripheral zone of prostratic glands; c. both benign nodulare hyperplasia and adenocarcinoma have a peak incidnece in elderly men; d. an increae in serum acid phophatase is useful in the detection of early adenocarcinoma; e. an increase in serum prostate-specific ag may occur with both benign nodular hyperplasia nad adenocarcinoma
An increase in serum acid phophatase is useful in the detcection of early adenocarcinoma
Serum acid phophatase remains normal in adenocarcinoma of the prostate until the tumor has penetrated the capsule in the adjacent tissues. The most useful measure for early diagnosis is digital rectal exam along with mearuement of prostat-specific ag.
All of the following factors contribute to the production of ascites in cirrhosis of the liver EXCEPT: a. hypoalbuminemia; b. increased hepatic lymph formation; c. increased portal venou pressure; d. portal-systemic venous shunting; e. renal retenttion of sodium and water
portal-systemic venous shunting
Poral-systemic venous shunting leads to esophageal varices, rectal hemorrhoids, and distention of periumbilical venou collaterals; it can also lead to encephalopathy by does not contribute to ascites.
Match the charcateristic with the appropriate intracranial neoplasm: Posterior cranial foss most freq site. A. glioblastoma, B. medulloblasatoma, C. meningioma, d. neurilemmoma, e. oligodendroglioma
Medulloblastoma, a cerebellar tumor, is sited in the posterior cranial fossa.
Match the characteristic with the testicular tumor assoc with it: Usually benign. A. androblastoma, b. endodermal sinus tumor, c. mature teratoma, d. mixed germ cell carcinoma, e. seminoma
Androblastoma, a non-germ cell tumor dervied from the sex cord, is most often benign. The endodrmal sinus tumor is a malignant germ cell tumor with peak incidence in infacny and early childhood. The mature teratoma of the testis is almost always malgnant, in contrast to the corresponding tumor in the ovary. Mixed germ cell tumors include varying mixes of seminoma, embryonal carcinoma, teratoma, and choriocarcinoma. The seminoma is a malignant germ cell tumor accounting for 40% of germ cell tumors.
Match the descriptive phrase with the assoc disorder: Complication of sever rheumatiod arthritis. A. renal amyloidosis, b. diabetic nephropathy, c. focal glomerulonephritis, d. memranous glomerulonephritis, e. minimal change disease, f. poststrep glomerulonephritis
renal amyloidosis
Renal amyloidosis can occur in both primary and soncdary amyloidosis. IN the latter, the most freq occurring underlying illness I rheumatoid arthritis.