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299 Cards in this Set
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A 50-year old man seeks medical attention because of shortness of breath (SOB. on minimal exertion. A chest X-ray reveals a right-sided pleural effusion. The aspirated fluid is straw colored and clear. The protein concentration is low and the specific gravity is 1.011. Microscopic examination reveals an occasional mesothelial cell. Which of the following is the most likely cause of the effusion.
A. Decreased oncotic pressure B. Left ventricular heart failure C. Mesothelioma D. Pneumonia |
B. Left ventricular heart failure
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A 30-year old woman dies after a short illness beginning in the late stages of labor. At autopsy, blood vessels in the lungs contained fetal debris, as did other vessels of multiple organs. Review of clinical history reveals that she had become acutely ill with dyspnea, hypotension, and seizures, and chest X-ray had demonstrated pulmonary edema. This was followed by prolonged hemorrhage from the vagina and generalized bleeding from other sites. The changes that were found within multiple blood vessels most likely are:
A. Bone marrow emboli B. Fat emboli C. Gas emboli D. Septic emboli E. Widespread thrombosis |
E. Widespread thrombosis
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Two days following cholecystectomy, a 30-year old hospitalized woman has sudden onset of dyspnea, pleural pain, and cough productive frothy, blood-tinged sputum. Ventilation-perfusion test indicates a perfusion defect. If it were possible to examine a portion of the affected lung, which of the following would most likely have been found?
A. Air embolism B. Anemic (White or pale infarct) C. DIC D. Generalized thrombosis E. Hemorrhagic (red infarct) |
E. Hemorrhagic red infarct
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A 80-year old man with a history of recurrent urinary tract infection presents with fever, tachypnea, tachycardia, and reduced blood pressure. Which of the following form of shock is most likely?
A. Anaphylactic shock B. Cardiogenic shock C. Hypovolemic shock D. Neurogenic shock E. Septic shock |
E. Septic shock
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A 50-yom with unstable angina (a form of acute coronary syndromE. is treated intravenously with glycoprotein IIb-IIIa inhibitor. The mechanism of action of this agent is its ability to :
A. Dilate coronary artery B. Inhibit atherogenesis C. Inhibit platelet adhesion D. Inhibit platelet aggregation E. Lyse thrombi |
D. Inhibit platelet aggregation
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A 20-yom undergoes surgery for fracture of the pelvis and left femur resulting from a high-speed motor vehicle accident. The following day he develops dyspnea, speech difficulties, and a petechial skin rash. Which of the following types of embolism is the likely cause of these findings?
A. Air B. Amniotic fluid C. Fat D. Paradoxical E. Thrombotic |
C. Fat
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A 45-yom is surgically treated by a four-vessel coronary artery bypass graft procedure and placed on a prophylactic daily aspirin therapy. Aspirin has been shown to prevent recurrent myocardial infarction through its ability to inhibit the synthesis of:
A. ADP B. Leukotriene B4 (LTB4. C. Nitric Oxide (NO2. D. Prostaglandin I2 (PGI2. E. Thromboxane A2 (TxA2. |
E. Thromboxane A2 TxA2
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A bedridden elderly patient experiences a sudden onset of pleuritic pain and hymoptysis. The underlying lesion that led to this complication was most likely located in which of the following sites.
A. Hepatic veins B. Lower extremity veins C. Pelvic veins D. Portal vein E. Pulmonary veins |
B. Lower extremity veins
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Fluid is aspirated from the grossly distended abdomen of a 35-yo chronic alcoholic man. The fluid is straw colored and clear and is found to have a protein content (largely albumin) of 2.5 g/dL. Which of the following is a major contributor to the fluid accumulation in this patient?
A. Blockage of lymphatics B. Decreased oncotic pressure C. Decreased sodium retention D. Increased capillary permeability E. Inflammatory exudation |
B. Decreased oncotic pressure
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A 39-yom dies during cardiac surgery. He had a history of long-standing rheumatic heart with mitral stenosis. At autopsy, the pathologists reports findings consistent with mitral stenosis and noted the presence of “heart failure cells.” This findings result from
A. Activation of coagulation cascade B. Chronic passive congestion of the lungs C. Hypoxic myocardial injury D. Myocardial hyperemia |
B. Chronic passive congestion of the lungs
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A 21-year-old pregnant woman experiences abruptio placentae at 37 weeks of gestation and develops severe vaginal bleeding that is difficult to control. Five months later, the patient presents with profound lethargy, pallor, muscle weakness, failure of lactation, and amenorrhea. Which of the following best explains the pathogenesis of pituitary insufficiency in this patient?
A. Abscess B. Embolism C. Infarction D. Passive hyperemia E. Thrombosis |
C. Infarction
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A 58-year-old woman is brought to the emergency department 4 hours after vomiting blood and experiencing bloody stools. The patient was diagnosed with alcoholic cirrhosis 2 years ago. Endoscopy reveals large esophageal varices, one of which is actively bleeding. Which of the following best explains the pathogenesis of dilated esophageal veins in this patient?
A. Decreased intravascular oncotic pressure B. Increased capillary permeability C. Increased intravascular hydrostatic pressure D. Vasoconstriction of arterioles E. Vasodilatation of capillaries |
C. Increased intravascular hydrostatic pressure
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A 22-year-old construction worker falls 30 feet and fractures several bones, including his femoral shafts. Six hours later, the patient develops shortness of breath and cyanosis. Which of the following hemodynamic disorders best explains the pathogenesis of shock in this patient?
A. Acute myocardial infarction B. Deep venous thrombosis C. Fat embolism D. Paradoxical embolism E. Septic shock |
C. Fat embolism
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A 69-year-old man is brought to the emergency room complaining of visual difficulty and weakness. On physical examination, the patient is aphasic with a right-sided hemiplegia. Retinal hemorrhages are seen bilaterally. You suspect that a thromboembolus coursed to the left middle cerebral artery and smaller emboli traveled to the retinal arteries. Which of the following anatomic sites is the most likely source for these emboli in this patient?
A. Adrenals B. Deep leg veins C. Heart D. Liver E. Lungs |
C. Heart
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A 68-year-old man with ischemic heart disease complains of increasing shortness of breath. On physical examination, the patient has swollen legs, an enlarged liver, and fluid in the pleural spaces. Which of the following hemodynamic disorders explains the pathogenesis of hepatomegaly in this patient?
A. Arterial thromboembolism B. Chronic passive congestion C. Deep venous thrombosis D. Multiple hepatic infarcts E. Thrombosis of hepatic vein |
B. Chronic passive congestion
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A 33-year-old woman presents with black stools. Laboratory studies demonstrate a hypochromic, microcytic anemia. Upper GI endoscopy reveals a duodenal ulcer. Which of the following best describes the stools in this patient with peptic ulcer disease?
A. Hematemesis B. Hematobilia C. Hematochezia D. Melena E. Steatorrhea |
D. Melena
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A 53-year-old man is hospitalized after injuring his neck in an automobile accident. He is placed in cervical traction. One week later, the patient develops painful swelling and erythema of his left calf. Doppler imaging discloses deep venous thrombosis. Which of the following is the most likely cause for the development of thrombosis in this patient?
A. Age B. Endothelial damage C. Hypercoagulability D. Infection E. Stasis |
E. Stasis
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A 23-year-old man with hemophilia is recently wheelchair bound. Which of the following best accounts for this development?
A. Hemarthrosis B. Hematemesis C. Hematocephalus D. Hematochezia E. Hemoptysis |
A. Hemarthrosis
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A 50-year-old fire fighter emerges from a burning house with third-degree burns over 70% of his body. The patient expires 24 hours later. Which of the following was the most likely cause of death?
A. Congestive heart failure B. Disseminated intravascular coagulation C. Hypovolemic shock D. Pulmonary saddle embolism E. Toxic shock syndrome |
C. Hypovolemic shock
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A 42-year-old woman undergoes a face lift. Two days later, she presents for follow-up care with confluent bluish hemorrhages in the skin around her eyes (“black eyes”). Which of the following best describes these superficial skin hemorrhages?
A. Ecchymoses B. Hematocephalus C. Maculopapular rash D. Petechia E. Purpura |
A. Ecchymoses
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A 19-year-old woman complains of swelling of her eyelids, abdomen, and ankles. At bedtime, there are depressions in her legs at the location of the elastic in her socks. A chest x-ray shows bilateral pleural effusions. Urine protein electrophoresis demonstrates 4+ proteinuria. A percutaneous needle biopsy of the kidney establishes the diagnosis of minimal change nephrotic syndrome. Soft tissue edema in this patient is most likely caused by which of the following mechanisms of disease?
A. Active hyperemia B. Chronic passive congestion C. Decreased intravascular oncotic pressure D. Hyperalbuminemia E. Increased capillary permeability |
C. Decreased intravascular oncotic pressure
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A 50-year-old alcoholic is rushed to the hospital with bleeding esophageal varices and expires. At autopsy, the patient's protruding abdomen is found to contain a large volume of serous fluid. What is the appropriate term used to describe this fluid?
A. Ascites B. Exudate C. Hemorrhage D. Hydrothorax E. Lymphedema |
A. Ascites
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A 67-year-old man presents with sudden left leg pain, absence of pulses, and a cold limb. His past medical history is significant for coronary artery disease and a small aortic aneurysm. Which of the following is most likely responsible for development of a cold limb in this patient?
A. Acute myocardial infarction B. Arterial thromboembolism C. Cardiogenic shock D. Deep venous thrombosis E. Ruptured aortic aneurysm |
B. Arterial thromboembolism
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A 72-year-old woman complains of shortness of breath on exertion. She states that she also becomes short of breath at night unless she uses three pillows (orthopnea) Physical examination reveals mild obesity, bilateral pitting leg edema, an enlarged liver and spleen, and fine crackling sounds on inspiration (rales). A chest x-ray shows cardiomegaly. What is the most likely cause of orthopnea in this patient?
A. Asthma B. Cardiac tamponade C. Emphysema D. Hypovolemic shock E. Pulmonary edema |
E. Pulmonary edema
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A 50-year-old woman appears at your office. She was subjected to radical mastectomy and axillary node dissection for breast cancer a year ago. She now notices that her arm becomes swollen by the end of the day. What is the appropriate name for this fluid accumulation?
A. Chylothorax B. Hydrothorax C. Lymphedema D. Purulent exudate E. Fibrinous exudate |
C. Lymphedema
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A 55-year-old woman presents with complaints of chest pain. She states that the chest
pain predictably occurs when she climbs four flights of stairs to reach her apartment or when she has been jogging for more than 10 minutes. She is particularly concerned because her mother died of a myocardial infarction at 50 years of age. Which of the following best describes this patient's state? A. Arrhythmia B. Myocardial infarction C. Prinzmetal angina D. Stable angina pectoris E. Unstable angina pectoris |
D. Stable angina pectoris
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Yesterday, a 60-year-old man presented to the emergency department with dyspnea, diaphoresis, and crushing substernal chest pain that radiated to his neck and left arm.
When asked to describe the pain, he put his fist to the center of his chest and stated that it felt "as if someone is squeezing my heart." An electrocardiogram demonstrated changes consistent with myocardial infarction, and serum troponin I levels were elevated. If the patient unexpectedly dies today, which of the following would almost certainly be found on histologic examination of the affected myocardium? A. Coagulative necrosis with neutrophil infiltration B. Fibrotic tissue replacing infarcted tissue C. No histologic changes D. Slight swelling of tissue and change of color E. Young fibroblasts and new vessels growing into the infarcted tissue |
A. Coagulative necrosis with neutrophil infiltration
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A 60-year-old-man is discharged after being observed in the hospital for 4 days
following a myocardial infarction. He returns to his normal activities, which include sedentary work only. This point in time following a myocardial infarct is noteworthy for the special danger of which of the following? A. Arrhythmia B. Mural thrombosis C. Myocardial (pump) failure D. Myocardial rupture E. Ventricular aneurysm |
D. Myocardial rupture
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A 10-year-old boy presents with migratory polyarthritis involving several large joints, fever, and malaise. Physical examination reveals a new heart murmur and friction rub on auscultation, and a painless nodule is detected on the extensor surface of the elbow. He had a severe sore throat approximately 2 weeks ago, apparently recovering without antibiotic therapy. The anti-streptolysin O (ASO) titer is elevated. Which of the following describes the most likely outcome for this patient?
A. Development of mitral valve stenosis over many months to years B. Development of mitral valve stenosis over the next few months C. Increasing severity of the current symptoms and findings over the next few decades D. Persistence of the current symptoms and signs over the patient's lifetime E. Total recovery after 1–2 months with no further complications or sequelae |
E. Total recovery after 1–2 months with no further complications or sequelae
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A 9-year-old girl is diagnosed with acute rheumatic fever. Instead of recovering as
expected, her condition worsens, and she dies. Which of the following is the most likely cause of death? A. Central nervous system involvement B. Endocarditis C. Myocarditis D. Pericarditis E. Streptococcal sepsis |
C. Myocarditis
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The myocardial lesions shown in the figure were observed at autopsy examination of a
pediatric patient who died after a short illness. During life, which of the following manifestations of his illness was most likely? A. Chorea B. Systemic embolization C. Systemic lupus erythematosus D. Unstable angina E. Wasting diseases |
A. Chorea
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A 50-year-old man presents with sudden weakness in his left leg. He has felt welllately and has no past medical history of coronary artery disease, hyperlipidemia, or hypertension, and no family history of myocardial infarction or stroke. Physical examination reveals motor weakness in the left leg, with no other neurologic deficits, and no cardiac murmur. Magnetic resonance imaging of the brain demonstrates a small ischemic infarct in the arterial distribution of the brain correlating with motor control of the left leg. Angiography and echocardiography reveal normal coronary arteries, normal valves with no vegetations, and a small right-to-left shunt. Which of the following is most likely associated with this scenario?
A. Atrial septal defect B. Bacterial endocarditis C. Nonbacterial thrombotic (marantiC. endocarditis D. Tetralogy of Fallot E. Ventricular septal defect |
A. Atrial septal defect
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A 3-year-old boy presents with cyanosis and shortness of breath that develops when heplays with friends. According to his mother, the boy was born cyanotic. The boy is very small and short for his age, and he squats on the floor next to his mother. Chest
radiography reveals a boot-shaped heart, normal heart size, and a right aortic arch. Echocardiography reveals a large ventricular septal defect with an overriding aorta, pulmonary stenosis, and right ventricular hypertrophy. Which of the following is the most likely diagnosis? A. Coarctation of the aorta B. Patent ductus arteriosus C. Rheumatic heart disease D. Tetralogy of Fallot E. Transposition of the great vessels |
D. Tetralogy of Fallot
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A 53-year-old woman presents with dyspnea on exertion, orthopnea, paroxysmalnocturnal dyspnea, edema in the legs and feet, and fatigue. She has no history of angina,other signs of coronary artery disease, hypertension, or valvular disease. Echocardiography reveals cardiomegaly, with four-chamber hypertrophy and dilation. Which of the following is the most likely diagnosis?
A. Congestive or dilated cardiomyopathy B. Hypertrophic cardiomyopathy C. Myocarditis D. Restrictive cardiomyopathy |
A. Congestive or dilated cardiomyopathy
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A 56-year-old woman presents with dyspnea on exertion, orthopnea, paroxysmal
nocturnal dyspnea, and pulmonary edema. She also presents with severe dizziness and syncope, fatigue, weight loss, and arthralgias. After undergoing several tests, she is diagnosed with a primary heart tumor that is causing a "ball-valve obstruction" of her mitral valve. Which of the following is the most likely tumor? A. Fibroma B. Leiomyoma C. Lipoma D. Myxoma E. Rhabdomyoma |
D. Myxoma
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A 64-year-old woman presents with dependent peripheral edema in her ankles and
feet. She has long-standing chronic obstructive lung disease and a long history of cigarette smoking. Further investigation reveals that she has cor pulmonale with rightsided heart failure. Which of the following is the most likely cause of the right-sided heart failure in this patient? A. Constrictive pericarditis B. Disease of the lungs or pulmonary vessels C. Left-sided heart failure D. Pulmonary infundibular or valvular stenosis E. Systemic hypertension |
B. Disease of the lungs or pulmonary vessels
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A 42-year-old man is seen because of a long history of slowly developing congestive
heart failure. His blood pressure is normal. Coronary artery angiography reveals no vascular disease. No heart murmurs are heard. The white blood cell count, differential, and erythrocyte sedimentation rate are normal. The most likely diagnosis is A. carcinoid heart disease. B. cardiomyopathy. C. coarctation of the aorta. D. constrictive pericarditis. E. myocardial infarction. |
B. Cardiomyopathy
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A heart murmur is noted during the preschool physical examination of a 4-year-old
girl. An echocardiogram reveals a defect between the right and left atrium involving the limbus of the foramen ovale. What is the most likely diagnosis? A. Atrial septal defect, ostium primum B. Atrial septal defect, ostium secundum C. Tetralogy of Fallot D. Truncus arteriosus E. Ventricular septal defect |
B. Atrial septal defect, ostium secundum
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A 15-year-old girl is brought to the emergency room with heart palpitations and
dyspnea. Her past medical history is significant for an unrepaired atrial septal defect (ASD) Physical examination reveals cyanosis, distended jugular veins, hepatosplenomegaly, and a systolic ejection murmur. This patient has most likely developed which of the following complications of congenital heart disease? A. Aortic aneurysm B. Myocardial infarction C. Paradoxical embolism D. Pneumonia E. Pulmonary hypertension |
E. Pulmonary hypertension
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A 5-year-old boy is found to have a harsh holosystolic murmur heard at the left 4thintercostal space. The child has a history of recurrent pneumonias and respiratory tract
infections. An echocardiogram reveals a heart defect and biventricular cardiac hypertrophy. Cardiac catheterization discloses pulmonary hypertension. Your patient likely has which of the following congenital heart diseases? A. Coarctation of aorta B. Hypoplastic left ventricle C. Patent ductus arteriosus D. Pulmonic stenosis E. Ventricular septal defect |
E. Ventricular septal defect
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An 8-month-old girl with Turner syndrome is brought to the emergency room by her
parents, who complain that their daughter is breathing rapidly and not eating. Physical examination reveals tachypnea, pallor, absent femoral pulses, and a murmur heard at the left axilla. There is hypertension in the upper extremities and low blood pressure in both legs. A chest x-ray shows notching or scalloping of the ribs. What is the appropriate diagnosis? A. Aortic valve stenosis B. Atrial septal defect C. Coarctation of aorta D. Patent ductus arteriosus E. Tetralogy of Fallot |
C. Coarctation of aorta
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A 2-week-old boy is irritable and feeding poorly. On physical examination, the infant
is irritable, diaphoretic, tachypneic, and tachycardic. There is circumoral cyanosis, which is not alleviated by nasal oxygen. A systolic thrill and holosystolic murmur are heard along the left sternal border. An echocardiogram reveals a heart defect in which the aorta and pulmonary artery form a single vessel that overrides a ventricular septal defect. What is the appropriate diagnosis? A. Atrial septal defect B. Coarctation of aorta, preductal C. Patent ductus arteriosus D. Tetralogy of Fallot E. Truncus arteriosus |
C. Patent ductus arteriosus
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A 2-week-old girl is found to have a harsh murmur along the left sternal border. The
parents report that the baby gets “bluish” when she cries or drinks from her bottle. Echocardiogram reveals a congenital heart defect associated with pulmonary stenosis, ventricular septal defect, dextroposition of the aorta, and right ventricular hypertrophy. What is the appropriate diagnosis? A. Atrial septal defect B. Coarctation of aorta, postductal C. Coarctation of aorta, preductal D. Tetralogy of Fallot E. Truncus arteriosus |
D. Tetralogy of Fallot
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A 56-year-old man presents to the emergency room with 1 hour of chest pain.
Laboratory studies show an increased leukocyte count and increased serum levels of cardiac enzymes. ECG confirms a massive transmural myocardial infarction of the left ventricle. The patient dies 2 days later. Histologic examination of the left main coronary artery at autopsy is shown. Examination of injured heart muscle would be expected to show which of the following pathologic changes by light microscopy? A. Collagen-rich scar tissue B. Extensive infiltration of myocardium with mononuclear cells C. Necrosis of cardiac myocytes and infiltrates of neutrophils D. No obvious changes evident by light microscopy E. Proliferation of fibroblasts and capillary endothelial cells |
C. Necrosis of cardiac myocytes and infiltrates of neutrophils
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A 44-year-old man presents to the emergency room with acute chest pain. The ECGis normal. Analysis of which pair of serum markers would be most helpful in excluding a
diagnosis of acute myocardial infarction? A. Cardiac troponin-I and myoglobin B. CK-BB and myoglobin C. CK-MB and cardiac troponin-I D. CK-MM and lactate dehydrogenase-1 E. Myoglobin and CK-BB |
C. CK-MB and cardiac troponin-I
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A 35-year-old man presents with acute chest pain and nausea. ECG and laboratory studies confirm the diagnosis of myocardial infarction. The patient expires 2 days later. This patient most likely suffered from which of the following hereditary diseases?
A. Ehlers-Danlos syndrome B. Familial hypercholesterolemia C. Kawasaki disease D. Marfan syndrome E. Systemic hypertension |
B. Familial hypercholesterolemia
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A 60-year-old man with a history of emphysema returns home from the hospital after
suffering a myocardial infarction involving the apex of the left ventricle. Six months later, an echocardiogram reveals the development of a ventricular bulge that does not contract during systole. The patient subsequently suffers a massive stroke and suddenly expires. Which of the following is an expected pathologic finding at autopsy? A. Calcific aortic stenosis B. Dilated cardiomyopathy C. Mitral valve prolapse D. Mural thrombus E. Ventricular rupture |
D. Mural thrombus
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A 50-year-old man with familial hyperlipidemia undergoes resection of an abdominal
aneurysm. Signs of congestive heart failure develop shortly after surgery. Despite treatment, the patient becomes hypotensive and expires 2 days later. Autopsy reveals marked narrowing of coronary arteries, without thrombosis. Multiple foci of necrosis are found circumferentially around the inner walls of both ventricles. Which of the following is the most likely cause of congestive heart failure in this patient? A. Calcific aortic stenosis B. Dilated cardiomyopathy C. Rupture of papillary muscle D. Subendocardial myocardial infarction E. Transmural myocardial infarction |
D. Subendocardial myocardial infarction
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After suffering an acute myocardial infarction, a 54-year-old man presents to the
emergency room 3 weeks later complaining of sharp pain on the left side of his chest. On physical examination, the patient is apprehensive and sweating. His blood pressure is 80/40 mm Hg, and the pulse rate is 100/min. The patient dies within minutes. The ventricular wall at autopsy is shown. What is the most likely cause of death? A. Cardiac tamponade B. Dissecting aortic aneurysm C. Pulmonary edema D. Pulmonary thromboembolism E. Septic shock |
A. Cardiac tamponade
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A 78-year-old man with a history of recurrent syncope undergoes surgery for aortic
valve disease. A hard, markedly deformed valve is observed, but the patient expires during surgery. The aortic valve at autopsy is shown. What is the appropriate diagnosis? A. Bacterial endocarditis B. Bicuspid aortic valve C. Calcific aortic stenosis D. Marantic endocarditis E. Syphilitic aortitis |
C. Calcific aortic stenosis
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A 10-year-old boy with a 2-week history of an upper respiratory infection was
admitted to the hospital with malaise, fever, joint swelling, and diffuse rash. The patient is treated and discharged. However, the patient suffers from recurrent pharyngitis and, a few years later, develops a heart murmur. This patient's heart murmur is most likely caused by exposure to which of the following pathogens? A. Beta-hemolytic streptococcus B. Candida albicans C. Epstein-Barr virus D. Staphylococcus aureus E. Streptococcus viridans |
A. Beta-hemolytic streptococcus
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For the patient described in Question 26, which of the following is the most common
life-threatening complication of his valvular heart disease? A. Congestive heart failure B. Dissecting aneurysm C. Hemolytic anemia D. Myocardial infarction E. Pulmonary thromboembolism |
A. Congestive heart failure
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A 34-year-old intravenous drug abuser presents to the emergency room with a 24-hour history of fever and shaking chills. His temperature is 38.7°C (103°C., pulse rate is 110/min, and blood pressure is 140/80 mm Hg. Physical examination reveals a harsh systolic murmur. The patient rapidly develops headache and right-arm paralysis. Which of the following is the most likely underlying cause of stroke in this patient?
A. Bacterial endocarditis B. Dissecting aortic aneurysm C. Myocardial infarction D. Paradoxical embolus E. Pulmonary thromboembolism |
A. Bacterial endocarditis
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A 45-year-old man with a history of intravenous drug abuse develops rapidly
progressive right-sided heart failure. These symptoms are most likely due to which of the following conditions? A. Aortic insufficiency B. Mitral regurgitation C. Ruptured chordae tendineae D. Tricuspid insufficiency E. Tricuspid stenosis |
D. Tricuspid insufficiency
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A 40-year-old woman with a history of rheumatic fever presents with shortness ofbreath, weight loss, fatigue, and abdominal distension. Physical examination shows rales in the lungs, hepatosplenomegaly, and 2+ pitting edema of the legs. A chest x-ray revealsleft atrial enlargement and pulmonary edema. What is the most likely cause of pulmonaryedema in this patient?
A. Aortic valve insufficiency B. Aortic valve stenosis C. Mitral valve stenosis D. Pulmonary valve stenosis E. Tricuspid valve insufficiency |
C. Mitral valve stenosis
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A 50-year-old woman presents with fatigue and shortness of breath. Physical examination shows clinical evidence of pulmonary edema, enlargement of the left atrium, and calcification of the mitral valve. A CT scan demonstrates a large mass in the left atrium. Before open heart surgery can be performed, the patient expires of an ischemic stroke. The heart at autopsy is shown. Which of the following is the most likely diagnosis?
A. Calcific aortic stenosis B. Cardiac myxoma C. Fibroelastoma D. Metastatic melanoma E. Mural thrombus |
B. Cardiac myxoma
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An autopsy is performed on a 42-year-old woman with HIV and AIDs. The microscopic sections of the lung reveal a foamy eosinophilic intra-alveolar exudate with interstitial plasma cells and lymphocytes. A GMS silver stain is performed on the lung tissue section and demonstrates round 5-m structures with a central dimple (shown). Which of the following statements is true regarding this disease?
A. Eosinophils are often very conspicuous in this disease. B. The etiologic microorganism is a fungus. C. Prevalence is similar in immunocompetent hosts. D. There is no effective or known treatment. |
B. The etiologic microorganism is a fungus
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What is the most common cause of a lung abscess?
A. Lymphatic spread of infection B. Intravenous drug use C. Obstruction secondary to tumor D. Tracheoesophageal fistula E. Aspiration of gastric or oral contents |
E. Aspiration of gastric or oral contents
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A 50-year-old male with alcoholism was brought to the emergency department by ambulance. Witnesses related that he had been drinking while boating on a nearby lake and he lost his balance and fell into the water. His initial chest radiograph in the ED was unremarkable. A few hours later, he became short of breath and hypoxic, and repeat imaging revealed bilateral, diffuse interstitial and alveolar infiltrates. A lung biopsy was obtained two days later and demonstrated interstitial edema with little inflammation. The alveolar spaces were lined by eosinophilic hyaline membranes. Which of the following statements best describes this disease?
A. Diffuse alveolar damage is a pattern of tissue reaction that can be seen with several different causes of lung injury. B. The cause of the diffuse alveolar damage can be determined by microscopic examination of the involved lung tissue. C. Acute respiratory disease syndrome (ARDS) is a term used to describe the clinical disease when the underlying/causative agent is unknown. D. With current medical technology, the mortality for patients with diffuse alveolar damage is low, <5%. E. In the organizing phase of diffuse alveolar damage, the hyaline membranes organize into a honeycomb pattern. |
A. Diffuse alveolar damage is a pattern of tissue reaction that can be seen with several different causes of lung injury.
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A 22-year-old male undergoes workup for recent history of hemoptysis. A chest radiograph reveals bilateral diffuse alveolar infiltrates. He has no other symptoms. Serologic tests reveal antiglomerular basement membrane antibodies. Which of the following statements is true regarding this disease?
A. With current therapeutic options including steroids and plasmapheresis, the prognosis is good. B. Immunofluorescence of the lung would reveal granular deposits within the pulmonary vessels. C. Biopsy of the lung would reveal red blood cells and hemosiderin-laden macrophages within the airspaces. D. Pulmonary symptoms occur a few days before findings of renal involvement and disease. |
C. Biopsy of the lung would reveal red blood cells and hemosiderin-laden macrophages within the airspaces.
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Which of the following statements regarding chronic bronchitis is true?
A. Because patients with chronic bronchitis are able to maintain hemoglobin saturation, they are known as “pink puffers.” B. Chronic bronchitis is characterized by the loss of mucous cells in the bronchial glands. C. Patients with chronic bronchitis are less likely than those with emphysema to develop cor pulmonale. D. Patients with chronic bronchitis are not at increased risk for bacterial infection. E. The majority (90%) of patients with chronic bronchitis are smokers. |
E. The majority (90%) of patients with chronic bronchitis are smokers.
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A 31-year-old woman presents to her family physician for evaluation of progressive shortness of breath. She has smoked about 1 pack of cigarettes a day for the past 10 years. A chest radiograph reveals enlarged lungs with flattening of the diaphragms. Serologic testing is performed and reveals she is a PiZZ homozygote. Which of the following statements is true regarding her condition/disease?
A. The deficient glycoprotein in this case is synthesized in the lungs. B. Lungs demonstrate destruction of central, proximal acinar structures. C. Smoking does not affect the severity of disease or impact the progression of disease. D. She is at risk for the development of cirrhosis in addition to emphysema. E. Pulmonary elastase activity is decreased in this case, with resulting tissue damage. |
D. She is at risk for the development of cirrhosis in addition to emphysema
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Which of the following statements regarding pneumoconiosis is correct?
A. Ferruginous bodies are characteristic of coal workers' pneumoconiosis. B. The amount of dust exposure does not correlate with the severity of disease. C. The most important factor is the ability of the inhaled particle to induce fibrosis. D. The ability to induce tissue damage does not depend on the size of the inhaled particle. E. Tuberculosis is much more common in patients with asbestosis. |
C. The most important factor is the ability of the inhaled particle to induce fibrosis.
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A 35-year-old African-American woman presents with chronic cough, and a chest radiograph reveals bilateral hilar adenopathy. A transbronchial lung biopsy demonstrates lung tissue with peribronchial noncaseating granulomas with rare star-shaped crystals. Which of the following statements is true about this disease?
A. The underlying pathogenesis is related to increased CD8 T-lymphocyte activity. B. Laboratory abnormalities include an elevated ACE level. C. Culture of lung tissue would reveal fungal organisms. D. Prognosis is poor due to the frequent progression to pulmonary fibrosis. E. There is no observed racial predilection. |
B. Laboratory abnormalities include an elevated ACE level.
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Which of the following statements regarding desquamative interstitial pneumonia (DIP) is true?
A. It is a disease seen in individuals who smoke. B. There is a specific radiologic finding. C. The prognosis is worse compared with UIP (usual interstitial pneumonia. D. The intra-alveolar cells are desquamated epithelial cells. E. The disease process is focal. |
A. It is a disease seen in individuals who smoke.
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Which of the following statements regarding lung carcinoma is true?
A. Less than 50% of cases of lung carcinoma are associated with a clinical history of smoking. B. Distinction between small-cell carcinoma and other types of lung carcinoma is important in terms of prognosis and treatment. C. With current therapies, the prognosis for lung cancer is good, with greater than 75% 5-year survival. D. Of all the lung cancers, adenocarcinoma has the strongest association with smoking. E. The brain is the most frequent site of non–lymph node metastasis of lung cancer. |
B. Distinction between small-cell carcinoma and other types of lung carcinoma is important in terms of prognosis and treatment.
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A 70-year-old male presents with drooping of his left eyelid, constriction of his left pupil, and lack of sweating on the left side of his face. Which of the following describes the underlying process leading to these clinical findings?
A. Antibodies to acetylcholine receptor B. Periorbital lymphoma C. Paraneoplastic syndrome D. Metastatic disease to brain E. Tumor involvement of nerves |
E. Tumor involvement of nerves
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A 75-year-old woman presents with weight loss and a lung mass. Biopsy of the lesion reveals sheets of small, round to oval blue cells with a small amount of cytoplasm. The chromatin is fine and granular without nucleoli (shown). Which of the following statements is true regarding this disease?
A. It is an epithelial neoplasm with neuroendocrine differentiation. B. The tumor grows slowly, so it is detected at an early stage. C. Unlike squamous cell carcinoma, it is not associated with a paraneoplastic syndrome. D. Mitosis and necrosis are infrequent findings in this tumor. E. Similar to lung adenocarcinoma, it is resistant to chemotherapy. |
A. It is an epithelial neoplasm with neuroendocrine differentiation.
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Which of the following statements regarding pulmonary carcinoid lesions is true?
A. Serologic studies demonstrate that these tumors secrete neuropeptides. B. Central lesions are described as an endobronchial polypoid mass. C. Histologically, there is prominent mitosis and necrosis. D. These are aggressive lesions, with 10% 5-year survival. E. These lesions do not occur in children. |
A. Serologic studies demonstrate that these tumors secrete neuropeptides.
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Metastatic disease to the lung is characterized by which of the following descriptions?
A. A single nodule rather than multiple foci of tumor B. Morphologically resembles that of the primary tumor C. Pulmonary metastasis is uncommon D. Cannot be identified on gross examination of the lung |
B. Morphologically resembles that of the primary tumor
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Which history corresponds with the findings depicted in the figure?
A. 75-year-old smoker with lung cancer B. 30-year-old HIV patient with Cryptococcus C. 40-year-old immigrant with fever and night sweats D. 60-year-old adult with history of colon cancer E. 5-year-old child with eosinophilia and arthralgias |
D. 60-year-old adult with history of colon cancer
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Which of the following best describes the growth pattern of mesothelioma?
A. Single parenchymal lung nodule B. Encases the lung like a pleural “rind” C. Multiple nodules involving both lobes D. Involves the mediastinal lymph nodes E. Involves the diaphragm and lung bases |
B. Encases the lung like a pleural “rind”
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Microscopic examination of adenocarcinoma corresponds with which of the following histologic descriptions?
A. Solid sheets of round, hyperchromatic cells with a fine chromatin pattern B. Glandular or acinar structures resembling columnar epithelium or bronchial glands C. Small round nests of eosinophilic cells with focal keratin pearls D. Areas of cartilage, fat, bone, and fibromyxoid tissue |
B. Glandular or acinar structures resembling columnar epithelium or bronchial glands
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Which of the following statements best describes the microanatomy of the lung?
A. Type II pneumocytes line approximately 95% of the alveolar surface. B. The lung has a single blood supply from the pulmonary system. C. Gas exchange occurs in the terminal bronchiole unit. D. Surfactant is produced and secreted by type I pneumocytes. E. The mucociliary blanket is one of the respiratory defense mechanisms. |
E. The mucociliary blanket is one of the respiratory defense mechanisms
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A 72-year-old male undergoes surgery and is bedridden for a week afterwards. He expires, and an autopsy is performed. The final autopsy report is sent to the patient's physician. The physician is not surprised to see pulmonary atelectasis as one of the autopsy findings. Which of the following microscopic descriptions would correspond to the diagnosis of atelectasis?
A. Bronchi distended with mucus B. Interstitial plasma cell infiltrate C. Intravascular thrombi D. Collapsed alveolar spaces E. Lymphatic proliferation |
D. Collapsed alveolar spaces
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Which of the following statements regarding bronchiectasis is true?
A. Immunosuppressive therapy causes reversal of the pathologic findings. B. Lymphomas arise in 50% of patients. C. Generalized bronchiectasis preferentially affects the upper lobes. D. Patients are frequently asymptomatic. E. Etiologies include tumor, infection, cystic fibrosis, and asthma. |
E. Etiologies include tumor, infection, cystic fibrosis, and asthma.
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A 34-year-old male with HIV presents to the infectious disease clinic for evaluation of recent onset of cough with night sweats. He has been noncompliant with his antiretroviral medications, and his CD4 count is less than 100 cells/L. A PPD is placed and is interpreted as nonreactive. A chest radiograph reveals a right upper lobe nodule that is subsequently resected. Microscopic examination of the lung lesion reveals a central area of necrosis with surrounding macrophages, lymphocytes, and fibrosis. Based on the clinical history and microscopic findings, which of the following is the best diagnosis?
A. Metastatic colorectal carcinoma B. Pulmonary Kaposi sarcoma C. Infection caused by mycobacteria D. High-grade lymphoma E. Bacterial abscess from IV drug use |
C. Infection caused by mycobacteria
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A 63-year-old man with small-cell carcinoma of the left mainstem bronchus begins chemotherapy. During the treatment period, he becomes febrile and develops a productive cough. The temperature is 38.7°C (103°F), respirations are 32/min, and blood pressure is 125/85 mm Hg. A CBC shows leukocytosis (WBC = 18,500/µL). The patient's cough worsens, and he begins expectorating large amounts of foul-smelling sputum. A chest x-ray shows a distinct cavity with an air/fluid level distal to the tumor area. Which of the following is the most likely diagnosis?
A. Atelectasis B. Bronchiectasis C. Ghon complex D. Lobar pneumonia E. Pulmonary abscess |
E. Pulmonary abscess
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A 40-year-old alcoholic man is admitted to the hospital in severe respiratory distress. The temperature is 38.7°C (103°F), respirations are 32/min, and blood pressure is 130/90 mm Hg. He coughs constantly and expectorates “currant-jelly” sputum. A chest x-ray reveals bilateral diffuse pulmonary consolidation. Physical examination shows bilateral crackles, dullness to percussion over both pulmonary fields, and use of accessory muscles. The patient subsequently dies from complications of bacterial sepsis. The left lung at autopsy (shown) shows a red, engorged lower lobe. What is the appropriate diagnosis?
A. Atypical pneumonia B. Bronchopneumonia C. Interstitial pneumonia D. Lobar pneumonia E. Pulmonary abscess |
D. Lobar pneumonia
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A 60-year-old alcoholic woman presents to the emergency room with fever, chills, and shortness of breath. The sputum is rusty-yellow and contains numerous neutrophils, red blood cells, and gram-positive cocci. A chest x-ray shows diffuse haziness over both lungs. One week following admission, the patient develops emphysema. This pulmonary condition is associated with the spread of bacterial infection to which of the following anatomic locations?
A. Blood B. Bronchi C. Interstitial space D. Pericardium E. Pleural space |
E. Pleural space
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A 22-year-old man with AIDS complains of persistent cough, night sweats, low-grade fever, and general malaise. A chest x-ray reveals an area of consolidation in the periphery of the left upper lobe, as well as hilar lymphadenopathy. Sputum cultures show acid-fast bacilli. Which of the following is the most likely diagnosis?
A. Bronchopneumonia B. Pulmonary abscess C. Sarcoidosis D. Tuberculosis E. Wegener granulomatosis |
D. Tuberculosis
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A 56-year-old woman with disseminated breast cancer undergoes multidrug chemotherapy. Ten days later, she develops cough and a fever of 38.7°C (103°F). A chest x-ray shows multiple areas of consolidation and a large cavity in the right upper lobe. Multiple pulmonary infarcts are also identified. The patient subsequently dies of multisystem organ failure. Histologic examination of the lungs at autopsy is shown. Which of the following is the most likely diagnosis?
A. Actinomycosis B. Blastomycosis C. Coccidioidomycosis D. Cryptococcosis E. Invasive aspergillosis |
E. Invasive aspergillosis
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A 38-year-old woman, who is being treated with corticosteroids for systemic lupus erythematosus, presents with chronic nonproductive cough. She breeds pigeons for avian hobbyists. A chest x-ray reveals a 2-cm nodule in the upper lobe of the right lung. The lung nodule is resected. Histologic examination reveals granulomas and budding yeast forms, which stain positively for polysaccharides (mucicarmine stain, shown). What is the appropriate diagnosis?
A. Actinomycosis B. Coccidioidomycosis C. Cryptococcosis D. Histoplasmosis E. Mycoplasma pneumonia |
C. Cryptococcosis
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A 36-year-old man with AIDS presents with fever, dry cough, and dyspnea. A chest x-ray shows bilateral and diffuse infiltrates. Laboratory studies reveal a CD4+ cell count of <50/µL. A lung biopsy discloses a chronic interstitial pneumonitis and an intra-alveolar foamy exudate. A silver stain of a bronchoalveolar lavage is shown. Which of the following organisms is the most likely pathogen responsible for these pulmonary findings?
A. Cryptococcus neoformans B. Cytomegalovirus C. Histoplasma capsulatum D. Mycoplasma pneumoniae E. Pneumocystis carinii |
E. Pneumocystis carinii
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A 48-year-old man with AIDS is admitted to the hospital with a fever of 38.7°C (103°F). The patient has a 2-week history of persistent cough and diarrhea. Laboratory studies show that the CD4+ cell count is <500/µL. A sputum culture reveals acid-fast organisms, which are further identified as Mycobacterium avium-intracellulare. This patient's pneumonia is characterized by extensive pulmonary infiltrates of which of the following cell types?
A. CD4+ helper T cells B. Eosinophils C. Macrophages D. Mast cells E. Neutrophils |
C. Macrophages
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A 16-year-old boy is rushed to the emergency room after sustaining a stab wound to the chest during a fight. Physical examination reveals a 1-inch entry wound at the right 5th intercostal space in the midclavicular line. His temperature is 37°C (98.6°F), respirations are 35/min, and blood pressure is 90/50 mm Hg. An x-ray shows air in the right pleural space. Which of the following pulmonary conditions is the expected complication of pneumothorax arising in this patient?
A. Atelectasis B. Chylothorax C. Diffuse alveolar damage D. Empyema E. Pyothorax |
A. Atelectasis
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A 62-year-old woman is rushed to the emergency room following an automobile accident. She has suffered internal injuries and massive bleeding and appears to be in a state of profound shock. Physical examination shows cyanosis and the use of accessory respiratory muscles. A CT scan of the chest is normal on arrival. Her condition is complicated by fever, leukocytosis, and a positive blood culture for staphylococci (sepsis). Two days later, the patient develops rapidly progressive respiratory distress and a pattern of “interstitial pneumonia” on chest x-ray. Which of the following is the most likely diagnosis?
A. Acute bronchiolitis B. Alveolar proteinosis C. Atelectasis D. Desquamative interstitial pneumonitis E. Diffuse alveolar damage |
E. Diffuse alveolar damage
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A 22-year-old man who is being treated for leukemia complains of shortness of breath on exertion, pleuritic chest pain, and low-grade fever. Physical examination reveals crackles in both lung bases and clubbing of the fingers. Bronchoalveolar lavage demonstrates PAS-positive material and elevated levels of surfactant proteins. An open-lung biopsy is shown. Which of the following is the most likely diagnosis?
A. Alveolar proteinosis B. Eosinophilic pneumonia C. Goodpasture syndrome D. Hyaline membrane disease E. Radiation pneumonitis |
A. Alveolar proteinosis
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A 55-year-old man is admitted to the hospital with increasing shortness of breath and dry cough for the past few years. He smokes 1.5 packs of cigarettes and drinks about four bottles of beer a day. He is constantly “gasping for air” and now walks with difficulty because he becomes breathless after only a few steps. Prolonged expiration with wheezing is noted. Physical examination shows a barrel chest, hyperresonance on percussion, and clubbing of the digits. The patient's face is puffy and red, and he has pitting edema of the legs. A chest x-ray discloses hyperinflation, flattening of the diaphragm, and increased retrosternal air space. Which of the following is the appropriate diagnosis?
A. Asthma B. Chronic bronchitis C. Emphysema D. Hypersensitivity pneumonitis E. Usual interstitial pneumonia |
C. Emphysema
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A 48-year-old man with a history of heavy smoking presents with a 3-year history of persistent cough and frequent upper respiratory infections, associated with sputum production. On physical examination, there are prominent expiratory wheezes. Analysis of arterial blood gases reveals hypoxia and CO2 retention. Which of the following is the appropriate diagnosis?
A. Bronchiectasis B. Chronic bronchitis C. Emphysema D. Goodpasture syndrome E. Usual interstitial pneumonia |
B. Chronic bronchitis
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An 8-year-old girl is brought into the physician's office in mild respiratory distress. She has a history of allergies to cats and wool, and her parents state that she has recurrent episodes of upper respiratory tract infections. Physical examination shows expiratory wheezes, use of accessory respiratory muscles, and a hyperresonant chest to percussion. Analysis of arterial blood gases discloses respiratory alkalosis, and the peripheral eosinophil count is increased. What is the appropriate diagnosis?
A. Acute bronchiolitis B. Asthma C. Cystic fibrosis D. Hypersensitivity pneumonitis E. Kartagener syndrome |
B. Asthma
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A 60-year-old mason complains of shortness of breath, which has become progressively worse during the past year. A chest x-ray shows small nodular shadows in both lungs. Pulmonary function studies reveal a pattern consistent with restrictive lung disease. The patient subsequently develops congestive heart failure and expires. Autopsy discloses numerous small, fibrotic nodules in both lungs. Histologic examination of these nodules is shown. Which of the following is the most likely diagnosis?
A. Anthracosis B. Asbestosis C. Sarcoidosis D. Silicosis E. Wegener granulomatosis |
D. Silicosis
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A 53-year-old woman with a history of cigarette smoking presents with a 3-month history of chest pain, cough, and mild fever. A chest x-ray reveals a peripheral mass in the left upper lobe. The surgical specimen is shown. What is the most likely diagnosis?
A. Adenocarcinoma B. Large cell carcinoma C. Mesothelioma D. Small cell carcinoma E. Squamous cell carcinoma |
A. Adenocarcinoma
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A 52-year-old woman presents with a 1-year history of upper truncal obesity and moderate depression. Physical examination shows hirsutism and moon facies. Endocrinologic studies reveal hypokalemia, high plasma corticotropin levels, and increased concentrations of serum and urine cortisol. CT scan of the thorax demonstrates a hilar mass. A transbronchial lung biopsy is shown. Electron microscopy discloses neuroendocrine granules within the cytoplasm of some tumor cells. What is the appropriate diagnosis?
A. Adenocarcinoma B. Bronchioloalveolar carcinoma C. Carcinoid tumor D. Metastatic carcinoma E. Small cell carcinoma |
E. Small cell carcinoma
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A 55-year-old man presents with increasing chest pain, bloody sputum, and weight loss over the past 3 months. A high-resolution CT scan reveals a mass circumscribing the right main bronchus, extending into its lumen. Histologic examination of an open-lung biopsy is shown. Electron microscopy shows numerous neuroendocrine granules within tumor cells. What is the appropriate diagnosis?
A. Adenocarcinoma B. Bronchioloalveolar carcinoma C. Carcinoid tumor D. Large-cell carcinoma E. Squamous cell carcinoma |
C. Carcinoid tumor
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A 68-year-old man who has worked in a shipyard and manufacturing plant all his life complains of a 4-month history of chest discomfort, malaise, fever, night sweats, and weight loss. A chest x-ray reveals a pleural effusion and pleural mass. The patient subsequently dies of cardiorespiratory failure. The lung at autopsy is shown. What is the most likely diagnosis?
A. Carcinoid tumor B. Large cell carcinoma C. Localized fibrous tumor of the pleura D. Mesothelioma E. Metastatic carcinoma |
D. Mesothelioma
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A 3-year-old girl presents to the emergency
department with fever, hoarseness, a "seal bark-like" cough, and inspiratory stridor. Her father states that she has had a cold for the past few days, with runny nose, nasal congestion, sore throat, and cough. He is now concerned because her cough has now become loud, harsh, and brassy. Which of the following is the most likely cause of her ailment? A. Fungus B. Gram-negative bacteria C. Gram-positive bacteria D. Parasite E. Virus |
E. Virus
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A 60-year-old man, a heavy smoker,
presents for advice to stop smoking. On physical examination, he is thin and has a ruddy complexion. He has a productive cough and a barrel-shaped chest. He sits leaning forward with his lips pursed to facilitate his breathing. A diagnosis of emphysema is made. Which of the following is the most likely histologic finding in the lungs? A. Bronchial smooth muscle hypertrophy with proliferation of eosinophils B. Diffuse alveolar damage with leakage of protein-rich fluid into alveolar spaces C. Dilation of air spaces with destruction of alveolar walls D. Hyperplasia of bronchial mucus-secreting submucosal glands E. Permanent bronchial dilation caused by chronic infection, with bronchi filled with mucus and neutrophils |
C. Dilation of air spaces with destruction of
alveolar walls |
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A 60-year-old woman with a heavy
smoking history presents with chronic productive cough that has been present for 3 consecutive months over the past 2 consecutive years. On physical examination, her skin has a bluish tinge, and she is overweight. The patient is diagnosed with chronic bronchitis. Which of the following is the most likely histologic finding in this patient's lungs? A. Bronchial smooth muscle hypertrophy with proliferation of eosinophils B. Diffuse alveolar damage with leakage of protein-rich fluid into alveolar spaces C. Dilation of air spaces with destruction of alveolar walls D. Hyperplasia of bronchial mucus-secreting submucosal glands E. Permanent bronchial dilation caused by chronic infection, with bronchi filled with mucus and neutrophils |
D. Hyperplasia of bronchial mucus-secreting
submucosal glands |
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A 65-year-old woman with a significant
smoking history presents with cough and shortness of breath. Computed tomography of the chest reveals a central mass near the left mainstem bronchus. Biopsy of the mass is performed. Histologic examination reveals small round blue cells, and a diagnosis of small cell carcinoma is made. Which of the following is a frequent characteristic of this form of lung cancer? A. Generally amenable to surgical cure at time of diagnosis B. More common in women, and a less clear relation to smoking than other forms of lung cancer C. Secretes a parathyroid-like hormone D. Secretes either corticotrophin or antidiuretic hormone E. Usually in a peripheral rather than in a central location |
D. Secretes either corticotrophin or
antidiuretic hormone |
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An 80-year-old woman, a retirement home
resident, has multiple bouts of pneumonia caused by Streptococcus pneumoniae. In an attempt to prevent such infections, polyvalent vaccines directed at multiple serotypes of the organism have been administered but have not elicited long-acting immunity. Which of the following is the probable explanation for this phenomenon? A. Memory T lymphocytes respond poorly to polysaccharide antigens. B. S. pneumoniae evades host immune response by forming capsular coatings composed of host proteins and recognized as "self" antigens. C. The bacterial capsule binds C3b, facilitating activation of the alternative complement pathway, inducing complementmediated lysis, and preventing immunization. D. The capsular polysaccharides of S. pneumoniae have limited hapten potential. E. The surface carbohydrate capsule on the surface of the organism acts as an opsonin, facilitating phagocytosis by neutrophils and thus preventing immunization. |
A. Memory T lymphocytes respond poorly to
polysaccharide antigens. |
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A 50-year-old man dies of a respiratory
illness that had been characterized by dyspnea, cough, and wheezing expiration of many years' duration. Initially episodic, his "attacks" had increased in frequency and at the time of death had become continuous and intractable. At autopsy, which of the following is the most likely histologic finding in the lungs? A. Bronchial smooth muscle hypertrophy with proliferation of eosinophils B. Diffuse alveolar damage with leakage of protein-rich fluid into alveolar spaces C. Dilation of air spaces with destruction of alveolar walls D. Hyperplasia of bronchial mucus-secreting submucosal glands E. Permanent bronchial dilation caused by chronic infection, with bronchi filled with mucus and neutrophils |
A. Bronchial smooth muscle hypertrophy
with proliferation of eosinophils |
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A 25-year-old man presents with a
progressive illness of several days' duration characterized by nonproductive cough, fever, and malaise. A lateral view chest radiograph reveals platelike atelectasis. Elevated titers of cold agglutinins are detected. Which of the following is the most likely type of pneumonia in this patient? A. Bacterial pneumonia, most likely caused by Streptococcus pneumoniae B. Hospital-acquired pneumonia, most likely caused by Pseudomonas aeruginosa C. Interstitial pneumonia, most likely caused by Mycoplasma pneumoniae D. Pneumocystis jiroveci (carinii) pneumonia, most likely related to an immunocompromised state E. Viral pneumonia, most likely caused by influenza virus |
C. Interstitial pneumonia, most likely caused
by Mycoplasma pneumoniae |
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A 60-year-old man presents with fever and
chills, productive cough with rusty sputum, pleuritic pain, and shortness of breath for the past several days. A complete blood count reveals neutrophilia and an increase in band neutrophils. A chest radiograph reveals consolidation involving the entire left lower lobe. Which of the following microorganisms is the most likely etiologic agent? A. Haemophilus influenzae B. Klebsiella pneumoniae C. Staphylococcus aureus D. Streptococcus pneumoniae E. Streptococcus pyogenes |
D. Streptococcus pneumoniae
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A 46-year-old woman presents with fever,
hemoptysis, weight loss, and night sweats. She has never smoked. She recently returned from a month-long trip to Asia. A chest radiograph reveals apical lesions with cavitation in the left lung. A purified protein derivative (PPD. test is placed, and 48 hours later an 18-mm wheal develops. Sputum cultures reveal numerous acid-fast organisms. This patient is put on contact precautions, and a regimen for tuberculosis is started. Which of the following disorders does this patient most likely have? A. Acquired immunodeficiency syndrome B. Congenital immunodeficiency C. Miliary tuberculosis, with seeding of distal organs with innumerable small millet seed-like lesions D. Primary tuberculosis, characterized by the Ghon complex E. Secondary tuberculosis, resulting from activation of a prior Ghon complex, with spread to a new pulmonary site |
E. Secondary tuberculosis, resulting from
activation of a prior Ghon complex, with spread to a new pulmonary site |
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A 25-year-old African-American woman
presents with fatigue, dyspnea, nonproductive cough, and chest pain. She does not smoke. A chest radiograph reveals prominent bilateral hilar lymphadenopathy ("potato nodules") and diffuse reticular densities in the interstitium of the lung. Laboratory studies reveal polyclonal hypergammaglobulinemia, hypercalcemia, and increased serum angiotensin-converting enzyme. Which of the following is the most likely diagnosis? A. Acute respiratory distress syndrome B. Adenocarcinoma of the lung C. Eosinophilic granuloma D. Idiopathic pulmonary fibrosis E. Sarcoidosis |
E. Sarcoidosis
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A 60-year-old man presents with dyspnea
on exertion and a nonproductive cough. He has never smoked, but he worked as a shipbuilder, with known asbestos exposure approximately 20 years ago. To which of the following conditions is this patient especially predisposed? A. Acute respiratory distress syndrome B. Goodpasture syndrome C. Idiopathic pulmonary fibrosis D. Idiopathic pulmonary hemosiderosis E. Malignant mesothelioma of the pleura |
E. Malignant mesothelioma of the pleura
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A female infant is born prematurely at 28
weeks' gestation. Shortly after birth, she shows signs of dyspnea, cyanosis, and tachypnea. She is placed on a ventilator for assisted breathing, and a diagnosis of neonatal respiratory distress syndrome (hyaline membrane diseasE. is made. Which of the following is the cause of this syndrome? A. Bronchopulmonary dysplasia B. Intraventricular brain hemorrhage C. Lack of fetal pulmonary maturity and deficiency of surfactant D. Necrotizing enterocolitis E. Patent ductus arteriosus |
C. Lack of fetal pulmonary maturity and
deficiency of surfactant |
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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 pleuritic 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 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 heart with migration to pulmonary blood vessels E. Venous thrombus originating in pulmonary blood vessels |
C. Deep venous thrombus of the lower
extremities with embolization to branches of the pulmonary artery |
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The chest radiograph of a 23-year-old
student reveals a calcified cavitary pulmonary lesion. The tuberculin test is positive, but sputum smears and cultures are negative for Mycobacterium tuberculosis. A presumptive diagnosis of secondary tuberculosis is made. If further studies, including a biopsy, were performed, which of the following findings would justify the diagnosis of secondary tuberculosis, as contrasted to primary tuberculosis? A. Calcification B. Caseating granulomas C. Cavitation D. Langhans giant cells E. Positive tuberculin test result |
C. Cavitation
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A patient with severe anemia has a peripheral blood smear with oval macrocytes, hypersegmented neutrophils, and decreased platelets. The most likely cause of the anemia is
A. A red cell membrane protein defect. B. An amino acid substitution in the β-globin chain. C. Iron deficiency. D. Marrow hypoplasia. E. Vitamin B12 or folate deficiency. |
E. Vitamin B12 or folate deficiency.
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A 62-year-old man presents with pallor, fatigue, and dyspnea on exertion. A complete blood count reveals microcytic hypochromic anemia. The most likely cause of these findings is
A. Dietary deficiency of iron. B. Gastrointestinal bleeding. C. Hemodilution. D. Hemolytic anemia. E. Increased iron requirement |
B. Gastrointestinal bleeding.
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A 60-year-old man presents with a 6-month history of increasing fatigue. Physical examination reveals marked pallor, and a CBC shows a macrocytic anemia. Which of the following is the most likely cause of anemia in this patient?
A. Alcoholism B. Chronic disease C. Iron deficiency D. Renal disease E. Thalassemia |
A. Alcoholism
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A 60-year-old man presents with headaches and pruritis. Physical examination reveals splenomegaly but no lymphadenopathy. A CBC demonstrates elevated hemoglobin of 19.5 g/dL, WBC of 12,800/μL, and platelets of 550,000/μL. The bone marrow displays hypercellularity of all lineages and depletion of marrow iron stores. Which of the following is the most likely diagnosis?
A. Acute myelogenous leukemia B. Essential thrombocythemia C. Idiopathic myelofibrosis D. Occult infection E. Polycythemia vera |
E. Polycythemia vera
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A 70-year-old woman has a long history of metastatic colon cancer, and she donates her body for use in medical school anatomy courses. At death, the body is emaciated and cachectic, and gross dissection reveals small fibrin deposits arranged around the line of closure of the leaflets of the mitral valve. The valvular lesions most likely represent:
A. Bacterial endocarditis. B. Endocarditis of the carcinoid syndrome. C. Libman-Sacks endocarditis. D. Nonbacterial thrombotic (marantic endocarditis) E. Rheumatic endocarditis. |
D. Nonbacterial thrombotic (marantic endocarditis)
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A 29-year-old woman complains of a 3-month history of nervousness and weakness. She feels hot and sweaty and has experienced a 9-kg (20-lB. weight loss over the past 2 months, despite increased caloric intake. She frequently finds her heart racing and can feel it pounding in her chest. Physical examination reveals an enlarged thyroid, warm hands, and bulging eyes. This patient is at risk of developing which of the following cardiovascular complications?
A. Cardiac tamponade B. Cor pulmonale C. High-output heart failure D. Pericardial effusion E. Ventricular aneurysm |
C. High-output heart failure
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A 38-year-old woman with type I diabetes mellitus presents with skin lesions. Physical examination shows xanthomas on the dorsal surface of both hands (shown) and xanthelasmas of the eyelids. Laboratory studies reveal serum cholesterol of 820 mg/dL and significantly elevated serum triglycerides and LDL. The patient most likely carries a mutation in a gene that encodes which of the following proteins?
A. Apolipoprotein E B. HDL receptor C. HMG CoA reductase D. LDL receptor E. Lecithin-cholesterol acyltransferase |
D. LDL receptor
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A 55-year-old man suffers from an acute myocardial infarction after occlusion of the left anterior descending coronary artery. The patient undergoes coronary bypass surgery 3 days later. Which of the following is the most frequent cause of saphenous vein graft failure several years following coronary bypass surgery?
A. Acute inflammation B. Atherosclerosis C. Graft versus host disease D. Metastatic calcification E. Microaneurysm |
B. Atherosclerosis
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A 50-year-old woman complains that her left upper arm is often swollen. Her past medical history is significant for a radical mastectomy for breast cancer 2 years ago. Which of the following is the most likely explanation for tissue swelling in this patient?
A. Chronic inflammation B. Increased oncotic pressure C. Lymphatic obstruction D. Thrombophlebitis E. Varicose veins |
C. Lymphatic obstruction
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A 62-year-old man is discovered to have hyperlipidemia on screening tests after a routine physical examination. Laboratory studies show total serum cholesterol of 285 mg/dL, LDL of 215 mg/dL, HDL of 50 mg/dL, and triglycerides of 300 mg/dL. This patient is most at risk of developing an aneurysm in which of the following anatomic locations?
A. Abdominal aorta B. Ascending aorta C. Circle of Willis D. Coronary artery E. Renal artery |
A. Abdominal aorta
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A 79-year-old man presents with extensive ulcers on both legs for 4 years. A photograph of the patient's legs is shown. What is the appropriate diagnosis?
A. Deep venous thrombosis B. Lymphangitis C. Milroy disease D. Severe arteriolosclerosis E. Varicose veins |
E. Varicose veins
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A 48-year-old man with a longstanding history of chronic constipation complains of anal itching and discomfort toward the end of the day. He describes perianal pain when sitting and finds himself sitting sideways to avoid discomfort. Physical examination reveals painful varicose dilations in the anal region, associated with edema. Which of the followings is the most likely diagnosis?
A. Anal cancer B. Anal fissure C. Hemorrhoids D. Ischiorectal abscess E. Rectal cancer |
C. Hemorrhoids
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A 70-year-old woman with a 2-year history of angina pectoris is admitted to hospital with excruciating substernal chest pain that is not relieved by medication. Physical examination shows a blood pressure of 100/80 mmHg, respiratory rate of 30/min, diaphoresis (sweating), and dyspnea. Results of laboratory studies include WBC of 13,000/mL, CK-MB of 6.8 ng/mL, and troponin I of 3.0 ng/mL. The patient expires 6 days later. A section through the heart at autopsy is shown. What was the most likely cause of death?
A. Cardiac tamponade B. Congestive heart failure C. Cor pulmonale D. Pulmonary saddle embolism E. Ruptured myocardial infarct |
A. Cardiac tamponade
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A 26-year-old woman from East Africa presents with a 2-month history of swelling of her right leg. Laboratory studies demonstrate a parasitic infestation. Soft tissue swelling of the lower extremities caused by filarial worms (elephantiasis) is caused by which of the following mechanisms of disease?
A. Heart failure B. Loss of protein from the circulation C. Lymphatic obstruction D. Peripheral vein thrombosis E. Thrombophlebitis |
C. Lymphatic obstruction
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A 67-year-old woman with a history of multiple myocardial infarcts is hospitalized for shortness of breath. Physical examination shows marked jugular venous distension, hepatomegaly, ascites, and pitting edema. A chest x-ray shows cardiomegaly. The patient subsequently dies of cardiorespiratory failure. Histologic examination of the lungs at autopsy is shown. Which of the following pigments has accumulated in the cytoplasm of these pulmonary macrophages?
A. Calcium B. Carbon particles C. Hemosiderin D. Lipofuscin E. Melanin |
C. Hemosiderin
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A 28-year-old intravenous drug abuser presents to the emergency room with a 24-hour history of fever and shaking chills. His temperature is 38.7°C (103°C., pulse rate is 110/min, and blood pressure is 140/80 mmHg. Physical examination reveals a harsh systolic murmur. The patient rapidly develops headache, becomes comatose, and expires. At autopsy, the heart valves show vegetations on the anterior leaflet of the mitral valve (shown). Which of the following is the most important complication of this patient's heart disease?
A. Cor pulmonale B. Embolization C. Myocardial infarction D. Septic shock E. Thrombosis |
B. Embolization
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A 76-year-old woman with a 4-year history of ischemic heart disease presents to the emergency room complaining of crushing substernal chest pain. On physical examination, the patient is apprehensive and sweating. The patient loses consciousness and dies of a cardiac arrhythmia within minutes. The lungs are examined at autopsy (shown). Which of the following hemodynamic disorders best explains the pathology illustrated in this slide?
A. Decreased capillary permeability B. Decreased intravascular oncotic pressure C. Increased intravascular hydrostatic pressure D. Increased intravascular oncotic pressure E. Vasodilation of precapillary arterioles |
C. Increased intravascular hydrostatic pressure
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A 68-year-old man complains of increasing pain under the right costal margin and chest pain on exertion. Physical examination reveals hepatomegaly and swollen legs. The patient subsequently suffers myocardial infarction and expires. The liver is examined at autopsy (shown). Which of the following hemodynamic disorders best explains these pathologic findings?
A. Decreased capillary permeability B. Decreased intravascular oncotic pressure C. Increased capillary permeability D. Increased intravascular hydrostatic pressure E. Vasoconstriction of arterioles |
D. Increased intravascular hydrostatic pressure
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A 70-year-old woman recovering from hip surgery complains of pain and swelling in her calf. On physical examination, the left leg is markedly edematous. The patient is scheduled for Doppler imaging studies but suffers a massive stroke and expires. The iliofemoral vein is opened at autopsy (shown). Which of the following best describes the most important risk factors for this pathologic finding?
A. Endothelial injury, autoimmune disease, and stasis B. Endothelial injury, stasis, and advanced age C. Endothelial injury, stasis, and hypercoagulability D. Endothelial injury, stasis, and hypertension E. Stasis, advanced age, and diabetes |
E. Stasis, advanced age, and diabetes
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A 77-year-old woman with a history of diabetes and hypertension is rushed to the emergency room with a 1-hour history of chest pain. Laboratory studies show an increased leukocyte count and increased serum levels of cardiac enzymes. ECG confirms a transmural infarct of the left ventricle. The patient dies 3 hours later. Autopsy reveals stenosis of the left coronary artery. Which of the following is the most likely cause of acute arterial blockage in this patient?
A Aneurysm B Cardiac tamponade C Fat embolism D Paradoxical embolism E. Thrombosis |
E. Thrombosis
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A 66-year-old woman develops sudden substernal chest pain. Laboratory studies and ECG confirm acute myocardial infarct of the left ventricle. Despite vigorous therapy, the patient cannot maintain her blood pressure and expires. Autopsy reveals occlusion of the left main coronary artery. What is the most important underlying cause of coronary artery blockage in this patient?
A. Atherosclerosis B. Chronic inflammation C. Coronary artery aneurysm D. Cystic medial necrosis E. Systemic hypertension |
A. Atherosclerosis
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A 68-year-old obese woman (BMI = 32 kg/m2. with a history of angina pectoris presents with substernal chest pain. The following day, she develops a mild fever of 38°C (101°F). Results of laboratory studies and ECG confirm the diagnosis of myocardial infarction of the left ventricular wall. The patient expires 24 hours after admission. A cross section of the heart at autopsy is shown. What was the most likely cause of death?
A. Cardiogenic shock B. Congestive heart failure C. Cor pulmonale D. Hemopericardium E. Pulmonary thromboembolism |
A. Cardiogenic shock
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A 79-year-old man is brought to the emergency department because of the sudden onset of left-sided chest pain, which is exacerbated upon inspiration. He had two episodes of hemoptysis. His temperature is 38°C (101°F), pulse is 110/min, respirations are 35/min, and blood pressure is 158/100 mmHg. The patient suffers respiratory insufficiency and expires 48 hours later. An autopsy reveals thromboembolism and pulmonary infarction. Which of the following best explains the color of this pulmonary infarct?
A. Bronchopneumonia B. Dual blood supply to the lungs C. Infarction of the left upper lobe of the lung D. Lower blood pressure in the pulmonary circulation E. Pulmonary edema and accumulation of heart failure cells |
B. Dual blood supply to the lungs
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A 68-year-old obese woman (BMI = 31 kg/m2. suffers a massive stroke while recovering from a myocardial infarct. The patient's brain is examined at autopsy (shown). What was the most likely cause of this brain lesion?
A. Atherosclerosis of the middle cerebral artery B. Congestive heart failure C. Disseminated intravascular coagulation D. Embolism from mural thrombus E. Widespread atherosclerosis |
D. Embolism from mural thrombus
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A 58-year-old man recovering from a recent myocardial infarct complains of chest pain. On physical examination, the patient is apprehensive and sweating. His blood pressure is 80/40 mmHg, and the pulse rate is 100/min. The patient loses consciousness and dies within minutes. The surface of the pericardial cavity at autopsy is shown. What is the most likely cause of death?
A. Cor pulmonale B. Dissecting aortic aneurysm C. Pulmonary thromboembolism D. Rupture of myocardial infarct E. Ruptured aortic aneurysm |
D. Rupture of myocardial infarct
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A 75-year-old woman in a nursing home dies in her sleep. Autopsy reveals multiple wedge-shaped lesions on the surface of the spleen (shown). These pale lesions are most likely caused by emboli originating from which of the following anatomic locations?
A. Brain B. Deep leg veins C. Heart D. Liver E. Lungs |
C. Heart
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An 80-year-old man with a history of myocardial infarction dies in his sleep. At autopsy, the pathologist finds a laminated thrombus adherent to the wall of the left ventricle (shown). During life, this patient was at risk for which of the following conditions?
A. Cerebral infarction B. Paradoxical embolism C. Portal hypertension D. Pulmonary embolism E. Venous thrombosis |
A. Cerebral infarction
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A 65-year-old man undergoes surgery for acute appendicitis. Four days after surgery, the patient gets out of bed for the first time since surgery, collapses, and cannot be resuscitated. What is the most likely pathologic finding at autopsy?
A. Acute myocardial infarction B. Hemopericardium C. Pneumothorax D. Ruptured left ventricle E. Saddle embolus |
E. Saddle embolus
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A 2-year-old boy is brought to the emergency room with a 3-hour history of intense abdominal pain. Physical examination reveals a tender abdomen without ascites. The child dies 24 hours after admission. Torsion (volvulus) of the small bowel is discovered at autopsy. The small bowel appears dilated, gangrenous, and hemorrhagic (shown). Which of the following hemodynamic disorders best explains these autopsy findings?
A. Air embolism B. Arterial occlusion C. Cardiogenic shock D. Hypovolemic shock E. Thromboembolism |
B. Arterial occlusion
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A 60-year-old man is brought to the emergency department 4 hours after vomiting fresh red blood and experiencing bloody stools. The patient was diagnosed with alcoholic cirrhosis 2 years ago. He subsequently goes into shock and expires. The histologic appearance of the esophagus at autopsy is shown. What is the underlying cause of dilated esophageal veins (varices) in this patient with alcoholic liver disease?
A. Active hyperemia B. Chronic inflammation C. Hyperalbuminemia D. Hypoalbuminemia E. Portal hypertension |
E. Portal hypertension
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A 4-year-old child attending a daycare center develops fever, chills, generalized rash, and a stiff neck. Blood cultures are positive for Neisseria meningitidis. She becomes hypotensive and expires the next day. Postmortem examination demonstrates adrenal hemorrhages (shown). This patient had developed which of the following syndromes?
A. Goodpasture syndrome B. Mallory-Weiss syndrome C. Marfan syndrome D. Von Recklinghausen disease E. Waterhouse-Friderichsen syndrome |
E. Waterhouse-Friderichsen syndrome
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A 54-year-old woman in excellent health transiently increases her blood volume by drinking a large quantity (4 L) of nonalcoholic punch at a party. Which of the following hormones would be expected to stimulate vasodilatation of renal arterioles and increase sodium excretion in the urine of this patient?
A. Aldosterone B. Angiotensin II C. Atrial natriuretic factor D. Renin E. Vasopressin |
C. Atrial natriuretic factor
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A 38-year-old man complains of swelling of his eyelids, abdomen, and ankles. His vital signs are normal. If this patient's peripheral edema is caused by decreased plasma oncotic pressure, then he may have a chronic disease process that affects which of the following internal organs?
A. Adrenals B. Intestines C. Kidneys D. Lungs E. Testes |
C. Kidneys
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A 58-year-old woman with no history of heart disease complains of pain in her right calf. On physical examination, the left calf is markedly edematous. The patient reports pain on dorsiflexion of her foot. Doppler imaging reveals deep vein thrombosis of the iliac vein. This patient is at risk for which of the following conditions?
A. Cerebral thromboembolism B. Hepatic vein thrombosis C. Pulmonary thromboembolism D. Renal vein thrombosis E. Splenic infarcts |
C. Pulmonary thromboembolism
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A 40-year-old woman is involved in an automobile accident in which she fractured her femur. She does well postoperatively, but 48 hours after surgery, she develops mental status changes, petechial hemorrhages, and respiratory difficulties and expires. A fast red stain of lung tissue at autopsy is shown. Which of the following best characterizes the red material in the lungs of this patient?
A. Amyloid protein B. Fat C. Hemosiderin D. Lipofuscin E. Nucleic acids |
B. Fat
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A 19-year-old woman is brought to the emergency room following a skiing accident. X-ray films of the extremities reveal broken bones, and a CT scan of the abdomen reveals extensive internal injury. The patient's blood pressure is 80/60 mmHg. This patient may be suffering from which of the following forms of shock?
A. Cardiogenic B. Hypovolemic C. Neurogenic D. Septic E. Toxic shock syndrome |
B. Hypovolemic
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A 28-year-old man with a history of malignant lymphoma has recently completed a course of chemotherapy. He presents with a 1-day history of diarrhea and a skin rash. The rash progresses visibly in the time he is in the emergency room. The patient's blood pressure drops to 80/60 mmHg, and his pulse increases to 120/min. His rash spreads down his arm. His temperature is 38.5°C, and his white blood cell count is 2000/mL, with 60% lymphocytes. The patient may be suffering from which of the following forms of shock?
A. Cardiogenic B. Hypovolemic C. Neurogenic D. Septic E. Toxic shock syndrome |
D. Septic
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A 68-year-old man undergoes surgery for an abdominal aortic aneurysm. During the operation, the patient's blood pressure drops to dangerously low levels (70/20 mmHg). A loop of small intestine is observed to turn dark bluish-red. Which of the following is the most likely pathologic diagnosis for this intestinal lesion?
A. Ecchymosis B. Infarct C. Petechia D. Purpura E. Ulcer |
B. Infarct
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A 50-yom with a history of multiple myocardial infarcts is hospitalized for shortness of breath. Physical examination reveals marked jugular distension, hepatomegaly ascites, and pitting edema. A chest X-ray reveals cardiomegaly. The patient subsequently dies of cardiorespiratory failure. Examination of lungs at autopsy would most likely disclose which of the following pathologic changes?
A. Diffuse alveolar purulent damage with hylline membranes B. Intra-alveolar purulent exudate C. Lymphocytic interstitial pneumonitis D. Pulmonary arteriopathy with plexiform lesions E. Vascular congestion and hemosiderin-laden macrophages |
E. Vascular congestion and hemosiderin-laden macrophages
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A 90-yow is brought to ER from a nursing home. Her blood pressure is 70/30 mm Hg. She is febrile and tachypenic. Laboratory studies demonstrate a WBC count of 22,000/micrometer with 92% neutrophils. Urinalysis reveals numerous gram-negative organisms. Which of the following accounts for this patient's signs and symptoms?
A. Anaphylactic shock B. Cardiogenic shock C. Hypovolemic shock D. Neurogenic shock E. Septic shock |
E. Septic shock
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A 40-year-old man was rushed to the hospital following the sudden onset of an episode of crushing substernal chest pain. He receives advanced life support measures. His course was marked by intractable cardiogenic shock and he died 4 days later. At autopsy, a large transmural anterolateral area of coagulative necrosis was found in the anterolateral wall of the left ventricle. Which of the following microscopic findings is most likely to be present?
A. Fibroblasts and collagen B. Granulation tissue C. Necrotic muscle and neutrophils D. Granulomatous inflammation E. Diffuse chronic inflammation |
C. Necrotic muscle and neutrophils
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On the 11th postoperative day following a radical prostatectomy for adenocarcinoma of the prostate, a 70-year-old man is recovering uneventfully. He then ambulates to the bathroom, but upon returning to his bed he suddenly becomes extremely dyspneic and diaphoretic, with chest pain, palpitations, and a feeling of panic. Which of the following post-operative complications has he most likely developed?
A. Pulmonary edema B. Pleural effusion C. Atelectasis D. Thromboembolus E. Diffuse alveolar damage |
D. Thromboembolus
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A 54-year-old man has had increasing dyspnea for the past 6 years, but no cough. On physical examination there is increased jugular venous distension. He is afebrile. A chest radiograph shows increased lucency in upper lung fields and increased lung volumes, with flattening of the diaphragmatic leaves. There are no infiltrates. The pulmonary arteries are enlarged and prominent bilaterally, and his right heart border is enlarged. Which of the following pathologic findings is most likely to be present in his main pulmonary arteries?
A. Granulomatous vasculitis B. Organizing thromboemboli C. Medial dissection D. Atherosclerosis E. Aneurysm formation |
D. Atherosclerosis
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A 70-year-old woman has been bedridden for 5 weeks following a cerebrovascular accident (CVA) She has the sudden onset of dyspnea, but has no further symptoms until two days later when she experiences left sided pleuritic chest pain. A day later she suffers another CVA and dies. At autopsy, she is found to have a wedge-shaped area of hemorrhage based on the pleura of the left lower lobe. Which of the following pathologic findings in her pulmonary arterial branches is she most likely to have?
A. Atherosclerosis B. Aspergillosis C. Fat embolism D. Vasculitis E. Thromboembolism |
E. Thromboembolism
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For the past 5 months, a 51-year-old woman has noted increased swelling of her lower legs as the day progresses. She has no fever and no cough. On physical examination, she has pitting edema to the knees. A chest radiograph reveals bilateral pleural effusions, and the right heart border is prominent. Laboratory studies show a serum AST of 238 U/L, ALT 263 U/L, LDH 710 U/L, and CK 127 U/L. Which of the following underlying diseases is most likely to cause these findings?
A. Goodpasture syndrome B. Recurrent thromboembolism C. Renovascular hypertension D. Bronchial asthma E. Rheumatoid arthritis |
B. Recurrent thromboembolism
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A 44-year-old previously healthy man has the sudden onset of severe dyspnea. On physical examination he is afebrile. There are absent breath sounds over the right lung fields. A chest x-ray shows pulmonary atelectasis involving all of the right lung. Which of the following conditions is most likely to produce these findings?
A. Aspiration of a foreign body B. Pulmonary embolism C. Squamous cell carcinoma D. Penetrating chest trauma E. Bronchiectasis |
D. Penetrating chest trauma
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A 66-year-old has not received any medical care nor seen a physician for years. He reports reduced exercise tolerance over the past 5 years. On occasion in the past year he has noted chest pain after ascending a flight of stairs. He smokes 2 packs of cigarettes per day. He is found to have a blood pressure of 155/95 mm Hg. His body mass index is 30. Laboratory findings include a total serum cholesterol of 245 mg/dL with an HDL cholesterol that is 22 mg/dL. Which of the following vascular abnormalities is most likely to be his most serious health risk?
A. Atherosclerosis B. Lymphedema C. Medial calcific sclerosis D. Deep venous thrombosis E. Hyperplastic arteriolosclerosis |
A. Atherosclerosis
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A 62-year-old man has experienced substernal chest pain upon exertion with increasing frequency over the past 6 months. An electrocardiogram shows features consistent with ischemic heart disease. He has a total serum cholesterol of 262 mg/dL. By angiography, there is 75% narrowing of the left anterior descending artery. Which of the following vascular complications is most likely to occur in this patient?
A. A systemic artery embolus from thrombosis in a peripheral vein. B. A systemic artery embolus from a left atrial mural thrombus. C. Pulmonary embolism from a left ventricular mural thrombus. D. A systemic artery embolus from a left ventricular mural thrombus. E. Pulmonary embolism from thrombosis in a peripheral vein. |
D. A systemic artery embolus from a left ventricular mural thrombus.
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On sectioning of an organ from a 60-year-old man at the time of autopsy, a focal, wedge-shaped area that is firm is accompanied by extensive hemorrhage, giving it a red appearance. The lesion has a base on the surface of the organ. In which of the following situations will this lesion most likely occur?
A. Lung with pulmonary thromboembolism B. Heart with coronary thrombosis C. Liver with hypovolemic shock D. Kidney with septic embolus E. Spleen with embolized mural thrombus F. Brain with cerebral arterial aneurysm |
A. Lung with pulmonary thromboembolism
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An 81-year-old woman has the sudden onset of dyspnea and palpitations with chest pain. A pulmonary ventilation-perfusion scan is performed and indicates a high probability for a perfusion defect involving right segmental pulmonary arterial branch. Of the following findings or conditions, which is the most important factor favoring development of these findings?
A. An increased white blood cell count B. Cirrhosis of the liver C. Altered blood flow with stasis D. An increased platelet count E. Generalized atherosclerosis |
C. Altered blood flow with stasis
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An autopsy study reveals that evidence for atheroma formation can begin even in children. The gross appearances of the aortas are recorded and compared with microscopic findings of atheroma formation. Which of the following is most likely to be the first visible gross evidence for the formation of an atheroma?
A. Thrombus B. Fatty streak C. Calcification D. Hemorrhage E. Ulceration |
B. Fatty streak
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A 73-year-old woman who exercises regularly falls down the stairs and injures her right hip. A radiograph is taken of the pelvis. There is no fracture but the radiograph reveals calcification of the small muscular arteries lateral to her uterus. What is the probable vascular lesion which accounts for this calcification?
A. Ulcerative atherosclerosis B. Calcific medial sclerosis C. Metastatic calcification D. Trauma E. Dystrophic calcification |
B. Calcific medial sclerosis
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A 55-year-old woman has been treated in the hospital for pancreatitis for the past three weeks. She is examined one morning on rounds and found to have a swollen right leg. It is tender to palpation posteriorly but is not warm. This condition is most likely to be the result of which of the following vascular complications?
A. Venous thrombosis B. Septic embolization C. Congestive heart failure D. Cellulitis E. Infarction |
A. Venous thrombosis
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In an experiment, a glass bead is embolized to a branch of the renal artery. A day later there is a focal area in which the renal parenchymal cells in the distribution of the occluded artery show karyolysis and karyorrhexis. The outlines of the cells are still visible, but the nuclei have lost basophilic staining and the cytoplasm is eosinophilic but pale. Which of the following types of cellular necrosis is most likely present?
A. Caseous B. Coagulative C. Fatty D. Gangrenous E. Liquefactive |
B. Coagulative
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An autopsy study is conducted involving the gross appearance of the aorta of adults ranging in age from 60 to 90. In some of these patients, the aorta demonstrates atheromatous plaques covering from 70 to 95% of the intimal surface area, mainly in the abdominal portion, with ulceration and calcification. Which of the following contributing causes of death are these patients most likely to have?
A. Hyperparathyroidism B. Hypertension C. Marfan syndrome D. Thrombophlebitis E. Vasculitis |
B. Hypertension
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A 59-year-old woman has the sudden onset of severe dyspnea and goes into cardiac arrest, from which she cannot be resuscitated. At autopsy, she has the gross finding of a saddle pulmonary embolus. This event is most likely to be present as a consequence of which of the following?
A. Placement of a hip prosthesis B. Marked thrombocytopenia C. Chronic alcoholism D. Infection with the human immunodeficiency virus E. An autoimmune disease |
A. Placement of a hip prosthesis
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A 50-year old man seeks medical attention because of shortness of breath (SOB. on minimal exertion. A chest X-ray reveals a right-sided pleural effusion. The aspirated fluid is straw colored and clear. The protein concentration is low and the specific gravity is 1.011. Microscopic examination reveals an occasional mesothelial cell. Which of the following is the most likely cause of the effusion.
A. Decreased oncotic pressure B. Left ventricular heart failure C. Mesothelioma D. Pneumonia |
B. Left ventricular heart failure
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All of the following are examples of edema except:
A. Anasarca B. Ascites C. Hydrothorax D. Hematopericardium E. Periorbital swelling |
D. Hematopericardium
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Oncotic edema caused by reduction of the colloid osmotic pressure of the plasma is a typical feature of chronic failure of the:
A. Heart B. Brain C. Lung D. Liver E. Thyroid |
D. Liver
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Pulmonary edema is a typical complication of:
A. Right heart failure B. Left-sided heart failure C. Pulmonary saddle embolus D. Cor pulmonale E. Pulmonary fibrosis |
B. Left-sided heart failure
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What sort of disease is: Tetralogy of Fallot?
1. Congenital heart disease 2. Ischemic vascular disease 3. Hypertension disease 4. Inflammatory disease 5. Metabolic disease |
1. Congenital heart disease
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What sort of disease is: Maternal rubella infection during pregnancy.
1. Congenital heart disease 2. Ischemic vascular disease 3. Hypertension disease 4. Inflammatory disease 5. Metabolic disease |
1. Congenital heart disease
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What sort of disease is: Bacterial endocarditis?
1. Congenital heart disease 2. Ischemic vascular disease 3. Hypertension disease 4. Inflammatory disease 5. Metabolic disease |
4. Inflammatory disease
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What sort of disease is: Myocardial infarcts?
1. Congenital heart disease 2. Ischemic vascular disease 3. Hypertension disease 4. Inflammatory disease 5. Metabolic disease |
2. Ischemic vascular disease
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What sort of disease is: Angina pectoris?
1. Congenital heart disease 2. Ischemic vascular disease 3. Hypertension disease 4. Inflammatory disease 5. Metabolic disease |
2. Ischemic vascular disease
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What sort of disease is: Rheumatic fever?
1. Congenital heart disease 2. Ischemic vascular disease 3. Hypertension disease 4. Inflammatory disease 5. Metabolic disease |
4. Inflammatory disease
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What sort of disease is: Hyperlipidemia?
1. Congenital heart disease 2. Ischemic vascular disease 3. Hypertension disease 4. Inflammatory disease 5. Metabolic disease |
5. Metabolic disease
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What sort of disease is: Thrombotic CVA complicating atherosclerosis?
1. Congenital heart disease 2. Ischemic vascular disease 3. Hypertension disease 4. Inflammatory disease 5. Metabolic disease |
2. Ischemic vascular disease
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What sort of disease is: Stroke in a person with chronic renal disease?
1. Congenital heart disease 2. Ischemic vascular disease 3. Hypertension disease 4. Inflammatory disease 5. Metabolic disease |
3. Hypertension disease
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The tetralogy of Fallot includes interventricular septal defect, dextroposition of aorta, pulmonary artery stenosis and ____________
A. Ostium primum B. Truncus Arteriosus C. Right ventricular hypertrophy D. Left ventricular atrophy |
C. Right ventricular hypertrophy
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Which is the most common symptom of ischemic heart disease?
A. Sudden death B. Myocardial infarction C. Angina pectoris D. Obesity |
C. Angina pectoris
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Three major elements that predispose a person to coronary artery stenosis are elevated blood cholesterol level, cigarette smoking and _______________
A. Sedentary life habits B. Use of oral contraceptives C. Arterial Hypertension D. Thromboembolism |
C. Arterial Hypertension
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Major cause of Ischemc heart disorder include the following except:
A. Elevated levels of CK, LDH. B. Increased oxygen demand (increased of cardiac output) C. Decreased supply of oxygen D. Conditions that influence the availability of Oxygen in the blood (anemia, Cyanide, Carbon monoxidE. |
A. Elevated levels of CK, LDH.
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The complications of myocardial infaction include the following, except:
1. Pericarditis 2. Persistent truncus arteriosus 3. Left ventricular failure and cardiogenic shock 4. Mural thrombosis and embolism 5. Rupture of the free wall of the myocardium 6. Left ventricular aneurysms 7. Arrhythmias |
2. Persistent truncus arteriosus
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Right ventricular hypertrophy and dilatation secondary to pulmonary fibrosis and chronic obstructive pulmonary disease is termed:
A. Cardiomyopathy B. Cor pulmonale C. Hypertensive heart disease D. Chronic ischemic heart disease |
B. Cor pulmonale
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The causes of cor Pulmonale include the following except:
A. Pulmonary vascular diseases B. Impaired movement of the thoracic cage C. Paranchymal disease of the lung (emphysema, cystic fibrosis) D. Congenital heart diseases E. Dextrocardia (inverted position of the heart) |
E. Dextrocardia (inverted position of the heart)
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A patient known to have coronary heart disease bled from esophageal varices and developed a subendocardial infarct. The most important pathogenetic factor for this type of infarct is _______________
A. Rheumatoid arthritis B. Hypotension C. Hypertension D. Acute rheumatic fever |
B. Hypotension
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The complications of chronic rheumatic heart disease include the following, except:
1. Cor pulmonale 2. Congestive heart failure 3. Mural thrombi 4. Adhesive pericarditis 5. Bacterial endocarditis 6. Systemic Lupus Erythematosus |
6. Systemic Lupus Erythematosus
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Staphylococcus aureus most often causes which cardiac disease?
1. Ankylosing spondylitis 2. Bacterial endocarditis 3. Acute rheumatic fever 4. Marantic endocarditis |
2. Bacterial endocarditis
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Name the usually lethal complication of the rupture of left ventricle on the fifth day after myocardial infarction.
1. Giant Cell Myocarditis 2. Cardiac tamponade 3. Cor pulmonale 4. Restrictive cardiomyopathy |
2. Cardiac tamponade
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Aschoff bodies are a sign of which disease?
1. Progressive Systemic sclerosis 2. Ankylosing Spondylitis 3. Rheumatic fever 4. Polyarthritis nodosa |
3. Rheumatic fever
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Which is the most common congenital heart defect recognized in clinical practice?
1. Transposition of great vessels 2. Coarctation of the aorta 3. Tetralogy of Fallot 4. Interventricular septal defect |
4. Interventricular septal defect
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Myocardial infarct involving the posterior portion of the interventricular septum is caused by an occlusion of which coronary artery?
1. Left anterior descending 2. Left circumflex 3. Right coronary artery 4. Left diagonal |
3. Right coronary artery
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What is the most common cause of death during the first 2 hours of an acute Myocardial infarction?
1. Loss of myosin from injured cells 2. Loss of calcium from sarcoplasmic reticulum 3. Arrhythmia 4. Rupture of the myocardium |
3. Arrhythmia
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Which of the following is the most likely cardiac consequnce of hyperthyroidism?
1. Marantic endocarditis 2. Subendocardial necrosis 3. Coronary spasm 4. Tachycardia |
4. Tachycardia
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Which of the following diseases is most often associated with nonbacterial thrombotic endocarditis?
1. Carcinoma of the stomach 2. Intestinal carcinoid metastatic to the liver 3. Rubella 4. Syphilis |
1. Carcinoma of the stomach
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An occlusion of the proximal portion of right coronary artery results in an infarct of the POSTERIOR basal region of the left ventricle and the posterior third of the interventricular septum.
1. True 2. False |
1. True
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Blockage of the left desending coronary artery (LAD) produces an infarct of the apical anterior wall of the left ventricle.
1. True 2. False |
1. True
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Infacts involve the right ventricle much more commonly and extensively than they do the left ventricle.
1. True 2. False |
2. False
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Congestive heart failure is the most common cause of death in hypertensive patients.
1. True 2. False |
1. True
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The most common cause of chronic cor pulmonale are chronic obstructive pulmonary disease and pulmonary fibrosis.
1. True 2. False |
1. True
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A 60 y.o.man came to emergency room complaining of sharp chest pain, begining two hours prior to admission. His blood pressure was low, and pulse fast. He had a history of hypertension for eight years. One hour after admission the pain radiated to the left flank and right side of the neck. He became hypotensive and died. This presentation is most compatible with:
A. Coronary artery disease B. Ruptured myocardial infact C. Aneurysm of the abdominal aorta D. Dissecting aortic aneurysm E. Pulmonary embolism |
D. Dissecting aortic aneurysm
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Although several mechanisms can result in systemic arterial hypertension, the common end result of them is:
A. Increased peripheral resistance B. Arteriolar medial necrosis C. Increased vascular permeability D. Severe venoconstriction E. Decreased cardiac output |
A. Increased peripheral resistance
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Common sites of severe artherosclerosis include all of the following EXCEPT:
A. Abdominal aorta B. Internal carotid artery C. Femoral artery D. Coronary arteries E. Pulmonary artery |
E. Pulmonary artery
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Factors that increase the risk of ischemic heart disease include all of the following except:
A. Elevated serum HDL B. Hypertension C. Elevated serum LDL D. Diabetes mellitus E. Cigarette smoking |
A. Elevated serum HDL
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A previously healthy 50 yom presents to the ER with numbness of his leg. Physical Examination shows pallor and a cool left leg with absence of distal pulse. An ECG reveals no abnormalities. An angiogram demonstrates a markely dilated abdominal aorta an occlusion of the left popliteal artery. The blockage is removed surgically and the patient recovers. Which of the following is the most likely source of the arterial thromboembolus in this patient?
A. Deep venous thrombosis B. Deep ventricular mural thrombus C. Nonbacterial endocarditis D. Paradoxical emboli E. Thrombus from an atheromatous aorta |
E. Thrombus from an atheromatous aorta
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A 40 yow develops the "worst headache of her life" and then becomes comatose. A CT scan reveals subarachnoid hemorrhage. The patient eventually dies, and autopsy reveals rupture of a berry aneurysm. The pathogenesis of this vascular abnormality is most closely linked to which of the following conditions?
A. Arterial wall defect due to diabetes B. Artherosclerosis C. Congenital defect of the arterial wall D. Cystic medial necrosis E. Endarteritis of the vasa vasorum |
C. Congenital defect of the arterial wall
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A 40-yow with type I diabetes presents with skin lesions. Physical examination shows Xanthomas on the dorsal surface of both hands and xanthelamas of the eyelids. Laboratory studies reveal serum cholesterol of 850mg/dL and significantly elevated serum triglycerides and LDL. The patient most likely carries a mutation in a gene that encodes which of the following proteins?
A. Apolipoprotein E B. HDL receptor C. LDL receptor D. Lecithin-cholesterol acyltransferase E. Aldosterone |
C. LDL receptor
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A 53-yow complains that her left upper arm is often swollen. Her past medical history is significant for a radical mastectomy for breast cancer 2 years ago. Which of the following is the most likely explanation for tissue swelling in this patient?
A. Chronic inflamation B. Increased oncotic pressure C. Lymphatic obstruction D. Thrombophlebitis E. Varicose veins |
C. Lymphatic obstruction
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A 70-yom presents with headaches and a visual disturbances. A thickened, tortous temporal artery is palpable on physical examination and is subjected to biopsy. What is the appropriate diagnosis?
A. Giant cell arteritis B. Hypersensitivity angitis C. Kawasaki disease D. Polyarteritis nodosa E. Wegener granulomatous |
B. Hypersensitivity angitis
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What type of anemia?
Atrophic gastritis, auto-immune disorder, lack of intrinsic factor. 1. Megaloblastic anemia 2. Iron deficiency anemia 3. Aplastic anemia 4. Hemolytic anemia |
1. Megaloblastic anemia
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What type of anemia? Microcytic hypochromic anemia.
1. Megaloblastic anemia 2. Iron deficiency anemia 3. Aplastic anemia 4. Hemolytic anemia |
2. Iron deficiency anemia
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What type of anemia? Extra corpuscular (mechanical, infectious,or chemicals) or intracorpuscular (membrame defect, enzyme deficiency or globin abnormalities).
1. Megaloblastic anemia 2. Iron deficiency anemia 3. Aplastic anemia 4. Hemolytic anemia |
4. Hemolytic anemia
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What type of disorder? Diagnosed by demonstrating that there is a decreased in the synthesis of alpha or beta globin chain
1. Thalassemia 2. Hemphilia A 3. Hereditary Spherocytosis 4. Desseminated intravascular coagulation 5. Multiple myeloma |
1. Thalassemia
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What type of disorder? Diagnosed by finding increased plasma cells in the bone marrow and monoclonal spike in serum electrophoresis.
1. Thalassemia 2. Hemphilia A 3. Hereditary Spherocytosis 4. Desseminated intravascular coagulation 5. Multiple myeloma |
5. Multiple myeloma
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What type of disorder? Diagnosed by finding increased fibrin split products in the serum
1. Thalassemia 2. Hemphilia A 3. Hereditary Spherocytosis 4. Desseminated intravascular coagulation 5. Multiple myeloma |
4. Desseminated intravascular coagulation
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What type of disorder? Diagnosis is made on the basis of histologic findings. There is almost always lymph node enlargement which is painless.
1. Lymphoma 2. Chronic Myelocytic Leukemia (CML) 3. Chronic Lymphocytic Leukemia (CLL) 4. Acute Myelocytic Leukemia (AML) 5. Acute Lymphoblastic Leukemia (ALL) |
1. Lymphona
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What type of disorder?
Most common form of leukemia (40%). Classified into MO-M7. 1. Lymphoma 2. Chronic Myelocytic Leukemia (CML) 3. Chronic Lymphocytic Leukemia (CLL) 4. Acute Myelocytic Leukemia (AML) 5. Acute Lymphoblastic Leukemia (ALL) |
4. Acute Myelocytic Leukemia (AML)
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What type of disorder? Most common form of malignant disease in children younger than 5 years of age.
1. Lymphoma 2. Chronic Myelocytic Leukemia (CML) 3. Chronic Lymphocytic Leukemia (CLL) 4. Acute Myelocytic Leukemia (AML) 5. Acute Lymphoblastic Leukemia (ALL) |
5. Acute Lymphoblastic Leukemia (ALL)
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What type of disorder? Disease of adulthood which usually end in a blast crisis. About 90% of the patients have philadelphia chromosome.
1. Lymphoma 2. Chronic Myelocytic Leukemia (CML) 3. Chronic Lymphocytic Leukemia (CLL) 4. Acute Myelocytic Leukemia (AML) 5. Acute Lymphoblastic Leukemia (ALL) |
2. Chronic Myelocytic Leukemia (CML)
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A 50-year-old man presents because of a pruritic rash of several years' duration. The rash is characterized by erythematous, eczematoid patches, and raised plaques and is distributed asymmetrically over the chest and abdomen. Biopsy of the plaques reveals atypical CD4+ T cells with cerebriform nuclei. Further marker studies lead to a diagnosis of mycosis fungoides. Which of the following is true of this disease?
A. The disease eventually disseminates to lymph nodes and internal organs B. The neoplastic cells most commonly display cell markers of CD19 and CD20. C. The skin rash most commonly disappears over time. D. This disease is caused by a chronic fungal infection in the skin. E. This is a benign condition and no further workup is necessary |
A. The disease eventually disseminates to lymph nodes and internal organs
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The monoclonal immunoglobulin, the so-called M protein of multiple myeloma, belongs to which class of immunoglobulins?
A. IgA B. IgM C. IgG D. IgD E. IgE |
C. IgG
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The patient described in Question above is at increased risk of developing which of the following conditions?
A. Cerebral aneurysm B. Cerebrovascular accident C. Cholelithiasis D. Osteogenic sarcoma E. Raynaud phenomenon |
B. Cerebrovascular accident
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A 23-year-old African-American man with a history since early childhood of severe anemia requiring many transfusions has nonhealing leg ulcers and recurrent periods of abdominal and chest pain. These signs and symptoms are most likely to be associated with which of the following laboratory abnormalities?
A. Decreased erythropoietin B. Increased erythrocyte osmotic fragility C. Schistocytes D. Sickle cells on peripheral blood smear E. Teardrop-shaped cells |
D. Sickle cells on peripheral blood smear
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A patient with severe anemia has a peripheral blood smear with oval macrocytes, hypersegmented neutrophils, and decreased platelets.The patient is found to be a severely malnourished alcoholic. The most likely cause of this disorder is
A. Aberrant intestinal bacterial flora. B. Crohn disease. C. Fish tapeworm infestation. D. Folate deficiency. E. Pernicious anemia. |
D. Folate deficiency.
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Punched-out bone lesions of the calvaria (skull) seen by X-ray examination are typical of:
1. Non-Hodgkin's lymphoma 2. Aplastic anemia 3. Hodgkin's lymphoma 4. Multiple myeloma |
4. Multiple myeloma
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Overall, the most common form of leukemia is:
A. Acute myelogenous leukemia B. Acute lymphoblastic leukemia C. Chronic myelogenous leukemia D. Chronic lymphocytic leukemia |
A. Acute myelogenous leukemia
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Aplastic anemia is most often:
A. Idiopathic B. Secondary to viral infection C. Radiation induced D. Drug induced |
A. Idiopathic
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Microcytic hypochromic anemia with low hemosiderin stores in the bone marrow will respond favorably to treatment with:
A. Vitamin C B. Vitamin B12 C. Folic acid D. Ferous salt |
D. Ferous salt
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What type? Neutrophilia
1. Skin infection, allergy and parasitic infections 2. Viral Infections 3. Bacterial infections 4. Histiocyte in the tissues 5. Analog of mast cells, contain heparin and histamine |
3. Bacterial infections
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What type? Lymphocytosis
1. Skin infection, allergy and parasitic infections 2. Viral Infections 3. Bacterial infections 4. Histiocyte in the tissues 5. Analog of mast cells, contain heparin and histamine |
2. Viral infections
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What type? Eosinophilia
1. Skin infection, allergy and parasitic infections 2. Viral Infections 3. Bacterial infections 4. Histiocyte in the tissues 5. Analog of mast cells, contain heparin and histamine |
1. Skin infections, allergies and parasitic infections
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What type? Basophils
1. Skin infection, allergy and parasitic infections 2. Viral Infections 3. Bacterial infections 4. Histiocyte in the tissues 5. Analog of mast cells, contain heparin and histamine |
5. Analog of mast cells, contains heparin and histamine
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What type? Monocytosis
1. Skin infection, allergy and parasitic infections 2. Viral Infections 3. Bacterial infections 4. Histiocyte in the tissues 5. Analog of mast cells, contain heparin and histamine |
4. Histiocyte in the tissues
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Type of disease? Thrombocytopathy
1. Disease of Red cell and their precursors 2. Disease of Segmented leukocytes their precursors 3. Disease of Lymphocytes and their precursors 4. Disease of platelets and their precursors 5. Disease of soluble clotting factors |
4. Disease of platelets and their precursors
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Type of disease? Infectious mononucleuosis.
1. Disease of Red cell and their precursors 2. Disease of Segmented leukocytes their precursors 3. Disease of Lymphocytes and their precursors 4. Disease of platelets and their precursors 5. Disease of soluble clotting factors |
3. Disease of Lymphocytes and their precursors
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Type of disease? Polycythemia.
1. Disease of Red cell and their precursors 2. Disease of Segmented leukocytes their precursors 3. Disease of Lymphocytes and their precursors 4. Disease of platelets and their precursors 5. Disease of soluble clotting factors |
1. Disease of red cells and their precursors
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Type of disease? Chronic lymphocytic leukemia.
1. Disease of Red cell and their precursors 2. Disease of Segmented leukocytes their precursors 3. Disease of Lymphocytes and their precursors 4. Disease of platelets and their precursors 5. Disease of soluble clotting factors |
3. Disease of Lymphocytes and their precursors
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Type of disease? Sickle cell anemia.
1. Disease of Red cell and their precursors 2. Disease of Segmented leukocytes their precursors 3. Disease of Lymphocytes and their precursors 4. Disease of platelets and their precursors 5. Disease of soluble clotting factors |
1. Disease of red cells and their precursors
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Type of disease? Acute myelocytic leukemia.
1. Disease of Red cell and their precursors 2. Disease of Segmented leukocytes their precursors 3. Disease of Lymphocytes and their precursors 4. Disease of platelets and their precursors 5. Disease of soluble clotting factors |
2. Disease of segmented leukocytes and their precursors
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Type of disease? Burkitt's Lymphoma.
1. Disease of Red cell and their precursors 2. Disease of Segmented leukocytes their precursors 3. Disease of Lymphocytes and their precursors 4. Disease of platelets and their precursors 5. Disease of soluble clotting factors |
3. Disease of Lymphocytes and their precursors
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Type of disease? Thalassemia.
1. Disease of Red cell and their precursors 2. Disease of Segmented leukocytes their precursors 3. Disease of Lymphocytes and their precursors 4. Disease of platelets and their precursors 5. Disease of soluble clotting factors |
1. Disease of red cells and their precursors
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Type of disease? Bleeding tendency due to Vitamin K deficiency.
1. Disease of Red cell and their precursors 2. Disease of Segmented leukocytes their precursors 3. Disease of Lymphocytes and their precursors 4. Disease of platelets and their precursors 5. Disease of soluble clotting factors |
5. Disease of soluble clotting factors
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A syndrome marked by minor respiratory symptoms of insidous onset and accompanied by radiographic evidence of interstitial infiltration and a mild intraalveolar exudation is typically caused by
Question options: A. Klebsiella pneumoniae B. Streptococus pneumoniae C. Streptococcus pyogenes D. Mycoplasma pneumoniae E. Staphylococcus aureus |
D. Mycoplasma pneumoniae
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Multiple thrombi in small branches of the pulmonary artery are typical of infection with
Question options: A. Adenovirus B. Hemophilus influenzae C. Parainfluenzae virus D. Mucormycosis E. Pneumocystis carinii |
D. Mucormycosis
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Asthma in children who have a positive skin test to a suspected antigen is mediated by
Question options: A. IgA B. IgG C. IgM D. IgE E. IgD |
D. IgE
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The most important cause of emphysema in the USA is
Question options: A. HIV B. Alpha 1 antitrypsin deficiency C. Cystic Fibrosis D. Air pollution E. Cigarette smoking |
E. Cigarette smoking
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The primary defence to tuberculosis is mediated by:
Question options: A. IgE B. T cells C. IgG D. IgG and IgM E. NK cells |
B. T cells
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Which disease? A 40-year old man with alpha 1 antitrypsin deficiency died of complications of cirrhosis. At autopsy his lungs showed widespread loss of alveolar septa, imparting a cotton candy-like appearance.
1. Coal worker's pneumoconiosis 2. Bronchiectasis 3. Emphysema 4. Atelectasis 5. Silicosisis 6. Asthma 7. Sarcoidosis |
3. Emphysema
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Which disease? A 30-year black woman had fever and joint pains for 3 months. A chest X-ray revealed symmetrical enlargement of the hilar lymph nodes. A transbronchial biopsy revealed noncaseating granulomas. Blood levels of serum angiotensin converting enzyme (ACE) were elevated.
1. Coal worker's pneumoconiosis 2. Bronchiectasis 3. Emphysema 4. Atelectasis 5. Silicosisis 6. Asthma 7. Sarcoidosis |
7. Sarcoidosis
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Which disease? A 60-year old stone mason complained of shortness of breath which has become worse during the last year. Multiple small nodular shadows were seen in both his lungs and functional studies revealed reduced pulmonary compliance and diffusing capacity. An autopsy revealed numerous small fibrotic nodules, which contained birefingent crystals.
1. Coal worker's pneumoconiosis 2. Bronchiectasis 3. Emphysema 4. Atelectasis 5. Silicosisis 6. Asthma 7. Sarcoidosis |
5. Silicosisis
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Which disease? A 24-year old woman with cystic fibrosis died of recurrent pneumonia. The bronchi of the lungs were dialated and contained prominent mucoopurulent plugs. These cylindrical bronchial lesions are know as ----
1. Coal worker's pneumoconiosis 2. Bronchiectasis 3. Emphysema 4. Atelectasis 5. Silicosisis 6. Asthma 7. Sarcoidosis |
2. Bronchiectasis
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Acute upper respiratory tract obstruction, known as croup, is most often caused by:
Question options: 1. Viruses 2. Fungi 3. Protozoa 4. Mycoplasma 5. Bacteria |
1. Viruses
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The most common consequence of pneumothorax is:
Question options: 1. Emphysema 2. Atelectasis 3. Emphysema 4. Diffuse alveolar damage 5. Pyothorax |
2. Atelectasis
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In lungs affected by sarcoidosis, there are numerous noncaseating granulomas and infiltrates of:
Question options: A. T Cytotoxic/suppresor cells B. Neutrophils C. Eosinophils D. Helper/inducer T-lymphocytes E. Plasma cells |
D. Helper/inducer T-lymphocytes
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Fibrin-rich hyaline membrane and protein-rich intralveolar edema are features of:
Question options: A. Aspiration pneumonia B. Bronchiiectasis C. Emphysema D. Diffuse alveolar damage (DAD. in adult respiratory distress syndrome E. Atelectasis |
D. Diffuse alveolar damage (DAD. in adult respiratory distress syndrome
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Mycoplasma pneumoniae infection usually causes
Question options: A. Lobular pneumonia B. Interstitial pneumonia C. Lobar pneumonia D. Aspiration pneumonia |
B. Interstitial pneumonia
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Complications that may follow pneumococcal pneumonia include the following except.
Question options: 1. Rheumatic heart disease 2. Emphysema 3. Pulmonary fibrosis 4. Pyothorax 5. Bacteremia 6. Lung Abscess 7. Pleuritis 8. Pleural effusion |
1. Rheumatic heart disease
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In pneumoconiosis, the extent of injury depends on all the following conditions, except:
1. Size, shape and solubility of the particle 2. Presence of antibodies (IgE) in the patient 3. Duration of exposure 4. Concentration of particles 5. Biochemical composition of the inhaled dust |
2. Presence of antibodies (IgE) in the patient
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Adult respiratory distress syndrome (ARDS) can be caused by all the following except:
Question options: A. Toxic lung injury (toxic fumes, cytotoxic drugs, bacterial endotoxins) B. Pneumonia (bacterial, viral) C. Shock (trauma, burns, acute cardiac failurE. D. Thrombophlebitis, polyarthritis nodosa and raynaud's syndrome E. Aspiration of fluids (neardrowing) |
D. Thrombophlebitis, polyarthritis nodosa and raynaud's syndrome
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Atelectasis (incomplete expansion or collapse of the alveolar) can be caused by all the following conditions except:
A. Allergic rhinitis (hay fever) B. Inability of premature neanate type II pneumocytes to produce surfactant C. Mucous plug or tumor of the lungs D. Compression of lungs from outside by accumulated exudate or transudate in the pleural cavity. E. Resorption of air distal to brochial obstruction. |
A. Allergic rhinitis (hay fever)
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A 25-yom with cystic fibrosis presents with increasing shortness of breath and production of abundant foul-smelling sputum. The sputum in this patient is most likely associated with which of the following pulmonary conditions?
Question options: A. Atelectasis B. Bronchioectasis C. Empyema D. Pneumothorax E. Pyothorax |
B. Bronchioectasis
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A 50-yo alcoholic woman presents to ER with fever, chills, and shortness of breath. The sputum is rusty-yellow and contains numerous neutrophils, red blood cells, and gram-possitive cocci. A chest X-ray shows diffuse haziness over both lungs. One week following admission, the patient develops emphysema. The pulmonary condition is associated with the spread of bacterial infection to which of the following anatomic locations?
Question options: A. Blood B. Bronchi C. Interstitial space D. Pericardium E. Pleural space |
E. Pleural space
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A 22-year old man with AIDS complains of persistent cough, night sweats, low grade fever, and general malaise. A chest X-ray reveals an area of consolidation in the periphery of the left upper lobe, as well as hilar lymphadenopathy. Sputum cultures show acid fast bacilli. Which of the following is most likely diagnosis?
Question options: A. Sarcoidosis B. Wegner granulomatosis C. Tuberculosis D. Pulmonary abcess E. Brochiopneumonia |
C. Tuberculosis
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A 63-year old man develops weakness, malaise, cough with bloody sputum and night sweats. A chest X-ray reveals numerous apical densities bilaterally. Exposure to Mycobacterium tuberculosis was documented 20 years ago, and M. tuberculosis is identified in his sputum. Which of the following describes the expected lung pathology in this patient.
A. Dense fibrosis B. Eosinophilic infiltrate C. Interstitial pneumonia D. Granuloma E. Plasma cell infiltrate |
D. Granuloma
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On the 11th postoperative day following a radical prostatectomy for adenocarcinoma of the prostate, a 70-year-old man is recovering uneventfully. He then ambulates to the bathroom, but upon returning to his bed he suddenly becomes extremely dyspneic and diaphoretic, with chest pain, palpitations, and a feeling of panic. Which of the following post-operative complications has he most likely developed?
Question options: A. Pulmonary edema B. Pleural effusion C. Atelectasis D. Thromboembolus E. Diffuse alveolar damage |
D. Thromboembolus
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A 60-year-old man has a 90 pack year history of smoking. For the past 5 years, he has had a cough productive of copious amounts of mucoid sputum for months at a time. He has had episodes of pneumonia with Streptococcus pneumoniae and E. coli cultured. His last episode of pneumonia is complicated by septicemia and brain abscess and he dies. At autopsy, his bronchi microscopically demonstrate mucus gland hypertrophy. Which of the following conditions is most likely to explain his clinical course?
Question options: A. Congestive heart failure B. Chronic bronchitis C. Bronchial asthma D. Bronchiectasis E. Centrilobular emphysema |
B. Chronic bronchitis
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Following a vehicular accident with blood loss leading to prolonged, severe hypotension, a 30-year-old man is intubated and placed on a mechanical ventilator. He has progressively decreasing oxygen saturations despite increasing PEEP and FI02 of 100%. He remains afebrile. He dies 3 days later. At autopsy, the distal lungs show pink hyaline membranes, thickened interstitium, and many macrophages but few neutrophils. Which of the following pulmonary diseases most likely complicated his course?
Question options: A. Bronchopneumonia B. Chronic bronchitis C. Bronchiectasis D. Viral pneumonia E. Diffuse alveolar damage |
E. Diffuse alveolar damage
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A 54-year-old man has had increasing dyspnea for the past 6 years, but no cough. On physical examination there is increased jugular venous distension. He is afebrile. A chest radiograph shows increased lucency in upper lung fields and increased lung volumes, with flattening of the diaphragmatic leaves. There are no infiltrates. The pulmonary arteries are enlarged and prominent bilaterally, and his right heart border is enlarged. Which of the following pathologic findings is most likely to be present in his main pulmonary arteries?
Question options: A. Granulomatous vasculitis B. Organizing thromboemboli C. Medial dissection D. Atherosclerosis E. Aneurysm formation |
D. Atherosclerosis
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A 70-year-old woman has been bedridden for 5 weeks following a cerebrovascular accident (CVA.. She has the sudden onset of dyspnea, but has no further symptoms until two days later when she experiences left sided pleuritic chest pain. A day later she suffers another CVA and dies. At autopsy, she is found to have a wedge-shaped area of hemorrhage based on the pleura of the left lower lobe. Which of the following pathologic findings in her pulmonary arterial branches is she most likely to have?
Question options: A. Fat embolism B. Atherosclerosis C. Vasculitis D. Thromboembolism E. Aspergillosis |
D. Thromboembolism
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A 60-yom presents with dyspnea on exertion and a non-productive cough. He has never smoked, but he worked as a shipbuilder, with known asbestos exposure aproximately 20 years ago. To which of the following conditions is the patient especially predisposed?
Question options: A. Acute respiratory distress syndrome B. Goodpasture syndrome C. Idiopathic pulmonary fibrosis D. Idiopathic pulmonary hemesiderosis E. Malignant mesothelioma of the pleura |
E. Malignant mesothelioma of the pleura
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A female infant is born prematurely at 28 weeks gestation. Shortly after birth, she shows signs of dyspnea, cyanosis, and tachypnea. She is placed on a ventilator for assisted breathing, and a diagnosis of neonatal respiratory distress syndrome (hyaline membrane diseasE. is made. Which of the following is the cause of this syndrome.
Question options: A. Bronchiopulmonary dysplasia B. Interventricular brain hemorrhage C. Lack of fetal pulmonary maturity and deficiency of surfactant D. Necrotizing enterocolitis E. Patent ductus arteriosus |
C. Lack of fetal pulmonary maturity and deficiency of surfactant
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A 60-year old woman has been immobilized in bed for several days after motor vehicle accident. She had been improving, but this morning she suffered the sudden onset of pleuritic chest pain, hemoptysis, tachypnea, tachycardia and dyspnea. What is the likely basis of this type of findings?
Question options: A. Arterial thrombus originating in pulmonary blood vessel B. Arterial thrombus originating in the lower extrimities with migration to pulmonary veins C. Deep venous thrombus of the lower extrimities with embolizetion to branches of pulmonary artery D. Mural thrombus originating in the left heart with migration to the pulmonary blood vessels E. Venous thrombus originating in pulmonary blood vessels |
D. Mural thrombus originating in the left heart with migration to the pulmonary blood vessels
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A 38-yow, who is been treated with corticosteroids for systemic lupus erythematosus, presents with chronic non-productive cough. She breeds pigeons for avian hobbyists. A chest X-ray reveals a 2-cm nodule in the upper lobe of the right lung. The lung nodules is resected. Histologic examination reveals granulomas and budding yeast forms which stain positively with polysaccharides. What is the appropriate diagnosis?
A. Actinomycosis B. Coccidioidomycosis C. Cryptococcosis D. Histoplasmosis E. Mycoplasma pneumonia |
D. Histoplasmosis
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Type of cancer? This tumor consists of small oval to spindle shaped cells with scant cytoplasm, and granular nuclear chromatin. These cells differentiate in the direction of the neuroendocrine cells. Majority of patients are symptomatic at the time of presentation.
1. Bronchioalveolar carcinoma 2. Squamous cell carcinoma 3. Small cell carcinoma 4. Carcinoid tumors 5. Eosinophilic granulomas of the lungs 6. Large cell undifferentiated carcinomas 7. Mesothelioma |
3. Small cell carcinoma
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Type of cancer? A group of neuroendocrine, pulmonary neoplasia derived from the pleuripotential basal layer of the respiratory epithelium.
1. Bronchioalveolar carcinoma 2. Squamous cell carcinoma 3. Small cell carcinoma 4. Carcinoid tumors 5. Eosinophilic granulomas of the lungs 6. Large cell undifferentiated carcinomas 7. Mesothelioma |
4. Carcinoid tumors
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Type of cancer? Patients with this tumor presents with a pleural effusion or a pleural mass, chest pain and dyspnea. Microscopically the tumor exibits a biphasic appearance and are related to asbestos exposure.
1. Bronchioalveolar carcinoma 2. Squamous cell carcinoma 3. Small cell carcinoma 4. Carcinoid tumors 5. Eosinophilic granulomas of the lungs 6. Large cell undifferentiated carcinomas 7. Mesothelioma |
7. Mesothelioma
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Type of cancer? This adenocarcinoma grows along the pre-existing alveolar walls. Most of the cancer originate from Clara cells and the prognosis is good provided there are no lymph node metastases.
1. Bronchioalveolar carcinoma 2. Squamous cell carcinoma 3. Small cell carcinoma 4. Carcinoid tumors 5. Eosinophilic granulomas of the lungs 6. Large cell undifferentiated carcinomas 7. Mesothelioma |
1. Bronchioalveolar carcinoma
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Type of cancer? A hilar tumor composed of keratinizing cells connected by intercellular bridges and desmosomes.
1. Bronchioalveolar carcinoma 2. Squamous cell carcinoma 3. Small cell carcinoma 4. Carcinoid tumors 5. Eosinophilic granulomas of the lungs 6. Large cell undifferentiated carcinomas 7. Mesothelioma |
2. Squamous cell carcinoma
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Type of disease? Characterized by paroxysms of wheezing, dyspnea and cough. Symptoms attributed to increased airway responsiveness to an inflammatory reaction provoked by diverse stimuli.
1. Asthma 2. Emphysema 3. Panacinar emphysema 4. Centribular Emphysema 5. Pneumoconioses 6. Hypersensitivity Pneumonitis 7. Sarcoidosis |
1. Asthma
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Type of disease? Enlargement of airspaces distal to the terminal bronchioles, with the distruction of their walls without fibrosis.
1. Asthma 2. Emphysema 3. Panacinar emphysema 4. Centribular Emphysema 5. Pneumoconioses 6. Hypersensitivity Pneumonitis 7. Sarcoidosis |
2. Emphysema
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Type of disease? Caused by inhalation of inorganic dust.
1. Asthma 2. Emphysema 3. Panacinar emphysema 4. Centribular Emphysema 5. Pneumoconioses 6. Hypersensitivity Pneumonitis 7. Sarcoidosis |
5. Pneumoconioses
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Type of disease? Almost always associated with cigarette smoking.
1. Asthma 2. Emphysema 3. Panacinar emphysema 4. Centribular Emphysema 5. Pneumoconioses 6. Hypersensitivity Pneumonitis 7. Sarcoidosis |
4. Centribular Emphysema
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Type of disease? In the final stage of this type of emphysema, a lacy network of supporting tissue ("cotton-candy lung") is left behind. The lesion is associated with alpha-1 antitrypsin deficiency.
1. Asthma 2. Emphysema 3. Panacinar emphysema 4. Centribular Emphysema 5. Pneumoconioses 6. Hypersensitivity Pneumonitis 7. Sarcoidosis |
3. Panacinar emphysema
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Type of disease? Carcinoid
1. Infectious Disease 2. Immune disease 3. Mineral dust-induced disease 4. Circulatory disease 5. Tumor |
5. Tumor
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Type of disease? Ghon complex
1. Infectious Disease 2. Immune disease 3. Mineral dust-induced disease 4. Circulatory disease 5. Tumor |
1. Infectious disease
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Type of disease? Mesothelioma
1. Infectious Disease 2. Immune disease 3. Mineral dust-induced disease 4. Circulatory disease 5. Tumor |
5. Tumor
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Type of disease? Lobar pneumonia
1. Infectious Disease 2. Immune disease 3. Mineral dust-induced disease 4. Circulatory disease 5. Tumor |
1. Infectious disease
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Type of disease? Sarcoidosis
1. Infectious Disease 2. Immune disease 3. Mineral dust-induced disease 4. Circulatory disease 5. Tumor |
2. Immune disease
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Type of disease? Goodpasteure syndrome
1. Infectious Disease 2. Immune disease 3. Mineral dust-induced disease 4. Circulatory disease 5. Tumor |
2. Immune disease
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Type of disease? Bronchiectasis
1. Infectious Disease 2. Immune disease 3. Mineral dust-induced disease 4. Circulatory disease 5. Tumor |
4. Circulatory disease
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Type of disease? Asthma
1. Infectious Disease 2. Immune disease 3. Mineral dust-induced disease 4. Circulatory disease 5. Tumor |
2. Immune disease
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Type of disease? Silicosis
1. Infectious Disease 2. Immune disease 3. Mineral dust-induced disease 4. Circulatory disease 5. Tumor |
3. Mineral dust-induced disease
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Type of disease? Legionella pneumonia
1. Infectious Disease 2. Immune disease 3. Mineral dust-induced disease 4. Circulatory disease 5. Tumor |
1. Infectious disease
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Which tract? CROUP (Acute laryngotrachobronchotis)
1. Upper Respiratory Tract 2. Lower Respiratory Tract 3. Middle Respiratory Tract |
3. Middle Respiratory Tract
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Which tract? Mostly caused by viral infections (Flu). Region commonly infiltrated with nonspecific inflammatory cells and the congested area produce runny nose.
1. Upper Respiratory Tract. 2. Lower Respiratory Tract 3. Middle Respiratory Tract |
1. Upper Respiratory Tract
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Which tract? Interstitial pneumonia
1. Upper Respiratory Tract. 2. Lower Respiratory Tract 3. Middle Respiratory Tract |
2. Lower Respiratory Tract
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Which tract? Caused by parainfluenza.
1. Upper Respiratory Tract. 2. Lower Respiratory Tract 3. Middle Respiratory Tract |
3. Middle Respiratory Tract
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Which tract? Alveolar pneumonia
1. Upper Respiratory Tract. 2. Lower Respiratory Tract 3. Middle Respiratory Tract |
2. Lower Respiratory Tract
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