Block 2 Flashcards by Andrea Whitley

A 45 year old male alcoholic with a history of portal hypertension presents with vomiting of blood (hematemesis) and hypotension. He denies any history of vomiting nonblood material or retching prior to vomiting blood. During workup he dies suddenly. Which of the following histologic changes is most likely to be seen in a biopsy specimen taken from his esophagus?

A. Metaplastic columnar epithelium
B. Numerous intraepithelial neutrophils
C. Decreased ganglion cells in the myenteric plexus
D. Mucosal outpouchings
E. Dilated blood vessels in the submucosa

E. Dilated blood vessels in the submucosa

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A 31 year old has had a 10 year history of intermittent, bloody diarrhea. She has no other major medical problems. Colonoscopy reveals a friable, erythematous mucosa with focal ulceration that extends from the rectum to the mid-transverse colon. Biopsies are taken and all reveal mucosal acute and chronic inflammation with crypt distortion, occasional crypt abscesses, and superficial mucosal ulceration. The patient is at greatest risk for development of which of the following conditions:

A. Perirectal fistula 
B. Diverticulitis 
C. Sclerosing cholangitis 
D. Acute pancreatitis 
E. Appendicitis

C. Sclerosing cholangitis

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A 39 year old man is having a routine physical examination because of a history of colon cancer in his family He has no abdominal tenderness or masses, and active bowel sounds are present. However, his stool is positive for occult blood. Colonscopy is performed. There are 7 polyps found in the ascending colon: three of these are small 0.5 cm pedunculated tubular adenomas, three are 1 cm tubulovillous adenomas, and one is a 2 cm sessile villous adenoma in the cecum containing a focus of well differentiated adenocarcinomas, Which of the following conditions best explains these findings:

A. Gardner's syndrome 
B. Hereditary non-polyposis colon carcinoma 
C. Peutz-Jehgers syndrome 
D. Familial polyposis coli 
E. Chronic ulcerative colitis

B. Hereditary non-polyposis colon carcinoma

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A. Atresia of the esophagus with fistula between the trachea and the blind upper segment
B. Atresia of the esophagus with fistula between the trachea and the distal esophageal segment
C. Atresia of the esophagus with fistula between both segments and the trachea
D. Atresia of the esophagus without tracheoesophageal fistula
E. Fistula between a normal esophagus and the trachea

B. Atresia of the esophagus with fistula between the trachea and the distal esophageal segment

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A. Mucosal outpouchings
B. Decreased ganglion cells in the myenteric plexus
C. Dilated blood vessels in the submucosa
D. Numerous intraepithelial neutrophils
E. Metaplastic columnar epithelium

C. Dilated blood vessels in the submucosa

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A 49 year old woman taking ibuprofen for increasing joint pain in her hands presents with increasing pain in her midsternal area. Gastroscopy reveals multiple, scattered, punctate hemorrhagic areas in her gastric mucosa as seen in the picture below. Biopsies from one of these hemorrhagic lesions reveal musocal erosions with edema and hemorrhage. No mucosal ulceration is seen. Which of the following is most likely diagnosis?

A. Peptic ulcer disease 
B. Active chronic gastritis 
C. Acute gastritis 
D. Chronic gastritis 
E. Autoimmune gastritis

C. Acute gastritis

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A 20 year old patient undergoes a total colectomy because of a family history of colon cancer at a young age. In the resected colon are over 200 tubular adenomas ranging in size from 0.2 to 1 cm on gross examination. He is otherwise healthy, with no other lesions present. Which of the following genetic conditions is most likely to account for these findings:

A. Hereditary non-polyposis colon carcinoma syndrome 
B. Adenomatous polyposis coli 
C. Multiple endocrine neoplasia 
D. Peutz-Jehgers syndrome 
E. Gardner's syndrome

A. Hereditary non-polyposis colon carcinoma syndrome

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A 53 year old man presents with increasing gastric pain and is found to have a 3 cm mass located in the anterior wall of his stomach. This mass is resected and histologic examination reveals a tumor composed of cells having elongated, spindle-shaped nuclei. The tumor does not connect to the overlying gastric epithelium and is instead found only in the wall of the stomach. The tumor cells stain positively with CD117, but negatively with both desmin and S-100. Special studies find that these tumor cells have abnormalities of the KIT gene. Which of the following is the most likely diagnosis?

A. Lymphoma of mucosa-associated lymphoid tissue (MALToma)
B. Ectopic islet cell adenoma (VIPoma)
C. Gastrointestinal stromal tumor (GIST)
D. Submucosal leiomyoma (“fibroid tumor”)
E. Nonchromaffin paraganglioma (chemodectoma)

C. Gastrointestinal stromal tumor (GIST)

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A 2 week old neonate presents with regurgitation and persistent, severe projectile vomiting. An olive-like epigastric mass is felt during physical examination. A chest c-ray does not reveal the presence of bowel gas in the chest cavity. This infant’s mother did not have polyhydramnios during this pregnancy. Which of the following is the most appropriate treatment for this infant’s condition?

A. Surgery to resect an aganglionic section of the intestines
B. Oral medication with vancomycin or metronidazole
C. Surgery to cut a hypertrophied stenotic band at the pylorus
D. Oral medication with omeprazole and clarithromycin
E. Surgery to remove a mass of the adrenal gland

C. Surgery to cut a hypertrophied stenotic band at the pylorus

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A 45 year old man has had malabsorbtion for the past year associated with a low volume, non-bloody diarrhea. He also has a polyarthritis and complains of occasional visual hallucinations. An abdominal CT scan reveals no masses, only generalized lymphadenopathy. On upper GI endoscopy, there are no esophageal or gastric lesions, but there are broad, flattened villi in the duodenum. Biopsies of the duodenum reveal numerous PAS-positive macrophages in the submucosa. Which of the following therapies is indicated for this patient?

A. A gluten-free diet
B. Antibiotics 
C. Antacids 
D. Segmental duodenal resection 
E. Corticosteroids

B. Antibiotics

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Ischemia with infarction of the small intestine is LEAST likely to occur with which of the following conditions:

A. Volvulus 
B. Intussusception 
C. Regional enteritis 
D. Incarcerated hernia 
E. Superior mesenteric artery thrombosis

C. Regional enteritis

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A 39-year-old female presents with the new onset of a bloody dis- charge from her right nipple. Physical examination reveals a 1-cm freely movable mass that is located directly beneath the nipple. Sections from this mass reveal multiple fibrovascular cores lined by several layers of epithelial cells. Atypia is minimal. The lesion is completely contained within the duct and no invasion into underlying tissue is seen. What is the correct diagnosis?

a. Benign phyllodes tumor
b. Ductal papilloma
c. Intraductal carcinoma
d. Paget’s disease
e. Papillary carcinoma

b. Ductal papilloma

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A 41 year old man has a history of drinking 1 to 2 liters of whiskey per day for the past 20 years. He has had numerous episodes of nausea and vomiting in the past. However, he experiences a bout of prolonged vomiting, followed by massive hematemesis. In the emergency room of the hospital, he has vital signs with T 36.6 C, R 24, P 110, and BP 80/40 mm Hg. On physical examination, his heart has a regular and rhythm with no murmurs and his lungs are clear to auscultation. There is no abdominal tenderness or distension of bowel sounds are present. His stool is negative for occult blood. Which of the following conditions is he most likely to have

A. Hiatal hernia
B. Esophageal laceration (Mallory-Weiss syndrome)
C. Esophageal pulsion diverticulum
D. Barrett esophagus
E. Esophageal squamous cell carcinoma
F. Esophageal stricture

B. Esophageal laceration (Mallory-Weiss syndrome)

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A 25 year old man complains of a low volume but chronic, foul smelling diarrhea for the past year. He has no nausea, vomiting, or abdominal pain. On physical examination he has skin lesion looks like a herpes lesion. A stool fat collection indicates steatorrhea. A stool sample for occult blood is negative. Upper GI endoscopy and biopsy of the duodenum is performed. The biopsy reveals the absence of villi, increased surface intraepithelial lymphocytes. Which of the following therapies is indicated:

A. Corticosteroids 
B. Gluten-free diet 
C. Vagotomy 
D. Segmental duodenal resection 
E. Antibiotics

B. Gluten-free diet

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An 18 year old woman presents with abdominal pain localized to the right lower quadrant, nausea and vomiting, mild fever, and an elevation of the peripheral leukocyte count to 17,000/iL. An appendectomy is performed. Which of the following statements best describes the expected microscopic appearance of her appendix?

A. A yellow tumor nodule at the tip of the appendix
B. Lymphoid hyperplasia and multinucleated giant cells within the muscular wall
C. An appendix with a normal appearance
D. A dilated lumen filled with mucus
E. Neutrophils within the muscular wall

B. Lymphoid hyperplasia and multinucleated giant cells within the muscular wall

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A 23-year-old man has been feeling tired for 3 weeks. On physical examination, there is no abdominal tenderness and no masses are noted. Bowel sounds are present. His stool is positive for occult blood. Laboratory studies show a hemoglobin of 9 g/dL with hematocrit 26.3%, MCV 72 fL, platelet count 189,000/microliter, and WBC count 7500/microliter. A small bowel radiographic series with barium reveals no masses or perforations, only a solitary 2 cm outpouching in the ileum. Which of the following conditions has most likely led to these findings?

A. Inheritance of a faulty APC gene

B. Ulceration of mucosa by ectopic gastric tissue

C. Proliferation of abnormal submucosal veins

D. Elaboration of enterotoxin by Escherichia coli

E. Antiphospholipid antibody

B. Ulceration of mucosa by ectopic gastric tissue

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A 39-year-old female presents with chronic abdominal cramps, watery diarrhea, and periodic facial flushing. Physical examination reveals wheezing and a slightly enlarged liver. Workup reveals several masses within the liver and a large mass in the small intestine. Which one of the listed substances is most likely to be elevated in the urine of this individual as a result of her disease?

a. 5-hydroxyindoleacetic acid (5-HIAA)
b. Aminolevulinic acid (ALA)
c. N-formiminoglutamate (FIGlu)
d. Normetanephrine
e. Vanillylmandelic acid (VMA)

a. 5-hydroxyindoleacetic acid (5-HIAA)

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A 45 year old man presents with increasing “heartburn” especially after eating or when lying down. Endoscopic examination finds a red velvety plaque located at the distal esophagus. Biopsies from this area, taken approximately 4 cm proximal to the gastroesophageal junction reveals metaplastic columnar epithelium. Which of the following is the most likely diagnosis?

a. Acquired achalasia
b. Barrett’s esophagus
c. Hamartomatous polyp
d. Metastatic adenocarcinoma

b. Barrett’s esophagus

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A 55 year old male present with dyspnea on exertion. chest xray shows nodular densities in both lung fields, most prominent in apical region. Calcified hilar lymph nodes were also present. A calcified node is sampled, and polarizeed microscopy shows birefringent particles surrounded by dense collagen fibers. This patient most likely has a history of exposure to:

A. Organic dust
B. Berillium 
C. Coal Dust 
D. Silica 
E. Asbestos

D. Silica

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A 35 year old male with recurrent hemoptysis is foun don chest X-ray to have apical infiltrative cavitary lung lesions. Sputum culture shows acid fast bacilli. Which of the following is the most likely mechanism of tissue damage in this patient?

A. Bacterial toxin induced cell necrosis
B. Exudation and alveolar hepatization
C. Delayed type hypersensitivity
D. Intra alveolar bacterial overgrowth
E. Obliterative lower airway inflammation

C. Delayed type hypersensitivity

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A mediastinal mass in a 65 year old smoker is biopsed. Histology demonstrated cluster of ovoid cells that are smaller than resting lymphocytes. Immohistochemical staining is positive for neuron specific enolase, chromagranin and synaptophysin. The mass most likely represents:

A. Squamous cell carcinoma 
B. Small cell carcinoma 
C. Large cell carcinoma 
D. Adenocarcinoma 
E. Bronchoalveolar carcinoma

B. Small cell carcinoma

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BLOCK 1
A 43 year old African American women presents to the hospital complaining of several weeks of malaise, 10 pound weight loss, nocturnal fevers and cough. She has no appreciable past medical history and has not had any recent travel but is a former prisoner. Her chest xray shows some hilar prominence, a palpable node in the supraclavicular bed is biopsied and pathology reveals well-formed, non-caseating granulomas. What is the most likely diagnosis?

A. Mycobacterium tuberculosis
B. Adenocarcinoma of the lung metastatic
C. Squamous cell carcinoma of the lung, metastatic
D. Sarcoidosis
E. Mycobacterium avium complex (MAC)
F. Hodgkin’s lymphoma
G. HIV infection

D. Sarcoidosis

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BLOCK 1
While recovering in bed 1 week after an abdominal hysterectomy, a 42 year old woman develops acute shortness of breath with hemoptysis. Physical examination finds the patient to be afebrile with moderate respiratory distress, calf tenderness, and a widely split S2. Which of the following is the most likely diagnosis?
A. Atelectasis
B. Bacterial pneumonia
C. Pulmonary embolus 
D. Pulmonary hypertension 
E. Viral pneumonia

C. Pulmonary embolus

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BLOCK 1
A 62 year old female presents to your office with cough and dyspnea. She expectorates copious amounts of a pale tan-colored fuild. Chest xray reveals a pulmoary infiltrate that is subsequently biopsied. Histological examination reveals columnar mucin-seceting cells that fill the alveolar spaces without invading the stroma or vessels. This patient’s condition is best characterized as

A. Interstitial pneumonia 
B. Pneumoconiosis 
C. Hypersensitivity pneumonitis 
D. Pulmonary infarction 
E. Benign neoplasm 
F. Malignant neoplasm

F. Malignant neoplasm

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A 46 year old homeless alcoholic man presents to the emergency room complaining of fevers, night sweats, weight loss, and productive cough. He describes his sputum as greenish and foul smelling. His temperature is 39 deg C(103 deg F), blood pressure is 110/65 mm Hg, pulse is 102 beats per minute, and respirations are 22 per minute. Chest x ray reveals a cavitary lesion in the middle lobe of the right lung with air fluid levels. Which of the following is the most likely cause of his condition? a. aspiration of gastric contents b. aspiration of oropharyngeal contents c. hematogenous spread from another focus of infection d. primary mycobacterial infection e. chronic aspergillus infection.

b. aspiration of oropharyngeal contents

BLOCK 1 A 54-year-old male presents to the physician because of difficulty rising from a chair. He was recently diagnosed with a lung cancer. Physical examination shows hip girdle weakness. Electrophysiological studies show a remarkable increase in the muscle response on repetitive motor nerve stimulation. This patient’s condition is most likely associated with which of the following? A. Segmental axonal demyelination B. Antibodies against presynaptic calcium channels C. Antibodies against postsynaptic acetyl choline receptors D. Medication-induced muscle fiber atrophy E. Perifascicular muscle inflammation

B. Antibodies against presynaptic calcium channels

A 37 year old woman presents with the acute onset of a productive cough, fever, chills, and pleuritic chest pain. A chest xray reveals consolidation of the entire lower lobe of her right lung. She unexpectedly dies before treatment due to cardiac arrhythmia. Histologic examination of lung tissue taken at the time of autopsy reveals multiple suppurative, neutrophil rich exudates filling the bronchi, bronchioles, and alveolar spaces. The majoritiy of lung tissue from her right lower lung is involved int his inflammatory process. Hyaline membranes are not found. Which of the following is the most likely diagnosis? ``` A. Bronchiectasis B. Bronchopneumonia C. Interstitial pneumonitis D. Lobar pneumonia E. Pulmonary abscess ```

D. Lobar pneumonia

A 68 year old man who worked for many years int he asbestos industry presents with weight loss and increasing chest pain. Examination of his sputum finds very rare asbestos bodies, while a CT scan shows a large mas involving the basal surface of his left lung. Surgery is performed and gross examination finds a lesion similar in appearance to that seen in the associated gross photograph of a sagittal section of the lung. Sections from this mass examined by electron microscopy reveal tumor cells with long microvilli on their surface. Which of the following is the most likely diagnosis? ``` A. Malignant mesothelioma B. Malignant thymoma C. Metastatic malignant melanoma D. Poorly differentiated adenocarcinoma E. Small-cell carcinoma ```

A. Malignant mesothelioma

A 36 year old man with AIDS presents with fever, dry cough, and dyspnea. A chest xray shows bilateral and diffuse infiltrates. Laboratory studies reveal a CD4+ cell count of less than 200/uL. A lung biopsy discloses a chronic interstitial pneumonitis and an intra-alveolar foamy exudate. A silver stain of a bronchoalveolar lavage is shown in the image. Which of the following organisms is the most likely pathogen responsible for these pulmoary findings? ``` A. Cryptococcus neoformans B. Cytomegalovirus C. Histoplasma capsulatum D. Mycoplasma pneumoniae E. Pneumocystis jiroveci ```

E. Pneumocystis jiroveci

A 68 year old man complains of shortness of breath, hoarse-ness, productive cough, and bloody sputum of 2 weeks in duration. He admits to smoking two packs a day for 45 years and drinks occasionally. Recently, he has experienced a significant loss of appetite and weight loss. Physical examination shows pallor, cachexia, clubbing of the fingers, and barrel-shaped chest. A chest xray reveals a mass at the right lung apex. Histologic examination of a trans-bronchial biopsy is shown in the image. What is the appropriate histologic diagnosis? ``` A. Adenocarcinoma B. Mesothelioma C. Metastatic adenocarcinoma D. Small cell carcinoma E. Squamous cell carcinoma ```

E. Squamous cell carcinoma

A 48 year old woman with a long standing history of ulcerative colitis presents with anemia and hortness of breath. Laboratory studues show increased serum levels of carcinoembryonic antigen. A chest ray reveals multiple round masses in both lungs. Histologic examination of an open-lung biopsy discolses nodules that are composed of gland-like structures. WHat is the most likely diagnosis? ``` A. Adenocarcinoma B. Bronchioloalveolar carcinoma C. Eosinophilic granuloma D. Large cell undifferentiated carcinoma E. Metastatic carcinoma ```

E. Metastatic carcinoma

Fine needle aspiraton of a pulmonary lesion in a 35 year old alcoholic female is performed. The specimen is cultured, and grows several bacterial species, including peptostreptococcus and prevotella. The most likely predisposing factor in this patients condition is: ``` A. Mitral valve prolapse B. Chest trauma C. Urinary infection D. Sepsis E. Repeated vomiting F. Occult malignancy ```

E. Repeated vomiting

A newborn infant is noted to have coughing and cyanosis during feeding. This infant is also noted to have marked gastric dilation due to “swallowed” air. Workup reveals that this infant has the most common type of esophageal atresia. Which one of the listed statements correctly describes this type of congenital abnormality? a. Atresia of the esophagus with fistula between both segments and the trachea b. Atresia of the esophagus with fistula between the trachea and the blind upper segment c. Atresia of the esophagus with fistula between the trachea and the distal esophageal segment d. Atresia of the esophagus without tracheoesophageal fistula e. Fistula between a normal esophagus and the trachea

C.Atresia of the esophagus with fistula between the trachea and the distal esophageal segment

A 49-year-old female presents with increasing problems swallowing food (progressive dysphagia). X-ray studies with contrast reveal that she has a markedly dilated esophagus above the level of the lower esophageal sphincter (LES). No lesions are seen within the lumen of the esophagus. This patient’s symptoms are most likely caused by a. Decreased LES resting pressure b. Absence of myenteric plexus in the body of esophagus c. Absence of myenteric plexus at the LES d. Absence of submucosal plexus in the body of esophagus e. Absence of submucosal plexus at the LES

b. Absence of myenteric plexus in the body of esophagus

A 45-year-old male alcoholic with a history of portal hypertension presents with vomiting of blood (hematemesis) and hypotension. He denies any history of vomiting nonblood material or retching prior to vom- iting blood. During workup he dies suddenly. Based on his history and physical findings, histologic sections from his esophagus would most likely reveal a. Columnar epithelium in the distal esophagus b. Decreased ganglion cells in the myenteric plexus c. Dilated blood vessels in the submucosa d. Mucosal outpouchings (diverticula) in the distal esophagus e. Numerous intraepithelial neutrophils with scattered eosinophils

c. Dilated blood vessels in the submucosa

The photomicrograph below shows an esophageal biopsy taken 10 cm above the lower esophageal sphincter. This condition is most likely to occur as a result of a. Destruction of the ganglion cells in Auerbach’s plexus b. Ingestion of lye c. Long-term gastroesophageal reflux d. Portal hypertension with portacaval shunting e. Vomiting against a closed lower esophageal sphincter

c. Long-term gastroesophageal reflux

A 71-year-old male presents with dysphagia and is found to have a 5-cm mass that is located in the middle third of the esophagus and extends into adjacent lung tissue. A biopsy from this mass would most likely reveal a. A mass composed of benign cartilage b. A mass composed of benign smooth-muscle cells c. Infiltrating groups of cells forming glandular structures d. Infiltrating sheets of cells forming keratin e. Infiltrating single cells having intracellular mucin

d. Infiltrating sheets of cells forming keratin

A 2-week-old neonate presents with regurgitation and persistent, severe projectile vomiting. An olive-like epigastric mass is felt during phys- ical examination. A chest x-ray does not reveal the presence of bowel gas in the chest cavity. This infant’s mother did not have polyhydramnios during this pregnancy. What is the best treatment for this infant’s condition? a. Oral medication with omeprazole and clarithromycin b. Oral medication with vancomycin or metronidazole c. Surgery to cut a hypertrophied stenotic band at the pylorus d. Surgery to remove a mass of the adrenal gland e. Surgery to resect an aganglionic section of the intestines

c. Surgery to cut a hypertrophied stenotic band at the pylorus

A 49-year-old female taking ibuprofen for increasing joint pain in her hands presents with increasing pain in her midsternal area. Gastroscopy reveals multiple, scattered, punctate hemorrhagic areas in her gastric mucosa. Biopsies from one of these hemorrhagic lesions reveal mucosal erosions with edema and hemorrhage. No mucosal ulceration is seen. What is the best diagnosis? a. Active chronic gastritis b. Acute gastritis c. Autoimmune gastritis d. Chronic gastritis e. Peptic ulcer disease

b. Acute gastritis

A biopsy of the antrum of the stomach of an adult who presents with epigastric pain reveals numerous lymphocytes and plasma cells within the lamina propria, which is of normal thickness. There are also scattered neu- trophils within the glandular epithelial cells. A Steiner silver stain from this specimen is positive for a small, curved organism, which is consistent with a. Enteroinvasive Escherichia coli b. Enterotoxigenic E. coli c. Helicobacter pylori d. Salmonella typhi e. Shigella species

c. Helicobacter pylori

A 51-year-old male presents with epigastric pain that is lessened whenever he eats. A gastroscopy is performed to evaluate these gastric symptoms and a solitary gastric ulcer is seen. This ulcer is round and has punched-out straight walls. The margins of the ulcer are slightly elevated, and gastric rugae radiate outward from the ulcer. Based on these findings, in order to relieve the epigastric pain this patient should a. Take indomethacin twice a day b. Abstain from smoking c. Eat only two meals per day d. Drink alcohol with his evening meal e. Have surgery to resect the ulcer

b. Abstain from smoking

Gastric tumors with the histologic appearance illustrated in the pho- tomicrograph below are likely to have a gross appearance described best by which one of the listed terms? a. Cystosarcoma phyllodes b. Linitis plastica c. Peau d’orange d. Rodent ulcer e. Sarcoma botryoides

b. Linitis plastica

The overall incidence of malignancies of the stomach in the United States is decreasing primarily due to a decreased incidence of a. Signet ring carcinoma b. Primary non-Hodgkin’s lymphoma c. Intestinal-type gastric carcinoma d. Gastric stromal sarcoma e. Diffuse gastric carcinoma

c. Intestinal-type gastric carcinoma

The congenital abnormality of the ileum illustrated below a. Is present in approximately 20% of normal persons b. Is lined by heterotopic gastric mucosa in less than 2% of cases c. Often shows mucosal ulceration d. Is related to persistence of the vitellointestinal duct e. Usually arises from the mesenteric border of the ileum

d. Is related to persistence of the vitellointestinal duct

The signs and symptoms in which one of the listed individuals are most likely to be due to intussusception of the bowel? a. An 18-year-old male with fever, leukocytosis, and right lower quadrant abdom- inal pain b. A 3-year-old child with the abrupt onset of colicky abdominal pain and bloody, “currant jelly” stools c. A 55-year-old male with the acute onset of severe abdominal pain d. A 67-year-old female with fever, leukocytosis, and left lower quadrant abdomi- nal pain e. A newborn infant with projectile vomiting and midepigastric mass

b. A 3-year-old child with the abrupt onset of colicky abdominal pain and bloody, “currant jelly” stools

A 10-month-old, previously healthy male infant develops a severe, watery diarrhea 2 days after visiting the pediatrician for a routine checkup. The most likely diagnosis is a. Rotavirus infection b. Enterotoxigenic E. coli infection c. Entamoeba histolytica infection d. Lactase deficiency e. Ulcerative colitis

a. Rotavirus infection

The appearance of the small intestinal mucosa illustrated in the pho- tomicrograph below indicates a. Small intestinal lymphoma b. Whipple’s disease c. Celiac disease d. Crohn’s disease e. Giardia lamblia infestation

c. Celiac disease

A 45-year-old male presents with fever, chronic diarrhea, and weight loss. He is found to have multiple pain and swelling of his joints (migratory polyarthritis) and generalized lymphadenopathy. Physical examination reveals skin hyperpigmentation. A biopsy from his small intestines reveals the presence of macrophages in the lamina propria that contain PAS- positive cytoplasm. The best diagnosis for this individual is a. Abetalipoproteinemia b. Crohn’s disease c. Hartnup disease d. Nontropical sprue e. Whipple’s disease

e. Whipple’s disease

Which one of the following statements is more characteristic of ulcerative colitis than of Crohn’s disease? a. Fibrosis may produce a “lead pipe” appearance with “creeping fat” around the outside of the gut b. Inflammation begins in the rectum and extends proximally without skip lesions c. Microscopy may reveal transmural inflammation with noncaseating granulo- mas d. Sudden abdominal pain may result from intestinal obstruction due to peri- colonic abscess e. Transmural involvement may produce fissures, fistulas, and bowel obstruction

b. Inflammation begins in the rectum and extends proximally without skip lesions

A 39-year-old male presents with bloody diarrhea. Multiple stool examinations fail to reveal any ova or parasites. A barium examination of the patient’s colon reveals a characteristic “string sign.” A colonoscopy reveals the rectum and sigmoid portions of the colon to be unremarkable. A biopsy from the terminal ileum reveals numerous acute and chronic inflammatory cells within the lamina propria. Worsening of the patient’s symptoms results in emergency resection of the distal small intestines. Gross examination of this resected bowel reveals deep, long mucosal fis- sures extending deep into the muscle wall. Several transmural fistulas are also found. What is the best diagnosis for this patient? a. Ulcerative colitis b. Lymphocytic colitis c. Infectious colitis d. Eosinophilic colitis e. Crohn’s disease

e. Crohn’s disease

Examine the gross picture of a colon below. Which one of the fol- lowing best describes signs and symptoms that may be produced by this abnormality? a. Abdominal cramps, diarrhea, and episodic facial flushing b. Epigastric pain that is relieved by food intake c. Fever, leukocytosis, and left-sided abdominal pain d. Fever, leukocytosis, and right-sided abdominal pain e. Retrosternal pain, especially when lying down

c. Fever, leukocytosis, and left-sided abdominal pain

a. 5-hydroxyindoleacetic acid (5-HIAA)

During routine colonoscopy of a 65-year-old male, a 2-mm “dewdrop”-like polyp is found in the sigmoid colon. A biopsy of this lesion is seen in the picture below. What is the best diagnosis? a. Hyperplastic polyp b. Hamartomatous polyp c. Inflammatory polyp d. Adenomatous polyp e. Lymphoid polyp

a. Hyperplastic polyp

Familial polyposis coli is characterized by a. Autosomal recessive pattern of inheritance b. Multiple hamartomatous polyps throughout the colon c. 100% risk of carcinoma d. An association with fibromatosis and multiple osteomas e. An association with tumors of the central nervous system

c. 100% risk of carcinoma

The Astler-Coller modification of the Dukes classification is used to classify cancers of the a. Colon b. Liver c. Lung d. Pancreas e. Stomach

a. Colon

An 18-year-oldwomanpresentswithabdominalpainlocalizedtothe right lower quadrant, nausea and vomiting, mild fever, and an elevation of the peripheral leukocyte count to 17,000/μL. Examination of the surgically resected appendix is most likely to reveal a. An appendix with a normal appearance b. Neutrophils within the muscular wall c. Lymphoid hyperplasia and multinucleated giant cells within the muscular wall d. A dilated lumen filled with mucus e. A yellow tumor nodule at the tip of the appendix

b. Neutrophils within the muscular wall

Postmortem histologic sections taken from the liver of a 19-year-old female who died from an overdose of acetaminophen would most likely reveal a. Centrilobular necrosis b. Focal scattered necrosis c. Geographic necrosis d. Midzonal necrosis e. Periportal necrosis

a. Centrilobular necrosis

The basic abnormality involved in the pathophysiology of Crigler- Najjar syndrome is a. Excess production of bilirubin b. Reduced hepatic uptake of bilirubin c. Impaired conjugation of bilirubin d. Impaired canalicular transport of bilirubin glucuronide e. Extrahepatic biliary obstruction

c. Impaired conjugation of bilirubin

Kernicterus is a term that refers to the deposition of bilirubin in the a. Basal ganglia b. Cornea c. Myocardium d. Retina e. Skin

a. Basal ganglia

A 62-year-old male with hepatic failure secondary to cirrhosis devel- ops a pungent odor in his breath (fetor hepaticus). He is also noted to have marked ascites, gynecomastia, asterixis, and palmar erythema. His serum ammonia levels are found to be elevated. This patient’s gynecomastia is the result of a. Decreased synthesis of albumin b. Defective metabolism of the urea cycle c. Deranged bilirubin metabolism d. Impaired estrogen metabolism e. The formation of mercaptans in the gut

d. Impaired estrogen metabolism

A 44-year-old male presents with the sudden onset of severe right upper quadrant (RUQ) abdominal pain, ascites, tender hepatomegaly, and hematemesis. These symptoms are suggestive of Budd-Chiari syndrome, a disorder that is caused by a. Obstruction of the common bile duct b. Obstruction of the intrahepatic sinusoids c. Thrombosis of the hepatic artery d. Thrombosis of the hepatic vein e. Thrombosis of the portal vein

d. Thrombosis of the hepatic vein

A 27-year-old female presents with headaches, muscle pain (myal- gia), anorexia, nausea, and vomiting. She denies any history of drug or alcohol use, but upon further questioning she states that recently she has lost her taste for coffee and cigarettes. Physical examination reveals a slight yellow discoloration of her scleras, while laboratory results indicate a serum bilirubin level of 1.8 mg/dL, and aminotransferases (AST and ALT) levels are increased. These signs and symptoms are most consistent with a diagnosis of a. Gilbert’s syndrome b. Chronic hepatitis c. Amebic liver abscess d. Acute viral hepatitis e. Acute hepatic failure

d. Acute viral hepatitis

A 4-year-old boy presents with mild fatigue and malaise. Several other children in the day-care center he attends 5 days a week have devel- oped similar illnesses. Physical examination finds mild liver tenderness, but no lymphadenopathy is noted. Laboratory examination finds mildly elevated serum levels of liver enzymes and bilirubin. The boy recovers from his mild illness without incident. This disorder was most likely caused by infection with a. Cytomegalovirus (CMV) b. Epstein-Barr virus (EBV) c. Group A β-hemolytic streptococcus d. Hepatitis A virus e. Hepatitis B virus

d. Hepatitis A virus

Which one of the following hepatitis profile patterns is most consis- tent with an asymptomatic hepatitis B carrier? Hepatitis B Surface Antigen (HBsAg) a. Positive b. Positive c. Positive d. Positive e. Negative Hepatitis B e Antigen (HBeAg) Negative Positive Positive Negative Negative Antibody to Surface Antigen (anti-HBs) Negative Negative Negative Negative Positive Antibody to Core Antigen (anti-HBc) Negative Negative Positive Positive Positive

D. postive negative negative positive

A mononuclear portal inflammatory infiltrate that disrupts the limit- ing plate and surrounds individual hepatocytes (piecemeal necrosis) is characteristic of a. Ascending cholangitis b. Chronic active hepatitis c. Acute alcoholic hepatitis d. Cholestatic jaundice e. Nutritional cirrhosis

b. Chronic active hepatitis

The combination of episodic elevations in serum transaminase levels along with fatty change in hepatocytes is most suggestive of infection with a. Hepatitis A virus b. Hepatitis B virus c. Hepatitis C virus d. Hepatitis D virus e. Hepatitis E virus

c. Hepatitis C virus

A 49-year-old female presents with increasing fatigue and is found to have elevated liver enzymes (AST and ALT). You follow her in your clinic and find over the next 9 months that her liver enzymes have remained ele- vated. All serologic tests for viral markers are within normal limits. A liver biopsy reveals chronic inflammation in the portal triads that focally destroys the limiting plate and “spills over” into the adjacent hepatocytes. There are no granulomas present, and there is no evidence of fibrosis sur- rounding any of the bile ducts within the portal triads. Anti-smooth- muscle antibodies and antinuclear antibodies are found in the patient’s serum. An LE cell test is positive. What is the diagnosis? a. Autoimmune hepatitis b. Chronic persistent hepatitis c. Primary biliary cirrhosis d. Primary sclerosing cholangitis e. Systemic lupus erythematosus

a. Autoimmune hepatitis

Dilated sinusoids and irregular cystic spaces filled with blood within the liver, which may rupture, leading to massive intraabdominal hemor- rhage, are most commonly associated with a. Salicylates b. Estrogens c. Anabolic steroids d. Acetaminophen e. Vinyl chloride

c. Anabolic steroids

A 49-year-old male presents with symptoms that developed follow- ing a long weekend of binge drinking. His serum reveals a γ-glutamyl transferase (GGT) level of 65 IU/L. A liver biopsy reveals fatty change (steatosis) of numerous hepatocytes. This patient’s liver abnormality is most likely the result of a. Decreased free fatty acid delivery to the liver b. Decreased production of triglycerides c. Increased mitochondrial oxidation of fatty acids d. Increased NADH production e. Increased release of lipoproteins

d. Increased NADH production

Cirrhosis, as illustrated in the photomicrograph below, is character- ized histologically by finding a. Enlarged hepatocytes with large purple intranuclear inclusions b. Fibrosis and regenerative nodules of hepatocytes c. Increased amounts of iron within Kupffer cells and hepatocytes d. Large red aggregates of PAS-positive, diastase-resistant material within hepato- cytes e. Perivenular fibrosis with Mallory bodies

b. Fibrosis and regenerative nodules of hepatocytes

Which of the listed types of cells found within the liver is the major source of the excess collagen deposited in cirrhosis? a. Hepatocytes b. Kupffer cells c. Ito cells d. Endothelial cells e. Bile duct epithelial cells

c. Ito cells

A 36-year-old male presents because his skin has been darkening recently. You notice that his skin has a dark, somewhat bronze color. Workup reveals signs of diabetes mellitus. His serum iron is found to be 1150 mg/dL, and his transferrin saturation is 98%. A liver biopsy is per- formed and reveals extensive deposits of hemosiderin in the hepatocytes and Kupffer cells. The mechanism most likely responsible for this constel- lation of findings is a. Defective excretion of copper into the bile b. Defective synthesis of α1 antitrypsin c. Defective synthesis of glycogen d. Excessive absorption of galactose from the small intestines e. Excessive reabsorption of iron from the small intestines

e. Excessive reabsorption of iron from the small intestines

A 5-year-old girl is brought in with severe vomiting that has devel- oped suddenly 5 days after she has had a viral infection. Upon questioning, her parents indicate that she was given aspirin for several days to treat a fever that occurred with the viral illness. She is hospitalized and quickly develops signs of cerebral edema. Liver tissue reveals marked steatosis. What is the correct diagnosis? a. α1 antitrypsin deficiency b. Dubin-Johnson syndrome c. Hepatitis D infection d. Reye’s syndrome e. Wilson’s disease

d. Reye’s syndrome

Which one of the following tumors is most likely to be associated with primary sclerosing cholangitis? a. Adenocarcinoma of the gallbladder b. Adenocarcinoma of the pancreas c. Cholangiocarcinoma d. Hepatoblastoma e. Hepatocellular carcinoma

c. Cholangiocarcinoma

A 26-year-old presents with right upper quadrant abdominal pain and is found to have a large cyst in the right lobe of his liver. X-rays reveal the cyst to have a calcified wall. The cyst is then surgically excised. Exami- nation of this tissue histologically reveals a thick, acellular, laminated eosinophilic wall. The fluid within the cyst is found to be granular and con- tain numerous small larval capsules with scoleces (“brood capsules”). Which one of the following is the correct diagnosis? a. Pyogenic liver abscess b. Amebic liver abscess c. Hydatid cyst d. Schistosomiasis e. Oriental cholangiohepatitis

c. Hydatid cyst

An oval lesion is found in the right lobe of the liver in an otherwise asymptomatic 24-year-old female. Surgical resection finds a single well- demarcated lesion that has a prominent, central, stellate white scar. This gross appearance is most consistent with a diagnosis of a. Metastatic adenocarcinoma b. Focal nodular hyperplasia c. Hemangioma d. Hepatocellular carcinoma e. Nodular regenerative hyperplasia

b. Focal nodular hyperplasia

A 51-year-old male alcoholic with a history of chronic liver disease presents with increasing weight loss and ascites. Physical examination reveals a slightly enlarged, soft, nontender prostate. Examination of the scrotum is unremarkable, and fecal occult blood tests are negative. A chest x-ray is unremarkable, but a CT scan of the abdomen reveals a single mass in the left lobe of the liver. Workup reveals elevated levels of α-fetoprotein in this patient’s blood. At this point the most likely diagnosis for the liver mass is a. Angiosarcoma b. Cholangiocarcinoma c. Hepatoblastoma d. Hepatocellular carcinoma e. Metastatic colon cancer

d. Hepatocellular carcinoma

A deficiency of which one of the listed enzymes is most likely to be associated with the formation of multiple pale yellow, hard, round stones within the gallbladder? a. 1-α-hydroxylase b. 7-α-hydroxylase c. 11-hydroxylase d. 17-hydroxylase e. 21-hydroxylase

b. 7-α-hydroxylase

A 54-year-old male presents with a high fever, jaundice, and colicky abdominal pain in the right upper quadrant. The gallbladder cannot be palpated on physical examination. Workup reveals hemoglobin level of 15.3 g/dL, unconjugated bilirubin level of 0.9 mg/dL, conjugated bilirubin level of 1.1 mg/dL, and alkaline phosphatase level of 180 IU/L. What is the correct diagnosis? a. Acute cholecystitis b. Chronic cholecystitis c. Bile duct obstruction by a stone d. Carcinoma of the gallbladder e. Carcinoma of the head of the pancreas

c. Bile duct obstruction by a stone

An infant is brought in by his mother, who says that his skin tastes salty. With time this patient’s pancreas is expected to undergo progressive fibrosis with atrophy of the exocrine glands and cystic dilation of the ducts. The basic abnormality in this infant involves a. Decreased synthesis of surface receptor b. Decreased intracellular cAMP c. Decreased glycosylated chloride channel d. Increased phosphorylation of chloride channel e. Increased ductal secretion of water

c. Decreased glycosylated chloride channel

A 54-year-old male alcoholic presents with the sudden onset of severe, constant epigastric pain that radiates to his midback. Further eval- uation finds fever, steatorrhea, and discoloration around his flank and umbilicus. Laboratory tests find elevated serum levels of amylase and lipase. What is the most likely cause of these findings? a. Acute appendicitis b. Acute cholangitis c. Acute cholecystitis d. Acute diverticulitis e. Acute pancreatitis

e. Acute pancreatitis

A 45-year-old male presents with weight loss, steatorrhea, and mal- absorption. A CT scan of the abdomen reveals a questionable mass in the head of the pancreas. A biopsy specimen microscopically reveals chronic inflammation and atrophy of the pancreatic acini with marked fibrosis. No malignancy is identified. What is the most common cause of this patient’s disease in adults in the United States? a. Abdominal trauma b. Chronic alcoholism c. Cystic fibrosis d. Gallstones e. Hyperlipidemia

b. Chronic alcoholism

A middle-aged male alcoholic has had repeated bouts of pancreatitis following periods of binge drinking. In recent months he has had a low- grade fever, and on examination a mass is palpated in the epigastrium. This mass, removed at celiotomy, is shown in the photograph below. What is the diagnosis? a. Pancreatic carcinoma b. Mucinous cystadenoma c. Perforated ulcer d. Pancreatic pseudocyst e. Cystic hepatoma

d. Pancreatic pseudocyst

According to Courvoisier’s law, a pancreatic cancer located in the head of the pancreas would characteristically produce a. Migratory thrombophlebitis b. Obstructive jaundice and a dilated gallbladder c. Obstructive jaundice and a nonpalpable gallbladder d. Steatorrhea and a nontender gallbladder e. Steatorrhea and a tender gallbladder

b. Obstructive jaundice and a dilated gallbladder

A 55-year-old female with painful chronic diarrhea, multiple recur- rent duodenal ulcers, and increased basal gastric acid output is most likely to have a. A gastrin-secreting tumor of the pancreas b. A serotonin-secreting tumor of the ileum c. A somatostatin-secreting tumor of the duodenum d. An epinephrine-secreting tumor of the adrenal medulla e. An erythropoietin-secreting tumor of the liver

a. A gastrin-secreting tumor of the pancreas

Whipple’s triad, seen in patients with a tumor that originates from the β cells of the pancreas, consists of a. Diabetes mellitus, cholelithiasis, and steatorrhea b. Hypercalcemia, signs of hypercalcemia, and signs of hypercalcemia relieved by hyperventilation c. Hypoglycemia, signs of hypoglycemia, and signs of hypoglycemia relieved by glucose d. Mild diabetes mellitus, necrolytic migratory erythema, and venous thrombi e. Watery diarrhea, hypochloremia, and achlorhydria

c. Hypoglycemia, signs of hypoglycemia, and signs of hypoglycemia relieved by glucose

An 11-year-old male presents with weight loss and dehydration despite excessive eating (polyphagia) and drinking of fluids (polydipsia). He has also had to go to the bathroom more often recently, and he has even had to wake up during the night to urinate. Laboratory examination reveals fasting hyperglycemia, while urinary examination reveals 4+ glucose (on a scale of 0 to 4+) and trace ketones. Which one of the listed abnormalities is the best diagnosis for this child? a. Insulin-dependent diabetes mellitus (IDDM) b. Nonobese non-insulin-dependent diabetes mellitus (NIDDM) due to impaired insulin release c. Nonobese non-insulin-dependent diabetes mellitus (NIDDM) due to insulin resistance d. Mature-onset diabetes of the young (MODY) e. Diabetes insipidus

a. Insulin-dependent diabetes mellitus (IDDM)

Which one of the listed findings is more characteristic of juvenile diabetes mellitus (type 1 diabetes mellitus) than of adult onset diabetes mellitus (type 2 diabetes mellitus)? a. Amyloid deposition occurs in islets of Langerhans b. It is associated with HLA-DR3 and HLA-DR4 c. Numbers of insulin receptors on adipocytes are decreased d. There is insulin resistance that results from marked obesity e. Treatment with oral hypoglycemic agents is effective

b. It is associated with HLA-DR3 and HLA-DR4

A laboratory test that measures serum levels of Hb A1c (glycosylated hemoglobin) can be used to measure long-term control of an individual with a. Autoimmune hemolytic anemia b. Cystic fibrosis c. Diabetes insipidus d. Diabetes mellitus e. Megaloblastic anemia

d. Diabetes mellitus

Which one of the listed statements best characterizes the renal abnormality described as Kimmelstiel-Wilson disease? a. Amyloid nephrosis b. Capsular drops c. Glycogen nephrosis d. Hyaline arteriolosclerosis e. Nodular glomerulosclerosis

e. Nodular glomerulosclerosis

Histologic sections (routine H&E stain) of lung reveal the alveoli to be filled with pale, nongranular pink fluid. Neither leukocytes nor erythro- cytes are present within this fluid. What is the most likely (i.e., most com- mon) cause of this abnormality? a. Bacterial pneumonia b. Congestive heart failure c. Lymphatic obstruction by tumor d. Pulmonary embolus e. Viral pneumonia

b. Congestive heart failure

A 7-year-old boy accidentally inhales a small peanut, which lodges in one of his bronchi. A chest x-ray reveals the mediastinum to be shifted toward the side of the obstruction. The best description for the lung changes that result from this obstruction is a. Absorptive atelectasis b. Compression atelectasis c. Contraction atelectasis d. Patchy atelectasis e. Hyaline membrane disease

a. Absorptive atelectasis

Histologic sections of lung tissue from an individual with adult res- piratory distress syndrome (ARDS) are most likely to reveal a. Angioinvasive infiltrates of pleomorphic lymphoid cells b. Deposits of needle-like crystals from the membranes of eosinophils c. Infiltrating groups of malignant cells having intercellular bridges d. Irregular membranes composed of edema, fibrin, and dead cells lining alveoli e. Plexiform lesions within pulmonary arterioles

d. Irregular membranes composed of edema, fibrin, and dead cells lining alveoli

While recovering in bed 1 week after an abdominal hysterectomy, a 42-year-old female develops acute shortness of breath with hemoptysis. Physical examination finds the patient to be afebrile with moderate respi- ratory distress, calf tenderness, and a widely split S2. What is the correct diagnosis? a. Atelectasis b. Bacterial pneumonia c. Pulmonary embolus d. Pulmonary hypertension e. Viral pneumonia

c. Pulmonary embolus

A specimen from a lung biopsy reveals occasional plexiform lesions within pulmonary arterioles. This abnormality is most characteristic of a. Churg-Strauss syndrome b. Adult respiratory distress syndrome c. Wegener’s granulomatosis d. Pulmonary hypertension e. Lymphomatoid granulomatosis

d. Pulmonary hypertension

A 19-year-old female presents with urticaria that developed after she took aspirin for a headache. She has a history of chronic rhinitis, and phys- ical examination reveals the presence of nasal polyps. This patient is at an increased risk of developing which one of the following pulmonary dis- eases following the ingestion of aspirin? a. Asthma b. Chronic bronchitis c. Emphysema d. Interstitial fibrosis e. Pulmonary hypertension

a. Asthma

Which one of the following is a correct association concerning the pathogenesis of smoking-induced emphysema? a. Destruction of distal acinus = centrilobular emphysema b. Destruction of distal acinus = paraseptal emphysema c. Destruction of entire acinus = panlobular emphysema d. Destruction of proximal acinus = centrilobular emphysema e. Destruction of proximal acinus = paraseptal emphysema

d. Destruction of proximal acinus = centrilobular emphysema

An abnormality that inhibits the normal functioning of the ATPase- containing dynein arms of cilia is most likely to produce a. Asthma b. Bronchiectasis c. Cirrhosis d. Emphysema e. Steatosis

b. Bronchiectasis

Histologic examination of lung tissue reveals multiple suppurative, neutrophil-rich exudates that fill the bronchi and bronchioles and spill over into the adjacent alveolar spaces only. The majority of lung tissue is not involved in this inflammatory process. Hyaline membranes are not found. This histologic appearance best describes a. Bronchiectasis b. Bronchopneumonia c. Lobar pneumonia d. Interstitial pneumonitis e. Pulmonary abscess

b. Bronchopneumonia

A 44-year-old male alcoholic presents with fever and a productive cough with copious amounts of foul-smelling purulent sputum. Physical examination finds that changing the position of this individual produces paroxysms of coughing. Which one of the following is most likely respon- sible for this patient’s signs and symptoms? a. Esophageal cancer b. Esophageal reflux c. Myocardial infarction d. Pulmonary abscess e. Pulmonary infarction

d. Pulmonary abscess

A 25-year-old female presents with fever, malaise, headaches, and muscle pain (myalgia). A chest x-ray reveals bilateral infiltrates. You draw a tube of blood from the patient (the tube contains anticoagulant) and place the tube in a cup of ice. After the blood has cooled, you notice that the red cells have agglutinated (not clotted). This agglutination goes away after you warm up the tube of blood. This patient’s illness is most likely due to infec- tion with a. Influenza A virus b. Mycoplasma pneumoniae c. Streptococcus pneumoniae d. Pneumocystis pneumoniae e. Mycobacterium tuberculosis

b. Mycoplasma pneumoniae

A 23-year-old HIV-positive male presents with a cough and increas- ing shortness of breath. A histologic section from a transbronchial biopsy stained with Gomori’s methenamine-silver stain is shown in the photomi- crograph below. What is the correct diagnosis? a. Pseudomonas pneumonia b. Aspergillus pneumonia c. Pneumocystis carinii pneumonia d. Cytomegalovirus pneumonia e. Influenza pneumonia

c. Pneumocystis carinii pneumonia

A routine chest x-ray performed on an asymptomatic adult male patient who works at sandblasting reveals a fine nodularity in the upper zones of the lungs and “eggshell” calcification of the hilar lymph nodes. The patient’s serum calcium level is 9.8 mg/dL, while his total protein is 7.2 g/dL. He denies any history of drug use or cigarette smoking. A biopsy from his lung reveals birefringent particles within macrophages. This mate- rial is most likely to be a. Asbestos b. Beryllium c. Carbon d. Silica e. Talc

d. Silica

he photomicrograph of the bronchial washing specimen shown below depicts a. Schaumann bodies b. Ferruginous bodies c. Cholesterol crystals d. Candida species e. Silica particles

b. Ferruginous bodies

A 24-year-old African American female presents with nonspecific symptoms including fever and malaise. A chest x-ray reveals enlarged hilar lymph nodes (“potato nodes”), while her serum calcium level is found to be elevated. Biopsies of the enlarged hilar lymph nodes would most likely reveal a. Caseating granulomas b. Dense, granular, PAS-positive, eosinophilic material c. Markedly enlarged epithelial cells with intranuclear inclusions d. Noncaseating granulomas e. Numerous neutrophils with fibrin deposition

d. Noncaseating granulomas

A 61-year-old male presents with increasing shortness of breath. A chest x-ray reveals a diffuse pulmonary infiltrate, while a transbronchial biopsy reveals fibrosis of the walls of the alveoli, many of which contain sheets of “desquamated” cells. Which of the following would be the best therapy for this patient? a. Theophylline b. Steroids c. Antibiotics d. Isoniazid e. Symptomatic treatment only

b. Steroids

Sections of the lung from a patient with Wegener’s granulomatosis who presents clinically with hemoptysis are most likely to show a. Atypical lymphocytes invading blood vessels b. Granulomatous inflammation of blood vessels with numerous eosinophils c. Granulomatous inflammation of bronchi with Aspergillus d. Large, serpiginous necrosis with peripheral, palisading macrophages e. Necrotizing hemorrhagic interstitial pneumonitis

d. Large, serpiginous necrosis with peripheral, palisading macrophages

A 45-year-old man presents with shortness of breath, cough with mucoid sputum, and some weight loss, and has diffuse, bilateral alveolar infiltrates on chest x-ray. Pulmonary function tests reveal decreased diffus- ing capacity and hypoxia. The patient had worked for several years at grinding aluminum. The photomicrograph below is from a lung biopsy. Your diagnosis is a. Pneumocystis carinii pneumonia b. Diffuse alveolar damage c. Pulmonary edema d. Pulmonary alveolar proteinosis e. Lipid pneumonia

d. Pulmonary alveolar proteinosis

Bronchiolitis obliterans with organizing pneumonia (BOOP) is char- acterized histologically in the lung by a. Asteroid bodies in giant cells within bronchioles b. Loose fibrous tissue within bronchioles and alveoli c. Multiple rheumatoid nodules within the interstitial tissue d. Numerous eosinophils within the walls of the alveoli e. Numerous lymphocytes within the walls of the alveoli

b. Loose fibrous tissue within bronchioles and alveoli

A 54-year-old male presents with several problems involving his face and pain in his shoulder. He states that he has smoked 2 packs of cigarettes a day for almost 40 years. Physical examination reveals ptosis of his left upper eyelid, constriction of his left pupil, and lack of sweating (anhidro- sis) on the left side of his face. No other neurologic abnormalities are found. This individual most likely has a. A bronchioloalveolar carcinoma involving the left upper lobe b. A small cell carcinoma involving the hilum of his left lung c. A squamous cell carcinoma involving the left mainstem bronchus d. An adenocarcinoma involving the apex of his left lung e. An endobronchial carcinoid tumor involving the right mainstem bronchus

d. An adenocarcinoma involving the apex of his left lung

During a routine physical examination, a 43-year-old male is found to have a 2.5-cm “coin” in the peripheral portion of his right upper lobe (RUL). Several sputum samples sent for cytology are unremarkable, and a bronchoscopic examination is also unremarkable. Surgery is performed and the mass is resected. Histologic examination reveals lobules of connec- tive tissue that contain mature hyaline cartilage. These lobules are sepa- rated by clefts that are lined by respiratory epithelium. What is the correct diagnosis? a. Adenocarcinoma b. Bronchioloalveolar carcinoma c. Carcinoid d. Fibroma e. Hamartoma

e. Hamartoma

A 67-year-old male long-term smoker presents with weight loss, a persistent cough, fever, chest pain, and hemoptysis. Physical examination reveals a cachectic male with clubbing of his fingers and dullness to per- cussion over his right lower lobe. A chest x-ray reveals a 3.5-cm hilar mass on the right and postobstructive pneumonia of the right lower lobe. Spu- tum cytology is suspicious for malignant cells. Histologic examination of a transbronchial biopsy specimen reveals infiltrating groups of cells with scant cytoplasm. No glandular structures or keratin production are seen. The nuclei of these cells are about twice the size of normal lymphocytes and do not appear to have nucleoli. What is the correct diagnosis of the lung lesion in this individual? a. Adenocarcinoma b. Hamartoma c. Large cell undifferentiated carcinoma d. Small cell undifferentiated carcinoma e. Squamous cell carcinoma

d. Small cell undifferentiated carcinoma

A 39-year-old female presents with a cough and increasing shortness of breath. A chest x-ray is interpreted by the radiologist as showing a right lower lobe (RLL) pneumonia. No mass lesions are seen. The woman is treated with antibiotics, but her symptoms do not improve. On her return visit, the area of consolidation appears to be increased. Bronchoscopy is per- formed. No bronchial masses are seen, but a transbronchial biopsy is obtained in an area of mucosal erythema in the RLL. After the diagnosis is made, the RLL is removed and a section from this specimen reveals well- differentiated mucus-secreting columnar epithelial cells that infiltrate from alveolus to alveolus. What is the correct diagnosis? a. Bronchioloalveolar carcinoma b. Carcinoid c. Large cell carcinoma d. Small cell carcinoma e. Squamous cell carcinoma

a. Bronchioloalveolar carcinoma

Which one of the listed abnormalities is an example of a type of pleural effusion that is better classified as an exudate (inflammatory edema) rather than a transudate? a. Chylothorax b. Empyema c. Hemothorax d. Hydrothorax e. Pneumothorax

b. Empyema

A 19-year-old female presents with sudden, severe right-sided chest pain that developed shortly after she had been placing heavy boxes on shelves in her garage. Physical examination reveals an afebrile female in mild respiratory distress. Breath sounds are markedly decreased on the right, and the right lung is hyperresonant to percussion. Which one of the following is most likely present in this individual? a. Pneumoconiosis b. Pneumocystis infection c. Bacterial pneumonia d. Viral pneumonia e. Pneumothorax

e. Pneumothorax

A 57-year-old male presents with a lesion similar to that seen in this gross photograph of a sagittal section of the lung. Which one of the listed characteristics, if present in this lesion, would favor the diagnosis of mesothelioma? a. Lamellar bodies seen by electron microscopy b. Long microvilli seen by electron microscopy c. Peripheral cytoplasmic keratin staining d. Positive CEA reaction e. Positive Leu-M1 staining

b. Long microvilli seen by electron microscopy

Block 2 Flashcards

(116 cards)