q bank

Question 1

A 52-year-old woman tells her physician that
she is concerned about her risk for developing endometrial cancer. Which of the following factors poses the largest risk for developing endometrial cancer?
a. Alcoholism
b Early sexual activity
c Prolonged unopposed estrogen use
d Low-fiber diet
e Multiparity

Answer 1

[Y]Prolonged unopposed estrogen use

Question 2

A 28-year-old married woman who has been
trying to become pregnant for the past 5 months presents to the emergency department with sudden and severe abdominal pain. Ultrasonography shows a mass in her left fallopian tube with free fluid in the cul-de-sac. Previous infection by which of the following agents most likely put this patient at a higher risk for developing this complication?
a Escherichia coli
b Chlamydia trachomatis
c Human papilloma virus
d Streptococcus agalactiae
e Herpes simplex virus

Answer 2

[Y]Chlamydia trachomatis

Question 3

A 1-month-old boy is brought to the pediatrician by his mother for a well-baby visit for the first time since his birth. On examination, the doctor notes that the patient has cryptorchidism, with both testicles remaining undescended. This patient is at increased risk for developing which of the following conditions?
a Hypogonadotropic hypogonadism
b Indirect inguinal hernia
c Retractile testis
d Testicular cancer
e Torsion of the spermatic cord

Answer 3

[Y]Testicular cancer

Question 4

A 69-year-old man presents with urinary frequency, nocturia, dribbling, and difficulty in starting and stopping urination. Rectal examination reveals the prostate to be enlarged, firm, and rubbery. A needle biopsy reveals increased numbers of glandular elements and stromal tissue. The glands are found to have a double layer of epithelial cells. Prominent nuclei or back-to-back glands are not seen. Which of the following is the most likely diagnosis?
a Atrophic prostatitis
b Atypical small acinar proliferation
c High-grade prostatic intraepithelial neoplasia
d Benign prostatic hyperplasia
e Prostatic adenocarcinoma

Answer 4

[Y]Benign prostatic hyperplasia

Question 5

Pediatric urology’s patient has a history of recurrent urinary tract
infections. Urine cultures have grown Escherichia coli, Proteus
mirabilis, and Enterococcus. Physical examination now shows
an abnormal constricted opening of the urethra on the ventral
aspect of the penis, 1.5 cm from the tip of the glans penis.
There also is a cryptorchid testis on the right and an inguinal
hernia on the left. What term best describes the child’s penile
abnormality?
a Bowen disease
b Paraphimosis
c Hypospadias
d Epispadias
e Balanitis

Answer 5

[Y]Hypospadias

Question 6

The patient recently noticed a pale area of discoloration
on the labia. Pelvic examination shows the presence
of a 0.6-cm flat, white area on the right labia majora. A biopsy
specimen is obtained and on microscopic examination shows
dysplastic cells that occupy half the thickness of the squamous
epithelium, with minimal underlying chronic inflammation.
In situ hybridization shows human papillomavirus type 16
DNA in the epithelial cells. What is the most likely diagnosis?
a Vulvar intraepithelial neoplasia
b Chronic vulvitis
c Condyloma acuminatum
d Lichen sclerosus et atrophicus
e Squamous hyperplasia

Answer 6

[Y]Vulvar intraepithelial neoplasia

Question 7

45 year old woman patient has had menometrorrhagia for the past 1.5 months. She has no history of prior irregular menstrual bleeding, and she has not yet reached menopause. On physical
examination, there are no vaginal or cervical lesions, and the uterus appears normal in size, but there is a right adnexal mass. An abdominal ultrasound scan shows the presence of a 6.5-cm solid right adnexal mass. Endometrial biopsy shows
hyperplastic endometrium, but no cellular atypia. What is the most likely lesion that underlies her menstrual abnormalities?
a Corpus luteum cyst
b Mature cystic teratoma
c Endometrioma
d Metastasis
e Polycystic ovarian syndrome
f Granulosa-theca cell tumor

Answer 7

[Y]Granulosa-theca cell tumor

Question 8

80 year old patient, previously healthy woman feels a lump
in her right breast. The physician palpates a 2.5-cm firm mass in
the upper outer quadrant. Nontender right axillary lymphadenopathy is present. A lumpectomy with axillary lymph node dissection is performed. Microscopic examination shows that
the mass is an infiltrating ductal carcinoma. Three of 10 axillary
nodes contain metastases. Flow cytometry on the carcinoma
cells shows a small aneuploid peak and high S-phase. Immunohistochemical tests show that the tumor cells are positive
for estrogen and progesterone receptor (ER/PR), negative for
HER2/neu expression, and positive for cathepsin D expression.
What is the most important prognostic factor for this patient?
a Lack of HER2/neu expression in the carcinoma
b Histologic subtype of carcinoma
c Expression of stromal proteases in the carcinoma
d Presence of lymph node metastases
e Age at diagnosis
f DNA content in the carcinoma
g Estrogen receptor positivity

Answer 8

[Y]Presence of lymph node metastases

Question 9

30 year old woman, gravida 3 para 3, comes to the office with worsening shortness of breath over the past week. She had a recent episodes of hemoptysis. The patient has also had ongoing vaginal bleeding after an uncomplicated vaginal delivery of her son 9 weeks ago. She has no bleeding elsewhere, and she has not resumed sexual intercourse. On physical examination, the patient’s uterus is enlarged and adnexa are normal. Laboratory studies show markedly increased beta-hCG levels. Chest radiograph shows multiple bilateral lung nodules. Which of the following would most likely be found on endometrial curettage in this patient?
a Bundles of smooth muscle cells with fibrosis
b Diffusely hydropic chorionic villi
c Fetal tissue with triploid karyotype
d Proliferation of cytotrophoblasts and syncytiotrophoblasts
e Glands lined by atypical columnar epithelial cells

Answer 9

[Y]Proliferation of cytotrophoblasts and syncytiotrophoblasts

Question 10

35 year old women, gravida 1, para 0, comes to the office for a routine prenatal checkup at approximately 33 weeks gestation. The patient has started having persistent, throbbing headaches that are not relieved by acetaminophen. She has no nausea, vomiting, or abdominal pain. She eats a well-balanced diet, takes prenatal vitamins, and has normal bowel movements. Medical history is unremarkable and prenatal care has been uneventful. Review of medical records show that her blood pressure was 12/75 mm Hg at 28 weeks gestation. Today, blood pressure is 170/100 mm Hg, and heart rate 95 per minute. Which of the following additional findings is most likely present in this patient?
a Proteinuria
b Splenomegaly
c Thrombocytosis
d Ketonuria
e Fasting hyperglycemia
f Arteriovenous nicking

Answer 10

[Y]Proteinuria

Question 11

A 35-year-old woman is seen 6 months
after giving birth to a normal infant. She
suffered severe cervical lacerations during
delivery, resulting in hemorrhagic shock.
Following blood transfusion and surgical
repair, postpartum recovery has so far been
uneventful. She now complains of continued
amenorrhea and loss of weight and
muscle strength. Further investigation might
be expected to demonstrate which of the
following findings?
a Decreased serum cortisol
b Hyperestrinism
c Hyperglycemia
d Increased hair growth in a male distribution pattern

Answer 11

[Y]Decreased serum cortisol

Question 12

During a yearlong training program, a
23-year-old female Air Force officer falls in
class rank from first place to last place. She
has also noted a lower pitch to her voice
and coarsening of her hair, along with an
increased tendency toward weight gain,
menorrhagia, and increasing intolerance
to cold. Which of the following laboratory
abnormalities is expected?
a Increased serum free T4
b Increased serum T3 resin uptake
c Increased saturation of thyroid hormone-binding sites on TBG
d Increased serum TSH

Answer 12

[Y]Increased serum TSH

Question 13

A 32-year-old woman presents with
amenorrhea, galactorrhea, and visual field
defects, all of several months’ duration.
Magnetic resonance imaging reveals a
hypophyseal mass impinging on the optic
chiasm. This is most likely a(n):
a prolactinoma.
b somatotropic adenoma
c corticotropic adenoma.
d craniopharyngioma.

Answer 13

[Y]prolactinoma.

Question 14

A 23-year-old woman presents with
tremor, restlessness, heat intolerance, palpitation,
and unexplained weight loss. The
thyroid is symmetrically enlarged, the pulse
is rapid, the skin is moist and warm, and
exophthalmos is apparent. This condition is
considered to be :
a autoimmune.
b congenital.
c iatrogenic.
d infectious.

Answer 14

[Y]autoimmune

Question 15

A palpable mass is noted in the right
lobe of the thyroid of a 45-year-old man who
visits his physician for a periodic checkup.
A biopsy is performed and results in a diagnosis
of medullary carcinoma of the thyroid.
Which of the following histologic features of
thyroid disease would most likely be present
in this biopsy specimen?
a Tumor cells with “Orphan Annie” nuclei
b Psammoma bodies
c Tumor cells embedded in an amyloid-laden stroma
d Infiltrates of lymphocytes with germinal center formation

Answer 15

[Y]Tumor cells embedded in an amyloid-laden stroma

Question 15

A palpable mass is noted in the right
lobe of the thyroid of a 45-year-old man who
visits his physician for a periodic checkup.
A biopsy is performed and results in a diagnosis
of medullary carcinoma of the thyroid.
Which of the following histologic features of
thyroid disease would most likely be present
in this biopsy specimen?
a Tumor cells with “Orphan Annie” nuclei
b Psammoma bodies
c Tumor cells embedded in an amyloid-laden stroma
d Infiltrates of lymphocytes with germinal center formation

Answer 15

[Y]Tumor cells embedded in an amyloid-laden stroma

Question 16

On routine examination, it is discovered
that a 35-year-old woman had been
exposed in utero to DES administered
to her mother, who had had a history of
recurrent spontaneous abortion. This
history suggests that the patient might be
at increased risk of :
a adenomyosis.
b clear cell adenocarcinoma.
c lichen sclerosis.
d squamous cell carcinoma

Answer 16

[Y]clear cell adenocarcinoma.

Question 17

A 23-year-old African-American man who
is known to have sickle cell anemia presents
to the emergency department with a painful
erection. The patient explains that the erection
had started 3 hours ago. This condition
is referred to as :
a balanitis.
b hypospadias.
c Peyronie disease.
d priapism.

Answer 17

[Y]priapism.

Question 18

A 3-year-old boy is brought to the
pediatrician because his mother noticed
an abnormal mass in his scrotum while
changing his diapers. Further workup
demonstrates elevated levels of serum
α-fetoprotein. Which of the following is the
most likely diagnosis?
a Choriocarcinoma
b Endodermal sinus (yolk sac) tumor
c Hepatocellular carcinoma
d Teratoma

Answer 18

[Y]Endodermal sinus (yolk sac) tumor

Question 19

A 66-year-old man visits his family
physician
with complaints of urinary
frequency,
hesitancy, and dysuria. Digital
rectal examination reveals an enlarged
prostate, and the consistency is rubbery and
nodular. Serum PSA is modestly increased.
Which of the following
is most closely related
to the pathogenesis of the likely disorder
described here?
a DHT
b Estrogen
c hCG
d Progesterone

Answer 19

[Y]DHT

Question 20

While on an international medical rotation,
you encounter a pregnant woman in
a rural village in India who presents with
fever, jaundice, and malaise. The patient
unexpectedly expires. This is the second
case this month with a similar presentation.
Which of the following is the most likely
form of hepatitis?
a Hepatitis A
b Hepatitis B
c Hepatitis C
d Hepatitis E

Answer 20

[Y]Hepatitis E

Question 21

A 35-year-old man complains of difficulty swallowing and a tendency to regurgitate his food. Endoscopy does not reveal any esophageal or gastric abnormalities. Manometric studies of the esophagus show a complete absence of peristalsis, failure of the lower esophageal sphincter to relax upon swallowing, and increased intraesophageal pressure. Which of the following is the most likely diagnosis?
a Achalasia
b Barrett esophagus
c Esophageal stricture
d Mallory-Weiss syndrome
c Schatzki ring

Answer 21

[Y]Achalasia

Question 22

A 45-year-old woman presents with general discomfort and increasing tightness in the skin of her face. She reports intermittent pain in the tips of her fingers when exposed to the cold. Physical examination shows “stone facies” and edema of the fingers and hands. Serologic tests for antinuclear and anti–Scl-70 antibodies are both positive. Which of the following gastrointestinal manifestations is expected in this patient?

a Adenocarcinoma of the esophagus
b Dysphagia
c Esophageal rupture
d Esophageal varices
e Squamous cell carcinoma of the esophagus

Answer 22

[Y]Dysphagia

Question 23

A 45-year-old man presents with long-standing heartburn and dyspepsia. An X-ray film of the chest shows a retrocardiac, gas-filled structure. This patient most likely has which of the following conditions?
a Boerhaave syndrome
b Esophageal varices
c Esophageal webs
d Hiatal hernia
c Mallory-Weiss syndrome

Answer 23

[Y]Hiatal hernia

Question 24

A 3-week-old boy is brought to the physician by his parents, who report that he vomits forcefully immediately after nursing. Physical examination reveals an “olive-like” palpable mass and visible peristaltic movements within the infant’s abdomen. What is the most likely cause of projectile vomiting in this infant?
a Appendicitis
b Congenital pyloric stenosis
c Hirschsprung disease
d Meconium ileus
e Tracheoesophageal fistula

Answer 24

[Y]Congenital pyloric stenosis

Question 25

A 40-year-old woman presents with a 2-month history of burning epigastric pain that usually occurs between meals. The pain can be relieved with antacids or food. The patient also reports a recent history of tarry stools. She denies taking aspirin or NSAIDs. Laboratory studies show a microcytic, hypochromic anemia (serum hemoglobin = 8.5 g/dL). Gastroscopy reveals a bleeding mucosal defect in the antrum measuring 1.5 cm in diameter. An endoscopic biopsy shows that the lesion lacks mucosal lining cells and is composed of amorphous, cellular debris and numerous neutrophils. Which of the following is the most important factor in the pathogenesis of this patient’s disease?
a Achlorohydria
b Acute ischemia
c Autoimmunity
d Gastrinoma
e Helicobacter pylori infection

Answer 25

[Y]Helicobacter pylori infection

Question 26

A 60-year-old woman presents with several years of abdominal pain radiating to her back and a 5-day history of yellow skin and sclerae. She has lost 15 lb during the past several months, and her stools have become lighter in color. On physical examination, the patient is cachectic and jaundiced. The liver edge descends 1 cm below the right costal margin and is nontender. Her right calf is tender and erythematous. Serum AST and ALT are at the upper limits of normal, but alkaline phosphatase is increased to 430 U/L. A CT scan shows a mass in the head of the pancreas. What is the most likely cause of jaundice in this patient?
a Acute viral hepatitis
b Alcoholic hepatitis
c α1-Antitrypsin deficiency
d Drug-induced hepatitis
e Extrahepatic biliary obstruction

Answer 26

[Y]Extrahepatic biliary obstruction

Question 27

A previously healthy, 24-year-old woman presents with a 1-week history of intermittent fever, lethargy, and yellow skin and sclerae. Physical examination shows jaundice. Laboratory studies reveal decreased serum albumin (2.2 g/dL), extremely high levels of AST and ALT (1,200 and 1,800 U/L, respectively), and elevated alkaline phosphatase (300 U/L). Her ceruloplasmin level is normal. She is admitted to the hospital. Her condition progressively deteriorates, and she develops hepatic encephalopathy and hepatorenal syndrome. Which of the following is the most likely diagnosis?
a Extrahepatic biliary obstruction
b Hereditary hemochromatosis
c Massive hepatic necrosis
d Primary biliary cirrhosis
e Sclerosing cholangitis

Answer 27

[Y]Massive hepatic necrosis

Question 28

A 47-year-old man suffers from long-standing peptic ulcer disease, which is largely unresponsive to pharmacologic therapy. Endoscopic examination reveals multiple, nonhealed ulcerations of the duodenum and jejunum. Which of the following is the most likely diagnosis?
a Carcinoid syndrome
b Insulinoma Pancreatic adenocarcinoma
c Verner-Morrison syndrome
d Zollinger-Ellison syndrome

Answer 28

[Y]Zollinger-Ellison syndrome

Question 29

A 35-year-old woman presents with 6-month history of skin rash and fatigue. Physical examination shows pallor and a necrotizing erythematous skin rash of her lower body. Laboratory studies reveal mild anemia and fasting blood glucose of 160 mg/dL. A CT scan of the abdomen demonstrates a 2-cm mass in the pancreas. Which of the following is the most likely diagnosis?
a Carcinoid tumor
b Gastrinoma
c Glucagonoma
d Insulinoma
e Pancreatic polypeptide-secreting tumor

Answer 29

[Y]Glucagonoma

Question 30

30- A 60-year-old woman with small cell carcinoma of the lung notes rounding of her face, upper truncal obesity, and muscle weakness. Physical examination reveals thin, wrinkled skin, abdominal striae, and multiple purpuric skin lesions. The patient’s blood pressure is 175/95 mm Hg. Laboratory studies will likely show elevated serum levels of which of the following hormones?
1- Aldosterone
2- Corticotropin
3- Epinephrine
4- Prolactin
5- Thyrotropin

Answer 30

[Y]Corticotropin

Question 31

31- Which of the following anemia profiles is typical of thalassemia?
1- ↓ MCV, ↓ plasma iron, ↓ ferritin, ↓ total iron binding capacity (TIBC)
2- ↓ MCV, ↓ ferritin, ↑ plasma iron, normal TIBC
3- ↑ MCV, normal ferritin, normal plasma iron, normal TIBC
4- ↓ MCV, normal ferritin, normal plasma iron, normal TIBC

Answer 31

[Y]↓ MCV, normal ferritin, normal plasma iron, normal TIBC

Question 32

32- A 12-year-old girl has the sudden onset of severe abdominal pain and back pain. On physical examination her abdomen is diffusely tender, but there are no masses. She is afebrile. A CBC shows Hgb 6.5 g/dL, Hct 19.0%, MCV 99 fL, platelet count 149,000/microliter, and WBC count 11,200/microliter. Examination of her peripheral blood smear shows nucleated RBCs and sickled RBCs. Which of the following types of gene mutation is she most likely to have?
1- Deletion
2- Duplication
3- Missense
4- Insertion
5- Nonsense

Answer 32

[Y]Missense

Question 33

33- Reed-Sternberg (RS )CD15 +and CD30+ seen in which of the following blood cell neoplasia?
1- Chronic myelogenous leukemia(CML )
2- Chronic lymphoblastic leukemia (CLL)
3- Hodgkin lymphoma (HL)
4- Non-Hodgkin lymphoma (NHL)

Answer 33

[Y]Hodgkin lymphoma (HL)

Question 34

34- The osmotic fragility diagnostic test is used in which of the following anemias?
1- B12 deficiency anemia
2- Hereditary spherocytosis
3- Iron deficiency anemia
4- Aplastic anemia
5- Anemia chronic disease(ACD)

Answer 34

[Y]Hereditary spherocytosis

Question 35

Which of the following is the BEST explanation of polycythemia?
1- An illegal way that professional athletes get a competitive edge
2- A blood disorder in which there are too many red blood cells
3- A blood disorder in which the red blood cells are lacking in enzymes
4- Ableeding disorder in which a person is missing important clotting factors.

Answer 35

[Y]A blood disorder in which there are too many red blood cells

Question 36

A 65-year-old female was brought to the physician due to jaw claudication and headaches lasting approximately a month. Laboratory shows markedly elevated ESR. which of the following is the most likely diagnosis?
1- Blindness
2- Intermittent claudication
3- Necrosis of the index finger
4- Coronary artery aneurysm

Answer 36

[Y]Blindness

Question 37

A 4-year-old child from china was brought to the pediatrician due to fevers lasting 5 days. fever is unresponsive to acetaminophen. Physical examination shows the desquamation of the skin on fingers, as well as edema of the hands and feet. The patient has bilateral conjunctival injection, cervical lymphadenopathy, erythema of the tongue. Immediate treatment with Aspirin and intravenous immunoglobulin was started to avoid which of the following complications?
1- Buerger disease
2- Takayasu arteritis
3- Kawasaki disease
4- Polyarteritis nodosa
5- Behcet disease

Answer 37

[Y]Kawasaki disease

Question 38

A 32-year-old female was brought to the cardiologist with fever, night sweats, myalgias. Physical examination shows diminished carotid and absent brachial pulsations. ESR was markedly elevated. Treatment with prednisolone was started. Which of the following vasculitis does she have?
1- Obliteration of small vessels
2- Granulomatous thickening and narrowing of the aortic arch
3- Narrowing of small veins
4- Leukocytoclastic vasculitis
5- Infiltration of the small vessels by macrophages

Answer 38

[Y]Granulomatous thickening and narrowing of the aortic arch

Question 39

A Young scientist studies chronic vasculitis, involving small and medium-sized arteries. The etiology of this vasculitis is unknown, but in 30 % of cases, it is associated with Hepatitis B infection. This adult type vasculitis does not involve pulmonary arteries and does not cause glomerulonephritis. There is perivascular inflammation resulting in nodularity, mIcroaneurysms are seen in 50% of cases. Which of the following most likely represents this vasculitis?
1- Churg strauss
2- Takayasu arteritis
3- Polyarteritis nodosa
4- Kawasaki disease
5- Wegener granulomatosis

Answer 39

[Y]Polyarteritis nodosa

Question 40

A 34-year-old female was brought to the physician. The patient has sinusitis, cough, skin nodules, significant purpura also noted on the extremities as well as carpal tunnel syndrome. The patient’s CBC shows eosinophilia. Pulmonary function tests show an obstructive pattern improved with beta-agonist and diagnosis of asthma was made. Which of the following is correct about her condition?
1- Patient is positive to anti ds DNA antibodies
2- Patient has inflammation of the aortic arch
3- Patient has elevated IgE levels
4- Her condition is inherited as autosomal dominant pattern
5- She has vasculitis associated with hepatitis C infection.

Answer 40

[Y]Patient has elevated IgE levels

Question 41

A 50-year-old man experiences episodes of severe substernal chest pain every time he performs a task that requires moderate exercise. The episodes have become more frequent and severe over the past year, but they can be relieved by sublingual nitroglycerin. On physical examination, he is afebrile, his pulse is 78/min and regular, and there are no murmurs or gallops. Laboratory studies show creatinine, 1.1 mg/dL; glucose, 130 mg/dL; and total serum cholesterol, 223 mg/dL. Which of the following cardiac lesions is most likely to be present?”
1- Rheumatic mitral stenosis
2- Serous pericarditis
3- Restrictive cardiomyopathy
4- Coronary atherosclerosis

Answer 41

[Y] Coronary atherosclerosis

Question 42

A 19-year-old man has had a low-grade fever for 3 weeks. On physical examination, his temperature is 38.3°C, pulse is 104/min, respirations are 28/min, and blood pressure is 95/60 mm Hg. A tender spleen tip is palpable. There are splinter hemorrhages under the fingernails and tender hemorrhagic nodules on the palms and soles. A heart murmur is heard on auscultation. Which of the following infectious agents is most likely to be cultured from this patient’s blood?
1- Viridans streptococci
2- Trypanosoma cruzi
3- Candida albicans
4- Mycobacterium tuberculosis

Answer 42

[Y] Viridans streptococci

Question 43

A 50-year-old man has sudden onset of severe substernal chest pain that radiates to the neck. On physical examination, he is afebrile, but has tachycardia, hyperventilation, and hypotension. No cardiac murmurs are heard on auscultation. Emergent coronary angiography shows a thrombotic occlusion of the left circumflex artery and areas of 50% to 70% narrowing in the proximal circumflex and anterior descending arteries. Which of the following complications of this disease is most likely to occur within 1 hour of these events?
1- Myocardial rupture
2- Thromboembolism
3- Ventricular fibrillation
4- Pericarditis

Answer 43

[Y]Ventricular fibrillation

Question 44

A 68-year-old man has had progressive dyspnea for the past year. On physical examination, extensive rales are heard in all lung fields. An echocardiogram shows that the left ventricular wall is markedly hypertrophied. A chest radiograph shows pulmonary edema and a prominent left-sided heart shadow. Which of the following conditions has most likely produced these findings?
1- Centrilobular emphysema
2- Tricuspid valve regurgitation
3- Chronic alcoholism
4- Systemic hypertension

Answer 44

[Y] Systemic hypertension

Question 45

A 12-year-old boy is taken to the physician because he has had increasing abdominal distention and pain for the past 3 days. Physical examination shows lower abdominal tenderness, and the abdomen is tympanitic with reduced bowel sounds. An abdominal CT scan shows a 7-cm mass involving the region of the ileocecal valve. Surgery is performed to remove the mass. Histologic examination of the mass shows sheets of intermediate-sized lymphoid cells, with nuclei having coarse chromatin, several nucleoli, and many mitoses. A bone marrow biopsy sample is negative for this cell population. Cytogenetic analysis of the cells from the mass shows a t(8;14) karyotype. Flow cytometric analysis reveals 40% of the cells are in S phase. The tumor shrinks dramatically in size after a course of chemotherapy. Which of the following is the most likely diagnosis?
1- Diffuse large B-cell lymphoma
2- Follicular lymphoma
3- Acute lymphoblastic leukemia
4- Burkitt lymphoma

Answer 45

[Y] Burkitt lymphoma

Question 46

A 9-year-old boy living in Uganda has had increasing pain and swelling on the right side of his face over the past 8 months. On physical examination, there is a large, nontender mass involving the mandible, which deforms the right side of his face. There is no lymphadenopathy and no splenomegaly, and he is afebrile. A biopsy of the mass is performed. Microscopically, the specimen is composed of intermediate-sized lymphocytes with a high mitotic rate. A chromosome analysis shows a 46,XY,t(8;14) karyotype in these cells. The hemoglobin concentration is 13.2 g/dL, platelet count is 272,000/mm3 , and WBC count is 5820/mm3. Infection with which of the following is most likely to be causally related to the development of these findings?
1- Cytomegalovirus
2- Epstein-Barr virus
3- Human papillomavirus
4- Respiratory syncytial virus

Answer 46

[Y] Epstein-Barr virus

Question 47

A 58-year-old man from Nagasaki, Japan, has noted an increasing number of skin lesions for the past 8 months. On examination, there are scaling red-brown patches on all skin surfaces. He also has generalized lymphadenopathy and hepatosplenomegaly. Laboratory studies show hemoglobin, 9.7 g/dL; hematocrit, 31%; MCV, 89 µm3 ; platelet count, 177,000/mm3 ; and WBC count, 18,940/mm3 with differential count of 35 segmented neutrophils, 2 band neutrophils, 58 lymphocytes, and 5 monocytes. His serum calcium is 11.5 mg/dL. Examination of his peripheral blood smear shows multilobated “cloverleaf” cells. Despite aggressive chemotherapy, his condition worsens with development of paresthesias along with erythematous plaques and red-brown nodules on his skin. Which of the following infectious agents most likely caused his illness?
1- Cytomegalovirus
2- Epstein-Barr virus (EBV)
3- HTLV-1
4- Rochalimaea henselae

Answer 47

[Y] HTLV-1

Question 48

A 76-year-old woman notices that small, pinpoint-to-blotchy areas of superficial hemorrhage have appeared on her gums and on the skin of her arms and legs over the past 3 weeks. On physical examination, she is afebrile and has no organomegaly. Laboratory studies show a normal prothrombin time and partial thromboplastin time. CBC shows hemoglobin of 12.7 g/dL, hematocrit of 37.2%, MCV of 80 µm3 , platelet count of 276,000/mm3 , and WBC count of 5600/mm3. Platelet function studies and fibrinogen level are normal, and no fibrin split products are detectable. Which of the following conditions best explains these findings
1- Meningococcemia
2- Metastatic carcinoma
3- Macronodular cirrhosis
4- vitamin C deficiency

Answer 48

[Y] Vitamin C deficiency

Question 49

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?
1- Decreased erythropoietin
2- Increased erythrocyte osmotic fragility
3- Sickle cells on peripheral blood smear
4- Teardrop-shaped cells

Answer 49

[Y]Sickle cells on peripheral blood smear

Question 49

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?
1- Central nervous system involvement
2- Endocarditis
3- Streptococcal sepsis
4- Myocarditis

Answer 49

[Y]Myocarditis