q bank part 2 Flashcards
A previously healthy 67-year-old man presents to the emergency room with numbness of his left leg. Temperature and blood pressure are normal. Physical examination shows pallor and a cool left leg with absence of distal pulse. An ECG reveals no abnormalities. An arteriogram demonstrates a markedly dilated abdominal aorta and 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?
1- Deep venous thrombosis
2- Left ventricular mural thrombus
3- Nonbacterial endocarditis
4- Paradoxical emboli
5- Thrombus from an atheromatous aorta
[Y]Thrombus from an atheromatous aorta
A 45-year-old black man undergoes renal biopsy for evaluation of chronic renal failure. The patient has a 60-pack-year history of smoking. Physical examination reveals a blood pressure of 190/120 mm Hg. A renal biopsy shows thickening of small arteries and arterioles, as well as edematous intimal expansion and fibrinoid necrosis. The Congo red stain is negative. Laboratory studies show hemoglobin is 10.2 g/dL and serum cholesterol is 250 mg/dL. BUN and serum creatinine are 42 and 5.5 mg/dL, respectively. Which of the following is the most likely cause of renal failure in this patient?
1- Amyloid nephropathy
2- Chronic pyelonephritis
3- Malignant hypertension
4- Polyarteritis nodosa
5- Proliferative glomerulonephritis
[Y]Malignant hypertension
A 60-year-old man presents with dizziness, nausea, and severe shortness of breath of several months’ duration. Physical examination shows hepatomegaly, ascites, and anasarca. His blood pressure is 200/115 mm Hg. An X-ray film of the chest demonstrates cardiomegaly and mild pulmonary edema. Although different mechanisms may have contributed to thepathogenesis of hypertension in this patient, the common end result for all of them is which of the following?
1- Arterial cystic medial necrosis
2- Decreased plasma oncotic pressure
3- Generalized vasodilation
4- Increased peripheral vascular resistance
5- Increased vascular permeability
[Y]Increased peripheral vascular resistance
A 6-year-old girl presents with a 2-week history of a skin rash over her buttocks and legs and joint pain. The parents report seeing blood in the urine. Physical examination reveals palpable purpuric skin lesions and markedly swollen knees. The results of laboratory studies reveal abnormally high erythrocyte sedimentation rate (30 mm/h), BUN of 25 mg/dL, and serum creatinine of 3 mg/dL. Urinalysis demonstrates RBCs and RBC casts. The stool guaiac test is positive. Biopsy of lesional skin reveals deposits of IgA in the walls of small blood vessels. Which of the following is the most likely diagnosis?
1- Henoch-Schönlein purpura
2- Hypersensitivity vasculitis
3- Kawasaki disease
4- Polyarteritis nodosa
5- Poststreptococcal glomerulonephritis
[Y]Henoch-Schönlein purpura
A 10-year-old boy suffers head trauma and lies unconscious for 2 weeks. He is now intubated. His temperature rises to 38.7°C (103°F), and oxygenation becomes more difficult. A chest X-ray reveals a pleural effusion and multiple abscesses in the lung parenchyma. Which of the following microorganisms is the most likely cause of this pulmonary infection?
1- Legionella pneumophila
2- Mycoplasma pneumoniae
3- Pneumocystis carinii
4- Staphylococcus aureus
5- Streptococcus pneumoniae
[Y]Staphylococcus aureus
A 40-year-old woman with leukemia is treated with chemotherapy. During treatment she develops increasing cough and shortness of breath. A chest X-ray shows diffuse lung infiltrates. Sputum cultures are negative, and the patient does not respond to routine antibiotic therapy. An open lung biopsy is diagnosed by the pathologist as viral pneumonia. Which of the following histopathologic findings would be expected in the lungs of this patient?
1- Clusters of epithelioid macrophages
2- Confluent areas of caseous necrosis
3- Fibrous scarring of lung parenchyma
4- Hyaline membranes and interstitial inflammation
5- Sheets of bacilli-filled macrophages
[Y]Hyaline membranes and interstitial inflammation
A 50-year-old woman presents with a 4-week history of fever, shortness of breath, and dry cough. She reports that her chest feels “tight.” The patient is a pigeon fancier. Blood tests show leukocytosis and neutrophilia, an elevated erythrocyte sedimentation rate, and increased levels of immunoglobulins and C-reactive protein. A lung biopsy reveals poorly formed granulomas composed of epithelioid macrophages and multinucleated giant cells. Which of the following is the appropriate diagnosis?
1- Actinomycosis
2- Goodpasture syndrome
3- Hypersensitivity pneumonitis
4- Nocardiosis
5- Wegener granulomatosis
[Y]Hypersensitivity pneumonitis
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?
1-Asthma
2- Chronic bronchitis
3- Emphysema
4- Hypersensitivity pneumonitis
5- Usual interstitial pneumonia
[Y]Emphysema
An 80-year-old man with long-standing diabetes and systemic hypertension dies of congestive heart failure. The luminal surface of the abdominal aorta is shown in the image N1. Which of the following pathologic changes would you expect to see on microscopic examination?
1- Acute inflammation of the vessel wall
2- Bacterial colonies in the vessel wall
3- Cystic medial necrosis
4- Lipid deposition and smooth muscle cell hyperplasia
5- Obliterative endarteritis of the vasa vasorum
[Y]Lipid deposition and smooth muscle cell hyperplasia
A 45-year-old man presents with pain in the legs upon exercise and destruction of the tips of his fingers. He has an 80-packyear history of smoking. Laboratory values include hemoglobin of 16 g/dL, WBC of 8,500/μL, serum cholesterol of 220 mg/dL, fasting blood sugar of 90 mg/dL, and negative tests for antinuclear antibodies. Biopsy of the affected area (shown in the image N2) reveals intraluminal thrombi in medium-sized arteries and inflammation extending from arteries to neighboring veins and nerves. What is the appropriate diagnosis?
1- Buerger disease
2- Churg-Strauss disease
3- Kawasaki disease
4- Polyarteritis nodosa
5- Takayasu arteritis
[Y]Buerger disease
A 45-year-old man is brought to the emergency room with rapid pulse and cold and clammy skin. Blood pressure is 90/50 mm Hg. An X-ray film of the chest demonstrates dilation of the ascending aorta. Cardiac auscultation reveals a diastolic murmur in the aortic region. Laboratory studies show that serum cholesterol is 160 mg/dL, hematocrit is 35%, and hemoglobin is 13.6 g/dL. The fluorescent Treponema antibody test is positive. The patient suddenly becomes hypotensive and dies. The luminal surface of the ascending aorta at autopsy is shown in the image N3. Which of the following was most likely involved in the pathogenesis of this aortic lesion?
1- Arterial wall defect due to diabetes
2- Atherosclerosis
3- Congenital defect of the arterial wall
4- Cystic medial necrosis
5- Endarteritis of the vasa vasorum
[Y]Endarteritis of the vasa vasorum
A 33-year-old man with AIDS presents with multiple, purplecolored skin nodules on his hands and feet. The lesions vary in size from 1 mm to 1 cm in diameter. Biopsy of lesional skin is shown in the image N4. Which of the following viruses is implicated in the pathogenesis of this patient’s skin neoplasm?
1- Cytomegalovirus
2- Human herpesvirus-6
3- Human herpesvirus-8
4- Human immunodeficiency virus
5- Human papillomavirus
[Y]Human herpesvirus-8
A 70-year-old woman complains of a throbbing unilateral headache and vision problems. She reports weight loss and mandibular pain while eating. The patient also has a history of recurrent bouts of fever accompanied by malaise and muscle aches. Physical examination reveals nodular enlargement of the temporal artery with pain on palpation. A biopsy is obtained (shown in the image N5). What is the appropriate diagnosis?
1- Giant cell arteritis
2- Hypersensitivity angiitis
3- Kawasaki disease
4- Polyarteritis nodosa
5- Wegener granulomatosis
[Y]Giant cell arteritis
A 60-year-old woman with a 30-pack-year history of smoking and a 10-year history of emphysema expires of congestive heart failure. There is no evidence of coronary artery disease or valvular heart disease. The heart at autopsy is shown in the image N6. Which of the following is the most likely cause of right ventricular hypertrophy?
1- Endocardial fibroelastosis
2- Essential hypertension
3- Pulmonary hypertension
4- Pulmonary stenosis
5- Systemic hypertension
[Y]Pulmonary hypertension
A 50-year-old man with adenocarcinoma of the pancreas is brought to the emergency room in a comatose state. A CT scan of the brain is consistent with a recent infarct in the left temporal lobe. Blood cultures are negative. The patient never regains consciousness and expires 2 days later. The heart at autopsy is shown in the image N7. Which of the following is the most likely underlying cause of stroke in this patient?
1- Calcific aortic stenosis
2- Carcinoid heart disease
3- Cardiac metastases
4- Nonbacterial thrombotic endocarditis
5- Subacute bacterial endocarditis
[Y]Nonbacterial thrombotic endocarditis
A 50-year-old man underwent heart transplantation for low output heart failure that was unresponsive to medical treatment. The affected heart at autopsy is shown in the image N8. It weighs 950 g (normal up to 350 g) and shows no evidence of coronary artery atherosclerosis. Histologically, the myocardium demonstrates hypertrophic myocytes and foci of myocardial fibrosis but no evidence of inflammation or myofiber disarray. Which of the following is the most likely diagnosis?
1- Cardiac amyloidosis
2- Dilated cardiomyopathy
3- Hypertrophic cardiomyopathy
4- Restrictive cardiomyopathy
5- Ventricular aneurysm
[Y]Dilated cardiomyopathy
A 40-year-old woman presents with dyspnea, heart palpitations, and pitting edema. She was seen for flu-like symptoms and prominent muscle pain 3 weeks ago. Physical examination shows tachycardia and irregular heart beats. A chest X-ray reveals cardiomegaly and pulmonary edema. The patient subsequently dies of cardiorespiratory failure. Histopathology of the heart muscle at autopsy is shown in the image N9. What is the appropriate diagnosis?
1- Acute bacterial endocarditis
2- Acute myocardial infarction
3- Endocardial fibroelastosis
4- Rheumatic heart disease
5- Viral myocarditis
[Y]Viral myocarditis
A 53-year-old woman presents with a 6-week history of fever, fatigue, and weight loss. Her temperature is 38.7°C (103°F), pulse rate 110 per minute, and blood pressure 140/80 mm Hg. Physical examination reveals petechiae and clubbing of the fingers. The patient develops mental status changes, suffers a massive stroke, and expires. The mitral valve is examined at autopsy (shown in the image N10). Which of the following is the appropriate pathologic diagnosis?
1- Bacterial endocarditis
2- Carcinoid heart disease
3- Libman-Sacks endocarditis
4- Marantic endocarditis
5- Mitral valve prolapse
[Y]Bacterial endocarditis
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 less than 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 in the image N11. Which of the following organisms is the most likely pathogen responsible for these pulmonary findings?
1- Cryptococcus neoformans
2- Cytomegalovirus
3- Histoplasma capsulatum
4- Mycoplasma pneumoniae
5- Pneumocystis jiroveci
[Y]Pneumocystis jiroveci
A 22-year-old man who is being treated for leukemia complains of shortness of breath on exertion, pleuritic chest pain, and a 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 in the image N12. Which of the following is the most likely diagnosis?
1- Alveolar proteinosis
2- Eosinophilic pneumonia
3- Goodpasture syndrome
4- Hyaline membrane disease
5- Radiation pneumonitis
[Y]Alveolar proteinosis
A 10-year-old boy dies following a severe episode of status asthmaticus. Histologic examination of the lung at autopsy is shown in the image N13. Which of the following best describes the pathologic features evident in this autopsy specimen?
1- Destruction of the walls of airspaces without fibrosis
2- Hyaline membranes and interstitial edema
3- Interstitial fibrosis of the lung parenchyma
4- Intra-alveolar hemorrhage and exudates containing neutrophils
5- Smooth muscle hyperplasia and basement membrane thickening
[Y]Smooth muscle hyperplasia and basement membrane thickening
A 25-year-old black woman presents with a 3-month history of cough and shortness of breath on exertion. A chest X-ray reveals enlargement of hilar and mediastinal lymph nodes. Laboratory studies show elevated serum levels of angiotensinconverting enzyme and an increase in 24-hour urine calcium excretion. An open-lung biopsy is shown in the image N14. Stains for microorganisms in the tissue are negative. Which of the following is the most likely diagnosis?
1- Goodpasture syndrome
2- Sarcoidosis
3- Silicosis
4- Tuberculosis
5- Wegener granulomatosis
[Y]Sarcoidosis
A 23-year-old man complains of nasal obstruction, serosanguinous discharge, cough, and bloody sputum. A chest X-ray shows cavitated lesions and multiple nodules over both lung fields. A CT scan discloses obliteration of several maxillary sinuses. Urinalysis reveals hematuria and RBC casts. Laboratory studies demonstrate anemia and elevated serum levels of C-ANCA. An open-lung biopsy is shown in the image N15. Which of the following is the most likely diagnosis?
1- Adenocarcinoma of lung
2- Churg-Strauss syndrome
3- Necrotizing sarcoid granulomatosis
4- Tuberculosis
5- Wegener granulomatosis
[Y]Wegener granulomatosis
A 10-year-old black girl is brought to the emergency room. She complains of severe pain in her chest, abdomen, and bones. Physical examination reveals jaundice and anemia. Her parents state that she has been anemic since birth. A CBC shows normocytic anemia with marked poikilocytosis. A peripheral blood smear is shown in the image N16. Hemoglobin electrophoresis demonstrates hemoglobin S. This child’s chest and bone pain is most likely caused by which of the following mechanisms?
1- Amyloidosis
2- Coagulopathy
3- Infection
4- Ischemia
5- Vasculitis
[Y]Ischemia
A 32-year-old man presents with mild fever and increasing fatigue. He is an immigrant from Russia and worked in a benzene factory. Physical examination does not reveal lymphadenopathy or splenomegaly, but petechial skin lesions are noted. A CBC demonstrates severe pancytopenia, with normocytic red cell indices. A bone marrow biopsy is shown in the image N17. Which of the following is the most likely underlying mechanism in the development of this patient’s anemia?
1- Damage to stem cells
2- Decreased erythropoietin production by the kidneys
3- Folate deficiency
4- Impaired globin chain synthesis
5- Neoplastic proliferation of committed stem cells
[Y]Damage to stem cells
A 40-year-old woman complains of fatigue and nausea of 3 months in duration. Physical examination reveals numerous pustules on the face, as well as splenomegaly and hepatomegaly. Laboratory studies show hemoglobin of 6.3 g/dL and platelets of 50,000/mL. A peripheral smear shows malignant cells with Auer rods (arrow) N18. The patient develops diffuse purpura, bleeding from the gums, and laboratory features of disseminated intravascular coagulation (DIC). Which of the following is the appropriate diagnosis?
1- Acute lymphoblastic leukemia
2- Acute megakaryocytic leukemia
3- Acute promyelocytic leukemia
4- Chronic myelogenous leukemia
5- Monocytic leukemia
[Y]Acute promyelocytic leukemia
A 40-year-old woman complains of fatigue and nausea of 3 months in duration. Physical examination reveals numerous pustules on the face, as well as splenomegaly and hepatomegaly. Laboratory studies show hemoglobin of 6.3 g/dL and platelets of 50,000/mL. A peripheral smear shows malignant cells with Auer rods (arrow) N18. The patient develops diffuse purpura, bleeding from the gums, and laboratory features of disseminated intravascular coagulation (DIC). Cytogenetic studies in malignant cells from this patient demonstrate a chromosomal translocation. Which of the following genes is most likely found at the translocation site?
1- abl
2- bcl-1
3- bcl-2
4- myc
5- Retinoic acid receptor
[Y]Retinoic acid receptor
