vc 222

Question 1

A 55-year-old woman with chronic pancreatitis undergoes coagulation screening tests before surgery. The PT and APTT
are found to be prolonged. Given the following choices, which of the following is the most likely reason for the abnormal
coagulation test results?
(A) Congenital inherited bleeding disorder
(B) Fat malabsorption and vitamin K deficiency
(C) Glutamate deficiency due to impaired digestion of dietary protein
(D) Nutritional vitamin C deficiency
(E) Post-pancreatitic carcinoma of the pancreas

Answer 1

(A) Congenital inherited bleeding disorder

Question 2

A clinical study of adult patients with chronic bloody diarrhea isperformed. One group of these patients is found to have a
statistically increased likelihood for the following: antibodies to Saccharomyces cerevisiae but not antineutrophil cytoplasmic
autoantibodies, NOD2 gene polymorphisms, 50% concordancerate in monozygous twins, higher rate of cigarette smoking,
TH1 immune cell activation, vitamin K deficiency, pernicious anemia, and gallstones. Which of the following diseases is this
group of patients most likely to have?

Answer 2

crohn

Question 3

. A 45-year-old man with an elevated bleeding time is scheduled to undergo an elective hernia repair in approximately 12 h.
He is given vitamin K orally and the bleeding time is still elevated. What is the most likely explanation for this finding?

Answer 3

Need to synthesize new coagulation factors

Question 4

. Which one of the following statements is more characteristic of ulcerative colitis than of Crohn’s disease?
1. Inflammation begins in the rectum and extends proximally without skip lesions
2. Fibrosis may produce a “lead pipe” appearance with “creeping fat” around the outside of the gut
3. Microscopy may reveal transmural inflammation with noncaseating granulomas
4.Transmural involvement may produce fissures, fistulas, and bowel obstruction

Answer 4

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

Question 5

crohs

Answer 5

with skip lisions

Question 6

. what increases the risk of premature birth, before completed 37 weeks of pregnancy ?

Answer 6

Severe iron deficiency anemia during pregnancy or Severe bleeding

Question 7

4.A 33-year-old woman with a history of menorrhagia presents with a 6-month history of increasing fatigue. A CBC reveals a
hypochromic, microcytic anemia (hemoglobin = 8 g/dL). Bimanual pelvic examination reveals an enlarged uterus with multiple,
irregular masses. A hysterectomy is performed, and a sharply circumscribed fl eshy tumor is found within the uterine wall .
Which of the following is the most likely cause of vaginal bleeding and anemia in this patient?
(A) Adenomyosis
(B) Cervical cancer
(C) Endometrial carcinoma
(D) Endometriosis
(E) Uterine leiomyoma

Answer 7

(E) Uterine leiomyoma

Question 8

. A 23-year-old, previously healthy man of Italian origin develops moderate to severe hemolytic anemia. The previous
evening he had celebrated a Saint’s day with a feast of beans and pasta. Urinalysis shows free hemoglobin, and the direct
Coombs test is negative. Supravital staining of the blood smear demonstrates numerous membrane-bound inclusions (Heinz
bodies) within erythrocytes. Which of the following is
the most likely diagnosis?
(A) G6PD defi ciency
(B) Paroxysmal nocturnal hemoglobinuria
(C) Sickle cell anemia
(D) β-Thalassemia minor
(E) Warm antibody autoimmune hemolytic anemia

Answer 8

(A) G6PD defi ciency

Question 9

6. Two days after receiving the antimalarial drug primaquine, a 27-yearold black man develops sudden intravascular
   hemolysis resulting in a decreased hematocrit, hemoglobinemia, and hemoglobinuria. Examination of the peripheral blood
   reveals erythrocytes with a membrane defect forming “bite” cells; when crystal violet stain is applied, many Heinz bodies are
   seen.The most likely diagnosis is

Answer 9

Glucose-6-phosphate dehydrogenase deficiency

Question 10

. The presence of Heinz bodies and bite cells in a patient having hemolytic anemia strongly suggests:
A. Sickle cell anemia
B. G6PD deficiency
C. Alpha thalassemia
D. Multiple myeloma
E. Hereditary spherocytosis

Answer 10

G6PD deficiency

Question 11

You suspect Glucose 6-phosphate Dehydrogenase Deficiency, and microscopic analysis of the child’s blood showing
(RBC)
A. Target Cells
B. Tear drop erthyrocytes
C. Heinz bodies in red blood cells

Answer 11

. Heinz bodies in red blood cells (henzi زي البز او الزيتونة

target cell seen in thalasimia

Question 12

A 30-year-old woman complains of recent easy fatigability,
bruising, and recurrent throat infections. Physical examination reveals numerous petechiae over her body and mouth.
Abnormal laboratory fi ndings include hemoglobin of 6 g/dL, WBC of 1,500/mL, and platelets of 20,000/mL. The bone marrow
is hypocellular and displays increased fat. What is the appropriate diagnosis?
(A) Aplastic anemia
(B) Iron-defi ciency anemia
(C) Megaloblastic anemia
(D) Myelofi brosis with myeloid metaplasia
(E) Pure red cell aplasia

Answer 12

(A) Aplastic anemia

Question 13

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. Which of the following is the most likely underlying mechanism in the development of this patient’s anemia?
(A) Damage to stem cells
(B) Decreased erythropoietin production by the kidneys
(C) Folate defi ciency
(D) Impaired globin chain synthesis
(E) Neoplastic proliferation of committed stem cells

Answer 13

(A) Damage to stem cells ( aplastic aniemia or - lama el bone marrow not producing proper rbc)

Question 14

. A 38-year-old woman has become increasingly
fatigued for the past 3 months. During the past week she has noted purple blotches on her skin. On physical examination there
are purpuric areas of skin on her trunk and extremities. She has no hepatosplenomegaly and no lymphadenopathy.
Laboratorystudies show Hgb 6.8 g/dL, Hct 20.7%, MCV 91 fL, platelet count 28,760/microliter, and WBC count 1940/
microliter. Which of the following is the most likely diagnosis?

Answer 14

Aplastic anemia

Question 15

A 24-year-old woman who is morbidly obese undergoes a surgical procedure under anesthesia. During the procedure, she
is given nitrous oxide. It turns out that after the procedure is completed, the patient learns that she was 10 weeks pregnant
while she has that procedure. Which of the following potential risks is possible in the fetus?

Answer 15

Aplastic anemia (photo)

Question 16

A 32-year-old woman presents with a solitary, nontender, firm nodule on the left side of her neck. Thyroid
function tests are within normal limits. A fine-needle biopsy reveals malignant cell. The tumor is excised and
examined by light microscopy(shown in the image). What is the appropriate pathologic diagnosis?
(A) Anaplastic carcinoma
(B) Follicular carcinoma
(C) Lymphoma
(D) Medullary carcinoma
(E) Papillary carcinoma

Answer 16

(E) Papillary carcinoma

Question 17

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 diag nosis 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
(E) Replacement of the thyroid with fibrous tissue

Answer 17

(C) Tumor cells embedded in an amyloid-laden stroma

Question 18

5.A 45-year-old woman complains of tingling in her hands and feet, 24 hours after surgery to remove a thyroid
follicular carcinoma. Her symptoms rapidly progress to severe muscle cramps, laryngeal stridor, and convulsions.
Which of the following laboratory fi ndings would be expected in this patient prior to treatment?
(A) Decreased serum calcium and decreased PTH
(B) Decreased serum calcium and increased PTH
(C) Increased serum calcium and decreased PTH
(D) Increased serum calcium and increased PTH
(E) Normal serum calcium and decreased PTH

Answer 18

(A) Decreased serum calcium and decreased PTH

Question 19

6. A 35-year-old woman visits her primary care physician after feeling a hard lump in her neck. Her physician notes
   that she has a single, hard, nontender nodule in the left lobe of her thyroid that moves when she swallows. A
   scintiscan shows a cold nodule in the left lobe of her thyroid. Tissue is obtained and a histological section is shown
   in the image. This patient most likely has which of the following? (Endo)
   A. Follicular carcinoma
   B. Medullary carcinoma
   C. Multinodular goiter
   D. Papillary carcinoma

Answer 19

D. Papillary carcinoma orphan annie ( empty appearing neclui ) cold nodle

Question 20

A 60-year-old woman has felt a “lump” on the right side of her neck for several months. On physical examination,
she has a firm 3-cm mass in the right lobe of the thyroid gland. There is no palpable lymphadenopathy. Laboratory
studies show a serum TSH level of 3 mU/L and a T4 level of 8.8 µg/dL. A fine-needle aspiration biopsy is done, and
she undergoes a thyroidectomy. A 3-cm solid mass is present within the right thyroid lobe. Six months later, she
visits her physician again because of pain in the right thigh. A radiograph shows a fracture of the right femur in
an area of lytic bone destruction. A radioiodine scan shows uptake localized to the

Answer 20

Follicular carcinoma

Question 21

. A 45-year-old man presents with swelling in the anterior portion of his neck. Physical examination reveals an
enlarged nodular thyroid. Thyroid function tests are within normal limits. A thyroid scintiscan shows a dominant “hot”
nodule. A biopsy of this nodule reveals neoplastic cells with evidence of vascular and capsular invasion (shown in the
image). X-rays demonstrate distant bony metastases. What is the most likely diagnosis?

Answer 21

Follicular carcinoma ( ras mutuation and hot nodle l

Question 22

medullary carcinoma

Answer 22

amlyeid , congo red , men 2a and and 2 b

Question 23

lymphoma

Answer 23

assoiated with hashimoto thyradiatis

Question 24

9.Which of the following is a probable mechanism for the development of pernicious and macrocytic anemia?

Answer 24

Vitamin B12 deficiency caused by depleted intrinsic factor

Question 25

What anemia is megaloblastic ?

Answer 25

Vitamin B12 deficiency

Question 26

Causes of vitamin B12 deficiency:
1) Pernicious anemia is the most common cause of vitamin Bl2 deficiency. Autoimmune destruction of parietal cells )( في سوال عنو
(body of stomach) leads to intrinsic factor deficiency.
2) Gastrectomy.
3) Pancreatic insufficiency.
4) Damage to the terminal ileum (like , Crohn disease or Diphyllobothrium latum
5) Dietary deficiency

Question 27

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) reveals intraluminal thrombi in medium-sized arteries and inflammation
extending from arteries to neighboring veins and nerves. What is the appropriate diagnosis?
A) Buerger disease
(B) Churg-Strauss disease
(C) Kawasaki disease.
(D) Polyarteritis nodosa
(E) Takayasu arteritis

Answer 27

A) Buerger disease

Question 28

This disease is characterized by a distinctive heliotrope discoloration
of the upper eyelids with periorbital edema that may accompany or
precede the onset of muscle disease? Road Map
A. Inclusion body myositis
B. Dermatomyositis
C. Myotonic Dystrophy
D. Myasthenia gravis

Answer 28

B. Dermatomyositis

Question 29

: A 6-year-old boy presents with fatigue, fever, and night sweats. Physical examination reveals marked pallor.
Palpation of his sternum demonstrates diffuse tenderness. Laboratory studies disclose anemia, thrombocytopenia,
and leukocytosis. The WBC differential count shows that 90% blasts. A bone marrow biopsy stained
immunohistochemically for terminal deoxynucleotidyl transferase (TdT) is shown in the image. Which of the following
is the appropriate diagnosis?
(A) Acute lymphoblastic leukemia
(B) Acute myelogenous leukemia
(C) Acute promyelocytic leukemia
(D) Chronic lymphocytic leukemia
(E) Chronic myelogenous leukemia

Answer 29

A) Acute lymphoblastic leukemia ———-thromboctopenia

Question 30

; A 5-year-old boy has become increasingly lethargic for the past 2 months. On physical examination his
temperature is 37.3°C. There are ecchymoses noted on the skin of his lower legs. Laboratory studies show Hgb 9.2
g/dL, Hct 27.8%, MCV 91 fL, platelet count 101,000/microliter, and WBC count 12,128/microliter. A bone marrow
biopsy is performed and on microscopic examination shows nearly 100% cellularity with replacement by primitive
cells that have large nuclei with delicate chromatin and indistinct nucleoli with scanty cytoplasm. These cells mark
for CD10 (CALLA) antigen. Which of the following is the diagnosis

Answer 30

Acute lymphoblastic leukemia

Question 31

A 55-year-old man presents with abdominal discomfort and fullness. Physical examination is remarkable for a
massively enlarged spleen. Attempts at bone marrow aspiration are unsuccessful. A bone marrow core biopsy
reveals numerous cells that have a single round nucleus surrounded by a cytoplasm with fine fibrillary projections.
A stain for TRAP confirms the likely diagnosis. Which of the following statements about this disorder is correct?
(A) The cell surface marker CD3 is almost always demonstrable.
(B) The neoplastic cells stain positive for nonspecific esterase, a marker of monocytic maturation.
(C) The typical patient with this disorder presents with a markedly elevated total leukocyte count.
(D) This is an example of a well-known B-cell disorder.
(E) There is currently no effective therapy for this condition

Answer 31

(D) This is an example of a well-known B-cell disorder.

Question 32

;A 55-year-old man presents with a 3-week history of abdominal discomfort. Physical examination demonstrates
splenomegaly but no lymphadenopathy. A CBC shows pancytopenia. Examination of a peripheral blood smear
reveals atypical lymphoid cells that exhibit tartrate-resistant acid phosphatase activity. Which of the following is the
appropriate diagnosis?
(A) Acute lymphocytic leukemia
(B) Chronic lymphocytic leukemia
(C) Chronic myelogenous leukemia
(D) Hairy cell leukemia
(E) Hodgkin disease

Question 33

A 49-year-old man has had increasing fatigue for the past 4 months. On physical examination he has massive
splenomegaly but no lymphadenopathy. Laboratory studies show a Hgb of 10.1 g/dL, Hct 30.3%, MCV 90 fL, WBC
count 1600/microliter, and platelet count 48,000/microliter. Examination of his peripheral blood smear shows
increased numbers of peripheral blood lymphocytes containing tartrate-resistant acid phosphatase. Which of the
following is the most likely diagnosis?

Answer 33

Hairy cell leukemia

Question 34

: A 43-year-old man with leukemia is hospitalized for treatment after his prior chemotherapeutic regimen failed to
produce remission. Bone marrow biopsy is repeated and indicates the presence of hairy cell leukemia.
Treatment with fludarabine has begun. This agent likely works in which of the following ways?

Answer 34

Initiates action via phosphorylation

Question 35

60-year-old Caucasian man with a 5-year history of gastroesophageal reflux dis ease (GERD) presents with
persistent pyrosis (heartburn) and acid regurgitation. He has had similar symptoms for the past 5 years.
Because this patient has a long history of GERD, an esophagogastroduodenoscopy is performed to screen for
Barrett esophagus, a well-known complication of long-standing GERD. Results reveal that Barrett’s esophagus
is indeed present. Which of the following is true of Barrett esophagus?
(A) A biopsy will show a histologic finding of columnar-to-squamous metaplasia.
(B) It is a known precursor of adenocarcinoma of the esophagus.
(C) It is a known precursor of carcinoma of the stomach.
(D) It is a known precursor of squamous cell carcinoma of the esophagus.
(E) The most common location is the proximal (upper) third of the esophagus.

Answer 35

(B) It is a known precursor of adenocarcinoma of the esophagus.

Question 36

10-day-old boy with projectile vomit ing and a palpable midepigastric mass most likely has?

Answer 36

congenital pyloric stenosis

Question 37

:A 10-day-old infant presents with pro jectile vomiting. His mother states that the infant will actively drink his milk,
but he forcefully vomits after each feeding. The infant shows signs of failure to thrive, with weight loss, dehydration,
and lethargy. Physical examination reveals a firm, non tender, mobile, “olive-shaped” epigastric mass. Which of the
following is the most likely diagnosis?

Answer 37

congenital pyloric stenosis
Note : not always they mention ‘olive’ some times :mid abdominal mass

Question 38

A 17-year-old girl is short in stature for her age. She has not yet shown any changes of puberty. On physical examination her vital signs include T 37°C, RR 18/minute, P 75/minute, and BP 165/85 mm Hg. She has a continuous murmur heard over both the front of the chest as well as her back. Her lower extremities are cool with diminished pulses and poor capillary filling. She has a webbed neck. A chest radiograph reveals a
prominent left heart border, no edema or effusions, and rib notching. Which of the following cardiovascular abnormalities is she most likely to have? (Cardio)
A. Shortening and thickening of chordae tendineae of the mitral valve
B. Narrowing of the aorta past the ductus arteriosus
C. Supravalvular narrowing in the aortic root
D. Lack of development of the spiral septum and partial absence of
conus musculature
C. Supravalvular narrowing in the aortic root
D. Lack of development of the spiral septum and partial absence of
conus musculature

Answer 38

Narrowing of the aorta past the ductus arteriosus

Question 39

( terner syndrom x0)

Answer 39

short stature + no pupurty + webbed neck = . Coarctation of the aorta

Question 40

A 29-year-old woman is noted to have chronic dyspnea and easy fatigue with exertion. A chest radiograph reveals hyperinflated lung fields without infiltrates.She denies a history of cigarette smoking. Which of the following is the mostlikely etiology for her condition? Case Files (Resp)

Answer 40

α1-Antitrypsin deficiency ( non smoker - emphysma - type panaliont - a- anttrypsin deficency )