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medical board > VIII - Environmental and Nutritional Diseases > Flashcards

VIII - Environmental and Nutritional Diseases Flashcards

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USMLE® Step 1 flashcards
1
Q

Gas formed by sunlight-driven reactions involving nitrogen oxides. Together with oxides and fine particulate matter, it forms “smog”.

A

Ozone(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 282

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2
Q

A nonirritating , colorless, tasteless, odorless gas produced by imperfect oxidation of carbonaceous materials. Binds to hemoglobin with high affinity causing systemic asphyxiation and CNS depression.

A

Carbon monoxide(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 282

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3
Q

Carbon monoxide in the blood is called _______.

A

Carboxyhemoglobin(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 282

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4
Q

Acute poisoning of carbon monoxide produces this characteristic color of the skin and mucous membranes.

A

Cherry red color(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 283

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5
Q

Microcytic, hypochromic anemia, with basophilic stippling of erythrocytes, peripheral demyelinating neuropathy which manifests as footdrop and wristdrop, colic characterized by extremely severe, poorly localized abdominal pain, and chronic renal damage are the features of poisoning with this heavy metal. SEE SLIDE 8.1

A

Lead(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 283

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6
Q

Main source of exposure to this heavy metal are contamintaed fish and dental amalgams, causing tremor, gingivitis and bizarre behavior.

A

Mercury(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 285

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7
Q

Consumption of fish contaminated with methyl mercury causing cerebral palsy, deafness, blindness, and major CNS defects in children exposed in utero.

A

Minamata disease(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 285

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8
Q

Antidote for mercury poisoning.

A

Thimerosal(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 285

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9
Q

Chronic exposure with this heavy metal results in hyperpigmentation and hyperkeratosis, which may develop into basal or squamous cell carcinomas.

A

Arsenic(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 285

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10
Q

This heavy metal is used mainly in batteries and fertilizers, which can contaminate soil. Can cause obstructive lung disease and kidney damage.

A

Cadmium(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 285

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11
Q

Disease caused by cadmium in Japan, presenting as a combination of osteoporosis and osteomalacia, associated with renal disease.

A

Itai-itai disease(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 285

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12
Q

May be released from combustion of fossil fuels, burning of coal and gas, and also present in tar and soot. Among the most potent carcinogens, implicated in lung and bladder cancer.

A

Polycyclic hydrocarbons(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 287

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13
Q

Synthetic products that resist degradation and are lipophilic, typically used as pesticides, with anti-estrogenic and anti-androgenic activity, and causes neurologic toxicity.

A

Organochlorines (e.g. DDT)(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 287

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14
Q

These can cause skin disorders such as folliculitis and chloracne, consisting of acne, cyst formation, hyperpigmentation, and hyperkeratosis, around the face and behind the ears.

A

Dioxins and Polychlorinatedbiphenyls (PCB)(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 287

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15
Q

It is the most preventable cause of human death.

A

Smoking(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 287

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16
Q

Components of cigarette smoke that are potent carcinogens in animals and are most likely involved in the causation of lung carcinomas in humans.

A

Polycyclic hydrocarbons and nitrosamines(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 288

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17
Q

Chronic alcoholics are at an increased risk of developing this type of cancer as a result of liver injury.

A

Hepatocellular carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 290

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18
Q

These refer to untoward effects of drugs that are given in conventional therapeutic settings.

A

Adverse drug reactions(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 291

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19
Q

A long acting tetracycline which can cause a diffuse blue-gray pigmentation of the skin.

A

Minocycline(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 293

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20
Q

Oral contraceptives have a protective effect against these cancers.

A

Endometrial and ovarian CA(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 294

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21
Q

Oral contraceptives may increase the risk of developing this type of cancer in women.

A

Cervical CA(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 294

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22
Q

Prolonged use of oral contraceptives is associated with the development of this rare benign tumor especially in older women.

A

Hepatic adenoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 294

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23
Q

Toxic metabolite of paracetamol or acetaminophen causing centrilobular necrosis that may progress to liver failure.

A

NAPQI (N-acetyl-p-benzoquinoneimine)(TOPNOTCH)Robbins Basic Pathology, 9th Ed p. 422

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24
Q

Toxic dose for acetaminophen.

A

15-25 grams/day(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 294

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25
Q

Antidote for acetaminophen poisoning.

A

N-acetylcysteine(TOPNOTCHRobbins Basic Pathology, 8th Ed p. 294

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26
Q

Manifested by headache, dizziness, tinnitus, difficulty of hearing, mental confusion, drowsiness, nausea, vomiting, and diarrhea, with CNS changes that can progress to convulsions and coma.

A

Salicylism(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 294

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27
Q

Adult toxic dose of aspirin.

A

10-30 grams(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 294

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28
Q

Mixtures of aspirin and phenacetin, or its active metabolite acetaminophen, when taken over several years can cause tubulointerstitial nephritis and renal papillary necrosis called _______.

A

Analgesic nephropathy(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 294

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29
Q

This drug of abuse can precipitate lethal arrythmias, hyperpyrexia, seizures, amd respiratory arrest during acute overdose. Causes nasal septal perforation, decrease in lung diffusing capacity in those who inhale smoke and dilated cardiomyopathy during chronic use.

A

Cocaine or “crack” (cocaine derivative)(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 295

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30
Q

Addictive opiod derived from the poppy plant which can cause euphoria, hallucinations, somnolence, sedation, and increased risk of sudden death.

A

Heroin(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 296

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31
Q

Drug made from the leaves of Cannabis sativa plant which can cause distortion of sensory perception and impairs motor coordination.

A

Marijuana(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 297

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32
Q

Psychoactive substance found in marijuana.

A

Delta 9- Tetrahydrocannabinol (THC)(TOPNOTCHRobbins Basic Pathology, 8th Ed p. 297

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33
Q

Mechanism of action of aspirin.

A

Irreversibly blocks the enzyme cyclooxygenase.(TOPNOTCHRobbins Basic Pathology, 8th Ed p. 297

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34
Q

A wound produced by scraping or rubbing resulting in removal of superficial layer of the skin.

A

Abrasion(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 298

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35
Q

A wound usually produced by a blunt object, characterized by damage to blood vessels and extravasation of blood into tissues.

A

Contusion (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 298

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36
Q

A tear or disruptive stretching of tissue caused by the application of force by a blunt object, causing jagged and irregular edges to the skin.

A

Laceration(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 298

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37
Q

A wound inflicted by a sharp instrument, wherein bridging blood vessels are severed.

A

Incision(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 298

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38
Q

A wound caused by a long, narrow instrument.

A

Puncture wound(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 298

39
Q

Burn classification which involves total destruction of the epidermis and dermis, with loss of thermal appendages.

A

Full thickness burn (3rd and 4th degree)(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 298

40
Q

Burn classification wherein the thermal appendages are spared but involves at least the deeper portions of the skin.

A

Partial thickness burn(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 298

41
Q

Partial thickness burn that involves both the epidermis and superficial dermis.

A

Second degree burn(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 298

42
Q

Partial thickness burn that involves the epidermis only.

A

First degree burn(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 298

43
Q

These burns are pink or mottled with blisters and are painful.

A

Second degree burn (partial thickness)(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 298

44
Q

Histologic change in the skin during burns.

A

Coagulative necrosis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 298

45
Q

Leading cause of death in burn patients.

A

Organ system failure secondary to burn sepsis. Most common offender is the opportunist Pseudomonas aeruginosa. (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 299

46
Q

Cramping of voluntary muscles in association with vigorous exercise as a result of electrolyte loss via sweating.

A

Heat cramps(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 299

47
Q

Most common hyperthermic syndrome. A sudden onset of prostration and collapse, resulting from failure of the cardiovascular system to compensate for hypovolemia, secondary to water depletion.

A

Heat exhaustion(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 299

48
Q

Associated with high ambient temperatures and high humidity. Thermoregulatory mechanisms fail, sweating ceases and core body temperature rises. Due to marked generalized peripheral vasodilation with peripheral pooling of blood and decreased effective circulating volume.

A

Heat stroke(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 299

49
Q

Two types of injuries caused by electricity.

A

BurnsVFib or cardiac and respiratory center failure(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 299

50
Q

This may injure cells directly or indirectly by generating free radicals from water or molecular oxygen, damages DNA and rapidly dividing cells. Exposure may predispose to neoplastic transformation, vascular damage, sclerosis and tissue fibrosis.

A

Ionizing radiation(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 300

51
Q

Malnutrition caused by lack of nutrients from the diet.

A

Primary malnutrition(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 304

52
Q

Malnutrition caused by malabsorption, impaired nutrient utilization or storage, excess losses or increased nutrient needs.

A

Secondary or conditioned malnutrition(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 304

53
Q

Protein energy malnutrition which occurs when protein deprivation is relatively greater than reduction in total calories. Associated with generalized edema, flaky paint appearance of the skin, alternating bands of pale and dark hair, enlarged fatty liver, apathy, listlessness and loss of appetite. There is also mucosal atrophy and loss of villi in the small bowel (Making them lactate intolerant initially)

A

Kwashiorkor. SEE SLIDE 8.2 (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 305

54
Q

Protein energy malnutrition caused by a decrease in both protein and calorie intake, and weight falls below 60% of normal for sex, height and age. Serum albumin is normal or slightly reduced.

A

Marasmus. SEE SLIDE 8.2 (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 305

55
Q

Self-induced starvation, resulting in marked weight loss.

A

Anorexia(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 306

56
Q

A condition wherein a patient binges on food and then induces vomiting.

A

Bulimia(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 306

57
Q

Deficiency of this vitamin causes night blindness, xerophthalmia, keratomalacia, Bitot spots and eventually corneal ulceration.

A

Vitamin A(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 307

58
Q

Condition in children as result of vitamin D deficiency causing the following signs and symptoms: Craniotabes (parietal bones buckle inward with pressure), frontal bossing of the head, rachitic rosary, pigeon breast deformity, lumbar lordosis and bow legs. SEE SLIDE 8.3

A

Rickets (children)(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 309

59
Q

Deficieny of this vitamin causes impaired collagen formation, leading to gum bleeding, easy bruisability, and impaired wound healing. SEE SLIDE 8.4

A

Vitamin C (Scurvy)(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 312

60
Q

Symptoms of cheilosis, stomatitis, glossitis, dermatitis and corneal vascularization results from deficiency of this vitamin.

A

Vitamin B2 (Riboflavin)(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 314

61
Q

Symptoms of cheilosis, glossitis, dermatitis, and peripheral neuropathy.

A

Vitamin B6 (Pyridoxine)(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 314

62
Q

Leading causes of death in developed countries

A

Ischemic heart disease and cerebrovascular disease (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 405

63
Q

The most important catalyst of phase I reactions; detoxify xenobiotics

A

Cytochrome P-450 enxyme system (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 407

64
Q

A 55 y/o male presented to the ER following a house fire. He was lethargic, tachycardic, tachypneic and displayed memory disturbance. Skin was noted to be cherry red. What is the most likely cause?

A

Carbon monoxide poisoning (TOPNOTCH)

65
Q

A 5 y/o boy presented to the clinic due to hyperactivity and impulsiveness. Hearing acuity was below normal, and speech and language were slightly delayed. History reveals that the boy lives in an old house in the community. PBS showed hypochromia and microcytosis. What is the most likely diagnosis?

A

Lead poisoning (TOPNOTCH)

66
Q

Toxic effects of this heavy metal include cerebral palsy, deafness, blindness, and kidney damage. Cause of Minamata disease.

A

Mercury (TOPNOTCH)

67
Q

Most toxic form of arsenic

A

Trivalent compounds of arsenic(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 412

68
Q

The most serious consequence of chronic exposure to this heavy metal is the increased risk for the development of cancers, particularly of the lungs, bladder, and skin.

A

Arsenic (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 412

69
Q

The principal toxic effects of toxicity to this heavy metal are obstructive lung disease and renal tubular damage that may progress to ESRD.

A

Cadmium (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 413

70
Q

Exposure to benzene increases risk of what hematologic condition

A

Leukemia (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 413

71
Q

Exposure to vinyl chloride used in the synthesis of polyvinyl resins leads to the development of what tumor?

A

Angiosarcoma of the liver (TOPNOTCH) Robbins Basic Pathology, 9th ed.,p.414

72
Q

Main enzyme system involved in alcohol metabolism

A

Alcohol dehydrogenase(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 417

73
Q

Enlarged and fatty liver is seen in kwashiorkor or marasmus?

A

Kwashiorkor(TOPNOTCH)

74
Q

A major complication of anorexia nervosa and bulimia

A

Cardiac arrythmia and sudden death due to hypokalemia (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 435

75
Q

Symptos of acute toxicity to these vitamin include headache, diziness, vomiting, stupor, and blurred vission, which may be confused with those of a brain tumor (pseudotumor cerebri)

A

Vitamin A(TOPNOTCH)Robbins Basic Pathology, 9th Ed p. 438

76
Q

Toxicity of this vitamin may cause calcification of soft tissue and bone pain.

A

Vitamin D(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 441

77
Q

Rash around the eyes, mouth (SEE SLIDE 8.5) ,and nose, anorexia, diarrhea, growth retardation, depressed wound healing and impaired night vision are associated with ____ deficiency

A

Zinc(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 443

78
Q

Muscle weakness, neurologic defects and abnormal collagen cross-linking are associated with ___ deficiency.

A

Copper(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 443

79
Q

Disease characterized by bone disease in growing children and by hemorrhages and healing defects in both children and adults.

A

Scurvy(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 443

80
Q

Syndrome composed of respiratory abnromalities in very obese persons.

A

Hypoventilation syndrome/pickwickian syndrome (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 448

81
Q

Hormone synthesized by fat cells which regulates food intake an energy expenditure. Its binding to its receptors in the hypothalamus increases energy consumption by stimulating POMC/CART neurons.

A

Leptin(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 448

82
Q

Aflatoxin is implicated in what type of cancer?

A

Hepatocellular carcinoma(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 449

83
Q

True or False. High animal intake and low fiber has been imlicated in colon cancer.

A

True (TOPNOTCH)

84
Q

Lead has a more damaging effect on the brains of children than in adults because of (A) a more permeable blood-brain barrier (B) immature lenticular nuclei (C) less microglia and astrocytes(D) greater proportion of fetal hemoglobin in the blood

A

a more permeable blood-brain barrier (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 283

85
Q

Chronic exposure to arsenic is associated with the development of the following malignancies EXCEPT (A) squamous cell carcinoma of the skin (B) mucoepidermoid carcinoma of the salivary glands (C) lung carcinoma (D) basal cell carcinoma

A

mucoepidermoid carcinoma of the salivary glands (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 285

86
Q

Exposure to vinyl chloride has been found to cause (A) multiple uterine leiomyomas (B) hepatic angiosarcoma (C) squamous cell carcinoma of the skin (D) transitional carcinoma of the bladder

A

hepatic angiosarcoma (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 287

87
Q

Tobacco smoke, when combined with this, is known to have a multiplicative effect on the risk of developing laryngeal cancer (A) alcohol (B) diet rich in animal fat (C) dietary nitrates (D) oral sex

A

alcohol (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 289

88
Q

Progestin is added to estrogen in hormone replacement therapy for menopausal women to reduce the risk of (A) breast cancer (B) endometrial cancer (C) thromboembolism (D) all of the above

A

endometrial cancer (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 293

89
Q

During a routine ultrasound, a 38 year old G1P0 was found to have a solitary, 4 cm diameter, hepatic mass in the right lobe, beneath the capsule. She has a history of regular oral contraceptive use since 18 years old, and stopped 1 year ago. She has never been infected by HBV or HCV. She does not drink alcohol. If the mass is excised, it would most likely show (A) benign-looking hepatocytes in cords and sheets, absent portal tracts, and prominent blood vessels (B) proliferation of endothelial cells some containing lumens with RBCs (C) portal tracts with chronic inflammation and bile duct proliferation (D) pleomorphic cells, bizarre giant cells, atypical mitoses, and necrosis

A

benign-looking hepatocytes in cords and sheets, absent portal tracts, and prominent vessels (hepatic adenoma) (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 294, p664)

90
Q

Liver damage in acetaminophen overdose is characterized histologically by (A) brisk neutrophilic infiltration of portal tracts (B) hepatocytes with extensively vacuolated cytoplasm (C) centrilobular necrosis (D) bile duct proliferation

A

centrilobular necrosis (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 294

91
Q

A 65 year old man has been regularly taking aspirin and acetaminophen for 20 years. This predisposes him to developing (A) chronic interstitial nephritis (B) renal papillary necrosis (C) transitional cell carcinoma of the renal pelvis (D) all of the above

A

all of the above (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 294, 564

92
Q

An 4 year old orphan boy with a scar on his forehead was found locked in a small room under the stairs by his abusive uncle and aunt. He has been kept there and fed crackers and milk since he was 1 year old. He has a squared appearance of the head, a pigeon breast deformity, lumbar lordosis, and bowing of the legs. These physical findings are due to deficiency of (A) calcium (B) vitamin A (C) vitamin C (D) vitamin D

A

vitamin D (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 309-312

93
Q

Basic derangement in both rickets and osteomalacia

A

Excess of unmineralized bone matrix. (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 300

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