Review Quiz 3 - Answer Key
1 - B. He has temporal arteritis, a form of giant cell arteritis that most often affects branches of the external carotid artery. This is not a systemic disease.
2 - E. The Reed-Sternberg cells are characteristic for Hodgkin's disease, and the bands of fibrosis suggest the nodular sclerosis variant.
3 - B. These hemorrhagic adrenals are characteristic for the Waterhouse-Friderichsen syndrome seen with meningococcemia.
4 - C. She has atopic asthma, a form of type I hypersensitivity. Contact with an allergen results in binding to IgE attached to sensitized mast cells, with release of granules and vasoactive amines such as histamine.
5 - D. The optic cupping is indicative of glaucoma, a condition that must be treated or the disks will be damaged and blindness will result.
6 - D. There is decreased bone mass from accelerated bone loss with osteoporosis. This condition is most common in older women past menopause.
7 - C. This is a purulent meningitis, with a yellowish exudate obscuring the sulci. The most common agent in older adults is pneumococcus.
8 - C. Fires in an enclosed space and to the head and neck area make an inhalation injury more likely. The inhalation of the hot gases damages the respiratory tract epithelium, predisposing to diffuse alveolar damage and infection.
9 - E. The aspirin will help reduce platelet function and decrease the risk for thrombosis. Glucocorticoids inhibit inflammation, but there are serious long-term side effects. TPA is used to try and treat a recently formed thrombus. Nitroglycerin is a vasodilator used to treat angina. Vitamin E may have long-term benefit to prevent aging and free radical injury, but has no specific effect on thrombosis.
10 - A. Such hemorrhage into the scalp across suture lines is termed caput succedaneum and is a benign process from moulding of the head with passage through the birth canal. With erythroblastosis fetalis, there is maternal antibody crossing the placenta that results in hemolysis of fetal RBC's, but not hemorrhage. Coagulopathies are generally not seen at birth, but if present do not produce such localized hemorrhage. Passive congestion and edema with CHF is more generalized, with hydrops, not hemorrhage. Placental abruption can lead to fetal distress, but the hemorrhage is retroplacental, not in the baby .
11 - B. This is amyloid. Most cases of amyloid are immunologic in origin with multiple myeloma as the underlying etiology. The amyloid can be deposited in a variety of organs.
12 - E. The renal colic is typical for passage of a urinary tract calculus. Most of these stones are formed of calcium oxalate, which is radiopaque. Such stones can form in alkaline urine. Hypercalciuria can favor stone formation. One cause for increased excretion of calcium is hypercalcemia from primary hyperparathyroidism. The most common cause for primary hyperparathyroidism is a parathyroid adenoma.
13 - C. The most common cause for cyanotic heart disease in the neonatal period is tetralogy of Fallot. The pulmonic stenosis, overriding aorta, and membranous ventricular septal defect result in a right-to-left shunt to produce cyanosis. The fourth feature, right ventricular hypertrophy, follows if the infant survives.
14 - D. Diabetics are more prone to bacterial infections. The acute nature of her symptoms suggests an acute inflammatory process. Bacterial organisms are most likely to produce acute inflammatory responses. The neutrophilic response to bacterial infections results in alveolar exudation and the productive cough.
15 - B. This is the malar 'butterfly' rash of systemic lupus erythematosus (SLE). A positive dsDNA antibody is quite specific for SLE, though it is present in less than half of cases.
16 - A. The findings point to acute gouty arthritis, and most cases are primary (idiopathic), but most of these are accompanied by increased serum uric acid and increased excretion of uric acid.
17 - B. TTP presents with a pentad of microangiopathic hemolytic anemia, thrombocytopenia, transient neurologic deficits, fever, and renal failure. Transfusion of platelets is contraindicated.
18 - D. He has a Meckel diverticulum, which is seen in about 2% of persons, but some of these have ectopic gastric mucosa.
19 - A. Ethanol is a toxin that results in hepatic steatosis. Marked steatosis can reduce the normal function of the liver, resulting in hypoalbuminemia and decreased oncotic pressure that increases loss of fluid into extravascular space.
20 - C. This is an acute chorioamnionitis, and bacterial infections that precede or follow premature rupture of membranes are most often to blame.
21 - A. This sudden event after immobilization is typical for a pulmonary thromboembolism. Her age is also a risk factor.
22 - E. Cervical dysplasias are most often related to human papillomavirus infection, which is a sexually transmitted disease.
23 - D. He has findings of asbestosis. Pneumoconioses take decades to become symptomatic, but the pulmonary disease is progressive.
24 - C. There is marked pulmonary hypoplasia, which results from the constriction produced by oligohydramnios. The amniotic fluid volume is reduced with urinary tract abnormalities, including cystic renal disease with reduced fetal urine production.
25 - C. When c-abl is translocated from its normal position on chromosome 9 to chromosome 22, it codes for a protein which is higher in molecular weight. The hybrid protein now has an active tyrosine kinase and results in development of chronic myelogenous leukemia.
26 - J. The WT-1 gene a Wilms tumor-suppressor gene located at chromosome 11p13 that encodes a transcription factor critical to development of normal kidneys and gonads. There can be autosomal dominant inheritance of familial Wilms tumor.
27 - C. She has findings that suggests Hashimoto thyroiditis, one of the most common causes for hypothyroidism in adults. This is an autoimmune type of thyroiditis, and in the course of the disease the anti-thyroid antibodies, including anti-microsomal and anti-thyroglobin antibodies, are often increased.
28 - F. She has pernicious anemia from atrophic gastritis, which can be an autoimmune condition with loss of parietal cells in the gastric mucosa.
29 - I. A pheochromocytoma can secrete catecholamines to produce hypertension. Most are located in an adrenal gland, but about 10% are extra adrenal.
30 - C. Worldwide, the most common risk factor for primary liver cancer is hepatitis B infection. The focal obstruction by the tumor increases the alkaline phosphatase, but not the bilirubin. Most hepatocellular carcinomas secrete alpha-fetoprotein.