Review Quiz 4 - Answer Key
1 - A. The majority of first trimester fetal losses occur as a consequence of fetal chromosomal anomalies, such as trisomies or monosomies resulting from meiotic non-disjunction. Erythroblastosis fetalis is unlikely in a primagravida without prior exposure (unless she had a mismatched blood transfusion) and most losses occur later than the first trimester (when there are more fetal RBC's to hemolyze). PROM is not a first trimester event, because there isnŐt much of a gestational sac. Folate deficiency can lead to an increased risk for neural tube defects, but these do not typically result in fetal loss. Congenital syphilis can produce hydrops in the third trimester, when the spirochetes are able to cross the placenta.
2 - E. The polycythemia suggests a paraneoplastic syndrome.
3 - B. These findings suggest secondary tuberculosis from Mycobacterium tuberculosis infection. In adults, this is the most common presentation of severe mycobacterial disease and results from the type IV hypersensitivity reaction and granulomatous inflammation.
4 - E. This rash has persisted long enough to be consistent with a contact dermatitis, a kind of type IV hypersensitivity reaction.
5 - A. This is the most common benign mass lesion in young women. The discreet nature of the mass and its hormonal responsiveness suggest a benign process.
6 - C. Painful abdominal crises can occur when the RBC's begin to sickle and occlude small vessels. Sickling results in hemolysis, with an elevation in indirect hyperbilirubinemia. Hyperbilirubinemia can lead to pigment gallstone formation. In childhood, the sickling results in progressive splenic infarction with 'autosplenectomy'.
7 - D. These findings point to a severe restrictive lung disease with cor pulmonale. Silicosis is a disease that can produce extensive interstitial fibrosis. Cigarette smoke is likely to lead to emphysema. Hypersensitivity pneumonitis upon exposure to antigens such as bird dust typically does not lead to extensive fibrosis. Ozone is a pollutant without significant pathologic effect. Formaldehyde exposure results in a pneumonitis, but not extensive chronic lung disease.
8 - A. The advanced nature of the atherosclerosis here suggests that other arteries, such as the coronaries, are also involved. Pulmonary thromboembolism results from thrombi in large veins embolizing to pulmonary arteries, and the risk for this process comes from venous stasis. Atherosclerosis does not involve veins. Atherosclerosis does not predispose to gastric ulceration. A subdural hematoma results from head trauma. A cryptococcal meningitis most often occurs in immunocompromised patients.
9 - C. She has myasthenia gravis. The antibody to the receptors causes cellular dysfunction without significant inflammation.
10 - D. The premature separation of the placenta results in markedly diminished oxygen and nutrient supply to the fetus and can result in stillbirth. Ultrasound will demonstrate a retroplacental blood clot.
11 - B. This is a hypertrophic cardiomyopathy, and about half of cases are inherited as an autosomal dominant condition, so the diagnosis has significance for other family members. Restrictive cardiomyopathies from amyloidosis and hemochromatosis are seen in older adults, as is aortic stenosis from a bicuspid valve. An endocarditis does not present this acutely.
12 - D. This is a hemopericardium. In a young person, this is typically the result of trauma. It is possible to have a ruptured myocardial infarction, but persons with this condition are typically older. Immunodeficiency states and opportunistic infections are not complicated by hemorrhage. Chronic alcoholism may contribute to coagulopathy, but not a spontaneous bleeding event.
13 - C. This is the most common germ cell tumor of a single cell type, and it accounts for about a third of testicular tumors, many of which are seen in young men. Seminomas tend to be circumscribed and solid. Pure seminomas are unlikely to be accompanied by elevations in AFP or HCG.
14 - A. The AST higher than the ALT is most characteristic for chronic alcholism. He does not have evidence for hemolysis because the bilirubin is not elevated. His WBC count is not markedly elevated, so CML is unlikely. The spleen is normal in size with ITP.
15 - D. These are cytomegalovirus inclusions in enlarged tubular cells. Congenital CMV can produce widespread fetal organ damage. One of the major causes for hydrops is congenital infection, including the 'TORCH' agents.
16 - E. It is typical for the dentist to ask about a history of heart disease, because a defect such as a ventricular septal defect will predispose to infective endocarditis with dental extraction. Despite use of antibiotic prophylaxis, such cases may still occur. Septic embolization can result in cerebral abscess formation.
17 - D. Gonorrhea may be suspected in sexually active young persons. The urethritis is typical in a male, and in some of these patients a septic arthritis can develop.
18 - A. This is a pulmonary infarction from a pulmonary thromboembolus. Recurrent thrombosis in a young person suggests a coagulopathy. The positive ANA suggests an autoimmune disease such as SLE. The 'lupus anticoagulant' or antiphospholipid antibody can be seen with autoimmune diseases and cause in vivo thrombosis.
19 - C. This is graft-versus-host disease. The engrafted marrow contains immunocompetent cells that can proliferate and attack host tissues, usually skin, liver, and gastrointestinal epithelium. TB skin testing is a form of delayed type hypersensitivity. Some chemotherapy agents can produce a drug reaction with more acute inflammation. Urticaria with type I hypersensitivity is a typical reaction to penicillin therapy. Patch testing is done to determine the type of allergens to which atopic persons may react.
20 - B. There are no physical signs to be seen with smothering. SIDS occurs in infancy between 1 month and 1 year of age. A pneumonia can be identified on histologic examination and by microbiologic culture. There will be injuries to the nervous system with shaken baby syndrome. Poisoning can be investigated through toxicology.
21 - B. The pyloric obstruction results from a hypertrophied pyloric muscle. This condition occurs most often in male infants.
22 - C. These mucosal crypt abscesses, along with the course and distribution of her disease, are most typical for ulcerative colitis. Extraintestinal manifestations of UC can include hepatic sclerosing cholangitis.
23 - E. This is the infant of a diabetic mother. The neonate has macrosomia. In utero, the fetal islets of Langerhans were in a hyperglycemic environment and became larger and more numerous.
24 - G. The setting suggests a suicide attempt from an overdose of acetaminophen, which is toxic to liver. Alcohol potentiates the effect of the acetaminophen.
25 - I. This is a twin-twin transfusion syndrome. This can complicate monochorionic twin placentas. The twin at greatest risk is the plethoric recipient because of the potential for congestive heart failure.
26 - B. The cystic renal disease led to oligohydramnios. When the pregnancy continues with this condition, there can be the formation of amnion nodosum on the fetal surface of the placenta. When oligohydramnios is present, the fetus is difficult to visualize by ultrasound because of the lack of fluid to echo sound waves.
27 - A. The presence of ischemic heart disease at a very young age suggests a genetic basis for advanced atherosclerosis.
28 - D. Most cases (99%) are type 1, the non-neurologic form. The storage of glucocerebrosidase occurs in cells of the mononuclear phagocyte system and leads to involvement of liver, spleen, lymph nodes, and marrow.
29 - I. This boy has minimal change disease. The proteinuria leads to hypoalbuminemia and edema.
30 - E. He has an autoimmune hemolytic anemia, with destruction of RBC's leading to an elevation in bilirubin (indirect, or unconjugated bilirubin).