The following examination includes items from all aspects of pathology, from basic mechanisms of disease through organ system pathology.
Fill in the following information:
A 33 year old female complains of a cough for several months, along with shortness of breath. A chest radiograph demonstrates multiple small nodules distributed throughout all lung fields, but more numerous in the upper lobes. A transbronchial biopsy is performed, and examination of the tissue reveals nodular aggregates of Langerhans cells admixed with eosinophils, plasma cells, and lymphocytes. These findings are most characteristic for:
A 38 year old male has a history of injection drug use. He is found to be hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (HBcAb) positive. A liver biopsy shows piecemeal necrosis with periportal lymphoplasmacytic infiltrates extending into the hepatic parenchyma. These findings are most consistent with which of the following serum laboratory tests:
An 18 month old child is feeding poorly for a couple of days, and then has rhinorrhea with low grade fever, cough, and wheezing with increasing difficulty breathing. Tachypnea develops and the child is transported to hospital where hypoxia is noted on admission. The occupancy rate in the hospital is very high because of many similar cases. The child had a normal birth weight at 40 weeks gestation and was sent home with mother from the hospital on the second day following birth. The most probable etiology for these findings is:
An 11 year old girl is brought to your office by her mother who is concerned that the child exhibits irregular, uncontrolled movements some of the time, but mostly does not want to get out of bed. You find that the child has a fever and leukocytosis. Physical examination reveals erythema marginatum and subcutaneous nodules. The most likely laboratory finding is:
Sputum cytology is negative in a previously healthy 62 year old male who has a left lower lobe consolidation which has not decreased in size over a couple of months on serial chest radiographs, despite antibiotic therapy. Which of the following lesions is most likely to be found in this setting:
While bathing her 1 year old baby boy, a mother notices that the baby's abdomen seems larger than normal. The baby has not been feeding well lately, and is below the expected weight for his age. She takes the infant to the family physician who palpates a mass lesion in the abdominal region. A CT scan reveals a 5 cm mass in the left retroperitoneum adjacent to the kidney and displacing the kidney. The most probable diagnosis is:
A 48 year old male has worsening congestive heart failure over several years, along with diabetes mellitus and worsening arthritis. He also has cirrhosis with portal hypertension. Which of the following diseases would best account for all of these findings:
A 44 year old male has had headaches for several months. He has had decreasing vision with pain in his left eye, and an ophthalmologist diagnoses cytomegalovirus retinitis. He also has generalized lymphadenopathy. A CT scan of the head reveals a 5 cm mass lesion involving the periventricular white matter of the left cerebral hemisphere. A stereotaxic brain biopsy of this lesion is most likely to reveal:
A 28 year old female has had episodes of pelvic pain for several years that occur both at home and at work. She reports no irregular vaginal bleeding, though she does have dysuria on occasion. Following an extensive workup, she is taken to surgery at which time are found groups of reddish blue to brownish 1 to 5 mm nodules scattered on the surface of the uterus, fallopian tubes, and bladder serosa. The most likely diagnosis is:
A 10 year old child complains of intense itching of his hands. Physical examination reveals several linear gray-brown lesions a few millimeters in length that appear in the skin between his fingers. Some of these lesions have been excoriated by scratching. The etiologic agent for these lesions is most likely to be:
A 71 year old female has vague upper abdominal pain with nausea and a feeling of fullness after eating very little food. Upper endoscopy reveals an ill-defined 6 cm mass on the lesser curve in the body of the stomach. Biopsy of the lesion shows numerous signet ring cells infiltrating into the muscularis. Which of the following conditions is most likely to have contributed most to the development of her disease:
Non-caseating granulomas are seen on transbronchial biopsy from a 39 year old African-American female who has had night sweats, fever, and non productive cough for months. Bacterial, fungal, and mycobacterial cultures show no growth. These findings are most consistent with a diagnosis of:
Episodic hypertension for several months' duration is documented in a 39 year old female who had been previously healthy. Which of the following laboratory findings is most likely to be present in this situation:
A 59-year-old male develops sudden severe anterior chest pain that radiates to his back. Within minutes, he is unconscious. He has a history of hypertension, but no history of heart disease. Which of the following do you suspect:
A 46 year old female has had irregular menses for several months. Pelvic examination is normal, and an abdominal ultrasound reveals no mass lesions. The uterus appears normal in size. An endometrial biopsy is performed and demonstrates a proliferative pattern. The most likely diagnosis is:
A 42 year old female notices that even minor bumps produce major bruises over her body. The protime and partial thromboplastin times are normal, but her platelet count is only 10,000/microliter. A bone marrow biopsy reveals a normocellular marrow with adequate numbers of erythroid and myeloid precursors, but there are increased numbers of megakaryocytes. These findings most strongly suggest a diagnosis of:
A 55 year old male has the acute onset of abdominal pain over a days' time. On physical examination, he has abdominal distension, and high-pitched bowel sounds are heard. His WBC count is only slightly elevated. A stool guaiac is negative. He had an appendectomy for acute appendicitis in his 20's, but no other major medical problems since then. The etiology for his condition is most likely:
Postmenopausal bleeding has been present for a couple of months, and a 59 year old female sees her physician. He refers her to a gynecologist, who performs an endometrial biopsy that reveals atypical adenomatous hyperplasia. This lesion most likely results from:
A 45 year old male has a feeling of heaviness but no pain in the scrotum, and physical examination reveals that there is a mass on the left that is about 4 cm in diameter. Ultrasound reveals the mass to be echogenic, and it is noted to transilluminate just before the clinic's flashlight goes dead. The most probable diagnosis is:
An 18 year old male is noted on physical examination to have marked bounding pulses in the upper extremities, but only weak pulses palpable in the lower extremities. Pulmonary function is normal. He does not have cyanosis. The most probable condition leading to these findings is:
A 17 year old male experiences easy fatiguability and cramping pain of muscles with exercise during physical education classes. This condition does not improve with additional exercise, with Gatorade (a sports drink containing electrolytes), with anti-inflammatory medications, or with yelling by the instructor. He does not have problems with activities of daily living. The best explanation is:
Multiple "hot spots" with increased uptake appear on bone scan of a 76 year old male. He has had pain in the right arm, left leg, and back, and there has been a fracture of the right humerus. The most likely laboratory finding in serum in this setting is:
A 19 year old female is admitted in diabetic ketoacidosis. Her glucose is difficult to get under control. During her hospitalization, she begins to develop left-sided facial pain along with facial swelling and proptosis of the left eye. She develops increasing obtundation. A biopsy of the left maxillary sinus is most likely to show:
A 50 year old female had a worsening headache for several weeks that was not relieved by analgesics. Following a grand mal seizure, she is admitted to the hospital. She is febrile. She has a lumbar puncture performed and the cerebrospinal fluid (CSF) opening pressure is 220 mm H2O (normal 50 to 180), the CSF protein 60 mg/dl (normal 15 to 45), and the CSF glucose 75 mg/dl (serum glucose 105 mg/dl). Biopsy of a 3 cm right parietal lesion reveals gliosis and fibrosis with necrosis, many neutrophils, and a few lymphocytes. These findings suggest:
A 37 year old female has periodic fainting episodes that are preceded by periods of mental confusion and a feeling of weakness. These have occurred for the past year. She is otherwise healthy. The most likely explanation for these findings, among the following conditions, is:
A 25 year old male has multiple firm nodules, some of which are up to several centimeters in size, that are disfiguring because they are located on his hands and arms. Also noted on physical examination are scattered light brown macules with smooth borders, averaging about 2 to 3 centimeters in size, over the skin of his trunk and arms. These lesions are most likely to represent:
Following a mild upper respiratory flu-like illness, a 47 year old male develops a rapidly ascending paralysis. A week later he is hospitalized and requires intubation with mechanical ventilation. Lumbar puncture yields clear CSF under normal pressure with a slightly elevated protein, but no red blood cells and only 3 mononuclear cells. He gradually improves over the next couple of weeks. He most likely has:
A 53 year old male has a long history of diabetes mellitus, type 1, which has been poorly controlled, as evidenced by an elevated hemoglobin A1C level. Which of the following funduscopic findings is most likely to be present:
The knee of a 22 year old Caucasian male is swollen and painful, so he has difficulty walking. Aspiration of fluid from the joint space reveals thick, yellow fluid which microscopically contains numerous neutrophils. The best explanation for these findings is:
The appearance of tear-drop RBC's along with nucleated RBC's and metamyelocytes in the peripheral blood of a 74 year old male with total WBC count of 4,900/microliter, Hgb 10.6 g/dL, Hct 29.8%, and platelet count of 189,000/microliter most strongly suggests:
A 29 day old neonate is brought in because his mother has noted that he forcefully vomits soon after feeding. This has been occurring over a week, and the baby is no longer gaining weight. The baby was 3550 gm at birth following a term gestation, and was initially doing well. The most likely explanation for these findings is:
Boys over several generations of a family are found to have onset of progressive muscular weakness in childhood, and none have lived past age 20. The mechanism for this disease is now known to be:
Bronchoalveolar lavage yields a specimen with numerous alveolar macrophages that are filled with hemosiderin. The patient, a 48 year old female, has orthopnea. These findings are most likely to be a consequence of:
The "employee of the year" is rewarded with a close-in parking space, but this space is very icy in winter, and she falls getting out of her car. She scrapes her arm on the pavement. She goes to the employee clinic, where the physician's assistant in charge observes only a superficial epidermal injury in which the skin is not completely broken. This injury to the arm is best termed a(an):
A six month old male infant has been getting one bacterial pneumonia after another with H. influenzae and S. pneumoniae. The pregnancy was uncomplicated and the birth occurred at term. The mother is a healthy 30 year old with no known illnesses. You should most strongly suspect:
This microscopic appearance was found at autopsy in a 30 year old male who had been involved in a motor vehicle accident in which he had sustained multiple fractures. His condition was stable for three days in hospital, but then his respiratory status worsened abruptly. The most likely explanation is:
A 70 year old female is found to have a WBC count of 32,000/microliter with differential count of 8 segs, 1 band, 88 lymphs, and 4 monos. Her Hgb is 12.2 g/dl, Hct 37.1%, and platelet count 178,000/microliter. Her peripheral blood smear is shown here. The best diagnosis is:
This 55 year old male presented with hypertension. Key laboratory findings include: serum cortisol at 8 am 15 microgram/dL (normal 6 - 23 microgram/dL); plasma renin activity 1.2 ng/mL/hr (normal 1.9 - 3.7 ng/mL/hr); serum aldosterone 44 ng/dL (normal 4.0 - 31.0 ng/dL); serum potassium 2.9 mmol/L (normal 3.3 - 5.0 mmol/L). The lesion shown here most likely represents:
A 15 year old male underwent bone marrow transplantation, with marrow donated from a sibling, with a 5 out of 6 antigen match. He later developed a fine, scaling skin rash as well as diarrhea. He also had the finding shown here microscopically in the liver. The laboratory finding most likely to accompany this microscopic appearance is:
The pulmonary arteries have been opened at autopsy to reveal the gross appearance shown here. The patient was a 62 year old female. Which of the following histories fits best with this appearance:
For each question below, select the lettered option that is most closely associated with it. The lettered options may be used once, more than once, or not at all.
Question 41
Question 42
Question 43
Question 44
Question 45
Question 46
Question 47
Question 48
Question 49
Question 50