Review Quiz 2 - Answer Key
1 - E. The clear round spaces in the peripheral pulmonary artery are fat globules that embolized to lung following release from fatty marrow with the fractures. There is usually a 24 to 72 hour delay from the time of the accident to the onset of symptoms.
2 - C. The emphysema and the varices from portal hypertension can be tied together with AAT deficiency, a disease that can affect both the liver (with cirrhosis) and the lung (with panlobular emphysema).
3 - C. The findings point to a diagnosis of amyotrophic lateral sclerosis (ALS), a progressive disease of unknown etiology which results in a neurogenic form of atrophy of skeletal muscle.
4 - A. This is a renal infarct, the result of coagulative necrosis from an ischemic injury. Such a focal lesion in the kidney is likely the result of an embolic event. Emboli must come via the systemic circulation. A source in the heart is likely. His injection drug use predisposes him to infective endocarditis.
5 - D. This is an 'oops' which should not have happened. Clearly, there was not close enough monitoring of the patient or adequate facilities to deal with a potential complication of this nature. You donŐt expect to have the complication of death with such minor surgery, and if the patient were unstable, then this elective surgery should not have been performed.
6 - B. This is a form of type III hypersensitivity (and type IV if the exposure is prolonged) from encounter with an antigen such as a mold found in the environment. Exposure to the antigen brings on the symptoms, which subside when the antigen is no longer present.
7 - A. She has malignant hypertension, along with additional findings that suggest scleroderma (diffuse systemic sclerosis).
8 - B. He has findings of chronic myelogenous leukemia (CML) in which there is maturation, but immature forms are present, along with eosinophilia and basophilia. CML is distinguished from a leukemoid reaction by the low LAP score. The t(9;22) translocation is the characteristic 'Philadelphia chromosome' of CML.
9 - C. Falls in the elderly lead to subdural hematomas. Such a hematoma may form insidiously with worsening neurologic status.
10 - E. This is a 'small blue cell tumor' of childhood that often involves the diaphyseal region of a long bone. Gaucher disease may on occasion produce a mass lesion, but there are large macrophages filled with a storage product. A chondrosarcoma has a chondroid matrix and generally is not a pediatric tumor. A giant cell tumor involves the diaphysis and has giant cells. CLL is seen in older adults and consists of small mature lymphocytes.
11 - B. This is systemic anaphylaxis, a type I hypersensitivity reaction in which the antigen contacts preformed antibody attached to mast cells, leading to mast cell degranulation in minutes.
12 - C. This is the typical 'excited delerium' seen with usage of large amounts of cocaine. Patients can have malignant hyperthermia. Both urine and blood will demonstrate significant quantities of cocaine and the metabolite benzoylecgonine.
13 - C. He has marked hyponatremia with the syndrome of inappropriate ADH, a paraneoplastic syndrome most often due to an 'oat cell' carcinoma of the lung.
14 - B. There can be one or more small foci of endometrial glands with stroma that can produce irritation and pain. These foci can be found on peritoneum anywhere in the pelvis, but most often on the uterine surface or adnexal structures.
15 - A. The location and the discreet nature of the mass are consistent with a benign process. Meningiomas are benign tumors more common in women. They are often located in a parasagittal region beneath the dura.
16 - E. Neural tube defects, such as the large meningomyelocele here, could be reduced with maternal dietary folic acid supplementation. Of course, the folate supplementation must begin BEFORE the conception.
17 - D. The fever with flank pain and pyuria with WBC casts is consistent with a kidney infection, which typically occurs from an ascending infection from the lower urinary tract. Women are affected more commonly than men because of the shorter urethra that predisposes to more bladder infections.
18 - D. The foreign body granulomas form in response to a foreign body--in this case suture material. Hypertrophic scars and granulomas are more likely to occur in persons with an exaggerated healing response.
19 - A. The episodic nature of his illness suggests exposure to a substance which affects no one else at the same time. Lactase deficiency is relatively uncommon amongst persons of European descent. Use of milk and milk products is frequent amongst persons of European extraction.
20 - A. Viral antigens bind to MHC class I molecules that are recognized by CD8 cells. The cytotoxic CD8 cells induce apoptosis. This results in hepatocyte death in viral hepatitis, which is often a slowly progressive process.
21 - B. These are metastases to the liver. A carcinoma is a likely primary, and there are a number of potential primary sites. Colon cancer is one of the most common cancers.
22 - C. Some papillary carcinomas of the thyroid initially present as cervical nodal metastases, and the thyroid may not be enlarged. The histologic finding of optically clear nuclei is characteristic for papillary carcinoma.
23 - D. These are cholesterol gallstones. Risks for such stones may include increasing age, female sex, high caloric diet, native American ancestry, oral contraceptive use, estrogens, and Crohn disease.
24 - A.These tumors are histologically benign but are aggressive and invade and destroy surrounding structures, making their eradication difficult.
25 - D. The description is that of gangrenous necrosis, which is most often a complication of severe peripheral atherosclerosis in a diabetic.
26 - B. The goal of therapeutic radiation is to more selectively damage tumor cells. The radiation injures the neoplastic cells because they cannot sustain and repair damage as much as normal cells, and oxygenation amplifies the damage. Radiation therapy is given in controlled doses and delivered in highly selective beams to avoid radiating as much normal tissue as possible, while targeting the neoplasm. Thus, syndromes of anemia, GI malfunction, cerebral edema seen with total body radiation are not present. Fibrosis is a late complication of radiation therapy. Mutations leading to cancer are a long term effect of exposure to radiation. The tissues do not actually become hot with radiation.
27 - E. Post-menopausal bleeding should alert you to the possibility of an endometrial carcinoma.
28 - A. The crescents in this biopsy point to a rapidly progressive glomerulonephritis.
29 - E. These findings point to hereditary hemochromatosis with a cardiomyopathy, hepatic fibrosis, and pancreatic failure ('bronze diabetes').
30 - D. Almost all duodenal peptic ulcerations are associated with the presence of H. pylori in the gastric mucus. These short little bacilli make their home in the gastric mucus.