Pathology Written Exam III
1. All of the following changes take place at birth or within a few months after birth
EXCEPT:
A. The foramen ovale closes
B. Neonatal plasma levels of gamma-immunoglobulin decline
C. Pulmonary arteriole wall thicknesses increase.
D. The right ventricular oxygen tension decreases.
E. The pulmonary vascular resistance decreases.
2. Examination of the dividing membranes of a twin placenta show two layers of amnion with
intervening chorion. Which conclusion may be drawn?
A. The placenta is diamniotic monochorionic
B. The placenta is diamniotic dichorionic
C. The twins are obligatory dizygous (fraternal)
D. The twins are obligatory monozygous (identical)
E. The placenta is monoamniotic monochorionic
3. Which of the following is most predictive of a premature infant's prognosis?
A. Length of labor
B. Apgar scores
C. Pulmonary maturity measurement
D. Birth weight
E. Renal Function
4. Which of the following is NOT a common malignancy of childhood?
A. Neuroblastoma
B. Rhabdomyosarcoma
C. Ewing's sarcoma
D. Nephroblastoma/Wilms' tumor
E. Colorectal carcinoma
5. All of the following are true of neuroblastoma EXCEPT:
A. The most common site of a neuroblastoma is the adrenal medulla
B. Neuroblastoma can be present at birth
C. Presentation at older ages is a favorable prognostic indicator
D. Neuroblastoma is the most common solid malignancy of infancy
E. Some neuroblastomas mature to ganglioneuromas
6. All of the following are true of infantile hemangiomas EXCEPT:
A. They are associated with Kasabach-Merritt syndrome
B. They are the most common benign tumor of infancy
C. Surgical excision is the preferred treatment
D. The most frequent sites are the skin of the face and scalp
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7. Which of the following lesions associated with prematurity is the main abnormality that drives
the progress of hyaline membrane disease and respiratory distress syndrome?
A. Increased thickness of airspace walls
B. Inadequate production of pulmonary surfactant
C. Poor approximation of capillaries to airspaces.
D. Increased thickness of pneumocytes
E. Decreased numbers of alveoli
8. All of the following statements about meconium aspiration are true EXCEPT:
A. It can lead to airway obstruction
B. It can lead to chemical pneumonitis
C. It is associated with intrauterine distress
D. Preterm infants are at highest risk for meconium aspiration
E. It can lead to persistent pulmonary hypertension
9. What is the most common cause of spontaneous first trimester abortions?
A. Encephalocoele
B. Abdominal wall malformations
C. Renal dysgenesis
D. Chromosomal abnormalities
E. Cardiac malformations
10. Of the following rickettsioses, which does not require an arthropod vector for transmission to
humans?
A. Rickettsialpox
B. Q fever
C. Ehrlichiosis
D. Rocky Mountain spotted fever
E. Louse-borne typhus
11. Which lab test or clinical finding has the greatest specificity for the diagnosis of bacterial
sepsis?
A. Recovery of pathogenic bacteria from sputum
B. Recovery of pathogenic bacteria from blood culture
C. Demonstration of leucocytosis or leucopenia
D. Demonstration of fever or hypothermia
E. Demonstration of low arterial blood pressure
12. Your 25-year-old patient is found to have mild hypercalcemia on routine labwork. When you
mention this to her, she says that others in her family, all healthy, have been told the same thing.
You suspect familial hypercalcemic hypocalciuria. What should you do next?
A. Order brain imaging studies to look for pituitary adenoma
B. Tell her that she has familial hypercalcemic hypocalciuria
C. Measure her (parathyroid hormone) PTH level
D. Measure her parathyroid hormone-related protein (PTHrP) level
E. Schedule her for parathyroidectomy
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13. What pathologic diagnosis is most often associated with secondary hyperparathyroidism?
A. Parathyroid adenoma
B. Parathyoid hyperplasia
C. Parathyroid dysplasia
D. Parathyroid aplasia
E. Parathyroid carcinoma
14. A 60-year-old male smoker presents with a 2 cm ulcer in the floor of his mouth, palpable
lymph nodes in his neck, and multiple lung masses by CT scan. If he had presented a few years
earlier, what precursor lesion would you have been most likely to discover in his mouth?
A. oral hairy leukoplakia
B. erythroplakia
C. pyogenic granuloma
D. aphthous ulcer
E. lipoma
15. A tumor with both epithelial elements and mesenchymal elements, embedded within a loose
myxoid background, is most often seen in which salivary gland?
A. submandibular gland
B. minor gland of the lip
C. sublingual gland
D. minor gland of the soft palate
E. parotid gland
16. A 45-year-old woman presents to you complaining of heartburn which worsens when she lies
down or bends over. What condition is she most likely to have?
A. paraesophageal hiatal hernia
B. sliding hiatal hernia
C. pulsion diverticulum
D. Zencker's diverticulum
E. Schatzki's ring
17. Your patient has a 20-year history of gastroesophageal reflux disease. What histologic
finding on esophageal biopsy would you find the most significant for long-term follow-up?
A. intraepithelial eosinophils and neutrophils
B. mucosal ulceration
C. elongation of lamina propria papillae
D. basal zone hyperplasia
E. metaplastic intestinal-type epithelium
18. Achalasia is characterized by:
A. fibrosis of lamina propria and atrophy of muscle
B. an etiologic association with forceful vomiting or retching
C. eventual development of squamous carcinoma in a small percentage of cases
D. Trypanosoma cruzi infection in most North American cases
E. over-relaxation of the lower esophageal sphincter with swallowing
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MATCHING: For each numbered item (Column 1) choose the most closely related
item in Column 2. Each answer may be used once, more than once or not at all.
19. Carbohydrate disorder resulting from the
the inability to degrade the sugarfound
in milk
20. X-linked lysosomal storage disease
resulting in neuropathy with pain and
parasthesias of the extremities.
21. Mucoplysaccharidoses sometimes
referred to as "short trunked dwafism"
that has features including joint laxity
and a broad mouth with widely spaced
teeth.
22. Lysosomal storage disease
characterized by finding positive sea
blue histocytes of foam cells in bone
marrow and many other tissues.
There are three types named A, B, and
C. Type C is actually an abnormal
accumulation of LDL cholesterol.
A. Galactose-6-sulfatase deficiency
(Morquio A) and Beta-galactosidase
deficiency (Morquio B).
B. Neimann-Pick disease (acid
sphingomyelinase deficiency)
C. Galactosemia (galactose phosphate
uridyl tranferase deficiency)
D. Fabry disease (a - galactosidase
deficiency)
23. The MOST frequent predisposing factor for acute pancreatitis is:
A. Gallstones
B. Hyperparathyroidism
C. Idiopathic
D. Chronic alcoholism
E. Infection
24. An important microscopic feature of acute pancreatitis is:
A. Necrosis of fat tissue with calcium precipitates
B. Interstitial lymphocytic infiltrates
C. Extensive fibrosis
D. Honeycombing with cysts containing serous fluid
E. None of the above
25. The MOST frequent tumor found in the pancreas is:
A. Mucinous Cystadenocarcinoma
B. Multiple endocrine neoplasia syndrome (MEN)
C. Metastatic gall bladder carcinoma
D. Adenocarcinoma (exocrine)
E. Islet cell tumor (endocrine)
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MATCHING: Relate the diseases in Column 1, to the leading clinical symptoms in
Column 2. Each disease in column 1 can be related to one, more than one or none of
the features in Column 2.
26. Acute hemorrhagic pancreatitis
27. Adenocarcinoma of the Pancreas
28. Islet cell tumor
29. Choleithiasis
A. Severe right upper quadrant pain
B. Sudden onset epigastric pain with
nausea, vomiting and shock
C. Constant boring pain unrelated to
eating, preferentially in left upper
quadrant
D. Weakness, fatigue, confusion,
convulsions
30. Carcinoma of the gall bladder is most frequently associated with:
A. Cigarette smoking
B. Cholecystitis and cholelithiasis
C. Cirrhosis of the liver
D. Chronic Alcoholism
E. Diabetes mellitus
31. Cirrhosis of the liver is NOT a frequent complication of:
A. Chronic alcoholism
B. Hemochromatosis
C. Hepatitis A virus infection
D. Hepatitis B virus infection
E. Hepatitis C virus infection
MATCHING: For each numbered item in Column 1, choose the letter of the most
closely related item in Column 2.
32. Lymphocytic infiltration, Councilman
bodies, bridging necrosis
33. Fatty change of hepatocytes, focal
hydropic degeneration, Mallory bodies,
patchy inflammation and portal fibrosis
34. Fibrosis of the liver with micronodular
pattern, brown color of tissue, only mild
portal inflammation
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A. Bilary chirrhosis, secondary
B. Acute viral hepatitis
C. Chronic alcoholism
D. Hemochromatosis
MATCHING: For each numbered item in Column 1, choose the most closely related item in
Column 2.
35. Hepatocellular carcinoma
36. Cholangiocarcinoma
37. Gall bladder carcinoma
38. Adenocarcinoma of Pancreas
A. Liver fluke (Opisthorchis sinensis)
B. Cholelithiasis
C. Hepatitis C virus infection
D. None of the above
39 A 40-year-old woman sees her family physician because of amenorrhea. She reports having
regular periods until about six months ago. She has been taking no medications or over-thecounter drugs. On physical exam, she is obese and has mild hirsutism. Her blood pressure is
elevated. Pelvic exam does not reveal any adnexal masses, nor an enlarged uterus or ovaries.
Laboratory studies reveal increased serum levels of ACTH and cortisol. Which of the following
is most likely responsible for this patient's findings?
A. Pituitary tumor
B. Adrenal medullary tumor
C. Endometrial carcinoma
D. Adrenal cortical adenoma
E. Polycystic ovarian disease
40. A 2-year-old girl is brought to the emergency department for decreased level of
consciousness and is found to be severely hypotensive. Her parents report that she had been well
until about four days previously when she developed high fever and irritability. Laboratory
studies show bacteria and an increased number of neutrophils in her peripheral blood, decreased
sodium, and increased potassium. Which of the following would most likely explain these
findings?
A. Conn's syndrome
B. Adrenogenital syndrome
C. Waterhouse-Friderichsen syndrome
D. Pheochromocytoma
E. Adrenal cortical adenoma
41. 35-year-old woman is evaluated for an enlarged thyroid gland. Laboratory studies reveal that
she is euthyroid, and a thyroid scan demonstrates a cold nodule. A fine-needle-aspiration biopsy
shows a follicular neoplasm, and the nodule is then surgically excised. Which of the following is
the most important feature in distinguishing a follicular adenoma from a follicular carcinoma?
A. Production of thyroglobulin by the tumor cells
B. Presence of anti-thyroglobulin antibodies
C. Pleomorphism of the tumor cells
D. Number of mitotic tumor cells
E. Extension of the tumor through the tumor capsule
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42. A 30-year-old woman has heat intolerance, a wide-eyed gaze, and a diffusely enlarged
thyroid gland. Elevated T3 and T4 levels and antibodies to the TSH receptor are demonstrated in
her blood. What is a biopsy of her thyroid gland most likely to show?
A. Extensive fibrosis of the thyroid gland
B. Fatty infiltration of the thyroid gland
C. Atrophy of the thyroid follicles
D. Papillary proliferation of the follicular epithelial cells and psammoma bodies
E. Hyperplasia and hypertrophy of follicular epithelium
43. The uterus, fallopian tubes, and upper third of the vagina are derived from:
A. Primordial germ cells
B. Gartner's ducts
C. Wolffian ducts
D. Mesonephric ducts
E. Mullerian ducts
44. The Schiller test is used as an aid in the diagnosis of:
A. Herpes group viral infections
B. Autoimmune thyroid disease
C. Uterine cervix neoplasia
D. ACTH-dependent Cushing disease
E. Cryptosporidium intestinal infection
45. A 28-year-old woman with infertility and metorrhagia is evaluated for dysfunctional uterine
bleeding. As part of her evaluation, an endometrial biopsy at the expected 25th day of her
menstrual cycle is obtained. However, the "dating" of the endometrium indicates secretory
endometrium consistent with the 20th day of the cycle. These findings suggest:
A. Increased estrogen effect
B. Chronic endometritis
C. Atrophic endometrium
D. Pregnancy
E. Inadequate luteal phase
46. A 48-year-old perimenopausal woman with abnormal uterine bleeding is found to have
endometrial carcinoma on biopsy. Upon removal of the uterus, a low-grade, well-differentiated
endometriod andenocarcinoma is present. Which of the following is most likely a risk factor for
developing this type of cancer?
A. Estrogen replacement therapy
B. Human papilloma virus 18
C. Chronic hepatitis
D. - High gravidity and parity
E. Anorexia nervosa
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47. A 60-year-old woman with a history of pelvic irradiation ten years previously for cervical
cancer has a large uterine tumor with areas of hemorrhage and necrosis filling the endometrial
cavity. Examination of the tumor demonstrates malignant epithelium and malignant stroma. The
most likely diagnosis is:
A. Atypical endometrial hyperplasia
B. Leiomyosarcoma
C. Metastatic ovarian stromal tumor
D. Desmoplastic cervical carcinoma
E. Malignant mixed Mullerian tumor
48. A 25-year-old woman with obesity, hirsutism and amenorrhea suspected of having
Polycystic Ovarian Syndrome is most likely to have which of the following additional
findings?
A. Renal insufficiency
B. Insulin resistance
C. Hyperestrogenism
D. Fibrocystic breast changes
E. Atrophic, cystic ovaries
49. A 45-year-old woman has bilateral, non-cystic ovarian tumors. By ultrasound, one of
the tumors measures approximately 5 cm and the other about 12 cm in greatest
dimension. Further evaluation of the patient reveals ascites and a right-sided pleural
effusion. Based on these findings, which of the following types of tumors is she most
likely to have?
A. Fibromas
B. Metastatic endometrial carcinoma to the ovaries
C. Granulosa cell tumors
D. Mucinous-cystadenocarcinomas
E. Brenner tumors
50. A 30-year-old woman being evaluated for infertility undergoes laproscopic examination.
The ovaries are normal in size, but an area of slight thickening and red-brown
discoloration on the surface of an ovary is biopsied. Microscopic examination of the
biopsy specimen shows benign glandular epithelium, loose stroma, and
hemosiderin-laden macrophages. Which of the following is the most likely diagnosis?
A. Borderline mucinous cystadenoma
B. Chronic salpingitis
C. Endometriosis
D. Ectopic pregnancy
E. Adenomyosis
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51. A 50-year-old woman is found to have a Brenner tumor of the ovary. Which of the
following statements is most appropriate to tell the patient?
A. Patients often have ascites associated with this type of tumor.
B. The tumor is nearly always benign.
C. The tumor arises from the stromal cells of the ovary.
D. This type of tumor may arise in endometriosis.
E. She is at risk for developing another, more aggressive type of ovarian tumor.
52. A 55-year-old woman has a scaly, ulcerated appearance of the nipple that upon biopsy
shows Paget disease. Which of the following statements is true for this disease?
A. It is often associated with a prior history of irradiation.
B. It is seen most often in men with breast cancer.
C. It is nearly always associated with an underlying adenocarcinoma.
D. It is composed of glandular epithelium and dense fibrous bands.
E. It is usually well-delineated from surrounding tissue.
53. Compared to typical ductal carcinoma, lobular carcinoma of the breast:
A. does not metastasize as often.
B. is more often bilateral.
C. is composed of larger tumor cells.
D. is much more clinically aggressive.
E. does not have an in-situ component.
54. A 60-year-old woman has a mastectomy for invasive adenocarcinoma of the breast.
Which of the following is the most important finding for her prognosis?
A. microcalcifications within the tumor
B. papillary architecture of the tumor cells
C. number of mitoses per high power field
D. nuclear-to-cytoplasmic ratio of the tumor cells
E. presence of metastases in axillary lymph nodes
55. Which of the following does NOT have squamous carcinoma in situ on histologic
examination?
A. Bowen's disease
B. Hypospadias
C. Bowenoid papulosis
D. Erythroplasia of Queyrat
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56. An uncircumcised 62 year old male presents with a 6.0 cm fungating/exophytic mass
that has destroyed half of the glans of his penis. The biopsy shows invasive nests of
squamous cells with high grade nuclear dysplasia infiltrating in the deep stromal tissue
of the glans. Which of the following is the correct diagnosis and correct association?
A. Diagnosis is squamous cell carcinoma, and the lesion most likely contains
HPV types 6 or 11.
B. Diagnosis is condyloma acuminatum, and the lesion most likely contains HPV
(human papillomavirus) types 6 or 11.
C. Diagnosis is zoon's balanitis, and the lesion most likely contains no HPV.
D. Diagnosis is squamous cell carcinoma, and the lesion most likely contains
HPV types 16 or 18.
57. Which of the following statements about developmental anomalies of the penis is true?
A. Hypospadias leads to squamous cell carcinoma in greater than 75% of males.
B. Hypospadias inevitably progresses to epispadias.
C. Paraphimosis arises years before phimosis is noted.
D. Paraphimosis is a complication of phimosis.
58. A 65 year old male presents with a chief complaint of difficulty with urination, overflow
dribbling, and the feeling of incomplete emptying of the bladder after urinating. Prior to
further studies being done, which of the following should be at the top of your
differential diagnosis list?
A. Chronic bacterial prostatitis
B. Benign prostatic hyperplasia
C. Acute bacterial prostatitis
D. Prostatic adenocarcinoma
59. Which of the following is the LEAST important to obtain in the work-up of a patient if
you are checking them for prostatic adenocarcinoma?
A. Serum PSA (prostatic specific antigen)
B. Digital rectal exam
C. Blood counts (check for anemia)
D. Biopsies of both prostate lobes
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60. All of the following are CORRECT with respect to germ cell tumors of the testis
EXCEPT:
A. Yolk sac tumor is a non-seminomatous germ cell tumor and the most common
testicular tumor of young children.
B. Seminomas are relatively radiosensitive, while non-seminomatous germ cell tumors
are usually more resistant to radiation therapy.
C. Teratomas can show histologic features of all three germ cell lines (endoderm,
mesoderm, and ectoderm.)
D. Seminoma is the most common germ cell tumor.
E. Choriocarcinoma usually remains localized to the testis, without metastasizing
until late in the course of the disease.
61. Cryptorchidism:
A. Once corrected by orchiopexy, guarantees the patient will not have a subsequent
testicular tumor.
B. Increases the chance of subsequent testicular germ cell tumors by 10-40 fold
C. Has an infectious etiology
D. Is never bilateral
62. A 67 year old male presents with a 6-month complaint of intermittent abdominal
cramping and occasional small quantities of blood in his stool. A barium enema shows
small outpouchings extending outward from the wall of the sigmoid, and the barium
remains trapped within these outpouchings. The most likely diagnosis is:
A. Diverticulosis or diverticulitis
B. Infarction of the entire colon
C. Acute appendicitis
D. E. coli infection localized to the colonic muscularis propria
63. Which of the following is more typical of Crohn's than it is of ulcerative colitis:
A. Inflammation of the mucosa of the colon
B. Inflammation of the submucosa of the colon
C. Skip areas, fissures, and fistula formation
D. Complaints of rectal bleeding or bloody diarrhea
64. Ulcerative colitis:
A. Does not result in an increased risk of colonic adenocarcinoma in the patient
B. Always results in severe inflammation of the colonic serosa, and sometimes also of
the colonic mucosa
C. Always involves the distal ileum soon after its onset
D. Begins in the rectum and the inflammation progresses in a contiguous fashion
proximally through the colon.
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65. Which of the following is TRUE with respect to colon polyps:
A. Colon polyps are rarely found in patients with familial adenomatous polyposis
syndrome
B. In general, villous adenomas are more likely to become malignant than tubular
adenomas
C. A tubular adenoma with high grade dysplasia is no more likely to be associated with
invasive adenocarcinoma than a polyp with low grade dysplasia
D. A 1.0 cm tubular adenoma is more likely to progress to an invasive
adenocarcinoma than a 3.5 cm tubular adenoma
E. Hyperplastic polyps always contain adenocarcinoma in their stalk
66. An 81 -year-old male presents with symptoms of weight loss and intermittent blood in
his stool for the past 6 months. He has a history of two villous adenomas of the left
colon that were removed during colonoscopy 3 years ago. Today's colonoscopy shows
a 5.0 cm exophytic mass in the left colon. An MRI shows an exophytic mass with
infiltration through the entire wall of the bowel, and three lesions in the liver with
diameters of 0.5 to 1.5 cm. Needle biopsies of the liver lesions are planned in order to
confirm your suspicions. Which of the following is MOST CORRECT:
A. The patient has an invasive colorectal carcinoma with probable metastases, and his
treatment will most likely include surgery and chemotherapy.
B. The patient age and lesion location is perfect for Hereditary Non-Polyposis
Colorectal Carcinoma Syndrome.
C. The diagnosis is diverticulosis of the colon, with abscesses in the liver.
D. The patient has a Peutz-Jegher polyp and incidental (unrelated) liver lesions.
67. Sporadic colorectal cancers:
A. Have no association whatsoever with diet, other than the protective effects of high
fat meals
B. Metastasize to ovary or testis more frequently than they do to the liver or lung
C. Should not be suspected in older men with anemia
D. Arise after a series of mutations occur in colonic crypt cells; most often it is the APC
gene which is mutated first
E. Are most often either lymphomas or squamous cell carcinomas
68. A 51 year old white male presents with complaints of weakness, change in skin color,
decreased libido, increased thirst, and increased frequency of urination. His labs show
increased total serum iron levels, elevated serum ferritin, increased transferring
saturation, and increased blood sugar (indicating diabetes). Your diagnosis is:
A. Anemia secondary to gastrointestinal bleeding
B. Lead poisoning
C. Pancreatic adenocarcinoma
D. Hemochromatosis
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69. The time during gestation when the embryo or fetus has maximum susceptibility to
malformation or disruption by exogenous stimuli is:
A. The entire gestational period
B. Third trimester
C. Second trimester
D. First trimester
70. Which are sequelae of germinal matrix hemorrhage in a prematurely born neonate?
A. Kernicterus
B. Hyaline membrane disease
C. Intraventricular hemorrhage
D. Subdural hematoma
71. Which factors have a role in the pathogenesis of congenital atresia of the ileum?
A. Intrauterine damage to the gut wall.
B. Defective canalization of the embryonal gut lumen.
C. Absent ganglion cells in the Auerbach plexus
D. Chromosomal abnormality
72. What are the anatomic features of Hirschsprung disease?
A. Absent myenteric ganglion cells in the distal colon
B. Constriction of the proximal colon
C. Absent myenteric ganglion cells in the proximal colon.
D. Dilatation of the distal colon
73. In which of the following conditions does the aorta receive blood from the right
ventricle?
A. Tetralogy of Fallot
B. Infracristal ventricular septal defect
C. Pulmonic valve stenosis
D. Coarctation of the aorta with a ligamentum arteriosum
E. Foramen secundum atrial septal defect
74. Systemic arterial blood has diminished oxygen saturation in which of these
cardiovascular malformations?
A. Supracristal ventricular septal defect
B. Coarctation of the aorta with a ligamentum arteriosum
C. Patent ductus arteriosus with a left to right shunt.
D. Valve competent foramen ovate
E. Truncus arteriosus
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75. Which of these malformations accompanies systemic hypertension and left ventricular
hypertrophy?
A. Aortic valve atresia
B. Intramuscular ventricular septal defect
C. Truncus arteriosus
D. Anomalous pulmonary venous drainage to the right atrium
E. Coarctation of the aorta
76. What are the pathologic effects of a cardiac ventricular septal defect with an
unobstructed pulmonary valve?
A. Pulmonary hypertension
B. Splanchnic hypoperfusion
C. Systemic arterial oxygen unsaturation and cyanosis
D. Diminished pulse pressures in the lower extremities
E. Diminished pulmonary blood flow
77. From the following types of renal cystic disease, which is less likely to occur in children?
A. Unilateral cystic renal dyplasia.
B. Bilateral cystic renal dysplasia.
C. Autosomal recessive polycystic kidney disease.
D. Uremic medullary cystic disease.
E. Autosomal-dominant polycystic kidney disease.
78. Which of the following is (are) true about autosomal recessive polycystic kidney disease?
A. The renal cysts are of distal nephron origin (collecting ducts).
B. There is association with hepatic fibrosis.
C. There is involvement of both kidneys.
D. The renal disease is more severe in the newborn period.
E. All of the above.
Match the following diagnostic clues with the appropriate infectious agent.
79. Multinucleated giant cells on a Tzanck
smear
80. Elementary bodies in a corneal
scraping
81. Gram negative diplococci in a Gram
stain from the cervix
82. Gram positive bacilli on a
pseudomembrane
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A. Neisseria gonorrheae
B. Bordetella pertussis
C. Varicella-zoster virus
D. Corynebacterium dipitheriae
E. Chlamydia trachomatis
83. The laboratory calls you to let you know that the direct fluorescent antibody test that
you ordered on the nasopharynbgeal swab from the 2 month old child with a cough
was positive. What is the most likely diagnosis?
A. Rubella
B. Rubeola
C. Pertussis
D. Mumps
E. Herpes Simplex
84. A 55-year-old man with recently diagnosed small cell carcinoma of the lung develops
decreased consciousness and is found to be severely hyponatremic. Which of the
following is the most likely explanation for these findings?
A. Metastases to the pituitary gland
B. Excessive production of ADH by the lung tumor
C. Second primary tumor of the pituitary glans
D. Secondary hyperparathyroidism
E. Renal dysfunction secondary to chemotherapy
85. A 30-year-old woman delivers her third child but fails to produce breast milk. The
pregnancy was uneventful, but the delivery was complicated by excessive blood loss.
Which of the following is the most likely explanation?
A. Diabetes insipidus
B. Diabetes mellitus
C. Polycystic ovarian syndrome
D. Conn syndrome
E. Sheehan syndrome
86. A patient complains of gastrointestinal discomfort occurring over the previous several
months. He has tried various over-the-counter medications, but none have produced
long lasting improvement in his symptoms. He undergoes endoscopy with gastric
biopsy. The biopsy demonstrates numerous slender curved bacteria in the mucus
overlying his gastric epithelium. Of the following disorders, the one which is LEAST
associated with these bacteria is:
A. Duodenal ulcer
B. Gastric lymphoma
C. Diffuse antral gastritis
D. Acute erosive gastritis
E. Adenocarcinoma of the stomach
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87. A patient is given a diagnosis of autoimmune gastritis. Of the following statements,
which is CORRECT?
A. Compared to the general population, her likelihood of developing gastric cancer is
not elevated.
B. Antibodies to intrinsic factor are found in patients with this condition.
C. The characteristic histologic abnormality is an increased number of fundic glands.
D. Decreased secretion of pepsin is the primary abnormality responsible for her disease.
E. Non-steroidal anti-inflammatory agents are a common trigger for this disorder.
88. A young man comes to the Emergency Room with right lower quadrant abdominal
pain, fever, and vomiting. Physical examination shows tenderness and spasm of the
abdominal wall. Laboratory tests reveal an elevated white blood cell count (leukocytosis).
He is taken to surgery. Which of the following statements is INCORRECT?
A. Lumenal obstruction of the appendix by a fecalith may be present.
B. His appendix will probably show acute inflammation in its wall.
C. False positive diagnosis of this process is rare.
D. Perforation with peritonitis and abscess formation is a potential complication of this
process.
E. Mucosal ischemia and subsequent bacterial invasion of the wall are believed to play
a part in the pathogenesis of this process.
89. An otherwise healthy patient develops diarrhea and malabsorption. A biopsy is
obtained from his small intestine, and shows numerous macrophages containing
PAS-positive bacteria. The MOST LIKELY diagnosis is:
A. Giardiasis.
B. Whipple's disease.
C. Salmonella infection.
D. Cryptosporidium infection.
E. Mycobacterium avium intracellulare infection.
90. Which of the following pathogens is a recognized cause of intestinal infections in patients
with AIDS, but is very uncommon in patients without AIDS?
A. Candida albicans.
B. E. coli.
C. Cryptosporidium.
D. Strongyloides stercoralis.
E. H. pylori.
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ANSWERS:
1. C
2. B
3. C
4. E
5. C
6. C
7. B
8. D
9. D
10. B
11. B
12. C
13. B
14. B
15. E
16. B
17. E
18. C
19. C
20. D
21. A
22. B
23. D
24. A
25. D
26. B
27. C
28. D
29. A
30. B
31. C
32. B
33. C
34. D
35. C
36. A
37. B
38. D
39. A
40. C
41. E
42. E
43. E
44. C
45. E
46. A
47. E
48. B
49. A
50. C
51. B
52. C
53. B
54. E
55. B
56. D
57. D
58. B
59. C
60. E
61. B
62. A
63. C
64. D
65. B
66. A
67. D
68. D
69. D
70. C
71. A
72. A
73. A
74. E
75. E
76. A
77. E
78. E
79. C
80. E
81. A
82. D
83. C
84. B
85. E
86. D
87. B
88. C
89. B
90. C
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