PATHOLOGY WRITTEN EXAM II
1. A 32-year-old man is admitted to the hospital with a gunshot wound to the abdomen.
He undergoes surgery, during which the damage caused by the wound is repaired.
However, on the third postoperative day he develops a bacterial infection and dies.
What is the proximate cause of death?
A. Bacterial sepsis
B. Homicide
C. Gunshot wound
D. Natural causes
E. Accidental
2. In the case above what is the manner of death?
A. Natural causes
B. Gunshot wound
C. Homicide
D. Bacterial sepsis
E. Accidental
3. Blackening of the conjunctiva due to postmortem desiccation is referred to as:
A. Tache noire
B. Hypostasis
C. Livor mortis
D. Melanosis oculi perstans
E. Putrefaction
4. A 60-year-old man, native to Houston, with no significant medical history, collapses and dies
suddenly. Which of the following is most likely the cause of death?
A. Acute myocarditis
B. Rupture of berry aneurysm of the Circle of Willis
C. Coronary artery disease
D. Anaphylaxis
E. Aortic valvular stenosis
5. Of the following, which potential weapon is most likely to produce a laceration?
A. Scimitar
B. Butcher knife
C. Ice pick
D. Baseball bat
E. Hunting arrow
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6. An alternative to putrefaction that usually occurs in bodies left in caves is:
A. Liquefaction
B. Mummification
C. Livor mortis
D. Rigor mortis
E. Adipocere formation
MATCHING: For each numbered item Column 1, choose the letter of the most closely
related item in Column 2. Each answer can be used once, more than once, or not all.
COLUMN 1
7. Chronic pyelonephritis
8. "Triple" stones
9. Calcium stones of cystine
10. Uric acid stones
COLUMN 2
A. Inflammation of the renal pelvis
B. Genetical defect in the renal transport
C. Infections by urea-splitting bacteria
D. Most common type of renal stones
E. Gout, leukemias
11. Your 63 year old grandfather has a brownish irregular raised plaque on his bulbar
conjunctiva, which extends laterally to cover a portion of his medial cornea. This lesion is not
associated with visual problems, but it does irritate.his eyelid mildly. It has not increased in size
for over a year. As you are a future doctor, he asks you "Hey Doc, whaddya think this thing is?"
Based on your knowledge of special sensory organ pathology, your MOST APPROPRIATE
RESPONSE should be which of the following?
A. "That's something you inherited from your mother. Not much we can do
about it."
B. "Wake the kids and phone the neighbors--I think your high blood
pressure must be out of control!"
C. "I think this is most likely caused by your diabetes. You had better
get your blood sugar checked!"
D. "Aw gramps, that's caused by chronic sun exposure. It can be
surgically excised if it bothers you."
E. "Looks like it's most likely malignant. I think you should get it
checked out immediately!"
12. A 9-year-old boy presented with neck pain, lower cranial nerve palsies and cerebellar ataxia.
MRI shows downward displacement of the vermis and brainstem. This malformation is most
frequently associated with:
A. L ssencephaly
B. Lumbar myelomeningocele
C. Agenesis of corpus caltosum
D. Large posterior fossa
E. Cystic fourth ventricle
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13. Lung cancer:
A. Can be associated with the superior vena cava syndrome
B. Cannot be diagnosed by examination of sputum samples
C. Is associated with a 70% overall 5-year survival rate
D. Is unlikely to metastasize to the adrenals
E. Survival is unrelated to tumor stage
14. During the last year, a 25-year-old patient (non-smoker) has had three episodes of
pneumonia. A chest x-ray shows a 2 cm well-circumscribed round nodule in the right upper lobe.
The patient undergoes bronchoscopy and an endobronchial mass with a smooth mucosal surface
is seen. Of the following, the MOST likely diagnosis is:
A. Thymoma
B. Adenocarcinoma
C. Carcinoid
D. Infarct
E. Squamous cell carcinoma
15. A 10-year-old boy complains of stiffness and has difficulty releasing his grip after a
handshake or in trying to throw a ball. His father had similar findings but as an older teenager. A
skeletal muscle biopsy shows atrophy of type I fibers, excessive numbers of central nuclei, and
ring fibers. What is the most likely diagnosis?
A. Dermatomyositis
B. Polymyositis
C. Myotonic dystrophy
D. Polio
E. Duchenne muscular dystrophy
16. Which of the following is LEAST IMPORTANT in the genesis of pulmonary hypertension:
A. Reduction in the cross-sectional area of open (non-obstructed) pulmonary vasculature
B. Cigarette smoke-induced vascular proliferation
C. Increased pulmonary blood flow
D. Hypoxemia causing pulmonary vasoconstriction
17. The primary glioblastoma multiforme (GBM):
A. Exhibits vascular proliferation.
B. Arises in older patients than the secondary GBM.
C. Shows EGFR amplification/overexpression.
D. Contains areas of necrosis.
E. All of the above
18. Which of the following is (are) cause(s) of acute renal failure:
A. Bladder neck obstruction
B. Acute interstitial nephritis
C. Acute vascular rejection
D. All of the above
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19. Goodpasture's syndrome is associated with:
A. Synthesis of parathormone by a squamous cell carcinoma
B. Hemoptysis and renal failure
C. IgA deficiency
D. Polylobation of the lungs
E. Diarrhea and flushing
20.The following are characteristic features of Alport’s syndrome, EXCEPT:
A. males are affected more often
B. inherited abnormality of collagen type IV
C. sex-linked inheritance in the majority of the cases
D. females often develop end-stage renal disease
E. sensorineural deafness can occur
21. A 30-year-old man presents with rapid alteration in the renal function. Renal biopsy shows a
crescentic GN. Immunofluorescence studies are negative. The BEST diagnosis is:
A. Henoch-Schbnlein purpura
B. Post infectious GN with >50% cellular crescents
C. Microscopic form of polyarteritis
D. Antiglomerular basement membrane disease
E. Membranoproliferative GN Type I with >50% cellular crescents
MATCHING: For each numbered item Column 1, choose the letter of the most closely
related item in Column 2. Each answer can be used once, more than once, or not all.
COLUMN I
COLUMN 2
22. Normal renal function with hematuria
23. Acute renal failure
24. Chronic renal failure
25. Nephrotic syndrome
A. Minimal change disease
B. Thin basement membrane disease
C. Acute interstitial nephritis
D. Post infectious GN
E. Long-standing arteriolonephrosclerosis
MATCHING: For each numbered item Column 1, choose the letter of the most closely
related item in Column 2. Each answer can be used once, more than once, or not all.
COLUMN I
COLUMN 2
26. Renal cell carcinoma
27. Angiomyolipoma
28. Oncocytoma
29. Malakoplakia features
A. Tuberous sclerosis B. Michaelis-Gutmann bodies
C. Renal arteriography has diagnostic
D. Abundant cytoplasm, packed with
mitochondria
E. Irradiation cystitis
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30. Which of the following is the MOST frequent clinical consequence of pulmonary embolism:
A. Nothing
B. Pulmonary hypertension
C. Pulmonary infarction
D. Pulmonary hemorrhage
E. Death
31. Atelectasis is LEAST likely to be associated with:
A. Pulmonary hemorrhage
B. Asthma
C. Pleural fibrosis
D. Pleural effusion
32. A patient with chronic obstructive pulmonary disease and cavitary tuberculosis begins to
cough up blood. A chest x-ray reveals a cavity with a rounded density in it, and the density
moves when the patient is moved. The organism that MOST likely accounts for this process is:
A. Aspergillus fumigatus
B. Cytomegalovirus
C. Mycobacteria
D. Streptococcus pneumoniae
E. Staphylococcus aureus
33. All of the following are correct statements about tuberculosis EXCEPT:
A. Granulomas that develop as a response to the infection can cause tissue injury and
destruction
B. The Ghon focus is present in a primary infection
C. Granulomas help to limit the spread of organisms
D. Miliary tuberculosis develops via lymphatic or vascular dissemination of the organism
E. More than 50% of people who become infected with tuberculosis develop active
disease
34. A 66 year old male has a known long-standing history of pernicious anemia. MRI exam of
his spinal cord confirms demyelination of dorsal and lateral columns. Which of the following is
the MOST LIKELY diagnosis?
A. subacute combined degeneration of the spinal cord
B. carbon monoxide poisoning
C. folate deficiency
D. alcoholic spinal degeneration
E. lead poisoning
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35. A 9-month-old infant is brought to the emergency room by her mother. The baby is
coughing and breathing with difficulty. Her temperature is 101.0F. Which of the
following is the MOST likely diagnosis:
A. Influenza A
B. Pseudomonas aeruginosa
C. Mycoplasma pneumonia
D. Respiratory syncytial virus
E. Histoplasmosis
36. An ANCA-positive laboratory test is helpful to confirm a diagnosis of:
A. Wegener's granulomatosis
B. Lupus nephritis
C. Membranoproliferative GN, type II
D. Microscopic form of polyarteritis
E. Two of the above
37. The etiologies of congenital CNS malformation include genetic defects and environmental
factors such as nutritional, diseases, infection and toxins. Deficiency of folate is most frequently
associated with:
A. Lissencephaly
B. Microcephaly
C. Dandy-Walker malformation
D. Spina bifida occulta
E. Polymicrogyria
38. An infant develops multiple episodes of bronchitis that eventually lead to bilateral
bronchiectasis. It is also noted that the child's heart is located on the right (dextrocardia). Which
of the following is MOST likely to be present:
A. Absent dynein arms on cilia
B. Alpha-1-antitrypsi n deficiency
C. Malignancy
D. An aspirated peanut
E. Elevated IgE
39. A temporary clerical worker develops shortness of breath when she works at Company A,
but not at Company B or C. She visits her pulmonologist, who orders a chest X-ray which shows
diffuse bilateral pulmonary infiltrates. He recommends that she not work at Company A, if
possible. After 6 months without working at Company A, the shortness of breath and infiltrates
are gone. Which of the following statements about this process is CORRECT:
A. Cultures of this patient's lung are likely to demonstrate an etiologic organism
B. Eosinophils are important in the pathogenesis of this process
C. This lung disease is usually resistant to corticosteroids and leads to death within 5
years of diagnosis
D. A biopsy during active disease is likely to show interstitial and bronchiolar
lymphocytes and granulomas
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40. A 2-year- old boy was noted by his mother to have a white mass visible behind his left pupil
(leukocoria). Exam confirms a clear lens. Which of the following is the MOST LIKELY
diagnosis?
A. choroidal melanoma
B. retinoblastoma
C. cataract
D. multiple sclerosis
E. retrolental fibroplasia
41. Aspiration can result in all of the following EXCEPT:
A. Diffuse alveolar damage
B. Pneumocystis carinii pneumonia
C. Bacterial pneumonia
D. Meat or vegetable material in the lung
E. Lung abscess
42. Malignant mesothelioma:
A. Can have a wide spectrum of histologic appearances including epithelial and
sarcomatoid features
B. Is associated with a high number of pack-years of cigarette smoking
C. Is an indolent neoplasm with an associated life expectancy > 10 yrs.
D. Develops rapidly (within 5 yrs.) after exposure to asbestos
E. Is associated with heavy exposures to coal dust
43. All of the following statements about chronic obstructive pulmonary disease (COPD) are
correct EXCEPT:
A. Symptoms of COPD usually become clinically apparent within a few years after
initiation of smoking.
B. in COPD decreased elastic recoil in the lung is important in the pathogenesis of
airway obstruction.
C. Exacerbations of COPD are often triggered by respiratory infections.
D. In COPD, airway narrowing is important in the pathogenesis of airway obstruction.
E. Cigarette smoking is the most important causative factor for COPD.
44. Berry aneurysms are described correctly as
A. Most commonly located in the basilar artery
B. Typically fusiform in shape
C. Virtually always solitary 3
D: The most common cause of subarachnoid hemorrhage
E. Usually atherosclerotic in origin
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45. The most common cause of nephritic syndrome in renal transplant patients is:
A. "de novo" membranous GN
B. Recurrent membranous GN
C. Recurrent focal segmental glomeruloscierosis
D. Transplant glomerulopathy
E. None of the above
46. A 43-year-old man with a corneal dystrophy has a corneal transplant. The excised native
cornea is submitted to surgical pathology for your examination. You notice the cornea is grossly
cloudy. Microscopic examination confirms an edematous cornea with numerous guttate
projections along Descemet's membrane. There is associated endothelial degeneration. Your
MOST LIKELY diagnosis is:
A. Glaucoma
B. Vitamin A deficiency
C. Pingeculae
D. Retrolental fibroplasia
E. Fuchs' disease
47. Which of the following is an example of thrombotic microangiopathy:
A. Diffuse intravascular coagulopathy
B. Henoch- Schonlein purpura
C. Microscopic form of polyarteritis
D. Crescentic glomerulonephritis
MATCHING: For each numbered item Column 1, choose the letter of the most closely
related item in Column 2. Each answer can be used once, more than once, or not all.
COLUMN I
COLUMN 2
48. Papillary renal cell carcinoma
49. Focal segmental glomerulosclerosis
with collapsing features
50. Papillary necrosis
51. Cast nephropathy
A. Analgesic nephropathy
B. Skin'rash, eosinophilia and fever
C. Trisomies of chromosomes 7 and 17
D. Myeloma
E. HIV-positive patient
52. Which pair represents a mechanism of development of pulmonary edema, and an example of
a process or factor that causes pulmonary edema via that mechanism:
A. Increased plasma oncotic pressure - hyperalbuminemia
B. Increased hydrostatic pressure - hypoalbuminemia
C. Decreased plasma oncotic pressure - congestive heart failure
D. Lymphatic obstruction - pulmonary embolism
E. Increased hydrostatic pressure - congestive heart failure
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53. A renal biopsy is performed in a 22-year old man with henaturia, mild proteinuria, and no
evidence of systemic diseases. All serologies are negative. Immunofluorescence shows positive
reaction with IgA in the glomerular mesangium and mesangial electron dense deposits are
observed. The diagnosis is:
A. Henoch-Schonlein purpura
B. Lupus nephritis, mesangioproliferative type
C. Cirrhotic glee erulosclerosis
D. Lupus nephritis, focal proliferative type
E. IgA nephropathy
54. All of the following are TRUE for autosomal dominant polycystic kidney disease,
EXCEPT:
A. Some patients can develop end-stage renal disease
B. Cysts in other organs can be present
C. ADPKD gene linked to chromosome 4 in most cases
D. Kidneys can weigh 2-3kg
55. A 45-year-old woman develops muscular weakness beginning in her extremities and
progressing to affect muscles used in respiration, starting about two weeks after an upper
respiratory infection. Her paresis progresses to the point that she must be intubated and placed on
mechanical ventilation. What is the most likely diagnosis?
A. Viral encephalitis
B. Prion disease
C. Multiple sclerosis
D. Becker muscular dystrophy
E. Guillain-Barre syndrome
56. All of the following are true for urinary tract neoplasms, EXCEPT:
A. cause and effect relationship has been demonstrated in some cases
B. neoplasms are often papillary
C. tendency for multiplicity and recurrence
D. metastases are present in >25% of the patients with stage A and BI at the time of
presentation
57. A 25-year-old man complained of headaches for several months. He then experienced
generalized seizures, and a CT scan revealed a 2 cm mass in the right cerebral hemisphere. The
mass was removed, and histological examination showed it to be composed of a jumble of
tortuous vessels of various sizes, surrounded by gliosis. The best diagnosis is:
A. Ruptured saccular aneurysm
B. Angiosarcoma
C. Prior head trauma
D. Ateriovenous malformation
E. Organizing abscess
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58. A treatable form of dementia is:
A. Huntington disease
B. Down syndrome with dementia
C. Lewy body dementia
D. Progressive supranuclear palsy
E. Normal (intermittent) pressure hydrocephalus
59. A 43-year-old male injection drug user is admitted with a 1-day history of increasing
headache and high fever. A lumbar puncture is performed. The CSF protein concentration is
elevated, but the glucose level is decreased. The most likely infectious agent account for these
findings is
A. Toxoplasma gondii
B. Staphylococcus aureus
C. Mycobacterium tuberculosis
D. J-C strain of papovavirus
E. Herpes simplex virus
60. Which of the following glomerular disease(s) is (are) associated with subendothelial electron
dense deposits:
A. Lupus nephritis, mesangioproliferative type
B. Lupus nephritis, diffuse proliferative type
C. Thin basement membrane disease
D. Membranoproliferative GN, type I
E. Two of the above
61. All of the following statements about tuberculosis are correct EXCEPT:
A. Transmission usually occurs via aerosolized droplets
B. Cavitary lesions usually contain numerous organisms
C. Secondary tuberculosis usually develops in the lower lobes, due to lower oxygen
tension
D. HIV-positive patients have a higher rate of extrapulmonary involvement than
HIV-negative people
E. HIV-infected patients may have non-reactive PPD tests even if they are infected
with tuberculosis
62. A 13-year-old boy hit a tree while riding a bicycle. He was initially unconscious but then got
up and walked one block to his home. After he got home, he again lost consciousness. This
clinical presentation is most consistent with which of the following?
A. Epidural hematoma
B. Ruptured berry aneurysm
C. Acute meningitis
D. Acute subdural hematoma
E. Contusion of frontal lobes
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63. A 4-month-old male infant is noted to be irritable with difficulty feeding and to be
hypertonic. Over the next few months, he loses neurologic reflexes and begins to have seizures.
Which of the following is most likely to be present in this patient?
A. Demyelinated white matter plaques
B. Deficiency of galactocerebroside beta-galactosidase
C. Decreased serum CPK
D. Elevated serum protein
E. Deposition of amyloid protein in cerebral vessels
64. A previously healthy 30-year-old woman seeks medical attention for a scaling, ear
rthematous eruption over the knuckles, elbows, and knees. She also says that her muscles ache
and that she has been having trouble getting up from a chair. Physical examination reveals
periorbital edema, lilac discoloration to her upper eyelids, and bilaterally symmetrical muscle
weakness, in addition to the rash. What is the most likely diagnosis?
A. Parkinsonism
B. Duchenne muscular dystrophy
C. Polio
D. Rabdomyolysis
E. Dermatomyositis
65. A 35-year-old HIV seropositive man presents with a severe headache. A lumbar puncture
reveals a few mononuclear cells, no neutrophils, no red blood cells, a normal glucose level, and a
normal protein concentration. An India ink preparation of the CSF reveals organisms with a thick
capsule. The organism most likely to produce these findings is:
A. Mycobacterium tuberculosis
B. Listeria monocytogenes
C. Toxoplasma gondii
D. Cryptococcus neoformans
E. Staphylococcus aureus
66. During the last year, a 75-year-old patient (heavy smoker) has had three episodes of
pneumonia. A chest x-ray shows a 2 cm irregular nodule in the right lung. The patient undergoes
bronchoscopy and an endobronchial mass with an irregular and ulcerated mucosal surface is seen
in the right mainstem bronchus. Of the following, the MOST likely diagnosis is:
A. Infarct
B. Squamous cell carcinoma
C. Carcinoid
D. Cytomegalovirus
E. Adenocarcinoma
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67. A 4-year-old boy develops increasing clumsiness. He had met normal developmental
milestones during the first few months after birth, but was delayed in walking. His mother says
that he cannot keep up with his friends while playing. Physical examination reveals decreased
strength in muscles of the pelvic girdle and enlarged muscles of the calf. Which of the following
could be used to establish a diagnosis in this patient?
A. Decreased levels of CPK in the serum
B. Demonstration of oligoclonal bands in the CSF
C. Finding viral inclusion bodies in muscle fibers on electron microscopy
D. Absence of dystrophin in affected muscle by Western blot analysis
E. Neutrophilic infiltrate on muscle biopsy
68. Multiple 1 to 3 cm, ring-enhancing lesions are seen by MRI in the cerebral gray matter
bilaterally in a 20-year-old man who has a history of HIV infection. A stereotaxic biopsy is most
likely to reveal
A. Squamous cell carcinoma
B. Large atypical lymphocytes
C. Budding cells with pseudohyphyae
D. Spongiform encephalopathy
E. Toxoplasma pseudocysts
69. Which of the following choices is MOST frequently associated with mucormycosis:
A. Excellent response to pharmacologic therapy
B. Vascular invasion with parenchymal infarction
C. Self-limited asymptomatic infections in healthy people
D. Calcified lung nodules and hilar adenopathy with calcification
E. Budding yeasts and septate fungal hyphae
70. A 30-year-old woman has enlarged hilar lymph nodes and interstitial opacities on chest Xray. A lung biopsy reveals non-necrotizing granulomas. Which of the following statements is
INCORRECT:
A. A stain for fungi, such as a methenamine silver stain, should be performed
B. An acid fast stain should be performed to evaluate for mycobacterial infection
C. Increased lung volumes and decreased FEV1/FVC support a diagnosis of
sarcoidosis
D. Cultures for mycobacteria and fungi should be ordered
E. If the stains and cultures do not reveal the presence of an organism, sarcoidosis is
a likely diagnosis.
71. Which of the following is TRUE of head trauma?
A. Severe damage to the soft tissues is always associated with severe brain damage.
B. Head trauma is more frequent in women than in men.
C. The most frequent cause of head trauma is assault.
D. Some form of head trauma is seen in the majority of automobile accidents.
E. Severe damage of the brain is always associated with severe scalp and skull damage.
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72. The type of lupus nephritis with the best prognosis is:
A. diffuse proliferative GN
B. membranous GN
C. focal proliferative GN
D. mesangial proliferative GN
E. the prognosis is similar in all types
73. You receive a warning that an antigenically new influenza A virus has been isolated from
multiple patients in your area. All of the following statements are correct EXCEPT:
A. If the hemagglutinin or neuraminidase antigen of the influenza A virus has
undergone mutation, this may lead to an epidemic of influenza A.
B. Influenza A can cause necrotizing tracheobronchitis.
C. Infected patients are at risk for bacterial superinfection.
D. Examination of sputum for viral inclusions may help you diagnose this infection in
your patients.
E. Your patients who have been previously infected by influenza A may become
infected again.
74. A wheezing child is brought to the emergency room by her mother. The child's mother says
that similar episodes have occurred multiple times in the past, usually after the child has played
with a friend's cat, and have lasted for several hours each time. All of the following are correct
statements about this process EXCEPT:
A. The process requires an IgE response to "cat" antigens for symptoms to develop.
B. The child will be at risk for chronic airway injury (fibrosis) if airway inflammation is
not reduced.
C. The child's airways likely show smooth muscle hypertrophy and inflammatory cell
infiltrates.
D. Continued exposure to cats should not be discouraged.
E. Skin testing is likely to produce a wheal-and-flare reaction in response to "cat"
antigens.
75. A good prognosis is usually expected in which of the following glomerular disease(s):
A. Minimal change disease
B. Idiopathic focal segmental glomerulosclerosis
C. Post infectious GN
D. Crescentic glomerulonephritis
E. Two of the above
76. The basic pathogenic mechanism of diabetic glomerular disease is:
A. Immune complex
B. Alternate pathway of complement
C. Progressive accumulation of basement membrane-like material
D. Ischemia
E. None of the above
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77. Each of the following malformations is associated with a neural tube defect EXCEPT:
A. Spina bifida
B. Anencephaly
C. Meningocele
D. Myelomeningocele
E. Polymicrogyria
78. A 60-year-old man recently started having resting tremor in his left arm, his right arm is
okay. The most likely finding in his brain or spinal cord is:
A. Lewy bodies
B. Demyelination of lateral pyramidal tracts
C.Demyelination of posterior columns of spinal cord
D. Senile plaques
E. Axonal torpedos
79. Cryptococcus:
A. Is a cause of acute-bronchopneumonia
B. Can only be found in the midwestern and southwestern United States
C. Does not have a capsule, unlike Histoplasma capsulatum
D. Can be acquired by inhalation of infected bird droppings
E. Typically produces disseminated disease in otherwise healthy people
80. In the pleural space, causes of exudative effusions include all of the following EXCEPT:
A. Congestive heart failure
B. Lung cancer
C. Collagen vascular disease
D. Bacterial infection
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ANSWERS:
1.A
2. C
3.A
4.A
5.D
6.E
7.A
8.C
9.D
10. E
11. D
12. B
13. A
14. B
15. C
16. B
17. E
18. D
19. B
20. D
21. E
22. B
23. C
24. E
25. A
26. C
27. A
28. D
29. B
30. A
31. D
32. A
33. E
34. A
35. D
36. E
37. D
38. A
39. B
40. B
41. B
42. A
43. A
44. D
45. D
46. B
47. A
48. C
49. E
50. A
51. D
52. E
53. E
54. C
55. E
56. C
57. B
58. E
59. B
60. D
61. C
62. A
63. B
64. E
65. D
66. B
67. D
68. E
69. C
70. C
71. D
72. D
73. B
74. D
75. E
76. C
77. E
78. A
79. D
80. A
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