General Pathology Questions (Part 4/4)

A 65-year-old man undergoes cardiac bypass surgery and is placed on postoperative, broad-spectrum, antibiotic prophylaxis. Several days later, he develops fever, abdominal pain, and bloody diarrhea. Colonoscopic biopsy demonstrates a thick mucopurulent exudate. Which of the following is the most likely etiology of this patient‟s gastrointestinal disorder? (A) Clostridium botulinum (B) Clostridium difficile (C) Clostridium perfringens (D) Clostridium tetani (E) Escherichia coli 0157-H7

(B) Clostridium difficile

A 74-year-old woman presents with acute chest pain and shortness of breath. Cardiac catheterization demonstrates occlusion of the left anterior descending coronary artery. Laboratory studies and ECG are consistent with acute myocardial infarction. Which of the following is the most likely pathologic finding in the affected heart muscle 4 weeks later? (A) Capillary-rich granulation tissue (B) Collagen-rich scar tissue (C) Granulomatous inflammation (D) Neutrophils and necrotic debris (E) Vascular congestion and edema

(B) Collagen-rich scar tissue

A 60-year-old farmer presents with multiple patches of discoloration on his face. Biopsy of lesional skin reveals actinic keratosis. Which of the following terms best describes this response of the skin to chronic sunlight exposure? (A) Atrophy (B) Dysplasia (C) Hyperplasia (D) Hypertrophy (E) Metaplasia

(B) Dysplasia

A 68-year-old coal miner with a history of smoking and emphysema develops severe air-flow obstruction and expires. Autopsy reveals a "black lung," with coal-dust nodules scattered throughout the parenchyma and a central area of dense fibrosis. The coal dust entrapped within this miner's lung was sequestered primarily by which of the following cells? (A) Endothelial cells (B) Fibroblasts (C) Lymphocytes (D) Macrophages (E) Plasma cells

(B) Fibroblasts

A 34-year-old woman has a benign nevus removed from her back under local anesthesia. Which of the following families of cell adhesion molecules is the principal component of the "provisional matrix" that forms during early wound healing? (A) Cadherins (B) Fibronectins (C) Integrins (D) Laminins (E) Selectins

(B) Fibronectins

A 31-year-old man with AIDS complains of diffi culty swallowing. Examination of his oral cavity demonstrates whitish membranes covering much of his tongue and palate. Endoscopy also reveals several whitish, ulcerated lesions in the esophagus. These pathologic findings are fundamentally caused by loss of which of the following immune cells in this patient? (A) B lymphocytes (B) Helper T lymphocytes (C) Killer T lymphocytes (D) Monocytes/macrophages (E) Natural killer (NK) cells

(B) Helper T lymphocytes

A 47-year-old man presents with a 6-week history of increasing fatigue and dark-colored stools. Complete blood count shows hemoglobin of 8.6 g/dL and microcytic, hypochromic RBCs. Upper gastrointestinal endoscopy reveals a peptic ulcer along the lesser curvature of the stomach. This patient‟s anemia is most likely caused by deficiency of which of the following? (A) Folic acid (B) Iron (C) Thiamine (D) Vitamin B12 (E) Zinc

(B) Iron???

A 62-year-old woman undergoing chemotherapy for breast cancer presents with a 3-day history of fever and chest pain. Cardiac catheterization reveals a markedly reduced ejection fraction with normal coronary blood flow. A myocardial biopsy is obtained, and a PCR test for coxsackievirus is positive. Histologic examination of this patient's myocardium will most likely reveal an abundance of which of the following inflammatory cells? (A) Eosinophils (B) Lymphocytes (C) Macrophages (D) Mast cells (E) Neutrophils

(B) Lymphocytes

A 28-year-old woman cuts her hand while dicing vegetables in the kitchen. The wound is cleaned and sutured. Five days later, the site of injury contains an abundance of chronic infl ammatory cells that actively secrete interleukin-1, tumor necrosis factor-α, interferon-α, numerous arachidonic acid derivatives, and various enzymes. Name these cells. (A) B lymphocytes (B) Macrophages (C) Plasma cells (D) Smooth muscle cells (E) T lymphocytes

(B) Macrophages

During a routine checkup, a 50-year-old man is found to have blood in his urine. He is otherwise in excellent health. An abdominal CT scan reveals a 2-cm right renal mass. You inform the patient that staging of this tumor is key to selecting treatment and evaluating prognosis. Which of the following is the most important staging factor for this patient? (A) Histologic grade of the tumor (B) Metastases to regional lymph nodes (C) Proliferative capacity of the tumor cells (D) Somatic mutations in the p53 tumor suppressor gene (E) Tumor cell karyotype (aneuploidy)

(B) Metastases to regional lymph nodes

A 19-year-old woman presents with vague lower abdominal pain and a swollen, painful right knee. She denies any trauma to the knee or history of arthritic disorders. Physical examination reveals an enlarged joint that is red, warm, and painful. Pelvic examination is exquisitely painful and reveals an ill-defined thickening in both adnexae. A green-yellow purulent vaginal discharge is noted. The patient is febrile and has an elevated WBC count of 15,000/L. Which of the following etiologic agents is most likely responsible for this patient‟s condition? (A) Escherichia coli (B) Neisseria gonorrhoeae (C) Streptococcus pyogenes (D) Treponema pallidum (E) Yersinia pestis

(B) Neisseria gonorrhoeae

A 52-year-old, obese man (BMI = 34 kg/m2) presents to his physician with complaints of hoarseness for 2 months. He has worked in a chemical factory for 25 years and gives a history of smoking, consumption of one or two beers a day, and occasional use of illicit drugs. Physical examination reveals enlarged and fi rm cervical lymph nodes. Direct laryngoscopy reveals a fixed and enlarged left vocal cord, which appears ulcerated. A biopsy of the lesion is interpreted by the pathologist as squamous cell carcinoma. What is the most likely cause of this man‟s disease? (A) Alcohol (B) Benzene inhalation (C) Cigarette smoking (D) Cocaine use (E) High-fat diet

(C) Cigarette smoking

A 48-year-old man with a longstanding history of chronic constipation complains of anal itching and discomfort toward the end of the day. He describes a perianal pain when sitting and finds himself sitting sideways to avoid discomfort. Physical examination reveals painful varicose dilations in the anal region, associated with edema. Which of the following is the most likely diagnosis? (A) Anal cancer (B) Anal fissure (C) Hemorrhoids (D) Ischiorectal abscess (E) Rectal cancer

(C) Hemorrhoids

A 59-year-old woman smoker complains of intermittent blood in her urine. Urinalysis confirms hematuria. A CBC reveals increased red cell mass (hematocrit). A CT scan demonstrates a 3-cm renal mass, and a CT-guided biopsy displays renal cell carcinoma. Which of the following cellular adaptations in the bone marrow best explains the increased hematocrit in this patient? (A) Atrophy (B) Dysplasia (C) Hyperplasia (D) Hypertrophy (E) Metaplasia

(C) Hyperplasia

A 32-year-old woman with poorly controlled diabetes mellitus delivers a healthy boy at 38 weeks of gestation. As a result of maternal hyperglycemia during pregnancy, pancreatic islets in the neonate would be expected to show which of the following morphologic responses to injury? (A) Atrophy (B) Dysplasia (C) Hyperplasia (D) Metaplasia (E) Necrosis

(C) Hyperplasia (?)

A 52-year-old woman loses her right kidney following an automobile accident. A CT scan of the abdomen 2 years later shows marked enlargement of the left kidney. The renal enlargement is an example of which of the following adaptations? (A) Atrophy (B) Dysplasia (C) Hyperplasia (D) Hypertrophy (E) Metaplasia

(C) Hyperplasia (?)

A 5-year-old boy punctures his thumb with a rusty nail. Four hours later, the thumb appears red and swollen. Initial swelling of the boy's thumb is primarily due to which of the following mechanisms? (A) Decreased intravascular hydrostatic pressure (B) Decreased intravascular oncotic pressure (C) Increased capillary permeability (D) Increased intravascular oncotic pressure (E) Vasoconstriction of arterioles

(C) Increased capillary permeability

A 50-year-old woman appears at your office. She was subjected to radical mastectomy and axillary node dissection for breast cancer a year ago. She now notices that her arm becomes swollen by the end of the day. What is the appropriate name for this fluid accumulation? (A) Chylothorax (B) Hydrothorax (C) Lymphedema (D) Purulent exudate (E) Fibrinous exudate

(C) Lymphedema

A 36-year-old woman with pneumococcal pneumonia develops a right pleural effusion. The pleural fl uid displays a high specifi c gravity and contains large numbers of polymorphonuclear (PMN) leukocytes. Which of the following best characterizes this pleural effusion? (A) Fibrinous exudate (B) Lymphedema (C) Purulent exudate (D) Serosanguineous exudate (E) Transudate

(C) Purulent exudate

A 35-year-old man asks for advice regarding seasonal eye itching and runny nose. Recurrent conjunctivitis in this patient is most likely caused by which of the following mechanisms of disease? (A) Autoimmunity (B) Bacterial infection (C) Chemical toxicity (D) Hypersensitivity (E) Viral infection

(D) Hypersensitivity

A 20-year-old man is brought to the emergency room after rupturing his spleen in a motorcycle accident. His blood pressure on admission is 80/60 mm Hg. Analysis of arterial blood gasses demonstrates metabolic acidosis. This patient is most likely suffering from which of the following conditions? (A) Acute pancreatitis (B) Cardiogenic shock (C) Hypersplenism (D) Hypovolemic shock (E) Septic shock

(D) Hypovolemic shock

A 32-year-old woman develops an Addisonian crisis (acute adrenal insuffi ciency) 3 months after suffering massive hemorrhage during the delivery of her baby. A CT scan of the abdomen shows small adrenal glands. Which of the following mechanisms of disease best accounts for adrenal atrophy in this patient? (A) Chronic inflammation (B) Chronic ischemia (C) Hemorrhagic necrosis (D) Lack of trophic signals (E) Tuberculosis

(D) Lack of trophic signals

A 22-year-old woman nursing her newborn develops a tender erythematous area around the nipple of her left breast. A thick, yellow fluid is observed to drain from an open fissure. Examination of this breast fluid under the light microscope will most likely reveal an abundance of which of the following inflammatory cells? (A) B lymphocytes (B) Eosinophils (C) Mast cells (D) Neutrophils (E) Plasma cells

(D) Neutrophils

A 33-year-old man presents with a 5-week history of calf pain and swelling and low-grade fever. Serum levels of creatine kinase are elevated. A muscle biopsy reveals numerous eosinophils. What is the most likely etiology of this patient‟s myalgia? (A) Autoimmune disease (B) Bacterial infection (C) Muscular dystrophy (D) Parasitic infection (E) Viral infection

(D) Parasitic infection

A 5-year-old boy is brought to the emergency room with a fever of 103°F (38.7°C), chest pain, and productive cough. The patient has a history of recurrent pulmonary disease and respiratory distress. What microorganism recovered from the lungs of this child is virtually diagnostic of cystic fibrosis? (A) Klebsiella sp. (B) Legionnella sp. (C) Pneumocystis sp. (D) Pseudomonas sp. (E) Streptococcus sp.

(D) Pseudomonas sp.

An 80-year-old man complains of lower abdominal pain, increasing weakness, and fatigue. He has lost 16 lb (7.3 kg) in the past 6 months. The prostate-specifi c antigen test is elevated (8.5 ng/mL). Rectal examination reveals an enlarged and nodular prostate. A needle biopsy of the prostate discloses invasive prostatic adenocarcinoma. Histologic grading of this patient‟s carcinoma is based primarily on which of the following criteria? (A) Capsular involvement (B) Extent of regional lymph nodes involvement (C) Pulmonary metastases (D) Resemblance to normal tissue of origin (E) Volume of prostate involved by tumor

(D) Resemblance to normal tissue of origin

A 22-year-old construction worker sticks himself with a sharp, rusty nail. Within 24 hours, the wound has enlarged to become a 1-cm sore that drains thick, purulent material. This skin wound illustrates which of the following morphologic types of necrosis? (A) Caseous necrosis (B) Coagulative necrosis (C) Fat necrosis (D) Fibrinoid necrosis (E) Liquefactive necrosis

(E) Liquefactive necrosis

A 60-year-old man with chronic cystitis complains of urinary frequency and pelvic discomfort. Digital rectal examination is unremarkable. Biopsy of the bladder mucosa reveals foci of glandular epithelium and chronic infl ammatory cells. No cytologic signs of atypia or malignancy are observed. Which of the following terms best describes the morphologic response to chronic injury in this patient? (A) Atrophy (B) Dysplasia (C) Hyperplasia (D) Hypertrophy (E) Metaplasia

(E) Metaplasia

A 50-year-old woman is discovered to have metastatic breast cancer. One week after receiving her first dose of chemotherapy, she develops bacterial pneumonia. Which of the following best explains this patient's susceptibility to bacterial infection? (A) Depletion of serum complement (B) Impaired neutrophil respiratory burst (C) Inhibition of clotting factor activation (D) Lymphocytosis (E) Neutropenia

(E) Neutropenia

A 68-year-old man presents for repair of an abdominal aortic aneurysm. Severe complicated atherosclerosis is noted at surgery, prompting concern for embolism of atheromatous material to the kidneys and other organs. If the patient were to develop a renal cortical infarct as a result of surgery, which of the following would be the most likely outcome? (A) Chronic inflammation (B) Granulomatous inflammation (C) Hemangioma formation (D) Repair and regeneration (E) Scar formation

(E) Scar formation

A 25-year-old machinist is injured by a metal sliver in his left hand. Over the next few days, the wounded area becomes reddened, tender, swollen, and feels warm to the touch. Redness at the site of injury in this patient is caused primarily by which of the following mechanisms? (A) Hemorrhage (B) Hemostasis (C) Neutrophil margination (D) Vasoconstriction (E) Vasodilation

(E) Vasodilation

Typical lesions in acute rheumatic fever include all of the following EXCEPT: (A) erythema marginatum (B) polyarthritis (C) poststreptococcal glomerulonephritis (D) subcutaneous nodules (E) verrucae on mitral valve

(E) verrucae on mitral valve

A 45-year-old man presents with chest pain, fever, productive cough, and rust-colored sputum. The patient was diagnosed with tuberculosis in his early 20s. A chest X-ray shows multiple, nodular infiltrates and cavitary lesions. A lung biopsy reveals necrotizing inflammation and vascular thrombi with branching fungal hyphae. Which of the following is the most likely diagnosis? (A) Actinomycosis (B) Aspergillosis (C) Candidiasis (D) Cryptococcosis (E) Histoplasmosis

(B) Aspergillosis

A 50-year-old alcoholic is rushed to the hospital with bleeding esophageal varices and expires. At autopsy, the patient‟s protruding abdomen is found to contain a large volume of serous fluid. What is the appropriate term used to describe this fluid? (A) Ascites (B) Exudate (C) Hemorrhage (D) Hydrothorax (E) Lymphedema

(A) Ascites

A 56-year-old woman with a history of hyperlipidemia and hypertension develops progressive, right renal artery stenosis. Over time, this patient's right kidney is likely to demonstrate which of the following morphologic adaptations to partial ischemia? (A) Atrophy (B) Dysplasia (C) Hyperplasia (D) Hypertrophy (E) Neoplasia

(A) Atrophy

During the physical examination of a 22-year-old man, a purified protein derivative isolated from Mycobacterium tuberculosis is injected into the skin. Three days later, the injection site appears raised and indurated. Which of the following glycoproteins was directly involved in antigen presentation during the initiation phase of delayed hypersensitivity in this patient? (A) CD4 (B) CD8 (C) Class I HLA molecules (D) Class II HLA molecules (E) GlyCAM-1

(A) CD4

A 26-year-old electrician is found unconscious in his backyard beside a metal ladder and an exposed electrical wire, suffering from a deep burn on his right hand. Resuscitation attempts are unsuccessful. Which of the following was the most likely cause of death? (A) Cardiac arrhythmia (B) Disseminated intravascular coagulation (C) Myocardial infarction (D) Rupture of the ascending aorta (E) Uncoupling of oxidative phosphorylation

(A) Cardiac arrhythmia

A 20-year-old man from China is evaluated for persistent cough, night sweats, low-grade fever, and general malaise. A chest X-ray reveals fi ndings "consistent with a Ghon complex." Sputum cultures grow acid-fast bacilli. Examination of hilar lymph nodes in this patient would most likely demonstrate which of the following pathologic changes? (A) Caseous necrosis (B) Coagulative necrosis (C) Fat necrosis (D) Fibrinoid necrosis (E) Liquefactive necrosis

(A) Caseous necrosis

A 30-year-old firefighter suffers extensive third-degree burns over his arms and hands. This patient is at high risk for developing which of the following complications of wound healing? (A) Contracture (B) Dehiscence (C) Incisional hernia (D) Keloid (E) Traumatic neuroma

(A) Contracture

A 23-year-old man with hemophilia is recently wheelchair bound. Which of the following best accounts for this development? (A) Hemarthrosis (B) Hematemesis (C) Hematocephalus (D) Hematochezia (E) Hemoptysis

(A) Hemarthrosis

A 40-year-old, malnourished woman presents with a 6-month history of night blindness. Physical examination reveals keratomalacia and corneal ulceration. Which of the following vitamin deficiencies would be suspected in this patient? (A) Vitamin A (B) Vitamin B2 (riboflavin) (C) Vitamin C (D) Vitamin E (E) Folic acid

(A) Vitamin A