WebPath Quiz Questions

A) Oligohydramnios

A 19-year-old primigravida gives birth at 34 weeks to a stillborn fetus. At autopsy, the fetal chest cavity has the gross appearance shown here. Which of the following conditions is most likely to produce this appearance? A) Oligohydramnios B) Toxoplasmosis C) Prematurity D) Gestational diabetes E) Trisomy 21

B) Placenta increta

A 31-year-old G2 P1 woman gives birth at 38 weeks gestational age to a male infant. However, the placenta cannot be delivered, and there is extensive hemorrhage. She undergoes emergent hysterectomy, and the gross appearance of the uterus is shown here. Which of the following is the most likely diagnosis? A) Abruptio placenta B) Placenta increta C) Chorioamnionitis D) Twin placenta E) Partial mole

B) 69, XXY

A 31-year-old G3 P2 woman is in the second trimester. She delivers a malformed fetus with marked intrauterine growth retardation. This is the gross appearance of placenta. Cytogenetic analysis of this tissue is most likely to yield which of the following karyotypes? A) 47, XXY B) 69, XXY C) 46, XX D) 47, XY, +18 E) 45 X

A) Cryptococcus neoformans

29-year-old woman has a 10 year history of HIV infection. She has had a non-productive cough for the past 2 weeks. In the past 2 days she has had a severe headache with increasing stiffness of the neck, then obtundation. On physical examination her temperature is 38.8°C, and there is nuchal rigidity. A lumbar puncture is performed, and the result of the India ink test is seen here. Which of the following infectious agents is most likely to account for these findings? A) Cryptococcus neoformans B) Cryptosporidium parvum C) Candida albicans D) Cytomegalovirus E) Mycobacterium avium complex

B) Systemic lupus erythematosus

A 19-year-old woman develops the physical examination finding seen here when she spends several hours outside at a ball game. Ordinarily, she avoids being in the sun, but a friend provided free tickets. When she sees her physician, a urinalysis is performed that shows hematuria and proteinuria. Which of the following is the most likely diagnosis? A) Diffuse systemic sclerosis B) Systemic lupus erythematosus C) Acute rheumatic fever D) Dermatomyositis E) Sjogren's syndrome

C) Cell-mediated immunity

43-year-old man in good health has a tuberculin skin test performed. The result shown here appeared 60 hours following injection of the PPD. This appearance is most likely to be a consequence of which of the following immunologic mechanisms? A) Antigen-antibody complex deposition B) Antibody-dependent cell mediated cytotoxicity C) Cell-mediated immunity D) Neutrophilic infiltration E) Immunoglobulin synthesis by plasma cells

C) Elevated antistreptolysin O titer

A 10-year-old girl was brought to the family physician because of increasing lethargy for 4 days. She had a sore throat 14 days prior to the office visit. On physical examination she has periorbital edema. Initial laboratory studies show a serum BUN of 25 mg/dL and creatinine 2.7 mg/dL. A microscopic urinalysis shows hematuria with dysmorphic RBC's. The light microscopic appearance of her renal biopsy shows hypercellularity, with PMN's present. The electron microscopic appearance is shown. Which of the following additional laboratory test findings is most likely to be present in this girl? A) Elevated serum glucose B) Antibody to double stranded DNA C) Elevated antistreptolysin O titer D) Antiglomerular basement membrane antibody E) Positive C3 nephritogenic factor

B) Congenital infection

A 20-year-old primigravida delivers a 34 week gestational age male infant who survives for only 2 hours following an uncomplicated vaginal delivery. At autopsy, there is hepatosplenomegaly. The brain shows areas of necrosis with periventricular calcifications. The microscopic appearance of his kidney is seen here. Which of the following conditions is the most probable cause for these findings? A) Prematurity B) Congenital infection C) Chromosomal abnormality D) Maternal malnutrition E) Congenital neoplasia

D) Respiratory distress

A 21-year-old primigravida gives birth at term following a prolonged labor with difficult delivery of a girl infant. The placenta is delivered 5 minutes later and has the appearance shown here. Which of the following complications is most likely to occur in this infant? A) Intraventricular hemorrhage B) Necrotizing enterocolitis C) Sepsis D) Respiratory distress E) Hypoglycemia

C) Discordant size

A 22-year-old primigravida gives birth to twin girl infants at 37 weeks gestation. The placental vasculature is injected with latex and shown here. This appearance of the fetal surface is most likely to occur in association with which of the following abnormalities? A) Placental infarction B) Congenital anomalies C) Discordant size D) Abruptio placenta E) Congenital infection

C) Complement mediated cell destruction

A 23-year-old G2 P1 woman has noted minimal fetal movement in the second trimester. An ultrasound scan at 19 weeks shows hydrops fetalis. A girl infant is born at 32 weeks gestation and is markedly icteric. The microscopic appearance of the placenta is shown here. Laboratory studies show the baby has a Hct of 18%, and an exchange transfusion is performed. Her first pregnancy was uncomplicated and resulted in the birth of a normal girl at term. Which of the following immunologic mechanisms is most likely to produce these findings? A) Anti-receptor antibody B) Immune complex formation C) Complement mediated cell destruction D) Delayed type hypersensitivity E) Loss of self tolerance

D) 45, X

A 24-year-old G3 P2 woman delivers a stillborn female fetus at 20 weeks gestation. The gross appearance of this fetus is shown here. A chromosome analysis of fetal cells is performed. Which of the following karyotypes is this fetus most likely to have? A) 47, XXY B) 47, XX, +13 C) 69, XXX D) 45, X E) 47, XXX

A) Apoptosis

A 24-year-old man has developed nausea and jaundice over the past week. On physical examination he has right upper quadrant tenderness; his sclerae are icteric. Laboratory studies show he has hepatitis B viral infection. His AST is 189 U/L and ALT 202 U/L. Which of the following microscopic findings is most likely shown here in his liver? A) Apoptosis B) Granuloma formation C) Coagulative necrosis D) Abscess formation E) Fatty metamorphosis

D) Transudation

A 25-year-old man has been working in his garden all day. This finding seen on physical examination. This is best characterized by which of the following descriptive terms? A) Exudation B) Erythema C) Ulceration D) Transudation E) Necrosis

E) Incidental finding

A 25-year-old primigravida gives birth to a term girl infant. The placenta is delivered 10 minutes later, and inspection of the umbilical cord reveals the gross appearance shown here. Which of the following is the most appropriate interpretation of this appearance? A) Multiple anomalies are present B) Presence of Potter facies C) Large hemorrhage at delivery D) Risk for infection E) Incidental finding

A) Marfan syndrome

A 25-year-old woman has a routine check of her health status. On physical examination she has a mid-systolic click upon auscultation of her chest. Echocardiography reveals the lesion depicted in this gross photograph of the heart. Which of the following underlying diseases is she most likely to have? A) Marfan syndrome B) Rheumatoid arthritis C) Acquired immunodeficiency syndrome D) Diabetes mellitus E) Rheumatic heart disease

D) Rapidly progressive loss of renal function

A 26-year-old man has the onset of nausea and lethargy over the past 3 days. On physical examination his blood pressure is 145/95 mm Hg. His serum creatinine is 4.4 mg/dL. Urinalysis shows hematuria and proteinuria. He has anti-glomerular basement membrane antibody. A renal biopsy is performed and the microscopic appearance with H&E stain is shown here. Which of the following historical findings is this patient most likely to provide? A) Poorly controlled diabetes mellitus B) Pharyngitis several weeks ago C) 100 pack year history of smoking D) Rapidly progressive loss of renal function E) Use of NSAIDS for many years

E) Abruptio placenta

A 29-year-old G3 P2 woman has an uncomplicated pregnancy, and an ultrasound scan at 18 weeks gestation is completely normal. At 37 weeks she has the sudden onset of pelvic pain accompanied by passage of blood per vagina. Her membranes have not ruptured nor is she having labor contractions. Fetal monitoring reveals that the baby is in distress, and an emergent cesarean section is performed. The gross appearance of the placenta is shown here. Which of the following is the most likely diagnosis? A) Ectopic pregnancy B) Placenta previa C) Placenta accreta D) Molar pregnancy E) Abruptio placenta

E) Prostaglandin

A 29-year-old woman has had abdominal pain for the past 3 days. On physical examination there are no abnormal findings. Upper GI endoscopy is performed and the gastric mucosa has the appearance depicted here. Release of which of the following chemical mediators is most likely to produce this appearance? A) Prostacyclin B) Interferon gamma C) Interleukin-6 D) Complement C3b E) Prostaglandin

D) Complete hydatidiform mole

A 30-year-old G2 P1 woman has a prenatal examination and is large for dates. An ultrasound scan at 19 weeks gestation reveals a 'snowstorm' effect. Her serum hCG level is markedly elevated. The representative gross appearance of the placenta is shown here. Which of the following is the most likely diagnosis? A) Placenta previa B) Triploidy C) Abruptio placenta D) Complete hydatidiform mole E) Gestational diabetes

C) Berger disease

A 35-year-old man notes passing dark urine following a flu-like illness that has lasted for 10 days. On physical examination his blood pressure is 140/90 mm Hg. Urinalysis shows hematuria. A week later his serum creatinine is 2.9 mg/dL. A renal biopsy is performed and microscopic examination with immunofluorescence pattern with antibody against human IgA is shown here. Which of the following is the most likely diagnosis? A) Lupus nephritis B) Goodpasture syndrome C) Berger disease D) Membranoproliferative glomerulonephritis E) Membranous nephropathy

E) Alpha-fetoprotein

A 36-year-old man has noted increasing scrotal enlargement for the past 8 months. On physical examination the left testis is enlarged and firm. This is the microscopic appearance of the excised mass, which grossly is reddish-brown and soft, with areas of hemorrhage on sectioning. He is referred for further therapy with retroperitoneal lymph node dissection and chemotherapy. Which of the following is the best laboratory test on his serum to aid in diagnosis and follow-up? A) Lactate dehydrogenase B) Carcinoembryonic antigen C) Human placental lactogen D) Prostate specific antigen E) Alpha-fetoprotein

C) S

A 37-year-old woman notes a lump in her breast on self-examination. Her physician palpates a 2 cm firm, irregular mass in her right breast. Biopsy of the mass shows cells with the histopathologic features seen here. Flow cytometric analysis is performed on these cells. Flow cytometry is most likely to show a feature from which of the following phases of the cell cycle? A) G0 B) G1 C) S D) G2 E) M

E) Adenomyosis

A 38-year-old woman has had dysmenorrhea for 9 months. On pelvic examination the uterus appears to be symmetrically enlarged. This microscopic appearance is representative of her myometrium. Which of the following is the most likely diagnosis? A) Invasive mole B) Endometriosis C) Ectopic pregnancy D) Teratoma E) Adenomyosis

B) Abscesses

A 40-year-old man has had a productive cough with yellowish sputum for 4 days. On physical examination his temperature is 38.3°C. Laboratory studies show that he has a total WBC count of 13,440/microliter with a left shift. The gross appearance shown here is representative of his lung. Which of the following is the most likely diagnosis? A) Granulomas B) Abscesses C) Metastatic carcinoma D) Primary squamous carcinoma E) Multiple infarcts

E) Chronic inflammation

A 41-year-old woman has noted a vaginal discharge persisting for 3 weeks. On pelvic examination her ectocervix is erythematous. Cervical biopsies are taken and on microscopic examination reveal the appearance seen here. Which of the following is the most likely diagnosis? A) Human papillomavirus infection B) Ingestion of chili peppers C) Diabetes mellitus D) Tuberculosis E) Chronic inflammation

C) Human papillomavirus infection

A 41-year-old woman has noted some intermenstrual spotting of blood for the past 6 months. A pelvic examination is performed and the cervical lesion seen here is found. She undergoes a total abdominal hysterectomy. Which of the following is the most likely risk factor that contributed to the appearance of this lesion? A) Diabetes mellitus, type II B) Vitamin A deficiency C) Human papillomavirus infection D) Syphilis E) Germline mutation

B) Mycobacterium tuberculosis

A 42-year-old man has had fever, night sweats, weight loss of 3 kg, and cough with hemoptysis over the past 3 months. On physical examination his temperature is 37.6°C. His chest radiograph shows reticulonodular infiltrates, primarily in upper lung fields. The representative microscopic appearance of his lung is seen here. He is most likely to be infected with which of the following organisms? A) Influenza A virus B) Mycobacterium tuberculosis C) Streptococcus pneumoniae D) Cytomegalovirus E) Pneumocystis jiroveci

D) Epithelial metaplasia

A 43-year-old man has complained of heartburn for the past 5 months. On physical examination there are no abnormal findings. Upper GI endoscopy is performed. Biopsies are taken of an erythematous area of the lower esophageal mucosa. There is no mass lesion and no hemorrhage. The biopsies have the microscopic appearance shown here. Which of the following is the most likely diagnosis? A) Acute inflammation B) Glandular hyperplasia C) Metastatic carcinoma D) Epithelial metaplasia E) Ischemic injury

C) Alcoholism

A 45-year-old man develops encephalopathy. On exam, his liver span is increased. His outstretched hands exhibit asterixis. His blood ammonia is increased. The representative microscopic appearance of his liver is shown. Which of the following etiologic factors most likely led to these findings? A) Atherosclerosis B) Thrombosis C) Alcoholism D) Hemolysis E) Starvation

A) Neutrophilia with left shift

A 50-year-old woman has had a high fever over the past day. On physical examination she has papilledema. The gross appearance of her disease process is shown here. Which of the following laboratory test results is she most likely to have? A) Neutrophilia with left shift B) Elevated serum lipase C) Decreased total serum complement D) Increased serum carcinoembryonic antigen E) Elevated serum alanine aminotransferase

B) Free radical injury

A 53-year-old man suffers a cardiac arrest and his wife calls paramedics, who arrive a few minutes later and begin resuscitative measures. A regular heart rate is established after about 40 minutes of resuscitative efforts as he is being transported to the hospital. A thrombolytic agent is administered on admission. Which of the following cellular changes is most likely to now be occurring within his myocardium? A) Apoptosis B) Free radical injury C) Heterophagocytosis D) Squamous metaplasia E) Accumulation of cytokeratins

E) Estrogen receptor

A 54-year-old woman feels a lump in her left breast. On physical examination there is an irregular, non-movable firm 3 cm upper outer quadrant mass. A mastectomy is performed. Gross examination reveals stromal invasion. Immunohistochemical staining of the cells in the mastectomy reveals the pattern seen here. Positivity for which of the following, which aids in selecting therapy, is most likely shown here? A) Reverse transcriptase B) Telomerase C) DNA topoisomerase II D) Protein kinase E) Estrogen receptor

E) Hypercholesterolemia

A 54-year-old woman had the sudden onset of severe chest pain. The representative high power microscopic appearance of her left circumflex artery is depicted here. Which of the following is the most likely contributing factor to this appearance? A) Hypercalcemia B) Hypercoagulability C) Hypoxemia D) Septicemia E) Hypercholesterolemia

D) Sarcoma

A 55-year-old man has experienced pain in his left leg for the past 7 months. On palpation he has swelling behind his left knee. The lesion has the representative gross appearance shown here. Which of the following is the most likely neoplasm he has? A) Adenoma B) Carcinoma C) Lymphoma D) Sarcoma E) Teratoma

B) Embolization

A 55-year-old woman with ischemic heart disease develops congestive heart failure. She develops back pain. A urinalysis shows hematuria. Which of the following is the most likely etiology for the gross appearance shown here? A) Apoptosis B) Embolization C) Metastasis D) HIV infection E) Trauma

A) Hypoalbuminemia

A 56-year-old man has noted increased swelling of his legs for the past year. He has the finding on physical examination shown here. This region is cool to touch and not painful. He is afebrile. Which of the following laboratory test results is most likely to explain this finding? A) Hypoalbuminemia B) Glucosuria C) Neutrophilia D) Thrombocytopenia E) Hypernatremia

A) Thrombocytopenia

A 56-year-old woman is undergoing chemotherapy for treatment of breast carcinoma. The gross appearance of her skin shown here is most typical for which of the following conditions? A) Thrombocytopenia B) Gangrene C) Congestive heart failure D) Metastatic breast carcinoma E) Pellagra

E) Essential hypertension

A 58-year-old man has experienced worsening orthopnea for 5 months. He becomes dyspneic with exercise, but without chest pain. He has no peripheral edema. A chest radiograph reveals pulmonary edema. Which of the following abnormalities do you most strongly suspect, based upon this gross appearance of his heart? A) Pulmonary emphysema B) Coronary thrombosis C) Viral myocarditis D) Atrial septal defect E) Essential hypertension

B) Hemolysis

A 60-year-old man has become increasingly fatigued for the past month. A physical examination finding is shown here. Which of the following underlying disorders is he most likely to have? A) Acute renal failure B) Hemolysis C) Hepatic metastases D) Thrombophlebitis E) Diabetes mellitus

C) Chronic renal failure

A 60-year-old man has had increasing lethargy for the past year. On physical examination he has an audible friction rub. He is afebrile. An echocardiogram shows normal valvular motion. The pericardial cavity has been opened here to reveal the epicardial surface representative of this man's disease. Which of the following underlying conditions would you most strongly suspect contributed to the appearance of the process shown here? A) Milary tuberculosis B) Metastatic carcinoma C) Chronic renal failure D) Congestive heart failure E) Restrictive cardiomyopathy

A) Polycythemia

A 61-year-old man has had dull flank pain for 2 months. On physical examination he has left costovertebral angle tenderness. He has plethora of his skin. Laboratory studies with urinalysis show 4+ blood. Abdominal CT scan shows hepatic vein thrombosis and liver infarction. The excised lesion from this man is shown here. Which of the following laboratory findings is most likely to be related to this finding? A) Polycythemia B) Hyponatremia C) Hyperaldosteronemia D) Hyperglycemia E) Hypercholesterolemia

A) Infiltrating ductal carcinoma

A 61-year-old woman comes to her physician because of a change in the appearance of her right breast over the past 7 months. On physical examination the skin overlying the breast is indurated, roughened, and reddish-orange. There is nipple retraction. The gross appearance of the cut surface of her subsequent mastectomy specimen is shown here. Which of the following is the most likely diagnosis? A) Infiltrating ductal carcinoma B) Intraductal carcinoma C) Phyllodes tumor D) Lobular carcinoma in situ E) Sclerosing adenosis

E) Thromboembolism

A 61-year-old woman is in the hospital for 2 weeks with bronchopneumonia following surgery for endometrial adenocarcinoma. She then becomes suddenly short of breath. This microscopic appearance from her lung is most typical for which of the following pathologic abnormalities? A) Metastatic adenocarcinoma B) Traumatic intubation C) Abscessing bronchopneumonia D) Severe occlusive atherosclerosis E) Thromboembolism

C) Smoking

A 65-year-old man has had hemoptysis and a 7 kg weight loss for the past 5 months. A chest radiograph shows a left lung mass. The representative gross appearance of his lung is seen here. Which of the following is the most likely risk factor for development of this man's lung lesion? A) Alpha-1-antitrypsin deficiency B) Cystic fibrosis C) Smoking D) Diabetes mellitus E) Asbestosis

A) Anthracotic pigmentation

A 66-year-old man is diagnosed with a squamous cell carcinoma of the right lung. While performing a pneumonectomy, the thoracic surgeon notes that the hilar lymph nodes are small, 0.5 to 1.0 cm in size, and jet black in color throughout. The microscopic appearance of one lymph node is seen here. Which of the following is the most likely diagnosis for this lymph node? A) Anthracotic pigmentation B) Metastatic carcinoma C) Hemosiderosis D) Accumulation of melanin E) Lipochrome deposition

C) Thromboxane

A 66-year-old woman has had increasing dyspnea for the past month. Shown here is the representative microscopic appearance of her lung. Which of the following chemical substances is most instrumental in the formation of the abnormality seen here? A) Tumor necrosis factor B) Leukotriene B4 C) Thromboxane D) TGF-beta E) Laminin

C) Liquefactive necrosis

A 67-year-old woman with a past history of myocardial infarction had an episode of altered consciousness 3 weeks ago, followed by inability to move her right arm. She now has the lesion seen here grossly in the brain. Which of the following is the most likely diagnosis? A) Organizing abscess B) Acute meningitis C) Liquefactive necrosis D) Metastatic carcinoma E) Granulomatous inflammation

E) Metastases from this lesion may be present

A 68-year-old man goes to his physician for a routine check-up. The only abnormal finding on physical examination is a positive stool guaiac. A colonoscopy is performed, and the lesion seen here is found and segmental colonic resection performed. Which of the following statements is most appropriate to make to this patient regarding these findings? A) Your children have a high risk for a similar lesion B) This is a benign lesion that will not recur C) A sexually transmitted disease led to this lesion D) This lesion is the result of smoking E) Metastases from this lesion may be present

D) Diabetes mellitus

A 68-year-old man has had abdominal pain for the past month. On physical examination there is a pulsatile abdominal mass palpated. The gross appearance shown here representative of this man's disease is most likely to be associated with which of the following underlying conditions? A) Marfan syndrome B) Hypercalcemia C) Metastatic carcinoma D) Diabetes mellitus E) Aging

B) Metastatic adenocarcinoma

A 72-year-old woman has been feeling fatigued for the past 6 weeks. She has had a 6 kg weight loss in the past 3 months. She has nausea, but no vomiting, hemoptysis, or hematemesis. She does not have a cough. On physical examination she is afebrile. A stool sample is positive for occult blood. Her serum carcinoembryonic antigen (CEA) is elevated but her alpha-fetoprotein (AFP) is not. The representative gross appearance of her liver is depicted here. Which of the following is the most likely diagnosis? A) Hepatic adenomas B) Metastatic adenocarcinoma C) Multifocal bilary tract dysplasia D) Hepatocellular carcinoma E) Micronodular cirrhosis

D) Monckeberg's arteriosclerosis

A 72-year-old woman has noted a bump on her neck enlarging for the past 2 years. On physical examination there is a right thyroid nodule. She undergoes subtotal thyroidectomy and the nodule on microscopic examination is a follicular adenoma. However, the pathologist notes that the surrounding small arteries around the thyroid show the changes seen here microscopically. Which of the following is the most likely diagnosis? A) Uncontrolled diabetes mellitus B) Systemic lupus erythematosus C) Parathyroid adenoma D) Monckeberg's arteriosclerosis E) Chronic hypertension

B) Medial calcific sclerosis

A 75-year-old woman falls down a flight of stairs. A radiograph of the pelvis is taken to determine if fracture is present. The radiograph reveals the presence of small calcified muscular arteries. The microscopic appearance of one of these arteries is depicted here. Which of the following is the most likely diagnosis? A) Hyaline arteriolosclerosis B) Medial calcific sclerosis C) Metastatic calcification D) Hyperplastic arteriolosclerosis E) Uncontrolled diabetes mellitus

C) Streptococcus pneumoniae

A 78-year-old woman has a history of Alzheimer disease. She develops fever, dyspnea, and productive cough over the past 2 days. A chest x-ray shows patchy infiltrates in all lung fields. Shown is the high power microscopic appearance of her lung. Which of the following infectious agents is the most likely cause for her pulmonary disease? A) Influenza A virus B) Mycobacterium tuberculosis C) Streptococcus pneumoniae D) Cytomegalovirus E) Pneumocystis jiroveci

B) Intravenous drug use

After a high fever for 3 days, a 29-year-old man becomes delirious, and his friends bring him to the emergency room. Physical examination reveals a cardiac murmur, along with splenomegaly and a temperature of 38.7°C. Splinter hemorrhages appear under the nails of both his hands. Echocardiography reveals the lesions seen here. Which of the following is the most likely diagnosis? A) Acute rheumatic fever B) Intravenous drug use C) Congenital bicuspid valve D) Trousseau syndrome E) Systemic lupus erythematosus

B) Rhabdomyosarcoma

An 8-year-old boy has complained of difficulty swallowing for the past 2 months. On physical examination he has a palpable nontender mass in the region of the right neck. A head CT scan reveals a 7 cm solid soft tissue mass lateral to his esophagus on the right. A biopsy of this mass is performed and shown here. Which of the following neoplsms is he most likely to have? A) Wilms tumor B) Rhabdomyosarcoma C) Neuroblastoma D) Squamous cell carcinoma E) Osteosarcoma

E) Atrophy

An 84-year-old man is a resident of a nursing home. He dies from pneumonia. At autopsy the gross appearance of the brain is shown here. Which of the following is the most likely diagnosis? A) Glioma B) Infarction C) Edema D) Meningitis E) Atrophy

D) Cardiac amyloidosis

During elective surgery to repair an inguinal hernia on a 50-year-old man with a history of diabetes mellitus, arrhythmias develop that the anesthesiologist cannot control, despite using multiple pharmacologic agents. Autopsy reveals an enlarged heart (540 gm) with microscopic appearance of the myocardium seen here with Congo red stain under polarized light. Which of the following is this man's most likely underlying cause of death? A) Dilated cardiomyopathy B) Hemochromatosis C) Diabetes mellitus D) Cardiac amyloidosis E) Arrhythmogenic right ventricular dysplasia

D) Leiomyomata

For the past two years, a 40-year-old woman has noted that her menstrual periods have been exceptionally heavy, lasting 6-8 days. She has noted occasional minor intermenstrual bleeding. For the past 3 months, she has been taking supplemental dietary iron for iron deficiency anemia. On physical examination her uterine cervix appears normal, but the uterus is enlarged to twice normal size and is somewhat nodular on examination. A hysterectomy is performed. The specimen is shown here. Which of the following is the most likely cause for her bleeding? A) Adenomyosis B) Endometriosis C) Metastatic carcinoma D) Leiomyomata E) Endometrial adenocarcinoma

D) Lymphocyte

In an experiment, mechanisms for entry of infectious agents into human cells is studied. One such mechanism is diagrammed here. Which of the following cells is most likely to become infected via this mechanism? A) Neuron B) Plasma cell C) Red blood cell D) Lymphocyte E) Sqaumous epithelial cell

A) DiGeorge syndrome

Soon after birth, a term infant develops tetany with marked hypocalcemia. This is treated, but at one month of age, a systolic heart murmur is heard on auscultation of the chest. Later in infancy, it is noted that the baby has been almost constantly ill with one infection after another, including respiratory syncytial virus, Candida, and Pneumocystis jiroveci pneumonia diagnosed. Which of the following primary immunodeficiency disorders is the child most likely to have? A) DiGeorge syndrome B) Severe combined immunodeficiency C) Common variable immunodeficiency D) Bruton agammaglobulinemia E) Wiskott-Aldrich syndrome

D) Histamine

Within minutes following a bee sting, a 40-year-old man develops the pathologic abnormality seen here. Release of which of the following chemical mediators is most likely responsible for this finding? A) Nitric oxide B) Prostaglandin E2 C) Complement C3b D) Histamine E) Tumor necrosis factor

D) Mural thrombosis

A 45-year-old woman suffers a 'stroke' with right parietal infarction. On physical examination a heart murmur is audible. Based upon the gross appearance shown here, which of the following conditions is she most likely to have? A) Vasculitis B) Pericardial tamponade C) Ketoacidosis D) Mural thrombosis E) Disseminated intravascular coagulation

A) Chronic myelogenous leukemia

A 48-year-old previously healthy woman develops increasing malaise over the past 4 months. On physical examination there are no abnormal findings. Laboratory studies show her Hgb is 8.5 g/dL with WBC count 241,400/microliter. A bone marrow biopsy is performed and shows a 100% cellular marrow. Chromosome analysis of the cells from the marrow yields the karyotype shown here. Which of the following is the most likely diagnosis? A) Chronic myelogenous leukemia B) Metastatic breast carcinoma C) Myeloid hyperplasia D) Granulomatous infection E) Multiple myeloma

E) SS-A

A 48-year-old woman has xerostomia that has caused her difficulty with eating for the past year, regardless of her fluid intake or the weather outside. A biopsy of her inner lip is performed and has the microscopic findings shown here. Which of the following serologic tests is most likely to be positive in this woman? A) Anti-Smith B) Anti-centromere C) Jo-1 D) Scl-70 E) SS-A

C) Coagulative necrosis

A 49-year-old man has had marked chest pain for the last 4 hours. An EKG shows ST segment elevation. Laboratory studies show troponin I of 10 ng/mL. The representative gross appearance of his disease process is depicted here. Which of the following findings is most likely to occur in this man? A) Liquefactive necrosis B) Caseous necrosis C) Coagulative necrosis D) Wet gangrene E) Apoptosis

B) Fibroblast growth factor

A 49-year-old woman experiences an acute episode of chest pain. The microscopic appearance of her left ventricular free wall is seen here 10 days following this episode. Which of the following is the most likely factor elaborated by macrophages at this site to produce this microscopic appearance? A) Platelet-derived growth factor B) Fibroblast growth factor C) Phospholipase A2 D) Fibronectin E) Epidermal growth factor

A) Wilms tumor

A 5-year-old child has complained of pain in his abdominal region for the past 2 months. Physical examination reveals a palpable mass in the posterior abdomen. An abdominal CT scan shows a mass involving the left kidney. A nephrectomy is performed and the specimen is shown here. Which of the following is the most likely diagnosis? A) Wilms tumor B) Urothelial carcinoma C) Renal cell carcinoma D) Angiomyolipoma E) Rhabdomyosarcoma

E) A family history of the disorder is lacking

A 17-year-old boy has 12 irregular brown 3 to 5 cm macules scattered over his skin. He also has multiple dermal skin nodules. The appearance of his hand is shown here. Which of the following characteristics is most representative of his genetic disorder? A) Expression of the defect is uniform among affected individuals B) Heterzygous females do not express the full phenotypic change C) Penetrance is observed in less than half of cases D) The onset of the disorder is in infancy E) A family history of the disorder is lacking

E) Focal segmental glomerulosclerosis

A 12-year-old boy has felt tired for the past 2 months. On physical examination he has periorbital edema. Laboratory studies show his serum urea nitrogen is 26 mg/dL and creatinine 2.4 mg/dL. He is given a course of corticosteroid therapy but does not improve. A renal biopsy is performed, and the microscopic appearance with trichrome stain is shown here. This appearance is 3 of 10 glomeruli present in the biopsy. Immunofluorescence staining is nonspecific. Which of the following renal diseases is he most likely to have? A) Minimal change disease B) Nodular glomerulosclerosis C) Alport's syndrome D) Berger's disease E) Focal segmental glomerulosclerosis

D) Glucocerebrosidase

A 16-year-old girl has had chronic fatigue since early childhood. She has noted pain in her lower right leg for the past 2 days. On physical examination she has a palpable spleen tip and pain on palpation over her right shin. Laboratory studies show her Hgb is 9.3 g/dL with platelet count 86,600/microliter and WBC count 2820/microliter. A radiograph shows a fracture of the right tibial shaft. A bone marrow biopsy is performed. The microscopic appearance of the marrow smear is shown here. She is most likely to have a deficiency of which of the following enzymes? A) Sphingomyelinase B) Galactose-1-uridyl transferase C) Glucose-6-phosphatase D) Glucocerebrosidase E) Glucose-6-phosphate dehydrogenase

C) Fibroadenoma

A 28-year-old woman felt a lump in her right breast last week. Her physician palpates a firm, rubbery, and movable mass. No axillary lymph nodes are palpable. Mammography confirms the presence of the lesion, which has no microcalcifications, and reveals no lesions of the opposite breast. The excised lesion is shown. Which of the following is the most likely diagnosis? A) Phyllodes tumor B) Lobular carcinoma in situ C) Fibroadenoma D) Paget's disease of breast E) Infiltrating ductal carcinoma

C) Elevated serum hemoglobin A1C

A 29-year-old G2 P1 woman gives birth at 32 weeks gestation to a male 3550 gm infant. No anomalies are noted. An episode of hypoglycemia is treated. Respiratory distress syndrome occurs soon after birth. Intubation with positive pressure ventilation is performed to maintain adequate oxygenation. The microscopic appearance of the infant's lung is seen here. Which of the following prenatal tests on the mother would most likely have predicted this outcome? A) Elevated maternal serum alpha-fetoprotein B) Ultrasound demonstrating polyhydramnios C) Elevated serum hemoglobin A1C D) Amniocentesis with karyotype showing 47, XYY E) Increased serum beta-human chorionic gonadotropin

A) Group B Streptococcus

A 30-year-old G3 P2 woman has had preterm premature rupture of membranes for a week. She gives birth at 31 weeks gestation to a male infant with initial Apgar scores of 6 at one minute and 7 at five minutes. The birth weight is normal for gestational age. No anomalies are noted. Within an hour the infant develops respiratory distress with grunting and retractions. The microscopic appearance of the placental fetal membranes seen here most strongly suggests infection with which of the following organisms? A) Group B Streptococcus B) Cytomegalovirus C) Treponema pallidum D) Candida albicans E) Mycobacterium avium complex

A) Cystic fibrosis

A 32-year-old G2 P1 woman gives birth at term to a girl infant. The infant has no anomalies. Within three days following birth, the infant has not passed any stool and has abdominal distension. Laparotomy is performed and the resected specimen is shown here. Later in childhood, malabsorption is present and the child develops recurrent pneumonia with Pseudomonas aeruginosa and Burkholderia cepacia cultured. Which of the following inherited disorders is this infant most likely to have? A) Cystic fibrosis B) Phenylketonuria C) Down syndrome D) Hirschsprung disease E) Kartagener syndrome

D) Human papillomavirus

A 32-year-old woman goes to her physician for a routine check-up. A Pap smear is taken, followed by a cervical biopsy. The microscopic appearance of the biopsy is shown here. This lesion is most likely to be etiologically related to infection with which of the following? A) Treponema pallidum B) Neisseria gonorrheae C) Trichomonas vaginalis D) Human papillomavirus E) Human immunodeficiency virus

B) Endometriosis

A 32-year-old woman has had intermittent pelvic pain for the past 6 years. She has been trying to become pregnant, but has not succeeded in 3 years. On physical examination there are no abnormal findings. Laparoscopy is performed and the microscopic finding shown here is from a biopsy of the broad ligament. Seven of these 1 to 2 mm lesions are also present on serosal surfaces of uterus and ovaries. Which of the following is the most likely diagnosis? A) Malignant mixed mullerian tumors B) Endometriosis C) Metastatic adenocarcinoma D) Herpes simplex virus infection E) Pelvic inflammatory disease

B) Mature cystic teratoma

A 32-year-old woman has noted lower abdominal pain for the past 6 months. On physical examination there is a right adnexal mass. An abdominal ultrasound reveals a circumscribed, solitary, mostly cystic right ovarian mass. The ovary is excised and the gross appearance is depicted here. Which of the following neoplasms is she most likely to have? A) Serous cystadenoma B) Mature cystic teratoma C) Dysgerminoma D) Endometrioma E) Granulosa cell tumor

A) Group A beta-hemolytic streptococcal infection

A 45-year-old woman has had worsening orthopnea for the past 3 years. She is unable to tolerate strenuous exercise. She has had increasing difficulty with swallowing for the past year. On physical examination she has a cardiac murmur. She is afebrile. Based upon the gross appearances of her heart shown here, which of the following is the most likely underlying cause for her illness? A) Group A beta-hemolytic streptococcal infection B) Uncontrolled diabetes mellitus C) Congenital anomaly D) Staphylococcus aureus infection E) Sexually transmitted disease

A) Dysphagia

A 43-year-old woman has noted for the past 2 years that her fingers turn white and become painful upon exposure to cold. Shown here is the appearance of the antinuclear antibody test using her serum at a titer of 1:1024. Which of the following complications is this patient most likely to have at this time? A) Dysphagia B) Anemia C) Melena D) Lymphadenopathy E) Skin rash

C) Systemic sclerosis

A 45-year-old woman has had a severe headache with nausea and vomiting for the past 2 days. On physical examination her blood pressure is 290/160 mm Hg. Laboratory studies show her serum creatinine is 3.7 mg/dL. The representative microscopic appearance of her kidneys is depicted here. Which of the following underlying diseases is she most likely to have? A) Hepatitis C infection B) Breast carcinoma C) Systemic sclerosis D) Secondary gout E) Diabetes mellitus

B) Hyperplastic arteriolosclerosis

A 45-year-old woman has had a worsening headache for the past 2 days. On physical examination her blood pressure is 300/150 mm Hg. Laboratory studies show her serum creatinine is 3.7 mg/dL. This microscopic appearance of her kidney is most consistent with which of the following vascular diseases? A) Benign nephrosclerosis B) Hyperplastic arteriolosclerosis C) Nodular glomerulosclerosis D) Hyaline arteriolosclerosis E) Medial calcific sclerosis

E) This is an incidental finding

A 45-year-old woman has had urinary incontinence with lower abdominal discomfort for the past 2 years. On physical examination the uterus is displaced downward. A total abdominal hysterectomy is performed. Note the appearance of the broad ligaments shown here. Which of the following statements regarding this finding is most appropriate? A) You are unlikely to survive 5 years B) A course of isoniazid therapy is warranted C) You have a sexually transmitted disease D) The source of the abdominal pain has been found E) This is an incidental finding

D) Left ventricular aneurysm

A 58-year-old man comes to his physician for a routine check-up. He is currently in stable condition, with no chest pain. His BMI is 33. He is afebrile. An echocardiogram shows an ejection fraction of 30%. Shown here is a representative high power H&E microscopic view of his myocardium. Which of the following pathologic abnormalities is most likely to be present at this physician visit? A) Hemopericardium B) Pericarditis C) Ventricular septal defect D) Left ventricular aneurysm E) Papillary muscle rupture

D) Coagulative necrosis

A 58-year-old man experienced chest pain 4 days ago. He now has increasing dyspnea and an irregular pulse. The representative gross appearance of his interventricular myocardium is shown here. Which of the following microscopic changes is most likely to be present? A) Liquefactive necrosis B) Caseous necrosis C) Wet gangrene D) Coagulative necrosis E) Apoptosis

E) Microalbuminuria

A 63-year-old man with atherosclerotic heart disease has increasing lethargy for the past 5 years. On examination his blood pressure is 160/110 mm Hg. Laboratory studies show serum creatinine 6 mg/dL and urea nitrogen 64 mg/dL. He has the microscopic appearance in his kidneys seen here. Which of the following findings on urinalysis is most specific for the underlying disease leading to this appearance? A) WBC casts B) Uric acid crystals C) CMV inclusions D) RBC casts E) Microalbuminuria

E) Amyloidosis

A 63-year-old woman has had back pain for the last 3 months. On physical examination there are no abnormal findings. Laboratory studies show a serum creatinine of 3.5 mg/dL. Bence-Jones proteinuria is present. A radiograph of the vertebral column demonstrates multiple 1 to 2 cm rounded areas of decreased bone density. From the electron micrographic finding seen here from a renal biopsy, which of the following complications of her underlying disease is she most likely to have? A) Pneumocystis jiroveci pneumonia B) Coronary atherosclerosis C) Sclerodactyly D) Chronic myelogenous leukemia E) Amyloidosis

D) Ischemic heart disease

A 65-year-old man has had increasing dyspnea and orthopnea for the past year. On physical examination there are rales in all lung fields. A chest x-ray shows cardiomegaly and pulmonary edema. An echocardiogram shows reduced cardiac output. The gross appearance of his heart shown here is most consistent with which of the following underlying conditions? A) Amyloidosis B) Systemic hypertension C) Diffuse scleroderma D) Ischemic heart disease E) Viral myocarditis

D) Dominant polycystic kidney disease

A 65-year-old man has had worsening renal failure for the past 10 years. He now requires hemodialysis. An abdominal ultrasound reveals that both his kidneys are enlarged. Based upon this gross appearance of his kidneys shown here, which of the following conditions is he most likely to have? A) Systemic lupus erythematosus B) Renal cell carcinoma C) Urinary tract obstruction D) Dominant polycystic kidney disease E) Chronic glomerulonephritis

B) Prostatic hyperplasia

A 69-year-old man has had recurrent urinary tract infections for the past 13 years, with Escherichia coli, Proteus mirabilis, and Staphylococcus saprophyticus cultured on multiple occasions. He now has a serum urea nitrogen of 40 mg/dL and serum creatinine of 3.9 mg/dL. A urinalysis shows no hematuria, proteinuria, or glucosuria. An intravenous pyelogram reveals that both kidneys are involved with the condition depicted here. Which of the following underlying conditions is he most likely to have? A) Diabetes mellitus B) Prostatic hyperplasia C) Gouty nephropathy D) Chronic glomerulonephritis E) Analgesic-induced nephropathy

A) Hyperglycemia

A 70-year-old man has noted coldness and numbness of his lower left leg, increasing over the past 2 weeks. He also experiences pain in this extremity when he tries walking more than 100 meters. On physical examination, his left dorsalis pedis, posterior tibial, and popliteal artery pulses are not palpable. He then suffers the complication pictured here. The most likely contributing cause for his symptoms and signs is indicated by which of the following laboratory test findings? A) Hyperglycemia B) Protein S deficiency C) Blood culture with Staphylococcus aureus D) Decreased arterial oxygen saturation E) Thrombocytopenia

B) CK-MB

A 70-year-old woman becomes more dyspneic and lethargic over the course of a day. On physical examination her blood pressure is 165/110 mm Hg. Laboratory studies show serum glucose 139 mg/dL and creatinine 1.2 mg/dL. Based upon this microscopic representation of her myocardium, which of the following laboratory tests would aid most in confirming the diagnosis in this woman? A) Hemoglobin A1C B) CK-MB C) LDH D) HDL cholesterol E) Homocysteine

D) Autophagocytosis

A 90-year-old woman dies from breast cancer. At autopsy, her liver is normal in size. Shown here is the microscopic appearance of her hepatocytes. Which of the following cellular mechanisms is most likely to produce this finding? A) Nuclear pyknosis B) Hypertrophy C) Coagulative necrosis D) Autophagocytosis E) Anaerobic glycolysis

C) Antigen-antibody complex deposition

A clinical study is performed with subjects who developed a skin rash. Skin biopsies from these subjects are analyzed by immunofluoresence. Some of the subjects have the immunofluorescence pattern shown here, with antibody to IgG. This appearance is most likely to be based upon which of the following pathologic mechanisms? A) Dermal CD4 lymphocyte infiltration B) Mast cell degranulation C) Antigen-antibody complex deposition D) Macrophage cytokine release E) Neutrophil emigration

E) Folic acid

A clinical study reveals that the incidence of the lesion shown here grossly could be reduced by maternal dietary supplementation before and during pregnancy. Which of the following nutrients is most likely to reduce the frequency of this lesion? A) Vitamin A B) Vitamin B1 C) Cobalamin D) Iron E) Folic acid

D) Prematurity

A newborn male infant is noted to have no congenital anomalies. On the second day of life, the infant exhibits seizure activity. The representative gross appearance of this infant's cerebrum is shown here. Which of the following is most likely to cause this appearance? A) Congenital infection B) Trisomy 21 C) Thrombocytopenia D) Prematurity E) Blunt force trauma

B) Dichorionic diamnionic twins

A pathologic study is performed involving placentas from term delivery of liveborn infants. Microscopic sections of the fetal membranes are examined. Some of these membranes have the appearance shown here. Which of the following is the most likely diagnosis? A) Congenital rubella B) Dichorionic diamnionic twins C) Maternal diabetes mellitus D) Extreme prematurity E) Bilateral renal agenesis with oligohydramnios

A) Hemorrhage/FONT>

A pathologic study is performed with placentas obtained at the time of delivery at term. Some of these placentas are observed to have the abnormality shown here. The delivery records are analyzed. Which of the following complications is most likely to accompany this placental abnormality? A) Hemorrhage/FONT> B) Infection C) Stillbirth D) Discordant size of twins E) Congenital anomalies

A) Adenoma

A previously healthy 40-year-old man is found to have systemic hypertension with blood pressure of 160/105 mm Hg on physical examination. Laboratory studies shown his plasma renin is increased and his serum potassium decreased. Laparoscopic resection is performed and the lesion shown here. Which of the following is the most likely diagnosis? A) Adenoma B) Metastasis C) Carcinoma D) Hyperplasia E) Sarcoma

E) Trisomy 21

A term male infant is noted to have a heart murmur on examination soon after birth. The representative gross appearance of his heart is depicted here. Which of the following underlying conditions is this child most likely to have? A) Congenital syphilis B) Beta-myosin gene mutation C) Hypertension D) Endocardial fibroelastosis E) Trisomy 21