Special Pathology Questions (Part 1/4)

A 45-year-old man presents with longstanding heartburn and dyspepsia. An x-ray film of the chest shows a retrocardiac, gas-filled structure. This patient most likely has which of the following conditions? a. Boerhaave syndrome b. Esophageal varices c. Esophageal webs d. Hiatal hernia e. Mallory-Weiss syndrome

d. Hiatal hernia

Connect hormone with appropriate disorder: Aldosterone A) Cushing Syndrome B) Grave's Disease C) Galactorrhea/amenorrhea D) Conn Syndrome E) Zollinger-Ellison syndrome F) Gigantism/Acromegaly G) Diabetes insipidus H) Osteitis fibrosa cystica I) WDHA syndrome (watery diarrhea hypokalemia and achlorhydria) J) Carcinoid syndrome

D) Conn Syndrome

Panacinar emphysema is associated with: a. Smoking b. Alpha 1 antitrypsin deficiency c. Scarring due to inflammation or infection d. Trauma e. All the above

b. Alpha 1 antitrypsin deficiency

Which diagnosis is confirmed by an elevated eosinophil number in the blood, Curschmann spirals, and Charcot-Leyden crystals in the sputum? a. Bacterial pneumonia b. Asthma c. Tuberculosis d. Sarcoidosis e. Viral pneumonia

b. Asthma

A 28-year-old woman with cystic fibrosis presents with increasing shortness of breath and production of abundant foul-smelling sputum. The sputum in this patient is most likely associated with which of the following pulmonary conditions? a. Atelectasis b. Bronchiectasis c. Empyema d. Pneumothorax e. Pyothorax

b. Bronchiectasis

A 55-year-old man was admitted to the hospital with a chief complaint of increasing shortness of breath over the past several years. The patient was a heavy smoker over the past 40 years. Physical examination reveals cyanosis, elevated jugular venous pressure, and peripheral edema. A high-resolution CT scan shows bullae over both lungs. Chronic intra-alveolar exposure to which of the following proteins is most likely associated with the pathogenesis of chronic obstructive pulmonary disease in this patient? a. Alkaline phosphatase b. α1-Antitrypsin c. Collagenase d. Elastase e. α2-Macroglobulin

d. Elastase (?)

Connect hormone with appropriate disorder: ACTH A) Cushing Syndrome B) Grave's Disease C) Galactorrhea/amenorrhea D) Conn Syndrome E) Zollinger-Ellison syndrome F) Gigantism/Acromegaly G) Diabetes insipidus H) Osteitis fibrosa cystica I) WDHA syndrome (watery diarrhea hypokalemia and achlorhydria) J) Carcinoid syndrome

A) Cushing syndrome

Connect hormone with appropriate disorder: TSH A) Cushing Syndrome B) Grave's Disease C) Galactorrhea/amenorrhea D) Conn Syndrome E) Zollinger-Ellison syndrome F) Gigantism/Acromegaly G) Diabetes insipidus H) Osteitis fibrosa cystica I) WDHA syndrome (watery diarrhea hypokalemia and achlorhydria) J) Carcinoid syndrome

B) Grave's Disease

Connect hormone with appropriate disorder: Prolactin A) Cushing Syndrome B) Grave's Disease C) Galactorrhea/amenorrhea D) Conn Syndrome E) Zollinger-Ellison syndrome F) Gigantism/Acromegaly G) Diabetes insipidus H) Osteitis fibrosa cystica I) WDHA syndrome (watery diarrhea hypokalemia and achlorhydria) J) Carcinoid syndrome

C) Galactorrhea/amenorrhea

Connect hormone with appropriate disorder: Gastrin A) Cushing Syndrome B) Grave's Disease C) Galactorrhea/amenorrhea D) Conn Syndrome E) Zollinger-Ellison syndrome F) Gigantism/Acromegaly G) Diabetes insipidus H) Osteitis fibrosa cystica I) WDHA syndrome (watery diarrhea hypokalemia and achlorhydria) J) Carcinoid syndrome

E) Zollinger-Ellison syndrome

Connect hormone with appropriate disorder: Somatotropin A) Cushing Syndrome B) Grave's Disease C) Galactorrhea/amenorrhea D) Conn Syndrome E) Zollinger-Ellison syndrome F) Gigantism/Acromegaly G) Diabetes insipidus H) Osteitis fibrosa cystica I) WDHA syndrome (watery diarrhea hypokalemia and achlorhydria) J) Carcinoid syndrome

F) Gigantism/Acromegaly

Emphysema is dilatation of air spaces without destruction of alveolar walls. True or False?

False

Pneumocystis jiroveci pneumonia is the most common opportunistic infection in patients with Horner syndrome. True or False?

False

Sarcoidosis can involve almost any organ system and it is characterized by formation of caseating granuloma. True or False?

False

The cause of nasopharyngeal carcinoma is CMV. True or False?

False

Interstitial pneumonia is caused by various infectious agents, most commonly bacteria. True or False?

False (?)

Connect hormone with appropriate disorder: ADH A) Cushing Syndrome B) Grave's Disease C) Galactorrhea/amenorrhea D) Conn Syndrome E) Zollinger-Ellison syndrome F) Gigantism/Acromegaly G) Diabetes insipidus H) Osteitis fibrosa cystica I) WDHA syndrome (watery diarrhea hypokalemia and achlorhydria) J) Carcinoid syndrome

G) Diabetes insipidus

Connect hormone with appropriate disorder: PTH A) Cushing Syndrome B) Grave's Disease C) Galactorrhea/amenorrhea D) Conn Syndrome E) Zollinger-Ellison syndrome F) Gigantism/Acromegaly G) Diabetes insipidus H) Osteitis fibrosa cystica I) WDHA syndrome (watery diarrhea hypokalemia and achlorhydria) J) Carcinoid syndrome

H) Osteitis fibrosa cystica

Connect hormone with appropriate disorder: VIP A) Cushing Syndrome B) Grave's Disease C) Galactorrhea/amenorrhea D) Conn Syndrome E) Zollinger-Ellison syndrome F) Gigantism/Acromegaly G) Diabetes insipidus H) Osteitis fibrosa cystica I) WDHA syndrome (watery diarrhea hypokalemia and achlorhydria) J) Carcinoid syndrome

I) WDHA syndrome (watery diarrhea hypokalemia and achlorhydria)

Connect hormone with appropriate disorder: Serotonin A) Cushing Syndrome B) Grave's Disease C) Galactorrhea/amenorrhea D) Conn Syndrome E) Zollinger-Ellison syndrome F) Gigantism/Acromegaly G) Diabetes insipidus H) Osteitis fibrosa cystica I) WDHA syndrome (watery diarrhea hypokalemia and achlorhydria) J) Carcinoid syndrome

J) Carcinoid syndrome

ARDS (Acute respiratory distress syndrome) is characterized by formation of an intra-alveolar hyaline membrane composed of fibrin and cellular debris. True or False?

True

Allergic rhinitis is mediated by an IgE type I immune reaction. True or False?

True

Asbestosis is characterized by ferruginous bodies. True or False?

True

Common cold is caused by viruses, especially the adenoviruses. True or False?

True

Primary tuberculosis is the initial infection, characterized by formation of Ghon complex. True or False?

True

A 35-year-old man complains of difficulty swallowing and a tendency to regurgitate his food. Endoscopy does not reveal anu esophageal or gastric abnormalities. Manometric studies of the esophagus show a complete abscence of peristalsis, failure of the lower esophageal sphincter to relax upon swallowing, and increased intra-esophageal pressure. Which of the following is the most likely diagnosis? a. Achalasia b. Barrett esophagus c. Esophageal stricture d. Mallory-Weiss syndrome e. Schatzki ring

a. Achalasia

A 60-year-old woman presents with a 2-week history of uterine bleeding. Gynecologic examination reveals an enlarged uterus. The hysterectomy specimen shows a large polypoid mass involving the endometrium and myometrium. Histologic examination reveals malignant glands and malignant stromal elements, including striated muscle and cartilage. What is the appropriate diagnosis? a. Carcinosarcoma b. Endometrioid adenocarcinoma c. Leiomyosarcoma d. Pleomorphic adenoma e. Rhabdomyosarcoma

a. Carcinosarcoma

A 4-year-old girl is brought to the physician because her parents noticed she has been having pale, fatty, foul-smelling stools. The patient is at the 50th percentila for height and 10th percentile for weight. Her symptoms respond dramatically to a gluten-free diet. Which of the following is the most likely diagnosis? a. Celiac sprue b. Cystic fibrosis of the pancreas c. Menetrier disease d. Tropical sprue e. Whipple disease

a. Celiac sprue

A 3-week-old boy is brought to the physician by his parents, who report that he vomits forcefully immediately after nursing. Physical examination reveals an "olive-like", palpable mass and visible peristaltic movements within the infant's abdomen. What is the most likely cause of projectile vomiting in this infant? a. Appendicitis b. Congenital pyloric stenosis c. Hirschprung disease d. Meconium ileus e. Tracheoesophageal fistula

b. Congenital pyloric stenosis

A 40-year-old woman presents with a 5-year history of dysmenorrhea. Physical examination and endocrine studies are normal. A hysterectomy is performed. Histologic examination of the uterine wall reveals areas of extensive adenomyosis. Which of the following best describes this patient's uterine pathology? a. Benign neoplasm of glandular epithelial cells b. Displacement of endometrial glands and stroma c. Endometrial intraepithelial neoplasia d. Hyperplasia of trophoblast as a sequel of incomplete abortion e. Premalignant uterine lesion composed of smooth muscle

b. Displacement of endometrial glands and stroma

A 27-year-old man with history of alcoholism and repeated bouts of aspiration pneumonia comes to the emergency room with a high fever and pleuritic chest pain. Physical examination reveals dullness on percussion and abscence of breath sounds in the right lower lung field. A chest x-ray demonstrates pleural fluid on the right side. Thoracentesis returns a thick, foul-smelling fluid. Which of the following is the most likely diagnosis? a. Chylothorax b. Empyema c. Hemothorax d. Hydrothorax e. Pneumothorax

b. Empyema

What are "heart failure" cells histologically seen in pulmonary edema? a. Hyperplasia of type II pneumocytes b. Hemosiderin laden macrophages c. Lipofuscin laden macrophages d. Hyperplasia of clara cells e. All the above

b. Hemosiderin laden macrophages

Psammoma bodies are seen in which neoplasm? a. Astrocytoma b. Meningioma c. Glioblastoma multiforme d. Cranyopharyngioma e. Chordoma

b. Meningioma

A 24-year-old man is brought to the emergency room with synotoms of acute intestinal obstruction. His temperature is 38°C (101°F), reaspirations are 25/min, and blood pressure is 120/80 mm Hg. Physical examination reveals a mass in the right lower abdominal uadrant. At laparoscopy, there are numerous small bowel strictures and a fistula extending into a loop of small bowel. Which of the following is the most likely diagnosis? a. Adenocarcinoma b. Carcinoid tumor c. Crohn disease d. Pseudomembranous colitis e. Ulcerative colitis

c. Crohn disease

A 52-year-old woman presents with chronic pelvic discomfort. A CT scan of the pelvis shows a 10-cm, well-circumscribed uterine mass. A hysterectomy is performed. On gross examination, the mass is soft with areas of necrosis and irregular borders extending into the myometrium. Histologic examination demonstrates large zones of necrosis surrounded by a rim of disorganized spindle cells that display numerous mitoses. Immunohistochemical staining for smooth muscle actin is positive. Which of the following is the most likely diagnosis? a. Adenomyosis b. Carcinosarcoma c. Endometrial stromal sarcoma d. Leiomyoma e. Leiomyosarcoma

c. Endometrial stromal sarcoma

A 60-year-old woman complains of increasing abdominal girth of 4 weeks in duration. Physical examination discloses ascites, and cytologic examination of the fluid reveals malignant glandular cells. Exploratory laparotomy shows multiple tumor nodules on the serosal surface of the small intestine. Which of the following is the most likely diagnosis? a. Adenocarcinoma of the colon b. Carcinoid tumor c. Gastrointestinal stromal tumor d. MALToma e. Metastatic carcinoma

c. Gastrointestinal stromal tumor

A 53-year-old man develops weakness, malaise, cough with bloody sputum, and night sweats. A chest x-ray reveals numerous apical densities bilaterally, some of which are cavitary. Exposure to Mycobacterium tuberculosis was documented 20 years ago, and M. tuberculosis is identified in his sputum. Which of the following describes the expected lung pathology in this patient? a. Dense fibrosis b. Eosinophilic infiltration c. Granulomas d. Interstitial pneumonia e. Plasma cell infiltration

c. Granulomas

A 34-year-old man presents with a 5-month history of weakness and fatigue. There is no history of drug or alcohol abuse. A CBC shows megaloblastic anemia and a normal reticulocyte count. Further laboratory studies reveal vitamin B12 deficiency. Anemia in this patient is most likely caused by which of the following? a. Acute erosive gastritis b. Autoimmune gastritis c. Helicobacter pylori gastritis d. Menetrier disease e. Peptic ulcer disease

c. Helicobacter pylori gastritis

A 2-year-old girl with a history of chronic constipation since birth is brought to emergency room because of nausea and vomiting. Physical examination shows marked abdominal distension. Abdominal radiography reveals distended bowel loops with a paucity of air in the rectum. A rectal biopsy shows an absence of ganglion cells. Which of the following is the most likely diagnosis? a. Acquired megacolon b. Anorectal stenosis c. Hirschprung disease d. Imperforate anus e. Rectal atresia

c. Hirschprung disease

A 34-year-old man with AIDS presents with a 3-month history of constipation and lower abdominal pain. The patient has a history of chronic diarrhea and persistent cough. Recently, he notices blood in his stool. Laboratory studies reveal mild iron-deficiency anemia. Stool specimens are positive for occult blood. A CBC shows a CD4 count of <50/μL. Sigmoidoscopy discloses a mass in the rectosigmoid region. In addition to B-cell lymphoma, this patient is at increased risk of developing which of the following tumors of the gastrointestinal tract? a. Carcinoid tumor b. Colonic adenocarcinoma c. Kaposi sarcoma d. Leiomyosarcoma e. Melanoma

c. Kaposi sarcoma

A 40-year-old woman with leukemia is treated with chemotherapy. During treatment she develops increasing cough and shortness of breath. A chest x-ray shows diffuse lung infiltrates. Sputum cultures are negative, and the patient does not respond to routine antibiotic therapy. An open lung biopsy is diagnosed by the pathologist as viral pneumonia. Which of the following histopathologic findings would be expected in the lungs of this patient? a. Clusters of epithelioid macrophages b. Confluent areas of caseous necrosis c. Fibrous scarring of lung parenchyma d. Hyaline membranes and interstitial inflammation e. Sheets of bacilli-filled macrophages

d. Hyaline membranes and interstitial inflammation

A 58-year-old woman presents with a 2-month history of abdominal discomfort and dark stools. Physical examination shows pallor but no evidence of jaundice. Laboratory studies disclose a microcytic, hypochromic anemia, with a hemoglobin level of 6.7 g/dL. A barium swallow radiograph reveals a "leather bottle" appearance of the stomach. Microscopis examination shows diffusely infiltrating malignant cells, many of which are "signet ring" cells, in the stomach wall. Which of the following is the most likely diagnosis? a. Fungating adenocarcinoma b. Gastric leiomyosarcoma c. Gastric lymphoma d. Linitis plastica e. Menetrier disease

d. Linitis plastica

What is the most common pleural tumor? a. Squamous cell carcinoma b. Adenocarcinoma c. Atypical carcinoid d. Malignant mesothelioma e. Small cell carcinoma

d. Malignant mesothelioma

A 36-year-old woman is evaluated for an abnormal Pap smear. A cervical biopsy shows atypical squamous cells throughout the entire thickness of the epithelium, with no evidence of epithelial maturation. The basal membrane appears intact. What is the appropriate diagnosis? a. Clear cell adenocarcinoma b. Invasive squamous cell carcinoma c. Mild dysplasia (cervical intraepithelial neoplasia-CIN-1) d. Severe dysplasia (CIN-3) e. Squamous metaplasia of the transformation zone

d. Severe dysplasia (CIN-3)

A 56-year-old man with history of cigarette smoking presents with difficulty swallowing and a muffled voice. Laryngoscopy reveals a 2-cm laryngeal mass. If this mass is a malignant neoplasm, which of the following is the most likely histologic diagnosis? a. Adenocarcinoma b. Leiomyosarcoma c. Small cell carcinoma d. Squamous cell carcinoma e. Transitional cell carcinoma

d. Squamous cell carcinoma

A 22-year-old man with AIDS complains of persistent cough, night sweats, low-grade fever, and general malaise. A chest x-ray reveals an area of condolidation in the periphery of the left upper lobe, as well as hilar lymphadenopathy. Sputum cultures show acid-fast bacilli. Which of the following is the most likely diagnosis? a. Bronchopneumonia b. Pulmonary abscess c. Sarcoidosis d. Tuberculosis e. Wegener granulomatosis

d. Tuberculosis

What causes restrictive pulmonary disease? a. Sarcoidosis b. Immune disorders c. Pneumoconioses d. Idiopathic pulmonary fibrosis e. All the above

e. All the above

A 48-year-old woman with a longstanding history of ulcerative colitis presents with anemia and shortness of breath. Laboratory studies show increased serum levels of carcinoembryonic antigen (CEA). A chest x-ray reveals multiple, bilateral, round masses in both lungs. Histologic examination of an open-lung biopsy discloses nodules that are composed of glandlike structures. What is the most likely diagnosis? a. Adenocarcinoma b. Bronchioloalveolar carcinoma c. Eosinophilic granuloma d. Large cell undifferentiated carcinoma e. Metastatic carcinoma

e. Metastatic carcinoma

A 60-year-old alcoholic woman presents to the emergency room with fever, chills, and shortness of breath. The sputum is rusty-yellow and contains numerous neutrophils, red blood cells, and gran-positive cocci. A chest x-ray shows diffuse haziness over both lungs. One week following admission, the patient develops empyema. This pulmonary condition is associated with the spread of bacterial infection to which of the following anatomic locations? a. Blood b. Bronchi c. Interstitial space d. Pericardium e. Pleural space

e. Pleural space

A 63-year-old man with small-cell carcinoma of the left mainstem bronchus begins chemotherapy. During the treatment period, he becomes febrile and develops a productive cough. The temperature is 38.7°C (103°F), respirations are 32/min, and blood pressure is 125/85 mm Hg. A CBC shows leukocytosis (WBC = 18,500/μL). The patient's cough worsens, and he begins expectorating large amounts of foul-smelling sputum. A chest x-ray shows a distinct cavity with an air/fluid level distal to the tumor area. Which of the following is the most likely diagnosis? a. Atelectasis b. Bronchiectasis c. Ghon complex d. Lobar pneumonia e. Pulmonary abscess

e. Pulmonary abscess