Path Questions
You are an M3 rotating through ER when an 18 year old male is brought in from a motor vehicle accident with an IV of normal saline running. He is bleeding from several sites, but his BP is stable & he is alert & able to talk with you. His Hb & Hct have fallen to 8 g/dL & 24%. You send a type & screen to the blood bank & request blood ASAP. Five minutes later you get a call from the blood bank technologist telling you that the patient is AB negative & his records shows that he has had an anti-Kell Ab in the past. There are no AB negative Kell-negative red cell available. What would be the next best choice for this patient?
*A negative, Kell-negative red cells*
What occurs in a type & cross match but not type & screen?
*Compatible blood is reserved for the patient*
What is the best way to submit a lymph node in order to work up a suspicion of malignant lymphoma?
*Delivered to lab fresh, sterile, & moistened with saline*
Patient who has been on coumadin needs emergency surgery for ruptured abdominal aortic aneurysm. He has a PT of 19 seconds due to coumaid. He should be transfused with what blood products as he is bring prepared for surgery?
*FFP*
A 55-year-old gentleman with acute GI bleeding required transfusion of packed RBCs. Patient blood type B-positive, began receiving first unit of a B-positive packed red blood cells. Twenty minutes after transfusion began, patient complained of chills & shaking. The nurse noted no rashes, but vital signs revealed the following: Before transfusion: Temp = 99.2 BP = 125/85 mmHg Pulse = 75 Respiration = 14 During transfusion: Temp = 102.4 BP = 140/105 Pulse = 96 Respiration = 18 Transfusion was stopped, & the resident determined that a transfusion reaction had occurred. The bag of blood, as well as blood & urine samples from the patient along with the paperwork were sent to the blood bank. The blood bank workup revealed no clerical error, & all repeat testing was consistent with pre-transfusion results. The urine was clear. The nurse administered Tylenol & Demerol, & the patient responded. The etiology of this transfusion reaction is most likely
*Febrile non-hemolytic*
An unidentified patient is brought into ER bleeding profusely from gunshot wound. The ambulence crew had already started an IV with normal saline and he received two liters en-route. Your clinical impression is that he needs a red cell transfusion immediately to save his life. You obtain a properly labeled sample from the IV line to send to the blood bank for type and crossmatch. What is the next thing you do?
*Immediately begin transfusing O negative red cells, until the blood bank can determine this ABO and Rh type and issue type-specific red cells*
What is the correct terminology used in reporting pre-malignant cervical cytology lesion in the Bethesda System?
*Low grade squamous intraepithelial lesion (LGSIL)*
Why do you *not* refrigerate a CSF collected for bacterial culture?
*Neisseria & Haemophilus are very sensitive to cold*
35 year old woman had gained 50 lbs over past 6 months. Her BP was 145/95 mmHg. She exhibited central obesity & proximal muscle wasting of her legs & arms. Bruises & striae were present in her skin. Blood tests revealed elevated plasma cortisol & elevated ACTH levels. What is the most likely diagnosis?
*Pituitary microadenoma*
Patient develops itching & an erythematous rash while receiving fresh frozen plasma (FFP), with no significant change in the vital signs. This pnenomenon is due to
*Plasma proteins within transfused unit of FFP*
75-year-old man found dead in bed at home. Neighbors state that they haven't seem him in several days. At autopsy, he is cachectic, & the cause of death is found to be severe bronchopneumonia secondary to bronchogenic carcinoma of right lung. No tobacco products found in house, & fam and friends state that he was a lifetime nonsmoker. What pollutants was most likely cause of carcinoma?
*Radon*
HLA DR4 associated with
*Rheumatoid arthritis*
You are rotating on the OB-GYN service. One of your post-op hysterectomy patients, whose hemoglobin/hematocrit fell to 7 g/dl & 21% during surgery two days ago was transfused with two units of packed red cells intraoperatively. In making morning rounds on post-operative day #2 yo note her current H/H to be 7.5 g/dL & 23%. You conclude that
*This considerably lower than expected level of 9 g/dL & 27% you are concerned about both postoperative bleeding & delayed hemolytic transfusion reaction*
The TDx FLM test is an automated test that indicates
*amount of surfactant in amniotic fluid, & therefore fetal lung maturity*
Burkitt lymphoma gene
*c-Myc*
54-year-old pathologist sustains closed fracture of left radius. Several weeks later, during a cast change, a hard nodule is palpated in the area of the fracture. This is most likely due to overgrowth of
*callus*
Soft, gray, gelatinous tumor removed from sacrococcygeal area of a 46-year-old man contains physaliphorous cells histologically. Best diagnosis is:
*chordoma*
37-year-old woman comes to your office because of long history of "swollen neck." On physical exam, you palpate an enlarged thyroid gland consisting of multiple nodules. Chemical analysis of her blood would most likely to reveal this patient to be
*euthyroid*
Of the methods of identification listed, what is the most accurate?
*fingerprints*
In longstanding HT, heart will most frequently show
*hypertrophy*
74-year-old white male comes to your office because of severe right lower leg pain. X-ray reveals stress fracture of the distal right tibia. Also, the tibia appears slightly bowed & more sclerotic than the right fibula. The patient states that he fractured his left tibia a year ago when his 3-year-old grandson "accidentally" kicked him in the shin. Exhaustive review of systems revealed that he has had increasing shortness of breath over the past few months. This main's condition is most likely
*infectious*
90% of patients with primary biliary cirrhosis have antibodies to M2. What is the most detailed description of where M2 is located?
*inner mitochondrial membrane*
2-year-old child with HT, diarrhea, large abdominal mass, & elevated homovainillic acid most likely has a
*neuroblastoma*
Most common site of origin of chondrosarcoma
*pelvic & shoulder girdles*
In normal pregnancy, hemoglobin falls because
*plasma volume expands more than erythrocyte mass*
Freshly voided urine specimen is permitted to stand at room temp for 8 hours before capping and submission to clinical lab for urinalysis. What is relatively stable & unlikely to give false positive or false negative results?
*protein*
What organ listed best withstands flames & heat best?
*uterus*
What body fluids is most useful for determining postmortem electrolyte & glucose concentration that most closely represents antemortem levels?
*vitreous humor*
descriptions of pigmented tumor
- adulthood tumor - subtypes based on histology of tumor - metastasizes to liver - arises from uvea
intrauterine growth retardation features
- chromosomal disorders of fetus - congenital infections - placental insufficiency - toxemia of pregnancy (eclampsia or preeclampsia)
Description of TRALI
- donor should not donate plasma-containing products in the future - non-cardiogenic pulmonary edema occurs - occurs within minutes to several hours of transfusion - involves passive transfer of fonor anti-granulocytic Abs into the recipient
One unit of platelet concentrates can be expected to raise an otherwise normal adult patient's platelet count by
5,000 to 10,000 per cubic mm
Unit of apheresis platelets can be expected to give normal recipient 30,000-60,000/uL increment in platelet count. How many whole blood-derived platelet concentrates would be required to give same increment?
6
Given following results of ABO & Rh testing what is the patient's blood type? Forward Anti-A = + Anti-B = O Reverse A1 cells = O B cells = + Anti-D = +
A Positive
32-year-old man has history of weight loss of 60 lbs over past 12 months. He also complains of weakness, poor appetite, & darkening of his skin. BP is 115/60, & he frequently gets dizzy when he stand up after he has been lying down. Serum electrolytes reveal sodium of 128 mmol/L & potassium of 6.3 mmol/L. Plasma ACTH level is elevated. What is the best diagnosis for this patient's condition
ACTH-independent chronic adrenal insufficiency
Disseminated Histoplasma capsulatum infection with destruction of adrenal cortex and chronic adrenocortical insufficiency
Addison's disease
Otherwise healthy, non-diabetic, 35-year-old patient has been experiencing postprandial hypoglycemia. What statement is correct?
Alimentary hypoglycemia is consistent with this scenario
low grade SIL
CIN I (mild dysplasia)
Carcinoma in situ is synonymous with
CIN III
10-year-old boy presents to office with fever and right leg pain. Physical exam reveals warm, tender mass in shaft of tibia. X-ray show a destructive, lytic tumor surrounded by layers of periosteal bone (so-called "onion-skin" pattern). Biopsy reveals small, round blue cells. Most likely diagnosis is
Ewing sarcoma
35-year-old man rushed to hospital with gunshot wound to chest. He immediately taken to operating room, where wound is debrided & explored, with extensive vascular & organ repair undertaken. He also receives numerous blood transfusions. He remains unconscious & unstable, & ultimately expires on seventh hospital day. A complete autopsy is performed. The investigating officer inquires as to distance from which fatal shot was fired. This can be determined by reviewing results of what?
External exam of wound at time of surgery
HIPAA stands for
Health Insurance Portability & Accountability Act
46-year-old patient with type 1 diabetes has been treated & has had good glucose control for 15 years. A urine test for microalbuminemia shows 100 mg/24 hours. Glomerular filtration rate is above normal range. This patient is best considered to have what renal complication of diabetes?
Incipident diabetic nephropathy
Coma develops in diabetics with hyperglycemia because of what?
Intracellular to extracellular water shifts secondary to osmotic diuresis
While taking history from female elective surgery patient, you are told that she frequently experiences episodes of increased sweating, accompanied by anxiety, dizziness, double vision, & confusion. These symptoms have no apparent relationship to meals. Shortly after you leave the ward, a nurse pages you to tell you that your patient is experiencing such an episode. You find the patient to be week and tachycardic, with slurred speech. You draw blood & administer glucose, & the symptoms subside within twenty minutes. Lab results are as follows Glucose, serum: 43 mg/dL (74-106 mg/dL) Insulin, serum: 51 IU/mL (1.9 - 23) C-peptide, serum: 7 ng/mL (0.6 - 3.2 ng/mL) Sulfonylurea, serum: negative (negative) The most likely diagnosis is
Islet cell tumor of pancreas
60-year-old O negative (Group O Rh negative) male trauma victim with no evidence of history of anti-D requires emergency transfusion it is safe to give him O positive blood. What is a potential downside of transfusing this patient with O positive red cells?
It is highly likely that, if he survives his trauma, he will make anti-D weeks to months from now, in which case he will need to receive only O negative red cells thereafter
Neoplasm of the eyes has distinctive structures made of cuboidal cells surrounding central lumen. What statements best describes this neoplasm.
It may involve both eyes & the pineal gland (trilateral)
Most common cause of death in diabetics
MI
hepatotoxic component in acetaminophen OD
N-acetyl-p-benzoquinoneimine
Bone disorder believed to result from viral infection
Paget disease
Cystic lesion out of sella into hypothalamus
Rathke's cleft cyst
cause of immune hydrops fetalis
Rh incompatibility
You arrive for your first day as a medical intern, and are immediately met by a ward clerk, who hand you the following lab results on one of your new patients: BUN: 52 mg/dL (9-20 mg/dL) Creatinine: 4.1 mg/dL (0.7-1.4 mg/dL) Calcium: 8 mg/dL (8.4-10.2 mg/dL) PTH: 100 pg/mL (10-60 pg/mL) Based solely on these results, you correctly surmise that your patient has:
Secondary hyperparathyroidism
65 year old man develops gradual swelling of swelling of his right thigh over period of several week.s Imaging studies reveal large mass deep to quadriceps muscles. Biopsy shows tumor composed of spindle-shaped cells arranged in storiform (swirling) pattern. There is significant anaplasia, with numerous giant cells & mitotic figures. The most likely diagnosis is
Synovial sarcoma
acute chorioamnionitis is....
a major cause of prematurity and of second trimester pregnancy loss
non classical 21 alpha hydroxylase deficiency presents with
acne/hirsutism at puberty
Centrally obese patient has overnight dexamethasone suppression test with morning cortisol level of 15 ug/dL (expected normal result < 5 ug/dL). ACTH level is below reference range. Patient most likely has
adrenal adenoma
baby with cyclopia, ethmocephaly, cebocephaly, premaxillary agenesis
alobar holoprosencephaly
In the vast majority of American hospitals, the lab in which cervicovaginal (Pap) smears are evaluated is a division of
anatomic pathology
Urine glucose & blood detection by urine dipstick may be falsely low or suppressed when what is present in the urine
ascorbic acid
Major cause of morbidity and mortality in diabetic patients is due to
atherosclerotic coronary artery disease
nitrite in urine specimen suggests presence of
bacteria
weakly birefringent. crystals white, friable. oval blue purple aggregated under normal microscopy.
calcium pyrophosphate cyrstal deposition disease
Your patient had twins, & the pathology report on placental exam states there was a placental body & that the placenta was dichorionic, diamniotic. You conclude that the twins ...
can be confidently considered dizygotic only if twins are of different sex
Which of the acute radiation syndromes requires the highest dose of radiation in order to be made manifest?
cerebral
epiphyseal location of skeletally immature patient
chondroblastoma
55-year-old man complains of progressively worsening hips pain over past four months. You palpate a mass which appears to be arising from ilium, & which radiologically appears as a lesion of varying density invading the soft tissue. Chest x-ray reveals scattered rounded densities. Fine-needle aspiration of one of the pulmonary densities would most likely reveal malignant:
chondrocytes
older man with pelvic bone mass. soft blue/white cut surface
chondrosarcoma
You patient, 11 weeks pregnant, has vaginal bleeding followed by passage of grape-like structures. You should be most concerned about the possibility of later dev't of
choriocarcinoma
cholesteatom of ear usually follows or is a result of
chronic otitis media
amniotic band syndrome is an example of
disruption
61-year-old woman limps to your office, complaining of aching joints, particularly in the mornings. Physical exam reveals bony outgrowths over lateral surfaces of DIP of fingers. Radiologic exam of knees shows narrowing of joint spaces, particularly on left. You decide to surgically replace her left knee joint. On exam in the surgical pathology lab, the articular surfaces of the bones of the knee are most likely to show
eburnation
After delivery of twins, it is discovered that there was only one placenta, but you have no more info about placenta. You can conclude from this info without further info that the twins are
either dizygous or monozygous, but you cannot tell which
phthisis bulbi results from
end-stage ocular disease
fungal parasites infecting grasses & cereals
ergot poison
Increased risk for DM
fasting glucose 100 & <126
febrile non-hemolytic transfusion reaction would present with
fever, rigors & HT
Classic acute hemolytic transfusion reaction would present with
flank pain, red urine & hypotension
E7 inhibits
function of Rb
Relatively common feature of necrotizing enterocolitis in premature infants...
gas bubbles in intestinal wall
Underwater blasts are more likely to injure what?
gas distended organs
In am emergency, give...
group O Rh negative packed RBCs without compatibility testing
thyroid adenoma vs follicular carcinoma
growing into capsules & vessels
Hiker is found unconscious in middle of nowhere. His skin is red, hot, & dry. His body temp is 107 F. He is suffering from
heat stroke
55-year-old woman develops aplastic anemia after single course of chloramphenicol at the usual therapeutic dose. This type of drug reaction would be best termed:
idiosyncractic
woman requests her records. when can you deny?
if it contains psychotherapy notes
The pathogenesis of clinical type 2 diabetes is best characterized by
impaired beta function, peripheral insulin resistance
microalbuminemia + increased GFR
incipient diabetic nephropathy
Acardiac 1,000 gram fetus ...
is dependent on monozygous twin for survival
Complete hydaditiform mole...
is diploid and has villi
What condition, if present, is most likely to lead to fetal death in utero?
large abruption
most common soft tissue sarcoma
liposarcoma
bacteria with ascending & hematogenous infection of mom
listeria monocytogenes
small chest, etc
lung hypoplasia
Essentially all gunshot entrance wounds are characterized by
marginal abrasion
Transfusion of fresh frozen plasma is typically type specific because the plasma...
may contain anti-A & anti-B Abs
26 yo man with painful subcutaneous mass, 2 cm- trauma 3 weeks prior.
nodular fasciitis
heberden's node associated with
osteoarthritis
22 year old woman complains of intermittent severe pain just above her left knee. She states that the only thing that relieves the pain is aspirin. X-ray of left femur reveals area of cortical thickening surrounding a lucent area appx one centimeter in greatest dimension. This lesion most likely represents an
osteoid osteoma
Very anxious 23-year-old medical student complains of severe pain just above his left knee. He states that the pain is worse at night, but that ingestion of aspirin provides significant relief. X-ray of the left knee reveals small lucency with sclerotic rim, located in the cortex of the distal femur. Being a brilliant orthopedic surgeon, you tell the patient that the lesion most likely represents an
osteoid osteoma
young boy who plays soccer has progressive pain...
osteosarcoma
Most common primary thyroid malignancy is
papillary carcinoma
p57+, paternal & maternal DNA
partial mole
phases that make drug more water soluble so you can get rid of it
phases I & II
35-year-old woman presents with left knee pain, which she states has been accompanied by swelling & locking. On physical exam, range of motion of left knee is limited. Her other joints are unremarkable. After a thorough preoperative workup, you resect a large amount of granular red- brown to orange- brown synovial tissue from her left knee. This tissue shows numerous folds & projections, & microscopically there are bland stromal & giant cells, admixed with hemosiderin. The most likely diagnosis is
pigmented villonodular synovitis
Most common cause of mortality among AIDS patients is
pneumonia
duodenal atresia, loss of AFP, etc associated with
polyhydramnios / hydramnios
What population has subacute lymphocytic thyroiditis
post-partum women
48-year-old man has had BP between 150/95 to 165/105 mmHg for 10 years and has been treated with ACE inhibitor. A recent BP was 180/110 mmHg. Serum chemistries have shown normal electrolytes. He was placed on a diet with a normal salt content & taken off his med for 4 weeks & tested for plasma aldosterone level & renin activity. Aldosterone was elevated & renin activity was low. He was asked to remain upright for 4 hours & return for another test for renin activity that was again low. What is the most likely cause of this patient's HT?
primary hyperaldosteronism due to adrenal adenoma
Title II portion of HIPAA ...
protects privacy of health info
what is most suggestive of acute glomerulonephritis
red blood cell casts
kid losing peripheral vision, feels like he is looking to tunnel. nightblindness. mother & father are related. gross exam of his eyes - loss of rods/cones, proliferation of retinal pigment epithelium around vessels.
retinitis pigmentosa
liposarcoma most likely to arise in
retroperitoneum
felty syndrome associated with
rheumatoid arthritis
OSHA
safety of workplace
velamentous umbilical cord, when it leads to difficulty in pregnancy or labor, is usually associated with
severe hemorrhage
Most common pre-existing conditions in cardiac transplant patients
severe ischemic heart disease & dilated cardiomyopthy
65 yo man robbed. What are you forbidden to do with his health records?
share his info with press without his written consent
Acromegaly results from adenoma of
somatrophs
naturally exfoliated specimen ex
sputum
If a patient receiving a blood product transfusion presents only with fever & shaking chills you should
stop the transfusion and notify blood bank
Treatment for acute hemolytic transfusion reactions includes
stop transfusion, give IV fluids, pressors and either mannitol or lasix
pregnant woman has cheese at party then has miscarriage
subtrophoblastic abscess - L monocytogenes
translocation (x;18)
synovial sarcoma
Urinalysis on specimen from febrile 3-year-old girl is positive for leukocyte esterase, protein, & nitrite. Further evaluation confirms your diagnosis. In addition to prescribing specific treatment you advise
that bubble baths should be avoided
birth control causes increased risk of
thromboembolism
severe, late complication of untreated proliferative diabetic retinopathy
traction on retina
(Gamma) irradiation is used to prevent what?
transfusion-associated graft-versus-host disease (TA-GVHD)
most common cause of workplace related deaths
transportation accidents
associated with myeloproliferative disorders in utero & ex utero
trisomy 21
sandal foot
trisomy 21
delayed hemolytic transfusion reaction would present with
unexplained drop in Hb/Hct & rise in bilirubin with few, if any, other symptoms or signs
Derivatives (blood products made by fractionation of plasma) such as Factos VIII concentrate have considerable potential for transmission of viral infection, because they are
virally-inactivated during manufacture
What is the estimated risk of a 45-year-old mother carrying a baby with any chromosomal abnormality?
*1 in 20*
Unit of single donor apheresis platelets should raise patient's count by
30,000 to 60,000 per cubic mm
thyroiditis that presents with *pain*
De Quervain Subacute Granulomatous Thyroiditis