PATHOLOGY WRITTEN AND PRACTICAL EXAM 1



PATHOLOGY WRITTEN EXAM IV

1. An adult has flat-topped purplish polygonal pruritic papules on the wrist. The MOST

LIKELY diagnosis is:

A. seborrheic dermatitis

B. seborrheic keratoses

C. lichen planus

D. psoriasis

E. atopic eczema

2. Which of the following DOES NOT cause fatty metamorphosis of the liver?

A. Reye's syndrome

B. Malnutrition

C. Diabetes mellitus

D. Wilson's disease

E. alcohol abuse

3. Each of the following is true of bacterial arthritis EXCEPT:

A. May result in permanent joint deformity

B. Most arise following direct inoculation of the joint with bacteria

C. Most arise following hematogenous spread of organisms

D. Patient's with Sickle cell disease are prone to infection by Salmonella

E. I.V. drug use is a predisposing condition

4. A pathologic change often accompanying eczema is:

A. granuloma formation

B. solar elastosis

C. parakeratosis

D. hyperkeratosis

E. spongiosis

5. Each of the following is TRUE EXCEPT:

A. Osteopetrosis is the result of osteoblast dysfunction

B. Osteogenesis imperfecta is characterized by Type I collagen deficiency

C. Patient's with classic achondroplasia have a disorder of the epiphyseal plate

D. Lytic lesions may be seen in X-rays of patients with Paget's disease of bone

E. Subchondral bone infarcts are a feature of osteonecrosis

6. A 40 year old obese woman presents with indigestion, right upper quadrant pain, and a

low grade fever after ingesting a Popeye's fried chicken three piece dinner and two

Burrito Supremes from Taco Bell. Ultrasound of the gallbladder confirms a thickened

wall. Cholecystectomy is performed. Diagnosis of acute and chronic cholecystitis is

issued by the surgical pathologist. Three ivory-white gallstones are identified in the

gallbladder lumen, with one impacted in the cystic duct. What type of gallstones are

these?

A. those associated with bacterial cholangitis

B. calcium pigment stones

C. hemolysis stones

D. cholesterol stones

E. pigment stones

7. Each of the following is true of Paget's disease of bone EXCEPT:

A. Is characterized by disordered bone remodeling

B. Tuberculous arthritis is a predisposing condition

C. Results in a gain of bone mass

D. Results in weak bones susceptible to fracture

E. Patients are at risk of developing osteosarcoma

8. Which is the most common cause of bacterial peritonitis?

A. tuboovarian abscess

B. portal hypertension

C. cholecystitis

D. performation of an abdominal viscus

E. intestinal volvulus

MATCHING: For each numbered item, (column 1), choose the letter of the most closely related item in coulmn 2. Each answer can be used once, more than once, or not at all.

9. A 60-year-old man with a history of A. Lymphoblastic lymphoma

Helicobacter pylori gastric infection for B. Mycosis fungoides

several years develops upper C. Burkitt's lymphoma

abdominal pain and is found to have a D. MALT lymphoma

thickened gastric mucoSA E. Follicular small cleaved cell lymphoma

10. A 47-year-old man has multiple

irregular plaques on his lower

extremities.

11. A 36-year old HIV positive man has an

abdominal mass associated with the

colon.

12. A 19-year-old patient has severe

respiratory distress and pleural

effusion. Chest x-ray shows a large

mediastinal mass.

13. Each of the following is TRUE EXCEPT:

A. Cavernous hemangiomas regress spontaneously during infancy

B. Leiomyoma most commonly occurs in the female genital tract

C. Fibromatoses are characterized by repeated recurrences without metastases

D. The tongue is a common site for granular cell tumor

E. Lipoma is most commonly found in the superficial subcutaneous tissue

14. Which of the following is MOST LIKELY to result in development of chronic hepatitis as

a sequela of infection?

A. Hepatitis E

B. Hepatitis C

C. Hepatitis A

D. Hepatitis B

E. Hepatitis D

15. Which of the following is a TRUE statement?

A. Osteosarcoma most commonly arises in the diaphysis of bones

B. Ewing's sarcoma characteristically affects the elderly

C. Myositis ossificans is associated with prior trauma

D. Fibrous dysplasia is a benign neoplasm

E. Angiosarcoma has a biphasic histologic pattern

16. Which lesion is LEAST LIKELY to metastasize?

A. superficial spreading melanoma

B. basal cell carcinoma

C. squamous cell carcinoma

D. nodular melanoma

E. acral lentiginous melanoma

17. How does an ACANTHOTIC epidermis differ from an ACANTHOLYTIC one?

A. One has intracellular edema and the other has extracellular edema

B. One is atrophic and the other is vacuolized

C. One is spongiotic and the other is dyskeratotic

D. One is thick and the other is discohesive

E. One is prematurely keratinized and the other is underkeratinized

18. Which of the following lab tests is used to determine whether hemolysis is occurring?

A. Serum folate level

B. Hemoglobin electrophoresis

C. Reticulocyte count

D. Glucose-6-phosphate dehydrogenase assay

E. Serum ferritin level

19. Which of the following can be differentiated from the others by the presence of bile duct

injury?

A. Hepatitis D

B. Hepatitis C

C. Hepatitis B

D. Hepatitis A

E. Hepatitis E

20. Characteristic features of Ewing's sarcoma include all of the following EXCEPT:

A. These tumors occur primarily in childhood

B. Small blue tumor cells are a typical microscopic feature

C. The cytoplasm of the tumor cells contains glycogen

D. There is a high rate of long-term survival with current treatment (>50% long term

survivors)

E. These tumors originate from the epiphyseal plate of bone

21. Clinically significant blood group antibodies (other than those of the ABO system):

A. Only form in individuals who have never been transfused.

B. React optimally at 25(C.

C. Are likely to cause decreased red cell survival.

D. Are usually IgM.

E. Tend to be naturally occurring.

22. Which lesions contain dysplastic keratinocytes?

A. Acrochordons

B. Epidermoid cysts

C. Lipomas

D. Junctional nevi

E. Actinic keratoses

23. A patient who has been massively transfused:

A. Will develop a positive direct antiglobulin test.

B. Typically becomes acidotic due to the low pH of stored blood.

C. Can develop hypercalcemia due to impaired hepatic function.

D. Will begin producing fibrin glue.

E. May develop a dilutional coagulopathy.

24. A 45-year-old white male presents with iron-deficiency anemia. What is the MOST

LIKELY etiology?

A. A bleeding lesion of the alimentary tract

B. Nutritional iron deficiency

C. Malabsorption of iron

D. Diversion of ingested iron to intestinal parasites

E. A bleeding lesion of the urinary tract

25. Rh Immune Globulin is indicated for:

A. Pregnant women who have anti-D

B. Pregnant women who are Rh-negative

C. Infants who are Rh-negative

D. Pregnant women who are Rh-positive

E. Infants who have not made anti-D

26. The most important prognostic indicator for malignant melanoma is:

A. Papanicolaou grade

B. depth of invasion into dermis

C. number of mitoses per high power field

D. location of the lesion

E. Duke's level

27. Your patient develops palpable purpura on the lower legs following angiography. What

is LIKLEY to prove most helpful in your management of the patient?

A. Give him an anticoagulant

B. Perform a Tzanck smear

C. Review his medications and lab results

D. Ask the pathologist to look for cholesterol crystals on the skin biopsy

E. Order radiologic studies

28. Which of the following represents a disorder associated with obstruction of hepatic veins?

A. Gilbert's syndrome

B. Budd-Chiari syndrome

C. Reye's syndrome

D. Wilson's disease

E. Alpha-1 anti-trypsin deficiency

29. Each of the following is true of Rheumatoid arthritis EXCEPT:

A. Autoimmunity plays a role in the pathogenesis

B. Calcium pyrophosphate crystals are deposited in the joints

C. Produces a proliferative synovitis

D. Is a multisystem disease

E. Affects small joints of the hand and feet

30. An indurated brown papule on the leg with a slight dimple is MOST LIKLEY a:

A. hemangioma

B. melanocytic nevus

C. neurofibroma

D. nevus sebaceus

E. dermatofibroma

31. It would be unlikely to see increased eosinophils in a skin biopsy of:

A. Exanthemic drug eruption

B. Scabies

C. Bullous pemphigoid

D. Staphylococcal scalded skin syndrome

E. Arthropod bite

32. Each of the following is true EXCEPT:

A. Synovial sarcoma has a biphasic histologic pattern

B. Paget's disease is a predisposing condition for sarcomas

C. Tumor cells of osteosarcoma produce osteoid

D. Patient's with 'multiple hereditary exostosis' have multiple chondromas

E. Fibrous dysplasia is thought to represent a developmental defect of bone

33. Biopsy of a purplish nodule on a leg shows spindled endothelial cells with slit-like

vascular spaces. The MOST LIKELY diagnosis is:

A. basal cell carcinoma

B. lichen planus

C. neurofibroma

D. Kaposi's sarcoma

E. dermatofibroma

34. Inadequate mineralization of bone is a predominant feature of.

A. Osteogenesis imperfecta

B. Osteopetrosis

C. Osteomyelitis

D. Osteomalacia

E. Osteoarthritis.

35. The MOST common cause of chronic pancreatitis in U.S. males is:

A. Alcohol abuse.

B. Pancreatic stones.

C. Congenital disorders.

D. None of the above.

E. Medications.

36. The blood component "Red Blood Cells" or RBCs:

A. Can be used to supply viable platelets for thrombocytopenic patients.

B. Can be irradiated for patients at risk of graft-versus-host disease.

C. Has a hematocrit of approximately 38%.

D. Is used for rapid reversal of warfarin therapy.

E. Contains adequate levels of all coagulation factors.

37. A linear yellowish verrucous scalp plaque persistent since birth on an infant is MOST

LIKELY a:

A. Mongolian spot

B. Spitz nevus

C. nevus flammeus

D. nevus sebaceus

E. nevus araneus

38. You have been called to come see a hospitalized 8-year-old girl with leukemia who has

developed a "rash". Before seeing the patient or obtaining more information, which of

the following do you consider to be the LEAST LIKELY etiology?

A. Leukocytoclastic vasculitis

B. Graft-vs-host disease

C. Stevens-Johnson syndrome

D. Herpes zoster

E. Pemphigus foliaceus

39. A 62-year-old man has weakness and fatigue for about a month. On physical exam, he

has splenomegaly but no lymphadenopathy. Laboratory studies show:

WBC: 80,0001cumm (4,800-10,800)

WBC Differential: Polys: 63%

Bands: 10%

Metamyelocytes 5%

Myelocytes: 5%

Eosinophils: 3%

Basophils: 3%

Blasts: 1%

Lymphs: 5%

Monocytes: 5%

Hemoglobin: 10g/dL (12-18)

MCV: 86 (80-95)

Platelets: 400,000/cumm (132,000-332,000)

Which of the following additional findings would be expected for this patient?

A. High serum protein level

B. t(8:14) cytogenetic abnormality

C. Hypocellular bone marrow

D. Very low Leukocyte Alkaline Phosphatase (LAP) score

E. Frequent CNS relapse

40. Molluscum bodies are:

A. Mostly found on the hands and feet of healthy adults

B. Associated with a "burrow" clinically

C. Another name for koilocytes

D. Intracytoplasmic inclusions in keratinocytes

E. Due to a papovavirus

41. A 57-year-old man complains of back pain and fatigue for several weeks. Physical

exam does not reveal lymphadenopathy or splenomegaly. Laboratory studies show a

normocytic anemia but other peripheral blood counts are normal. Serum chemistries

show hypercalcemia and hypergammaglobulinemia. Which of the following would be

the MOST APPROPRIATE next step in this patient's evaluation?

A. HIV testing

B. CT scan of the abdomen

C. Lymph node biopsy

D. Serum iron studies

E. Serum protein electrophoresis

42. The direct antiglobulin test (DAT):

A. Is used to diagnose sickle cell disease.

B. Is dependent on the presence of IgM on circulating RBCs.

C. Detects the ABO antigens on red cells.

D. Measures the hematocrit of whole blood units.

E. Is often positive in a hemolytic transfusion reaction.

43. The parents of a newborn complain that he has a scaly scalp that they think looks like

"cradle cap." He probably has:

A. tinea capitis

B. atopic dermatitis

C. stasis dermatitis

D. rosacea

E. seborrheic dermatitis

44. Each of the following is TRUE of malignant fibrous histiocytoma EXCEPT:

A. It is the most common sarcoma of adults

B. Metastasizes to the lungs

C. Involves the extremities

D. Arises from endothelial cells of blood vessels.

E. Prior irradiation is a predisposing condition.

45. A 65-year-old man showed you a brown papule on the back which appeared stuck on

the skin like molten wax. The MOST LIKELY diagnosis is:

A. actinic cheilitis

B. actinic keratosis

C. seborrheic keratosis

D. malignant melanoma

E. squamous cell carcinoma

46. MOST of the body's iron is found where?

A. In all body fluids as ferratin

B. In bone marrow as hemosiderin

C. In red cells as hemoglobin

D. In plasma as transferrin

E. In skeletal muscle as myoglobin

47. A 50 year old man showed you ten 4 mm red papules on his back, unchanged for at

least ten years. The MOST LIKELY diagnosis is:

A. pyogenic granulomas

B. squamous cell carcinomas

C. melanocytic nevi

D. cherry hemangiomas

E. acrochordons

48. Which of the following would be expected during an acute hemolytic transfusion reaction?

A. Increased numbers of eosinophils.

B. Urticaria

C. Elevated ceruloplasmin levels.

D. Dactylitis.

E. Decreased haptoglobin.

49. Which of the following is INCORRECT concerning hereditary hemochrometosis?

A. Definitive diagnosis may be made by determination of quantitative iron in a liver

biopsy.

B. The disease exhibits autosomal recessive inheritance pattern.

C. The cirrhosis is typically micronodular.

D. Can result in diabetes mellitus.

E. Iron in macrophages excludes this diagnosis.

50. A man has a thick white plaque on his scalp. Biopsy shows hyperkeratosis,

parakeratosis, and acanthosis, without cytologic atypia of keratinocytes or atypia of

lymphocytes. Diagnosis is:

A. squamous cell carcinoma

B. molluscum contagiosum

C. halo nevus

D. psoriasis

E. mycosis fungoides

51. Severe intravascular hemolysis causes which of the following to decrease?

A. Reticulocyte count

B. Serum methemalbumin

C. Mean corpuscular volume (MCV)

D. Serum haptoglobin

E. Urinary iron excretion

52. Which of the following clinical diseases is caused by Malessezia furfur?

A. mycosis fungoides

B. ringworm

C. thrush

D. tinea pedis

E. Pityriasis "tinea" versicolor

53. Each of the following has been shown to be transmitted by blood transfusion EXCEPT:

A. Creutzfeldt-Jacob disease

B. Malaria

C. Chagas' disease

D. Cytomegalovirus (CMV)

E. HIV-1

54. Which of the following is TRUE of hepatocellular carcinoma (HCC)?

A. Hemochromatosis is the most common underlying predigposing condition.

B. Brain metastasis are commonly presented in advanced disease.

C. Is preceded by hepatic adenoma in most cases.

D. More than 50% of patients with alcoholic cirrhosis will eventally develop HCC.

E. Alpha fetoprotein is elevated in 50% or more of cases.

55. Hemoglobin E is most prevalent in which population?

A. Japanese

B. Han Chinese

C. Sub-Saharan Africans

D. Mediterraneans

E. Southeast Asians

56. Lesions that are ring shaped are said to be:

A. telangiectatic

B. granulated

C. indurated

D. reticulated

E. annular

57. A hemolytic transfusion reaction would be EXPECTED in:

A. An AB Positive patient who receives B Positive RBCs.

B. A B Negative patient who receives O Negative RBCs

C. An A Positive patient who receives O Positive FFP.

D. An A Negative patient who receives AB Negative FFP.

E. An O Positive patient who receives O Negative RBCs.

58. Primary Biliary Cirrhosis is characterized by all of the following EXCEPT?

A. Prominent itching (urticaria)

B. Affects males predominantly

C. Affects females predominately

D. It is an autoimmune disorder

E. Bile duct injury

59. An ulcerated 2 cm erythematous pearly nodule with a rolled-up edge on the face of a

76 year old man is MOST LIKELY a(n):

A. dermatofibroma

B. melanocytic news

C. cherry hemangioma

D. basal cell carcinoma

E. actinic keratosis

60. Beta-thalassemia major is characterized by which of the following?

A. Hypochromic, microcytic anemia

B. Ineffective erythropoiesis

C. Hyperuricemia

D. Folate deficiency

E. All of the above

61. Which of the following is USUALLY ONLY serious in pregnant patients?

A. Hepatitis D

B. Hepatitis E

C. Hepatitis C

D. Hepatitis A

E. Hepatitis B

62. Which condition is MOST LIKELY to have elevated serum IgE?

A. seborrheic dermatitis

B. nummular dermatitis

C. stasis dermatitis

D. atopic dermatitis

E. contact dermatitis

63. Blisters are LEAST LIKELY to occur in which location?

A. Subdermal

B. Subcomeal

C. Intraspinous

D. Suprabasal

E. Subepidermal

64. Which of the following is INCORRECT concerning Hepatitis C (HCV)?

A. Hepatitis C can be sexually transmitted.

B. Hepatitis C cannot be sexually transmitted.

C. Hepatitis C can be acquired via skin piercing.

D. None of the above is incorrect.

E. Hepatitis C can be transmitted via blood.

65. A 70 kg patient with a platelet count of 25,000/(L is scheduled for orthopedic surgery. The surgeon wants the platelet count increased to at least 65,000/(L prior to surgery. How many units of random-donor platelet concentrates should be ordered for transfusion?

A. 3 units

B. 1 unit

C. 26 units

D. 8 units

E. 14 units

66. A 5-year-old boy has fatigue and easy bruising for a few days. Evaluation of the bone

marrow reveals an acute lymphoblastic leukemia. Which of the following findings would

be associated with a better prognosis in this patient?

A. Increased number of normal chromosomes (hyper diploidy)

B. Expression of CALLA on the leukemia cells

C. The age of this patient

D. t(12;21)

E. All of the above

67. A 3-year-old child has had widespread ruptured blisters since early infancy, with

associated scarring. The condition is exacerbated by rough play. Urine and plasma

studies are negative for porphyrin metabolites. Based on clinical features and skin

biopsy finding, you make the diagnosis of epidermolysis bullosa. What can you offer this patient or family?

A. Clinical remission with high-dose corticosteroids

B. Genetic counseling for future pregnancies

C. Vigorous massage therapy

D. An increased risk to the parents for development of an adult form of the disease

E. Nothing - the child certainly will be dead before age five

68. A patient who is not anemic may have an abnormally low hematocrit under what circumstance?

A. Severe hemolysis

B. Fluid overload

C. Chronic iron deficiency

D. None of the above

E. Decreased red cell mass

69. Kemicterus is due to the effects of:

A. Anemia

B. Hemosiderin

C. Exchange transfusion

D. Titer of anti-A

E. Unconjugated bilirubin

70. An elderly man has a whitish plaque on the muscosal aspect of his lip. Biopsy shows

solar elastosis and atypical keratinocytes without dermal invasion. The diagnosis is:

A. halo nevus

B. premalignant leukoplakia

C. amelanotic malignant melanoma

D. candidiasis

E. basal cell carcinoma

71. A 23-year-old alcoholic female, who has recently delivered an underweight but otherwise healthy baby, presents with anemia. Lab studies show normal mean corpuscular hemoglobin concentration (MCHC) and increased mean corpuscular volume (MCV). The anemia is MOST LIKELY caused by deficiency of...

A. Iron

B. Folate

C. Glucose-6-phosphate dehydrogenase

D. Pyruvate kinase

E. Vitamin B12

72. Anti-desmoglein antibodies are associated with what disorder?

A. Pemphigus vulgaris

B. Pemphigoid gestationis

C. Dermatitis herpetiformis

D. Epidermolysis bullosa acquisita

E. Bullous pemphigoid

73. Rh Immune Globulin is given without regard for fetal Rh type in each of the following

conditions EXCEPT:

A. Full-term delivery

B. Amniocentesis

C. Miscarriage at 8 weeks

D. Chorionic villus sampling

E. Ectopic pregnancy

ANSWERS:

1. C

2. D

3. B

4. E

5. A

6. D

7. B

8. D

9. D

10. B

11. C

12. A

13. A

14. B

15. C

16. B

17. D

18. C

19. B

20. E

21. C

22. E

23. E

24. A

25. B

26. B

27. C

28. B

29. B

30. E

31. D

32. D

33. D

34. D

35. A

36. B

37. D

38. E

39. D

40. D

41. E

42. E

43. E

44. D

45. C

46. C

47. D

48. E

49. E

50. D

51. D

52. E

53. A

54. E

55. E

56. E

57. C

58. B

59. D

60. E

61. B

62. D

63. A

64. B

65. A

66. E

67. B

68. B

69. E

70. B

71. B

72. A

73. A

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