Lecture-based Exam Review Questions



1. A 38-y/o apparently healthy non-smoker comes in for her first pap smear in nearly 5 years, and results return abnormal. Lacking insurance, she does not follow up for another 3 years, when she again comes in for a pap smear. This time, investigation reveals a moderately differentiated mass lesion several centimeters in diameter and impinging on the left ovary. There is regional lymph node spread. There is no evidence of metastasis. 8 months following radiation and chemotherapy, the tumor is found once again to be growing in the right and left pelvic cavity. CXR shows two small lung nodules. Biopsy of a lung nodule reveals poorly differentiated cells. What is the grade and stage of the neoplasia before therapy, and 8 months following therapy?

a) Grade I, Stage Tis; Grade III, Stage IV

b) Grade II, Stage II; Grade IV, Stage IV

c) Grade II, Stage III; Grade III, Stage IV

d) Grade II, Stage Tis; Grade II, Stage IV

e) Grade II, Stage I; Grade III, Stage III

2. Which of the following is true with regards to protooncogenes/ oncogenes?

a) 50% of all cancers have a Ras mutation; p53, among other things, regulates GAP; and CDKs promote the cell cycle through key regulatory checks.

b) 50% of all cancers have a p53 mutation; Ras, among other things, regulates GAP; and CDKIs promote the cell cycle through key regulatory checks.

c) 50% of all cancers have a p53 mutation; Ras may be constitutively active with a mutant GAP; and bcl-2, upregulated by p53, promotes protective apoptosis.

d) 50% of all cancers have a Ras mutation; p53 may be null (constitutively inactive) with a mutant GAP; and bax, upregulated by p53, promotes protective apoptosis.

e) CDKIs protect by inhibiting premature progress through the cell cycle; Ras, a key signal transducer, uses raf-1 to activate the MAP-kinase pathway; and bcl-2, in some respects, opposes the effect of p53.

3. NPV is related to which of the following (multiple answers):

a) False Positives

b) False Negatives

c) Prevalence

d) True Negatives

e) True Positives

4. Likely diagnosis?

5. All of the following cause a hemolytic anemia except:

a) Human parvovirus B19

b) SLE

c) Acanthocytosis

d) Malaria

e) Disseminated Intravascular Coagulation

6. Which statement is false?

a) Thalassemia MAJOR is the only “form” in which blood transfusions are required.

b) A patient with a thalassemia will produce increased amounts of the globin chains present in their genome, such as those of minor normal adult hemoglobins like Hb-Barts.

c) Hb A1c levels are useful in monitoring compliance of diabetic therapy.

d) Hb A2, Hb F, and Hb A1c are are all minor normal adult hemoglobins.

e) Homozygous Hb E Disease produces a mild hemolytic anemia.

7. Which of the following is a condition which must be met prior to or during granulocyte therapy?

a) There must be a well-established infection, whether localized or systmeic.

b) You must be certain than the pathogen is bacterial or fungal.

c) Granulocyte counts must be less than 300-500/uL.

d) Antibiotic therapy must be given concurrently and at least for 3 days.

e) The patient must be at least 18 months of age since the granulocytes may not be well tolerated in a neonate.

8. The following paragraph describes hemostasis, but one statement is incorrect. Your mission, should you choose to accept it, is to choose the statement that is wrong and the correct corresponding statement. (1) Primary hemostasis is the events leading to vessel wall-platelet interactions resulting in an unstable plug. (2) Vessel injury leads to the release of VWF from the endothelium. VWF is immobilized on the collagen. Platelet adhehion is accomplished through interactions of glycoprotein receptor GPIa with the VWF (which has high affinity for GPIa), and this leads to platelet activation. GPIb facilitates the adhesion of platelets to collagen. (3) Arachidonic acid is released into the cytoplasm, and cyclooxygenase converts it into thromboxane A2; aspirin prevents coagulation by inhibiting cyclooxygenase. (4) Thromboxane A2 potentiates the mobilization of calcium. ADP and serotonin are released from dense granules. (5) ADP allows GPIIb and GPIIIa receptors to be cross-linked by fibrinogen, and the platelet plug is formed.

a) (3) Arachidonic acid is released into the extracellular matrix, and cyclooxygenase converts it into thromboxane A2; aspirin prevents coagulation by inhibiting cyclooxygenase.

b) (5) ADP allows GPIIa and GPIIIb receptors to be cross-linked by fibrinogen, and the platelet plug is formed.

c) (1) Primary hemostasis is the events leading to vessel wall-platelet interactions resulting in a stable plug.

d) (2) Vessel injury leads to the release of VWF from the endothelium. VWF is immobilized on the collagen. Platelet adhehion is accomplished through interactions of glycoprotein receptor GPIb with the VWF (which has high affinity for GPIb), and this leads to platelet activation. GPIa facilitates the adhesion of platelets to collagen.

e) (4) Thromboxane A2 potentiates the mobilization of calcium. VWF and platelet factor 4 are released from dense granules.

9. The types of Von Willebrand Disease which lack high-molecular-weight VWF multimers include:

a) 2M & 2N

b) 2A & 2M

c) 3 &1

d) 2A, 2B, & 2M

e) 2A & 2B

10. Which of the following is false regarding anticoagulation?

a) Only free Factor S can participate as a cofactor.

b) A homozygous deficiency of Protein C may manifest as a skin lesion on neonates. The condition is fatal when untreated.

c) APC cleaevs Factors VIIIa and Va, blocking the formation of fibrin.

d) The majority of Factor S is free and able to participate as a cofactor for ACP catalytic activity.

e) A heterozygous deficiency of Protein C is usually asymptomatic.

11. While on your service, you notice that a patient bruises easily and has a prolonged bleeding time as a result of minor cuts. Your work-up discovers Diffuse Intravascular Coagulation. Upon further history, physical exam, and follow-up, which of the following would NOT be discovered?

a) Colon Cancer

b) Schistocytes resulting from Microangiopathic Hemolytic Anemia

c) A gram negative sepsis

d) Decreased fibrinogen

e) Decreased levels of D-dimers

12. Which of the following does not belong with Tetralogy of Fallot?

a) Patent Ductus Arteriosus

b) Overriding aorta

c) Right Ventricular Hypertrophy

d) Ventricular Septal Defect

e) Right Ventricular Outflow Tract Obstruction

13. Hirschprung’s Disease is characterized by:

a) Difficulty in neonatal respiration

b) Necrotizing inflammation of the intestines in neonates

c) Failure to pass meconium and chronic constipation

d) Pancreatic insufficiency

e) Mild anemia and jaundice

14. A 14 year old presents to your office with something growing on her arm. Your finding confirm a painless mass on the distal right forearm, and biopsy reveals a small round blue cell tumor with skeletal muscle differentiation (strap cells). You identify the mass as ____ and report the news that her prognosis is _____.

a) Wilms Tumor; good.

b) Rhabdomyosarcoma; poor.

c) Ewing Sarcoma; good.

d) Ewing Sarcoma; poor.

e) Rhabdomyosarcoma; good.

15. CHF results in all of the following compensations except

a) Increased end-diastolic wall tension

b) Muscle-derived vasodilators

c) Sodium and water retention

d) Myocardial dilatation

e) Increased sympathetic output

16. Which of the following is not given as part of thrombolytic therapy?

a) Tissue plasminogen activator

b) Streptokinase

c) Digoxin

d) Aspirin

e) Heparin

17. Most common clinical presentation of cardiac myxoma:

a) Pericarditis

b) Idiopathic Fever

c) Sudden Death

d) Si/Sx of Mitral Valve Disease

e) Si/Sx of Pulmonary Valve Disease

18. Which disease is characterized by vasculitis of the arteries (esp. the coronaries), aneursyms, and is identical to polyarteritis?

a) Kawasaki’s Disease

b) Takayasu’s Arteritis

c) Coarctation of the Aorta

d) Wegener’s Granulomatosis

e) Hypersensitivity Angitis

19. Which is not true concerning diagnosing cardiac events?

a) Flipped LDH (LDH1>LDH2) can be caused by an acute MI.

b) Myoglobin is a good SnNout test.

c) Troponin subunits can be measured to test for acute MI; TnI is measured in the US, while TnT is more often measured in Europe.

d) A timed profile of CK and CK-MB is the current gold standard of MI detection.

e) Presence of an MM band is indicative of myocardial damage.

20. Which of the following is not matched correctly?

a) Dilated Cardiomyopathy - Cardiomegaly.

b) Hypertrophic Cardiomyopathy – Common condition.

c) Dilated Cardiomyopathy – .S3 gallop and ST changes.

d) Restrictive Cardiomyopathy – Uncommon condition.

e) Hypertrophic Cardiomyopathy – May have a genetic component.

21. A 53y/o black male is in your office for a work physical from his computer software design company. He reports his health to be “very good,” and there is no history of major disease. His blood pressure is 142/81. His records show these previous systolic BP values, starting with most recent: 145, 141, 138, 135, and 134. What should you do?

a) Admit to hospital

b) Treat with medications

c) Monitor

d) Suggest lifestyle changes

e) Treat with medications and suggest lifestyle changes

22. Which classification of lung disease does Chronic Bronchitis fall into?

a) Non-neoplastic, diffuse, restrictive

b) Non-neoplastic, localized, obstructive

c) Non-neoplastic, diffuse, obstructive

d) Non-neoplastic, localized, restrictive

e) Neoplastic, malignant

23. Regarding bronchiectasis all of the following are true except:

a) Inflammatory process are at work in the lung

b) Obstruction may be secondary to a tumor

c) Obstruction results in atelectasis

d) Obstruction is the major influece; infection may contribute but is not necessary

e) Copious amounts of foul-smelling sputum is produced

24. A medical examiner seeks to determine all of the following except:

a) Mode of Death (eg homicide vs murder)

b) Circumstances of death (eg whether the shooter was close range vs indeterminate range)

c) Cause of Death (eg gunshot)

d) Mechanism of Death (eg bleeding)

e) Manner of Death (eg homicide vs natural)

25. Which of the following DILD diseases is independently associated with lung cancer?

a) Asbestos exposure and berylliosis

b) Asbestos exposure and silicosis

c) Silicosis and berylliosis

d) Asbestos exposure only

e) Coal worker’s pneumoconiosis and silicosis

26. Which disease is characterized by cough, hemoptysis, anemia, weight loss, diffuse pulmonary infiltrates, consolidated and heavy lungs, and no renal involvement or anitbody involvement?

a) BOOP

b) Desquamative interstitial pneumonia

c) Idiopathic pulmonary hemosiderosis

d) Pulmonary eosinophilia

e) Goodpasture’s syndrome

27. If a cancer presents microscopically with keratinization and intercellular bridges, which therapy will probably not be considered?

a) Radiation

b) Surgical resection

c) Chemotherapy

d) Radiation or chemotherapy

e) None of the above

28. In hypoxemia due to V/Q mismatch, why will hyperventilation not significantly increase pO2?

a) Hyperventilation will lead to sympathetic stimulation from a “panic response,” increasing cardiac demand, and comsuming the benefit of extra oxygen

b) The extra work of breathing will consume most of the benefit

c) Poorly oxygenated blood will still mix with saturated blood from normal parts of lung

d) Hyperventilation does nothing to improve lung perfusion, the original cause of the hypoxemia

e) None of the above

29. You are treating a patient for a pneumonia which on CXR shows no consolidation. In your excitement, taking the history slipped your mind. You reason that the patient probably acquired the pneumonia from/ as a result of:

a) Someone from the community sneezing profusely on the #3 bus

b) Their possible HIV status

c) A possible recent hospital stay in which the infection was overlooked by your mentor

d) Probably either the hospital or the #3 bus

e) Probably either their possible HIV status or the #3 bus

f) Who knows? It could be any.

30. Which of the following is incorrect:

a) Forensic pathologist is in charge of determining the cause of death

b) Most common cause of death in fire accident is asphyxiation

c) Manner of death is etiologically specific

d) Cause of death is etiologically specific

e) Forensic pathologist is not in charge of the body in the scene of crime

31. A person was shot in the abdomen by his neighbour, underwent surgeries with no complication. The person seemed to be doing fine until the tenth day when the person suddenly felt terrible pain in the right lower quadrant of his abdomen and died within several hours. On autopsy, found burst appendix. Which of the following is true:

a) The neighbor should be told to hire Johnny Cochran

b) The manner of death is homicide

c) The immediate cause of death is appendicitis

d) The proximate cause of death is appendicitis

e) The mechanism of death cessation of respiratory system

32. Which one of these is not caused by injuries affecting the integrity of tissues caused by blunt impact:

a) Graze

b) Contusion

c) Laceration

d) Fracture

e) Chop

33. Centrally located, functional (hormone producing PTH), well differentiated, moderate, poor tumor. Which of the following best match the description:

a) Bronchogenic carcinoma adenocarcinoma type

b) Bronchogenic carcinoma squamous cell type

c) Brochogenic carcinoma small cell

d) Bronchial carcinoid

e) Hamartoma

34. Which is not true about exudates?

a) Caused by increase in capillary permeability

b) Caused by increased hydrostatic pressure

c) High Specific gravity

d) LDH ................
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