[SEM2] PATHO #4

Question 1

A 35-year-old man has complained of purpura and bleeding of the gums for two weeks. Physical exam finds him pale, and his temperature is 39˚C. This clinical picture is most compatible with:
A. CLL
B. ALL
C. CML
D. AML

Answer 1

Question 2

An 80-year-old woman presents with a severe headache localized to the left temporal area. She also has visual impairment in her left eye. Which of the following is the most cost-effective screening test to exclude or confirm a diagnosis?
A. ESR
B. Temporal artery biopsy
C. Serum C3 complement
D. Serum antinuclear antibody

Answer 2

Question 3

A 2-year-old girl with Type II Crigler-Najjar syndrome is treated with phenobarbital. This drug causes hyperplasia of the smooth endoplasmic reticulum in liver cells and decreases serum indirect bilirubin levels. Which one of the following enzymes is most likely to be deficient in this patient?
A. L-iduronosulfate sulfatase
B. Gamma-glutamyl transferase
C. Galactosylceramide beta-galactosidase
D. Bilirubin-UDP-glucuronyl transferase

Answer 3

Question 4

A young woman with photophobia, morning stiffness in her hands, and an unexplained pericardial effusion would most likely have a positive test for:
A. HLA-B27 haplotype
B. Rheumatoid factor
C. Antistreptolysin antibodies
D. Serum antinuclear antibodies

Answer 4

Question 5

A 70-year-old man presents with a one-week history of lower abdominal pain. Physical exam finds a mid-abdominal pulsatile mass. This mass obliterates the left psoas shadow on X-ray. Each of the following is likely, EXCEPT:
A. Leakage of blood from an aneurysm
B. An emergency operation is needed
C. Atherosclerotic aortic aneurysm
D. Syphilitic aneurysm

Answer 5

Question 6

A 30-year-old woman has been troubled by headaches for the past three months. She also reports producing milk from her breast within the past week. Physical examination demonstrates impaired peripheral vision in both eyes. Which of the following functions will most likely be unaffected in this woman?
A. Salt retention
B. Free water absorption
C. Menstruation
D. Thyroid hormone production

Answer 6

Question 7

Reference intervals are most commonly defined as the range of values into which:
A. 85% of non-diseased individuals will fall.
B. 95% of non-diseased individuals will fall.
C. 85% of diseased individuals will fall.
D. 95% of diseased individuals will fall.

Answer 7

Question 8

A 70-year-old woman presents to the clinic with an erythematous, scaly rash on her right labia majora. Biopsy of the rash reveals large pale-staining cells surrounded by a halo. They extend into the adnexal structures but not into the underlying dermis. The cells are mucin positive and S100 antigen negative. This lesion is best described as:
A. A benign tumor of squamous origin
B. An intraepithelial malignancy
C. A malignant tumor derived from melanocytes
D. A malignant tumor associated with an underlying malignancy in the dermis

Answer 8

Question 9

A tumor in an adult that involves the optic nerve, spinal cord, or skull bone and is associated with new onset seizure activity would most likely have which of the following histologic features?
A. Perivascular pseudorosettes
B. Vascular proliferation and necrosis
C. Antoni A and B areas
D. Psammoma bodies

Answer 9

Question 10

This test is used to monitor average blood sugar levels of patients over the past 3 months:
A. Random blood sugar test
B. Fasting blood sugar test
C. Hemoglobin A1c test
D. Glucose tolerance test

Answer 10

Question 11

11. True or False: The hepatic lobule is centered on the centrilobular vein and surrounded at its periphery by approximately six portal tracts.
    A. True
    B. False

Answer 11

Question 12

12. The pediatric disease that most closely resembles amyotrophic lateral sclerosis is:
    A. Niemann-Pick disease
    B. Schilder disease
    C. Tabes dorsalis
    D. Werdnig-Hoffmann disease

Answer 12

Question 13

13. A 25-year-old woman in the third trimester of her first pregnancy develops persistent headaches and swelling of her legs and face. Early during her pregnancy her physical exam was remarkable; however, now her blood pressure is 170/105 mmHg and urinalysis shows slight proteinuria. Which one of the following is the most likely diagnosis?
    A. Nephritic syndrome
    B. Nephrotic syndrome
    C. Preeclampsia
    D. Eclampsia

Answer 13

Question 14

14. A 10-year-old boy with a clinical diagnosis of acute appendicitis undergoes surgery. To support the boy’s clinical diagnosis, what should be seen in his appendix?
    A. Infiltration of lymphocytes and plasma cells in the submucosal layer
    B. Infiltration of neutrophils in the submucosal layer
    C. Infiltration of lymphocytes and plasma cells in the muscularis layer
    D. Infiltration of neutrophils in the muscularis layer

Answer 14

Question 15

15. A 25-year-old woman with a history of recurrent right lower quadrant pain has a palpable right ovarian mass. Ultrasound confirms the presence of a cystic lesion of the ovary. No calcifications are noted. The patient most likely has:
    A. Serous cystadenoma
    B. Follicular cyst
    C. Mucinous cystadenoma
    D. Cystic teratoma

Answer 15

Question 16

16. Extramedullary hematopoiesis would most likely be associated with which of the following disorders?
    A. Severe iron-deficiency anemia
    B. Congenital spherocytic anemia
    C. Agnogenic myeloid metaplasia
    D. Beta-Thalassemia minor

Answer 16

Question 17

17. True or False: The submucosa of the gallbladder contains mucous glands.
    A. True
    B. False

Answer 17

Question 18

18. TRUE or FALSE: Osteophytes located over the distal interphalangeal joints are called Bouchard’s nodes.
    A. False
    B. True

Answer 18

Question 19

19. Which one of the following skin diseases most closely resembles a squamous cell carcinoma of the skin in its gross and microscopic appearance?
    A. Ichthyosis vulgaris
    B. Actinic keratosis
    C. Lichen planus
    D. Keratoacanthoma

Answer 19

Question 20

20. A hypotensive 19-year-old woman is found to have hyponatremia, hyperkalemia, hypoglycemia, and decreased plasma cortisol on laboratory examination. Two days ago, she exhibited pharyngitis and high-grade fever. Which of the following would be the most likely finding in her adrenal glands?
    A. Tuberculous granulomas
    B. Metastatic carcinoma
    C. Extensive hemorrhage
    D. Amyloidosis

Answer 20

Question 21

21. Which of the following disorders is most likely to be present in an elderly individual with a pathologic fracture due to a lytic lesion in bone?
    A. Multiple myeloma
    B. Fibrous cortical defect
    C. Metastatic prostate cancer to bone
    D. Osteoporosis

Answer 21

Question 22

22. A pathologist receives a testicular mass obtained from a 2-year-old patient. Grossly, the mass is characterized by a spongy texture on the surface. Microscopic examination finds a distinct pattern characterized by fibrovascular cores “festooned” by tumor cells. What is the most likely diagnosis of this tumor?
    A. Choriocarcinoma
    B. Embryonal carcinoma
    C. Seminoma
    D. Yolk sac tumor

Answer 22

Question 23

23. Neurogenic diabetes insipidus is associated with which of the following conditions?
    A. Increased plasma vasopressin
    B. Hyponatremia
    C. Increased free water clearance
    D. Hypertension

Answer 23

Question 24

24. A 6-year-old girl accidentally inhales a small peanut, which lodges in one of the bronchi. A chest X-ray reveals the mediastinum to be shifted toward the side of the obstruction. Which one of the following pulmonary abnormalities is most likely present in this girl?
    A. Absorptive atelectasis
    B. Compression atelectasis
    C. Contraction atelectasis
    D. Patchy atelectasis

Answer 24

Question 25

25. A pathologist receives a biopsy specimen labeled “vocal cord masses” excised from a 5-year-old boy who presented with dysphagia. The masses measure around 0.6-1.0 cm in diameter. Microscopic findings show finger-like projections of orderly squamous epithelium overlying fibrovascular cores. Which one of the following viruses is most closely associated with these lesions? A. CMV B. EBV C. HPV D. HSV

Answer 25

Question 26

26. The ability of a laboratory test to detect negativity in the absence of disease is known as: A. Sensitivity B. Relative risk C. Specificity D. Negative predictive value

Answer 26

Question 27

27. Enteropathy-associated T-cell lymphoma is most commonly a complication of which of the following diseases? A. Crohn disease B. Whipple disease C. Peutz-Jegher syndrome D. Celiac sprue

Answer 27

Question 28

28. A 60-year-old man experienced sudden severe chest pain radiating to the back. Physical exam finds hypertension (170/110 mmHg), distant heart sounds, and pulsus paradoxus. Pericardiocentesis yields blood. Which of the following pathologic findings is most likely to have occurred in his aorta? A. Dissection B. Aneurysm C. Vasculitis D. Thrombosis

Answer 28

Question 29

29. Anisocytic red blood cells will reflect in an automated Complete Blood Count (CBC) as: A. Increased Mean Corpuscular Volume (MCV) B. Decreased Mean Corpuscular Volume (MCV) C. Increased Red Cell Distribution Width (RDW) D. Decreased Red Cell Distribution Width (RDW)

Answer 29

Question 30

30. A patient treated with vitamin K antagonist Coumadin will most likely have: A. Prolonged aPTT and PT B. Prolonged aPTT and normal PT C. Normal aPTT and prolonged PT D. Normal aPTT and normal PT

Answer 30

Question 31

31. It is the first step in evidence-based medicine: A. Ask a clinical question or issue based on a patient encounter B. Analyze and critically evaluate the information and reach a conclusion C. Apply the information to individual patients D. Audit the effectiveness of the conclusion and monitor the literature

Answer 31

Question 32

32. Which of the following disorders is most likely associated with erythroid hyperplasia in the bone marrow? A. Anemia of chronic disease B. Beta-Thalassemia minor C. Iron deficiency D. Chronic obstructive pulmonary disease

Answer 32

Question 33

33. Which benign breast disorder has been linked to the development of breast carcinoma in special cases? A. Duct ectasia B. Fat necrosis C. Fibrocystic changes D. Fibroadenoma

Answer 33

Question 34

34. A non-Hodgkin lymphoma characterized by CD10-positive and CD5-negative lymphocytes with elevated levels of cytoplasmic IgG and a nodular pattern of growth will most likely have which one of the following translocations? A. t(14;18) B. t(8;14) C. t(11;14) D. t(2;5)

Answer 34

Question 35

35. A pathologist receives a penectomy specimen from a 55-year-old patient. Gross examination of the specimen finds a 1.5-cm diameter reddish-brown ulcerated mass eroding the glans penis. What is most likely to be seen on microscopic examination? A. Dysplastic urothelium above the basement membrane B. Hyperkeratotic, acanthotic, squamous epithelium overlying ectatic blood vessels C. Infiltrating, pleomorphic, poorly differentiated squamous cells D. Invasive glands with tall columnar mucinous epithelium

Answer 35

Question 36

36. A risk factor for the development of malignant melanoma is: A. The basal cell nevus syndrome B. Having a family history of breast cancer C. The dysplastic nevus syndrome D. Young age

Answer 36

Question 37

37. An urban health care center in a large city in Metro Manila offers testing for infection with syphilis. The health center uses a screening test designed to obtain maximum sensitivity, but a second test must be done to all positive results before results are reported. Which of the following outcomes is most likely to characterize the screening test? A. Increased false positive results B. Decreased false positive results C. Increased false negative results D. Decreased false negative results

Answer 37

Question 38

38. Total Iron-Binding Capacity (TIBC) in iron deficiency is: A. The same as the TIBC level in cases of anemia of chronic disease B. Increased compared with anemia of chronic disease C. Decreased compared with anemia of chronic disease D. Within normal level

Answer 38

Question 39

39. Which of the following scenarios for the development of the interatrial septum in the heart is true? A. The ostium primum develops as an opening within the septum primum B. The ostium primum closes before the ostium secundum develops C. The septum secundum develops on the right side of the septum primum and covers the ostium secundum D. The ostium primum gets larger as the septum primum grows

Answer 39

Question 40

40. Which of the following skin carcinomas is least likely to metastasize? A. Superficial spreading melanoma B. Squamous cell carcinoma C. Nodular melanoma D. Basal cell carcinoma

Answer 40

Question 41

41. A total stapedectomy is done to treat a 45-year-old man's otosclerosis. Which one of the following histologic changes is most likely to be present? A. No changes: Pathologic changes are limited to otic capsule B. Spongiosis and formation of large marrow cavities C. New woven bone formation in the footplate D. New woven bone formation in the crura

Answer 41

Question 42

42. Two weeks after starting a course of an antibiotic, a pneumonia patient develops fever, hematuria, proteinuria, skin rash, and eosinophilia. Which one of the following is the most likely diagnosis? A. Crescentic glomerulonephritis B. Acute interstitial nephritis C. Acute tubular necrosis D. Pyelonephritis

Answer 42

Question 43

43. Which of the following laboratory results is NOT compatible with disseminated intravascular coagulation? A. Elevated aPTT and PT B. Elevated D-dimer C. Elevated platelet count D. Elevated WBC count

Answer 43

Question 44

44. A section of skeletal muscle in a patient dying with an esophageal carcinoma would show which of the following histologic features most prominently: A. Inflammation B. Degeneration and regeneration C. Atrophy D. Necrosis

Answer 44

Question 45

45. Which one of the following skin diseases has a different pathogenesis from the others listed? A. Pemphigus vulgaris B. Bullous pemphigoid C. Pityriasis rosea D. Vitiligo

Answer 45

Question 46

46. Neutrophil alkaline phosphatase is increased in: A. Chronic myelogenous leukemia B. Granulocytic leukemoid reaction C. Acute myeloid leukemia D. Aplastic anemia

Answer 46

Question 47

47. A 35-year-old woman runner presents with pain in the plantar portion of her foot between the third and fourth metatarsal bones. Which one of the following is the most likely cause of her foot pain? A. Morton neuroma B. Schwannoma C. Ganglioneuroma D. Traumatic neuroma

Answer 47

Question 48

48. Two months after an acute anterior myocardial infarction, a 68-year-old man has an abnormal bulge on the precordium during systole. The most common complication associated with this abnormality is: A. Chronic heart failure B. Rupture C. Paradoxical embolization D. Valvular dysfunction

Answer 48

Question 49

49. A certain laboratory test result is known to be pathologic if: A. It is within a reference range B. It falls within +/- 2 SD of values established by the laboratory C. It is outside of reference range D. It falls within +/- 1 SD of values established by the laboratory

Answer 49

Question 50

50. In which of the following groupings is the first disorder associated with indirect hyperbilirubinemia and the second disorder associated with direct hyperbilirubinemia? A. Gilbert disease --- Crigler-Najjar syndrome B. Physiologic jaundice of the newborn --- ABO incompatibility C. Rh hemolytic disease of the newborn --- extrahepatic biliary atresia D. Breast milk jaundice --- autoimmune hemolytic anemia

Answer 50

Question 51

51. When are cardiac arrhythmias associated with acute myocardial infarction most likely to occur? A. 0-12 hours postinfarction B. 12-24 hours postinfarction C. 3-7 days postinfarction D. 7-10 days postinfarction

Answer 51

Question 52

D. 7-10 days postinfarction 52. A pathologist receives a specimen excised from a patient with a history of pain and bleeding during bowel movement. Microscopic examination reveals anal tissues lined by stratified squamous epithelium exhibiting acanthosis with several dilated and congested vascular channels in the underlying stroma. What is the histopathological diagnosis for this lesion? A. Carcinoma-in-situ B. Angiodysplasia C. External hemorrhoids D. Internal hemorrhoids

Answer 52

Question 53

53. A 45-year-old woman is found to have gallstones on ultrasound examination of the abdomen after she complains of some vague upper abdominal pain of several days' duration. Which of the following statements regarding this finding is most accurate? A. She has a markedly increased risk for development of adenocarcinoma of the gallbladder B. Stones are probably also present in the intrahepatic bile ducts C. A hemolytic anemia is probably present D. The gallstones probably contain cholesterol with bile and calcium salts

Answer 53

Question 54

54. A 40-year-old female patient has been experiencing heavy menses for two years because of submucous myoma. Physical examination shows pale palpebral conjunctivae and nail beds. Her CBC shows a hemoglobin level of 9.8 g/dL (12-15 g/dL). Her peripheral blood smear will most likely show: A. Microcytic, hypochromic RBCs with reticulocytosis B. Normocytic, normochromic RBCs C. Macrocytic, hypochromic RBCs with hypersegmentation of Neutrophils D. Macrocytic, hypochromic RBCs with reticulocytosis

Answer 54

Question 55

55. A middle-aged woman has a 3-month history of suprapubic discomfort, dysuria, and frequency. Urine cultures are negative. The finding of mucosal fissures on cystoscopy and mucosal/submucosal chronic inflammation with mast cells on biopsy are most consistent with: A. Cystitis glandularis B. Follicular cystitis C. Interstitial cystitis D. Malakoplakia

Answer 55

Question 56

56. Which of the following disorders would most likely explain blurry vision in a child with a recent onset of polyuria, polydipsia, and weight loss? A. Refractive error B. Retinoblastoma C. Retinal hemorrhages D. Cataracts

Answer 56

Question 57

57. This enzyme assay provides sensitivity and specificity for pancreatic disease: A. Amylase B. Lipase C. AST D. ALT

Answer 57

Question 58

58. A 45-year-old woman with normal laboratory results gives birth to a term infant but with several malformations. These include endocardial cushion defect, brachycephaly, prominent epicanthal folds, and bilateral palmar creases. The heart defect of the infant is most likely associated with: A. Autosomal trisomy B. Spontaneous new gene mutation C. Teratogen exposure D. Gestational diabetes

Answer 58

Question 59

59. Dilated sinusoids and irregular cystic spaces filled with blood within the liver, which may rupture and lead to massive intraabdominal hemorrhage, are most closely associated with which one of the following substances? A. Estrogens B. Anabolic steroids C. Acetaminophen D. Vinyl chloride

Answer 59

Question 60

60. Which of the following is the most common type of cancer arising from urachal remnants? A. Adenocarcinoma B. Small cell/neuroendocrine carcinoma C. Squamous cell carcinoma D. Urothelial carcinoma, usual type

Answer 60

Question 61

61. One would least expect which of the following as a further complication of a patient with Paget disease of bone? A. Enlargement of the sella turcica B. Pathologic fractures C. An increased incidence of osteogenic sarcoma D. High-output cardiac failure

Answer 61

Question 62

62. The urinalysis results from an adult man show the following findings: white blood cells = none, red blood cells = none, bacteria = none, specific gravity = 1.015, protein = 4+, oval fat bodies = present. Which one of the following pathological changes can be expected in this patient’s kidney? A. Basement membrane spikes B. Glomerular capillary loop breaks C. Cellular crescents D. Subepithelial humps

Answer 62

Question 63

63. A 31-year-old woman presents with a recent onset of oligomenorrhea followed by amenorrhea and then the loss of female secondary characteristics. She has also developed acne, deepening of her voice, and temporal balding. Which one of the following types of ovarian tumor is most likely to produce these symptoms? A. Epithelial tumor B. Stromal tumor C. Germ cell tumor D. Surface tumor

Answer 63

Question 64

64. Which one of the following patients is most likely to have a breast lesion consisting of a solitary well-circumscribed 1 cm firm nodule palpated in the lower outer quadrant on physical examination? A. 5-year-old girl with precocious puberty B. 20-year-old man with bilateral breast enlargement C. 22-year-old woman who is asymptomatic D. 45-year-old woman with bloody nipple discharge

Answer 64

Question 65

65. A four-year-old male presents to the Emergency Department with a history of 5 days of fever and acute onset of red-colored urine. Peripheral blood smear shows schistocytes and reticulocytes. This finding is consistent with: A. Anemia of Chronic Disease B. Iron Deficiency Anemia C. Hemolytic Anemia D. Aplastic Anemia

Answer 65

Question 66

66. Which of the laboratory tests will you request for your patient if you want to differentiate pancreatitis from other acute abdominal disorders? A. AST, ALP B. Alkaline phosphatase C. Amylase, Lipase D. Lactate dehydrogenase

Answer 66

Question 67

67. Cytogenetic studies done on a renal tumor demonstrate the presence of terminal deletion of the short arm of chromosome 3. Which one of the following is the most likely neoplasm? A. Collecting duct carcinoma B. Oncocytoma C. Renal cell carcinoma, chromophobe type D. Renal cell carcinoma, clear cell type

Answer 67

Question 68

68. A 75-year-old female, bed-ridden patient with a sacral ulcer was brought to the Emergency Department due to septicemia. Her CBC reveals WBC level of 52 x 10^9/L (4.5 - 11 x 10^9/uL). Which of the following is compatible with the peripheral blood smear of the patient? A. Severe leukocytosis with numerous monoblasts B. Severe leukocytosis with numerous small lymphoblasts C. Severe leukocytosis with left shift in the neutrophil series including numerous myeloblasts D. Severe leukocytosis with neutrophils showing toxic granulations and presence of some bands, metamyelocytes, and myelocytes

Answer 68

Question 69

69. With which one of the following do gallstones and/or chronic cholecystitis not have a recognized association? A. Acute pancreatitis B. Hemolytic anemia C. Hepatitis B infection D. Intestinal obstruction

Answer 69

Question 70

70. Which of the following signs is a marker of an erythropoietin-stimulated bone marrow? A. Polychromasia (shift cells) in the peripheral blood B. Decreased serum ferritin C. Increased myeloid : erythroid ratio D. Low reticulocyte count

Answer 70

Question 71

71. Which one of the following salivary gland tumors has the highest prevalence in males and is bilateral/multifocal in 10% of cases? A. Acinic cell tumor B. Warthin tumor C. Adenoid cystic carcinoma D. Mucoepidermoid carcinoma

Answer 71

Question 72

72. A peripheral blood smear taken from a 6-year-old male shows red blood cells of varying size and shape with central pallor more than 1/3 of its diameter. Which of the following statements best describes the PBS? A. Microcytic, hypochromic RBCs B. Poikiloanisocytic, hypochromic RBCs C. Anisocytic, hypochromic RBCs D. Macrocytic, hypochromic RBCs

Answer 72

Question 73

73. Which one of the following lab findings in the table best represents a patient with long-standing rheumatoid arthritis with a guaiac-negative stool? A. A B. B C. C D. D

Answer 73

Question 74

74. In an individual with situs inversus, recurrent sinopulmonary infections, and sterility, the mechanism most likely responsible for these findings is: A. A defect in humoral immunity B. An immune complex disease C. A defect in ciliary structure and function D. A defect in exocrine secretions

Answer 74

Question 75

75. Which of the following is not associated with Duchenne's muscular dystrophy? A. Marked increase in glycogen content of muscle fibers B. Striking early muscle fibrosis C. Hypertrophied calves D. Lack of the muscle membrane protein dystrophin

Answer 75

Question 76

76. Which of the following is the risk factor with the strongest correlation with testicular germ cell tumors? A. Cryptorchidism B. Family history of testicular germ cell tumor C. Prior testicular germ cell tumor D. Lower socioeconomic class

Answer 76

Question 77

77. Which one of the following is the most common cause of anemia of malignancy? A. Blood loss B. Bone marrow metastasis C. Anemia of inflammation D. Vitamin B12 deficiency

Answer 77

Question 78

78. A 35-year-old man presents with the painless enlargement of one testicle. Physical examination finds a single nontender testicular mass that measures approximately 3 cm in the greatest dimension and does not transilluminate. Which of the following types of testicular tumor is most likely to be present in this individual? A. Germ cell tumor B. Gonadal stromal tumor C. Mesenchymal tumor D. Sex cord tumor

Answer 78

Question 79

79. Which of the following test results is most specific for myocardial infarction? A. Elevated AST B. Elevated Troponin I C. Elevated myoglobin D. Elevated LDH

Answer 79

Question 80

80. The most characteristic morphologic change in the liver of patients with α-1-antitrypsin deficiency is: A. Cytoplasmic keratin inclusions B. Iron accumulation C. Microvesicular steatosis D. PAS-positive cytoplasmic globules

Answer 80

Question 81

81. Glomus tumors originate in structures that are responsible for which function? A. Blood pressure regulation B. Temperature regulation C. Taste sensation D. Tactile sensation

Answer 81

Question 82

82. A renal biopsy from an adult who presented with progressive renal failure and hematuria reveals linear deposits of IgG within the glomeruli. Which one of the following types of autoantibodies is most likely to be present in this individual? A. Anticentromere antibodies B. Anti-basement membrane antibodies C. Anti–double-stranded DNA antibodies D. Antimitochondrial antibodies

Answer 82

Question 83

83. A 32-year-old drug abuser with a CD4 lymphocyte count of 300 is noted to have confluent adherent white plaques on the upper surface of the tongue. Histopathology of this lesion will most likely reveal which one of the following findings? A. Multinucleated giant cells B. Spherules with endospores C. Caseous granulomas D. Budding cells with pseudohyphae

Answer 83

Question 84

84. The skin overlying the right breast of a 60-year-old woman is indurated, roughened, and reddish-orange. Her nipple is retracted. Mammography reveals a 2-cm mass with microcalcifications. The best diagnosis for this case is: A. Phyllodes tumor B. Sclerosing adenosis C. Intraductal carcinoma D. Infiltrating ductal carcinoma

Answer 84

Question 85

85. Ability of a laboratory test to detect positivity in the presence of disease: A. Positive predictive value B. Specificity C. Sensitivity D. Relative risk

Answer 85

Question 86

86. Which of the following conditions is consistent with low serum thyroid-stimulating hormone and elevated serum thyroxine? A. Graves disease B. Secondary (pituitary) hyperthyroidism C. Iodine deficiency D. Tertiary (hypothalamic) hyperthyroidism

Answer 86

Question 87

87. Which one of the following diseases could be found in a history of a patient with Richter’s syndrome? A. Chronic lymphocytic leukemia B. Diffuse large B-cell lymphoma C. Burkitt lymphoma D. Lymphoblastic lymphoma

Answer 87

Question 88

88. Which of the following is NOT TRUE of Ferritin? A. It is increased in acute inflammatory process B. It is decreased in anemia of chronic disease C. It is the stored form of iron D. It is decreased in Iron deficiency anemia

Answer 88

Question 89

89. A patient is diagnosed with an inflammatory bowel disease. Which of the following is not associated with ulcerative colitis? A. Entire colon is affected B. Presence of granuloma C. Presence of inflammatory cells infiltrating the mucosa and submucosa D. Formation of pseudopolyps

Answer 89

Question 90

90. Which of the following laboratory test results suggest primary hyperthyroidism? A. Increased TSH, increased FT4 and FT3 B. Increased TSH, decreased FT4 and FT3 C. Decreased TSH, decreased FT4 and FT3 D. Decreased TSH, increased FT4 and FT3

Answer 90

Question 91

91. A patient treated with the anticoagulant heparin will most likely have a coagulation test result of: A. Prolonged aPTT and PT B. Prolonged aPTT and normal PT C. Normal aPTT and prolonged PT D. Normal aPTT and normal PT

Answer 91

Question 92

92. Hidradenoma papilliferum was diagnosed histologically in an ulcerated vulvar nodule. Which one of the following breast lesions is morphologically like this tumor? A. Paget disease B. Invasive ductal carcinoma C. Intraductal papilloma D. Fibroadenoma

Answer 92

Question 93

93. Which one of the following histopathologic changes is most likely to be seen when examining a mucosal biopsy of the urinary bladder from an individual with acute cystitis due to infection with Escherichia coli? A. Sheets of macrophages with granular cytoplasm B. Noncaseating granulomas C. An infiltrate of neutrophils D. Inflammation with eosinophils

Answer 93

Question 94

94. A laboratory test result may represent a life-threatening situation if: A. It is within the reference range B. It shows critical values C. It falls within +/- 2 SD of values established by the laboratory D. It is within normal range

Answer 94

Question 95

95. A midline, lobulated, mucoid mass occurring in the sphenoccipital or sacrococcygeal region is most likely derived from: A. Ependymal cells B. Astrocytes C. Microglial cells D. Notochord

Answer 95

Question 96

96. A peripheral blood smear taken from a 70-year-old man reveals a monotonous population of small, round, mature-looking lymphocytes. Flow cytometry demonstrates these cells to be CD19-positive, CD5-positive, and TdT-negative. Cytogenetic and molecular analysis of the abnormal cells would most likely reveal: A. Clonal rearrangement of immunoglobulin genes B. Clonal rearrangement of the T-cell receptor genes C. t(8;14) leading to c-MYC overexpression D. t(14;18) leading to BCL2 overexpression

Answer 96

Question 97

97. A 2-year-old boy presents with a yellow, crusty lesion around the mouth. The organism responsible for the lesion is probably a: A. Gram-positive streptococcus B. Gram-positive filamentous bacteria C. Gram-negative rod D. Gram-negative diplococcus

Answer 97

Question 98

98. A 65-year-old male patient has a 5-day history of cough, productive with yellowish phlegm, accompanied by high-grade fever. Laboratory examination was requested. Gram stain of phlegm reveals the presence of Gram-positive cocci arranged in chains and in pairs. What is the most likely WBC abnormality seen in the complete blood count? A. Monocytic leukocytosis B. Lymphocytic leukocytosis C. Neutrophilic leukocytosis D. Leukopenia

Answer 98

Question 99

99. Which one of the following lung tumors would most likely contain neurosecretory granules on electron microscopy? A. Scar carcinoma B. Bronchial carcinoid C. Large cell undifferentiated carcinoma D. Bronchioloalveolar carcinoma

Answer 99

Question 100

100. Reduced lung compliance is least likely to be associated with which one of the following conditions? A. Thoracic kyphoscoliosis B. Bronchial asthma C. Sarcoidosis D. Aging

Answer 100