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121

Patients with sickle cell disease have an increased risk of streptococcal pneumonia because (A) macrophages that remove the encapsulated organims are significantly reduced due to a nonfunctioning spleen (B) there is immunologic anergy to the streptococcal capsule which has structural similarity to hemoglobin S (C) the inherent resistance to malaria in sickle cell patients primes the cytotoxic T cells for protozoan, but not bacterial, infections (D) chronic hemolysis in sickle cell disease releases growth factors for the fastidious streptococcal bacteria

macrophages that remove the encapsulated organims are significantly reduced due to a nonfunctioning spleen (TOPNOTCH)Robbins Basic Pathology, 8th Ed. Pp 428, 509

122

Which of the following patients with secondary tuberculosis have an increased likelihood of NEGATIVE sputum AFB smears? (A) 55 year old HIV-positive man with CD4+ counts 300 cells/mm3 (C) 43 year old HIV-negative man

55 year old HIV-positive man with CD4+ counts

123

A 55 year old man with a 50 pack year smoking history presents with a 5 cm right lung mass in the middle lobe. A CT-guided aspiration biopsy is performed, which shows round to polygonal cells twice the size of lymphocytes, with unappreciable cytoplasm, finely granular chromatin. Some of the cells demonstrate nuclear molding. What is the first line of treatment? (A) lobectomy (B) radiation therapy (C) chemotherapy (D) anti-Koch's

chemotherapy (small cell carcinoma) (TOPNOTCH)Robbins Basic Pathology, 8th Ed. Pp 531-534)

124

A 41 year old asymptomatic woman presents with a nodule on a routine xray. CT scan showed a 3-cm bronchial mucosal plaque penetrating the bronchial wall and fanning out into the peribrochial tissue, resembling a collar button. A bronchoscopy with core biopsy is done, which showed nests of uniform cells bearing regular round nuclei with salt-and-pepper chromatin, with little pleomorphism and mitosis. Which of the following is TRUE? (A) 70-80%% of patients with this tumor have hilar node metastasis at presentation (B) the tumor is thought to arise from the Kupffer cells that line the bronchial mucosa (C) Patients commonly present with the syndrome of diarrhea, flushing, and cyanosis (D) it can be considered as a less aggressive cousin to small cell carcinoma, both belonging in a spectrum of pulmonary neuroendocrine neoplasms

it can be considered as a less aggressive cousin to small cell carcinoma, both belonging in a spectrum of pulmonary neuroendocrine neoplasms (A- 5-15% nodal metastasis; B - arises from Kulchitsky cells; C - rarely presents with the syndrome) (TOPNOTCH)Robbins Basic Pathology, 8th Ed. Pp 534

125

A 28 year old man complains of epistaxis of one month duration. His otorhinolaryngologist finds an ill-defined erythematous mass in his nasopharynx, and performs a biopsy, which showed sheets and clusters of large epithelial cells having indistinct cell borders with eosinophilic nucleoli, with a background of lymphocytes. Which of the following is TRUE? (A) the mass is associated with EBV infection (B) the lymphocytes are neoplastic (C) the mass is usually resistant to radiotherapy (D) 5-year survival rates are less than 5%

the mass is associated with EBV infection (nasopharyngeal carcinoma) (B - the lymphocytes are not neoplastic; C - it is radiosensitive; D - 5-year survival rates 50% even for advanced cancers) (TOPNOTCH)Robbins Basic Pathology, 8th Ed. Pp 537

126

In laryngeal carcinoma, which tumor location has the best prognosis? (A) supraglottis (B) glottis (C) sublottis (D) epiglottis

glottis (TOPNOTCH)Robbins Basic Pathology, 8th Ed. Pp 538