Multiple choice questions in:

Dr. Ammar C. Al-Rikabi

Systemic Pathology

MULTIPLE CHOICE QUESTIONS IN:

Dr. Ammar C. Al-Rikabi

Respiratory system. Gastrointestinal

tract. Liver and Exocrine pancreas. Kidney and urinary pancreas.

Endocrine glands and diabetes mellitus. Skin diseases.

Respiratory system

A 60-year-old man, a heavy smoker, presents for advice to stop smoking. On physical examination, he is thin and has a ruddy complexion. He has a productive cough and a barrel-shaped chest.He sits leaning forward with his lips pursed to facilitate his breathing. A diagnosis of emphysema is made. Which of the following is the most likely histologic finding in the lungs ?

(A) Bronchial smooth muscle hypertrophy with proliferation of eosinophils

(B) Diffuse alveolar damage with leakage of protein- rich fluid into alveolar spaces

(C) Dilatation of air spaces with destruction of alveolar walls

(D) Hyperplasia of bronchial mucus-secreting submucosal glands

(E) Permanent bronchial dilatation caused by chronic infection, with bronchi filled with mucus and neutrophils

Respiratory system

(A) Bronchial smooth muscle hypertrophy with proliferation of eosinophils

(B) Diffuse alveolar damage with leakage of protein- rich fluid into alveolar spaces

(C) Dilatation of air spaces with destruction of alveolar walls

(D) Hyperplasia of bronchial mucus-secreting submucosal glands

(E) Permanent bronchial dilatation caused by chronic infection, with bronchi filled with mucus and neutrophils

Respiratory system

A 60-year-old woman with a heavy smoking history presents with chronic productive cough that has been present for 3 consecutive months over the past 2 consecutive years. On physical examination, her skin has a bluish tinge, and she is overweight. The patient is diagnosed with chronic bronchitis. Which of the following is the most likely histological finding in this patient's lungs ?

Respiratory system

(A) Bronchial smooth muscle hypertrophy with proliferation of eosinophils

(B) Diffuse alveolar damage with leakage of protein-rich fluid into alveolar spaces

(C) Dilatation of air spaces with destruction of alveolar walls

(D) Hyperplasia of bronchial mucus-secreting submucosal glands

(E) Permanent bronchial dilatation caused by chronic infection, with bronchi filled with mucus and neutrophils

Respiratory system

(A) Bronchial smooth muscle hypertrophy with proliferation of eosinophils

(B) Diffuse alveolar damage with leakage of protein-rich fluid into alveolar spaces

(C) Dilation of air spaces with destruction of alveolar walls

(D) Hyperplasia of bronchial mucus-secreting submucosal glands

(E) Permanent bronchial dilation caused by chronic infection, with bronchi filled with mucus and neutrophils

Respiratory system

A 65-year-old woman with a significant smoking history presents with cough and shortness of breath. Computed tomography of the chest reveals a central mass near the left mainstem bronchus. Biopsy of the mass is performed. Histologic examination reveals small round blue cells, and a diagnosis of small cell carcinoma is made. Which of the following is a frequent characteristic of this form of lung cancer ?

Respiratory system

(A) Generally amenable to surgical cure at time of diagnosis

(B) More common in women, and a less clear relation to smoking than other forms of lung cancer

(C) Secretes a parathyroid-like hormone(D) Secretes either corticotrophin or

antidiuretic hormone(E) Usually in a peripheral rather than in a

central location

Respiratory system

(A) Generally amenable to surgical cure at time of diagnosis

(B) More common in women, and a less clear relation to smoking than other forms of lung cancer

(C) Secretes a parathyroid-like hormone(D) Secretes either corticotrophin or

antidiuretic hormone(E) Usually in a peripheral rather than in a

central location

Respiratory system

A 50-year-old man dies of a respiratory illness that had been characterized by dyspnea, cough, and wheezing expiration of many years' duration. Initially episodic, his "attacks" had increased in frequency and at the time of death had become continuous and intractable. At autopsy, which of the following is the most likely histologic finding in the lungs ?

Respiratory system

(A) Bronchial smooth muscle hypertrophy with proliferation of eosinophils

(B) Diffuse alveolar damage with leakage of protein-rich fluid into alveolar spaces

(C) Dilatation of air spaces with destruction of alveolar walls

(D) Hyperplasia of bronchial mucus-secreting submucosal glands

(E) Permanent bronchial dilatation caused by chronic infection, with bronchi filled with mucus and neutrophils

Respiratory system

(A) Bronchial smooth muscle hypertrophy with proliferation of eosinophils

(B) Diffuse alveolar damage with leakage of protein-rich fluid into alveolar spaces

(C) Dilation of air spaces with destruction of alveolar walls

(D) Hyperplasia of bronchial mucus-secreting submucosal glands

(E) Permanent bronchial dilation caused by chronic infection, with bronchi filled with mucus and neutrophils

Respiratory system

A 60-year-old man presents with dyspnea on exertion and a nonproductive cough. He has never smoked, but he worked as a shipbuilder, with known asbestos exposure approximately 20 years ago. To which of the following conditions is this patient especially predisposed ?

Respiratory system

(A) Acute respiratory distress syndrome(B) Goodpasture syndrome(C) Idiopathic pulmonary fibrosis(D) Idiopathic pulmonary hemosiderosis (E) Malignant mesothelioma of the pleura

Respiratory system

(A) Acute respiratory distress syndrome(B) Goodpasture syndrome(C) Idiopathic pulmonary fibrosis(D) Idiopathic pulmonary hemosiderosis (E) Malignant mesothelioma of the pleura

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Gastrointestinal tract

A 45-year-old woman with long-standing rheumatoid arthritis complains of dry eyes and dry mouth. Bilateral enlargement of the parotids is noted on physical examination. The syndrome described here is best described as

Gastrointestinal tract

(A) autoimmune(B) infectious(C) metabolic(D) metastatic(E) primary neoplastic

Gastrointestinal tract

(A) autoimmune(B) infectious(C) metabolic(D) metastatic(E) primary neoplastic

Gastrointestinal tract

A 45-year-old man complains of "heartburn" and burning epigastric pain, relieved by antacids and triggered by eating spicy or acidic foods or by assuming a recumbent position. The patient smokes two packs of cigarettes a day and consumes several alcoholic drinks each evening. Which of the following is the usual cause of this patient's condition?

Gastrointestinal tract

(A) Columnar intestinal metaplasia of esophageal squamous epithelium

(B) Excessive acid production in the stomach

(C) Excessive nonsteroidal anti-inflammatory drug use

(D) Helicobacter pylori infection(E) Hiatal hernia and incompetent lower

esophageal sphincter

Gastrointestinal tract

(A) Columnar intestinal metaplasia of esophageal squamous epithelium

(B) Excessive acid production in the stomach

(C) Excessive nonsteroidal anti-inflammatory drug use

(D) Helicobacter pylori infection(E) Hiatal hernia and incompetent lower

esophageal sphincter

Gastrointestinal tract

A 60-year-old man presents with hematemesis, melena, guaiac-positive stools, and signs of circulatory collapse. He has a 20-year history of burning midepigastric pain and tenderness relieved by food, milk, or antacids. Also, he has been taking high doses of nonsteroidal anti-inflammatory drugs to relieve the pain of long-standing arthritis. Esophagogastroduodenoscopy reveals a peptic ulcer in the upper duodenum. Which of the following is an important association of duodenal peptic ulcer disease ?

Gastrointestinal tract

(A) Barrett esophagus and columnar intestinal metaplasia of esophageal squamous epithelium

(B) Evolution into carcinoma is a likely sequela(C) Helicobacter pylori infection(D) Hiatal hernia and incompetent lower

esophageal sphincter(E) Pernicious anemia and achlorhydria

Gastrointestinal tract

(A) Barrett esophagus and columnar intestinal metaplasia of esophageal squamous epithelium

(B) Evolution into carcinoma as a likely sequela(C) Helicobacter pylori infection(D) Hiatal hernia and incompetent lower

esophageal sphincter(E) Pernicious anemia and achlorhydria

Gastrointestinal tract

A 65-year-old man presents with dysphagia, weight loss, and anorexia. Physical examination is normal. Esophagogastroduodenoscopy with biopsy of an esophageal lesion is performed, revealing squamous cell carcinoma. Which of the following is true regarding this cancer?

Gastrointestinal tract

(A) Cigarette smoking and chronic alcohol use are associated risk factors.

(B) Gastroesophageal reflux disease and Barrett esophagus are associated risk factors.

(C) Histologic findings include disordered, back-to-back submucosal glands.

(D) It most frequently arises in the lower third of the esophagus.

(E) This cancer is characterized by an indolent course, and long survival is common.

Gastrointestinal tract

(A) Cigarette smoking and chronic alcohol use are associated risk factors.

(B) Gastroesophageal reflux disease and Barrett esophagus are associated risk factors.

(C) Histologic findings include disordered, back-to-back submucosal glands.

(D) It most frequently arises in the lower third of the esophagus.

(E) This cancer is characterized by an indolent course, and long survival is common.

Gastrointestinal tract

For the past week, a 65-year-old woman has been treated for a severe infection with broad-spectrum antibiotics, and she had recovered well. However, over the past day she has developed foul-smelling, voluminous, greenish, watery diarrhea, as well as abdominal pain and fever. She is diagnosed with pseudomembranous colitis. Which of the following is the mechanism associated with this condition?

Gastrointestinal tract

(A) Aggregation of bacterial colonies on the lumen, forming pseudomembranes

(B) Bacterial release of exotoxin, inducing necrosis of the mucosa

(C) Physical invasion of bacteria into the superficial mucosa, leading to pseudomembrane formation

(D) Selective killing of Clostridium difficile bacteria by antibiotics

(E) Spread of the previous infection to the colon

Gastrointestinal tract

(A) Aggregation of bacterial colonies on the lumen, forming pseudomembranes

(B) Bacterial release of exotoxin, inducing necrosis of the mucosa

(C) Physical invasion of bacteria into the superficial mucosa, leading to pseudomembrane formation

(D) Selective killing of Clostridium difficile bacteria by antibiotics

(E) Spread of the previous infection to the colon

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Liver and exocrine pancreas

A 25-year-old obese woman who denies any history of alcohol abuse presents with severe abdominal pain radiating to the back. Laboratory results indicate an increase in serum amylase and lipase, with a marked decrease in calcium. Which of the following likely has caused this condition?

Liver and exocrine pancreas

(A) Abetalipoproteinemia (B) Alcohol(C) Cholelithiasis (D) Cystic fibrosis (E) Mumps

Liver and exocrine pancreas

(A) Abetalipoproteinemia (B) Alcohol(C) Cholelithiasis (D) Cystic fibrosis (E) Mumps

Liver and exocrine pancreas

A 23-year-old woman is involved in a minor motor vehicle accident, prompting an abdominal computed tomography scan, which was read by the emergency department radiologist as normal with the exception of a questionable mass in the right lobe of the liver. A subsequent fine-needle biopsy confirms the presence of a liver adenoma. Which of the following is associated with the development of this lesion?

Liver and exocrine pancreas

(A) Hepatitis B(B) Hepatitis C(C) Oral contraceptives(D) Polycythemia vera (E) Polyvinyl chloride

Liver and exocrine pancreas

(A) Hepatitis B(B) Hepatitis C(C) Oral contraceptives(D) Polycythemia vera (E) Polyvinyl chloride

Liver and exocrine pancreas

While on an international medical rotation, you encounter a pregnant woman in a rural village in India who presents with fever, jaundice, and malaise. The patient unexpectedly expires. This is the second case this month with a similar presentation. Which of the following is the most likely form of hepatitis?

Liver and exocrine pancreas

(A) Hepatitis A (B) Hepatitis B (C) Hepatitis C (D) Hepatitis D (E) Hepatitis E

Liver and exocrine pancreas

(A) Hepatitis A (B) Hepatitis B (C) Hepatitis C (D) Hepatitis D (E) Hepatitis E

Liver and exocrine pancreas

A 32-year-old woman seeking to become pregnant visits her physician for a prepregnancy examination. Routine prenatal laboratory testing demonstrates the following profile: HBsAg (-), anti-HBsAg (+), anti-HBcAg (-), anti-HBeAg (-), and HBV DNA (-). Which of the following likely represents the status of the patient?

Liver and exocrine pancreas

(A) Hepatitis B carrier(B) Immunized against hepatitis B(C) Infected and within the "window period" (D) Infected with hepatitis B and highly

transmissible(E) Recently infected with hepatitis B

Liver and exocrine pancreas

(A) Hepatitis B carrier(B) Immunized against hepatitis B(C) Infected and within the "window period" (D) Infected with hepatitis B and highly

transmissible(E) Recently infected with hepatitis B

Liver and exocrine pancreas

(A) Hepatitis B carrier(B) Immunized against hepatitis B(C) Infected and within the "window period" (D) Infected with hepatitis B and highly

transmissible(E) Recently infected with hepatitis B

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Kidney and urinary tract

A 3-year-old boy is brought to the pediatrician because his mother noticed an abnormal mass in his scrotum while changing his diapers. Further workup demonstrates elevated levels of serum α-fetoprotein. Which of the following is the most likely diagnosis?

Kidney and urinary tract

(A) Choriocarcinoma(B) Endodermal sinus (yolk sac) tumor (C) Hepatocellular carcinoma (D) Leydig cell (interstitial) tumor (E) Teratoma

Kidney and urinary tract

(A) Choriocarcinoma(B) Endodermal sinus (yolk sac) tumor (C) Hepatocellular carcinoma (D) Leydig cell (interstitial) tumor (E) Teratoma

Kidney and urinary tract

A 66-year-old man visits his family physician with complaints of urinary frequency, hesitancy, and dysuria. Digital rectal examination reveals an enlarged prostate, and the consistency is rubbery and nodular. Serum prostate-specific antigen is modestly increased. Which of the following is most closely related to the pathogenesis of the likely disorder described here?

Kidney and urinary tract

(A) Dihydrotestosterone(B) Estrogen

(C) α-Fetoprotein(D) Human chorionic gonadotropin (E) Testosterone

Kidney and urinary tract

(A) Dihydrotestosterone(B) Estrogen

(C) α-Fetoprotein(D) Human chorionic gonadotropin (E) Testosterone

Kidney and urinary tract

A 58-year-old African-American man presents to the emergency department with severe back pain. His history is negative for trauma and he has no other complaints. He denies urinary frequency, hesitancy, or dysuria. A digital rectal examination confirms the presence of a firm, hard, asymmetrical, and stony prostate. Imaging of the spine suggests osteoblastic involvement of the spine at lumbar vertebrae L3 - L4. In addition to an increase in PSA, which serum marker might also be elevated?

Kidney and urinary tract

(A) Alkaline phosphatase(B) Androgens(C) Carcinoembryonic antigen-125(D) α -Fetoprotein(E) Human chorionic gonadotropin

Kidney and urinary tract

(A) Alkaline phosphatase(B) Androgens(C) Carcinoembryonic antigen-125(D) α -Fetoprotein(E) Human chorionic gonadotropin

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Endocrine glands and diabetes mellitus

A 46-year-old man is referred to an endocrinologist because of the recent onset of diabetes mellitus. However, his overall appearance is striking, and on questioning, he describes marked changes that have been occurring slowly over many years. Comparison with old photographs reveals that he has developed generalized coarseness of his facial features, including frontal bossing, thickening of the nose, prognathism (enlargement and increased prominence of the jaw), and macroglossia (enlargement of the tongue). In addition, he has enlarged extremities, with sausage-like fingers, and he says that he is no longer able to wear his wedding ring and that his shoe size has increased. These findings are characteristic of increased activity of which of the following?

Endocrine glands and diabetes mellitus

(A) Corticotropin(B) Dopamine(C) Insulinlike growth factor- I(D) Prolactin(E) Thyroid-stimulating hormone

Endocrine glands and diabetes mellitus

(A) Corticotropin(B) Dopamine(C) Insulinlike growth factor- I(D) Prolactin(E) Thyroid-stimulating hormone

Endocrine glands and diabetes mellitus

A 23-year-old woman presents with tremor, restlessness, heat intolerance, palpitation, and unexplained weight loss. The thyroid is symmetrically enlarged; the pulse is rapid; the skin is moist and warm; and exophthalmos( protrusion of the eye ball) is apparent. This condition is considered to be:

Endocrine glands and diabetes mellitus

(A) autoimmune (B) congenital (C) iatrogenic (D) infectious (E) nutritional

Endocrine glands and diabetes mellitus

(A) autoimmune (B) congenital (C) iatrogenic (D) infectious (E) nutritional

Endocrine glands and diabetes mellitus

A 26-year-old primigravida develops gestational diabetes and remains hyperglycemic during the remainder of her pregnancy. Which of the following abnormalities in the newborn child is likely related to the maternal hyperglycemia?

Endocrine glands and diabetes mellitus

(A) Ambiguous genitalia (B) Cretinism(C) Increased birth weight (D) Sheehan syndrome (E) Thyroglossal duct cyst

Endocrine glands and diabetes mellitus

(A) Ambiguous genitalia (B) Cretinism(C) Increased birth weight (D) Sheehan syndrome (E) Thyroglossal duct cyst

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Skin Diseases

A 20-year-old woman presents with a skin rash. The rash is localized to the extensor surfaces of her elbows and knees, and is composed of multiple well -demarcated circular to oval-shaped plaques and papules covered by a silvery scale overlying reddened erythematous skin. The silvery scale can be scraped off, revealing inflamed skin underneath. She states that several family members have a similar rash. Which of the following is the most likely diagnosis?

Skin Diseases

(A) Neurodermatitis (lichen simplex chronicus)(B) Psoriasis(C) Pemphigus vulgaris (D) Bullous pemphigoid(E) Dermatitis herpetiformis

Skin Diseases

(A) Neurodermatitis (lichen simplex chronicus)(B) Psoriasis(C) Pemphigus vulgaris (D) Bullous pemphigoid(E) Dermatitis herpetiformis

Skin Diseases

A 55-year-old man presents with a large, black-colored, asymmetric skin lesion with ill-defined borders on his back. He reports a family history of malignant melanoma. Which of the following clinical variants of malignant melanoma has the poorest prognosis?

Skin Diseases

(A) Lentigo maligna melanoma(B) Superficial spreading melanoma (C) Nodular melanoma (D) Acral-lentiginous melanoma

Skin Diseases

(A) Lentigo maligna melanoma(B) Superficial spreading melanoma (C) Nodular melanoma (D) Acral-lentiginous melanoma

Skin Diseases

A 70-year-old man presents with a scaling, indurated, ulcerated nodule on the back of his left hand. He states that the nodule has been growing larger over time. The patient has had much direct sun exposure in the past. Which of the following is the most likely histologic finding in this patient's skin lesion?

Skin Diseases

(A) Invasion of the dermis by sheets and islands of neoplastic epidermal cells, often with "keratin pearls"

(B) Clusters of darkly staining basaloid cells, with a palisading arrangement of the nuclei of the cells at the periphery of the clusters

(C) Malignant melanocytes with numerous mitotic figures

(D) Abnormal proliferation of the connective tissue, with deranged arrangement of collagen fibers

Skin Diseases

(A) Invasion of the dermis by sheets and islands of neoplastic epidermal cells, often with "keratin pearls"

(B) Clusters of darkly staining basaloid cells, with a palisading arrangement of the nuclei of the cells at the periphery of the clusters

(C) Malignant melanocytes with numerous mitotic figures

(D) Abnormal proliferation of the connective tissue, with deranged arrangement of collagen fibers

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