GENERAL PATHOLOGY 2ND BIMONTHLY EXAMINATION 2020

1. A 56-year-old woman dies in a hospital where she is being evaluated for

shortness of breath, ankle edema, and mild hepatomegaly. Because of the
gross appearance of the liver at necropsy, which is seen in the photograph
below, which of the following abnormalities is most likely present? *

1 point

Portal vein thrombosis

Splenic amyloidosis

A pulmonary saddle embolus

Biliary cirrhosis

Right sided heart failure

Source: http://med-mu.com/wp-content/uploads/2018/06/Pathology.Pre-Test.pdf

Ratio:157. The answer is b. Right heart failure (Kumar, pp 122, 563, 918. Rubin, pp 283–284.) The
photograph shows the classic pattern of hepatic congestion around central veins, which leads to
necrosis and degeneration of the hepatocytes surrounded by pale peripheral residual parenchyma.
This is the pattern arising in the liver from chronic passive congestion as a result of right heart failure
(“nutmeg liver”). Mitral stenosis with consequent pulmonary hypertension leads to right heart failure,
as does any cause of pulmonary hypertension, such as emphysema (cor pulmonale). Right heart
failure also leads to congestion of the spleen and transudation of fluid into the abdomen (ascites) and
lower- extremity soft tissues (pitting ankle edema) as a result of venous congestion. Portal vein
thrombosis is most often seen in association with hepatic cirrhosis.

2. A 45-year-old woman dies several days after a partial small bowel resection
for repair of a volvulus. The surgery had apparently gone well, but shortly
afterward she developed intractable fever, hypotension, multiorgan failure,
and marked respiratory distress. Just prior to death, chest radiographs
showed complete "whiteout" of both lungs. At autopsy, both lungs were found
to have collapsed or distended alveoli, many of which were lined with fibrin-
rich hyaline membranes. The cause of these pulmonary findings is best
characterized as *

1 point

Pneumothorax

Generalized atelectasis

Diffuse alveolar damage

Lobar consolidation

Aspiration
 3. The image below is taken from the endometrium a 65-year-old woman with
uterine bleeding. Which of the following is associated with this condition? *

1 point

Arsenic exposure

BRCA mutations

Prolonged exposure to estrogens

Sexual promiscuity

Endometriosis

4. A 67-year-old man, a heavy smoker, is seen because of dyspnea and cough. A

chest X-ray reveals abnormal densities, and a computed tomography (CT)
scan is suggestive of a neoplasm involving the pleura. A biopsy confirms the
diagnosis of mesothelioma. Other than cigarette smoke, this finding suggests
exposure to which toxin? *

1 point
β-Naphthylamine

Aflatoxin B1

Ionizing radiation

Asbestos

Diethylstilbestrol (DES)

5. A 50-year-old woman had a partial colectomy with apparent complete and

uneventful recovery. The histologic findings is shown below.At follow up
visits, her physician is particularly interested in changes that may occur in
which of the following laboratory measures? *

1 point

α-fetoprotein (AFP)

CA 125
Vanillylmandelic acid (VMA)

Carcinoembryonic antigen (CEA)

Human chorionic gonadotropin (hCG)

Sourcw:
https://www.memorangapp.com/flashcards/167665/BRS+Pathology+Comprehensive/

6. Molecular analysis of the tumor in the image below reveals that it harbors a
mutation in codon 12 of the ras oncogene. The mutant gene codes for a ras
protein product that has *

1 point

increased protein phosphatase activity

increased responsiveness to growth factors

increased tyrosine kinase activity

decreased GTPase activity

decreased reverse transcriptase activity

7. Commonly altered gene in this neoplasm as shown in this image is the *

1 point
RB gene

APC gene

ABL gene

MYC gene

WT gene

8. A 60-year-old man presents with progressive bone deformity and pain,

progressive hearing loss, and increasing skull size. Workup revealed
generalized increased bone density with cortical thickening, normal serum
calcium and phosphorus, and markedly elevated serum alkaline phosphatase.
Biopsy image is shown below. Which one of the following tumors is a known
complication of the disorder suggested by this scenario? *

1 point

Metastatic duct carcinoma of the breast

Ewing sarcoma
 Multiple enchondromas

Osteosarcoma

Giant cell tumor

Source:
https://www.memorangapp.com/flashcards/167665/BRS+Pathology+Comprehensi
ve/

9. What is the usual route of metastasis of malignant tumors of the bone? *

1 point

Lymphatics

Direct seeding

Hematogenous

10. A 56-year-old man is seen in the emergency room because of the acute onset
of severe crushing precordial chest pain that began on the golf course 1 hour
earlier and has persisted until the time of admission. The ECG reveals
precordial QS waves and elevated ST segments. Although normal at
admission, both the serum creatine kinase MB (CK-MB) and troponin I (cTn-I)
are significantly elevated 12 hours later. These changes are related to which
type of necrosis? *

1 point
CASEATION

ENZYMATIC FAT

LIQUEFACTIVE

GANGRENOUS

COAGULATIVE

11. What is the most likely diagnosis in this case? *

1 point

CARDIOMYOPATHY

MYOCARDIAL INFARCTION

MYOCARDIAL HYPERTROPHY

MYOCARDITIS
 12. What is the most common cause of coronary artery thrombosis? *

1 point

Hypercoagulability

Stasis or turbulent blood flow

Endothelial injury

13. Ten years later, the patient developed this complication as shown in the photo
below. What is the most likely diagnosis? *

1 point

Pulmonary edema
Pulmonary congestion

Bronchopneumonia

Lobar pneumonia

14. The patient's complication is caused by *

1 point

Lymphatic obstruction

Decreased colloid osmotic pressure

Sodium retention

Increased vascular permeability

Increased hydrostatic pressure

15. What is the earliest and most significant symptom of left sided heart failure? *

1 point

Dyspnea on exertion

Chest pain

Orthopnea

16. Upper and lower gastrointestinal endoscopic examinations are performed on

a 45-year-old man. A lesion is found and the patient is told that the lesion has
NO malignant potential. Of the following choices, which is the lesion that was
most likely found? *

1 point
Duodenal peptic ulcer

Option 5

Colorectal villous adenoma (PLEASE RECHECK)

Familial multiple polyposis (Pls. Sad ko double check ani :))

Crohn disease

17. A pathologist examines an excisional biopsy specimen and confirms the

working diagnostic impression of adenocarcinoma. Because of the nature of
the tumor, he requests molecular diagnostic evaluation by the molecular
pathology laboratory. Amplification of the HER-2/neu oncogene is
demonstrated. This finding is a negative prognostic indicator in carcinoma of
the *

1 point

KIdney

Adrenal

Thyroid

Stomach

Breast

18. The patient underwent targeted treatment using Herceptin but stopped after
two sessions. Ten years later, she complained of difficulty of breathing. CT
scan of the chest shows multiple lung lesions. With the present findings, the
patient is now in *

1 point

Stage 1

Stage II
 Stage IV

Stage III

19. What is the most important prognostic indicator of malignancy *

1 point

Tumor stage

Features of Anaplasia

HIgh Mitotic count

Tumor grade

With current treatment protocols, tumor stage rather than histologic type is the most important
prognostic variable. -Robbins

20. A 35-year-old man presents with a painless lump in his right testicle. Scrotal
ultrasound reveals a homogeneous intratesticular mass. The microscopic
picture is shown below. How do you call a malignant tumor arising from the
testicular epithelium? *

1 point
Sertoli cell tumor

Spermatocytic tumor

Dysgerminoma

Testicular carcinoma

Seminoma SAKTO ni

-(🤩thank you)

21. A 30-year-old woman presents with weakness and hyperreflexia of the left
lower extremity. These symptoms had begun as mild weakness, but had
slowly and progressively become more severe. A CT scan of the head reveals
a well-defined right-sided parasagittal mass compressing (but not invading)
the brain parenchyma. Patient underwent surgery and below is the histologic
findings. How do you call a tumor arising *

1 point

Oligodendroglioma

Glioblastoma multiforme

Neurilemmoma (schwannoma)

Meningioma
 22. A 65-year-old man presents with urinary hesitancy, frequency, urgency,
sensation of incomplete bladder emptying, and straining to start the urinary
stream. Digital rectal examination is performed. Further workup reveals the
diagnosis based on the histologic findings below. Is this a benign or
malignant lesion? *

1 point

BENIGN

MALIGNANT

23. A 65-year-old man presents with urinary hesitancy, frequency, urgency,

sensation of incomplete bladder emptying, and straining to start the urinary
stream. Digital rectal examination is performed. Further workup reveals the
histologic findings below. Which of the following is an association of this
disorder? *

1 point huhu
Tends to arise in the peripheral zone of the prostatic glands

Often improves over time without intervention

May frequently progress to bony osteoblastic metastases

Tends to arise in the central zone of prostatic glands.

24. A 60-year-old man presents with painless hematuria. Cystoscopy followed by

transurethral biopsy of the bladder mass is performed. Histologic findings is
shown below. How do you call a benign neoplasm arising from this organ? *

1 point

Urothelioma

Urothelial carcinoma

Urothelial papilloma kindly check lang po

Urothelial sarcoma

Renal adenoma

25. A 35-year-old woman consults a gynecologist because she has postcoital

vaginal bleeding. The Papanicolaou (Pap) smear is abnormal. Colposcopy and
cervical biopsy lead to a diagnosis of carcinoma of the cervix with histologic
findings below. Which of the following is most characteristic of this disorder?
*

1 point

History of exogenous estrogen therapy

Secretion of AFP

Association with human papillomavirus (HPV) infection

Association with EBV infection

26. A 65-year-old man presents with recurrent fever and painless cervical and
supraclavicular lymphadenopathy. FNAB was done in one of the enlarged
 nodes and confirmed by tissue biopsy which is shown below. How do you call
a malignant tumor arising from the lymphoid tissue? *

1 point

Lymphangiosarcoma

Lymphosarcoma

Lymphangioma

Lymphoma

Source:Robbins chapter 6 Neoplasia table 6.1

27. A 25-year-old woman is seen because of numbness and pain in her fingers
and hands on exposure to cold. When either her hands or feet are very cold,
they turn white and then blue. These changes are characteristic of which of
the following? *

1 point

Kawasaki disease

Buerger disease (thromboangiitis obliterans)

Takayasu arteritis

Raynaud disease
 28. A cystic ovarian mass was palpated in a 23-year-old woman. If X-ray films
revealed calcifications in the mass, which of the following would be most
likely? *

1 point

Choriocarcinoma

Krukenberg tumor

Mature Teratoma

Brenner tumor

29. A 52-year-old, female goes to her internist because of vague abdominal pain
and a feeling of fullness. Her medical history is noncontributory. Her internist
does a physical exam and He noted abdominal fullness with a fluid wave
consistent with ascites. He also performs a pelvic exam. A 10 cm left adnexal
mass is easily felt. Cytologic examination of the ascitic fluid is performed . At
laparotomy, an ovarian malignancy is diagnosed by the pathologist by doing a
frozen section . Tumor is found to have spread to her other ovary, omentum,
and numerous sites on her peritoneum. She receives chemotherapy. One of
the serum marker listed below is requested before laparotomy *

1 point
AFP

CA 19-9

B-HCG

CEA

CA 125

30. A 56 year old female is monitored every six months for her B-HCG level. Which
among the histologic findings best describes this case? *

1 point

Option 5 pls. Double check

Option 2

Option 1
 Option 3

Option 4

31. A 59-year-old man is found to have a 3.5-cm mass in the right upper lobe of
his lung. A biopsy of this mass is shown below. Workup reveals that no bone
metastases are present, but laboratory examination reveals that the man’s
 serum calcium level is 11.5 mg/dL. This patient’s paraneoplastic syndrome is
most likely the result of the ectopic production of which of the following
substances? *

1 point

Parathyroid hormone

Calcitonin- related peptide

Parathyroid hormone–related peptide

Erythropoietin

Calcitonin

32. A 37-year-old woman presents with a slowly enlarging lesion on her left
forearm. The lesion is excised and a representative section is shown below.
What is the correct diagnosis? *

1 point
Adenoma

Fibroma

Hemangioma

Lymphangioma

Leiomyoma

33. A 56-year-old man presents with signs and symptoms of iron deficiency
anemia due to losing blood from a tumor mass in his colon. A biopsy from
this mass is seen in the associated picture. Which of the following is the cell
of origin of this tumor? *

1 point

Smooth muscle cell

Endothelial cell
Glandular epithelial cell sakto ni 🤩

Urothelial epithelium

Squamous epithelial cell PLS DOUBLE CHECK

34. The product of the p53 antioncogene is a nuclear protein that regulates DNA
replication and prevents the proliferation of cells with damaged DNA. It does
this by stopping the cell cycle at which point? *

1 point

Between S and G2

Between M and G1

Between G1 and S

Between G2 and M

35. A 34-year-obese male long-term smoker has a history of hypertension and

diabetes mellitus. Workup finds elevated serum levels of cholesterol,
homocysteine, and apoprotein(a). Further evaluation finds that he does not
exercise and is under tremendous stress at work. Which one of the following
is considered to be a major risk factor for this patient to develop
atherosclerosis? *

1 point

Lack of exercise

Cigarette smoking

Male gender

Increased homocysteine
 36. During a routine physical examination, a 60-year-old man is found to have a 5-
cm pulsatile mass in his abdomen. Angiography reveals a marked dilation of
his aorta distal to his renal arteries. Which of the following is the most likely
cause of this aneurysm? *

1 point

Congenital defect

Hypertension

Trauma

Atherosclerosis

Previous syphilitic infection

37. A 59-year-old man presents with increasing shortness of breath and problems
sleeping. He has a long history of poorly controlled hypertension. Physical
examination finds distention of his neck veins, crepitant rales in both lower
lungs with histologic findings below, and bilateral edema of his feet. A chest
x-ray reveals his heart to be dilated and enlarged. Which of the following is the
basic defect that caused these clinical signs? *

1 point
Decreased peripheral resistance caused low-output cardiac failure

Increased contractility of cardiac muscle caused high-output cardiac failure

Increased preload caused diastolic dysfunction of his heart

Decreased viscosity of blood caused decreased diastolic filling of his heart

Increased afterload caused systolic dysfunction of his heart

38. A 59-year-old man develops intense substernal, crushing chest pain that is not
relieved by nitroglycerin. He is admitted to the MICU, where ECGs find
evidence of myocardial infarction with ST-segment elevation. His condition
rapidly worsens as he develops severe heart failure and dies 2 days later. At
autopsy a large necrotic area is found that involves the anterior left ventricle.
What is the most likely cause of this patient’s myocardial infarction? *

1 point

Coronary artery thrombosis

Coronary artery embolism

Coronary amyloid deposition

Coronary macroscopic arteritis

Coronary artery vasospasm

 39. A 63-year-old man presents with signs of congestive heart failure, including
shortness of breath, cough, and paroxysmal nocturnal dyspnea. Physical
examination reveals a hyperdynamic, bounding, “water-hammer” pulse and a
high-pitched decrescendo diastolic murmur at the left sternal border after the
second heart sound. His hyperdynamic pulse causes “bobbing” of his head.
Which of the following is the most likely diagnosis? *

1 point

Mitral stenosis

Mitral regurgitation

Aortic stenosis

Constrictive pericarditis

Aortic regurgitation

40. A 7-year-old boy presents with the acute onset of fever, pain in several joints,
and a skin rash. Physical examination finds an enlarged heart, several
subcutaneous nodules, and a skin rash on his back with a raised,
erythematous margin. Laboratory tests find an elevated erythrocyte
sedimentation rate and an elevated antistreptolysin O titers. Which one of the
following is most likely to be present in the heart of this child? *

1 point

Trypanosoma cruzi organisms

Anitschkow cells

Psammoma bodies

β-Hemolytic streptococci

Ratio:
Rheumatic fever (RF) is a systemic autoimmune disease that usually develops 10
days to 6 weeks after a pharyngeal infection with group A beta-hemolytic
streptococci. This autoimmune disorder results from crossreactions between
cardiac antigens and antibodies evoked by one of the many streptococcal antigens,
e.g., streptococcal M protein. Rheumatic fever produces both acute and chronic
manifestations. Acute RF include migratory polyarthritis of large joints, carditis,
erythema marginatum of skin (although skin involvement is not very common),
subcutaneous nodules, and Sydenham chorea. The acute cardiac lesions of
rheumatic fever (carditis) are characterized by the accumulation of modified tissue
monocytes (called Anitschkow myocytes) around areas of fibrinoid necrosis. This
entire area is called an Aschoff body. The nuclei of the Anitschkow cells are long,
slender, wavy ribbons that resemble a caterpillar (hence the name “caterpillar cells”).
Occasional multinucleated giant cells (Aschoff cells) may be seen. The Aschoff
body, which is pathognomonic for acute rheumatic fever, may be found in any of the
three layers of the heart (pancarditis). In the pericardium, there is a fibrinous
pericarditis, which is called a “bread and butter” pericarditis. The endocardial
response in acute rheumatic fever is characterized by the formation of small friable
vegetations (verrucae) along the lines of closure of the valves.

In contrast, chronic RF mainly produces damage to cardiac valves. The mitral valve
is most commonly involved, followed by the aortic valve. The stenotic valve has the
appearance of a “fish mouth” or “buttonhole.” An additional finding in chronic RF is a
rough portion of the endocardium of the left atrium, called a MacCallum’s patch.

41. At the time of autopsy of a 39-year-old woman who died of complications of

systemic lupus erythematosus, several medium-sized vegetations are found
on both sides of the mitral valve and tricuspid valve. Histologic sections of
these lesions reveal the presence of hematoxylin bodies. Which one of the
listed terms best describes these lesions? *
1 point

MacCallum patches

Roth spot

Libman-Sachs endocarditis

Marantic endocarditis

Janeway lesions

42. Gross examination of the heart from an autopsy of a 38-year-old man who
was a long-term alcoholic and died from congestive heart failure reveals the
heart to be markedly enlarged, banana shaped, and flabby, with dilation of all
four chambers. The walls of the ventricles are thin and there are multiple
small mural thrombi present. No abnormalities of the cardiac valves are seen.
The coronary arteries are within normal limits. What is the best classification
for this abnormal heart? *

1 point

Hyperptrophic cardiomyopathy

Obliterative cardiomyopathy

Dilated cardiomyopathy

Hyperplastic cardiomyopathy

43. What is the characteristic morphologic change seen in the heart of an autopsy
case of a 38 year old man? *

1 point

Four chamber dilatation

Interstitial myocardial inflammatory cells

Asymmetric septal hypertrophy

Exudates in the pericardium

Firm and non compliant myocardium

44. A 2-month-old girl is being examined for a routine checkup. She was born at
term, and there were no problems or complications during the pregnancy. The
baby appeared normal at birth and has been asymptomatic. Physical
examination at this time finds a soft systolic murmur with a systolic thrill. No
cyanosis is present, and her peripheral pulses are thought to be within normal
limits. An ECG reveals slight left ventricular hypertrophy. Which of the
following is the most likely diagnosis? *

1 point

Coarctation of the aorta

Patent ductus arteriosus

Ventricular septal defect

Persistent truncus arteriosus

45. Which one of the following statements correctly describes the flow of blood in
an individual with an atrial septal defect who develops Eisenmenger
syndrome? *

1 point

Right ventricle to left ventricle to aorta to right atrium to right ventricle

Aorta to pulmonary artery to lungs to left atrium to left ventricle to aorta

Left atrium to right atrium to right ventricle to lungs to left atrium

Left ventricle to right ventricle to lungs to left atrium to right ventricle

 Right atrium to left atrium to left ventricle to aorta to right atrium - wako sure ani paki double
check lang palihog thank youu🤩

46. While recovering in bed 1 week after an abdominal hysterectomy, a 42-year-

old woman develops acute shortness of breath with hemoptysis. Physical
examination finds the patient to be afebrile with moderate respiratory
distress, calf tenderness, and a widely split S2. Which of the following is the
most likely diagnosis? *

1 point

Atelectasis

Pulmonary embolus

Bacterial pneumonia

Viral pneumonia

Pulmonary hypertension

Was about to answer na… salamat sa nag highlight!

47. A 63-year-old man who is a long-term smoker presents with increasing

shortness of breath and dyspnea. He has smoked more than two packs of
cigarettes per day for more than 40 years. He denies having a productive
cough or any recent infections. Physical examination reveals a thin elderly
appearing man in moderate respiratory distress. While sitting he leans slightly
forward and breathes quickly through pursed lips. He is afebrile and his blood
pressure is within normal limits. Examination of his chest reveals an
increased anteroposterior diameter and his lungs are hyper-resonant to
percussion. His respiratory rate is increased, but no clubbing or cyanosis is
present. Chest x- ray reveals his heart to be of normal size, but there is
hyperinflation of his lungs. Laboratory examination reveals that while
breathing room air, his arterial PO2 is decreased but his arterial PCO2 is
normal. Which of the following statements is an accurate association
concerning the pathogenesis of this man’s pulmonary disease? *
1 point

Destruction of the cilia on the respiratory epithelial cells resulted in bronchiectasis

Destruction of the proximal acinus caused centrilobular emphysema

Hyperplasia on the respiratory mucus glands caused chronic bronchitis

Hyperplasia of the respiratory smooth-muscle cells resulted in intrinsic asthma

48. A 39-year-old woman presents with a cough and increasing shortness of

breath. A chest x-ray is interpreted by the radiologist as showing a right lower
lobe (RLL) pneumonia. No mass lesions are seen. The woman is treated with
antibiotics, but her symptoms do not improve. On her return visit, the area of
consolidation appears to be increased. Bronchoscopy is performed. No
bronchial masses are seen, but a transbronchial biopsy is obtained in an area
of mucosal erythema in the RLL. After the diagnosis is made, the RLL is
removed and a section from this specimen reveals well-differentiated mucus-
secreting columnar epithelial cells that infiltrate from alveolus to alveolus.
Which of the following is the most likely diagnosis *

1 point
Small cell carcinoma

Lepidic (Bronchioloalveolar ) adenocarcinoma

Carcinoid

Large cell carcinoma

Squamous cell carcinoma

49. During a routine physical examination, a 43-year-old man is found to have a

2.5-cm “coin” in the peripheral portion of his right upper lobe (RUL). Several
sputum samples sent for cytology are unremarkable, and a bronchoscopic
examination is also unremarkable. Surgery is performed and the mass is
resected. Histologic examination reveals lobules of connective tissue that
contain mature hyaline cartilage. These lobules are separated by clefts that
are lined by respiratory epithelium. Which of the following is the most likely
diagnosis? *

1 point
Lepidic adenocarcinoma

Hamartoma

Carcinoid

Finroma

Adenocarcinoma

50. A 37-year-old woman presents with the acute onset of a productive cough,
fever, chills, and pleuritic chest pain. A chest x-ray reveals consolidation of the
entire lower lobe of her right lung. She unexpectedly dies before treatment
due to a cardiac arrhythmia. Histologic examination of lung tissue taken at the
time of autopsy reveals multiple suppurative, neutrophil-rich exudates filling
the bronchi, bronchioles, and alveolar spaces as shown in the image below.
The majority of lung tissue from her right lower lung is involved in this
inflammatory process. Hyaline membranes are not found. Which of the
following is the most likely diagnosis? *

1 point
Lobar pneumonia

Bronchopneumonia

Bronchiectasis

Interstitial pneumonitis

Pulmonary abscess

51. A 44-year-old alcoholic man presents with fever and a productive cough with
copious amounts of foul-smelling purulent sputum. Physical examination
finds that changing the position of this individual produces paroxysms of
coughing. Which of the following is the most likely cause of this patient’s
signs and symptoms? *

1 point

Esophageal reflux

Myocardial infarction
 Pulmonary abscess

Esophageal cancer

Pulmonary infarction

A pulmonary abscess is a localized suppurative process within the pulmonary parenchyma that is
characterized by tissue necrosis and
marked acute inflammation.
- Possible causes of a lung abscess include aerobic and anaerobic streptococci, Staphylococcus
aureus, and many gram-negative
organisms.
- Aspiration more often gives a right-sided single abscess, because the airways on the right side are
more vertical. Antecedent pneumonia
gives rise to multiple diffuse abscesses.
- The abscess cavity is filled with necrotic suppurative debris unless it communicates with an air
passage. Clinically an individual with a
lung abscess will have a prominent cough producing copious amounts of foul-smelling, purulent
sputum.
- Changes in position evoke paroxysms of coughing. There is also fever, malaise, and clubbing of the
fingers and toes.
- With antibiotic therapy 75% of lung abscesses resolve. Complications of a lung abscess include
pleural involvement (empyema) and
bacteremia, which could result in brain abscesses or meningitis

SOURCE: https://www.coursehero.com/file/p2okfbu/A-44-year-old-alcoholic-man-presents-with-fever-
and-a-productive-cough-with/

52. A routine chest x-ray performed on an asymptomatic 31-year-old man who

works at sandblasting reveals a fine nodularity in the upper zones of the lungs
and “eggshell” calcification of the hilar lymph nodes. The patient’s serum
calcium level is 9.8 mg/dL, while his total protein is 7.2 g/dL. He denies any
history of drug use or cigarette smoking. A biopsy from his lung reveals
birefringent particles within macrophages. This individual has an increased
risk for developing which one of the listed disorders? *

1 point
Myxomatosis

Anthracosis

Tuberculosis

Berylliosis

Sarcoidosis

53. Two years later, the patient in the above case developed lymphadenopathies.
Which of the following histologic abnormalities is most likely to be seen in
biopsy specimens from these enlarged hilar lymph nodes? *

1 point

Option 1
Option 3

Option 4
Option 2

54. A 20-year-old woman complains of double vision, fainting spells, tingling of

the fingers of her left hand, and numbness of the fingers of her right hand.
Physical examination reveals absence of pulse in her right arm. Laboratory
tests show elevated erythrocyte sedimentation rate and thrombocytosis. An
aortogram demonstrates narrowing and occlusion of branching arteries,
including the right subclavian artery. What is the treatment for this disease? *

1 point

Corticosteroids

Vitamin B complex

Massage

NSAIDS

Anti-hypertensives
 55. 19-year-old man with a history of recent-onset asthma presents with chest
pain, intermittent claudication, and respiratory distress that is unresponsive to
bronchodilators and antibiotics. Physical examination reveals mild
hypertension (blood pressure = 150/100 mm Hg), bilateral wheezing, and
numerous purpuric skin lesions on the feet. Laboratory studies demonstrate
that leukocytes are increased to 14,000/uL with increased eosinophils and
platelets are increased to 450,000/uL. BUN is elevated to 30 mg/dL, and
serum creatinine is elevated to 3.5 mg/dL. The serum antineutrophil
cytoplasmic antibody test is positive. Urinalysis discloses 3+ proteinuria and
RBCs. A renal biopsy demonstrates vasculitis of medium-sized arteries,
accompanied by eosinophilia. This disease is positive for: *

1 point

ANA

p-ANCA

c-ANCA

Anti-endothelial cell antibodies

Complex formation

56. A 50-year-old man has a 2-year history of angina pectoris that occurs during
exercise. On physical examination, his blood pressure is 135/75 mm Hg, and
his heart rate is 79/min and slightly irregular. Coronary angiography shows a
fixed 75% narrowing of the anterior descending branch of the left coronary
artery. He has several risk factors for atherosclerosis: smoking, hypertension,
and hypercholesterolemia. Which of the following is the hallmark of
atherosclerosis? *

1 point
thrombosis

fatty streaks

LDL deposition

Atheromatous plaque

Endothelial dysfunction

57. A 70-year-old, previously healthy man presents with right upper quadrant pain.
Physical examination demonstrates hepatomegaly. A liver biopsy reveals a
vascular lesion composed of pleomorphic endothelial cells with
hyperchromatic nuclei and numerous mitoses. Laboratory tests for HIV
infection are negative. Which of the following is the most likely diagnosis? *

1 point

Kaposi sarcoma

Hemangioma

Dermatofibroma

Angiosarcoma

Glomus tumor

58. A neonate developing normally has a newborn checkup. On physical

examination, there is a systolic murmur. Echocardiography reveals a muscular
defect of the intraventricular septum. A checkup 30 years later fails to reveal
either a murmur or a flow defect between the ventricles. Which of the
following cells most likely proliferated and led to disappearance of the defect?
*

1 point

Stem cells
Fibroblasts

Adipocytes

Conduction cells

Endothelial cells

59. A 50-year-old man with adenocarcinoma of the pancreas is brought to the

emergency room in a comatose state. A CT scan of the brain is consistent
with a recent infarct in the left temporal lobe. Blood cultures are negative. The
patient never regains consciousness and expires 2 days later. The heart at
autopsy is shown in the image. Which of the following is the most likely
underlying cause of stroke in this patient? *

1 point

Calcific aortic stenosis

Nonbacterial thrombotic endocarditis

Subacute bacterial endocarditis

Carcinoid heart disease

Cardiac metastases

60. A 2-week-old boy is irritable and feeding poorly. On physical examination, the
infant is irritable, diaphoretic, tachypneic, and tachycardic. There is circumoral
 cyanosis, which is not alleviated by nasal oxygen. A systolic thrill and
holosystolic murmur are heard along the left sternal border. An
echocardiogram reveals a heart defect in which the aorta and pulmonary
artery form a single vessel that overrides a ventricular septal defect. What is
the appropriate diagnosis? *

1 point

Patent ductus arteriosus

Tetralogy of Fallot

Truncus arteriosus

Atrial septal defect

Coarctation of aorta, preductal

61. The coronary artery shown is from a 22-year-old man who died in a motor
vehicle accident. What laboratory test is an independent and highly predictive
indicator of risk of myocardial infarction or cardiac-related death? *

1 point

Homocysteine

CK-MB

Troponin

CRP

LDL-cholesterol

Source: Robbins - page 493

 62. A 40-year-old diabetic woman was evaluated in the emergency room for chest
pain. She had a history of hypertension and a 30 pack-year smoking history.
Her medications included antihypertensives and cholesterol-lowering
agents.Vital signs: HR 105, BP 100/50 (her usual BP was about 155/95),
temp. 100F She was obese and diaphoretic (sweating profusely) with pale
skin and labored respirations.Rales were heard over both lung fields. An EKG
and serial cardiac markers were ordered and showed elevation of CK-MB and
Troponin I values.What is the most likely diagnosis?*

1 point

Hypertensive cardiomyopathy

Valvular heart disease

Congestive heart failure

Ischemic heart disease

63. What is the biochemical marker of choice for the assessment of acute
coronary syndromes? *

1 point

Lipase

CK MB

LDH

Troponin I

64. A ten-year-old child was brought to a pediatrician because of a mild sore

throat. The pediatrician noticed some redness, swabbed her throat, tested for
group A streptococci in the office, sent blood for antistreptolysin O titer, and
prescribed treatment.Three weeks later, the child returned with fever and
 painful swelling of the knee joints, followed by pain and swelling of elbow
joints. Physical examination revealed a pericardial friction rub and a murmur
suggestive of mitral regurgitation. The antistreptolysin O titer was elevated
over the previous value.The week before her next admission, she went to a
dentist because of tooth pain, and underwent a dental extraction. She
returned to the hospital with high spiking fevers and overt signs and
symptoms of heart failure. What is the most likely diagnosis? *

1 point

Subacute infective endocarditis

Rheumatic heart disease

Acute infective endocarditis

NOne of the above

65. What best describes vegetative endocarditis of this heart disease? *

1 point

Small or medium-sized vegetations on either or both sides of the valve leaflets

Small,blands vegetations attached to the line of closure

Large irregular masses on the valve cusps

Small warty vegetations along the lines of closure of the valve leaflets

66. A 45-year-old man was found wandering in downtown with alcohol on his
breath and coughing up thick, rusty sputum Physical exam revealed a thin
white male who was anxious and mildly cyanotic. Other abnormal physical
findings included tachypnea and chest splinting accompanied by fine rales,
and decreased breath sounds by auscultation over the aright lower lobe. His
temperature was 100.2° but his pulse was normal.WBC count was 16 x 103/µl
 (ref. range 4.1-10.9 x 103/Blood gases demonstrated hypoxia and respiratory
alkalosis. Sputum was collected for smear and culture and two sets of blood
cultures over the next hour were drawn. A gram stain of the sputum showed
lancet-shaped gram-positive diplococciHowever, he became progressively
more hypoxic, was placed in the intensive care unit on increasing
concentrations of oxygen, and expired 24 hours after admission. During this
time both of the blood cultures were positive for S. pneumoniae. An autopsy
was done. In the four stages of lobar pneumonia, this stage is characterized
by progressive disintegration of red cells and persistence of
fibrinosuppurative exudate *

1 point

Congestion

Resolution

Red hepatization

Gray Hepatization

67. This is one of the most feared complication of pneumonia? *

1 point
Pleuritis

Bacteremic dissemination

Emphysema

Abscess formation

68. What predisposed this patient to get pneumonia? *

1 point

Chronic alcoholism

Malnutrition

Immunosuppression

All of the three

69. What accounts for the rusty sputum in this case?The sputum is comprised of
the exudate in the alveoli; it is rusty because of *

1 point

Red cells in the exudate

Carbon pigments in the exudate

WHite cells in the exudate

Hemosiderin-laden pigments in the exudate

70. ..A 52-year-old woman develops fatigue and dyspnea that have been
worsening over about 6 months. She also complains of occasional
palpitations. She describes a serious illness she had as a child, with fever,
rash, joint pain and difficulty controlling her movements. She recovered after
about a month.Cardiac examination reveals a loud S1, an opening snap and a
 diastolic rumble. A chest radiographs shows an enlarged left atriumWhich of
the following is the best possible explanation for the heart murmurs on
auscultation? *

1 point

The presence of a ventricular septal defect as part of the syndrome

The presence of vegetations at the valve leaflets that obstructs blood flow

Large vegetation at the septum that impinge on the conduction system

All three mentioned

71. Aschoff bodies are defined as: *

1 point

Collections of large histiocytes with vesicular nuclei

Nodular foci of valvular myxoid change

Interstitial or perivascular areas of fibrinoid necrosis surrounded by inflammatory infiltrate

Valvular excrescences seen in cases of rheumatic endocarditis

Thickened endocardial ridges in the left atrium

72. 75/F dies from massive hemoptysis.Post mortem exam reveals hilar
lymphadenopathy with necrosis and infiltration and destruction of a large
pulmonary artery.Extensive pulmonary consolidation with other areas of
necrosis is noted.In what clinical setting/s is the patient likely to develop
miliary tuberculosis? *

1 point
In patients who are immunosuppressed, particularly patients undergoing cancer chemotherapy
or dialysis

In transplant recipients

In HIV-infected persons

In developing countries, children are also particularly susceptible

All of the four mentioned not sure

need help

73. An 18-year-old male had presented four years previously with difficulty in
breathing and wheezing. These attacks occurred intermittently, but were not
related to any known circumstances. x-ray of the chest was unremarkable, but
lung function tests performed when he was symptomatic demonstrated a
markedly decreased FEV1, which improved significantly after he inhaled a few
puffs of -adrenergic agonist. He was brought to ER.On arrival to the ER he was
in considerable distress; he could barely talk and was breathing 30
times/minute. Physical exam was remarkable for rare wheezing and markedly
diminished breath sounds. Arterial blood gases pH = 6.9, pCO2 = 88, pO2 = 35.
While awaiting therapy the patient suffered a cardiac arrest and could not be
resuscitatedAt autopsy, gross findings were limited to the respiratory tract.
The lungs were overinflated, with focal areas of atelectasis. And many of the
bronchi were occluded by thick, tenacious mucous plugs.What is the earliest
feature of chronic bronchitis: *

1 point

Mucus hypersecretion

Recurrent infections

Marked increase in goblet cells of small airways

Chronic irritation of the airways

 74. What best describes Reid index: *

1 point

Ratio of the thickness of the cartilage to the thickness of the epithelium

Is the ratio of the thickness of the mucous gland layer to the thickness of the wall between the
epithelium and cartilage

Ratio of the goblet cell layer to the bronchial epithelium

Ratio of the hypertrophied mucous gland layer to the wall of the alveoli

75. A 64-year-old male factory worker presented with a history of chest pain and
hemoptysis. He had lost more than 3 kg in weight in the last four weeks and
complained of feeling "run down and having no energy.” He had smoked
heavily since adolescence.The only relevant past history was a squamous cell
carcinoma of the larynx three years previously, which had been treated with
surgery and radiationPhysical examination revealed a cachectic, nervous man
with decreased breath sounds on the right side of the chest. An x-ray
demonstrated a large right upper lobe mass with central cavitation. CT scans
indicated that the mediastinal nodes were enlarged.Sputum cytology revealed
a moderate number of metaplastic and dysplastic squamous cells, and rare
malignant cells. Laryngoscopy indicated no evidence of recurrence of his
original tumor. Bronchoscopy revealed several thickened white areas, which
were biopsied, and a large polypoid mass obstructing the right upper lobe
bronchus.He received radiation therapy to the chest, but his condition
deteriorated and he died four months later. An autopsy was performed. What
is the most likely diagnosis? *

1 point

Adenocarcinoma

Squamous cell carcinoma

Lepidic carcinoma

Small cell carcinoma

76. Pathogenesis involving tobacco-associated carcinogens *

1 point

Produces point mutation of TP53

Generation of free radicals that react with the genome

Direct binding to DNA

Carcinogen activation is accomplished by cytochrome P-450 enzymes that produce reactive

electrophiles that can directly combine with DNA (not sure)

Source: Some of the metabolites produced by the p450s react with DNA or other
macromolecules to form covalent binding products known as adducts. (Neoplasia trans)

77. Type of lung cancer less strongly associated with cigarette smoking *

1 point

Small cell carcinoma

squamous cell carcinoma

Adenocarcinoma of the lung

Lepidic carcinoma

78. A woman finds her 68-year-old husband dead in his bed. During the last year
of his life he had slept on a bed in the downstairs living room, as he was
unable to walk upstairs because of extreme and worsening breathlessness.
As his death is sudden and somewhat unexpected, the General Practitioner
discusses the case with the local coroner who decides that a post-mortem
 examination is requiredAt autopsy the most significant features on external
examination are an abnormally shaped chest with an increase in the
anteroposterior diameter, and mild peripheral oedema. The most significant
abnormality on examination of the organs is seen in the lungs, which are
voluminous and meet in the anterior mediastinum, where they overlap the
heart anteriorly. There are also large air-filled and intact bullae seen in
subpleural positions and more strikingly at the apex. There is also mild
thickening of the right ventricular heart muscle. Which of the following
conditions is the most likely diagnosis of this case? *

1 point

Contraction atelectasis

Emphysema

Bronchiectasis

Chronic Bronchitis

79. Which of the following histologic features best describes the diagnosis? *

1 point

Thin and dilated alveolar walls. Chec plz not sure

Multiple microabscess formation

Hyperplastic mucus/submucus glands

Edema with eosinophilic infiltrates

80. A chain smoking 48-year-old company executive was referred to an

endocrinologist with complaints of increasing facial hair, a florid complexion,
weight gain, depression, and a productive cough. Levels of free cortisol in his
urine were very greatly increased. X-rays of his skull indicated that the
 pituitary fossa was of normal size. However, a chest x-ray demonstrated a
large mass in the right lung and he was sent to the Chest Clinic.
Bronchoscopy revealed focal areas of thickening in the right upper and middle
lobe bronchi, and compression of the middle lobe bronchus.Biopsies were
obtained and a specimen of bronchial washing was sent for cytological exam.
The tumor cells were relatively small, tightly clustered, and had inconspicuous
nucleoli. Electron microscopy revealed that some of the tumor cells contained
a few small dense core granules in the cytoplasm. Immunostains indicated
that the cells stained positive for ACTH and calcitonin. Bone scans and
biopsies were obtained.Despite further chemotherapy, his condition
progressively declined and he died six weeks later. At autopsy multiple body
sites were involved with tumor. Microscopic examination of the metastases
revealed tumor containing multiple forms of differentiation including small
cell, squamous cell, and adenocarcinoma elements. What is the most likely
diagnosis in this case? *

1 point

Metastatic carcinoma

Adenocarcinoma

Bronchoalveolar carcinoma

Small cell carcinoma

Squamous cell carcinoma

81. Which of the following features best describes the malignant tumor found in
this patient? *

1 point

The tumor cells can elaborate ACTH and Calcitonin.

The neoplasm is capable of metastasis to other organs.

The hormone excess and the tumor are two different cases.

Radiologic studies are often diagnostic in this case

Thickening of the bronchi is a consistent finding.

82. A 62-year old man was admitted to the hospital with a chief complaint of
"short of breath." For several months prior to admission the patient noted a
gradual onset ki weakness and fatigue and a 15 pound weight loss. When he
became short of breath on climbing one flight of stairs, he came to the
emergency room. In the emergency room a chest x-ray revealed diffuse
interstitial markings. Significant past history indicated that he had worked as
a sandblaster for three years as a young man but he asserted that he was
careful to wear a facemask. He denied a history of smoking and exposure to
beryllium, irradiation, coal dust, or asbestos. Oral temperature was 37.0°C,
blood pressure 120/80 mm Hg, pulse 80 beats/min and respiration 20
breaths/min. The remainder of the physical exam was unremarkable.
Laboratory Data: WBC and differential counts were normal. Hematocrit,
hemoglobin, urinalysis, and a serum chemistry profile were normal.
Pulmonary function tests: diminished total lung capacity, decreased diffusion
capacity, mildly decreased forced expiratory volume at 1 sec (FEV1).The
patient had a dry cough and was unable to produce sputum. His PPD skin test
response was negative at 48 hr. An open lung biopsy was performed. Over the
ensuing few years the patient's lung function progressively deteriorated, and
he eventually required continuous oxygen. He expired and an autopsy was
performed.Which of the following explains the significance of the diffuse
interstitial markings seen in the patient’s chest X-ray result? *

1 point

An active pulmonary tuberculosis is difficult to rule out at this point.

Diffuse fibrosis of alveolar walls indicative of interstitial lung disease

The patient has the typical presentation of obstructive lung disease

This is typical of pulmonary hypertension, edema, and congestion

The finding indicates an underlying acute respiratory distress syndrome.

83. A 30-year-old female presented with fever, chills, and shortness of breath x 24
hours. She was well until 4 da in ys earlier, when she noted pain on urination
followed shortly thereafter by pain in her left flank. She had a history of
diabetes and was treated with insulin. On arrival: Blood pressure 70/40, pulse
120, respiratory rate 24, temperature 39°. On examination, wet rales were
present in both lungs, and there was tenderness in the left flank. Chest x-ray
revealed bilateral diffuse pulmonary infiltrates. Lab investigations: WBC:
14,000, 90% PMN, 10% bands, Hematocrit 26, with fragmented red cells on
peripheral blood smear; platelets = 25,000; protime = 18 sec (normal = 12
sec), PTT = 80 sec (normal = 35 sec); arterial blood gases pH = 7.25, pCO2 =
36, pO2 = 68; creatinine 4.8, glucose 600; urine cloudy with protein and
increased polys.Course: Patient was intubated, placed on Dopamine, 100% 02,
and intravenous antibiotics. She experienced progressive hypotension, an
upper GI hemorrhage, and intractable acidosis; blood cultures grew gram
negative rods. She died on the second hospital day. At autopsy her lungs were
heavy, firm, red, and boggy. Which of the following statements is least likely
related to the condition of the patient? *

1 point

The low platelet count with extended protime and PTT may have meant DIC

The patient is rendered immunocompromised due to her Diabetes mellitus

The same microorganism may have caused the patient’s UTI and pneumonia.

Antibiotic treatment may lead to negative growth patterns in blood cultures

Heart attack triggered by a kidney stone might have caused the patient’s death
 84. An 18-year-old male had presented four years previously with difficulty in
breathing and wheezing. These attacks occurred intermittently but were not
related to any known circumstances. An x-ray of the chest was unremarkable,
but lung function tests performed when he was symptomatic demonstrated a
markedly decreased FEV1, which improved significantly after he inhaled a few
puffs of B-adrenergic agonist. The patient was prescribed a B-adrenergic
inhaler. Although the latter provided some relief, the patient continued to
experience episodes of breathlessness and was subsequently prescribed a
steroid inhalant. While this provided much greater relief for four years, he had
stopped taking all medication for the past several weeks because of financial
reasons. He now presented to the ER with severe shortness of breath of 8
hours duration. On arrival to the ER he was in considerable distress; he could
barely talk and was breathing 30 times/minute. Physical exam was
remarkable for rare wheezing and markedly diminished breath sounds.
Arterial blood gases pH = 6.9, pCO2 = 88, pO2 = 35. While awaiting therapy the
patient suffered a cardiac arrest and could not be resuscitated.At autopsy,
gross findings were limited to the respiratory tract. The lungs were
overinflated, with focal areas of atelectasis. Many of the bronchi were
occluded by thick, tenacious mucous plugs.Which of the following
microscopic findings will most likely point to Bronchial asthma as the
etiology? *

1 point

Squamous metaplasia in the respiratory epithelium

Hyperplastic mucous and submucous glands (Not sure)

Curschmann spirals and Charcot-Leyden cyrstals

Honeycomb pattern of pulmonary fibrosis.

Edema and extensive fibripurulent exudates

Pathology

Why can't the patient breathe?

(Bronchi and bronchioles contain thick, tenacious mucous plugs. The mucous contains
Curschmann's spirals, eosinophils and Charcot-Leyden crystals.)

85. A 21 year old nulliparous woman complains of lower abdominal

“heaviness”.On examination, she has a normal-sized,non-tender uterus and a
9cm right adnexal mass is palpated. On sonography, the mass appears cystic
and solid. Right oophorectomy was done and grossly the ovary was enlarged
and on sectioning shows a multiloculated thin walled mass with opaque gray
white surface filled with sebum and hairs. Within the walls are gritty and
yellow areas. One of the following is not seen microscopically in a Mature
cystic teratoma. *

1 point

Sebaceous gland

Thyroid follicles

Stratified squamous epithelium

Neuroepithelial tissues

Brain

86. A 28-year-old male presents with a three-week history of nausea, vomiting,

abdominal pain, and bloody stools.Sigmoidoscopy reveals the presence of
multiple lesions distributed throughout the colon. The following serum tumor
markers are associated with this neoplasm except *

1 point

CEA

AFP

CA 19-9
 TAG 75- dili kani?

The most common cancers that elevate CEA are in the colon and rectum but it can be
elevated with gastric, ovarian and other cancers

?Elevated level of Alpha-Fetoprotein (AFP) has proved to be a golden ticket to track

down tumors and various cancers such as Hepatocellular Carcinomas (HCC),
Gastric (GC) and colorectal cancers.

87. This 60-year-old man came to his doctor with complaints of headache and
weakness in his left arm for the last few weeks. Seizures and papilledema
were likewise noted.A CT scan of the head revealed a ring-enhancing mass in
the right frontal region with mass effects including asymmetrical enlargement
of the right cerebral hemisphere and compression of the right lateral ventricle.
Patient eventually died and autopsy was done.Coronal sections of the brain
revealed an apparently well-circumscribed mass in the right frontal region
with a variegated tan-yellow-red appearance, and focal hemorrhage and
necrosis . Headache and papilledema in this patient are caused by *

1 point

Intracranial pressure

Mass effects

Both

88. A 17-year-old white male presented to his physician with a history of insidious,
often transitory pain in his left knee, which had persisted over the last six
months.On physical examination the physician could palpate a hard bony
expansion in the metaphyseal area of the tibia. Radiographs revealed a large
area of lucency in the metaphysis of the tibia, which focally destroyed the
cortex. Molecular studies have shown that this tumor below show mutations
in well-known tumor suppressors and oncogenes except *
1 point

TP53

INK4A

Rb

Cyclin D

89. An immunohistochemical positivity of most of the tumor cells for vimentin.

The most probable diagnosis of the tumor is: *

1 point

Carcinoma

Melanoma

Lymphoma

Sarcoma

90. A 40-year-old woman presents with endometrial carcinoma. Her family history
reveals that her mother died of endometrial cancer at age 50, while her 42-
year-old brother was recently diagnosed with colon cancer. You begin to
suspect a familial cancer syndrome. What gene is most likely to be mutated in
this family? *

1 point

MSH2

WT-1

APC

P53
 91. A 52-year-old male smoker presents with fever and a cough productive of
greenish-yellow sputum. The patient states that he has had a morning cough
with excessive mucus production for the past 5 years. Which of the following
abnormalities would most likely be found in this patient? *

1 point

Enlarged hilar lymph nodes on x-ray

Curschmann spirals in his sputum

Apical cavitary lesions on x-ray

Increased Reid index

92. A 40 year old air-hostess man has experienced increasing respiratory

difficulty for the past 18 months. She is unable to clear her annual physical
fitness examination. She therefore approaches a physician. She has normal
physical findings on examination but pulmonary function tests reveal a
normal FEV1 and reduced FVC. Her chest X-ray is highly suggestive of diffuse
interstitial disease without any abnormal mass or hilar lymphadenopathy.
Blood investigations reveal normal hemogram. Special investigations also
have negative results for antibodies like ANA and anti – DNA topoisomerase I.
Which of the following is the most likely diagnosis? *

1 point

Silicosis

Idiopathic pulmonary fibrosis

Goodpasture’s syndrome

Scleroderma
 93. On sectioning of an organ at the time of autopsy, a focal wedge-shaped firm
area is seen accompanied by extensive hemorrhage, with a red appearance.
The lesion has a base on the surface of the organ. This findings is typically of
*

1 point

Kidney with septic embolus

Liver with hypovolemic shock

Lung with pulmonary thromboembolism

Heart with coronary thrombosis

94. Which of the following would most likely be observed in the lung during an
autopsy of a 2-week-old infant who died of neonatal respiratory distress
syndrome? *

1 point

Enlarged air space

Hyaline membranes and collapsed alveoli

Alveoli filled with neutrophils

Dense fibrosis of the alveolar walls

95. Which of the following features is not part of the histologic changes
associated with the resolution of ARDS? *

1 point

Endothelial cell restoration

Replacement of alveolar epithelium

Fibroblastic proliferation

Removal of dead cells by macrophage

Resorption of exudates

96. A 44-year-old woman presents with insidious onset of shortness of breath,

chest pain, and fatigue. Chest x-ray

films reveal bilateral pulmonary infiltrates
and enlarged
hilar lymph nodes. There is no history of occupational
exposure to mineral dusts or organic dusts. A biopsy of


 one of these lesions
shows non-necrotizing granulomas.

Special stains for fungi and
mycobacteria are negative. Which of the following is the most likely
diagnosis? *

1 point

Berylliosis

Sarcoidosis

Asbestos

Tb

97. A 67 yr old male with history of chronic smoking hemoptysis with cough.
Bronchoscopic biopsy from centrally located mass shows undifferentiated
tumor histopathologically. Most useful I.H.C. (immunohistochemical) marker
to 

make a proper diagnosis would be: *

1 point

Cytokeratin

Parvalbumin

Hep-Par1

HMB 45
 98. A 75 year old male with a significant smoking history presents to the
emergency room with complaints of dyspnea and truncal, arm, and facial
swelling for one week. Physical examination is remarkable for facial erythema
and facial, truncal, and arm edema with prominence of thoracic and neck
veins. On chest x-ray, there is a mass in the right mediastinum with
adenopathy. Which of the following is the most likely diagnosis? *

1 point

Adenocarcinoma

Non Hodgkin Lymphoma

Large cell carcinoma

Small cell carcinoma

Pulmonary Hamartoma

99. A man acquired HTLV-1 infection through sexual contact. Twenty-one years
later he develops generalized lymphadenopathy with 
hepatosplenomegaly, a
skin rash, hypercalcemia, and an elevated white blood count. This man has
most likely developed which of the following?
*

1 point

Delayed hypersensitivity reaction

Autoimmunity

Leukemia

Recurrent infection

AIDS
 100. The patient is 44-year-old woman who presents to your office
complaining of early satiety. She gives a history of a 5 to 10 pound
unintentional weight loss. She notes associated night sweats and fevers up to
100° F. Your physical examination demonstrates a woman in no acute
distress. The spleen is markedly enlarged, but no peripheral lymphadenopathy
is noted. The complete blood count (CBC) reveals:Blood count reveals a high
WBC count of 225,000/mm3, consisting mostly of granulocytes in different
stages of maturation, and including granulocytes, myelocytes, myeloblasts,
basophils, and eosinophils.Cytogenetic analysis of spontaneously dividing
peripheral blood white cells revealed the presence of a chromosomal
translocation t(9;22) generating the Philadelphia chromosome. What is the
reason for this patient's early satiety? *

1 point

Hepatomegaly

Esophageal carcinoma

Splenomegaly

Gastric carcinoma