Pathology Test

Question 1

A 16-year-old boy is undergoing evaluation for jaundice.
Laboratory studies show normal hepatic enzyme activities, a negative direct antiglobulin (Coombs) test, increased mean corpuscular hemoglobin concentration, and increased osmotic fragility of erythrocytes.
Which of the following types of erythrocyte is most likely to be seen on a peripheral blood smear?

Accepted Answer

Spherocyte

Answer

Ovalocyte

Answer

Schistocyte

Answer

Target cell

Answer

Teardrop cell

Question 2

A 34-year-old woman is brought to the emergency department by her husband because of confusion for 2 hours. She is unconscious on arrival. Her husband says that she has a 1-year history of episodes of nervousness, light-headedness, and dizziness that resolve after she eats a meal. Physical examination shows no other abnormalities. Her serum glucose concentration is 25 mg/dL. After an intravenous infusion of 0.9% saline and glucose, she regains consciousness. Which of the following is the most likely diagnosis?

Accepted Answer

Insulinoma

Answer

Cushing syndrome

Answer

Multiple endocrine neoplasia syndrome

Answer

Pancreatic gastrinoma

Answer

Pheochromocytoma

Question 3

A 60-year-old man comes to the physician because of a cough for 2 months. He says that he has noticed changes in his face during the past 3 months. He has smoked 2 packs of cigarettes daily for 30 years. His temperature is 37°C (98.6°F), pulse is 72/min, respirations are 19/min, and blood pressure is 160/95 mm Hg. Physical examination shows a round face, central obesity, excess fat over the posterior neck and back, and abdominal striae. His serum calcium concentration is 9 mg/dL. Urine dipstick of a clean-catch midstream specimen shows 3+ glucose. A chest x-ray shows a 3-cm mass in the left upper lobe with enlargement of hilar nodes. A biopsy specimen of the mass shows small cell carcinoma. Further serum studies are most likely to show an increased concentration of which of the following proteins?

Accepted Answer

Adrenocorticotropic hormone

Answer

Epidermal growth factor

Answer

IgM

Answer

Parathyroid hormone-related protein

Answer

Serotonin

Question 4

A 45-year-old man with chronic pancreatitis has a 9-kg (20-lb) weight loss and diarrhea. Analysis of a 24-hour stool sample shows 28 g of fat. A deficiency of which of the following enzymes is the most likely cause?

Accepted Answer

Lipase

Answer

Amylase

Answer

Carboxypeptidase

Answer

Lactase

Answer

Lipoprotein lipase

Question 5

A 70-year-old man comes to the physician because of a 2-year history of shortness of breath and progressive chest pain. He worked as a carpenter installing insulation from the ages of 21 to 31 years. Physical examination shows absent breath sounds and dullness to percussion over the right lung base. A chest x-ray shows thickened pleura on the right side and a medium-sized pleural effusion. Pleural fluid studies show a protein concentration greater than 3 g/dL (N=1–2). A pleural biopsy specimen shows spindle cells. Which of the following is the most likely diagnosis?

Accepted Answer

Mesothelioma

Answer

Emphysema

Answer

Lung abscess

Answer

Small cell carcinoma of the lung

Answer

Viral pneumonia

Question 6

A previously healthy 28-year-old man dies in a motor vehicle collision. At autopsy, the kidneys are enlarged bilaterally, and each weighs 3 kg. The external surface of the kidneys appears to be a mass of cysts. Microscopic examination of the kidneys shows intact nephrons interspersed between the cysts. The most likely cause of these changes in the kidneys involves which of the following modes of inheritance?

Accepted Answer

Autosomal dominant

Answer

Autosomal recessive

Answer

Chromosome 22q11.2 deletion

Answer

Mitochondrial

Answer

X-linked

Question 7

An autopsy of a 24-year-old woman shows pleuritis, membranous thickening of glomerular capillary walls, concentric rings of collagen around splenic arterioles, and excrescences on the underside of the mitral valve. Analysis of blood is most likely to show which of the following?

Accepted Answer

Antinuclear antibody

Answer

Increased C3 concentration

Answer

Lymphocytosis

Answer

Monoclonal gammopathy

Answer

Positive bacterial culture

Question 8

At autopsy, the heart of a 30-year-old man weighs 550 g. The left ventricle is dilated and hypertrophied. The aortic root is markedly dilated, and the aortic valve cusps are intact. The external iliac arteries contain irregular, focal cystic areas within the media with pools of mucopolysaccharide and fraying fragmentation of the elastica. Which of the following is the most likely diagnosis?

Accepted Answer

Marfan syndrome

Answer

Ankylosing spondylitis

Answer

Cardiovascular syphilis

Answer

Osteogenesis imperfecta, type II (recessive)

Answer

Systemic lupus erythematosus

Question 9

A 10-year-old boy is brought to the emergency department 15 minutes after he sustained abdominal injuries in a motor vehicle collision. Physical examination shows massive ecchymoses over the trunk and abdomen. A CT scan shows internal bleeding. The patient undergoes operative removal of a portion of the lower left lobe of the lung, the left lobe of the liver, half of the left kidney, half of the spleen, and a 2-foot section of the small intestine. Assuming survival of the acute trauma, which of the following organs is likely to have the most complete regeneration in this patient?

Accepted Answer

Liver

Answer

Kidney

Answer

Lung

Answer

Small intestine

Answer

Spleen

Question 10

A previously healthy 2-year-old boy is brought to the emergency department because of bloody stools for 2 days. His vital signs are within normal limits. Abdominal examination shows no abnormalities. Laboratory studies show: Hemoglobin 11 g/dL Hematocrit 37% Leukocyte count 9500/mm3 Platelet count 250,000/mm3 Test of the stool for occult blood is positive. During an emergency laparotomy, a 3 × 2-cm protrusion is found on the antimesenteric border of the small intestine approximately 50 cm proximal to the ileocecal valve. Which of the following is the most likely cause of this patient’s condition?

Accepted Answer

Meckel diverticulum

Answer

Carcinoid tumor

Answer

Ectopic adrenal gland

Answer

Retrocecal appendix

Answer

Umbilical hernia