PATHOLOGY EXAM # 4 Feb. 11, 1998 Name:_______________________________ (Please si ! "#$% e&am i' "#$ (is) i* %e*$%!

e+ *# "#$, Practical Questions: 1. This congenital heart defect represents: A. Transposition of the great arteries B. Truncus arteriosus -. Coarctation of the aorta - infantile form D. Coarctation of the aorta - adult form The event depicted in this coronar arter !ould least li"el result in: A. #udden cardiac death B. $nsta%le angina pectoris C. Acute m ocardial infarction .. T pical angina pectoris &. Arr thmia This patient had no evidence of s stemic h pertension or valvular o%struction. (hich of the follo!ing is not associated !ith the depicted heart disease) A. #udden death B. Autosomal dominant pattern of inheritance -. Am loidosis D. Disproportionate thic"ening of ventricular septum &. * ofi%er disarra The most li"el etiolog of the depicted disease of the mitral valve is: A. *itral valve prolapse /. Chronic rheumatic heart disease C. Carcinoid heart disease D. *itral annular calcification &. ,on%acterial throm%otic endocarditis The m A. B. C. .. &. ocarditis depicted !ould most li"el result from: .iral infection Bite of the reduviid %ug / me disease &ating ra! por" Drug h persensitivit

2.

'.

+.

-.

0.

(hich one of the follo!ing is true regarding this appendiceal lesion) 1,ote: there are 2 slides to this 2uestion3 A. 4t can ela%orate vasoactive amines

5.

B. 4t has a high metastatic rate C. 4t arises from glandular go%let cells D. This !ill li"el lead to carcinoid s ndrome A 2+ ear old male !ho had consumed e6cess ethanol presented to the emergenc room !ith hematemesis. This photographs demonstrates the lesion. Diagnosis: A. B. -. D. Achalasia Plummer .inson s ndrome *allor (eiss s ndrome Barrett7s esophagus

8.

(hich one of the follo!ing is true of this lesion seen in the stomach) A. 4t occurs most commonl in females /. *ost occur in the stomach and pro6imal duodenum C. $suall presents !ith hematemesis D. &ndoscop alone can rule out malignanc The lesion sho!n on this photomicrograph is most consistent !ith A. A malignant lesion arising from the pancreatic duct epithelium B. A %enign lesion arising from the pancreatic duct epithelium C. A lesion arising from cell of the pancreatic islet D. A malignant lesion arising from stromal fi%ro%last of the pancreas The stone sho!n on this gross photograph is fre2uentl seen in: A. Patients !ith %ile stasis and infection B. ;emale native Americans C. Patients !ith cirrhosis D. 4n patients !ith hemol tic anemia The medical histor of the patient pictured is least li"el to include: A. Autosomal recessive Crigler-,a<<ar T pe 4 s ndrome diagnosed in infanc B. 4ntravenous drug a%use C. Chronic alcoholism D. =istor of e6posure to thorotrast &. Associated renal failure This liver %iops demonstrates a liver condition !hich: A. 4s specific for one particular diagnosis /. Can %e reversi%le C. 4s al!a s associated !ith hepatomegal D. 4s al!a s s mptomatic This histological finding in a salivar gland tumor is: A. 4ncidental and unrelated to diagnosis B. 4rrelevant -. #ignificant and helpful in securing the diagnosis

9.

1:.

11.

12.

1'.

D.

,ot consistent !ith an salivar gland tumor histolog

14.

Your differential based on the gross appearance of this lung would include all except: A. Metastatic carcinoma from the colon B. E. coli pneumonia C. Adenovirus pneumonitis D. Tuberculosis E. Bronchioloalveolar carcinoma

15.

A 65 year old man presented with fever, weight loss, hyponatremia, and an area of radiodensity in his left lower lobe. He has a 40 pack year smoking history and carried a diagnosis of chronic bronchitis. This poor fellow was another victim of the Graham Ambulance Service outside the ER, providing this gross and microscopic specimen. Based on your diagnosis, what would have been the best inital treatment of the lesion (if he had survived....) ? 1,ote: there are 2 slides to this 2uestion3 A. Antibiotics B. Surgery alone C. Chemotherapy D. Radiation alone E. Anticoagulation 16. Identify the histological finding and the disease in a 54 year old woman with several metatarsal fractures. A. Malignant osteoid; osteosarcoma B. Plasma cells; multiple myeloma C. Osteoid seams; osteomalacia D. Sequestrum; osteomyelitis E. Cartilage; enchondromata

17. A 23 year old man with pain in his buttock. Your diagnosis from this xray and histological section: 1,ote: there are 2 slides to this 2uestion3 A. Osteosarcoma B. Osteochondroma C. Ewing's sarcoma of bone D. Osteoid osteoma E. Enchondroma 18. this The most likely diagnosis in a 72 year old man who presented with low back pain and xray and biopsy: 1,ote: there are 2 slides to this 2uestion3

A. B. C. D. E. 19.

Enchondroma Metastatic adenocarcinoma, likely from the prostate Non ossifying fibroma Osteosarcoma Chrondrosarcoma

A 45 year old man presented with a history of multiple episodes of shortness of breath of over the past few years. During his workup, he keeled over, lost vital signs and could not be resuscitated. If he had survived, his most appropriate treatment would have been: A. Antibiotics B. Surgery alone C. Chemotherapy D. Radiation alone E. Anticoagulation (ritten Questions: 2:. Trisom 21 ma %e associated !ith: A. Transposition of the great arteries B. Coarctation of the aorta -. &ndocardial cushion defect 1Arterioventricular septal defect3 D. Tricuspid atresia (hich features are seen !ith Tetrolog of ;allot: A. .entricular septal defect B. >verriding aorta C. ?ight ventricular outflo! o%struction D. ?ight ventricular h pertroph E. All of the a%ove The most common cardiac malformation is: A. Atrial septal defect B. &ndocardial cushion defect -. .entricular septal defect D. Aortic stenosis Coarctation of the aorta - adult form is not associated !ith: A. = pertension in arms /. = pertension in legs C. Claudication and cold legs D. Collateral circulation !ith ri% notching A +2 ear old patient !as diagnosed as having the most common primar tumor of the adult heart. (here is the most li"el location of the tumor) A. ?ight atrium /. /eft atrium C. ?ight ventricle

21.

22.

2'.

2+.

D. &. 2-.

/eft ventricle ,one of the a%ove

A +8 ear old patient reported transient chest pains at rest. (hile significant #T segment evaluations !ere seen on &@AB there !as no evidence of o%structing vascular lesions on cardiac angiograph . The most li"el diagnosis is: A. Acute m ocardial infarction B. /ud!ig7s angina C. T pical angina pectoris D. Crescendo angina E. PrinCmetal7s variant angina

20.

A -5 ear old patient presented !ith a large pulsatile a%dominal mass confirmed to %e an aortic aneur sm. All of the follo!ing statements concerning this lesion are true e6cept: A. ;ound %et!een the level of the renal arteries and the %ifurcation of tha aorta. B. Atherosclerosis is a ma<or etiologic factor C. *a present % compressing a ureter .. Those greater than - cm are inopera%le &. ?upture is associated !ith high mortalit rate

*atching: The follo!ing pertain to 2uestions 25 through ':. Dou ma use an ans!er onceB more than onceB or not at all. A 12 ear old patient presented !ith migrator pol arthritis and su%cutaneous nodules three !ee"s after a documented case of group A %eta-hemol tic streptcoccal phar ngitis. A. *itral stenosis B. Acute m ocarditis C. Aschoff %odies D. # denham7s chorea 25. 28. 29. ':. '1. *ost life threatening complication in childhood. 1B3 Associated !ith involuntar purposeless movements. 1D3 *ost common long term se2uelae !ithout proph la6is 1A3 Considered pathognomic of rheumatic fever 1C 3 A -8 ear old patient is diagnosed as having acute m ocardial infarction. (hen is the ris" highest for ventricular rupture) A. 1-2 da s after onset

/. C. D.

+-5 da s after onset 11-1+ da s after onset 15-21 da s after onset

*atching: The follo!ing pertain to 2uestions '2 through '-. Dou ma use an ans!er onceB more than onceB or not at all. A. B. C. D. '2. ''. '+. '-. '0. Associated !ith pure right-sided heart failure Associated !ith pure left-sided heart failure Both A and B ,either

An"le edema 1A3 Pulmonar edema 1B3 E,utmegF liver 1chronic passive congestion3 1A3 Ascites 1A3 (hich of the follo!ing is not associated !ith coronar arter disease) A. #udden cardiac death B. * ocardial infarction C. Angina pectoris .. Cor pulmonale &. Chronic ischemic heart disease

*atching: The follo!ing pertain to 2uestions '5 through '9. Dou ma use an ans!er onceB more than onceB or not at all. A. B. C. D. '5. '8. '9. +:. T pical angina pectoris PrinCmetal7s variant angina Both A and B ,either

Paro6 smal su%sternal chest discomfort or pain 1C 3 Due to coronar arter spasm 1B3 ?elated to ph sical e6ertion 1A3 (hat is the most common serious complication of acute m ocardial infarction) A. Throm%oem%olism B. .entricular rupture -. Cardiac arrh thmias D. /eft ventricular congestive failure

&.

Cardiogenic shoc"

*atching: The follo!ing pertain to 2uestions +1 through +'. Dou ma use an ans!er onceB more than onceB or not at all. A. B. C. D. +1. +2. +'. Acute infective endocarditis #u%acute infective endocarditis Both A and B ,either

#taph lococcus aureus 1A3 .alvular vegetations 1C 3 Previousl a%normal heart 1B3

*atching: The follo!ing pertain to 2uestions ++ through +8. Dou ma use an ans!er onceB more than onceB or not at all. A. B. C. D. &. ++. +-. +0. +5. +8. +9. Peptic ulcer Breath h drogen test Tu%ular adenomas Angiod splasia =amartomatous pol ps

/actase deficienc 1B3 *ucosal e6posure of digestive <uices 1A3 Premalignant potential 1C 3 ;amilial pol posis 1C 3 PeutC-Gegher s ndrome 1&3 (hich one of the follo!ing pathological conditions of the esophagus is thought to have premalignant potential) A. =iatus hernia /. Achalasia C. / e stricture

D. -:.

Hen"er7s diverticulum

A 0: ear old patient presents !ith pernicious anemia. The stomach !ould e6hi%it !hich one of the follo!ing characteristicall : A. = pertrophic gastritis B. 4ncreased num%er of argentaffin cells C. = peracidit .. *ucosal atroph A 1 ear old %a% presents !ith vomiting and severe cramp a%dominal pain. Barium enema sho!s no a%normalit . After the procedure the infant7s condition improved and the a%dominal pain su%sided !ithout the need of surgical intervention. The most li"el cause of the infant7s condition !as: A. .olvulus of the sigmoid colon B. 4ncarcerated inguinal hernia -. 4ntussusception D. ,ecrotiCing enterocolitis

-1.

*atching: The follo!ing pertain to 2uestions -2 through -0. Dou ma use an ans!er onceB more than onceB or not at all. A. B. C. D. &. -2. -'. -+. --. -0. -5. #"ip lesions Curling7s ulcers To6ic megacolon Cushing7s ulcers 4ncreased incidence of l mphoma

&6tensive surface %urns 1B3 Crohn7s disease 1A3 $lcerative colitis 1C 3 4ntracranial lesion 1D3 Celiac sprue 1&3 The most common cause of cancer death in the $nited #tates is A. Cancer of pancreas

/. Cancer of lung C. Cancer of prostate D. Cancer of %reast -8. A -:- ear old patient presented !ith er thematous s"in lesions that occur most prominentl in the groinB perineumB %reast and %uttoc"s. The er thematous lesions are su%se2uentl follo!ed % central necrosisB then ecCematoid appearance !ith er thematous margins and central clearing and scaling after t!o !ee"s. This patient most li"el has: A. 4nsulinoma /. Alucagonoma C. #omatostatinoma D. Aastrinoma

*atching: The follo!ing pertain to 2uestions -9 through 02. Dou ma use an ans!er onceB more than onceB or not at all. A. B. C. D. -9. 0:. 01. Carcinoma of the head of the pancreas Dia%etes mellitusB gallstoneB diarrhea and steatorrhea Aastrin cell h perfunction Acute pancreatitis

= pocalcemia 1D3 &levation of %iliru%in and migrator thom%ophle%itis 1Trousseau7s sign3 1A3 Borderline elevation of gastrin !ith no elevation of gastrin level !ith intravenous secretin in<ection test. =o!everB serum gastrin increases more than 2::I after standard meal provocative test. 1C 3 #omastatinoma 1B3

02.

0'.

The follo!ing diseases are associated !ith elevation of serum am lase e6cept: A. Acute pancreatitis B. Aastroduodenal perforation -. $ncomplicated gallstone D. &ctopic pregnanc The incidence of cholesterol gallstone is highest in A. ,ative American females B. (hites C. African-Americans D. >rientals

0+.

*atching: Questions 0- through 08. *atch each set of clinical-pathological findingsJstudies 1num%ered3 !ith the most li"el patient histor 1lettered3. Dou ma use an ans!er onceB more than onceB or not at all. A. B. C. D. 0-. 18 ear old female !ith <aundiceB prolonged prothrom%in timeB movement disorder 1Eflapping tremorsF of the upper e6tremities3 and manic-depressive ps chosis. /iver %iops sho!s non-specific steatosis and fi%rosis. '5 ear old male !ith a histor of ulcerative colitis presents !ith progressive fatigueB <aundice and elevated serum al"aline phosphatase. - ear old %o !ith a recent histor of upper respirator tract infection presents !ith sudden vomiting and change in mental statusB terminating in coma. '- ear old male !ith E%ronCeF s"in pigmentationB dia%etes mellitusB a%normal liver function tests and mar"edl elevated serum ferritin.

4ncreased %lood ammonia levelB microvesicular steatosis on liver %iops . 1C 3

00. 05. 08.

Deficienc of plasma ceruloplasminB @aiser-;leischer rings on refractive e e e6amination. 1A3 *ar"ed disruption of mitochondrial cristae on electron microscopic e6amination of hepatoc tes. 1C 3 Characteristic concentric Eonion ringsF fi%rosis around %ile ducts on %iops 1B3

*atching: The follo!ing pertain to 2uestions 09 and 5:. Dou ma use an ans!er onceB more than onceB or not at all. A. B. C. D. 09. 5:. 51. =epatocellular carcinoma Cholangiocarcinoma Both A and B ,either A or B

Alpha-fetaprotein elevated in serumB also found in tumor cells % immunohistochemistr . 1A3 ;i%rolamellar variant of this tumor is associated !ith a %etter survivaal rate. 1A3 ?egarding viral hepatitis: A. =epatitis B virus 1=B.3 is a D,A non-enveloped virus B. 4nfection !ith hepatitis C virus 1=C.3 has a lo! rate of progression to chronic hepatitis C. /iver patholog in acute viral hepatitis demonstrates specific findings for various t pes of hepatitis viruses D. =BcAg 1core antigen3 is considered a good mar"er of active viral replication and its persistence indicates continued infectivit B !ith a poor prognostic implication. E. ;or hepatitis D virus 1Edelta agentF3 in the presence of =%sAgB the rate of the progression to chronic hepatitis is much higher in superinfection than in acute coinfection.

52. ?egarding the pathogenesis of various liver conditionsB select one statement !hich is false: A. 4ncreased lipid s nthesis in alcoholic steatosis can %e partiall attri%uted to e6cessive generation of ,AD= % the enC me alcohol deh drogenase B. 4n cirrhosis of the liver e6cessive collagen fi%ers are of t pes 4 and 444 and are produced % 4to cells transforming into fi%ro%last-li"e cells C. Ail%ert7s s ndrome 1%enign h per%iliru%inemia3 is %elieved to %e due to a depressed levels of the enC me $DP gl curon l transferase .. Anti-smooth muscle anti%odies are primaril responsi%le for the autoimmune etiolog of primar %iliar cirrhosis 1PBC3 &. Aflato6ins 1carcinogens made % aspergillus species "no!n to %e gro!ing on the surface of peanuts and pistachio nuts3 have %een implicated in the pathogenesis of

hepatocellular carcinoma *atching: Questions 5' and 5+. *atch each patient7s histor 1num%ered3 !ith the most li"el diagnosis 1lettered3. Dou ma use our ans!er onceB more than once or not at all. A. -: ear old male patient !ith a slo!l enlarging mass in the parotid region. *ore recentl the patient noticed also small s!elling in the contralateral location. >n electron microscop the tumor cells demonstrate the presence of numerous mitochondria in the c toplasm. -0 ear old male !ith a t!o ear histor of a painful nodule on the hard palate. ,o! seen in the doctor7s office for incidentall discovered several round lung lesions on chest K-ra . Biops of the palate lesion demonstrates infiltrates of small cells arranged in a cri%riform pattern and demonstrating perineural invasion. ++ ear old female !ith a painlessB slo!l enlarging unilateral preauricular mass. Tissue su%mitted for a froCen section demonstrates sheets and acini of epithelial cells set in a loose m 6oid stroma containing foci of chondroid differentiation. +: ear old female !ith firmB smoothB mildl tender %ilateral enlargement of the parotid glands. >ther complaints include dr ness in the mouth causing s!allo!ing pro%lemsB and a feeling of %ilateral Ee e %urningF. ?elevant la%orator results include positive rheumatoid factor.

B.

C. D.

5'. 5+.

(arthin7s tumor 1A3 Adenoid c stic carcinoma 1B3

*atching: The follo!ing pertain to 2uestions 5- and 50. Dou ma use an ans!er onceB more than onceB or not at all. A. B. C. D. 5-. 50. 55. /ar ngeal papillomas Cholesteatoma Both A and B are correct ,either A or B

True neoplasia 1A3 =P. 1=uman Papilloma .irus3 implicated in pathogenesis 1A3 Patients !ith panacinar emph sema A. =ave diffuse interstitial lung fi%rosis /. Ma" )a0e %ela*e+ 1#%*al )"1e%*e!si#! C. Characteristicall sho! mucus gland h perplasia !ith an increase in the ?eid D. =ave ple6iform vascular lesions and medial h pertroph of pulmonar arterial vessels % age 2-

inde6

58.

Patient !ith most li"el com%ination of histor L end result of pulmonar em%olus: A. 2- ear old male athlete !ith superficial leg %ruiseL sudden death B. 2- ear old male athlete !ith superficial leg %ruiseL as mptomatic C. +5 ear old o%ese female after 15 hour long airline flightL acute shortness of .. &. 42 "ea% #l+ #bese 'emale a'*e% 12 )#$% l#! ai%li!e 'li )*3 as"m1*#ma*i4 +5 ear old man !ith colon cancerL cor pulmonale

%reath

59.

The least li"el finding in acute or healing A?D#: A. = aline mem%ranes B. T pe 2 pneumoc te proliferation C. Alveolar sac atelectasis .. 5!*%aal0e#la% 4l$s*e%s #' !e$*%#1)ils &. 4nterstitial fi%rosis Pulmonar edema !ould %e least li"el in: A. 62 "ea% #l+ 7$a%*8 mi!e% )i* b" a *%$49 B. '8 ear old man !ith congestive heart failure C. 2+ ear old overdosed heroin addict D. 19 ear old male mountain clim%er !ho collapsed and died on *ount (hitne Pulmonar h ptertension is least li"el in: A. /ong surviving cancer patient !ith histor of pulmonar em%oli B. Chronic %ronchitis C. ?heumatoid arthritis .. P%ima%" *$be%4$l#sis *echanical and %iochemial endothelial in<ur is associated !ith: A. Decreased prostoc cline and nitric o6ide !ith vasodilation /. .e4%ease+ 1%#s*#4"4li!e a!+ !i*%i4 #&i+e (i*) 0as#4#!s*%i4*i#! C. Decreased prostoc cline and nitric o6ide !ith decreased platelet adhesion D. 4ncreased prostoc cline and nitric o6ide !ith vasodilation &. 4ncreased prostoc cline and nitric o6ide !ith vasoconstriction Chronic %ronchitis is defined as A. *ucus gland h perplasia of %ronchi B. *ucus gland h perplasia of %ronchioles -. -)%#!i4 1%#+$4*i0e 4#$ ) '#% *)%ee m#!*)s i! *(# 4#!se4$*i0e "ea%s D. Ao%let cell h perplasia in terminal %ronchioles &. Ao%let cell metaplasia in terminal %ronchioles

8:.

81.

82.

8'.

8+.

A ' ear old %o aspirates a peanut. The least li"el pathological conse2uence: A. Bronchiectasis B. /ung a%scess

C. .. &. 8-.

Atelectasis /$lla Bronchopneumonia

The least li"el cause of a radiographic picture of %ronchopneumonia: A. Staphlococcus aureus /. M"4#1lasma 1!e$m#!iae C. Hemophilus influenza D. Pseudomonas aeroginosa &. Escherichia coli These pulmonar diseases often respond to steroidsB e6cept: A. Bronchiolitis o%literans-o%structive pneumonia MB>>PN B. Asthma C. Des2uamative interstitial pnuemonia .. 5+i#1a*)i4 1$lm#!a%" 'ib%#sis :$s$al i!*e%s*i*ial 1!e$m#!ia;

80.

85.

A 05 ear old man presented !ith a slo!l !orsening shortness of %reath and a recent episode of hemopt sis. A nonsmo"erB he had %een a construction !or"er for ears. ;indings from radiographic e6ams and an e6plorator left thoracotom revealed a + centimeter left lo!er lo%e lung mass in the %ac"ground of diffuse interstitial fi%rosis !hich !as more prominent in the lo!er lo%es. Pla2ues of candle !a6 -li"e fi%rous tissue !ere found on the diaphragmatic pleural surface. The most li"el histological findings of diffuse disease: solitar nodule A. 4diopathic interstitial fi%rosis: tu%erculosis B. Coal minerOs pneumoconiosis: progressive massive fi%rosis -. Asbes*#sis: P%ima%" a+e!#4a%4i!#ma D. #ilicosis: ?heumatoid arthritis &. A?D#: fungal %all in old a%scess cavit 88. A 0- ear old !omanB a +: pac" ear smo"erB presented !ith une6plained !eight lossB fever and a cough productive of a %lood tinged ello! sputum. A - to 0 cm centimeter cavitated area of radiodensit !ith an Eair fluidE level in the right upper lo%e !as found. >ther la% studies !ere normal e6cept for an elevated !hite %lood cell count !ith a neutrophil predominance and an elevated serum calcium. CT scans and other radiographic studies sho!ed no evidence of other visceral or focal %one a%normalities. most li"el diagnosis: A. ;i%rocaseous tu%erculosis B. #arcoidosis -. <7$am#$s 4ell 4a%4i!#ma D. #mall cell undifferentiated carcinoma &. =istoplasmosis

The

89.

Aranulomas are characteristic of all e6cept A. Tu%erculosis B. = persensitivit pneumonitis C. =istoplasmosis D. #arcoidosis E. Asbes*#sis *alignant mesotheliomas: A. Causall related to cigarette smo"ing /. O'*e! )a0e a bi1)asi4 e1i*)eli#i+ = s1i!+le 4ell )is*#l# i4al 1a**e%! C. Arise from pleural pla2ues D. ?espond rapidl and !ell to chemotherap &. Causall related to silica cr stals #treptococcal pneumonia A. Al!a s presents as a lo%ar pneumonia B. CharacteriCed % granulomatous interstitial inflammation -. M#s* 4#mm#! 4a$se #' ba4*e%ial 1!e$m#!ia D. ,ecrosis and a%scess formation common /egg-Calve-PerthesO disease: A. A0as4$la% !e4%#sis #' *)e 4a1i*al 'em#%al e1i1)"sis B. Prion disease in Persian cats C. Deep vein throm%osis in giraffes D. Diaph seal infarction in patient !ith sic"le cell anemia &. #teroid related avascular necrosis of the femoral head Prominent osteoclastic resorption of %one is not a feature of A. ;racture callus B. PagetOs disease of %one -. >steomalacia D. Primar h perparath roidism >steopeniaB localiCed or generaliCedB is a feature of all the follo!ing e6cept: A. Os*e#1e*%#sis B. PagetOs disease of %one C. Primar h perparath roidism D. >steogenesis imperfecta &. Postmenopausal osteoporosis Pathological fractures are least common in A. An 8- ear old retired male insurance e6ecutive B. 0- ear old postmenopausal !oman on no medications C. ,e!%orn girl !ith %lue scleraB %ilateral inguinal hernias and histor of short lim%s seen on ultrasound .. 1> "ea% #l+ b#" (i*) a! #s*e#i+ #s*e#ma

9:.

91.

92.

9'.

9+.

9-.

&. 90.

05 ear old man !ith a + cm radiolucent pro6imal femoral lesion and a histor of renal cell carcinoma

Pseudoarthrosis: A. False ?#i!* as a %es$l* #' 1##% '%a4*$%e )eali! B. ?heumatoid arthritis affecting the great toe C. Benign %one tumor D. #upernumer finger &. Avascular necrosis medial femoral cond le *ost li"el cause of septic arthritis in a '+ ear old female: A. Neisseria gonorrhea B. * co%acterium tu%erculosis C. Escherichia coli D. Pseudomonas aeroginosa &. Salmonella typhus A 5' ear old !oman !ith shoulder pain is found to have an irregular illdefined radiolucent lesion in her pro6imal humerus. Dour differential: A. >steosarcomaB &!ingOs sarcomaB l mphoma B. ,on-ossif ing fi%romaB enchondromaB osteoid osteoma C. ChondrosarcomaB osteosarcomaB giant cell tumor of %one .. Me*as*asis, 1lasma 4ell m"el#ma, 4)#!+%#sa%4#ma &. *etastasisB osteosarcomaB &!ingOs sarcoma The most li"el diagnosis from the %iops of a spong one centimeter su%cutaneous nodule over the olecranon prominence in a '' ear old !oman !ith recent s!elling of all her P4P and *CP <oints: A. *onosodium urate granulomata B. /iposarcoma -. @)e$ma*#i+ !#+$le D. #u%cutaneous a%scess &. =emangioma

95.

98.

99.

*atching: The follo!ing pertain to 2uestions 1:: through 1:'. Dou ma use an ans!er onceB more than onceB or not at all. A. Charcot Leyden crystals B. Hamman Rich syndrome C. Gohn's complex D. Schaumann body E. Kulchitsky cell 100. 101. Sarcoidosis [D] Asthma [A]

102. 103.

Usual interstitial pneumonia [B] Primary tuberculosis [C]

*atching: The follo!ing pertain to 2uestions 1:+ through 1:0. Dou ma use an ans!er onceB more than onceB or not at all. A. B. C. D. E. 104. 105. 106. Legg-Calve-Perthes' disease Pott's disease Ollier's syndrome Albers- Schonberg disease Shepard's crook deformity

Tuberculosis (B) Enchondromatosis [C] Fibrous dysplasia [E]

*atching: The follo!ing pertain to 2uestions 1:5 through 1:9. Dou ma use an ans!er onceB more than onceB or not at all. A. B. C. D. E. 107. 108. 109. 110. Osteitis fibrosa cystica Bony ankylosis Charcot's joint Involucrum Tophus

Osteoarthritis in a patient with tabes dorsalis in syphilis {C} Severe rheumatoid arthritis {B} Gout {E} A 45 year old woman comes to your medical office complaining of progressive dyspnea on exertion. On physical exam you hear inspiratory crackles. Her spirometry reveals a forced vital capacity (FVC) that is 56% of predicted, a forced expired volume in one second (FEV1) that is 53% of predicted. Your tentative diagnosis is: A. Asthma B. Emphysema C. Pulmonary Fibrosis D. Chronic Bronchitis A 62 year old woman presents to the clinic with a 2-3 year history of progressive shortness of breath and cough. She smokes about 2 packs of cigaretes a day and has done

111.

so for the past 44 years. The cough is usually productive of white sputum. On physical exam, she has mild diffuse wheezing throughout both lung fields. She thinks she has asthma but you feel she has COPD. Spirometry reveals an obstructed ventilatory pattern which is consistent with both diagnosis. Which of the following tests would help you the most in differentiating COPD from asthma? A. Chest X-ray B. Lung Volumes C. Diffusing Capacity D. Arterial Blood Gas

112.

A 22 year old college student presents to the clinic complaining of wheezing and shortness of breath mainly with exercise. His symptoms occasionally wake him up at night but are more noticeable when he jogs. His spirometry reveals an obstructive ventilatory defect with improvement in values after he has used a bronchodilator. His CXR is within normal limits. Your diagnosis is asthma. Besides a bronchodilator, you feel he needs to be on which other type of medicine? A. Antibiotic B. Antihistamine C. Cough suppressant D. Anti-inflammatory medicine A 55 year old business woman from Australia has recently flown from Melbourne to Lubbock for a business meeting. Two days into the meeting she develops sudden onset of chest discomfort and shortness of breath. In the emergency room, her CXR reveals atelectasis (alveolar collapse) in the right base and an ABG reveals hypoxemia (low oxygen level) and a slightly low PCO 2. Her EKG is within normal limits. To confirm your suspected diagnosis, which test would you order next? A. Pulmonary function tests B. Ventilation-Perfusion scan C. Chest CT D. Methacholine challenge (bronchoprovocation tests) You are given partial pulmonary function test results on a patient with shortness of breath. The FEV1 is reduced. You are unable to find the FVC. Based on the reduced FEV1 alone, you conclude that your patient may have: A. Emphysema B. Chronic bronchitis C. Asthma D. Pulmonary fibrosis E. Any one of the above A 65 year old male patient presents to your clinic complaining of shortness of breath. His sense of shortness of breath has been increasing slowly over the past few years. On physical exam his respiratory rate is 28 breaths per minute and the breaths appear to be

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shallow. He has inspiratory crackles and clubbing of the fingers. Chest x-ray has a reticular-nodular pattern predominately in the bases of both lungs with a "honey-comb appearance. On physiological testing of his lungs you would expect to find: A. An obstructive pattern on spirometry B. Decreased lung compliance C. A normal diffusing capacity D. Increased total lung cvapacity 116. ;att strea"s are first detected in arterial !alls during !hich stage of life) A. adolescence 112-19 rs.3 B. oung adults 12:-29 rs.3 C. middle age 1':-'9 rs.3 D. older adults 1+:-0: rs.3

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The %lood level of total cholesterol concentration recommended % the ,ational 4nstitute =ealth is: A. less than 2-: mgJdl B. less than 22- mgJdl -. less than 2:: mgJdl D. less than 1-: mgJdl The lipoprotein su%-fraction associated !ith the term PgoodF cholesterol is: A. ver lo! densit lipoprotein 1./D/3 B. lo! densit lipoprotein 1/D/3 -. high densit lipoprotein 1=D/3 D. pre %eta lipoprotein 1PB/3 The lipoprotein su%-fraction associated !ith the term P%adF cholesterol is: A. ver lo! densit lipoprotein 1./D/3 /. lo! densit lipoprotein 1/D/3 C. high densit lipoprotein 1=D/3 D. pre %eta lipoprotein 1PB/3 The follo!ing are cardiac ris" factors e6cept for: A. h pertension B. h percholesterolemia C. famil histor of coronar heart disease .. famil histor of renal disease

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