217 Pathology

Examination Tips
A 25-year-old woman palpates a left breast "lump" on self-examination. Her
nurse practitioner palpates an ill-dened mass. There is no pain or
tenderness. No axillary lymphadenopathy is noted. Fine needle aspiration is
performed and cytologic examination shows cells that appear benign. The
lesion persists, and 6 months later another biopsy is taken and shows ductal
epithelial proliferation with ductal apocrine metaplasia, stromal brosis, and
sclerosing adenosis. Which of the following is the most likely diagnosis?
A. Inltrating ductal carcinoma
B. Ductal carcinoma in situ
C. Fibrocystic changes
D. Lobular carcinoma in situ
Decreased airway radius occurs in chronic bronchitis due to all the following
except:
A. Increased elastic recoil
B. Excessive amounts of sputum
C. Airway scarring
D. Inammation
A 35-year-old woman has noted a palpably rm, irregular mass in her right
breast for the past 3 months. On physical examination there is no
tenderness or swelling. By mammography there is an irregular 2 cm
density that contains scattered microcalcications. Biopsy of this mass
reveals extensive fat necrosis. Which of the following is the most likely
cause for this breast lesion?
A. Trauma
B. Prolactinoma
C. Pregnancy
D. Lobular carcinoma in situ
Air trapping associated with chronic obstructive diseases results in an
increase in which of the following components of pulmonary function
testing?
A. Residual volume
B. Forced expiratory volume in one second (FEV1)
C. Vital capacity
D. Expiratory reserve volume
A 52-year-old woman feels a lump in her right breast on self-examination
and goes to her physician. On physical examination the 4 cm mass is not
freely movable and feels quite hard. A ne needle aspirate is performed
and cytologic examination shows cells are present consistent with
carcinoma. Which of the following features of this carcinoma is most likely
to suggest a worse prognosis?
A. Axillary lymph node metastases
B. Presence of an in-situ component
C. Family history of breast carcinoma
D. Estrogen receptor positivity
Clinical ndings of prolonged hypoxemia in long-standing cystic brosis
include:
A. Cough
B. Frequent respiratory infections
C. Clubbing of the ngers
D. Crackles in the lungs
A 41-year-old woman has felt a large breast lump that has increased
slowly in size for the past 3 years. On physical examination there is a 9 cm
rm, movable mass present in her left breast. The overlying skin appears
normal; there is no axillary lymphadenopathy. The mass is excised and
grossly appears soft and eshy. On microscopic examination this mass
has a lymphoid stroma with little brosis surrounding sheets of large
vesicular cells with frequent mitoses. Which of the following is the most
likely diagnosis?
A. Medullary carcinoma
B. Colloid carcinoma
C. Inltrating ductal carcinoma
D. Lobular carcinoma
Extrinsic / allergic asthma:
A. Is mediated by IgG
B. Presents with different signs and symptoms than intrinsic asthma
C. Is due to an antigen-antibody reaction on IgE-bearing mast cells
D. Often is precipitated by exercise
A 45-year-old woman feels a "lump" in her left breast. Her physician
palpates a 2 cm irregular area in the upper outer quadrant. A biopsy is
performed and microscopic examination shows no evidence for carcinoma.
Which of the following microscopic ndings in this biopsy is most likely to
suggest an increased risk for subsequent development of breast
carcinoma?
A. Galactocele
B. Sclerosing adenosis
C. Apocrine metaplasia
D. Atypical hyperplasia
Pathophysiologic differences between emphysema and chronic bronchitis
include the fact that:
A.
Emphysema is characterized by hypersecretion of goblet and mucus
cells
B.
Chronic bronchitis commonly results in polycythemia to compensate
for persistent hypoxemia
C. Chronic bronchitis produces destruction of alveolar walls
D.
Emphysema is due to chronic inammation resulting in brotic
airwways
25yr HIV-positive presents w/ low grade fever, nonproductive cough,
increasing shortness of breath. Routine histologic sections from
transbronchial biopsy reveal foamy frothy eosinophilic material within alveoli.
Silver stains reveal presence of numerous cup-shaped organisms with
central dark spots. Which of the following is the most likely diagnosis?
A. Atypical pneumonia
B. Organizing pneumonia
C. Paragonimus pneumonia
D. Pneumocystis pneumonia
Signs or symptoms of tracheobronchial obstruction include all of the
following except:
A. Stridor
B. Wheezing
C. Sternal retractions
D. Crackles
A 20-year-old woman notes a mass in her left breast after following the
directions for breast self-examination provided by her health clinic. Her
physician palpates a rm, 1 to 2 cm mass. There is no nipple discharge and
no pain. No axillary adenopathy is present. The overlying skin of the breast
appears normal. Her left breast is slightly larger than the right, a condition
she says has been present since puberty. Her urine pregnancy test is
negative. Mammography conrms the presence of a rounded density, which
has no microcalcications, and reveals no lesions of the opposite breast.
Which of the following is the most likely diagnosis?
A. Focus of fat necrosis
B. Fibroadenoma
C. Intraductal papilloma
D. Inltrating ductal carcinoma
Arterial blood gases for a patient with mild to moderate emphysema would
reect:
A. Severe hypoxemia
B. Increased PaCO2
C. Near-normal PaO2 and normal to low PaCO2
D. Respiratory failure
A 26 yr woman present w/ acute onset of fever, malaise, headache, muscle
pain, dry hacking nonproductive cough. Laboratory evaluation nds presence
of cold agglutins in her serum, mainly immunoglobulin M (IgM) anti- I cold
agglutinins. Which histologic changes would most likely be present in the lung
parenchyma of this individual?
A. Eosinopils within walls of capillaries
B. Lymphocytes within walls of alveoli
C. Microthrombi within lumen of capillaries.
D. Neutrophils within lumen of alveoli
Which of the following assesment ndings is indicative of an asthma attack?
A. Wheezing
B. Thin, watery mucus production
C. Nonproductive cough
D. Fever
A study of postpartum women is performed. Some of them developed a
palpable "lump" in one or both breasts postpartum. The lump appeared
following cessation of breast feeding and persisted for more than one month,
Many of these lumps regressed following ne needle aspiration. Which of the
following breast lesions is most likely to fulll these criteria?
A. Papilloma
B. Fat necrosis
C. Galactocele
D. Ductal epithelial hyperplasia
A classic clinical nding when a patient has epiglottitis is:
A. Pain and difculty swallowing
B. Pain with inspiration
C. Unequal thoracic expansion
D. Earaches
A 31-yr woman presents 2 A&E w/ Acute onset of malaise, fever, & productive
cough. CXT shows consolidation of R lower lobe along with air bronchograms
and Gram stain of her sputum shows a predominance of Gram-positive lancet-
shaped cocci in pairs & chains.
Which of the following is the most likely causative agent of this individual's
infectious disease?
A. H. inuenza
B. Klebsiella pneumonia
C. Pseudomonas aerogenosa
D. Streptococcus pneumonae
Bronchoiolitis, commonly seen in infants due to respiratory syncytial virus, is
characterised by:
A. Airway inammation and mucus formation
B. Athrophy of smooth muscle of the airway
C. Oncreased compliance of lung tissue
D. Thin secretions from the nose
A 52-year-old woman has felt a lump in her breast for the past 2 months. On
physical examination a rm 2 to 3 cm mass is palpable in the upper outer
quadrant of her right breast. There are no palpable axillary nodes. A
lumpectomy with axillary node dissection is performed. The breast lesion is
found to have positive immunohistochemical staining for HER2/neu (c-erb B2).
Staining for estrogen and progesterone receptors is negative. Which of the
following treatment options is most likely to be efcacious in this woman?
A. Letrozole
B. Tamoxifen
C. Trastuzumab
D. Prednisone
Croup is a syndrome, a collection of signs and symptoms that may be due to
several etiologic factors. The most characteristic nding croup is:
A. Earaches
B. Barking cough with respiratory stridor
C. Enlarged lymph nodes in the neck
D. Marked fever
A 47-year-old woman undergoes routine mammographic screening and
there are multiple small areas of increased density, though a single
distinctive mass lesion is not detectable either by palpation or by
mammography. A ne needle aspiration biopsy of an abnormal density
reveals cells suspicious for a malignancy. An excisional breast biopsy
yields a diagnosis of lobular carcinoma in situ of the breast. Which of the
following is the most likely nding associated with this woman's carcinoma?
A. No residual carcinoma
B. Opposite breast involvement
C. Absent family history of breast cancer
D. Concomitant Paget disease of the nipple
Acute and chronic bronchitis differ in which of the following ways?
A. Chronic bronchitis is caused by repeated infections
B. Acute bronchitis is not associated with increased mucus production
C.
Acute bronchitis produces arterial blood gas changes reecting
signicant hypoxemia
D. Chronic bronchitis results in airway changes that are irreversible
A 20-year-old woman gives birth to a term girl infant following an
uncomplicated pregnancy. She breast feeds the infant. Six weeks later, her
left breast becomes painful and slightly swollen. On physical examination
there is a tender 3 cm mass in the left breast beneath a nipple that shows
several painful ssures. Which of the following pathologic ndings is most
likely to be present in this breast?
A. Inltrating ductal carcinoma
B. Staphylococcus aureus infection
C. Sclerosing adenosis
D. Fat necrosis
Which of the following statements regarding cystic brosis is correct?
A. It is caused by a bacterial infection
B. It can be prevented by a vaccine
C. It is associated with a generic defect in chloride transport
D. It affects only the pulmonary system
A 49-year-old woman notes increasing size to her right breast over the past
year. This breast is not painful, but the heaviness causes some discomfort.
On physical examination the overlying skin and nipple appear normal. There
is no nipple discharge. There is no axillary lymphadenopathy.
Mammography reveals a solid 12- cm circumscribed mass. The mass is
biopsied, and on microscopic examination shows a cellular stromal
component along with an epithelial component. Which of the following is the
most likely diagnosis?
A. Fibroadenoma
B. Sclerosing adenosis
C. Medullary carcinoma
D. Phyllodes tumor
A 65 yr woman complains of itching and scaliness of breast nipple. A 1-cm
palpable mass is felt underlying the skin. A biopsy conrms Paget disease.
Which of the following is likely to be an association?
A. Inltrating ductal carcinoma
B. Lobular carcinoma in situ
C. Invasive lobar carcinoma
D. Intraductal papilloma
High-dose oxygen therapy must be used cautiously in patients with
chronic bronchitis because:
A.
V/Q changes can result in further elevations in partial pressure of
carbon dioxide in arterial blood (PaCO2)
B.
Pulmonary vasoconstriction will worsen, increasing the work of the
right heart
C.
Respiratory smooth muscle constriction will result in increased air
trapping
D.
Peripheral chemoreceptors will be depressed, and the patient will
stop breathing
Pursed-lip breathing is commonly used by patients with emphysema because
it:
A. Increases the pressure gradient for gas exchange
B. Helps strengthen accessory respiratory muscles
C. Decreases small airway collapse during expiration
D. Prolongs inspiration to allow gas to reach distal air sacs
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