Multiple choice questions in:

Systemic Pathology Multiple choice questions in: Dr. Ammar C. Al-Rikabi

Respiratory system. Gastrointestinal tract. Liver and Exocrine pancreas. Kidney and urinary pancreas. Endocrine glands and diabetes mellitus. Multiple choice questions in: Skin diseases. Dr. Ammar C. Al-Rikabi

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

(A) Bronchial smooth muscle hypertrophy with proliferation of eosinophils (B) Diffuse alveolar damage with leakage of protein- rich fluid into alveolar spaces (C) Dilatation of air spaces with destruction of alveolar walls (D) Hyperplasia of bronchial mucus-secreting submucosal glands (E) Permanent bronchial dilatation caused by chronic infection, with bronchi filled with mucus and neutrophils Respiratory system

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

(A) Bronchial smooth muscle hypertrophy with proliferation of eosinophils (B) Diffuse alveolar damage with leakage of protein-rich fluid into alveolar spaces (C) Dilatation of air spaces with destruction of alveolar walls (D) Hyperplasia of bronchial mucus-secreting submucosal glands (E) Permanent bronchial dilatation caused by chronic infection, with bronchi filled with mucus and neutrophils Respiratory system

(A) Bronchial smooth muscle hypertrophy with proliferation of eosinophils (B) Diffuse alveolar damage with leakage of protein-rich fluid into alveolar spaces (C) Dilation of air spaces with destruction of alveolar walls (D) Hyperplasia of bronchial mucus-secreting submucosal glands (E) Permanent bronchial dilation caused by chronic infection, with bronchi filled with mucus and neutrophils Respiratory system

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

(A) Generally amenable to surgical cure at time of diagnosis (B) More common in women, and a less clear relation to smoking than other forms of lung cancer (C) Secretes a parathyroid-like hormone (D) Secretes either corticotrophin or antidiuretic hormone (E) Usually in a peripheral rather than in a central location Respiratory system

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

Bronchial smooth muscle hypertrophy with proliferation of eosinophils Diffuse alveolar damage with leakage of protein-rich fluid into alveolar spaces Dilatation of air spaces with destruction of alveolar walls Hyperplasia of bronchial mucus-secreting submucosal glands (E) Permanent bronchial dilatation caused by chronic infection, with bronchi filled with mucus and neutrophils Respiratory system

Bronchial smooth muscle hypertrophy with proliferation of eosinophils Diffuse alveolar damage with leakage of protein-rich fluid into alveolar spaces Dilation of air spaces with destruction of alveolar walls Hyperplasia of bronchial mucus-secreting submucosal glands (E) Permanent bronchial dilation caused by chronic infection, with bronchi filled with mucus and neutrophils Respiratory system

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

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

(A) Acute respiratory distress syndrome (B) Goodpasture syndrome (C) Idiopathic pulmonary fibrosis (D) Idiopathic pulmonary hemosiderosis (E) Malignant mesothelioma of the pleura Respiratory system Back to main menu

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

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

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

(A) Columnar intestinal metaplasia of esophageal squamous epithelium (B) Excessive acid production in the stomach (C) Excessive nonsteroidal anti-inflammatory drug use (D) Helicobacter pylori infection (E) Hiatal hernia and incompetent lower esophageal sphincter Gastrointestinal tract

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

(A) Barrett esophagus and columnar intestinal metaplasia of esophageal squamous epithelium (B) Evolution into carcinoma is a likely sequela (C) Helicobacter pylori infection (D) Hiatal hernia and incompetent lower esophageal sphincter (E) Pernicious anemia and achlorhydria Gastrointestinal tract

(A) Barrett esophagus and columnar intestinal metaplasia of esophageal squamous epithelium (B) Evolution into carcinoma as a likely sequela (C) Helicobacter pylori infection (D) Hiatal hernia and incompetent lower esophageal sphincter (E) Pernicious anemia and achlorhydria Gastrointestinal tract

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

(A) Cigarette smoking and chronic alcohol use are associated risk factors. (B) Gastroesophageal reflux disease and Barrett esophagus are associated risk factors. (C) Histologic findings include disordered, back-to-back submucosal glands. (D) It most frequently arises in the lower third of the esophagus. (E) This cancer is characterized by an indolent course, and long survival is common. Gastrointestinal tract

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

(A) Aggregation of bacterial colonies on the lumen, forming pseudomembranes (B) Bacterial release of exotoxin, inducing necrosis of the mucosa (C) Physical invasion of bacteria into the superficial mucosa, leading to pseudomembrane formation (D) Selective killing of Clostridium difficile bacteria by antibiotics (E) Spread of the previous infection to the colon Gastrointestinal tract

(A) Aggregation of bacterial colonies on the lumen, forming pseudomembranes (B) Bacterial release of exotoxin, inducing necrosis of the mucosa (C) Physical invasion of bacteria into the superficial mucosa, leading to pseudomembrane formation (D) Selective killing of Clostridium difficile bacteria by antibiotics (E) Spread of the previous infection to the colon Gastrointestinal tract Back to main menu

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

(A) Abetalipoproteinemia (B) Alcohol (C) Cholelithiasis (D) Cystic fibrosis (E) Mumps Liver and exocrine pancreas

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

(A) Hepatitis B (B) Hepatitis C (C) Oral contraceptives (D) Polycythemiavera (E) Polyvinyl chloride Liver and exocrine pancreas

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

(A) Hepatitis A (B) Hepatitis B (C) Hepatitis C (D) Hepatitis D (E) Hepatitis E Liver and exocrine pancreas

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

(A) Hepatitis B carrier (B) Immunized against hepatitis B (C) Infected and within the "window period" (D) Infected with hepatitis B and highly transmissible (E) Recently infected with hepatitis B Liver and exocrine pancreas

(A) Hepatitis B carrier (B) Immunized against hepatitis B (C) Infected and within the "window period" (D) Infected with hepatitis B and highly transmissible (E) Recently infected with hepatitis B Liver and exocrine pancreas Back to main menu

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

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

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

(A) Dihydrotestosterone (B) Estrogen (C) α-Fetoprotein (D) Human chorionic gonadotropin (E) Testosterone Kidney and urinary tract

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