PATHOLOGY Instructions:
Choose the BEST answer
1. Acute myelogenous leukemia is: a. most common in females b. most common in adults over 60 years old c. occasionally aleukemic d. associated with massive splenomegaly 1. Answer: C Robbins 6th ed pp. 677
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2. Hodgkin’s lymphoma with the worst prognosis: a. lymphocyte predominance b. nodular sclerosis c. mixed cellularity d. lymphocyte depletion 2. Answer: D Robbins 6th ed pp. 672
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3. The a. b. c. d. 3.
most important difference between a benign reactive lymph node and lymphoma : interstitial fibrosis follicular hyperplasia effacement of normal architecture presence of plasma cells Answer: C Robbins 6th ed pp. 649 MPL 0.33
4. Plasma cells are characterized by a. abundant surface immunoglobulins b. Fc surface receptors c. Abundant cytoplasm immunoglobulins d. Complement surface receptors 4. Answer: C Robbins 6th ed pp. 82
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5. Paroxysmal hypertension is most typically associated with which of the following? a. adrenal adenoma b. thyroid adenoma c. parathyroid adenoma d. pheochromocytoma 5. Answer: D Robbins 6th ed pp. 1166 MPL 1 6. The association of medullary carcinoma of the thyroid with pheochromocytoma with or without parathyroid hyperplasia or adenoma is called: a. Conn’s syndrome b. Cushing’s syndrome c. Sipple’s syndrome d. Waterhouse-Friedricksen’s syndrome 6. Answer: C Robbins 6th ed pp. 1167 MPL 0.25 7. Which of the following is the most common cause of Cushing’s syndrome a. exogenous corticosteroids b. adrenal cortical carcinoma c. oat cell carcinoma of the lungs d. basophilic adenoma of the pituitary 7. Answer: A Robbins 6th ed pp. 1153 MPL 0.33 8. A destructive lesion in this area will result in diabetes insipidus: a. mamillothalamic tract b. adenohypophysis c. subthalamic fasciculus d. supraoptic and paraventricular hypothalamic nuclei 8. Answer: D Robbins 6th ed pp. 1129 MPL 0.25 9. Conn’s syndrome is primarily associated with an excess of : a. glucocorticoids b. mineralocorticoids c. thyroid hormone d. ADH 9. Answer: B Robbins 6th ed pp. 1155 MPL 0.25 10. Primary hyperaldosteronism is associated with:
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a. hyponatremia b. hypotension c. elevation of plasma renin levels d. hypokalemia 10. Answer: D Robbins 6th ed pp. 1155
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11. The single most frequent adrenal lesion producing primary hyperaldosteronism: a. single unilateral adenoma b. multiple unilateral adenomas c. bilateral adenomas d. carcinoma 11. Answer: A Robbins 6th ed pp. 1155 MPL 0.25 12. Truncal obesity, easy bruising and osteoporosis is associated with: a. craniopharyngioma b. adrenal adenoma c. thyroid adenoma d. parathyroid adenoma 12. Answer: B Robbins 6th ed pp. 1154-1155 MPL 1 13 Urinalysis results show proteinuria, red blood cells and casts, and 1-2 pus cells per HPO. These findings are consistent with: a. acute cystitis b. acute pyelonephritis c. chronic pyelonephritis d. acute post-streptococcal glomerulonephritis 13. Answer: D Robbins 6th ed pp. 950 MPL 1 14. Membranous glomerulopathy and poststreptococcal glomerulonephritis are similar in that they both: a. are self-limiting and transient renal diseases b. are commonly associated with nephrotic syndrome c. are most commonly seen in children d. have glomerular immune complex deposits 14. Answer: D Robbins 6th ed pp. 953 MPL 0.5 15. A patient with hemoptysis and renal failure has a renal biopsy which reveals crescentic glomerulonephritis, with linear deposits of IgG and C3 on immunofluorescence. Diagnosis? a. acute post-infectious glomerulonephritis b. membranous nephropathy c. Goodpasture’s syndrome d. Minimal change disease 15. Answer: C Robbins 6th ed pp. 951 MPL 1 16. The most characteristic feature of rapidly progressive glomerulonephritis: a. crescent formation b. hyaline nodules c. subepithelial dense deposits d. thickened capillary loops 16. Answer: A Robbins 6th ed pp. 951 MPL 1 17. Benign nephrosclerosis is best defined as: a. fibrinoid necrosis of afferent arterioles with ischemic atrophy of nephrons b. hyalinization of afferent arterioles with ischemic atrophy of nephrons c. diffuse thickening of glomerular capillary basement membrane leading to glomerulosclerosis d. deposition of basement-like material within the glomerular mesangium leading to glomerulosclerosis 17. Answer: B Robbins 6th ed pp. 981-982 MPL 0.25 18. Ischemic acute tubular necrosis occurs most commonly in association with: a. septic shock b. ruptured aneurysm c. carcinoma of the prostate d. malignant hypertension 18. Answer: A Robbins 6th ed pp. 969 MPL 1
19. The most common appearance of nephrotic syndrome in adults is:
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a. b. c. d.
proliferative glomerulonephritis membranous glomerulonephritis rapidly progressive glomerulonephritis wire-loops
19. Answer: B
Robbins 6th ed pp. 953
20. “Nutmeg liver” is a gross finding seen in: a. petechial hemorrhages b. viral hepatitis c. alcoholism d. chronic passive congestion 20. Answer: D Robbins 6th ed pp. 116-117
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21. Which of the following is associated with high levels of serum alkaline phosphatase? a. hemolytic anemia b. metastatic carcinoma to the liver c. Dubin-Johnson syndrome d. Gilbert’s syndrome 21. Answer: B Robbins 6th ed pp. 891 MPL 1 22. The most common outcome in-patients with acute Hepatitis B is: a. complete recovery without residual dysfunction b. chronic persistent hepatitis c. chronic active hepatitis d. postnecrotic cirrhosis 22. Answer: A Robbins 6th ed pp. 858 MPL 1 23. In a patient suspected of having viral hepatitis, which laboratory finding would indicate the most severe and life threatening amount of liver damage? a. prolonged prothrombin time b. high serum bilirubin c. high serum aspartate transaminases d. high serum alkaline phosphatase 23. Answer: A Robbins 6th ed pp. 867 MPL 1 24. The most important substance in the formation of gallstones is: a. calcium c. bile salts b. bilirubin d. lecithin 24. Answer: C Robbins 6th ed pp. 894 MPL 0.25 25. Cirrhosis produces most of its clinical manifestations by means of: a. hepatic necrosis leading to insufficient number of liver cells to sustain life b. cancerous change in regenerating nodules c. obstruction of large biliary passages d. vascular derangements in the liver 25. Answer: D Robbins 6th ed pp. 853 MPL 0.25 26. The major cause of portal hypertension is: a. Intrahepatic c. prehepatic b. Posthepatic d. cardiac 26. Answer: A Robbins 6th ed pp. 855
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27. The most common factor in the formation of esophageal varices is obstruction at the level of: a. esophageal vein b. hepatic vein c. intrahepatic vessels d. portal vein 27. Answer: C Robbins 6th ed pp. 783 MPL 0.25 28. When a person dies suddenly from a “heart attack” the most likely event causing it will be: a. aortic aneurysm b. coronary artery embolism c. congestive heart failure d. arrhythmia 28. Answer: D Robbins 6th ed pp. 562 MPL 1 29. Acute rheumatic heart disease is associated with: a. arthritis b. emboli to multiple organs
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c. cardiac tamponade d. right to left shunt 29. Answer: A Robbins 6th ed pp. 572
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30. The most frequent and clinically significant residual lesion of acute rheumatic fever is: a. myocardial fibrosis b. aortic stenosis c. mitral stenosis d. pericardial adhesion 30. Answer: D Robbins 6th ed pp. 570-571 MPL 0.25 31. The absolute criterion of cardiomegaly: a. increase in size b. increase wall thickness c. increase in weight d. change in shape 31. Answer: C Robbins 6th ed pp. 544
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32. Myocardial disease gradually producing 4-chamber dilatation: a. viral myocarditis b. hypertrophic cardiomyopathy c. congestive cardiomyopathy d. restrictive cardiomyopathy 32. Answer: C Robbins 6th ed pp. 579-581 MPL 1 33. Necrotizing infection caused by highly virulent organisms seeding a normal valve: a. rheumatic heart disease b. SLE endocarditis c. acute infective endocarditis d. marantic Endocarditis 33. Answer: C Robbins 6th ed pp. 572-573 MPL 1 34. The most common cause of intestinal obstruction is: a. adhesions b. volvulus c. neoplasm d. hernia 34. Answer: A Robbins 6th ed pp. 825 (table)
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35. A two-week old boy has projectile vomiting. The most likely diagnosis is : a. pyloric stenosis b. esophageal atresia c. annular pancreas d. incomplete rotation of the gut 35. Answer: A Robbins 6th ed pp. 789 MPL 0.25 36. An endoscopic gastric biopsy finding of intestinal type epithelia is most likely due to: a. chronic gastritis b. congenital heterotopia c. precancerous dysplasia d. metastatic carcinoma 36. Answer: A Robbins 6th ed pp. 790 MPL 0.25 37. Most characteristic of right sided colon cancer compared to left-sided cancer: a. anemia b. associated with polyposis c. bowel obstruction d. diarrhea 37. Answer: A Robbins 6th ed pp. 834 MPL 0.33
38. Acute erosive gastritis is characterized by: a. superficial and multiple gastric mucosal ulceration b. pus in the gastric mucosa c. deep ulcer with scarred base d. frequent association with gastric cancer
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38. Answer: A
Robbins 6th ed pp. 789-790
39. The most common site of chronic gastric peptic ulcer: a. lesser curvature at the antral-body junction b. anterior wall of the duodenal verge c. greater curvature at the mid-antrum d. esophago-gastric junction 39. Answer: A Robbins 6th ed pp. 795 40. The definitive finding in acute appendicitis: a. obstruction of the lumen by a fecalith b. mucus inspissation in the lumen c. neutrophils in the muscularis d. serosal congestion and margination of polys 40. Answer: C Robbins 6th ed pp. 839
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41. Morphologic appearance favoring benign rather than malignant gastric ulcer: a. large ulcer b. heaped up margin c. antral location d. folds radiating from the ulcer 41. Answer: C Robbins 6th ed pp. 795 MPL 0.25 42. Most frequently found neoplasm in the appendix: a. adenoma b. polyp c. carcinoid d. adenocarcinoma 42. Answer: C Robbins 6th ed pp. 840 43. The most common malignant soft tissue tumor: a. rhabdomyosarcoma b. malignant fibrous histiocytoma c. leiomyosarcoma d. liposarcoma 43. Answer: D Robbins 6th ed pp. 1261
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44. Brown tumors of bone is associated with: a. hyperparathyroidism b. trauma c. metastatic carcinoma d. vitamin deficiency 44. Answer: A Robbins 6th ed pp. 1228
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45. The most frequent site of compression fracture is: a. femur b. radio-ulnar area c. clavicle d. vertebrae 45. Answer: D Robbins 6th ed pp. 1229-1231
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46. Rheumatoid arthritis usually has its origin in: a. ball and socket joints b. lumbo-sacral joints c. small peripheral joints d. major weight-bearing joints 46. Answer: C Robbins 6th ed pp. 1251
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47. Most common primary malignant bone tumor in 15-25 years of age: a. chondrosarcoma b. osteosarcoma c. Ewing’s sarcoma d. Chondroblastoma 47. Answer: B Robbins 6th ed pp. 1236 MPL 1
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48. The most likely malignant bone tumor in a 65 yo man is: a. Giant cell tumor b. Osteosarcoma c. Metastatic prostatic cancer d. Multiple myeloma 48. Answer: C Robbins 6th ed pp. 1245
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49. The most common primary type of bronchogenic carcinoma is: a. metastatic carcinoma b. adenocarcinoma c. squamous cell carcinoma d. small cell carcinoma 49. Answer: C Robbins 6th ed pp. 743-744 MPL 1 50. The source of surfactant is believed to be: a. Type I pneumocyte b. Type II pneumocyte c. Mast cell d. Alveolar mcrophage 50. Answer: B Robbins 6th ed pp. 471
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51. The single most characteristic feature of bronchiectasis is: a. excessive mucus secretion b. immotile cilia c. dilatation of bronchi d. alpha-1 antitrypsin deficiency 51. Answer: C Robbins 6th ed pp. 716 MPL 1 52. Non-communicating hydrocephalus means obstruction: a. between ventricles and subarachnoid space b. at the cisterna ambiens c. at the arachnoid granulations d. at the vein of Galen 52. Answer: B Robbins 6th ed pp. 1298-1299
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53. The most common cause of bacterial meningitis in a patient <2 months old is: a. Escherichia coli b. Hemophilus influenza c. Streptococcus pneumoniae d. Neisseria meningitides 53. Answer: A Robbins 6th ed pp. 1314 MPL 1 54. The most important and consistent site for histologic lesion in parkinsonism is: a. caudate nucleus b. substantia nigra c. red nucleus d. putamen 54. Answer: B Robbins 6th ed pp. 1334 MPL 1 55. Increased hormonal stimulation may cause cells to undergo: a. atrophy c. hyperplasia b. metaplasia d. dysplasia 55. Answer: C Robbins 6th ed pp. 32-33 MPL 1 56. A reversible change or alteration in adult cells characterized by variation in size, shape and organization: a. metaplasia c. dysplasia b. hyperplasia d. atrophy 56. Answer: C Robbins 6th ed pp. 466 MPL 1
57. Type of cellular adaptation where there is marked increase in the number of autophagosomes accompanied by decrease in the number of mitochondria, myofilaments, ad endoplasmic reticulum: a. hypertrophy c. hyperplasia b. atrophy d. metaplasia 57. Answer: B Robbins 6th ed pp. 36 MPL 1 58. The most common cause of hypoxic injury is; a. ischemia
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b. depletion of oxygen-carrying capacity of blood c. poisoning of the oxidative enzymes within the cells d. thrombosis 58. Answer: A Robbins 6th ed pp. 4
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59. The sum of all morphologic changes following cell death: a. necrosis c. autolysis b. heterolysis d. autophagy 59. Answer: A Robbins 6th ed pp. 2 MPL 1 60. The characteristic cellular infiltrate in the early phase of acute inflammation: a. lymphocyte c. plasma cells b. neutrophils d. eosinophil 60. Answer: B Robbins 6th ed pp. 51 MPL 1 61. The immediate transient phase of vascular permeability in most types of tissue injury is mediated by: a. histamine c. complement b. prostaglandins d. bradykinin 61. Answer: A Robbins 6th ed pp. 66 MPL 0.5 62. The characteristic cell of a granuloma: a. Langhan’s type giant cell c. lymphocyte b. epithelioid cell d. plasma cell 62. Answer: B Robbins 6th ed pp. 83-84 Answer: MPL 1 63. The essential features of a granulation tissue: a. fibroblasts and inflammatory cells c. edema & inflammatory cell b. small blood vessels and fibroblasts d. inflammatory cells & vessels 63. Answer: B Robbins 6th ed pp. 102-103 MPL 0.5 64. Acute pancreatitis: a. coagulation necrosis c. liquefaction necrosis b. caseation necrosis d. enzymatic fat necrosis 64. Answer: D Robbins 6th ed pp. 17-18 MPL 1 65. Acute inflammation is characterized by the following: A. relatively long duration B. proliferation blood vessels and connective tissue 65. Answer: D Robbins 6th ed pp. 51
C. emigration of macrophages D. exudation MPL 1
66. The most common mechanism of vascular leakage elicited by free oxygen radicals: A. endothelial contraction C. leukocyte-dependent leakage B. direct endothelial cell injury D. regeneration of endothelial cell th 66. Answer: B Robbins 6 ed pp. 55 / 76 MPL 0.25 67. Leukocyte adhesion, chemotaxis and activation are important inflammatory mediator processes performed by complement factor: A. C7a C. C5a B. C6a D. C1a 67. Answer: C Robbins 6th ed pp. 61 MPL 0.33 68.
Oxygen-derived free radicals are implicated in: A. endothelial cell damage B. release of histamine 68. Answer: A Robbins 6th ed pp. 76
C. tissue regeneration D. prostaglandin release MPL 0.5
69. This inflammatory infiltrate is the prima donna of chronic inflammation because of the great number of biologically active substances it releases: A. lymphocytes C. neutrophils B. macrophage D. plasma cells 69. Answer: B Robbins 6th ed pp. 79 MPL 1 70. Adaptation has happen: a. if the cell undergoes necrosis c. ..is replaced by another cell type b. loses its genetic apparatus d. undergoes dystrophic calcification 70. Answer: C Robbins 6th ed pp. 36-37 MPL 1 71. Characteristics of benign tumors: a. invasive
c. immortal
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b. cohesive 71. Answer: B
Robbins 6th ed pp. 270
d. escape from regulatory control MPL 0.33
72. The most reliable feature of malignancy: a. metastasis c. rate of growth b. differentiation d. invasion 72. Answer: A Robbins 6th ed pp. 268 MPL 1 73. The most common route of metastasis of a carcinoma: a. contiguity c. hematogenous b. lymphatic d. iatrogenic 73. Answer: B Robbins 6th ed pp. 269 MPL 1 74. The most important prognostic factor for malignancy: a. stage c. invasion b. grade d. localization 74. Answer: A Robbins 6th ed pp. 321-322 MPL 1 75. A 25-year-old man with a history of intravenous drug use has had one bout of Pneumocystis carinii pneumonia which was successfully treated a year ago. He now has a WBC count of 3600/microliter with differential count of 78 segs, 3 bands, 5 lymphs, and 14 monos. He has recently developed painful, progressive visual loss involving both eyes. Which of the following infections is he most likely to have: A. Klebsiella pneumoniae C. Mycobacterium tuberculosis B. Staphylococcus aures D. Cytomegalovirus 75. Answer: D Robbins 6th ed pp. 1319 MPL 0.25 76. A 65-year-old previously healthy woman has had a non-productive cough increasing in severity over the last 10 days. She has a temperature of 38.0 C. A chest radiograph shows faint interstitial infiltrates but no areas of consolidation. A CBC reveals a WBC count of 8900/microliter with differential count of 60 segs, 3 bands, 25 lymphs, and 12 monos. A sputum gram stain reveals a few gram positive cocci, gram negative cocci, and Candida with few neutrophils. Her condition gradually improves over the next week. Which of the following infectious agents is most likely responsible for her illness: A. Klebsiella pneumoniae C. Mycobacterium tuberculosis B. Staphylococcus aures D. Influenza A virus 76. Answer: D Robbins 6th ed pp.348 MPL 0.25 77. A 39-year-old man had an acute febrile illness with fever, pharyngitis, lymphadenopathy, and malaise following a trip to a city known for its commercial sex workers. In how many years would you predict that his peripheral blood CD4 lymphocyte count will drop below 200/microliter: A. one C. ten B. five D. fifteen 77. Answer: C Robbins 6th ed pp.246-248 MPL 0.25 78. A 20-year-old commercial sex worker has lower abdominal pain of 24 hours duration. There is no previous history of pain. She is febrile, her total WBC is 29,000/mm3 with 85% neutrophils. She has a markedly tender lower abdomen on palpation. Laparotomy reveals a distended, fluid-filled reddened left fallopian tube that is about to rupture. The tube is removed. A culture of the fluid from the tube is most likely to grow: A. TB bacilli C. AIDS virus B. Neisseria gonorrhea D. Human Papilloma virus 78. Answer: B Robbins 6th ed pp.362 MPL 0.25 79. A 10-year-old child has a severe watery diarrhea that causes her to become severely dehydrated over the past two days. The persistent activation of adenylate cyclase by GTP leads to excessive intestinal fluid loss. Which of the following organisms is most likely to produce a toxin that has this effect: A. Eschericia coli C. Vibrio cholera B. Entamoeba histolytica D. Salmonella enteritidis 79. Answer: C Robbins 6th ed pp.808 MPL 0.5
80. An 18-year-old man is plowing a field on a hillside. He discovers a deep, penetrating puncture wound to his foot. He walks home and washes the soil off the wound site and puts a bandage over it. A week later the wound is healing, and the leg is not swollen, but he begins to experience generalized muscle spasms, with stiffness and pain in his shoulders and back. He has difficulty with eating and
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swallowing, with painful stiff jaw and facial muscles. Which of the following organisms is most likely responsible for these findings : A. Clostridium tetani C. Staphylococcus aureus B. Clostridium perfringens D. Streptococcus pneumoniae 80. Answer: A Robbins 6th ed pp.368-369 MPL 1 81. A 41-year-old man has a chronic cough and recently experienced an episode of hemoptysis. A chest radiograph shows a cavitary 4 cm nodule in the right upper lung. There are a few adjacent smaller nodules with calcifications. The best diagnosis is: A. AIDS with cytomegalovirus C. Bronchopneumonia with pseudomonas B. Secondary tuberculosis D. peripheral organizing pulmonary thromboembolus 81. Answer: C Robbins 6th ed pp.376-377 MPL 0.25 82. A 40-year-old man has had a productive cough with yellowish sputum for several days. A complete blood count shows that he has a total WBC count of 15,700/microliter with differential count of 73 segs, 10 bands, 12 lymphs, and 5 monos. He has a fever of 38.9 C. A chest radiograph reveals a nodule in the left upper lobe that has a central cavity with an air-fluid level. Which of the following findings is most likely to be present in his sputum|: A. +2 acid fast bacilli C. 4+ gram positive cocci B. atypical squamous cells D. hemosiderin-laden macrophages 82. Answer: C Robbins 6th ed pp.367 / 722 MPL 0.33 83. A 78-year-old woman has a history of Alzheimer's disease. She dies after an illness lasting only a two-day history of fever and cough productive of copious amounts of yellowish sputum. Her vital signs on admission included blood pressure 110/75 mm Hg, pulse 105, respirations 26, and temperature 38.1 C. She had dullness to percussion at the right lung base. The microscopic findings from the right lower lobe at autopsy include numerous neutrophils within the alveolar spaces, with minimal destruction of alveolar walls. What was the most likely infectious cause for her pulmonary disease: A. Influenza A virus C. streptococcus pneumoniae B. Mycobacterium tuberculosis D. Cytomegalovirus 83. Answer: C Robbins 6th ed pp.719 MPL 0.33 84. A 22-year-old woman has experienced episodes of myalgias, pleural effusions, pericarditis, and arthralgias without joint deformity over the course of several years. She has continued working at her job. A CBC reveals a mild normocytic anemia. The best laboratory screening test to begin the workup for her condition would be a(an): A. CD4 lymphocyte count C. antinuclear antibody test B. Blood culture D. creatine phosphokinase 84. Answer: C Robbins 6th ed pp.216-217 MPL 0.25 85. A male infant was born at term. No congenital anomalies were noted at birth. A year later he now has failure to thrive and has been getting one bacterial pneumonia after another with both Hemophilus influenzae and Streptococcus pneumoniae cultured from his sputum. You should most strongly suspect that he has which of the following diseases A. Di George Syndrome C. EBV infection B. Selective IgA deficiency D. X-inked agammaglobulinemia th 85. Answer: D Robbins 6 ed pp.232-233 MPL 0.25 86. An appropriate, useful type I hypersensitivity response of the immune system, accompanied by eosinophilia, would be directed against: A. amyloid protein C. neoplasms B. pinworm infection D. inhaled dusts 86. Answer: B Robbins 6th ed pp.82 MPL 1 87. A 54-year-old woman is found to have a blood pressure of 170/110 mm Hg. Her fingers become cold and painful upon exposure to cold. She has mild dyspnea, but no wheezing. The antinuclear antibody test is positive with a titer of 1:256 and a nucleolar pattern. Her serum urea nitrogen is 15 mg/dL with creatinine of 1.1 mg/dL. These findings most strongly suggest that she has which of the following autoimmune diseases: A. discoid lupus erythematosus C. polymyositis-dermatomyositis B. progressive systemic sclerosis D. rheumatoid arthritis 87. Answer: B Robbins 6th ed pp.226-229 MPL 0.25 88. Several hours after going on a hike through dense foliage, a 40-year-old man notices a slightly raised and tender irregular reddish rash on one forearm that was not covered by clothing. This rash gradually increases in intensity for a couple of days and then fades after two weeks. The rash is most indicative of: A. Type I C. Type III B. Type II D. Type IV
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88. Answer: D Robbins 6th ed pp.204-206 MPL 0.25 89. The second pregnancy of a 23-year-old woman appears uncomplicated until ultrasound performed at 19 weeks shows hydrops fetalis. The fetal organ development is consistent for 19 weeks, and no congenital anomalies are noted. Her first pregnancy was uncomplicated and resulted in the birth of a normal girl at term. The current pregnancy yields a baby born prematurely at 32 weeks gestation with marked icterus. The baby is also markedly anemic, and an exchange transfusion is performed. Which of the following immunologic mechanisms best explains these findings A. anti-receptor antibody C. immune complex formation B. complement-mediated cell destruction D. delayed type hypersentsitivity 89. Answer: B Robbins 6th ed pp.199-201 MPL 0.25 90. A man in his mid-30's presents with malar skin rash, polyarthritis with swelling and warmth of his hands, and sensitization to cold. On physical examination he has generalized lymphadenopathy and pale conjunctivae. Laboratory findings include a hemoglobin of 9.5 g/dL, total WBC count of 2100/microliter, total serum protein 8.8 g/dL, albumin 3.6 g/dL, creatinine 1.1 mg/dL, and creatine kinase of 468 U/L. His antinuclear antibody test is positive at 1:256. The best additional serologic test to help determine his underlying disease process is: A. Anti-centromere C. Rheumatoid Factor B. Anti-RNP D. Serum C1q complement level 90. Answer: B Robbins 6th ed pp.218 MPL 0.25 91. Several weeks following a pharyngitis in which the throat culture grew group A hemolytic streptococcus, a child is noted to have hematuria on urinalysis. An immunofluorescence staining pattern in a renal biopsy shows granular deposition of IgG and complement around glomerular capillary loops. Which of the following immune hypersensitivity mechanisms is most likely responsible for this pattern of findings A. Type I C. Type III B. Type II D. Type IV 91. Answer: C Robbins 6th ed pp.204-226 MPL 0.25 92. A 48-year-old man has a chronic cough with fever that have persisted for several months. The chest radiograph reveals a diffuse reticulonodular pattern. Microscopically on transbronchial biopsy there are focal areas of inflammation containing epitheloid macrophages, Langhan's giant cells, and lymphocytes. These findings are most typical for which of the following immunologic responses: A. Type I C. Type III B. Type II D. Type IV 92. Answer: D Robbins 6th ed pp.204-226 MPL 0.25 93. A 31-year-old woman with chest pain for the past week has a chest radiograph that shows modest bilateral pleural effusions. On chest CT scan, the pleural effusions, as well as a pericardial effusion, are observed. A thoracentesis on the left yields clear fluid with a low protein and cell count. She is found to have an anti-double stranded DNA titer of 1:512. If she is later found to have a serum urea nitrogen that is 55 mg/dL, it will probably be the result of which of the following pathologic processes A. atherosclerosis C. amyloid deposition B. glomerular immune deposits D. Anti-glomerular basement membrane 93. Answer: B Robbins 6th ed pp.216-225 MPL 0.25 94. A 5 cm well-encapsulated mass was excised from the breast of a 21-year-old woman. Histologically, the mass was composed of elongated, ductlike structures surrounded by loose, fibrous connective tissue. Diagnosis A. fibroadenoma B. intraductal papilloma C Pagets disease D. Phyllodes tumor 94. Answer: A Robbins 6th ed pp. 1102-1103 MPL 0.25 95. An 18-year-old medical student complains of poor concentration and easy fatigability. She had heavy menstrual bleeding but was otherwise healthy. Examination of the blood showed a microcytic, hypochromic erythrocytes. Diagnosis? A. aplastic anemia B. sickle cell anemia C. thalassemia D. iron deficiency anemia 95. Answer: B Robbins 6th ed pp. 627-630 MPL 1 96. A 30-year-old man known to be a heavy smoker developed gangrene of the leg, which had to be amputated. Intraluminal thrombi associated with microabscesses in the wall of medium sized arteries were found in the resected leg. Diagnosis? A. Henoch-Sholein purpura B. Syphilis
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C. Polyarteritis nodosa D. Buerger disease 96. Answer: D Robbins 6th ed pp.523
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97. Ocular muscle weakness and general fatigability were found in a 38-year-old woman who also had antibodies to acetylcholine receptors. Diagnosis? A. Graves disease B. Polymyositis C. Myasthenia gravis D. Wiscott-Aldrich syndrome 97. Answer: C Robbins 6th ed pp.1289 MPL 1 98. Congenital aplasia of the thymus and parathyroid glands was discovered in a neonate that developed spastic contraction on the second postpartum day. Diagnosis? A. Goodpasture syndrome B. DiGeorge syndrome C. Isolated IgA deficiency D. Brutons agammaglobulinemia 98. Answer: B Robbins 6th ed pp.235 MPL 1 99. Hemorrhagic cutaneous nodules in a male homosexual with AIDS. Diagnosis? A. hemangioma B. lentigo maligna C. neurofibroma D. Kaposi sarcoma 99. Answer: D Robbins 6th ed pp535 MPL 0.33 100. Short female with web neck and amenorrhea. Her karyotype was 45,X. Diagnosis? A. Turner syndrome B. Klinefelter syndrome C. Down syndrome D. Fragile-X syndrome Answer: A Robbins 6th ed pp.174-176 MPL 0.33
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