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Gen Path.doc


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Gen Path.doc

  1. 1. GENERAL PATH 1-15 1. A 53-year-old man has experienced severe chest pain for the past 6 hours. On physical examination he is afebrile, but has tachycardia. Laboratory studies show a serum troponin I of 10 ng/mL. A coronary angiogram is performed emergently and reveals >90% occlusion of the left anterior descending artery. In this setting, an irreversible injury to myocardial fibers will have occurred when which of the following cellular changes occurs? a. Glycogen stores are depleted b. Cytoplasmic sodium increases c. Nuclei undergo karyorrhexis * d. Intracellular pH diminishes e. Blebs form on cell membranes 2. While in a home improvement center warehouse buying paint, a 35-year- old man hears "Look out below!" and is then struck on the leg by a falling pallet rack, which strikes him on his left leg in the region of his thigh. The skin is not broken. Within 2 days there is a 5 x 7 cm purple color to the site of injury. Which of the following substances has most likely accumulated at the site of injury to produce a yellow-brown color 16 days after the injury? a. Lipofuscin b. Bilirubin c. Melanin d. Hemosiderin * e. Glycogen 3. A 50-year-old woman with a history of unstable angina suffers an acute myocardial infarction. Thrombolytic therapy with tissue plasminogen activator (tPA) is administered to restore coronary blood flow early in the course of this myocardial infarction. In spite of this therapy, the degree of myocardial fiber injury may increase because of which of the following cellular abnormalities? a. Cytoskeletal intermediate filament loss b. A decreased intracellular pH from anaerobic glycolysis c. An increase in toxic oxygen radicals * d. Mitochondrial swelling e. Nuclear chromatin clumping and decreased protein synthesis
  2. 2. 4. A 40-year-old woman has the sudden onset of severe abdominal pain. On physical examination she has diffuse tenderness in all abdominal quadrants, with marked guarding and muscular rigidity. An abdominal CT scan reveals peritoneal fluid collections and decreased attenuation along with enlargement of the pancreas, consistent with a diagnosis of pancreatitis. Which of the following cellular changes is most likely to accompany these findings? a. Ccagulative necrosis b. Dry gangrene c. Fat necrosis * d. Apoptosis e. Liquefactive necrosis 5. Cloudy swelling, hydropic change and fatty change are all examples of a. early neoplastic change b. hyaline change c. patterns of cell death d. postmortem artefact e. reversible cell injury * 6. Which of the following is an example of an agent capable of producing a toxic metabolite? a. acetaminophen * b. aspirin c. carbon monoxide d. carbon biphosphate e. cocaine
  3. 3. 7. The pattern of cell death that is characterized by conversion of a single cell to an acidophilic body, usually with loss of the nucleus but with preservation of its shape to permit recognition of cell boundaries is termed a. apoptosis * b. caseous necrosis c. fibrinoid necrosis d. liquefactive necrosis e. autolysis 8. Histologic examination of a tumor shows many foci in which individual tumor cells appeared shrunken and deeply eosinophilic, and their nuclei exhibited condensed aggregates of chromatin under the nuclear membrane. The process affecting these cells was MOST LIKELY triggered by the release of which of the following substances into the cytosol? a. Lipofuscin b. Cytochrome c * c. Catalase d. Phospholipase e. BCL-2 9. Which of the following is NOT an example of cellular adaptation? Hyperplasia Dysplasia * Metaplasia Hypertrophy Atrophy
  4. 4. 10. Which of the following involves generation of such intracellular markers as Russell bodies, viral inclusions, and masses of intermediate filaments, and leads to a homogeneous, glassy pink appearance in routine histologic sections stained with hematoxylin and eosin? a. Glycogen deposition b. Hyaline changes * c. Calcification d. Cellular aging e. Steatosis 11. An 80-year-old man dies from complications of Alzheimer disease. At autopsy, his heart is small (250 gm) and dark brown on sectioning. Microscopically, there is light brown perinuclear pigment with H&E staining of the cardiac muscle fibers. Which of the following substances is most likely increased in the myocardial fibers to produce this appearance of his heart? a. Hemosiderin resulting from iron overload b. Lipofuscin from "wear and tear" * c. Glycogen resulting from a storage disease d. Cholesterol as a consequence of atherosclerosis e. Calcium deposition following necrosis 12. A 17-year-old black man with a known history of sickle cell disease presents to the emergency department complaining of left upper quadrant pain suggestive of a splenic infarct. Microscopic examination of the spleen would most likely reveal (A) caseous necrosis (B) coagulative necrosis * (C) fibrinoid necrosis (D) gangrenous necrosis (E) liquefactive necrosis
  5. 5. 13. Orchiectomy (removal of testes) would be expected to cause which of the following in prostatic epithelium in a 70 year old man: a. atrophy * b. fatty change c. hyperplasia d. hypoplasia e. metaplasia 14. A 72-year-old woman is brought to the hospital with left-sided paralysis consistent with an ischemic infarct of the right cerebral cortex. She dies two days after admission. Which of the following would most likely be seen on microscopic examination of the affected area of brain? (A) caseous necrosis (B) coagulative necrosis (C) enzymatic fat necrosis (D) gangrenous necrosis (E) liquefactive necrosis * 15. A circumscribed mass of light yellow crumbly to pasty material associated microscopically with a macrophage response is characteristic of (A) caseous necrosis * (B) coagulative necrosis (C) fibrinoid necrosis (D) gangrenous necrosis (E) liquefactive necrosis
  6. 6. CARDIOVASCULAR PATH 16-35 16. A 17-year-old male high school athlete with no significant medical history, suddenly collapsed during a football practice and could not be resuscitated. At autopsy, the heart is enlarged and there is myocyte disarray on histologic evaluation. What is the most likely diagnosis? (A) amyloid heart disease (B) glycogen storage disease (C) hypertrophic cardiomyopathy * (D) patent ductus arteriosus (E) viral myocarditis 17. A 55-year-old woman had left atrial fibrillation that responded poorly to medical treatment. She eventually suffered a massive stroke and died a few days later. The autopsy revealed marked left atrial dilatation and hypertrophy and a stenotic mitral valve. These findings would be best explained if she had a past history of (A) alcoholism (B) amyloidosis (C) chronic lung disease (D) mucinous adenocarcinoma (E) rheumatic fever * 18. Worldwide, the most common cause of subacute infective endocarditis is (A) Candida albicans (B) immune reaction to bacterial toxins (C) Staphylococcus aureus (D) Streptococcus pneumoniae (E) Streptococcus viridans *
  7. 7. 19. A 32-year-old woman has the onset of fever and chills associated with subungual, linear, dark-red streaks, small nodular hemorrhages in the palms and soles, and tender nodules of the finger pads. As a child, she had streptococcal sore throat followed by a three-week long episode of fever, joint pain, and a skin rash. The current condition in this patient is most likely (A) bacterial endocarditis * (B) floppy mitral valve (C) infiltrative cardiomyopathy (D) systemic lupus erythematosus (E) tuberculosis 20. The cardiac lesion associated with lupus erythematosus is (A) MacCallum's patch (B) tricuspid atresia (C) Libman-Sacks endocarditis * (D) shortening and thickening of the chordae tendineae (E) tricuspid insufficiency 21. Which of the following may produce lesions of cardiac valves? (A) pheochromocytoma of adrenal with metastases to liver (B) carcinoid tumor of ileum with metastases to liver * (C) Zollinger-Ellison syndrome (D) Waterhouse-Friderichsen syndrome (E) Graves' disease 22. The incidence of constrictive pericarditis is highest in patients with (A) tuberculosis * (B) lupus erythematosus (C) uremic pericarditis (D) syphilitic heart disease (E) subacute bacterial endocarditis 23. The mechanism of death in cardiac tamponade is (A) acute right heart failure * (B) anemia due to acute blood loss (C) myocardial infarct (D) obstruction to outflow from the aorta (E) pulmonary edema complicated by pneumonia
  8. 8. 24. In tetralogy of Fallot, which is the most important factor in determining direction and amount of shunt? (A) overriding aorta (B) ventricular septal defect (C) pulmonary stenosis * (D) right ventricular hypertrophy (E) patent foramen ovale 25. Of the following, the congenital cardiac anomaly most commonly associated with cyanosis is (A) ventricular septal defect (B) atrial septal defect (C) tetralogy of Fallot * (D) coarctation of the aorta (E) patent ductus arteriosus 26. In which of the following diseases do respiratory and renal findings usually dominate? (A) dermatomyositis (B) polyarteritis nodosa (C) scleroderma (D) systemic lupus erythematosus (E) Wegener granulomatosis * 27. Which of the following is characterized by a granulomatous reaction in vessel walls? (A) dermatomyositis (B) polyarteritis nodosa (C) systemic lupus erythematosus (D) temporal arteritis * (E) thromboangiitis obliterans 28. Takayasu arteritis typically involves the (A) aorta * (B) coronary artery (C) mesenteric artery (D) pulmonary artery (E) renal artery
  9. 9. 29. Tobacco smoking is important in the pathogenesis of (A) Buerger disease * (B) polyarteritis nodosa (C) Raynaud disease (D) Takayasu arteritis (E) Wegener granulomatosis 30. Most fatal cases of systemic lupus erythematosus are the result of damage to which of the following organs? (A) brain (B) heart (C) kidney * (D) liver (E) lung 31. Therapy of temporal arteritis is largely directed at preventing (A) aneurysm of the temporal artery (B) loss of vision * (C) occlusion of the temporal artery (D) polymyalgia rheumatica (E) rupture of the temporal artery 32. Of antigens known to be associated with polyarteritis nodosa, the most common is (A) basement membrane (B) DNA (C) hepatitis B surface protein * (D) streptococcal cell membrane (E) c-ANCA
  10. 10. 33. A 32-year-old-man presents with a 9-month history of intermittent fever, hypertension, weight loss, and abdominal pain. Laboratory findings include the presence of perinuclear antineutrophil cytoplasmic antibodies (P- ANCA) in the serum. Biopsy shows fibrinoid necrosis in a segment of a medium-sized artery with areas of transmural scarring in other areas. This would be most characteristic of (A) giant cell arteritis (B) Henoch-Schönlein purpura (C) polyarteritis Nodosa * (D) Takayasu arteritis (E) Wegener granulomatosis 34, The correct order of color changes of the hand associated with Raynaud phenomenon is? (A) red, blue, white (B) blue, white, red (C) white, red, blue (D) blue, red, white (E) white, blue, red * 35. A characteristic of polyarteritis nodosa is (A) a butterfly-shaped rash over the face (B) greatly thickened skin and sloughing of the epidermis (C) jaundice (D) necrotizing arteritis (E) severe anemia *