Anatomical path

  1. A 20-year-old man collapsed and died suddenly at home. He had a short history of a ‘flu-like illness. At post mortem he had a floppy and dilated heart. Which would you most likely see on histology from the heart?

    Select one:





    E. Lymphocytic infiltrate
  2. A 27 year old patient presents with fever, night sweats and weight loss. He has haematuria and fingernail splinter haemorrhages.
    Which is the most likely diagnosis?
    Select one:





    D. Subacute infective endocarditis
  3. A 27-year-old woman presents with acute onset of severe headaches and vomiting. She describes these headaches as being the worst headaches she has ever had. There is no history of trauma. She is a febrile and her blood pressure is normal. Physical examination reveals a stiff neck. A lumbar puncture shows blood within the CSF. Her abnormality is most likely to be due to:
    Select one:





    D. Rupture of a berry aneurysm on the circle of Willis
  4. A 28-year-old pregnant woman discovered a lump in her left breast. On examination there was a 2cm discrete, freely moveable mass beneath the nipple. What is the most likely diagnosis?
    Select one:





    B. Fibroadenoma
  5. A 35-year-old man presents with a 3 mm flat light brown lesion on his left forearm. The lesion is excised and histology reveals nests of naevus cells at the dermoepidermal junction. They do not extend into the dermis and there is no evidence of cytological atypia. Which of the following is the most likely diagnosis?
    Select one:





    B. Junctional naevus
  6. A 41-year-old men presents with in voluntary rapid jerky movements and progressive dementia. After death brain examination reveals a marked degeneration of the caudate nucleus. His father died in a similar way. His disease is most likely to be:
    Select one:






    E. Huntington's disease
  7. A 44 year old man was found to have a mucosal lesion at colonoscopy. The histology of this lesion demonstrates serrated mucosal glands. What is the most likely diagnosis of this lesion?
    Select one:





    E. Hyperplastic polyp
  8. A 45 year old woman presents with unilateral tinitus and unilateral hearing loss. CT scan reveals a tumour at the cerebellopontine angle. Which of the following findings is most likely on histological examination of the tumour?
    Select one:





    A. Antoni A areas with Verocay bodies
  9. A 63-year-old woman is hospitalised due to markedly decreased vision. A CT scan of the head finds expansion of the pituitary fossa and an expansile mass compressing her optic nerves, but no other abnormalities. All her endocrine tests are normal. Which of the following tumours is most likely?
    Select one:





    B. Pituitary adenoma
  10. A 64-year-old woman suffered a large myocardial infarction. The patient experienced worsening ventricular function and died six months later.
    Which complication of myocardial infarction MOST LIKELY lead to her death?
    Select one:





    A. Aneurysm
  11. A 68-year-old woman presents with a uniformly brown round lesion that appears to be stuck on the side of her face. The lesion is excised and histology reveals hyperkeratosis with horn cyst formation within the epidermis. Which of the following is the most likely diagnosis?
    Select one:





    D. Seborrhoeic keratosis
  12. A 72-year-old man presents with a slowly growing ulcerated lesion on the pinna of his right ear. The lesion is excised and histologic sections reveal infiltrating groups of cells showing peripheral pallisading, a hyper-chromatic appearance with little cytoplasm, separation from the surrounding stroma, and scattered mitoses. Which of the following diagnoses is most likely?
    Select one:





    D. Basal cell carcinoma
  13. A 79-year-old woman who lived alone and had a history of poorly controlled chronic hypertension died while at home. During the autopsy the pathologist finds a recent intracerebral haemorrhage involving the putamen. Which of the following is he likely to discover on histology?
    Select one:





    C. Charcot-Bouchard aneurysm
  14. An appendix sent to the laboratory as probable appendicitis was found to have a carcinoid tumour at the tip. Carcinoid tumour is a neoplastic proliferation of which cell type?
    Select one:





    E. Neuroendocrine cells
  15. A previously healthy 22 year old male is found dead in bed. At post mortem the heart seems macroscopically normal but microscopy shows an infiltrate of lymphocytes. The most likely diagnosis is.
    Select one:







    A. Viral myocarditis
  16. A 27 year old patient presents with fever and weight loss. He has haematuria and fingernail splinter haemorrhages. For the above patient what would you most likely expect to see on histology?
    Select one:





    D. A valve vegetation
  17. A 12 year old boy presented with cramps and bloody diarrhoea, accompanied by anal fissures. On biopsy fissuring ulceration and granulomata are seen. The most likely diagnosis is:
    Select one:







    D. Crohn's disease
  18. A 69 year old man admitted for treatment of atypical pneumonia develops acute diarrhoea. His stool culture shows Clostridium difficile. On biopsy the findings are most likely to be of:
    Select one:







    G. Pseudomembranous colitis
  19. A 68 year old man experiences diarrhoea. He has a colonoscopy and bowel biopsy. The biopsy shows glands lined by atypical cells infiltrating the mucosa and submucosa. His diagnosis is most likely to be:
    Select one:







    C. Colonic adenocarcarcinoma
  20. A 38 year old woman has a macrocytic anaemia. A gastric biopsy shows atrophy of glands in the body of the stomach and chronic inflammation. The most likely cause of this is:
    Select one:






    C. An autoimmune reaction against parietal cells
  21. A 49 woman who has suffered from Coeliac disease most of her life notices that her gluten free diet no longer controls her symptoms. A biopsy of her duodenum shows an infiltrate of small round cells which destroy Brunners glands. The most likely diagnosis is
    Select one or more:






    D. Lymphoma
  22. A 55 year old man has a gastric biopsy for upper GI pain. The report says “the gastric lamina propria is expanded by signet ring cells. The glands show intestinal metaplasia.” The diagnosis in this man is
    Select one:
    f. Lymphoma
    a. Acute erosive gastritis
    e. Gastric reflux disease
    g. Peptic ulcer
    b. Hyperplastic polyps
    c. Gastric adenocarcinoma
    d. Pernicious anaemia
    c. Gastric adenocarcinoma
  23. Mutation of the APC tumour suppressor gene is implicated in the development of which hereditary syndrome?
    Select one:





    C. Familial adenomatous polyposis
  24. A cervical biopsy in a 32-year-old woman shows atypical squamous cells in the full thickness of the epithelium with no evidence of maturation. No invasion of the underlying stroma is seen. The best diagnosis is:
    Select one:
    d. CIN 2
    c. CIN 1
    e. CIN 3
    f. Herpes simplex virus
    b. Chlamydia
    g. Squamous metaplasia
    a. Adenocarcinoma-in-situ
    e. CIN 3
  25. A 55-year-old woman presents with heavy post menopausal bleeding. On sectioning of the uterus multiple circumscribed white whorled nodules are seen in the myometrium. The most likely diagnosis is:
    Select one:
    a. Hyperplastic polyp
    b. Endometriosis
    c. Complex hyperplasia with atypia
    d. Simple hyperplasia
    e. Leiomyoma
    f. Endometrioid adenocarcinoma
    g. Squamous metaplasia
    h. Complex hyperplasia without atypia
    i. Endometritis
    j. Adenomyosis
  26. A 55-year-old woman presents with heavy post menopausal bleeding. On sectioning of the uterus multiple circumscribed white whorled nodules are seen in the myometrium. The most likely diagnosis is:
    Select one:









    A. Leiomyoma
  27. On histologic examination of a colonic adenocarcinoma tumour is seen at the serosal surface. In the TNM staging system how is this reported?
    Select one:





    E. T4
  28. A 70-year-old woman has been in a rest home for the past two years because of her dementia. She is lethargic and spends most of her days in a wheelchair or in bed. She develops an acute febrile illness and is noted to be coughing up increasing quantities of yellowish sputum. Her temperature is 38.2 C. A chest xray shows densities that nearly fill the left lower lobe. She dies four days later. At autopsy, there is extensive consolidation of the left lower lobe, with numerous neutrophils within alveoli. Which of the following infectious agents is most likely to cause her pulmonary disease?
    Select one:







    G. Streptococcus pneumoniae
  29. Which of these features is NOT seen in colorectal adenocarcinoma?
    Select one:





    C. Keratin pearls

    A keratin pearl is a keratinized structure found in regions where abnormal squamous cells form concentric layers. Also called an epithelial pearl, due to a location among squamous cells of the epithelium, this type of structure is sometimes seen with squamous cell carcinoma.
  30. A 78 year old alcoholic presents with progressive heart failure. At postmoterm his heart is enlarged, but no focal changes are seen. His coronary arteries are 50% occluded. He is most likely to have suffered from:
    Select one:






    E. Congestive (dilated) cardiomyopathy
  31. Which of the following most closely matches the 10 year disease free survival rates for invasive breast carcinomas of no special type:
    Select one:



    A. 75% for node negative, 35% with 1-3 nodes involved
  32. Indicate which of these statements regarding osteoporosis are correct
    Select one or more:
    a. remaining bone shows reduced mineralisation
    b. involvement of vertebrae is only seen in advanced osteoporosis
    c. weight training can reduce the rate of bone loss
    d. trabecular bone shows the greatest loss
    Both c. weight training can reduce the rate of bone loss and d. trabecular bone shows the greatest loss
  33. A 50-year-old man notes several small, baglike lesions that have appeared on the skin in front of his armpits over the past 2 years. On physical examination, five small, soft papules in the anterior axillary line are covered by wrinkled skin and attached to the skin surface by a thin pedicle. They are 0.5 to 0.8 cm in length and about 0.3 cm in diameter. One lesion has undergone torsion and is more erythematous and painful to touch than the others. What is the most likely diagnosis
    Select one:





    C. Fibroepithelial polyp
  34. 64-year-old man has noted changes in the texture and color of skin in his armpit and groin over the past 3 months. On physical examination, there is thickened, darkly pigmented skin in the axillae and flexural areas of the neck and groin. These areas are neither painful nor pruritic. A punch biopsy specimen of axillary skin shows undulating epidermal acanthosis with hyperkeratosis and basal layer hyperpigmentation. Which of the following underlying diseases is most likely to be present in this patient?

    Select one:




    A. Colonic adenocarcinoma
  35. A 55-year-old woman has had poorly controlled diabetes for many years. Urinalysis shows 1+ proteinuria; 2+ glucosuria; and no blood. Which of the following pathologic findings is most likely to be present in both kidneys?
    Select one:






    G. Nodular hyaline mesangial masses

    This patient has diabetes mellitus. Nodular and diffuse glomerulosclerosis often occur in patients with long-standing diabetes mellitus. Infections with bacterial organisms also occur more frequently in patients with diabetes mellitus. Deposits of IgG and C3 in the glomerular basement membrane occur with forms of glomerulonephritis caused by immune complex deposition, including lupus nephritis and membranous glomerulonephritis. The only abnormality observed in minimal change disease is effacement of podocyte foot processes, but this change is not specific for minimal change disease and may be seen in other disorders that produce proteinuria. Crescentic glomerulonephritis is not typically seen in diabetes mellitus. IgA deposition in the mesangium occurs in IgA nephropathy (Berger disease). A necrotizing granulomatous vasculitis can be present in the kidneys of patients with Wegener's granulomatosis. Thickening and thinning of glomerular basement membranes occurs in Alport syndrome.
  36. A 60 year old man presented with severe back pain after a long distance travel in a bus. On x-ray of the vertebral column the man was shown to have a fracture of the first lumbar vertebra with associated punched out lesions of the other vertebrae. A urine specimen showed presence of casts and Bence-Jones protein. Serum electrophoresis for immunoglobulins showed the presence of abnormal amounts of IgG immunoglobulin. The most likely diagnosis is :
    Select one:





    B. Multiple myeloma
  37. With regard to primary bone tumours which of the following statements is true?
    Select one:




    D. Most bone tumours develop in the 1st several decades of life
  38. A 45 year old female presents with a discrete solitary firm painless movable mass in her left breast. A mammogram shows a stellate lesion associated with pleomorphic calcification. Which of the following statements is true?
    Select one:




    A. The tumour is most likely to be infiltrating ductal carcinoma
  39. A 12-year-old girl to presents at the clinic with reports of frequent fainting and lethargy. The girl is 5 ft tall and weighs 36kg. Skin fold tests show an abnormally low percentage of body fat. Which of the following hormones is likely to be severely diminished in the patient described above?
    Select one:




    C. Thyroxin
  40. A 27 year old man was referred with an acute hepatic illness. Which laboratory finding would indicate the need for inpatient management?
    Select one:




    B. Prothrombin time 24 s (11.5-15.5)
  41. A 40 year old female presents to her physician with a goitre. On examination her skin is coarse, she has a large tongue and a prominent supra-orbital ridge of the face. Examination of the hands revealed thick, spade-like fingers. These features are most likely to be secondary to an abnormal level of which hormone?
    Select one:




    C. Growth hormone
  42. A 45 year old female develops swelling in her neck and diarrhoea. X-ray shows dense calcification in her thyroid. A nuclear scan of her thyroid detects a cold nodule that does not concentrate radio-iodine. Her doctor does serum assays for several hormones. After the hormone is assayed, he tells her general practitioner that the patient probably has medullary carcinoma of the thyroid since one of the hormones is markedly raised. What hormone did the doctor find was elevated?
    Select one:




    B. Calcitonin
  43. A 55-year-old man presents with prolonged epigastric pain and severe vomiting. Laboratory evaluation finds that his blood pH is increased to 7.46, while his serum bicarbonate is increased to 30 mmol/l. Blood gases also reveal the arterial carbon dioxide to be increased. Physical examination finds the man to be afebrile with dry mucous membranes and decreased skin turgor. His heart is increased, but his respiratory rate is decreased in frequency. Which of the following is the most likely diagnosis?
    Select one:




    A. Metabolic alkalosis with respiratory compensation
  44. A 56-year-old man with long standing poorly controlled diabetes mellitus visits his primary care physician for a follow up after recent hospitalisation. The patient experienced an episode of acute renal failure while in the hospital and his creatinine level rose to 350 mmol/l. Creatinine, a marker of renal function is produced from which of the following precursors?
    Select one:




    C. Glycine, Arginine and Methionine
  45. A known alcoholic was found lying semiconscious by his landlady at the bottom of a stairwell with a broken arm, he was then taken to the emergency room. Initial laboratory studies showed relatively large anion gap of 34 (normal = 9 to 15). His blood alcohol was elevated at 245 mg/dL (intoxication level = 150 to 300 mg/dL), and his blood glucose was 2.2 mmol/l (low normal). The patient's large anion gap and hypoglycemia can best be explained by which of the following?
    Select one:




    D. Inhibition of dehydrogenase enzymes by NADH
  46. A patient came in with diabetic ketoacidosis, his blood glucose is now 10mmol/l. Which is the fluid of choice on a sliding scale?
    Select one:





    C. 5% Dextrose solution
  47. An anxious 19-year-old woman presents with perioral numbness and carpopedal spasm. Laboratory examination reveals decreased PCO2 and decreased bicarbonate. Which of the following is the most likely diagnosis?
    Select one:




    B. Respiratory alkalosis due to hyperventilation.
  48. The respiratory rate of a hospitalized patient increased from 12 per minute to 38 per minute. This increase in respiratory rate continued for 5 minutes. Which of the following blood parameters would increase?
    Select one:





    D. pH
  49. Which of the following is true about bilirubin
    Select one:




    C. Conjugated bilirubin is soluble in water and relatively non-toxic
  50. Which of the following regulatory mechanisms would be stimulated as a result of the increased osmolality that results from a Na+ level of 152 mmol/l?
    Select one:




    D. An increased release of ADH
  51. Which one of the listed substances is a fairly specific serum marker for ventricular dilatation and is used clinically to monitor a patient with congestive heart failure?
    Select one:




    B. β-type natriuretic peptide (BNP)
  52. You have just admitted Mary Roberts, a 70 year-old-woman, to the hospital for GI bleeding. Her blood pressure is 130/80, pulse 80/min and irregular, respirations 18/min, and temperature 37.8 celcius. Mrs Roberts denies pain at this time although she appears anxious and very pale. Her medical history includes lung cancer that was diagnosed two weeks ago, peptic ulcer disease with reflux esophagitis, and “fluid retention”. Admission lab work shows a plasma Na of 152 mmol/l and K of 2.8 mmol/l. The K level of 2.8 mmol/l indicates hypokalemia. Low plasma K levels will cause
    Select one:





    B. Muscle weakness
  53. Specificity of a test is defined by which one of the following expressions?
    Select one:




    D. True negatives/(true negatives + false positives)
Author
vickrum
ID
324551
Card Set
Anatomical path
Description
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Updated