Pathology - Malek

69. A 62-year-old man is taken to the emergency department in a state of inebriation. He is well known there because this scenario has been repeated many times over 15 years. On physical examination, he is afebrile. The spleen tip is palpable, and the liver edge is firm. Laboratory studies show hemoglobin of 8.2 g/dL, hematocrit of 25.1%, MCV of 107 um3, platelet count of 135,000/mm3, and WBC count of 3920/mm3. The peripheral blood smear shows prominent anisocytosis and macrocytosis. Polychromatophilic RBCs are difficult to find. A few of the neutrophils show six to seven nuclear lobes. Which of the following is the most likely explanation of these findings in his peripheral blood cells? A. Diminished nuclear maturation from impaired DNA synthesis B. Extravascular hemolysis of antibody-coated cells C. Imbalance in synthesis of a-globin and B-globin chains D. Increased susceptibility to lysis by complement E. Reduced deformability of RBC membranes

68. A 23-year-old African-American man passes dark reddish brown urine 3 days after taking an anti-inflammatory medication that includes phenacetin. He is surprised, because he has been healthy all his life and has had no major illnesses. On physical examination, he is afebrile, and there are no remarkable findings. CBC shows a mild normocytic anemia, but the peripheral blood smear shows precipitates of denatured globin (Heinz bodies) with supravital staining and scattered "bite cells" in the population of RBCs. Which of the following is the most likely diagnosis? A. a-Thalassemia minor B. B-Thalassemia minor C. Glucose-6-phosphate dehydrogenase deficiency D. Sickle cell trait E. Abnormal ankyrin in RBC cytoskeletal membrane

67. Most common type of thyroid carcinoma? A. Medullary B. Follicular C. Anaplastic D. Follicular E. Lymphoma

43-year- ar-old man presents with several pruritic purple papules on the flexor surface of his arms. A biopsy of one of these is obtained and examined. Which one of the listed microscopic descriptions would be most characteristic of lichen planus? A. A band-like lymphocytic infiltrate at the epidermal-dermal junction B. Acute inflammation below a zone of degenerated collagen in the lower dermis C. Chronic inflammation below a zone of degenerated collagen d. Liquefactive degeneration of the basal layer of the epidermis e. Solar elastosis of the dermis with atypia of the squamous epidermal cells About lichen planus, all the following is true except: A- theres neutrophil infiltration B- the pattern of inflammation was zigzag contour (sawtoothing) حسب ما اتذكر باقي الاختيارات كلها مذكورة بشرح الملزمة بس اول اختيار مغيرة كلمة المفروض المفو

65. After having an attack of MI, a 60-year old man decides to specific diet to improve his condition. A decraese in which of the following serum markers suggests that his diet was successful? A. Glucose B. Albumin C. Cholesterol D. Creatinine

64. A biopsy taken from the liver of an alcoholic patient shows fatty changes. If this patient decides to abstain from drinking alcohol, which of the following is excpected to happen? A. Nothing will change. B. The liver will progress to fatty hepatitis. C. The liver will return back to normal.

63. A 38-year-old man presents with jaundice and pruritus. Laboratory examination reveals markedly elevated serum levels of alkaline phosphatase. Antinuclear antibodies are not present, but a serologic test for p-ANCA is positive. An endoscopic retrograde cholangiopancreatography reveals "beading" of the bile ducts. A liver biopsy specimen showed that many of the bile ducts to be surrounded by marked collagenous connective tissue deposition with epithelial atrophy and luminal narrowing. What is the best كان سؤال مشابه ? diagnosis A. Autoimmune hepatitis B. Chronic active hepatitis C. Chronic persistent hepatitis D. Primary biliary cirrhosis E. Primary sclerosing cholangitis

62. A 6-year-old girl has become increasingly lethargic over the past 2 weeks. On examination she has puffiness around the eves. Her temperature is 36.9° C. and blood pressure is 100/60 mm Hg. Laboratory findings show serum creatinine, 0.7 mg/ dL; urea nitrogen, 12 mg/dL; and cholesterol, 217 mg/dL. Urinalysis shows pH, 6.5; specific gravity, 1.011; 4+ proteinuria; lipiduria; and no blood or glucose. The 24-hour urine protein level is 3.8 g. The child's condition improves after glucocorticoid therapy. Which of the following findings by electron microscopy is most likely to characterize this disease process? A. Areas of thickened and thinned basement membrane B. Effacement of podocyte foot processes C. Increased mesangial matrix D. Reduplication of glomerular basement membrane E. Subepithelial electron-dense humps

61. A 35-year-old man has had an outbreak of pruritic lesions over the extensor surfaces of the elbows and knees during the past month. He has a history of malabsorption that requires him to eat a special diet, but he has had no previous skin problems. On physical examination, the lesions are 0.4- to 0.7-cm vesicles. A 3-mm punch biopsy of one of the lesions over the elbow is performed and on microscopic examination shows accumulation of neutrophils at the tips of dermal papillae and formation of small blisters caused by separation at the dermoepidermal junction. Immunofluorescence studies show granular deposits of IgA localized to tips of dermal papillae. Laboratory studies show serum antigliadin antibodies. What is the most likely diagnosis? A. Bullous pemphigoid B. Contact dermatitis C. Dermatitis herpetiformis

60. A 34-year-old woman has noticed a bloody discharge from the nipple of her left breast for the past 3 days. On physical examination, the skin of the breasts appears normal, and no masses are palpable. There is no axillary lymphadenopathy. She has regular menstrual cycles and is using oral contraceptives. Excisional biopsy is most likely to show which of the following lesions in her left breast? A. Acute mastitis B. Fibroadenoma C. Intraductal papilloma D. Phyllodes tumor Sclerosing adenosis

59. A 35-year-old woman has had increasing abdominal enlargement for the past 6 months. She states that she feels like she is pregnant, but results of a pregnancy test are negative. On physical examination, there is abdominal distention with a fluid wave. A pelvicultrasound scan shows bilateral cystic ovarian masses, 10 cm on the right and 7 cm on the left. The masses are surgically removed. On gross examination, the excised masses are unilocular cysts filled with clear fluid, and papillary projections extend into the central lumen of the cyst. Microscopic examination shows that the papillae are covered with atypical cuboidal cells that invade underlying stroma. Psammoma bodies are present. What is the most likely diagnosis? A. Endometrioid tumor B. Cystadenocarcinoma C. Dysgerminoma D. Granulosa cell tumor E. Mature cystic teratoma

58. A 22-year-old woman experiences sudden onset of severe lower abdominal pain. Physical examination shows no masses, but there is severe tenderness in the right lower quadrant. A pelvic examination shows no lesions of the cervix or vagina. Bowel sounds are detected. An abdominal ultrasound scan shows a 4-cm focal enlargement of the proximal right fallopian tube. A dilation and curettage procedure shows only decidua from the endometrial cavity. Which of the following laboratory findings is most likely to be reported for this patient? A. Cervical culture positive for Neisseria gonorrhoeae B. Detection of human chorionic gonadotropin in serum C. 69,XXY karyotype on decidual tissue cells D. Pap smear showing pseudohyphae of Candida E. Positive result of serologic testing for syphilis

57. A 52-year-old woman has noted increasing size of a red, pruritic lesion on her left labium over the past 7 months. On physical examination, this rough, scaly lesion is 0.4 x 0.9 cm. The perineum appears normal; there is no lymphadenopathy, and there are no rectal lesions. A Pap smear shows no abnormal findings. The lesion is excised and on microscopic examination shows large atypical cells lying singly or in small clusters within the epidermis. These cells have abundant cytoplasm that stains with periodic acid-Schiff (PAS). What is the most likely diagnosis? A. Condylomata acuminata B. Extramammary Paget disease C. Lichen sclerosus et atrophicus D. Lichen simplex chronicus E. Vulvar intraepithelial neoplasia

56. A 32-year-old woman has cyclic abdominal pain that coincides with her menses. Attempts to become pregnant have failed over the past 5 years. There are no abnormal findings on physical examination. Laparoscopic examination shows numerous hemorrhagic 0.2- to 0.5-cm lesions over the peritoneal surfaces of the uterus and ovaries. Which of the following conditions this patient most likely has? A. Fibroma B. Brenner tumor C. Endometriotic cyst D. Krukenberg tumor E. Metastatic choriocarcinoma

55. A 42-year-old woman has had menometrorrhagia for the past 2 months. She has no history of prior irregular menstrual bleeding, and she has not yet reached menopause. On physical examination, there are no vaginal or cervical lesions, and the uterus appears normal in size, but there is a right adnexal mass. An abdominal ultrasound scan shows the presence of a 7-cm solid right adnexal mass. Endometrial biopsy shows hyperplastic endometrium, but no cellular atypia. What is the most likely lesion that underlies her menstrual abnormalities? A. Corpus luteum cyst B. Endometrioma C. Granulosa-theca cell tumor D. Mature cystic teratoma E. Metastasis

54. A 62-year-old obese, nulliparous woman has an episode of vaginal bleeding, which 00 produces only 5 mL of blood. On pelvic examination, there is no enlargement of the uterus, and the cervix appears normal. A Pap smear shows cells consistent with adenocarcinoma. Which of the following preexisting conditions is most likely to have contributed to the development of this malignancy? A. Adenomyosis B. Chronic endometritis C. Endometrial hyperplasia D. Human papillomavirus infection E. Use of oral contraceptives

صححته

53. A healthy 59-year-old woman has had a feeling of pelvic heaviness for the past 11 months. There is no history of abnormal bleeding, and her last menstrual period was 8 years ago. Her physician palpates an enlarged nodular uterus on bimanual pelvic examination. A Pap smear shows no abnormalities. Pelvic CT scan shows multiple solid uterine masses; there is no evidence of necrosis or hemorrhage. A total abdominal ممتأكدة اذا كان موجود ?hysterectomy is performed. What is the most likely diagnosis A. Adenomyosis B. Endometriosis C. Leiomyomas D. Metastases E. Tuberculosis

52. A 23-year-old woman has had pelvic discomfort for 4 months. On pelvic examination, there is a large, nontender, right adnexal mass. An abdominal CT scan shows the 11-cm mass to be solid and circumscribed. On surgical removal, the mass is solid and white, with small areas of necrosis. Microscopically, it contains mostly primitive mesenchymal cells along with some cartilage, muscle, and foci of neuroepithelial differentiation. What is the most likely diagnosis? A. Brenner tumor B. Dysgerminoma C. Mature teratoma D. Immature teratoma E. Leiomyosarcoma

51. A 21-year-old G2, P1 woman is in the early second trimester. She has noted a small amount of vaginal bleeding for the past week and has had marked nausea and vomiting for 3 weeks. On physical examination, the uterus measures large for dates. An ultrasound examination shows intrauterine contents with a "snowstorm appearance," and no fetus is identified. Which of the following substances is most likely to be greatly increased in her serum? A. Acetylcholinesterase B. a-Fetoprotein C. Estradiol D. Human chorionic gonadotropin E. Human placental lactogen