Everything's up to date in Kansas City! A. caseous necrosis B. coagulation necrosis C. enzymatic fat necrosis D. fibrinoid necrosis E. liquefaction necrosis *36. I got a steering wheel in my gut in a I-635 pileup. [C] 37. I don't care about my infarcted heart, KC barbecue is the *best in the world. [B] *38. I slept in starling dropping and got histoplasmosis. [A] *39. I teased a diamondback rattlesnake. [E] 40. Our world-class pathologists diagnose polyarteritis nodosa *with ease! [D] Managed care has mandated only one special stain per case. A. acid fast auramine O or ZN B. elastic stain C. methenamine silver D. metachromatic Romanowsky stain E. sudan iv 41. I am worried about pneumocystis or histoplasmosis in this *lung [C] 42. I like a good, multicolored smear of bone marrow to screen *[D] *43. I think his lung is damaged by a fat embolus [E] *44. I think this is a TB granuloma [A] *45. I think that artery is recovering from Wegener's [B] Sorting out edema. A. excess total body sodium and water B. excess venous hydrostatic pressure C. inflammation D. low plasma albumin E. plugged lymphatics *46. elephantiasis [E] *47. exudate [C] *48. glucocorticoid excess [A] *49. hemosiderin deposition [B] *50. kwashiorkor [D] Use them to confirm your diagnostic impression. A. anti-centromere B. anti-double stranded DNA C. anti-Jo D. anti-Scl70 / topoisomerase E. anti-U1 ribonucleoprotein *51. CREST [A] *52. mixed connective tissue disease [E] *53. polymyositis [C] *54. scleroderma [D] *55. systemic lupus [B] "Just maybe the underlying cause is..." A. amyloidosis B. dermatomyositis C. polyarteritis nodosa D. scleroderma E. systemic lupus *56. C2 complement component deficiency [E] *57. graft vs. host [D] *58. hepatitis B [C] *59. leprosy [A] *60. stomach cancer [B] You are investigating the inheritance pattern of TABP ("toothless albino banjo player disease"). You interview people in the community. A. autosomal recessive B. genetic anticipation C. mitochondrial inheritance D. polygenic E. X-linked inheritance 61. Dunno. Sometimes a couple has more than one TABJ baby. Easy to tell who's got it. Don't seem to be no pattern otherwise. Unless'n you're not close-related to your *partner, seems like that makes it less common. [A] 62. Nope. I don' think it's genes at all. There's some in most families down here in the hills. And y'know, the better a banjo player your brother is, the fewer teeth you seem to *have yourself! [D] 63. Strange. There's this one lady -- couldn't play a note herself -- had five sons and three daughters, all TABP's, all by different fathers. All different talent levels. You can't tell who's gonna be affected until they're school-age, *sometimes later. [C] 64. Yup. Easy to tell. You are or you aren't TABP. And y'know, only boys get it, and almost always somebody in *mom's family has it. [E] 65. Yup. Runs in the family, real reg-yoo-lar. Every generation they're lighter, have fewer teeth, and play the *banjo better! [B] 66. Host susceptibility to HIV A. CSW * B. CKR4 (CCR5) C. CTRPN D. GP128 E. HHV8 67. In "chronic granulomatous disease" of kids, the body must use its macrophages rather than its neutrophils as its major defense against certain invaders, the most important of this is: A. candida B. clostridia C. neisseria * D. staphylococci E. various protozoans 68. Shy-Drager, a much-discussed entity in the differential diagnosis of orthostatic blood pressure drops, is a disease of the A. arteries and veins only * B. brain C. heart D. kidneys E. smooth muscle of the entire body 69. Apoptosis will NOT produce A. crosslinking of proteins B. dissolution of cytoskeleton C. fragmentation of the genome * D. inflammation around the dead cell E. separation from surrounding cells 70. Which is NOT a feature of Chediak-Higashi syndrome? A. neutrophils are too slow B. neutrophils are too slow C. neutrophil granules are too big D. neutrophil granules fail to join phagosomes properly * E. neutrophil nuclei are not segmented 71. TWO KODACHROMES. Autopsy heart. A. bacterial infection with acute inflammation B. calcified valve * C. recent infarct D. scarring from old infarct E. no pathology here 72. FOUR KODACHROMES. All show A. acute inflammation B. emboli C. hemorrhage D. necrosis * E. thrombi 73, ONE KODACHROME. Photomicrograph displaying A. abscess B. infarct C. granulation tissue D. granuloma * E. petechia 74. ONE KODACHROME. The rope mark was * A. ante-mortem, because the face is congested B. ante-mortem, because the face is hyperemic C. post-mortem -- the murderer tried to fool us! 75. TWO KODACHROMES. Autopsy brain with A. abscess B. atrophy * C. massive fresh infarct D. massive hematoma E. no pathology 76. TWO KODACHROMES. Skin changes of A. atopic dermatitis B. dermatomyositis * C. discoid lupus D. Kaposi's sarcoma E. scleroderma 77. ONE KODACHROME. Illustration from (a) A. anaplastic but non-invasive lesion (dysplasia) B. epithelial hyperplasia C. granulation tissue * D. granuloma E. necrotic focus, perhaps gangrene 78. ONE KODACHROME. The lipid in these lesions is * A. contained within macrophages B. inside adipocytes which have overgrown C. inside cells of the epidermis D. inside the vessel walls E. transformed to calcium soap 79. ONE KODACHROME. Connective tissue from a person with longstanding mild high blood pressure and diabetes. The arteries show hyaline composed primarily of A. beta pleated stuff * B. basement membrane C. fibrin D. immunoglobulin E. prekeratin 80. TWO KODACHROMES. A man and his artery. This one's easy. A. AIDS and candidiasis B. atopic dermatitis C. lupus D. scleroderma * E. Wegener's 81. ONE KODACHROME. The hyaline in this section of lung is composed mostly of A. amyloid B. basement membrane material C. dense collagen * D. fibrin E. prekeratin and ubiquitin 82. ONE KODACHROME. Your best diagnosis? A. discoid lupus B. diphtheria * C. noma D. polyarteritis nodosa E. systemic lupus 83. ONE KODACHROME. Most of the cells in the pulmonary edema fluid are A. anaplastic B. eosinophils C. lymphocytes D. macrophages * E. neutrophils 84. ONE KODACHROME. Smallpox immnization gone bad. The T- cells attack the endothelium, and the resulting necrosis is A. caseous, because it is all apoptosis * B. coagulation C. enzymatic fat necrosis D. liquefaction E. pseudomembrane formation because it is a toxin 85. ONE KODACHROME. It's a shot of A. acute inflammation, it's mostly neutrophils B. granuloma, purple rice krispies on a frayed pink tablecloth * C. loose connective tissue with edema and chronic inflammatory cells D. polyarteritis or some other kind of vasculitis E. some kind of cancer because of the anaplasia 86. ONE KODACHROME. Some things you just have to memorize. Hurler's... A. chondroitin sulfate B. ganglioside C. glucocerebroside D. glycogen * E. mucopolysaccharide 87. ONE KODACHROME. Liver. * A. alcohol effect B. blood vessel hamartoma C. fatty ingrowth D. scarring, etiology unknown E. tuberculosis 88. ONE KODACHROME. This is most likely A. Angelman's B. Fabry's C. Marfan's * D. Prader-Willi E. Trisomy 13 89. ONE KODACHROME. Artery. What's wrong? A. atherosclerosis with occlusion B. post-mortem thrombus C. scleroderma-type changes * D. recanalized thrombus E. Wegener's granulomatosis with fibrinoid 90. ONE KODACHROME. Heart. What's the pigment? A. bile, this is metastatic hepatocellular carcinoma B. hemosiderin, this is iron overload C. homogentisic acid * D. lipofuscin E. melanin, this is metastatic melanoma 91. ONE KODACHROME. Test your histopathology skills! A. bacterial infection with neutrophils * B. foreign-body reaction to a suture C. squamous metaplasia of the endocervix D. tuberculosis E. Wegener's granulomatosis 92. ONE KODACHROME. Heart, sectioned through ventricles. It displays: A. abscess formation B. brown atrophy * C. hypertrophy D. rupture of an infarct E. septal defect, probably congenital 93. ONE KODACHROME. Lung. What are the prominent, blue- staining structures? * A. calcium deposits B. hyaline C. prominent lymphoid aggregates as in SJogren's lung D. tuberculosis E. normal histology 94. ONE KODACHROME. The medulla oblongata was destroyed instantly. The mechanism of death was most likely: * A. autonomic nervous system failure B. blood loss C. hypothermia D. iatrogenic fluid overload E. respiratory failure 95. ONE KODACHROME. Lung. Your best diagnosis? A. acute inflammation (pneumonia) * B. bone marrow embolus C. thromboembolus with infarction D. thromboembolus without infarction E. tuberculosis, good caseous necrosis 96. ONE KODACHROME. Choroid plexus. What are the prominent, blue-staining strcutres? A. basement membrane * B. calcium deposits C. Monckeberg's medial calcific sclerosis D. lymphocytes E. plasma cells 97. TWO KODACHROME. Don't worry about where you are. What is it? A. enzymatic fat necrosis B. fatty change, as in diphtheria * C. fatty ingrowth D. non-enzymatic fat necrosis, as from trauma E. normal fat, from the panniculus 98. ONE KODACHROME. The hyaline in this picture is made of A. basement membrane B. beta-pleated something-or-other C. fibrin * D. immunoglobulin E. keratin and ubiquitin 99. THREE KODACHROMES. AIDS was first discovered as the combination of A. Brain damage in IV drug users and gay men * B. Kaposi's sarcoma and pneumocystis in the otherewise healthy C. Lymphocyte less and unexplained deaths D. Toxoplasmosis in Haitian immigrants E. Unexpected candida infections in gay men 100. ONE KODACHROME. What karyotype? * A. XO B. XXY C. XYY D. 47, trisomy 23 E. Prader-Willi BONUS ITEMS: 101. ONE KODACHROME. Why does he have arthritis? [alkaptonuria] 102. TWO KODACHROMES. What is pus? [I need some mention of neutrophils plus necrosis] 103. What does finding a ragged red fiber on muscle biopsy tell you? [mitochondrial disease] 104. What do we mean by "histotoxic hypoxia"? [primary problem is with the cytochromes] 105. If you see a section of kidney with basement membranes accentuated in shocking pink, what stain is it? [PAS] 106. What is a lithopedion? [stone baby] 107. Delayed-prolonged leakage is a mode of inflammation that indicates what change in the capillaries? [apoptosis] 108. What is the predominant inflammatory cell in the lesions of the classic bacterial disease, typhoid fever? [monocyte / macrophage] 109. C3b, produced in inflammation, is best-known for what effect? [opsonization] 110. "-desis", on the end of the name of a surgical operation, means what? [two things made to stick together] 111. What is a "chylous effusion"? [lymph / hurt thoracic duct] 112. Who said, "Knowledge makes you vain, education makes you humble?" [Creutzfeldt] 113. The clinician heard a water-wheel murmur over the heart, and decided the patient had a [air embolus] 114. Mention one purported chemical mechanism of reperfusion injury? [calcium precipitates stuff / calcium clamps sarcomeres / oxygen makes free radicals] 115. What molecule is the autoantigen in Grave's disease? [TSH receptor] 116. What is rheumatoid factor? [IgM binding IgG / will settle for antibody against antibody] 117. What's the most serious problem faced by people with hereditary absence of IgA? [allergy to transfused plasma] 118. What's an "ileus"? [extra fluid in the small bowel for any reason] 119. What is the "nephrotic syndrome"? [severe urinary protein wasting] 120. Why is this man smiling? [easy test, +1 for any good answer] NAME: ______________________ UHS PATHOLOGY 1998-9 Exam I READ CAREFULLY! For the multiple choice items, give your best answer. For the matching items, use each choice exactly once. There are a few type K questions off quizbank. You are welcome to come and sit at the front during the picture show. For the completion items, use ink if you have it. We cannot reconsider the grading of one of these items if there is evidence of erasure or correction. If you have a question, please raise your hand. Please be considerate of other exam-takers. Do not phonate. If you must use the bathroom, raise your hand. Being courteous to your classmates and instructors is very important, now and afterwards. Creutzfeldt is the author of the quotation about knowledge and education. Please be considerate of others. The first person finished posts the key, and afterwards there are no more bathroom breaks. Please write your challenges on the key. Posting the key is NOT equivalent to giving you your grade. You are on your honor not to share the contents of this exam with anyone who has not taken it. You also have the option of obtaining a challenge form from one of the TA's -- but why wait? There will be more challenging exams later in the course. GOOD LUCK!