36. Carcinoid heart disease is most likely to involve the A. aortic valve and outflow tract B. epicardium C. myocardium D. mitral valve * E. tricuspid valve 37. Which probably does NOT contribute to the vicious cycle of congestive heart failure? A. altered physical shape of the cardiac chambers * B. dilatation of the pulmonic valve annulus C. diminished myosin ATP-ase D. loss of epinephrine receptors on the muscle cells E. poor perfusion of the myocardium 38. The usual cause of unstable angina is * A. a thrombus forming in a coronary artery B. emotional factors precipitating autonomic disturbances C. hypertrophic cardiomyopathy in someone undergoing aerobic conditioning D. reversal of a congenital shunt E. spasms of the coronary arteries 39. Because you took "Path" at UHS, your local medical society has appointed you medical examiner for your rural community. Gus was a 48 year old farmer, never sick a day in his life. At autopsy, his lateral wall is soft-solid and green, and under the microscope you see many neutrophils without any granulation tissue. Choose the best age for the infarct A. 4 hours old B. 16 hours old * C. 48 hours old D. 2 weeks old E. this is not an infarct, but an abscess 40. Which endocrine problem is most likely to produce atrial fibrillation? A. Cushingism (excess cortisol) * B. hyperthyroidism C. hyperparathyroidism D. hypothyroidism E. hypoparathyroidism 41. What's the most likely explanation for "the French paradox", i.e., fatty diet but little heart disease? A. cobalt in beer * B. heavy alcohol drinking C. lack of chlamydia because of clean-living D. lead in wine E. tannins in red wine 42. Your 60 year old patient just dropped to the floor. The pulse is 40, and your EKG shows complete heart block. There is no other physical findings or EKG charge. Which is the LEAST LIKELY explanation? A. amyloid deposit * B. hypertrophic cardiomyopathy C. iron overload D. ischemia E. sarcoidosis 43. A cardiomyopathy is most common in A. Bernard-Soulier disease B. cystic fibrosis * C. Duchenne's muscular dystrophy D. Loeffler's hypereosinophilia E. sickle cell anemia 44. Little rhabdomyomas in the heart are probably due to A. anabolic steroid use B. Carney complex C. Down's syndrome * D. tuberous sclerosis (Bourneville's disease) E. syphilis 45. "Mandated choice" is a legal term for an agenda to A. ensure a patient's right to know about therapeutic options B. ensure death with dignity but WITHOUT active euthanasia C. ensure the right to abortion * D. obtain more organs for transplantation E. provide for legal physician-assisted suicide 46. Which is NOT a known effect of cocaine? A. makes cardiac rhythm disturbances more likely * B. lowers HDL cholesterol C. opens sodium channels D. prevents reuptake of catecholamines E. produces contraction bands 47. Which drug in your medicine cabinet, when overused, is a noted cause of cardiomyopathy? A. acetaminophen B. aspirin C. calcium carbonate antacid * D. ipecac E. milk of magnesia 48. Which is LEAST LIKELY to cause high-output failure? A. anemia * B. aortic valve disease C. high fever D. Paget's disease of bone E. shunt placed for renal dialysis 49. "Sudden death in a teen. Since there's no sign of hypertrophic cardiomyopathy, and since there's a suggestive history, I'm going to look for "bypass fibers" from atrium to ventricle, bypassing the bundle of His." This very smart pathologist was considering a diagnosis of A. Amyloidosis B. Carney complex C. Friedreich's ataxia D. Prader-Willi * E. Wolf-Parkinson-White 50. Uremic bone disease is now attributed largely to the toxicity of * A. aluminum B. cadmium C. mercury D. urea E. vanadium 51. You are MOST LIKELY to neoplastic cartilage in A. renal cell carcinoma B. renal hemangioma, since it is also mesenchyme C. transitional cell carcinoma D. tuberous sclerosis lesions * E. Wilms nephroblastoma 52. Uremia is LEAST LIKELY to produce A. bone "cysts" * B. jaundice C. neuropathy D. pancreatitis E. pericarditis 53. What's the composition of a "coffin lid" crystal, as seen in proteus infections? A. ammonium biurate B. calcium oxalate * C. magnesium ammonium phosphate D. uric acid, serving as nidus for proteus E. white cell remnants 54. What's a more familiar name for "endothelially-derived relaxation factor?" A. interleukin 8 B. laughing gas C. methemoglobin * D. nitric oxide E. surfactant 55. What was the etiologic agent of "plasma cell pneumonia" seen in war orphans in the late 1940's? A. Lyme disease B. myeloma * C. pneumococcus D. pneumocystis E. syphilis 56. Which is LEAST LIKELY to produce pulmonary edema? A. gunshot wound to the brain with coma B. heroin overdose C. mountain sickness D. rheumatic mitral valve disease * E. tetralogy of Fallot 57. The pathogen that's presently under strong suspicion as the cause of the recent epidemic of new asthma cases is a * A. chlamydia B. common bacterium C. DNA virus D. fungus E. RNA virus 58. Abundant tonofilaments in an electron microscopic picture of a lung cancer suggest a diagnosis of A. adenocarcinoma B. adenoid cystic carcinoma C. bronchial carcinoid D. oat cell carcinoma * E. squamous cell carcinoma 59. Which paraneoplastic syndrome is typical of bronchogenic squamous cell carcinoma? A. cerebellar degeneration B. Cushingism C. Eaton-Lambert * D. hypercalcemia E. inappropriate ADH 60. Most cancers of the larynx have what histology? A. adenocarcinoma B. carcinoid C. sarcoma * D. squamous E. transitional cell carcinoma 61. Autosplenectomy and the requirement for pneumococcal vaccine is important to remember in patients with A. G6PD deficiency B. pyruvate kinase deficiency * C. sickle cell disease D. thalassemia E. von Willebrand's 62. The prothrombin time tests for each of these coagulation factors EXCEPT A. fibrinogen (I) B. prothrombin (II) C. VII * D. VIII E. X 63. In Bernard-Soulier disease A. the platelets lack granules B. the platelet's won't aggregate * C. the platelet's won't stick where they should D. the fibrin clot is torn up almost as fast as it's made E. the fibrin clot won't contract 64. THREE KODACHROMES. What is the diagnosis? A. adenocarcinoma * B. pulmonary embolus C. squamous cell carcinoma D. oat cell carcinoma E. Wegener's granulomatosis 65. FOUR KODACHROMES. Kidney. What is the diagnosis? A. diffuse proliferative glomerulonephritis B. focal-segmental glomerulosclerosis * C. membranous glomerulopathy D. mesangial proliferative glomerulonephritis E. rapidly progressive glomerulonephritis 66. TWO KODACHROMES. What's wrong with the blood? A. disseminated intravascular coagulation B. idiopathic / immune thrombocytopenic purpura C. iron deficiency * D. sickle cell disease E. sideroblastic anemia 67. TWO KODACHROMES. What's wrong with the kidney? * A. diffuse proliferative glomerulonephritis B. membranous glomerulopathy C. pyelonephritis D. rapidly progressive glomerulonephritis E. this is cancer 68. TWO KODACHROMES. What's wrong with the lung? A. asthma B. bacterial pneumonia C. bronchiectasis * D. viral pneumonitis E. Wegener's 69. TWO KODACHROMES. Blood. What is the diagnosis? A. abetalipoproteinemia B. Heinz body anemia of some sort of other * C. sickle cell disease D. thalassemia of some sort or other E. this is within normal limits 70. TWO KODACHROMES. Kidney. What's the diagnosis? A. diffuse proliferative glomerulonephritis B. lupus nephritis * C. malignant hypertension D. membranous glomerulopathy E. rapidly-progressive glomerulonephritis 71. TWO KODACHROMES. Lung. What is the diagnosis? * A. alveolar lipoproteinosis B. aspiration of mineral oil C. Goodpasture's disease D. pneumonia E. tuberculosis 72. ONE KODACHROME. Heart. What is the diagnosis? A. atrial myxoma B. myocardial aneurysm C. patent ductus arteriosus * D. patent foramen ovale E. tetralogy of Fallot 73. TWO KODACHROMES. What glomerular disease? A. diffuse proliferative glomerulonephritis * B. focal-segmental glomerulosclerosis C. hemolytic-uremic syndrome D. minimal change disease E. none, these are normal "gloms" 74. TWO KODACHROMES. What lung disease? A. adenocarcinoma * B. adult respiratory distress syndrome C. oat cell carcinoma D. squamous carcinoma E. tuberculosis 75. TWO KODACHROMES. What glomerular disease? * A. Goodpasture's B. lupus C. membranous glomerulopathy D. membranoproliferative tram-track disease E. mesangial proliferative glomerulonephritis 76. ONE KODACHROME. The material in this diabetic's glomerulus is primarily * A. basement membrane / mesangial matrix B. dense type I collagen C. hyalinosis stuff D. fibronectin E. integrin 77. TWO KODACHROMES. Lung. What is the diagnosis? A. asthma B. carcinoma C. emphysema * D. fibrosing alveolitis E. vasculitis, perhaps Wegener's 78. THREE KODACHROMES. What lung disease? A. aspergillosis B. oat cell carcinoma C. sarcoidosis * D. squamous cell carcinoma E. tuberculosis 79. ONE KODACHROME. Your best diagnosis for this blood smear, please. A. iron deficiency B. malaria C. megaloblastic anemia * D. spherocytosis E. thalassemia 80. ONE KODACHROME. The youngster has A. Blackfan-Diamond * B. hemolysis C. iron deficiency D. kidney failure E. metastatic cancer 81. TWO KODACHROMES. Lung from an infant. What is the diagnosis? A. bronchiolitis consistent with RSV B. fibrosis consistent with bronchopulmonary dysplasia C. hyaline membrane disease * D. pneumonia, probably bacterial E. pneumonitis, probably viral 82. TWO KODACHROMES. Kidney. What is the diagnosis? A. dense deposit disease B. Goodpasture's C. membranous glomerulopathy D. mesangial proliferative disease / IgA nephropathy * E. minimal change disease 83. ONE KODACHROME. Lung. What's wrong? A. asthma B. bacterial pneumonia C. emphysema * D. pneumoconiosis E. viral pneumonitis 84. ONE KODACHROME. Lung. What is the diagnosis? A. amnionic band syndrome B. bronchiectasis * C. last year's pulmonary emboli D. scissors murder E. no diagnosis, this is normal anatomy 85. FOUR KODACHROMES. Lung. What is the diagnosis? A. asthma B. bronchiectasis C. emphysema D. Goodpasture's * E. sarcoidosis 86. TWO KODACHROMES. Lung. What is the diagnosis? * A. oat cell carcinoma B. pneumocystosis C. pulmonary fibrosis without asbestosis D. tuberculosis E. viral pneumonia with lymphocytes 87. TWO KODACHROMES. Lung. What is the diagnosis? A. adult respiratory distress syndrome * B. emphysema C. fibrosing alveolitis consistent with Hamman-Rich D. pneumonia, probably bacteria E. viral pneumonitis 88. TWO KODACHROMES. Kidney disease. What kind? A. acquired dialysis cystic disease B. cystic dysplasia C. medullary sponge kidney or uremic medullary cysts D. polycystic kidneys, autosomal dominant * E. polycystic kidneys, autosomal recessive 89. ONE KODACHROME. Heart. What is the diagnosis? A. aortic valve disease consistent with old rheumatic fever B. dilated cardiomyopathy C. endocardial fibrosis * D. hypertrophic cardiomyopathy E. mitral valve disease consistent with old rheumatic fever 90. TWO KODACHROMES. Kidney. Your best diagnosis? A. angiomyolipoma B. nephrolithiasis C. pyelonephritis D. renal abscess * E. renal cell carcinoma 91. THREE KODACHROMES. What's wrong with this kidney? A. acute tubular necrosis B. common hypertension C. fungal infection D. malignant hypertension * E. pyelonephritis 92. TWO KODACHROMES. Kidney. You're thinking of... A. amyloidosis B. diabetes C. Goodpasture's disease D. post-streptococcal glomerulonephritis * E. polyarteritis nodosa 93. ONE KODACHROME. The hyaline droplets in the cytoplasm of the proximal tubular cells suggest A. acute tubular necrosis B. lead or cadmium poisoning C. lupus * D. nephrotic syndrome E. NSAID nephropathy 94. ONE KODACHROME. Which is most likely? A. Eisenmenger's B. hypoplastic left heart * C. Kartagener's D. Lutembacher's E. transposition 95. ONE KODACHROME. What is the diagnosis? A. disseminated intravascular coagulation * B. iron deficiency C. sickle cell disease D. thalassemia major E. thalassemia minor 96. ONE KODACHROME. Kidney. What is the diagnosis? A. acquired dialysis cystic disease B. medullary sponge kidney C. lead poisoning * D. nephritic syndrome E. renal cell carcinoma 97. ONE KODACHROME. What is the diagnosis? A. atrial septal defect B. Chinese restaurant syndrome C. mitral hypoplasia / hypoplastic left heart * D. tetralogy of Fallot E. transposition of the great vessels 98. ONE KODACHROME. Your best diagnosis. A. alcoholism * B. hemoglobin C C. iron deficiency D. pernicious anemia E. sickle cell disease 99. TWO KODACHROMES. Blood. What is the diagnosis? * A. hemolytic anemia B. infectious mononucleosis C. megaloblastic anemia D. normal smear E. thalassemia 100. ONE KODACHROME. Left side of the heart. What is the diagnosis? * A. endocardial cushion defect in Down's syndrome B. hypertrophic cardiomyopathy C. hypoplastic left heart D. tetralogy of Fallot E. transposition BONUS ITEMS 101. The annulus of which cardiac valve is most likely to undergo dystrophic calcification as you get older? [mitral] 102. Why are patients with significant mitral valve disease prone to develop a cough? [big left atrium irritates bronchus] 103. What does "friable" mean? [crumbly] 104. You've heard of Generation X, X-ratings, and the X-files. It's easier to understand "Syndrome X", which is... [microvascular angina] 105. Five letters. A ballplayer is struck over the sternum by a fast ball, right during cardiac repolarization, and drops down in ventricular fibrillation. The fast deformation of the bone produced an electric charge by the _____-electric effect. [piezo] 106. Which autoantibody produces heart block in "neonatal lupus"? [anti-Ro] 107. What is the likely mechanism of action of the renal protective agent, aminoguanidine? [inhibits non-enzymatic glycosylation] 108. Recent studies have focused on a previously-unrecognized, rather common cause of membranous nephropathy which, thankfully, is reversible on removal of the cause, which is (be specific): [NSAID's] 109. The famous "tubular arrays", long-mistaken for myxoviruses, in the endothelium of lupus patients are made of: [interferon] 110. What kidney disease places patients at particular risk for berry aneurysms? Be specific. [adult polycystic] 111. What is Conn's syndrome? [I'll settle for too much aldosterone] 112. A thick layer of tough fibrous tissue in the intimal layers of most of the small arteries within the kidney strongly suggests longstanding [hypertension] 113. What is the principal component of most pulmonary hamartomas? [cartilage] 114. What is the synaptic autoantigen in Eaton-Lambert syndrome? [calcium channel] 115. What is the "pulse pressure"? [systolic minus diastolic] 116. What is a "Heinz body"? [chunk of denatured / irreversibly oxidized hemoglobin] 117. Numerous Howell-Jolly bodies in a peripheral smear usually results from what? [spleen gone] 118. In a "ringed sideroblast", whereabouts in the baby red cell is the stainable iron? Be specific. [mitochondria] 119. The combination of transient neurologic defects, thrombocytopenia, hemolysis, fever, renal failure, and little pink-staining microthrombi throughout the body suggests what diagnosis? (Hint: Don't put "hemolytic-uremic syndrome.") [thrombotic thrombocytopenic purpura] 120. Why is this man smiling? ["Does this count as a human rights violation?" +1 any good] NAME: _____________________________ 100 points UHS PATHOLOGY Exam 3 1997-8 INSTRUCTIONS: Complete the answers. There are 100 items, plus 20 bonus items, on this exam. If you have a question, raise your hand. Please do NOT phonate. This is a rather tough exam. Remember we do not expect a perfect score. GOOD LUCK.