31. Which gene is mutated in "idiopathic chronic pancreatitis? (A) amylase (B) chymotrypsin (C) insulin (D) lipase * (E) trypsinogen 32. Which is the most common benign tumor of the exocrine pancreas? * (A) cystadenoma (B) glucagonoma (C) insulinoma (D) papillary adenoma (E) VIP-oma 33. What intrauterine exposure is most strongly linked today to late-onset diabetes? (A) cow's milk (B) high-carbohydrate diet (C) tobacco in any form (D) tobacco, smoked * (E) total calorie malnutrition 34. The "dawn phenomenon" is caused by generous production, during sleep, of which hormone? (A) ACTH and cortisol * (B) growth hormone (C) leptin (D) somatomedin (E) somatostatin 35. The islands of the baby of a diabetic mother are likely to (A) be atrophic (B) contain granulomas * (C) contain numerous eosinophils (D) contain numerous plasma cells (E) exhibit Crooke's hyaline change 36. "Advanced glycosylation products" result from interaction of glucose, non-enzymatically, with (A) mucopolysaccharide ground substance (B) neutral lipids (C) phospholipids * (D) proteins (E) steroid hormone and sterols such as cholesterol 37. Today, clinicians slow the progression of sclerosis in advancing renal disease with (A) ACE inhibitors * (B) angiotensin II receptor blockers (C) anti-adrenergic drugs (D) leuprolide (E) thiazide diuretics 38. Renal tubular acidosis IV reflects * (A) damage to the JGA, with insufficient renin (B) dysfunction of the podocytes (C) failure of the basement membrane (D) failure of the distal tubule (E) failure of the proximal tubule 39. Which is LEAST likely to raise pulse pressure? * (A) aortic valve stenosis (B) AV fistula for dialysis (C) getting excited during a pathology exam (D) hot thyroid adenoma ("Plummer's") (E) severe Monckeberg's with marked loss of aortic arch compliance 40. Endothelially-derived relaxation factor is (A) a catecholamine molecule (B) assayed by urinary 5-HIAA * (C) nitric oxide radical (D) protein hormone produced locally (E) steroid hormone made by endothelium 41. Which is NOT a typical benign hypertensive lesion in the kidney is (A) fibrosis of the arterial intima (B) finely granular kidney surface (C) reduplication and concentric fibrosis under Bowman's capsule (D) thickening by hyaline of the afferent arteriole, sparing the efferent * (E) segmental sclerosis 42. The lumpy-bumpy deposits in post-streptococcal GN are usually located (A) in the mesangium (B) intramembranously (C) subendothelialily * (D) subepithelially (E) these are not lumpy-bumpy deposits, I am being tricky 43. The wire loops of lupus are located (A) in the mesangium (B) intramembranously * (C) subendothelialily (D) subepithelially (E) it's lupus, not LOOP-us, and wire loops are not markers for it 44. Which immunoglobulin is most deposited in Henoch-Schonlein purpura? * (A) IgA (B) IgD (C) IgE (D) IgG (E) IgM 45. Which immunoglobulin is most typically deposited in dense deposit disease? (A) IgA (B) IgE (C) IgG (D) IgM * (E) C3 is deposited but the immunoglobulins usually aren't 46. Antibodies against the tubular basement membrane usually mean (A) Goodpasture's (B) Henoch-Schonlein * (C) lupus (D) membranous glomerulopathy (E) NSAID nephropathy 47. Doubled glomerular basement membranes (A) idiopathic benign familial hematuria (B) lupus usually (C) membranous glomerulonephritis * (D) membranoproliferative glomerulonephritis (E) double blood pressure (Groucho Marx's disease) 48. Which is LEAST LIKELY to invade veins and metastasize early via the bloodstream? (A) adrenal cortical carcinoma (B) follicular carcinoma of the thyroid gland (C) hepatocellular carcinoma (D) renal cell carcinoma (E) seminoma of the testis 49. Which is most likely to be affected by TB? * (A) epididymis (B) glans penis (C) prostate (D) skin of the scrotum (E) testicular parenchyma 50. Which occupational exposure is known to place a man at risk for prostate cancer? (A) aluminum (B) asbestos * (C) cadmium (D) gasoline (E) lead 51. Which testicular tumor metastasizes most aggressively? (A) embryonal cell carcinoma * (B) choriocarcinoma (C) seminoma, anaplastic (D) seminoma, common (E) seminoma, spermatocytic 52. Many prostate cancers exhibit primarily a swiss-cheese ("cribriform") pattern. This makes their Gleason grade: (A) I (B) II (C) III (D) IV (E) V 53. Prostatic intra-epithelial neoplasia usually does NOT exhibit (A) hyperchromatic nuclei * (B) numerous mitotic figures (C) piling-up of epithelial cells (D) prominent nucleoli (E) some crowding of cells 54. Sheehan's typically results from (A) autoimmunity (B) carotid artery pulsations (C) mechanical pressure by an adenoma (D) obstetrical catastrophe (E) sickle cell disease 55. Enhancing dopamine production by the hypothalamus will usually shrink a pituitary (A) basophilic ACTH-producing adenoma (B) neuroblastoma (C) pheochromocytoma (D) prolactinoma (E) TSH-oma, thankfully rare 56. By definition, Cushing's disease results from (A) a pituitary adenoma (B) an adrenal cortical adenoma (C) iatrogenic administration of glucocorticoids (D) unexplained adrenal cortical hyperplasia (E) any cause of hyperadrenocorticism 57. Which vegetable, eaten in massive quantities, will enlarge, and slow down, your thyroid gland? (A) bananas * (B) cabbage (C) celery, which also contains psoralens (D) carrots (E) tomatoes 58. What's the Graves's autoantigen? (A) calcitonin (B) microsomes (C) thyroglobulin (D) thyroxine * (E) TSH receptor 59. Hot Mexican peppers puts you at risk for (A) kidney stones (B) renal cell carcinoma * (C) sterile urethritis (D) prostate cancer (E) transitional cell carcinoma 60. ONE KODACHROME. Your best diagnosis? A. autosomal dominant polycystic kidneys B. autosomal recessive polycystic kidneys C. cretinism D. exstrophy of the urinary bladder * E. oligohydramnios sequence only BONUS ITEMS 61. ONE KODACHROME. Thyroid. Your best diagnosis? [deQuervains / granulomatous] 62. ONE KODACHROME. Kidney. PAS stain. Your best diagnosis? [diabetes OR FSGS] 63. FOUR KODACHROMES. Thyroid. Your best diagnosis? [papillary carcinoma, must have both words, carc. can be cancer] 64. ONE KODACHROME. Pancreas. Adenocarcinoma or chronic pancreatitis. JUSTIFY your answer. [adenocarcinoma; incomplete gland in center is ONLY criterion] 65. ONE KODACHROME. Pancreas. What is the diagnosis? [CMV] 66. ONE KODACHROME. Kidney. Your best diagnosis? [any necrotizing vasculitis, i.e., wegener's, mHTN, PAN, HSP] 67. ONE KODACHROME. Kidney. Identify the structure to which your instructor is pointing. [cast is sufficient] 68. ONE KODACHROME. Kidney. Your best diagnosis? [necrotizing glomerular anything, RPGN III, Weg, PAN] 69. ONE KODACHROME. Eye. Your best diagnosis? [this is hypertension, not diabetes, accept arterial dz] 70. TWO KODACHROMES. Your best diagnosis? [membranous GN, will NOT take MPGN] 71. ONE KODCHROME. Your best diagnosis? [acromegaly / HGH adenoma] 72. ONE KODACHROME. Newborn boy. What is the diagnosis? [hypospadias] 73. ONE KODACHROME. What syndrome? [Cushing] 74. TWO KODACHROMES. What kidney disease? [minimal change, accept any synonym or FSGS] 75. ONE KODACHROME. Why is this man smiling? [passed his postage stamp coil test, +1 for any correct answer] NAME: _______________________ 60 points Seat: Who's near you? UHS Pathology Exam V 1999-2000 Instructions: You know how to do this. Please don't phonate during the exam. This is a hard exam. We need to schedule 3 more Friday sessions for bonus presentations towards "C"'s. Class officers please do this. Good Luck!