UNIVERSITY OF HEALTH SCIENCES PATHOLOGY EXAM II 1994-1995 INSTRUCTIONS For the multiple-choice items, including the pictures, fill in your answers on the answer sheet provided. For the completion items, put your answers on the exam sheet. Use ink if you have it. Your instructor will only review possible grading errors if there is no evidence of erasure. We have tried to write a fair test, but there will surely be problems with certain items. If you have a question, raise you hand and we'll talk about it QUIETLY (don't phonate!) during the exam. THIS IS YOUR FIRST CHANCE, BUT YOU WILL BE SHOWING OTHERS WHAT YOU DID OR DID NOT LEARN IN "PATHOLOGY" EVERY DAY, FOR THE REST OF YOUR LIFE. GOOD LUCK! [Items 1-35 on this exam are GRIPE bank items.] 36. The famous 8:14 translocation in Burkitt's lymphoma places what gene under the control of the IgG promoter? A. bcr/abl * B. myc C. p53 D. ras E. src 37. Right now there's considerable excitement over splice variants of CD44, the lymphocyte adhesion molecule which seem to give cancer cells the ability to: A. avoid immune surveillance B. grow faster than neighboring cells C. induce the growth of their own stroma * D. metastasize E. pierce through basement membrane 38. Cancer-causing DNA viruses produce products that inactivate the products of which genes? A. NF-1 and NF-2 * B. p53 and RB C. the myc family D. the ras family E. VHL and WT-1 39. High serum calcium due to production of a novel parathormone-like substance is typical of A. breast cancer B. carcinoid, especially if metastatic in the liver C. medullary (C-cell) carcinoma of the thyroid D. small-cell ("oat cell") lung cancer * E. squamous cell lung cancer 40. "Eaton-Lambert syndrome", a distressing paraneoplastic syndrome found in many patients with oat-cell carcinoma of the lung, closely resembles the more familiar: A. dermatomyositis B. hypercalcemia of osseous metastases * C. myasthenia gravis D. thiamine deficiency polyneuropathy E. thrombophlebitis 41. All are characteristics of HIV gp120 protein EXCEPT: A. binds CD4 B. allows attachment to dendritic macrophages C. envelope protein D. neurotoxic * E. reverse transcriptase 42. Which is known to transmit the AIDS virus (and to do so quite well)? A. a human bite by an infected biter * B. breast-feeding by an infected mother C. lesbian sex with one partner infected D. sharing beer steins E. the quack 1992 gp160 AIDS vaccine 43. Which country's government tested its entire populace and put all HIV-positive people in concentration camps? * A. Cuba B. East Germany C. Haiti D. Red China E. Rumania 44. What imparts the brown color to Kaposi's sarcoma lesions? A. bilirubin and biliverdin * B. hemosiderin C. lipofuscin D. melanin E. tissue necrosis 45. Finding epithelioid-type giant cells in brain, in the absence of necrosis or classic granulomas, would make you think of: * A. AIDS without other infection B. cryptococcus C. cysticercosis D. toxoplasmosis E. sarcoidosis 46. "Stellate microabscesses" are pathologists' favorite findings in bacterial infections of lymph nodes, typical of all EXCEPT * A. anthrax B. cat-scratch fever C. glanders D. lymphogranuloma venereum E. tularemia 47. Which did you probably NOT get from a cat? * A. brucellosis B. Pasteurella multicida C. Rochalimaea henselae D. toxocara E. toxoplasmosis 48. "Hyperinfection", due to a change in the life-cycle, is a noted complication of putting Appalachian chronic lung patients on glucocorticoids: A. ascariasis B. hookworm C. North American trypanosomiasis * D. strongyloidiasis E. toxoplasmosis 49. If you live in Kansas City and are doing things with your life, you are MOST LIKELY to contain at least a few organisms of: A. coccidioidomycosis B. cryptococcosis * C. histoplasmosis D. para-coccidioidomycosis E. tuberculosis 50. The most important complication faced by many onchocerciasis patients is: * A. blindness B. brain damage C. iron deficiency D. liver damage E. lung damage 51. Operation Desert Storm's "Baghdad Boil" was A. capillariasis * B. leishmaniasis C. opisthorchiasis D. trachoma (dry climate, problems with flies and hygiene) E. virulent staphylococcal infection 52. Tobacco smoking is LEAST PLAUSIBLY linked to A. kidney cancer * B. mesothelioma C. mouth and throat cancer D. pancreatic cancer E. wrinkling of the skin 53. Noted for causing cancer: * A. asbestosis B. coal-worker's pneumoconiosis C. farmer's lung D. marijuana smoking E. silicosis MATCHING!! While most drugs have a wide range of side-effects, some "unexpected" links are infamous for being relatively common. Use each choice once A. clozapine (for schizophrenia) B. isoniazid (for tuberculosis) C. methysergide (for migraine) D. penicillin (for pneumococcal pneumonia) E. phenacetin and non-steroidal anti-inflammatory agents (for everything) 54. Anaphylactic shock *[D] 55. Drop in the neutrophil count *[A] 56. Hepatitis *[B] 57. Kidney tubular shutdown *[E] 58. Retroperitoneal fibrosis and crushing of the ureters *[C] 59. The pathologist wants to know whether the patient died of hyperkalemia, and needs a semi-reliable check on electrolyte status at the moment of death? Which sample will give the best information? A. bile B. blood C. cerebrospinal fluid D. urine * E. vitreous humor 60. Which is LEAST LIKELY to be a medical examiner's case? A. a drunken 48 year old man who staggers out of the bar and is found frozen to death in a nearby snowdrift * B. an 80-year-old patient who dies a grisly death of pneumonia, cardiomyopathy, skin loss, and DIC while participating in a protocol "New Super-Aggressive Chemotherapy for Disseminated Cancer of the Pancreas in the Elderly" C. a 42 year old pathologist getting his routine care at the UHS clinic, considered to have no life-threatening disease or any bad habits except swearing, who suddenly croaks while walking past Chubby's D. a 45 year old chain-smoking, burger-chomping lawyer with known angina pectoris, with two previous heart attacks, who falls over dead two minutes after receiving a brand-new experimental HIV vaccine E. a 92 year old prison inmate with known disseminated cancer, who is in for life-without-parole for some reason 61. Which is a form of matter? * A. a cosmic ray B. a curie C. a rad D. a roentgen E. an x-ray 62. The familiar "pugilistic attitude" of a dead body results from: A. boxing death B. cold injury C. drowning D. electrical injury * E. heat injury 63. A defense lawyer is strangled by an irate convicted guilty client. The medical examiner is MOST LIKELY to see petechiae on the: * A. conjunctival membranes B. corpus callosum C. dependent parts D. front of the neck E. tongue 64. In an amateur bedroom suicide of a healthy, 40 year old male lawyer, the medical examiner is LEAST LIKELY to see A. feet still in contact with the floor * B. fractured neck C. Tardieu spots D. tongue occluding the airway E. Y-shaped ligature mark 65. Caffeine has been plausibly linked to A. atherosclerosis * B. headache as withdrawal syndrome C. hypertension D. stroke E. sudden death 66. In the 1980's, it was very popular to purchase "aerosolized" whipped cream in order to get high on A. amyl-nitrate B. carbon monoxide C. fluorocarbons (how environmentally insensitive!) * D. nitrous oxide E. paraquat 67. "Basophilic stippling" of the red blood cells, in the absence of thalassemia, suggests intoxication with A. arsenic B. cocaine C. ethanol; this is a good marker for chronic abuse * D. lead E. organophosphate 68. Before indulging in cocaine, a would-be mother should be aware that cocaine is unhealthy for her and her baby, and is noted for causing all EXCEPT: A. abruption of the placenta B. cardiac toxicity in the mother C. direct toxicity to the fetus D. ischemia of the fetus through placental vasoconstriction * E. liver disease in the mother 69. Maggots are the medical examiner's friends mostly becuase * A. their development helps pinpoint the hour of death B. their presence drives the clinicians away C. they are fun to crunch underfoot D. they destroy tissue that could yield valuable information E. they may be used to make reagents for the Van Gieson stain 70. Cystic fibrosis patients are LEAST LIKELY to have * A. failure of the endocrine pancreas B. failure of the exocrine pancreas C. no sperms in the ejaculate (if they are post-pubertal men) D. scarred lungs from many infections E. sweat that is very salty, even when it's cool 71. A child born without an iris presents at age 2 with a disseminated cancer. It is probably A. glial in origin, since this is the most common solid tumor of children B. Ewing's sarcoma C. leukemia D. neuroblastoma * E. Wilms tumor 72. Facial nerve palsy in a baby without other problems most likely resulted from * A. application of obstetrical forceps B. congenital rubella or CMV C. child-abuse D. herpes E. sarcoidosis 73. "Very low birth weight" means less than A. 500 gm B. 1000 gm * C. 1500 gm D. 2000 gm E. 2500 gm 74. THREE KODACHROMES. Lung disease. What is it? A. asbestosis B. coal worker's pneumoconiosis, simple type C. coal worker's pneumoconiosis with TB * D. pneumocystosis E. silicosis 75. ONE KODACHROME. Rats and/or their fleas transmit all except A. Haverhill fever B. leptospirosis C. murine typhus D. plague * E. scrub typhus 76. TWO KODACHROMES. This tumor is * A. adenocarcinoma B. adenoma C. lipoma D. tumor of vascular origin E. none of these 77. ONE KODACHROME. How far away was the muzzle of the handgun? A. tight contact B. loose contact C. two inches * D. fourteen inches E. ten feet 78. TWO KODACHROMES. These wounds are probably A. abrasions B. avulsions C. chop wounds D. lacerations * E. stab wounds 79. FOUR KODACHROMES. This tumor is A. adenocarcinoma B. adenoma C. leukemia / lymphoma * D. squamous cell carcinoma E. this is a granuloma, not a tumor, silly 80. ONE KODACHROME. This kid probably has A. AIDS * B. kwashiorkor C. pellagra D. rickettsiosis E. scurvy 81. ONE KODACHROME. If your partner is symptomatically infected and you aren't, which are you LEAST LIKELY to catch from a hot, sizzling, one-month unprotected-sex love affair? A. chlamydia B. Epstein-Barr C. human immunodeficiency retrovirus * D. leprosy E. syphilis 82. FOUR KODACHROMES. Name the bug. * A. amoeba B. balantidium C. cryptosporidium D. giardia E. schistosome egg 83. ONE KODACHROME. "M" stands for A. malignant B. melanoma C. metastatic potential D. mitotic figure * E. all of the above! 84. THREE KODACHROMES. These are all examples of A. AIDS-induced lesions B. aspergillosis * C. candidiasis D. remote effects of cancer E. trichophyton or its close relatives 85. ONE KODACHROME. From the lung of a person with asbestosis. Papanicolaou stain. What are they? A. asbestos fibers coated with iron ("ferruginous bodies") * B. cancer cells C. normal lymphocytes D. normal respiratory epithelium with cilia E. squamous cells, either metaplastic or mesothelium 86. TWO KODACHROMES. What's your best diagnosis? A. adenovirus * B. measles C. mumps D. rickettsiosis E. tuberculosis 87. ONE KODACHROME. The most likely infectious agent is: A. herpes B. leprosy C. nocardia D. sporotrichosis * E. trichophyton ("athlete's foot") 88. ONE KODACHROME. Which schistosome egg? A. hmatobium * B. japonicum C. mansoni 89. ONE KODACHROME. From a deep chest infection. What is the diagnosis? * A. actinomycosis B. cat scratch fever C. sarcoidosis, whether this is an infection nobody knows D. staphylococcus, probably E. tuberculosis or histoplasmosis, they look similar 90. TWO KODACHROMES. Finger lesion and pap smear of the unroofed blisters. What's your diagnosis? A. blastomycosis B. dermatophyte infestation C. histoplasmosis * D. herpes E. leprosy 91. TWO KODACHROMES. Fungal infection. Which one? A. aspergillosis B. blastomycosis * C. coccidioidomycosis D. histoplasmosis E. cryptococcosis 92. THREE KODACHROMES. Various examples of infection with what virus? A. chlamydia (these are not really viruses) * B. cytomegalovirus C. herpes simplex D. measles E. wart virus 93. THREE KODACHROMES. Lung. What is the diagnosis? A. asbestosis B. Caplan's syndrome in a coal worker C. farmer's lung D. silicosis * E. tuberculosis 94. TWO KODACHROMES. Endocardium from an immunocompromised patient. What is the diagnosis? A. aspergillosis * B. candidiasis C. histoplasmosis D. toxoplasmosis E. tuberculosis 95. ONE KODACHROME. Look closely. What is the diagnosis? A. candidiasis B. coccidioidomycosis C. cryptococcosis * D. paracoccidioidomycosis E. tinea versicolor 96. THREE KODACHROMES. What's the diagnosis? * A. blastomycosis B. candidiasis C. mucormycosis D. staphylococcal furuncle E. squamous cell carcinoma 97. ONE KODACHROME. Brain from a patient with A. cystic fibrosis with brain abscess B. metastatic cancer C. neurofibromatosis * D. tuberous sclerosis E. Von Hippel Lindau's disease 98. TWO KODACHROMES. Lymph nodes from an AIDS patient. What's the diagnosis? A. candidiasis B. coccidioidomycosis * C. cryptococcosis D. cryptosporidiosis E. pneumocystosis, this can occur outside the lungs 99. TWO KODACHROMES. The histopathology of Rocky Mountain Spotted Fever is A. DIC with minimal inflammation B. granulomas * C. microvasculitis D. necrosis with minimal inflammation E. suppuration 100. ONE KODACHROME. Which is NOT transmitted by flies? A. African trypanosomiasis * B. American trypanosomiasis C. leishmaniasis D. onchocerciasis E. shigella BONUS ITEMS: 101. ONE KODACHROME. Acid-fast (Fite) stain of a section from the ulcerated, mutilated foot of a jungle-dweller. What is the pathogen? [nocardia] 102. FOUR KODACHROMES. You'll need to guess the stain yourself. What is the diagnosis? [leprosy] 103. ONE KODACHROME. Give me your best definition of cancer. In your definition, do not use the words "malignant". [I need "neoplasia" and "invasiveness"] 104. ONE KODACHROME. How did these wounds on the decedent probably happen? [defense] 105. TWO KODACHROMES. Look carefully. What is the diagnosis? [smallpox vaccination] 106. ONE KODACHROME. Heart. What is the diagnosis? Try to be precise. [intravascular cancer; accept plain "adenocarcinoma"; ] [won't take plain "cancer"] 107. TWO KODACHROMES. What is your best diagnosis? [infectious mononucleosis / EBV] 108. TWO KODACHROMES. What is the cause of this annoying rash? [zoster / shingles / varicella] 109. THREE KODACHROMES. Brain. What is the diagnosis? [aspergillosis] 110. FIVE KODACHROMES. The many faces of what disease? [syphilis] 111. ONE KODACHROME. Tumor. Give it a name. [lipoma / hibernoma / will take mucinous adenoma] 112. ONE KODACHROME. Intestine. What's the pathogen? [cryptosporidiosis] 113. TWO KODACHROMES. Esophagus. What is the diagnosis? [any herpes except EBV or CMV] 114. ONE KODACHROME. What is the diagnosis? [dracunculiasis / guinea worm] 115. What is the Delaney Clause? [no chemical carcinogen in any amount in food] 116. What is an "ultimate carcinogen"? [actual molecular species that makes the mutation] 117. Which is the virus responsible for most cases of hepatocellular carcinoma worldwide? [hepatitis B] 118. An epidemic of angiosarcoma of the liver was caused by what industrial poison? [vinyl chloride] 119. Cite any piece of evidence that Kaposi's "sarcoma" is actually a viral infection, not a cancer. [multifocal / lack of anaplasia / response to antivirals] [epidemiology / gay link / seen in other immunosuppression] 120. The Missouri seal contains the motto "Salus populi suprema lex est." What does this mean? [public health considerations over-ride supposed "individual rights"] ["Public Health is the Supreme Law", etc. etc.] 121. What is a fomite? [inanimate object that carries germs] 122-124. THREE POINT ITEM. As the leading primary-care physician in a rural community, you are asked to give the school board your opinion on the new media claim that fingerpainting is an important cause of childhood leukemia. Several retrospective studies demonstrated that kids with leukemia and their families remembered twice as much total experience with fingerprint compared with age-matched, class-matched controls without leukemia. The relationship holds up at the p<0.001. All dyes in the fingerprint passed the Ames test (i.e., none mutated typhoid bacilli), but a colony of 10,000 rats fed huge doses of mixed fingerprint dyes (10 mg/gm body weight per day) ended up getting a higher-than-random (50, expected 2, odds p<0.0001) carcinomas of the stomach, though the rate of leukemia was not increased. A liberal education expert testifies that "fingerprinting is an essential experience for our students' self-esteem and multicultural awareness." A conservative educational expert testifies that "corporations will be unwilling to hire graduates who have not fingerpainted." A Ph.D.- biochemist public health expert testifies "fingerprinting will double our students' risk for leukemia, and may be expected to produce 3 excess cases in our community of 10,000 people in the next decade." Tell the school board why you should or should not eliminate fingerprinting from the curriculum. [essentials: retrospective study means report bias] [likely that huge doses act as promoter] [if decide "eliminate", indicate it is cover-your-butt only] [better answer is to recommend to retain] [+1 for each to maximum of +3] 125. Why is this man smiling? [our criminal law is stacked in favor of defendants; +1 for any correct answer]