36. According to early-1995 thinking, what percent of HIV-positive people exhibit "nonprogressive infection", with normal CD4 counts and very little virus in the blood over many years? A. none in the U.S., anyway B. 0.01% C. 0.1% D. 1% E. 5% (*) 37. Which viral infection causes the dread retinitis of AIDS? A. cytomegalovirus (*) B. herpes 6 C. HIV itself D. Kaposi's virus E. toxoplasmosis 38. Which is the agent of the trivial "exanthem subitem" and is also implicated in AIDS progression? A. Epstein-Barr herpes 4 B. herpes 6 (*) C. measles virus D. papovavirus JC E. picornavirus, not yet classified 39. Which is MOST DISTINCTIVE for HIV encephalitis? A. apoptosis of neurons B. enormous nuclei C. giant cells like in a granuloma (*) D. lots of lymphocytes E. owl-eye cells 40. HIV-2, "the other AIDS virus", is found mostly where? A. the southwestern part of Africa above the equator (*) B. South Africa C. Thailand D. Uganda, around the lakes E. United States MATCHING! You need to know the great, classic carcinogens.... A. Anabolic steroids ("breakfast of champions") B. Arsenical treatment for syphilis C. Benzene D. Nickel dust E. Vinyl chloride 41. Angiosarcoma of the liver [E] 42. Hepatocellular carcinoma [A] 43. Leukemia [C] 44. Lung cancer [D] 45. Skin cancer [B] MATCHING ... and some famous molecules.... A. CA-125 B. myc C. p53 D. ras E. VEGF 46. activated by translocation alongside an immunoglobulin gene in Burkitt's [B] 47. allows tumor cells to induce the growth of their own blood supply [E] 48. bound to human wart virus E6 protein in carcinogenesis [C] 49. distinctive point-mutation in U.S. colon cancer [D] 50. noted tumor marker used clinically to screen for ovary cancer [A] 51. The pneumonia first identified recently among the Navajo nation: A. hantavirus (*) B. herpesvirus C. orthomyxovirus D. paramyxovirus E. parvovirus 52. Milwaukee diarrhea epidemic, 1993 A. campylobacter B. cryptosporidiosis (*) C. giardia D. Norwalk agent E. rotavirus 53. Macrophages all over the Peyer's patches of the gut, gobbling up red blood cells... A. cholera B. helicobacter infestation C. intestinal anthrax D. shigellosis E. typhoid (*) 54. You will see the LEAST inflammatory response in hepatitis due to A. alcohol abuse B. cytomegalic inclusion disease C. hepatitis B D. neonatal herpes E. yellow fever (*) 55. "Globi" are the huge masses of organisms typically seen under the microscope in bad cases of A. actinomycosis B. ascariasis C. leprosy (*) D. toxoplasmosis E. tuberculosis 56. According to current knowledge, Lassa fever is "hemorrhagic" because A. something produced during the infection causes the platelets not to function (*) B. the infection causes disseminated intravascular coagulation C. the viruses damage the bone marrow, preventing production of platelets D. the viruses damage the liver, preventing production of clotting factors E. the viruses multiply in endothelium, destroying it 57. The annoying "inclusion conjunctivitis" of pool-swimmers is caused by a A. chlamydia (*) B. conventional bacterium C. mycoplasma D. rickettsia E. virus 58. "Protein A" of staphylococci protects the bug by A. binding to antibodies (*) B. breaking down hydrogen peroxide C. coagulating blood to form a protective fibrin cocoon D. poisoning neutrophils and causing them to die E. preventing killing by neutrophils 59. You catch dengue when A. a mosquito bites you (*) B. a louse bites you C. a tick bites you D. a sheep coughs in your face E. you make an unfortunate sexual contact 60. Chronic fatigue syndrome is probably A. an infection by a specific, unknown virus B. a peculiar, widespread, systemic immune activation problem (*) C. a Yuppie's way of saying he or she is depressed D. just a media hype E. the result of Yuppie drug abuse 61. Which is NOT true of the "flesh-eater" streptococcus? A. caused the death of Jim Hensen (creator of Miss Piggy) B. excites an intense suppurative response, with lots of pus (*) C. kills by overactivating the body's army of T-cells D. produces a protease that digests tissue E. takes the Gram stain ("Gram-Positive") 62. The bad form of galactosemia is caused by lack of A. galactocerebrosidase B. galactokinase C. galactomutase D. galactose phosphate uridyl transferase (*) E. galactose synthetase 63. Which is LEAST LIKELY to cause oligohydramnios? A. agenesis of the kidneys B. agenesis of the urethra C. large infarct in the placenta D. Rh incompatibility leading to hydrops fetalis (*) E. tiny hole in the membranes 64. Meconium ileus, i.e., stool that is too dense to be expelled during the first day of life, is a harbinger of A. cystic fibrosis (*) B. fetal alcohol syndrome C. galactosemia D. Hirschsprung's aganglionic megacolon E. sudden infant death syndrome 65. Which actually contributes, in a big way, to the deaths of the most children worldwide? A. niacin deficiency B. thiamine deficiency C. vitamin A deficiency (*) D. vitamin C deficiency E. vitamin D deficiency 66. What's the fundamental problem in vitamin D deficiency? A. bone fails to mineralize (*) B. cartilage fails to turn into bone C. osteoclasts are hyperactive D. osteoid is inadequate E. skin fails to pigment 67. The Hayflick phenomenon is A. a group of signs in classic progeria B. failure of cells to divide further after fifty divisions (*) C. loss of telomeres during cell division D. premature aging in Werner's syndrome E. the cause of loss of brain neurons later in life 68. The anti-cancer drug adriamycin ("the red death") is most noted for causing: A. cardiomyopathy (*) B. depression C. peripheral neuropathy D. pulmonary fibrosis E. urinary bladder inflammation 69. Delaying ejaculation in the male may be good or bad, depending on the man's physiology and wishes. Which drug is most likely to cause this? A. cantharidin (Spanish fly) B. clomipramine (selective serotonin uptake inhibitor) (*) C. methyldopa ("Aldomet", anti-hypertensive) (*) D. opiates (prescribed morphine, street heroin) E. thioridazine ("Mellaril", the noted anti-psychotic) 70. Aerosolized whipped cream is a favorite source for what recreational substance? A. acetone B. amyl nitrite C. ethyl alcohol for minors D. fluorocarbon E. nitrous oxide (*) 71. "Death angel" mushroom poison produces its effect by A. activating protein kinase C B. disaggregating ribosomes C. disrupting neuromuscular transmission D. inhibiting RNA polymerase (*) E. solubilizing membranes 72. In the movie "Death in the West", the Phillip-Morris tobacco company's research director said: A. "If there were something harmful in tobacco smoke, we could remove it." B. "So what are we supposed to do? Stop living? The best way to avoid dying is not to be born." C. "Too much of anything can kill you. Too much applesauce can kill you." D. "You must be trying to get me to admit that smoking is bad for you." E. All of the above. (*) 73. A dose of 300 total-body rads, sustained by a Russian during their next nuclear-power-plant disaster, will produce A. cerebral syndrome B. bone marrow suppression and possibly death in the acute phase (*) C. gastrointestinal radiation syndrome, death in a few days D. nothing acutely, but an increase in leukemia later in life E. nothing acutely, and probably no increased cancer risk 74. The pathologist describes the body as exhibiting the "pugilistic attitude". The death probably involved A. cadaveric spasm B. electrocution C. fire (*) D. fistfighting E. tetanus 75. Which is the usual electrolyte disturbance in the acute burn situation? A. hypercalcemia B. hyperkalemia (*) C. hypernatremia D. hypokalemia E. hyponatremia 76. You may have been surprised when your instructor told you that which of these is probably NOT an independent risk factor for atherosclerosis? A. cigaret smoking B. diabetes C. high blood pressure D. high LDL cholesterol E. obesity (*) 77. If you want to increase your circulating oxidized LDL, you should A. do aerobic exercise B. control your blood sugar, since glucose is a reducing sugar C. exercise; either aerobic or strength training is fine D. smoke a lot of cigarets (*) E. take anti-malarial drugs so long as you are not G6PD deficient 78. The infamous "Jack-in-the-Box hamburger" disease in the Pacific Northwest, caused by some kid not cooking those burgers through- and-through, was: A. Erlichiosis ("Rocky Mountain spotless fever") B. hemolytic-uremic syndrome (*) C. tapeworm larvae in the brain D. trichinosis, pork had been substituted for beef E. toxoplasmosis 79. A teenager with a coronary artery aneurysm probably once had: A. Buerger's disease B. Kawasaki's disease (*) C. syphilis D. Takayasu's pulseless disease E. Wegener's 80. Which tumor (or quasi-tumor) is most likely to be painful? A. Kaposi's B. Kasabach-Merritt hemangioma C. glomangioma (*) D. lymphangioma E. Osler-Weber-Rendu telangiectasia 81. THREE KODACHROMES. This hanging is A. Antemortem (*) B. Postmortem 82. ONE KODACHROME. This man was playing "chicken" on the railroad tracks. I don't know if this is a "win" or "lose", but the results were fatal. What was the MANNER of death? A. accident (*) B. cardiopulmonary arrest C. natural D. suicide E. trauma 83. FOUR KODACHROMES. Death scene. The MANNER of death is A. accident (*) B. asphyxiation C. cardiopulmonary arrest D. homicide E. suicide 84. TWO KODACHROMES. What caused this injury? A. fell on a stake B. machete C. post-mortem rat activity D. rifle or handgun E. shotgun (*) 85. ONE KODACHROME. The neck wound is a(n): A. abrasion B. chop C. incision (*) D. laceration E. strangulation wound 86. ONE KODACHROME. The facial injury is a(n): A. abrasion (*) B. chop C. contusion D. incision E. laceration 87. ONE KODACHROME. Medium-sized artery. This is probably A. atherosclerosis, mostly cholesterol-rich debris B. atherosclerosis, mostly fibrous (*) C. polyarteritis nodosa or a variant D. scleroderma or hemolytic-uremic syndrome E. temporal ("granulomatous") arteritis 88. ONE KODACHROME. This was in somebody's spleen. What is it? A. abscess B. angiosarcoma (*) C. infarct from atheroembolization D. hemangioma E. vasculitis lesion 89. ONE KODACHROME. The bug that causes stomach ulcers. A. Helicobacter (*) B. Listeria C. Salmonella D. Shigella E. Yersinia 90. TWO KODACHROMES. The etiologic agent is: A. gram-negative bacillus B. gram-negative coccus (*) C. gram-positive bacillus D. gram-positive coccus E. since the gram-stain is negative, it's chlamydia 91. TWO KODACHROMES. Epithelium. The histopathology indicates A. herpes (*) B. molluscum C. ringworm D. rabies E. staph infection 92. ONE KODACHROME. Pancreas. The patient has A. cystic fibrosis B. cytomegalovirus (*) C. herpes simplex D. fat necrosis from alcohol E. polyarteritis 93. TWO KODACHROMES. Soft-tissue infection of mediastinum. What's the pathogen? A. actinomycosis (*) B. aspergillus C. pseudomonas D. staph E. strep ("flesh-eater") 94. KODACHROME. From the gut. What's the bug? A. amoeba (*) B. giardia C. herpes ("gay bowel syndrome") D. shigella E. trichomonas 95. TWO KODACHROMES. Which type of leprosy? A. multibacillary / lepromatous B. paucibacillary / tuberculoid (*) 96. ONE KODACHROME. PAS stain. What is it? A. armpit sarcoid B. blastomycosis (*) C. gonorrhea D. histoplasmosis E. syphilis 97. ONE KODACHROME. This is sore, and the patient has a bit of a fever. What's the likely infectious agent? A. staphylococcus B. leprosy bacillus C. streptococcus (*) D. tinea versicolor E. tuberculosis 98. ONE KODACHROME. Which kind of "blastomycosis"? A. North-American B. South-American (*) C. German-American D. All-American E. "I don't like to be called an American!" 99. ONE KODACHROME. We never did culture or see the bug, but when we found out that this rash crawled up the arm from the prick of a rose thorn, we treated her for.... A. blastomycosis B. candidiasis C. sporotrichosis (*) D. syphilis ("The Sick Rose", by William Blake) E. tinea versicolor 100. ONE KODACHROME. The rash is most suggestive of A. Lyme disease B. kwashiorkor (*) C. scurvy D. smallpox E. zoster-varicella BONUS ITEMS! 101. Abundant tonofilaments visible on electron microscopy of a lung cancer indicates which histologic subtype? [squamous cell carcinoma] 102. What do we mean when we say a tumor exhibits "endophytic growth"? [ulcer] 103. Suppose we say a tumor's growth is "desmoplastic". What do we mean? [lots of fibrous stroma] 104. And suppose we want to describe a sarcoma of skeletal muscle origin. What prefix do we attach to the root "-sarcoma"? [rhabdomyo; "rhabdo" isn't sufficient] 105. What was the name given by its proponents to the popular "alternative" cancer remedy of the 1970's that was extracted from apricot pits? [laetrile] 106. What do we mean when we say an oncogene has been "transduced"? [picked up by a virus that just happened to be around] 107. What's an "ultimate carcinogen"? [the molecular species that actually does the damage to the gene] 108. The Ames test for carcinogenicity uses what living creature? [typhoid bacterium] 109. What's the name of the newly-studied gene whose product suppresses appetite when bodyfat is abundant? [Ob] 110. How did the disease "cystic fibrosis" get its name? [histopathology of the pancreas] 111.What happened to Silvester Stallone which caused the lower left side of his face to become paralyzed? [obstetrical forceps; no credit for saying your instructor beat him up] 112. You make a Tzanck smear, right at the bedside, to diagnose what infection? [herpes] 113. A "smudge cell" would tip me off that my patient died of pneumonitis caused by which virus? [adenovirus] 114. How did "anthrax" get its name? [black eschar at inoculation site] 115. What is "byssinosis"? No nicknames. [cotton dust pneumoconiosis] 116. At autopsy of a body of a "John Doe", with no known medical history, the pathologist finds hyaline sclerosis of vessels and large, hyperchromatic fibroblast nuclei in the connective tissues of the mediastinum, neck, and shoulders. There does not appear to be any frank tumor, but the connective tissue is just a little bit denser than usual. Elsewhere, the histology of the tissues is normal. What's the cause? [radiation] 117. How much radiation in a curie? [37000000000 disintegrations per second] 118. What's the chemical name for endothelial-derived relaxation factor? [nitric oxide] 119. What is LpS2, which you'll screen for someday? Be specific. [bad apolipoprotein A allele] 120. Why is this man smiling? [DID punch-out Silvester Stallone; +1 for any correct answer] UNIVERSITY OF HEALTH SCIENCES PATHOLOGY EXAM III 1995-1996 INSTRUCTIONS For the multiple-choice items, including the pictures, fill in your answers on the answer sheet provided. Matching items use each choice once, unless otherwise specified. 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. "PATHOLOGY" IS A VERB! LEARN ACTIVELY! GOOD LUCK!