36. Molecular biology! Genes are regulated on and off during the process of growing up and aging largely through methylation of their: A. adenine B. cytosine (*) C. guanine D. thymine E. uracil 37. Which has a greater maximum life span than others of its species? A. fruit flies with a great excess of a free-radical scavenger B. humans in the Himalayan Hunza tribe C. inbred animals with a low genetic load, and no bad genes D. rats given big doses of vitamin C and vitamin E E. roundworms with a mutation that has been selected against in (*) nature 38. Under most circumstances, a dividing cell loses a bit of DNA from its A. centromeres B. granulomeres C. hyalomeres D. mitochondria E. telomeres (*) 39. According to your lecturer's rather dubious list, which of the following is "age-dependent", i.e., part of the programmed process of aging? A. calcific aortic stenosis B. glaucoma C. plasma cell myeloma D. prostate hyperplasia (*) E. temporal arteritis 40. Both Hutchinson-Gilford classic progeria and Werner's syndrome feature all EXCEPT: A. accelerated atherosclerosis with high LDL B. early hair loss C. early loss of sexual function D. early osteoporosis E. precocious Alzheimer's disease (*) 41. Which makes LDL into the bad oxidized-LDL, as its likely principal mechanism as an atherosclerotic risk factor? A. cigaret smoking (*) B. diabetes C. hypertension D. inheritance of defective LpS2 allele E. stress 42. Which country has a worse atherosclerosis prevalence than the U.S.? A. Eskimo Country (all the very high northern latitudes) B. Finland (*) C. France D. Japan E. Red China 43. Which feature of an atherosclerotic plaque can regress, given the proper lifestyle changes and perhaps pharmacologic interventions? A. damage to the overlying endothelium (i.e., it heals) B. extracellular lipid C. fibrous tissue D. intracellular lipid E. all of the above (*) 44. Hyperplastic arteriolar sclerosis is a striking feature of all EXCEPT A. Eisenmenger's B. hemolytic-uremic syndrome ("Jack-In-The-Box disease") C. malignant hypertension D. radiation injury (*) E. scleroderma 45. Epidemiologists continue to find an empirical link between Kawasaki's disease and A. carpet cleaning (*) B. cigaret smoking C. imported cars D. ingestion of raw fish E. motorcycle riding 46. In temporal arteritis, the pathologist expects to see granulomas attacking the A. adventitia B. endothelium C. internal elastic membrane (*) D. myointimal cells E. smooth muscle 47. Kasabach-Merritt syndrome is said to be present when a hemangioma causes A. high-output heart failure B. malignant change C. massive hemorrhage D. severe facial disfigurement E. thrombocytopenia (*) 48. "Wavy fibers" reported by the pathologist are fibers that A. became hypertrophic, perhaps from hypertension B. correspond to gross "road kill" necrosis C. stopped beating shortly before death (*) D. underwent coagulation necrosis E. underwent dystrophic calcification 49. Which birth defect is often complicated by coarctation of the aorta? A. congenital syphilis B. Kartagener's dextrocardia C. tuberous sclerosis D. tricuspid atresia E. Turner's XO (*) 50. Which will shift the mediastinum TOWARD the pathology? A. aortic dissection B. lobar pneumonia C. lung cancer producing massive atelectasis (*) D. massive pleural effusion E. "pneumonia alba" of tuberculosis 51. Alpha-1 protease inhibitor (antitrypsin) deficiency will produce A. bronchiectasis B. emphysema (*) C. pulmonary fibrosis D. respiratory distress of the newborn E. situs inversus 52. The bacterium that is infamous for superinfecting influenza pneumonitis is A. anaerobe family B. Friedlander's pneumonia C. pneumococcus D. staphylococcus (*) E. streptococcus B 53. Hypercalcemia is a notorious paraneoplastic syndrome seen most typically with bronchogenic: A. adenocarcinoma B. carcinoid C. mesothelioma D. oat cell carcinoma E. squamous cell carcinoma (*) 54. Amplified myc is a hallmark of: A. adenocarcinoma B. carcinoid C. mesothelioma D. oat cell carcinoma (*) E. squamous cell carcinoma 55. Mean corpuscular hemoglobin concentration is likely to be a bit high in A. acute blood loss B. hereditary spherocytosis (*) C. iron deficiency D. pernicious anemia E. thalassemia minor 56. A bit of vinegar added to the anticoagulated blood may help show up the rod-shaped crystals that confirm your diagnosis of A. hemoglobin C disease or trait (*) B. hemoglobin S disease or trait C. hereditary spherocytosis (spectrin crystals) D. sarcoidosis; crystals of angiotensin-converting enzyme E. thalassemia disease or trait 57. Which drug, given in high doses, is notorious for binding to the red cell membrane and causing antibodies to attack it directly? A. coumarin B. methotrexate C. methyldopa ("Aldomet") D. penicillin (*) E. quinidine 58. In "anemia of chronic disease", iron A. is handled normally by the body B. isn't absorbed by the gut C. isn't placed properly into the heme ring D. isn't taken up by marrow macrophages E. isn't taken up by the normoblasts (*) 59. In sideroblastic anemia, the Prussian-blue stainable iron is in the: A. hemoglobin B. lysosomes C. macrophages D. mitochondria (*) E. nucleus 60. The distinctive neuropathological lesion in pernicious anemia is in the A. central gray of the spinal cord B. hippocampus C. neocortex D. posterior columns of the spinal cord (*) E. substantia nigra 61. Four beta chains make A. a Heinz body B. a Howell-Jolly body C. a Pappenheimer body D. hemoglobin Bart's E. hemoglobin H (*) 62. The "Ham test" tests for abnormal sensitivity of red cells to complement-mediated lysis at low pH, which is the problem in: A. AIDS anemia B. cold agglutinin disease C. hereditary spherocytosis D. paroxysmal nocturnal hemoglobinuria (*) E. thalassemia minima 63. Hypersegmented neutrophils are a familiar finding in: A. anemia of chronic disease B. chronic granulocytic leukemia C. iron deficiency anemia D. pernicious anemia (*) E. sepsis Coagulation! Use each choice once. A. Clot retraction B. D-dimer C. Partial thromboplastin time D. Prothrombin time E. Urea solubility 64. Flunking this test is specific, if fibrin and platelet counts are normal, for Glanzmann's disease [A] (*) 65. Flunking this test is the most specific, among the above, for diagnosing DIC [B] (*) 66. Flunking this test lets you know there's a problem with factor I, II, V, VII, and/or X. [D] (*) 67. Flunking this test lets you know there's a problem with factor I, II, V, VIII, IX, X, XII and/or XIII. [C] (*) 68. Flunking this test lets you know there's a problem with factor XIII. [E] (*) 69. Patients with scurvy bleed because of a problem with A. capillary integrity (*) B. factor II only C. factors II, VII, IX, and X D. fibrinogen E. platelets 70. Which has the best chance of prolonged survival without therapy? A. adult T-cell leukemia-lymphoma B. Burkitt's lymphoma C. immunoblastic lymphoma D. follicular large-cell lymphoma E. follicular small-cleaved cell lymphoma (*) 71. Which is the BEST histologic evidence that your H&E slide of a lymph node is malignant lymphoma? A. distinct cortex and medulla B. mantle of resting lymphocytes C. monotonous, uniform cells (*) D. real germinal centers E. vascular proliferation 72. In 1994, the woman who lost five successive babies to SIDS and whose case launched the "apnea monitor" business: A. confessed that she really murdered all five of them (*) B. died suddenly herself C. received a tribute from grateful stockholders D. was found to carry a rare genetic disease causing SIDS E. wrote a book and made lots of money 73. The bcr/abl translocation is always present in: A. acute myelogenous leukemia M3 B. Burkitt's lymphoma C. chronic granulocytic leukemia (*) D. oat cell carcinoma E. Waldenstr”m's macroglobulinemia 74. ONE KODACHROME. Cigaret smokers may expect all EXCEPT: A. decreased lung elasticity B. enhanced cocaine effect on the coronaries C. increased cancer risk D. increased production of protective lung mucin E. decreased total lung volume (*) 75. TWO KODACHROMES. Lung. What is the diagnosis? A. bacterial pneumonia B. CMV C. pneumocystosis D. sarcoidosis (*) E. viral pneumonitis 76. THREE KODACHROMES. What is the diagnosis? A. ARDS (*) B. bacterial pneumonia C. emphysema D. mesothelioma E. lung cancer of some kind or other 77. ONE KODACHROME. Lung. Feel free to come up and look. What's the diagnosis? A. ARDS B. bacterial pneumonia (*) C. bronchioloalveolar cell carcinoma D. malignant lymphoma E. viral pneumonitis 78. TWO KODACHROMES. Lung. The patient had: A. cancer B. emphysema (*) C. Goodpasture's D. pulmonary fibrosis E. Wegener's 79. TWO KODACHROMES. Which type of lung cancer? A. adenocarcinoma, not otherwise specified B. bronchioloalveolar carcinoma (*) C. mesothelioma D. oat cell E. squamous cell 80. ONE KODACHROME. Artery from the lung. You suspect: A. cancer B. mineral oil aspiration C. polyarteritis nodosa D. ventricular septal defect (*) E. Wegener's 81. TWO KODACHROMES. Which kind of lung cancer? A. adenocarcinoma B. mesothelioma C. oat cell (*) D. pulmonary lymphoma E. squamous cell 82. ONE KODACHROME. Aorta and iliacs. The result of A. atherosclerosis (*) B. Buerger's C. syphilis D. Takayasu's E. thromboembolization, perhaps atrial fibrillation 83. ONE KODACHROME. Aerobic athletes can expect all EXCEPT: A. big QRS complex B. decreased risk of coronary sudden death C. increased hematocrit (*) D. left ventricular hypertrophy E. low resting heart rate 84. ONE KODACHROME. This mitral valve shows: A. acute rheumatic fever B. bacterial endocarditis C. Barlow's valve D. old rheumatic fever (*) E. rupture from myocardial infarct 85. ONE KODACHROME. Heart. Look closely, and trust your eyes. What's the diagnosis? A. amyloid cardiomyopathy B. coxsackie cardiomyopathy C. endocardial fibroelastosis (*) D. hypertrophic cardiomyopathy E. massive, old infarct 86. ONE KODACHROME. Tight aortic valve with two leaflets. This became symptomatic at the age of A. before birth B. immediately after birth C. two weeks after birth D. school age E. old age (*) 87. ONE KODACHROME. Proximal thoracic aorta. What's the diagnosis? A. atherosclerosis without other lesions B. gunshot wound C. medial dissection (*) D. syphilitic aneurysm E. Takayasu's 88. ONE KODACHROME. Tight aortic valve with three leaflets. This became symptomatic at the age of A. before birth B. immediately after birth C. two weeks after birth D. school age E. old age (*) 89. ONE KODACHROME. Mitral valve leaflets seen from above. What's the most likely diagnosis? A. Barlow's (*) B. bacterial endocarditis C. normal valve D. old rheumatic fever E. ruptured papillary muscle 90. ONE KODACHROME. He either loves or hates the red marks, but his doctors keep asking whether he has: A. AIDS B. Sturge-Weber (*) C. tuberous sclerosis D. Von Hippel-Lindau E. Von Recklinghausen's neurofibromatosis 91. ONE KODACHROME. This was the most segmentation we found in any neutrophil in this patient. What's the diagnosis? A. Alder-Reilley B. Chediak-Higashi C. leukemia of some kind or other D. Pelger-Huet (*) E. terrible case of sepsis 92. ONE KODACHROME. Peripheral smear. What is the diagnosis? A. acute leukemia consistent with M7 B. acute leukemia, but not M7 C. chronic granulocytic leukemia D. chronic lymphocytic leukemia E. lung cancer (*) 93. ONE KODACHROME. Lymph node. I'm going to let you guess the stain. What is the diagnosis? A. Burkitt's lymphoma B. Hodgkin's lymphoma C. metastatic lung cancer (*) D. mixed small-and-large cell lymphoma E. normal lymph node 94. ONE KODACHROME. Peripheral blood. What is the diagnosis? A. acute leukemia (*) B. chronic lymphocytic leukemia C. chronic myelogenous leukemia D. hairy cell leukemia E. infectious mononucleosis 95. THREE KODACHROMES. What is the diagnosis? A. Burkitt's lymphoma B. Hodgkin's (*) C. hyperplastic lymph node D. normal germinal center E. squamous cell carcinoma 96. ONE KODACHROME. Skin. What is the diagnosis? A. hemangioma B. Kaposi's sarcoma C. mycosis fungoides (*) D. Rocky Mountain spotted fever E. no pathology 97. ONE KODACHROME. Peripheral smear. What's the diagnosis? A. DIC B. hemoglobin C disease C. malaria D. sickle cell disease (*) E. thalassemia minor 98. ONE KODACHROME. Spleen. The diagnosis is A. diffuse lymphoma B. nodular lymphoma (*) 99. ONE KODACHROME. This acute leukemia is: A. hairy cell B. lymphoid C. myeloid (*) D. can't tell from the picture 100. ONE KODACHROME. These "lacunar" Reed-Sternberg cells suggest: A. lymphocyte depletion Hodgkin's disease B. lymphocyte predominance Hodgkin's disease C. mixed cellularity Hodgkin's disease D. nodular sclerosing Hodgkin's disease (*) E. fool's Hodgkin's disease, i.e., perhaps infectious mono BONUS ITEMS 101. ONE KODACHROME. The cells with abundant, pale cytoplasm contain lipid droplets phagocytized from the blue cells, in which they are less abundant. What is the diagnosis? [Burkitt's lymphoma] (*) 102. TWO KODACHROMES. Mass from the lung. What is the diagnosis? [angiosarcoma; accept any blood vessel tumor] (*) 103. TWO KODACHROMES. Lung. Give a reasonable diagnosis. [asbestosis / pleural fibrosis / mesothelioma] (*) 104. THREE KODACHROMES. Lung. What is the diagnosis? [thromboemboli] (*) 105. TWO KODACHROMES. Bone. What is the diagnosis? [myeloma] (*) 106. THREE KODACHROMES. Heart. Just the right diagnosis, please. [hypertrophic cardiomyopathy] (*) 107. TWO KODACHROMES. Heart. Just the right diagnosis, please. [rheumatic fever] (*) 108. What is the Hayflick phenomenon? [cells stop dividing after a certain number of times] (*) 109. What does the word "grumous" mean? [finely granular semi-solid material; "grunge", etc.] (*) 110. What's a "mycotic aneurysm"? [from infection at branch point, key is "infection"] (*) 111. What's Budd-Chiari syndrome? [thrombosis of the hepatic veins] (*) 112. Briefly explain why folks with aortic stenosis from any cause are prone to fall over death without much warning? [no time for coronary filling / Bernoulli's Venturi effect] (*) 113. What's the chemical name for endothelially-derived relaxation factor? [nitric oxide] (*) 114. Which cytokine, a very potent neutrophil attractor, has recently been found to be tremendously elevated in the lung in adult respiratory distress syndrome? [interleukin 8] (*) 115. The real difference between a "pink puffer" and a "blue bloater" is that the "blue bloater" has lost: [hypercarbic drive] (*) 116. What do we mean by "red hepatization", and when do we use the term? [fibrin consolidates a hemorrhagic bacterial pneumonia] (*) 117. What is the autoantigen in Eaton-Lambert syndrome? [calcium channels] (*) 118. What's the molecular problem in thalassemia? [cannot make enough of a globin chain] 119. A patient with no other lung cancer risk asks for your assessment of the "radon in your home" scare. Somebody wants to charge her $5000 to "radon-proof" her home, which supposedly has more radon than it should. What do you say? [she must weight the risk, which is very small for a non-smoker] 120. Why is this man smiling? [all quacks smile, +1 for any answer] NAME:_________________________ Neighbors: UNIVERSITY OF HEALTH SCIENCES PATHOLOGY EXAM III 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. YOU'RE IN MEDICAL SCHOOL. EVEN IF YOU'RE NOT MY TOP SCORER THIS TIME, YOU'RE STILL ONE OF AMERICA'S INTELLECTUAL LITE. GOOD LUCK!