NAME: __________________ 100 points 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. YEAH, YOU GOTTA KNOW SOME FACTS. AND ITS GOOD TO KNOW AS MUCH AS YOU CAN. HOWEVER... NOBODY WILL DIE BECAUSE YOU DIDN'T LEARN SOME LOUSY LITTLE DETAIL IN "PATHOLOGY"... SOMEBODY WILL DIE UNNECESSARILY IF YOU DON'T LEARN TO THINK CLEARLY ABOUT DISEASE! GOOD LUCK! 36. Which is LEAST LIKELY to result from non-injected cocaine use? A. accentuation / potentiation of rhythm disturbances B. cardiac individual-fiber necrosis, contraction bands C. getting shot by one of your lowlife friends D. inflammation of the cardiac valves (*) E. spasm of the coronary arteries 37. An "endocardial cushion" septal malformation of the heart would make you suspect: A. Fetal alcohol syndrome B. Fetal rubella syndrome C. Kartagener's syndrome D. Trisomy 21 (*) E. Turner's XO 38. Which is NOT a feature of tetralogy of Fallot? A. left ventricular hypertrophy (*) B. overriding aorta C. right ventricular hypertrophy D. pulmonic valve stenosis E. ventricular septal defect 39. "Bypass fibers" conduct signals inappropriately from the atria to the ventricles in which syndrome? A. Barlow B. Fetal rubella C. Freiderich's ataxia D. Reggie Lewis's disease (disease, not syndrome) E. Wolff-Parkinson-White (*) 40. Which chemotherapeutic agent is an infamous heart poison? A. adriamycin (*) B. busulfan C. cis-platinum D. vinblastine E. vincristine Matching item: Right out of those memory banks! A. Lack of IX B. Lack of S C. Lack of VIII-C D. Lack of VIII-R E. Lack of VIII-R binder on platelets 41. Bernard-Soulier [E] 42. Christmas disease [A] 43. Classic hemophilia [C] 44. Hypercoagulable blood [B] 45. von Willebrand's disease [E] 46. If I'm deficient in factor VII, I will have: A. Long PT, long PTT B. Long PT, normal PTT (*) C. Normal PT, long PTT D. Normal PT, normal PTT E. One or both is short 47. Which is LEAST LIKELY to get a pulmonary embolus? A. a hurt football jock, six weeks in traction on "ortho" B. a former vice-president whose right lower leg really hurts, and has a knot in it, after a long plane flight C. a newborn with very bad hyaline membrane disease (*) D. a pathologist with nothing wrong except heterozygous protein C deficiency E. a woman seven months pregnant, with a tobacco smoking habit Little molecules in our lungs! A. endothelin 1 B. leukotriene C. nitric oxide D. protease inhibitor E. vitamin D 48. Both a bronchoconstrictor and a chemotactic agent in asthma [B] 49. Deficiency will give emphysema even to a non-smoker [D] 50. Produced in its most active form by the granulomas in sarcoidosis [E] 51. Relaxes the vessels in the walls of pulmonary blood vessels [C] 52. Strongly implicated as the agent of lung vessel wall thickening in response to longstanding pulmonary hypertension [A] 53. In 1994, the woman whose "tragic loss of five children to SIDS" launched the multi-billion dollar apnea monitor fiasco: A. confessed she smothered her five children (*) B. revealed she had fed them raw honey C. was found to carry a fatty-acid metabolic defect D. was found to have ectodermal dysplasia herself E. went to Washington as a health policy consultant 54. What is the principal cause of the breathing problems in common chronic bronchitis? A. bronchi narrowed by thickened, gland-laden walls B. bronchi obstructed by mucus C. bronchoconstriction D. coexisting emphysema (*) E. all of these are important 55. "TWAR" is a strain of A. chlamydia (*) B. gram-positive cocci C. legionella D. mycoplasma E. virus 56. Which is LEAST LIKELY to produce fibrosis of the lung? A. adriamycin chemotherapy (*) B. asbestosis C. bone marrow transplantation D. radiation for breast cancer E. scleroderma 57. Walt Disney, cartoonist, supposedly modelled Mickey Mouse on a semi-tame mouse in his Kansas City studio. Under slightly different circumstances, the mouse might have infected Mr. Disney with A. adenovirus ("smudge cells") B. hantavirus (*) C. histoplasmosis ("Kansas City disease") D. legionellosis E. pneumocystosis 58. Why are T-helper (CD4) cells diminished in the circulating blood in sarcoidosis? A. sarcoidosis is an AIDS-like disease B. sarcoidosis often damages the thymus gland C. they got destroyed in the spleen D. they went to the site of the disease (*) E. they aren't, the writer is making this up 59. Which lung cancer is MOST LIKELY to produce hypercalcemia as a paraneoplastic syndrome? A. adenocarcinoma B. carcinoid C. large cell undifferentiated carcinoma (100 day cancer) D. oat cell carcinoma E. squamous cell carcinoma (*) 60. One surprising new research finding is the alleged presence, on the surfaces of lung cancer cells, of receptors for A. asbestos B. immunoglobulin C. nicotine (*) D. radon E. tumor necrosis factor 61. Finding neurosecretory granules on electron microscopy of a lung cancer tells you it's probably A. adenocarcinoma (glands secrete) B. Kaposi's sarcoma C. metastatic from the brain or cord (neuraxis) D. oat cell carcinoma or carcinoid (*) E. squamous cell carcinoma 62. G6PD deficiency A. common anti-malarial drugs help re-reduce hemoglobin B. G6PD is a glycolytic enzyme C. mostly a white people's disease D. hemoglobin gets locked in the oxidized, denatured state (*) E. red cells have very little 2,3-DPG 63. You're likely to see the famous "bird in flight" crystals in: A. G6PD deficiency B. hemoglobin C disease C. sickle cell anemia D. sickle-C disease (*) E. sputum of an asthmatic 64. "Paroxysmal nocturnal hemoglobinuria" results from loss of a membrane component which protects cells from A. bacteria B. complement (*) C. neutrophil enzymes D. oxidation of hemoglobin E. splenic lysis 65. Which autoimmune disease, not otherwise complicated, is MOST LIKELY to develop into malignant lymphoma? A. lupus B. polymyositis C. rheumatoid arthritis D. Sjogren's (*) E. Wegener's 66. Which is NOT clearly linked to any lymphoma? A. a gram-negative bacterium B. Epstein-Barr virus C. HTLV-1 D. Kaposi's virus E. smoking (*) 67. Tartrate-resistant acid phosphatase is your best stain for: A. acute granulocytic leukemia B. hairy-cell leukemia (*) C. histiocytosis X family D. plasma cell myeloma E. T-cell lymphoma (the mean type) 68. Around what percent of children with childhood leukemia can expect a cure? A. none B. 1% C. 10% D. 70% (*) E. 90% 69. Which form of acute leukemia is caused, at least in part, by a mutation involving the vitamin A receptor, and is treatable by variants of vitamin A? A. acute lymphoblastic leukemia B. M3 promyelocytic leukemia (*) C. M4 myelomonocytic leukemia D. M6 erythroleukemia E. hairy cell leukemia 70. In a sideroblastic anemia, the iron-rich granules surrounding the nuclei of normoblasts are A. Heinz bodies B. Howell-Jolly bodies C. lysosomes D. mitochondria (*) E. free particles 71. You meet a 21 year old male, lowlife-hanging-out and pitching pennies on the street-corner. It turns out that what you thought was chewing tobacco is actually a 4 cm mass within his mandibular ramus. It's been like that for years, he says. He lets you scrape it out, and you find it's a mix of woven bone and nice, benign-looking dense-irregular fibrous tissue. What did he have? A. ameloblastoma B. fibrous dysplasia (*) C. healed fracture D. osteogenic fibroma E. periapical abscess site 72. Which type of bacterium is the main culprit in tooth decay? A. gram-negative anaerobe B. fungi C. staphylococcus D. streptococcus (*) E. no bacterium, it's all the refined sugar 73. Which is LEAST HELPFUL in diagnosing reflux esophagitis histologically? A. fibrovascular papillae 2/3 of the way up the epithelium B. eosinophils in the epithelium C. hyperplasia of the basal layer D. lymphocytic infiltration (*) E. all of these are really quite helpful, thanks 74. Which is NOT a known risk factor for squamous cancer of the esophagus? A. alcohol abuse B. bad Chagas' disease C. old lye strictures D. smoking E. reflux (*) 75. When I was a psych orderly in college, an annoyed patient told me, "I hope you get nothing to eat for the rest of your life except 'Wheaties'". This would be particularly unfortunate if I were also to develop: A. celiac sprue (*) B. Crohn's regional enteritis C. giardiasis D. tropical sprue E. Whipple's disease 76. Fistula formation is typical in A. Crohn's disease (*) B. ulcerative colitis C. both D. neither E. C & D 77. Lynch's hereditary non-polyposis coli syndrome, which is quite common, is caused by loss of genes for A. bactericidal activity in the colon B. DNA mismatch repair (*) C. growth suppression by DNA binders D. tyrosine kinase transmembrane receptors E. nobody knows what those genes do yet 78. A new (1995 surprise) research finding, which will be very important if confirmed, involves prophylaxis of colon cancer by: A. drinking red wine with tannins B. high-roughage diet C. restricting meat products D. taking aspirin (*) E. very small doses of bile-salt binding resins 79. Dracula and the Wolf Man may have been based, in part, on a community of folks with which type of porphyria? A. acute intermittent B. congenital erythropoietic (*) C. cutanea tarda D. lead-related E. variegate 80. Iatrogenic disease! The most notorious pharmaceutical-industry scandal of 1994 was the discovery that thousands of Americans had been killed, and probably nobody helped, by drugs administered to A. control asthma B. prevent problems with thrombosis C. prevent progression of heart rhythm problems (*) D. treat leukemia E. treat lung cancer 81. THREE KODACHROMES. Lung. What's the problem? A. ARDS, can't tell much else (*) B. caseating pneumonia, probably TB or histoplasmosis C. cryptococcal pneumonia D. eosinophilic pneumonitis E. pulmonary hypertension lesion, as in Eisenmenger's 82. TWO KODACHROMES. Lung. What's the trouble? A. acute pneumonia, probably bacterial B. ARDS, can't tell anything else C. cryptococcus pneumonia D. cytomegalovirus pneumonia (*) E. pneumocystosis 83. TWO KODACHROMES. Lung. This is A. abscess B. adenocarcinoma C. oat cell carcinoma D. sarcoidosis E. squamous cell carcinoma (*) 84. FOUR KODACHROMES. Lung. This is A. abscess B. adenocarcinoma C. oat cell carcinoma D. sarcoidosis (*) E. squamous cell carcinoma 85. THREE KODACHROMES. Lung. This is A. abscess B. adenocarcinoma C. oat cell carcinoma (*) D. sarcoidosis E. squamous cell carcinoma 86. THREE KODACHROMES. Lung. This is A. asbestosis (*) B. bronchogenic carcinoma, non-oat cell C. idiopathic Hamman-Rich D. oat cell carcinoma E. sarcoidosis 87. THREE KODACHROMES. Colon. This is A. amebiasis with amebomas B. Crohn's disease C. familial polyposis coli (*) D. melanosis coli E. ulcerative colitis with pseudopolyps 88. ONE KODACHROME. Intestine. Gross, and trichrome stain. What's your diagnosis? A. cancer B. Crohn's disease (*) C. ulcerative colitis D. red infarct E. white infarct 89. ONE KODACHROME. Heart. What is the diagnosis? A. cocaine heart B. mycotic aneurysm C. rheumatic fever D. thrombotic thrombocytopenic purpura (*) E. nothing, this section of heart is normal 90. ONE KODACHROME. Heart. Patient died of: A. Chinese restaurant syndrome B. hypertrophic cardiomyopathy (*) C. lollipop accident D. rheumatic aortic stenosis E. syphilitic aortic valve disease 91. ONE KODACHROME. Heart. Looks like a(n): A. cocaine heart B. early myocardial infarct (*) C. hypertrophic cardiomyopathy D. old myocardial infarct E. rheumatic fever 92. ONE KODACHROME. Heart. This is MOST CONSISTENT with A. acute myocardial infarct B. acute rheumatic fever C. amyloidosis D. hypertrophic cardiomyopathy E. transplant rejection (*) 93. ONE KODACHROME. Heart. What's the problem? A. bacterial endocarditis B. Barlow's mitral valve C. hypertrophic cardiomyopathy D. old rheumatic mitral stenosis (*) E. ruptured papillary muscle 94. ONE KODACHROME. Heart. Which problem? A. acute myocardial infarction B. dilated cardiomyopathy (*) C. endocardial fibroelastosis D. hypertrophic cardiomyopathy E. restrictive cardiomyopathy 95. ONE KODACHROME. Blood. Your patient has A. acute leukemia, can't tell what kind B. acute myelogenous leukemia (*) C. chronic lymphocytic leukemia D. chronic myelogenous leukemia E. hairy cell leukemia 96. ONE KODACHROME. Blood. The cell in the middle looks funny, but exhibits no nucleoli, and considerable heterochromatin. Your patient has: A. infectious mononucleosis (*) B. leukemia 97. THREE KODACHROMES. Lymph node. Your patient has A. Burkitt's lymphoma B. Hodgkin's disease (*) C. lymphoblastic lymphoma D. oat cell carcinoma E. well-differentiated lymphocytic lymphoma 98. ONE KODACHROME. Blood. Your patient has A. acute myelogenous leukemia B. acute leukemia, cannot tell which kind C. chronic myelogenous leukemia D. chronic lymphocytic leukemia E. erythroblastosis fetalis (*) 99. ONE KODACHROME. Look carefully. This section of tissue is probably: A. Burkitt's lymphoma B. eosinophilic pneumonia C. squamous cell carcinoma D. pus, as in a lung abscess E. plasma cell myeloma (*) 100. ONE KODACHROME. Which will NOT be increased in a long-term smoker? A. alveolar macrophage number B. elastase production and release C. mucous gland size D. total lung volume E. none, all of these will be increased. (*) BONUS ITEMS: 101. TWO KODACHROMES. How's your histopathology? From the lung. Give me your best diagnosis. [I expect some kind of carcinoma, and not oat cell] 102. TWO KODACHROMES. How's your histopathology? From the lung. Give me your best diagnosis. [alveolar lipoproteinosis] 103. ONE KODACHROME. What known antibody is most likely to cause this? [lupus anticoagulant] 104. TWO KODACHROMES. What's the name given to this familiar little cyst of the mouth mucosa? [mucocele / ranula] 105. ONE KODACHROME. What's the generic term given to this kind of lesion, whether benign or malignant? [leukoplakia] 106. ONE KODACHROME. How's your histopathology? I found this in somebody's esophageal mucosa. What is it? [carcinoma in situ / dysplasia, I will NOT take cancer, it's not] [invading] 107. ONE KODACHROME. Gastric biopsy from the fundus. Give me your best diagnosis. [atrophic gastritis, I need both] 108. ONE KODACHROME. Give the exact histopathologic name for this salivary gland cancer. [adenoid cystic] 109. THREE KODACHROMES. How's your histopathology? Heart. What's your diagnosis? [rheumatic fever] 110. TWO KODACHROMES. Lymph node smear and section. Give me the exact diagnosis. [Burkitt's / L3] 111. ONE KODACHROME. How's your histopathology? Lung. I need an exact diagnosis. I'll be very happy with anyone who gets this. [cancer embolus, must include both] 112. All the patient's neutrophils looked like this. Why? [Pelger-Huet] 113. TWO KODACHROMES. Tissue around the aorta. Give me your best diagnosis. [well-differentiated lymphocytic lymphoma] [will take CLL, lymphocyte predominance Hodgkin's] 114. What's the name we give to the hemoglobin, typical of the worst alpha-thalassemias, composed of four gamma chains? [Bart's] 115. What is "Syndrome X", supposedly a cause of angina in diabetics without obvious coronary artery disease? [autonomic microvascular dysfunction] 116. What's the eponym given to angina secondary to coronary spasm? [Prinzmetal's] 117. What's the eponym given to the autoimmune heart inflammation that may result from myocardial infarct? [Dressler's] 118. "Lutembacher's syndrome" merely refers to mitral stenosis plus an atrial septal defect. What do you think happens? [left to right shunt tremendously increased; show me you understand] 119. This year, the JAMA published an article evaluating the claim that CRP was performed better using what implement? [toilet plunger] 120. Why is this man smiling? I I I I I I ___________ (\___/<\___/) \_____/ \_______/ [Item #119, +1 for any reasonable answer] ____ ______ \___/ \