36. You are planning a course for adult learners. If you want them actually to learn and remember, you'd do best to... A. begin with historical aspects of the subject * B. have them do something resembling what they'll do in a real-life setting C. have them read the thickest book possible D. keep them guessing what's testable E. make sure your lecture is as detailed as possible 37. Non-Hodgkin's malignant lymphomas presenting as anterior mediastinal masses are usually derived from A. B-cells B. null cells * C. T-cells D. thymic epithelium E. true macrophages 38. And the Hodgkin's variant with the big, pale-cytoplasm malignant cells which also tends to appear in the anterior mediastinum is A. lymphocyte depletion B. lymphocyte predominance C. mixed cellularity * D. nodular sclerosis E. popcorn cell disease 39. Agnogenic myeloid metaplasia typically produces what sign at presentation? A. distaste for one's cigarets * B. enlarged spleen C. itching in the hot shower D. pain upon ingesting alcohol E. splinter hemorrhages 40. You've gotten sheep red cells to form a rosette around a leukemia cell in an old-fashioned test. What does it mean? A. the leukemia is due to a zoonotic virus B. the leukemia is entering blast crisis C. the leukemia is of B-cell origin * D. the leukemia is of T-cell origin E. the patient will develop autoimmune hemolysis 41. Bone marrow usually yields a dry tap but a good core specimen in * A. hairy cell leukemia B. Hodgkin's disease C. plasma cell myeloma D. polycythemia vera in the early stages E. refractory anemia with excess of blasts 42. Which is NOT characteristic of Behcet's? A. aphthous ulcers in the mouth B. autoantigen recently characterized C. genital ulcers D. inflammation of the eye * E. one cause is chewing tobacco 43. What causes an aggressive adenocarcinoma of the salivary glands among the Inuit (Eskimo) people? A. Aleutian mink virus B. botulism in traditional ethnic food * C. Epstein-Barr virus D. herpes simplex plus an unknown environmental toxin E. Kaposi's virus 44. An angiofibroma of the throat (a curious lesion which you should not biopsy) most often occurs in A. female children B. middle-aged men C. people with Gardner's anti-oncogene deletion syndrome D. perimenopausal women * E. teenaged males 45. What percent of mucoepidermoid tumors of the salivary glands are malignant? A. 0% B. 20% C. 50% D. 80% * E. 100% 46. Which is LEAST LIKELY to cause acute stomach erosions? A. alcohol B. aspirin * C. autoimmune gastritis D. "food poisoning" from staph E. ischemia 47. Urinary cyclic AMP reflects the renal response to A. aldosterone B. antidiuretic hormone ("vasopressin") C. atrial natriuretic peptide (the heart is also an endocrine organ) * D. parathyroid hormone E. renin 48. Cancer of what organ has been most increased among people exposed as children to the aftermath of Chernobyl? A. adrenal B. liver, as with "Thorotrast" C. skin D. stomach * E. thyroid 49. You are most likely to see granulomas in * A. Crohn's disease B. helicobacter infestation C. typhoid D. ulcerative colitis (near the ulcers) E. Zenker diverticulum 50. Which is LEAST LIKELY to produce steatorrhea? A. abetalipoproteinemia B. common duct stone C. gluten enteropathy D. tropical sprue * E. ulcerative colitis 51. Which colonic bump is MOST LIKELY to turn malignant on you? A. hyperplastic polyp B. juvenile polyp C. Peutz-Jegher polyp D. tubular adenoma * E. villous adenoma 52. Giant mitochondria ("Yokoo bodies") in the liver suggest: * A. alcoholism B. autoimmune hepatitis C. echinococcal disease, their mitochondria are larger D. mitochondrially inherited disease E. phenytoin ("Dilantin") toxicity 53. Hemochromatosis is LEAST LIKELY to exhibit iron accumulation in the A. adrenal cortex * B. brain C. heart D. liver E. pancreas 54. Noted cause of viral pancreatitis A. adenovirus (seeks glands) B. herpes simplex 1 C. herpes zoster * D. mumps E. Jack Daniels virus 55. Which genes is most often mutated in maturity onset diabetes of the young? A. insulin B. glucagon * C. glucokinase D. somatomedin E. somatostatin 56. Which is NOT a feature of diabetic microangiopathy? A. chaotic opening and closing of the small arterioles * B. enhanced adhesion of neutrophils leading to ulceration C. excess production of basement membrane D. loss of pericytes in the retina E. stiffness of the wall, interfering with opening and closing 57. A parathyroid adenoma is LEAST LIKELY to produce A. ACTH B. FSH (ICSH) C. growth hormone D. prolactin * E. TSH 58. Which is LEAST LIKELY to produce necrosis of the pituitary gland? * A. sarcoidosis B. shock at the time of parturitoin C. sickle cell disease D. temporal arteritis E. trauma disrupting the portal system 59. Which thyroid cancer is infamous for invading vessels? * A. follicular carcinoma B. hemangioendothelioma of Queyrat C. papillary carcinoma D. medullary carcinoma E. thyroid lymphoma 60. Regardless of cause, Addison's disease patients are prone to develop A. hypercalcemia * B. hyperkalamia C. hypokalemia D. weight gain from edema E. weight gain from increased appetite 61. Salt losing "infant Hercules" A. cyclin D1 deficiency B. cyclin D2 deficiency C. 11-beta-hydroxylase deficiency D. 17-hydroxyprogesterone deficiency * E. 21-hydroxylase deficiency 62. Thymoma patients are especially prone to develop A. cachexia and emaciation * B. failure of red cell production C. flushing and wheezing D. immune complex vasculitis E. neuromas on the inner surfaces of the mouth 63. Which will NOT cause secondary hyperparathyroidism? A. calcium malabsorption B. kidney failure C. medullary carcinoma of the thyroid * D. milk-alkali syndrome E. vitamin D deficiency 64. Islet cell tumors in Wermer's multiple endocrine neoplasia type I usually produce * A. gastrin B. glucagon C. insulin D. somatostatin E. vasoactive intestinal polypeptide 65. What accumulates in adrenal leukodystrophy (of "Lorenzo's oil" fame)? A. glucocorticoid metabolites B. long polysaccharides * C. long-chain fatty acids D. short-chain fatty acids E. ubiquitin 66. A patient with autoimmune adrenalitis is LEAST LIKELY to have which one of the following as well? A. celiac sprue * B. lupus C. lymphocytic thyroiditis D. pernicious an emia E. vitiligo 67. ONE KODACHROME. How is Treacher-Collins inherited? * A. autosomal dominant B. autosomal recessive C. sex-linked recessive D. mitochondrial E. true polygenic 68. ONE KODACHROME. Adrenal. What's wrong? A. adrenal cortical carcinoma / adenocarcinoma B. consistent with adenoma C. ganglioneuroma * D. neuroblastoma E. pheochromocytoma 69. ONE KODACHROME. This pictures shows TWO A. band neutrophils B. basophils C. blast forms * D. eosinophils E. lymphocytes 70. ONE KODACHROME. Which is MOST LIKELY to be elevated in Dubin-Johnson? A. anti-microsomal antibodies B. anti-mitochondrial antibodies * C. conjugated bilirubin D. unconjugated bilirubin E. transaminases 71. TWO KODACHROMES. Thyroid. What is the principal autoantigen? A. elemental iodine B. microsomal protein C. thyroglobulin D. TSH protein * E. TSH receptor 72. TWO KODACHROMES. Liver tumor. A. angiosarcoma B. focal nodular hyperplasia C. hepatocellular carcinoma * D. metastases E. not tumor, but infarction 73. TWO KODACHROMES. Liver. What's the pink stuff? A. alpha-1 antitrypsin B. Councilman body / bodies C. eosinophil basic (cationic) protein D. glycogen * E. Mallory's hyaline 74. ONE KODACHROME. Bone marrow. What is the diagnosis? A. Burkitt's lymphoma B. DiGuglielmo's leukemia (M6) C. Hodgkin's disease D. metastatic cancer * E. nothing, that's just a megakaryocyte 75. TWO KODACHROMES. H&E and trichrome. Hepatitis B infection. What's the diagnosis? A. acute disease * B. chronic active hepatitis C. chronic persistent hepatitis D. healthy carrier E. hepatocellular carcinoma 76. TWO KODACHROMES. Pancreas. * A. acute pancreatitis B. adenocarcinoma of the pancreas C. chronic pancreatitis D. diabetes,type I E. diabetes, type II 77. TWO KODACHROMES. Liver biopsies. What's wrong? A. acute hepatitis B. chronic active hepatitis C. common bile duct stone or something similar D. Hodgkin's disease * E. primary biliary cirrhosis 78. ONE KODACHROME. What's the most likely cause of this cirrhosis case? A. alcohol abuse * B. hepatitis B C. iatrogenic bile duct stenosis D. iron overload E. primary biliary cirrhosis 79. THREE KODACHROMES. Thyroid. What's your diagnosis? * A. papillary carcinoma B. follicular carcinoma C. medullary carcinoma D. thyroid adenoma E. thyroid lymphoma 80. ONE KODACHROME. The neutrophil displays A. Auer rods * B. Dohle bodies C. hypersegmentation as in pernicious anemia D. ingested cryptococci E. mucopolysaccharide-laden granules 81. TWO KODACHROMES. Liver. What's the diagnosis? A. alcoholic cirrhosis B. angiosarcoma C. cholangiocarcinoma * D. hepatocellular carcinoma E. infarct 82. TWO KODACHROMES. Gut. What's the diagnosis? A. adenocarcinoma * B. Crohn's C. pseudomembranous colitis D. ulcerative colitis E. Whipple's 83. TWO KODACHROMES. Gut. What's the diagnosis? * A. pseudomembranous colitis B. tubular adenomatous polyp C. ulcerative colitis D. villous adenoma E. Whipple's 84. ONE KODACHROME. Gallbladder. The stones are made mostly of A. calcium bilirubinate * B. cholesterol C. granite D. magnesium ammonium phosphate E. uric acid 85. TWO KODACHROMES. Mouth stuff. What's the diagnosis. A. aphthous ulcer(s) B. candida C. lichen planus * D. squamous carcinoma in situ E. trench mouth / necrotizing gingivitis 86. TWO KODACHROMES. Esophagus. What's the diagnosis? * A. adenocarcinoma B. herpes C. squamous cell carcinoma in situ D. squamous cell carcinoma, invasive E. varix 87. TWO KODACHROMES. Cell of origin? A. B-cell B. dendritic macrophage C. plasma cell * D. T-cell E. not a tumor, just lichen planus 88. ONE KODACHROME. Peripheral blood. Your best diagnosis, please! A. acute lymphoblastic leukemia B. acute myelogenous leukemia C. chronic lymphocytic leukemia * D. chronic myelogenous leukemia E. Lyme disease 89. TWO KODACHROMES. Colon. What is the diagnosis? * A. adenocarcinoma B. Crohn's C. pseudomembranous colitis D. tubular adenomatous polyp E. villous adenoma 90. FOUR KODACHROMES. Liver. What's the diagnosis? A. alcoholism with giant mitochondria * B. alpha-1 antitrypsin deficiency C. glycogen storage disease D. iron overload E. primary biliary cirrhosis 91. TWO KODACHROMES. Pancreas. What's wrong? A. acute pancreatitis B. adenocarcinoma * C. fat necrosis D. type I diabetes E. type II diabetes 92. TWO KODACHROMES. Thyroid. What is the diagnosis? A. DeQuervain's B. Graves' * C. Hashimoto's' D. Jod-Basedow E. Plummer's 93, ONE KODACHROME. Blood. What's the diagnosis? A. acute lymphoblastic leukemia * B. acute myelogenous leukemia, M2 C. acute myelogenous leukemia, M5 / monocytes D. acute myelogenous leukemia, M6 / DiGuglielmo's E. infectious mononucleosis 94. ONE KODACHROME. Pancreas from a diabetic. The cause of the diabetes is probably A. type I B. type II * C. neither 95. ONE KODACHROME. Amyloid in a thyroid cancer like this should raise the suspicion of A. Alzheimer's disease B. multiple endocrine neoplasia I * C. multiple endocrine neoplasia II D. Peutz-Jegher's E. plasma cell myeloma 96. ONE KODACHROME. Diabetic's pancreas. What's the most likely cause? A. type I * B. type II C. adenocarcinoma of the pancreas D. acute alcoholic pancreatitis E. old alcoholic pancreatitis 97. TWO KODACHROMES. Colon with A. adenocarcinoma B. amebiasis C. Crohn's D. pseudomembrane * E. ulcerative colitis 98. ONE KODACHROME. Famous disease which also places a person at risk for A. demodex infestation B. gallstones * C. hepatocellular carcinoma D. kidney failure E. malabsorption 99. ONE KODACHROME. Autopsy photo. What's wrong? * A. bowel infarct B. melanosis coli C. peritonitis D. pseudomembranous colitis E. ulcerative colitis 100. FOUR KODACHROMES. Noah's A. antitrypsin deficiency B. B virus infection C. copper overload syndrome * D. drunkenness E. galactosemia BONUS ITEMS 101. TWO KODACHROMES. Mention the famous industrial risk factor for this hepatic angiosarcoma. [vinyl chloride] 102. TWO KODACHROMES. Around the opened aorta. Your best diagnosis, please. [any diffuse small lymphoma OR CLL or LP Hodgkin's] 103. TWO KODACHROMES. Patient photos. Your best diagnosis, please? [acromegaly] 104. THREE KODACHROMES. Lymph node. What is the diagnosis? [Hodgkin's] 105. ONE KODACHROME. Which kind of lymphoma? [Burkitt's / L3] 106. ONE KODACHROME. Salivary gland tumor. What kind? [pleomorphic adenoma / mixed tumor / any cartilage] 107. ONE KODACHROME. What anti-oncogene deletion syndrome? [Peutz-Jeghers] 108. ONE KODACHROME. Liver. Give me your best diagnosis. [amyloidosis] 109. ONE KODACHROME. What's the eponym for this hepatic vein phenomenon? [Budd Chiari] 110. ONE KODACHROME. Blood. What is the diagnosis? [Pelger-Huet] 111. What is a "chloroma"? [solid phase of neutrophilic malignancy / solid AML] 112. What's the term for the polysaccharide goo that streptococci synthesize from sugar-candy to coat your teeth, before it calcifies? [plaque] 113. What's a trichobezoar? Be specific. [hairball in stomach] 114. The etiologic agent of what famous disease of the small intestine grows within macrophages as PAS-positive rods? [Whipple's] 115. What is "prognathism"? [big jaw] 116. Glutamic acid decarboxylase turns out to be the autoantigen in what illness? [diabetes] 117. What's the usual cause of "central hyaline sclerosis" of the liver? [alcohol] 118. What's an "osmotic diuresis", as in diabetes? [unresorbable solute carries water out] 119. What is "Lynch's disease"? [non-polyposis colon cancer / no mismatch repair] 120. ONE KODACHROME. Why is this man smiling? [visitor from Phoenix, +1 any reasonable answer] NAME: _________________________ 100 points Seat: ____ List your neighbors here: UHS Pathology Exam IV 1997-8 INSTRUCTIONS As usual. Please don't phonate. This is a very tough exam. Medical school is supposed to be difficult. Consider the alternatives. GOOD LUCK!