36. Before he drank the poison, Socrates A. said all people, good and bad, by nature desire knowledge * B. said grace C. said he'd rather die than take a pathology course D. said that governments should allow free speech to their citizens E. said that the end does not justify the means 37. Which of the following is more likely to involve the epididymis than the testis? A. carcinoma in situ B. mumps * C. tuberculosis D. syphilis E. all of these 38. The fundamental problem in osteopetrosis is failure of the A. cartilage matrix B. fibroblasts C. osteoblasts * D. osteoclasts E. osteocytes 39. Which is NOT implicated in the pathogenesis of squamous cell carcinoma of ordinary skin? A. arsenic B. being a redhead * C. HPV D. Kaposi's sarcoma virus E. old burns 40. Thickening of the spiny layer, absent granular, and plenty of scales which retain their nuclei? It must be A. erythema multiforme B. impetigo C. lichen planus D. pemphigus * E. psoriasis 41. You'll see IgA in the tips of the dermal papillae if it's... A. balanitis xerotica * B. dermatitis herpetiformis C. impetigo D. pemphigoid E. pemphigus 42. A teen has pale spots on his tanned skin. They look like a pattern of raindrops. The teen has A. impetigo B. pityriasis rosea C. scabies D. seborrhea * E. tinea versicolor 43. Erythema nodosum pops up on the A. ears B. face C. groin D. hands and wrists * E. shins 44. Peliosis hepatis from anabolic steroid abuse is A. benign tumor(s) B. cholestatic jaundice * C. dilated veins D. liver cell unrest E. necrosis, as a Zahn infarct 45. What's the common water-bug that infects the hair follicles in swimmer's ears? A. E. coli B. proteus * C. pseudomonas D. serratia E. staphylococcus 46. "Leber cells" are macrophages, packed with organisms and debris, seen on smears from patients with A. herpes B. impetigo C. meningitis * D. trachoma E. trichomonas prostatitis 47. Having allele 4 for apolipoprotein E puts you at risk for * A. Alzheimer's B. meningioma C. Parkinsonism D. Pick's E. prion disease 48. Amyloid in the walls of blood vessels is typical of A. adrenoleukodystrophy * B. Alzheimer's C. Binswanger's D. medulloblastoma E. Parkinsonism 49. Most bladder stones are made of A. calcium oxalate B. calcium phosphate C. granite * D. magnesium ammonium phosphate E. uric acid 50. What's the most common soft tissue sarcoma? A. angiosarcoma B. fibrosarcoma C. liposarcoma * D. malignant fibrous histiocytoma E. synoviosarcoma ("Robert Urich's cancer") 51. All are true of Hunner's interstitial cystitis EXCEPT A. all three layers of the bladder wall involved B. abnormal epithelium remains abnormal in tissue culture C. chronic inflammation, with pain * D. difficulty phagocytizing proteus E. female preponderance 52. Which herniation produces the infamous dilated-and-fixed ipsilateral pupil? A. cingulate B. inguinal C. tonsillar D. transcalvarial * E. uncal 53. A coloboma is a malformed A. cornea * B. iris C. optic nerve D. orbit E. pinna 54. ONE KODACHROME. A man who does not work out but who develops impressive musculature is likely to have A. inclusion body disease * B. myotonia congenita C. myotonic dystrophy D. nemaline myopathy E. Stein-Leventhal 55. ONE KODACHROME. Brain. Your best diagnosis. A. acute subdural hematoma B. atrophy consistent with Alzheimer's * C. bacterial meningitis D. chronic subdural hematoma E. edema, possibly with hydrocephalus 56. ONE KODACHROME. Brain. The most likely histology is A. astrocytoma B. medulloblastoma C. multiple sclerosis * D. schwannoma E. tuberculosis 57. ONE KODACHROME. Your best diagnosis, please. A. Charcot's joint * B. Dupuytren's contracture C. osteoarthritis D. rheumatoid arthritis E. sarcoma 58. ONE KODACHROME. A sign of possible A. Gardener's / Turcot's B. gonorrhea C. neurofibromatosis / von Recklinghausen's * D. Sturge-Weber E. tuberous sclerosis 59. TWO KODACHROMES. Sun-exposure and its result. What's the diagnosis? A. atypical fibroxanthoma * B. basal cell carcinoma with squamous pearl (basosquamous) C. lentigo maligna melanoma D. nodular melanoma E. solar elastosis without other disease 60. ONE KODACHROME. Brain. Your best diagnosis, please! * A. epidural hematoma B. glioblastoma C. meningioma D. subarachnoid bleed E. subdural hematoma 61. ONE KODACHROME. Soft tissue tumor, most likely a(n) A. chondrosarcoma B. extraskeletal osteosarcoma * C. leiomyosarcoma D. lipoma E. liposarcoma 62. ONE KODACHROME. Vertebral column, illustrating * A. ankylosis B. fracture C. multiple hemangiomas D. osteoarthritis E. Pott's tuberculosis 63. ONE KODACHROME. Brain. Your best diagnosis, please. A. hemorrhagic infarct B. hypertensive bleed * C. glioblastoma D. medulloblastoma E. meningioma 64. ONE KODACHROME. Most likely associated birth defect? A. agenesis of the corpus callosum B. Arnold-Chiari * C. holoprosencephaly D. hypoplasia of the cerebellar vermis E. schizencephaly 65. ONE KODACHROME. Muscle biopsy. You suspect... A. Duchenne's muscular dystrophy B. mitochondrial myopathy * C. myotonic dystrophy D. nemaline myopathy E. overtraining 66. ONE KODACHROME. Skin. What do you think is wrong? * A. atopic dermatitis B. erythema multiforme C. lichen planus D. pityriasis rosea E. psoriasis 67. ONE KODACHROME. Luxol fast blue stain of spinal cord. Your most likely diagnosis... A. ependymoma B. multiple sclerosis or some other demyelinating disease C. poliomyelitis * D. tabes dorsalis or B12 deficiency E. Werdnig-Hoffman or Kugelberg's 68. TWO KODACHROMES. Ovarian tumor. Which type? A. choriocarcinoma B. brenner tumor C. mucinous cystadenoma * D. serious cystadenocarcinoma E. thecoma 69. ONE KODACHROME. Muscle. What's the most likely diagnosis? * A. Duchenne's B. inclusion body myositis C. lipoma D. polymyositis E. Werdnig-Hoffman 70. TWO KODACHROMES. Brain. What's the diagnosis? A. Alzheimer's B. Huntington's C. multi-infarct dementia D. Parkinson's * E. Pick's 71. ONE KODACHROME. Brain. What's the diagnosis? A. epidural bleed * B. infarct C. meningioma D. old contusion E. subarachnoid bleed 72. THREE KODACHROMES. What bone disease? A. osteogenesis imperfecta B. osteoid osteoma C. osteomalacia D. osteoporosis * E. Paget's osteitis deformans 73. ONE KODACHROME. What brain tumor? A. acoustic neuroma * B. glioma C. medulloblastoma D. meningioma E. this is an infarct, not a tumor 74. ONE KODACHROME. What breast lesion? * A. gynecomastia B. lobular carcinoma in situ C. medullary carcinoma D. mucinous carcinoma E. scirrhous carcinoma 75. TWO KODACHROMES. What's in the neurons? A. central chromatolysis B. granulovacuolar degeneration * C. Lewy bodies D. neurofibrillary tangles E. red neurons, dead 76. TWO KODACHROMES. Which is clearly NOT a risk factor for endometrial adenocarcinoma? A. diabetes B. hypertension * C. HPV infection D. nulliparity E. ovarian thecoma 77. ONE KODACHROME. What is the diagnosis? * A. congenital nevus B. contusion C. dermatofibroma D. malignant melanoma E. Stevens-Johnson syndrome 78. ONE KODACHROME. The hand changes are most suggestive of A. dermatomyositis B. Dupuytren's contracture C. osteoarthritis D. polyarteritis * E. rheumatoid arthritis 79. TWO KODACHROMES. What is the diagnosis? A. arachnoid cyst B. craniopharyngioma * C. infarct D. subarachnoid bleed E. subdural bleed 80. ONE KODACHROME. What is the diagnosis? A. glioma of some sort B. ischemic injury, acute * C. ischemic injury, old D. leukodystrophy E. tuberous sclerosis 81. ONE KODACHROME. What brain disease? A. Alzheimer's * B. Huntington's C. multi-infarct dementia D. Parkinson's E. Pick's 82. ONE KODACHROME. Ovarian tumor. What's the diagnosis? A. dysgerminoma B. serous cystadenocarcinoma * C. teratoma D. thecoma E. this is not a tumor, it is endometriosis 83. ONE KODACHROME. Which brain tumor? A. colloid cyst of the third ventricle B. glioma of some kind or other C. medulloblastoma * D. meningioma E. metastatic lung cancer 84. ONE KODACHROME. Circle of Willis. This pathology is more common in patients who also have * A. adult polycystic kidney disease B. breast cancer C. dysplastic nevus syndrome D. fibrocystic disease of the breast E. hypercholesterolemia 85. TWO KODACHROMES. Muscle. What's your best diagnosis? A. Duchenne's muscular dystrophy B. inclusion body myositis * C. mitochondrial myopathy D. myotonic dystrophy E. polymyositis 86. ONE KODACHROME. In severe generalized muscular atrophy, the fibers will tend to become A. angulated B. basophilic C. inflamed * D. round E. targeted 87. ONE KODACHROME. What probably caused this bleed? A. AV malformation B. berry aneurysm * C. hypertension D. syphilis E. trauma 88. TWO KODACHROMES. Bone. What is the diagnosis? A. chondrosarcoma B. healing fracture * C. osteosarcoma D. osteoporosis E. Paget's osteitis deformans 89. ONE KODACHROME. Skin lesion. What's the diagnosis? A. basal cell carcinoma B. lichen planus * C. melanoma D. psoriasis E. vasculitis 90. ONE KODACHROME. Most color blindness is inherited how? A. autosomal dominant B. autosomal recessive C. mitochondrial myopathy D. X-linked dominant * E. X-linked recessive *There will be ten items on the second part of this test. BONUS ITEMS 101. ONE KODACHROME. Depolymerization of what substance will produce, in this case, failure of the synovial fluid to clot? [hyaluronic acid] 102. TWO KODACHROMES. Bone. Your best diagnosis, please? [prostate cancer. I am so tricky. Adenocarcinoma is good enough.] 103. ONE KODACHROME. Brain. Your best diagnosis? [central pontine myelinolysis] 104. ONE KODACHROME. Bone. Your best diagnosis? [osteoporosis] 105. TWO KODACHROMES. Motorcycle mishap. Your best diagnosis? Be specific. [acute subdural; "subdural" is sufficient] 106. ONE KODACHROME. What do we call this Alzheimer-related change? [granulovacuolar degeneration] 107. TWO KODACHROMES. Bone. Your best diagnosis, please? [multiple sclerosis] 108. TWO KODACHROMES. Testicular tumor. Which one? Hint: The cut surface was a homogeneous, creamy yellow. [seminoma] 109. Stigma Fly, one of the oldest men's fraternities, is plagued by myiasis. Five percent of the brothers are infected, with flies erupting from their breeding places at embarrassing moments. Although the definitive diagnostic procedure is autopsy, presumptive diagnosis is based on the Buzz Test, The Buzz Test is 80% sensitive and 80% specific. What is the predictive value of a positive buzz test? Show your work. No partial credit; no credit if no work is shown. [of 1,000,000 brothers, 50,000 are sick 40,000 true positives 10,000 false negatives 950,000 are healthy 190,000 false positives 760,000 true negatives Predictive value = TP/(TP+FP)=17%] 110. What hormone does a hemangioblastoma of the cerebellum produce? [erythropoietin] 111. What's the maximum number of strata of nuclei which you can see in benign bladder epithelium? [8, accept 6 or 7] 112. What is a desmoid? [locally invasive tumor of fibroblasts] 113. What is the generic term for acute inflammation of the epidermis? [eczema] 114. What is the major protein constituent of a hirano body? [actin] 115. "Retraction balls / spheroids" in the CNS indicate what? Be specific. [physical / diffuse axonal injury] 116. What is Felty's syndrome? [hypersplenism in rheumatoid arthritis, accept neutropenia + spleen] 117. What's the name we give to a big chunk of benign cartilage in the shaft of a bone, where it doesn't belong? [enchondroma] 118. What is hypotelorism? [eyes set close together] 119. What's the popular name for histidyl-tRNA synthetase, as an autoantigen? [Jo] 120. ONE KODACHROME. Why is this man smiling? [the tragedy of deinstitutionalization. +1 for any reasonable answer] University of Health Sciences Year II Pathology Exam 5, 1997-8 PART I Instructions: As usual. Don't phonate. When you are done, hand your test book and answer sheet to the proctor and get the second part. Good Luck. University of Health Sciences Year II Pathology Exam 5, 1997-8 PART II Instructions: Open book. Use a different sheet of paper. You are welcome to use your copy of "The Right Test", or anybody else's. When you are done, hand your machine-gradable answer sheet to the proctor. You may keep this portion of the exam. Good Luck. 1. What is a reasonable decision level for a fasting transferrin saturation level, above which you'd pursue the diagnosis of hemochromatosis? A. >1% B. >3% C. >10% D. >60% E. >90% 2. Which vitamin, taken in generous amounts by mouth, can produce a false-negative test for blood on the urinalysis reagent strip? A. vitamin A (retinoic acid) B. vitamin B1 (thiamine) C. vitamin B3 (niacin) D. vitamin C (ascorbic acid) E. vitamin E (tocopherol) 3. Which is LEAST LIKELY to give you hypercalcemia? A. disseminated skeletal metastases of breast cancer B. oat cell carcinoma without clinically evident metastases C. overzealous ingestion of vitamin D D. sarcoidosis involving lungs and several groups of nodes E. thiazide diuretics taken for high blood pressure 4. Which cardiac enzyme goes up first and is most useful in the early diagnosis of myocardial infarction? A. alkaline phosphatase B. creatine kinase C. gamma-glutamyl transpeptidase D. lactate dehydrogenase E. SGOT / AST 5. Which is NOT a possible cause of red and/or brown urine? A. beets in the diet B. massive intravascular hemolysis C. phenytoin ("Dilantin") D. rhabdomyolysis from being struck by lightning E. serratia infection 6. The overnight dexamethasone suppression test is a good screen for A. acromegaly B. addisonism C. cushingism D. diabetes E. herpes zoster 7. "Anemia of chronic disease" typically shows A. high iron, high iron binding capacity, ferritin >100 ng/dL B. high iron, low iron binding capacity, ferritin >100 ng/dL C. low iron, high iron binding capacity, ferritin <100 ng/dL D. low iron, low iron binding capacity, ferritin >100 ng/dL E. low iron, low iron binding capacity, ferritin <100 ng/dL 8. Low plasma haptoglobin is a marker for A. good diabetic control B. hemolysis C. progression of HIV D. post-hepatic jaundice E. von Willebrand's 9. Vitamin K deficiency is likely to produce A. normal PT, long PTT B. normal PT, normal PTT, long bleeding time C. normal PT, normal PTT, normal bleeding time D. long PT, long PTT E. long PT, normal PTT 10. If you ingest d-xylose and it fails to appear in your urine, you probably have A. bacterial overgrowth of a blind loop B. disease of the small intestine C. malabsorption, either pancreatic or intestinal D. low GFR E. nephrotic syndrome