UNIVERSITY OF HEALTH SCIENCES PATHOLOGY EXAM VI 1995-1996 INSTRUCTIONS As usual. Any questions? Ask quietly. For the matching items, use each choice once. * * * "My victim will feel nothing but a slight sense of refreshing coolness on the neck." -- Joseph Guillotin, Paris physician 1789 36. Urine sodium above 40 mEq, in an untreated patient with acute renal failure, says: * A. acute tubular necrosis B. diffuse renal cortical necrosis C. hypoperfusion from shock D. hypoperfusion from congestive heart failure E. papillary necrosis 37. Who might you reasonably screen for hypothyroidism? A. an old man who's just not himself the last few months B. a new mom with a one-month-old baby C. a pathologist with a serum cholesterol above 300 mg/dL D. a teen whom you've just discovered has autoimmune Addison's * E. all of these folks 38. The overnight dexamethasone suppression test is a pretty good way to diagnose A. coarctation of the aorta B. congenital adrenal hyperplasia C. Conn's hyperaldosteronism * D. cushingism E. pheochromocytoma 39. Which is NOT one of the four key clinical criteria for strep throat testing in an adult? A. big tender lymph nodes in the front of the neck * B. cough C. exudate on the tonsils D. temperature over 100øF E. all of these are criteria 40. Two populations of red cells on the peripheral smear, one small and pale, and the other more-or-less normal, makes you think of: A. "anemia of chronic disease" B. disseminated intravascular coagulation C. pregnancy * D. sideroblastic anemia E. thalassemia minor 41. Low serum iron, low total iron binding capacity, and serum iron above 100 ng/mL is suggestive of * A. anemia of chronic disease, as in rheumatoid arthritis B. hemochromatosis C. iron deficiency D. Lyme disease E. sideroblastic anemia 42. The BUN/creatinine ratio is 25. Which is LEAST LIKELY? * A. acute tubular necrosis B. bad bleeding duodenal ulcer C. congestive heart failure D. living on tuna-fish-in-water E. shock with hypoperfusion of good kidneys 43. Synovial fluid is MOST LIKELY to give a poor string and a poor mucin clot if the arthritis is due to: * A. gonorrhea B. Kashin-Beck mongolian epidemic osteoarthritis C. sickle-cell disease with a bone infarct D. tertiary syphilis with a Charcot joint E. traumatic arthritis 44. "The Right Test" prefers which assay to screen for pheochromocytoma? A. dexamethasone suppression test B. imaging studies C. metyrapone test D. phentolamine test * E. urine metanephrines 45. Cholesteatoma of the middle ear most closely resembles A. atherosclerotic debris B. basal cell carcinoma * C. epidermoid cyst D. granulation tissue E. xanthoma 46. What is Ameslan? A. a calcium-channel blocker which elevates PT and PTT B. a possible third-party in the 1996 elections C. a radical environmental group linked to the Unabomber * D. a sign language used by the deaf E. a tumor marker for cancer of ovary (serum Ameslan) 47. What's a coloboma? * A. birth-defect of iris / ciliary body B. cornea shaped like a cone, rather than flat C. protein spots on the retina D. protein-lipofuscin in basement membrane of choroid E. turned-in eyelids 48. "Silver wires" on fundoscopy indicate * A. arteriolar sclerosis B. diabetic snowflake cataract C. glaucoma D. optic neuritis E. retinitis pigmentosa 49. Your best diagnosis: A. astrocytoma B. glioblastoma C. meningioma D. metastatic carcinoma * E. multiple sclerosis 50. Your best diagnosis: * A. astrocytoma B. glioblastoma C. meningioma D. metastatic carcinoma E. multiple sclerosis BONUS ITEMS: 51. A patient recalls several tick bite two weeks previously while at a naturist picnic in the woods. It was followed by a local rash that might or might not have been the typical erythema migrans chronicum. You didn't see it. Now he's had the 'flu, a stiff neck, and a headache for several days. Lumbar puncture two days ago showed "consistent with viral meningitis." Your partner did a Lyme serology two days ago, and it has just come back negative. What do you do? A. culture blood for Lyme agent B. culture spinal fluid for Lyme agent C. repeat serology for Lyme disease, treat if titer appears D. tell the patient Lyme disease is ruled out * E. treat for Lyme disease now 52. Eosinophils in a pleural effusion indicate A. autoimmunity B. chylothorax C. likelihood of cancer D. probable allergic or helminthic disease * E. none of these 53. If you want to be sure that the glucose levels in the serum don't decrease between specimen collection and testing, which is the best tube to use? A. blue-top calcium * B. gray-top fluoride C. green-top heparin D. purple-top EDTA calcium chelator E. red-top nothing 54. "Clue cells" and pH>4.5 are markers for vaginal A. candidiasis B. chlamydia * C. gardnerella D. gonorrhea E. trichomoniasis 55. "I grow old ever learning many things." The "Japanese restaurant syndrome" ("The Right Test", page 70), is an immediate, idiosyncratic response to A. ciguatera fish * B. horseradish C. monosodium glutamate D. nitrite E. sulfite 56. When we say "sclerosis" in the brain, what do we mean? Be VERY specific! [ loss of myelin/oligodendroglia, ] [ I also need either preservation of axons,] [ or proliferation of astrocytes] 57. Suppose an ELISA is 99.9% sensitive and 99% specific for AIDS. You are screening blood donors. About one in 5000 really has the AIDS virus. What is the predictive value of a positive ELISA? [ 10,000,000 people, let's say] [ 2000 have the AIDS virus] [ 1998 will be true-positives] [ 2 will be false-negative] [ 9,998,000 do not have the AIDS virus] [ 9 898 020 true-negatives] [ 99,980 false-positives] [] [ Predictive value of a positive is] [ TP / (TP+FP) = 1998/(1998+99980)] [ or about 2000/100000 or 2%] 58. Same as #57. This time, though, you're screening people who appear to have AIDS clinically, and who are members of high-risk groups. Ninety-nine percent have AIDS. What is the predictive value of a positive ELISA now? [ 10,000,000 people, let's say] [ 9,900,000 have the AIDS virus] [ 9,890,100 will be true-positives] [ 9,900 will be false-negative] [ 100,000 do not have the AIDS virus] [ 99,000 true-negatives] [ 1,000 false-positives] [] [ Predictive value of a positive is] [ TP / (TP+FP) = 9,890,100/(1000+9,890,100)] [ or >99%] 59. Write one verse for possibly inclusion in the forthcoming song "The Pathology Blues". Two rhyming lines minimum. [+1 but it has to rhyme] 60. ONE KODACHROME. Why is this man smiling? [+1 for any reasonable answer]