PATHOLOGY BOARD EXAM QUESTIONS: (C) Hyperplasia

SCORE:
___9. A 24yo woman accidentally ingests carbon tetrachloride (CCl4) in the
NAME: laboratory and develops acute liver failure. Which of the following cellular
proteins was directly involved in the development of hepatotoxicity in this
Instructions: patient?
Kindly print your name. Put the correct letter on the space provided. (A) Acetaldehyde dehydrogenase (D) Mixed function oxygenase
Answers will be provided with explanation to those who will pass their (B) Alcohol dehydrogenase (E) Superoxide dismutase
papers ON TIME. You are given 1 hour and 30 minutes to answer the (C) Glucose-6-phosphate dehydrogenase
questions. God bless!
___10. A 22yo woman nursing her newborn develops a tender erythematous
___1. A 32yo woman with poorly controlled diabetes mellitus area around the nipple of her left breast. A thick, yellow fl uid is observed to
delivers a healthy boy at 38 weeks AOG. As a result of maternal drain from an open fissure. Examination of this breast fluid under the light
hyperglycemia during pregnancy, pancreatic islets in the neonate would be microscope will most likely reveal an abundance of which of the following
expected to show which of the following morphologic responses to injury? inflammatory cells?
(A) Atrophy (D) Metaplasia (A) B lymphocytes (D) Neutrophils
(B) Dysplasia (E) Necrosis (B) Eosinophils (E) Plasma cells
(C) Hyperplasia (C) Mast cells

___2. A 52yo woman loses her right kidney following an automobile ___11. A 5yo boy punctures his thumb with a rusty nail. Four hours later, the
accident. A CT scan of the abdomen 2 years later shows marked enlargement thumb appears red and swollen. Initial swelling of the boy’s thumb is
of the left kidney. The renal enlargement is an example of which of the primarily due to which of the following mechanisms?
following adaptations? (A) Decreased intravascular hydrostatic pressure
(A) Atrophy (D) Hypertrophy (B) Decreased intravascular oncotic pressure
(B) Dysplasia (E) Metaplasia (C) Increased capillary permeability
(C) Hyperplasia (D) Increased intravascular oncotic pressure
(E) Vasoconstriction of arterioles
___3. 20yo man from China is evaluated for persistent cough, night sweats,
low-grade fever, and general malaise. A chest X-ray reveals findings ___12. A 36yo woman with pneumococcal pneumonia develops a right
“consistent with a Ghon complex.” Sputum cultures grow acid-fast bacilli. pleural effusion. The pleural fl uid displays a high specific gravity and
Examination of hilar lymph nodes in this patient would most likely contains large numbers of polymorphonuclear (PMN) leukocytes. Which of
demonstrate which of the following pathologic changes? the following best characterizes this pleural effusion?
(A) Caseous necrosis (D) Fibrinoid necrosis (A) Fibrinous exudate (D) Serosanguineous exudate
(B) Coagulative necrosis (E) Liquefactive necrosis (B) Lymphedema (E) Transudate
(C) Fat necrosis (C) Purulent exudate

___4. An 82yo man has profound bleeding from a peptic ulcer and dies of ___13. A 33yo man presents with a 5-week history of calf pain and swelling
hypovolemic shock. The liver at autopsy displays centrilobular necrosis. and low-grade fever. Serum levels of creatine kinase are elevated. A muscle
Compared to viable hepatocytes, the necrotic cells contain higher biopsy reveals numerous eosinophils. What is the most likely etiology of this
intracellular concentrations of which of the following? patient’s myalgia?
(A) Calcium (D) Iron (A) Autoimmune disease (D) Parasitic infection
(B) Cobalt (E) Selenium (B) Bacterial infection (E) Viral infection
(C) Copper (C) Muscular dystrophy

___5. A 22yo construction worker sticks himself with a sharp, rusty nail. ___14. A 14yo boy receives a laceration on his forehead during an ice hockey
Within 24 hours, the wound has enlarged to become a 1-cm sore that drains game. When he is first attended to by the medic, there is blanching of the
thick, purulent material. This skin wound illustrates which of the following skin around the wound. Which of the following mechanisms accounts for this
morphologic transient reaction to neurogenic and chemical stimuli at the site of injury?
types of necrosis? (A) Constriction of postcapillary venules
(A) Caseous necrosis (D) Fibrinoid necrosis (B) Constriction of precapillary arterioles
(B) Coagulative necrosis (E) Liquefactive necrosis (C) Dilation of postcapillary venules
(C) Fat necrosis (E) Ischemic necrosis

___6. A 5yo boy suffers blunt trauma to the leg in an automobile accident. ___15. A 25yo machinist is injured by a metal sliver in his left hand. Over the
Six months later, bone trabeculae have formed within the striated skeletal next few days, the wounded area becomes reddened, tender, swollen, and
muscle at the site of tissue injury. This pathologic condition is an example of feels warm to the touch. Redness at the site of injury in this patient is caused
which of the following morphologic adaptations to injury? primarily by which of the following mechanisms?
(A) Atrophy (D) Metastatic calcification (A) Hemorrhage (D) Vasoconstriction
(B) Dysplasia (E) Dystrophic calcification (B) Hemostasis (E) Vasodilation
(C) Metaplasia (C) Neutrophil margination

___7. A 32yo woman develops an Addisonian crisis (acute adrenal ___16. A 68yo man with prostate cancer and bone metastases presents with
insufficiency) 3 months after suffering massive hemorrhage during the shaking chills and fever. The peripheral WBC count is 1,000/μL (normal =
delivery of her baby. A CT scan of the abdomen shows small adrenal glands. 4,000 to 11,000/μL). Which of the following terms best describes this
Which of the following mechanisms of disease best accounts for adrenal hematologic fi nding?
atrophy in this patient? (A) Leukocytosis (D) Pancytopenia
(A) Chronic inflammation (D) Lack of trophic signals (B) Leukopenia (E) Leukemoid reaction
(B) Chronic ischemia (E) Tuberculosis (C) Neutrophilia
(C) Hemorrhagic necrosis
___17. A 50yo woman is discovered to have metastatic breast cancer. One
___8. A 60yo farmer presents with multiple patches of discoloration on his week after receiving her fi rst dose of chemotherapy, she develops bacterial
face. Biopsy of lesional skin reveals actinic keratosis. Which of the following pneumonia. Which of the following best explains this patient’s susceptibility
terms best describes this response of the skin to chronic sunlight exposure? to bacterial infection?
(A) Atrophy (D) Hypertrophy (A) Depletion of serum complement
(B) Dysplasia (E) Metaplasia (B) Impaired neutrophil respiratory burst
(C) Inhibition of clotting factor activation Which of the following is the most important factor that determines whether
(D) Lymphocytosis this wound will heal by primary or secondary intention?
(E) Neutropenia (A) Apposition of edges (D) Skin site affected
(B) Depth of wound (E) Vascular supply
___18. A 10yo girl presents with a 2-week history of puffiness around her (C) Metabolic status
eyes and swelling of the legs and ankles. Laboratory studies show
hypoalbuminemia and proteinuria. The urinary sediment contains no infl ___27. A 30yo firefighter suffers extensive third-degree burns over his arms
ammatory cells or red blood cells. Which of the following terms describes and hands. This patient is at high risk for developing which of the following
this patient’s peripheral edema? complications of wound healing?
(A) Effusion (D) Lymphedema (A) Contracture (D) Keloid
(B) Exudate (E) Transudate (B) Dehiscence (E) Traumatic neuroma
(C) Hydropic change (C) Incisional hernia

___19. A 68yo coal miner with a history of smoking and emphysema ___28. A 9yo boy receives a deep laceration over his right eyebrow playing
develops severe air-fl ow obstruction and expires. Autopsy reveals a “black ice hockey. The wound is cleaned and sutured. Which of the following
lung,” with coal-dust nodules scattered throughout the parenchyma and a describes the principal function of macrophages that are present in the
central area of dense fibrosis. The coal dust entrapped within this miner’s wound 24 to 48 hours after injury?
lung was sequestered primarily by which of the following cells? (A) Antibody production (D) Phagocytosis
(A) Endothelial cells (D) Macrophages (B) Deposition of collagen (E) Wound contraction
(B) Fibroblasts (E) Plasma cells (C) Histamine release
(C) Lymphocytes
___29. A 35yo man asks for advice regarding seasonal eye itching and runny
___20. A 40yo man presents with 5 days of productive cough and fever. nose. Recurrent conjunctivitis in this patient is most likely caused by which of
Pseudomonas aeruginosa is isolated from a pulmonary abscess. The CBC the following mechanisms of disease?
shows an acute effect characterized by marked leukocytosis (50,000 (A) Autoimmunity (D) Hypersensitivity
WBC/μL), and the differential count reveals numerous immature cells (band (B) Bacterial infection (E) Viral infection
forms). Which of the following terms best describes these hematologic (C) Chemical toxicity
fi ndings?
(A) Leukemoid reaction (D) Myeloproliferative disease ___30. A 45yo woman presents with a 1-year history of dry mouth and eyes.
(B) Leukopenia (E) Neutrophilia A biopsy of a minor salivary gland reveals infiltrates of lymphocytes forming
(C) Myeloid metaplasia focal germinal centers. Which of the following cellular organelles is a target
for autoantibodies in this patient?
___21. A 19yo woman presents with 5 days of fever (38°C/101°F) and sore (A) Centromere (D) Peroxisome
throat. She reports that she has felt fatigued for the past week and has diffi (B) Lysosome (E) Plasma membrane
culty swallowing. A physical examination reveals generalized (C) Nucleus
lymphadenopathy. If this patient has a viral infection, a CBC will most likely
show which of the following hematologic findings? ___31. An 8-month-old boy with a history of recurrent pneumonia is
(A) Eosinophilia (D) Neutrophilia found to have almost no circulating IgG. Cellular immunity is normal. His
(B) Leukopenia (E) Thrombocythemia brother had this same disease and died of echovirus encephalitis. His parents
(C) Lymphocytosis and sisters have normal serum levels of IgG. What is the appropriate
diagnosis?
___22. A 25yo woman sustains a deep, open laceration over her right (A) DiGeorge syndrome
forearm in a motorcycle accident. The wound is cleaned and sutured. Which (B) Isolated IgA defi ciency
of the following cell types mediates contraction of the wound to facilitate (C) Severe combined immunodefi ciency
healing? (D) Wiskott-Aldrich syndrome
(A) Endothelial cells (D) Myofibroblasts (E) X-linked agammaglobulinemia of Bruton
(B) Fibroblasts (E) Smooth muscle cells
(C) Macrophages ___32. A 20yo woman with a history of asthma and allergies undergoes skin
testing to identify potential allergens in her environment. A positive skin
___23. A 4yo boy falls on a rusty nail and punctures his skin. The wound is reaction to ragweed in this patient would be mediated by which of the
cleaned and covered with sterile gauze. Which of the following is the initial following classes of immunoglobulin?
event in the healing process? (A) IgA (D) IgG
(A) Accumulation of acute infl ammatory cells (B) IgD (E) IgM
(B) Deposition of proteoglycans and collagen (C) IgE
(C) Differentiation and migration of myofibroblasts
(D) Formation of a fibrin clot ___33. A 20yo gardener presents to his family physician for treatment of
(E) Macrophage-mediated phagocytosis of cellular debris what he describes as “poison ivy.” The patient’s hands and arms appear red
and are covered with oozing blisters and crusts. Which of the following best
___24. A 10yo boy trips at school and scrapes the palms of his hands. The describes the pathogenesis of these skin lesions?
wounds are cleaned and covered with sterile gauze. Which of the following (A) Cytotoxic antibody production
terms best characterizes the healing of these superfi cial abrasions? (B) Delayed-type hypersensitivity
(A) Fibrosis (D) Regeneration (C) Deposition of antigluten antibodies
(B) Granulation tissue (E) Secondary intention (D) Deposition of circulating immune complexes
(C) Primary intention (E) IgE-mediated mast cell degranulation

___25. A 34yo woman has a benign nevus removed from her back under ___34. A 28yo woman with a history of drug abuse presents
local anesthesia. Which of the following families of cell adhesion molecules is with an infectious mononucleosis-like syndrome and lymphadenopathy.
the principal component of the “provisional matrix” that forms during early Blood tests subsequently indicate that she is HIV-positive. Which of the
wound healing? following lymphocyte-associated proteins mediates the entry of HIV into
(A) Cadherins (D) Laminins host cells in this patient?
(B) Fibronectins (E) Selectins (A) CD4 (D) GP120
(C) Integrins (B) CD8 (E) LFA-1
(C) GP41

___26. A 29yo carpenter receives a traumatic laceration to her left arm. ___35. A 12yo boy presents with a 5-day history of sore throat. His
temperature is 38.7°C (103°F). Physical examination reveals inflamed tonsils (C) Hematocephalus
and swollen cervical lymph nodes. Trafficking and recirculation of blood- (D) Hematochezia
borne lymphocytes through the cervical lymph nodes in this patient occurs (E) Hemoptysis
primarily at which of the following locations?
(A) Afferent lymphatic vessel (D) High endothelial venules ___44. A 50yo fire fighter emerges from a burning house with 3rd-degree
(B) Efferent lymphatic vessel (E) Peyer patches burns over 70% of his body. The patient expires 24 hours later. Which of the
(C) Hassall corpuscles following was the most likely cause of death?
(A) Congestive heart failure
___36. A 62yo woman presents with a breast lump that she discovered 6 (B) Disseminated intravascular coagulation
days ago. A breast biopsy shows lobular carcinoma in situ. Compared to (C) Hypovolemic shock
normal epithelial cells of the breast lobule, these malignant cells would most (D) Pulmonary saddle embolism
likely show decreased expression of which of the following proteins? (E) Toxic shock syndrome
(A) Desmin (D) P selectin
(B) E-cadherin (E) Telomerase ___45. A 20yo man is brought to the ER after rupturing his spleen in a
(C) Lysyl hydroxylase motorcycle accident. His blood pressure on admission is 80/60 mm Hg.
Analysis of arterial blood gasses demonstrates metabolic acidosis. This
___37. A 60yo man who worked for 30 years in a chemical factory complains patient is most likely suffering from which of the following conditions?
of blood in his urine. Urine cytology discloses dysplastic cells. A bladder (A) Acute pancreatitis (D) Hypovolemic shock
biopsy demonstrates transitional cell carcinoma. Which of the following (B) Cardiogenic shock (E) Septic shock
carcinogens was most likely involved in the pathogenesis of bladder cancer (C) Hypersplenism
in this patient?
(A) Aniline dyes (D) Cisplatinum ___46. An autopsy of a 70yo woman reveals a subendocardial,
(B) Arsenic (E) Vinyl chloride circumferential infarct of the left ventricle. This type of infarct is most
(C) Benzene commonly associated with which of the following?
(A) Deep venous thrombosis
___38. A 35yo woman complains of nipple discharge and irregular menses of (B) Hypotensive shock
5 months duration. Physical examination reveals a milky discharge from both (C) Pericardial tamponade
nipples. MRI shows an enlargement of the anterior pituitary. Which of the (D) Thrombotic occlusion of the right coronary artery
following is the most likely histologic diagnosis of this patient’s pituitary (E) Thrombotic occlusion of the circumflex artery
tumor?
(A) Adenoma (D) Papilloma __47. A neonate was noted to have mild growth retardation and facial
(B) Choristoma (E) Teratoma dysmorphology. The mother was a known abuser of several substances. This
(C) Hamartoma infant’s problem most likely resulted from maternal intake of which of the
following?
___39. A 65yo man dies after a protracted battle with metastatic colon (A) Alcohol (D) Heroin
carcinoma. At autopsy, the liver is filled with multiple nodules of cancer, (B) Cocaine (E) Marijuana
many of which display central necrosis (umbilication). Which of the following (C) Ethylene glycol
best explains the pathogenesis of tumor umbilication in this patient?
(A) Biphasic tumor (D) Ischemia and infarction ___48. A 10yo boy presents with irritability and ataxia. He is subsequently
(B) Chronic infl ammation (E) Stimulation of angiogenesis found to have anemia, basophilic stippling of erythrocytes, and dark-gray
(C) Granulomatous infl ammation pigmentation of the gums. Exposure to which of the following chemical
agents is most likely associated with this disease?
___40. A 59yo woman complains of “feeling light-headed” and losing 5 kg (A) Arsenic (D) Mercury
(11 lb) in the last month. A CBC reveals a normocytic, normochromic anemia. (B) Copper (E) Nickel
The patient subsequently dies of metastatic cancer. Based on current (C) Lead
epidemiologic data for cancer-associated mortality in women, which of the
following is the most likely primary site for this patient’s malignant ___49. A healthy adult runs a marathon in the summer and develops hot dry
neoplasm? skin, cessation of sweating, lactic acidosis, hypocalcemia, and muscle
(A) Brain (D) Lung necrosis (rhabdomyolysis). Which of the following is the appropriate
(B) Breast (E) Urinary bladder diagnosis?
(C) Colon (A) Dysautonomia (D) Myotonic dystrophy
(B) Heat stroke (E) Polymyositis
___41. A 63yo woman with chronic bronchitis presents with shortness of (C) Malignant hyperthermia
breath. A chest X-ray reveals a 2-cm “coin lesion” in the upper lobe of the
left lung. A CT-guided lung biopsy is obtained. Which of the following __50. A sailor on a nuclear-powered submarine is seen by a physician after a
describes the histologic features of this lesion if the diagnosis is breach in the reactor containment system. PE is unremarkable, but the
hamartoma? patient subsequently develops profound pancytopenia. Hemoglobin is 7.8
(A) Benign neoplasm of epithelial origin g/dL, WBC count is 900/μL, and platelets are 20,000/μL. How many rads of
(B) Disorganized normal tissue acute total-body radiation did this patient most likely receive?
(C) Ectopic islands of normal tissue (A) 1 (D) 300
(D) Granulation tissue (B) 3 (E) 3,000
(E) Granulomatous inflammation (C) 30

___42. A 50yo alcoholic is rushed to the hospital with bleeding esophageal ___51. A 40yo, malnourished woman presents with a 6-month history of
varices and expires. At autopsy, the patient’s protruding abdomen is found night blindness. Physical examination reveals keratomalacia and corneal
to contain a large volume of serous fluid. What is the appropriate term used ulceration. Which of the following vitamin defi ciencies would be suspected
to describe this fluid? in this patient?
(A) Ascites (D) Hydrothorax (A) Vitamin A (D) Vitamin E
(B) Exudate (E) Lymphedema (B) Vitamin B2 (riboflavin) (E) Folic acid
(C) Hemorrhage (C) Vitamin C

___43. A 23yo man with hemophilia is recently wheelchair bound. Which of ___52. A 28yo radar technician aboard an aircraft carrier has been subjected
the following best accounts for this development? to intense microwave radiation for 7 years. He has an elevated risk for
(A) Hemarthrosis developing which of the following?
(B) Hematemesis (A) Aplastic anemia (D) Myelogenous leukemia
(B) Hodgkin disease (E) None of the above (C) Neisseria gonorrhoeae
(C) Lymphocytic leukemia (D) Neisseria meningitidis
(E) Staphylococcus aureus
___53. Petechial hemorrhages were noticed on the upper and lower
extremities of a 5-day-old infant. Hemorrhagic disease of the neonate was ___61. A 42yo man presents with a 1-week history of myalgia, low-grade
most likely caused by a defi ciency of which of the following vitamins? fever, and swelling of the left calf. The patient reports recently attending a fi
(A) Vitamin B2 (riboflavin) (D) Vitamin K reman’s pig-roast. Laboratory data show elevated serum levels of creatine
(B) Vitamin D (E) Pyridoxine kinase. Examination of a muscle biopsy in this patient would most likely
(C) Folic acid reveal an infi ltrate of which of the following cell types?
(A) Eosinophils (D) Segmented neutrophils
___54. A 24yo beating victim is brought to the ER with a 4-cm linear tear of (B) Mast cells (E) Smooth muscle cells
the skin caused by blunt trauma. Which of the following terms best describes (C) Plasma cells
this patient’s skin lesion?
(A) Abrasion (D) Contusion ___62. A 22yo student living in a college dormitory presents with a 4-week
(B) Avulsion (E) Laceration history of a nonproductive cough and previous low-grade fever. An X-ray fi
(C) Blast injury lm of the chest shows patchy consolidation of the right lower lobe, with
evidence of interstitial involvement. Which of the following is the most likely
___55. A 65yo man undergoes cardiac bypass surgery and is placed on etiology of this patient’s pulmonary infection?
postoperative, broad-spectrum, antibiotic prophylaxis. Several days later, he (A) Klebsiella pneumoniae
develops fever, abdominal pain, and bloody diarrhea. Colonoscopic biopsy (B) Mycobacterium tuberculosis
demonstrates a thick mucopurulent exudate. Which of the following is the (C) Mycoplasma pneumoniae
most likely etiology of this patient’s gastrointestinal disorder? (D) Staphylococcus aureus
(A) Clostridium botulinum (D) Clostridium tetani (E) Streptococcus pneumoniae
(B) Clostridium diffi cile (E) Escherichia coli 0157-H7
(C) Clostridium perfringens ___63. A 65yo coal miner is admitted for evaluation of chronic lung disease.
The patient admits to smoking one pack of cigarettes a day for 40 years. On
___56. A 24yo woman develops an expanding erythematous skin lesion after physical examination, he is noticed to have a barrel chest and use accessory
hiking through the woods in Connecticut. The rash disappears, but 1 year muscles for inspiration. His face is puffy and red. He has 2+ pitting edema of
later, the patient develops arthralgias and right facial nerve palsy. Which of the lower extremities. A chest X-ray is compatible with diffuse
the following is the most likely etiologic agent responsible for this patient’s fi brosis, with some nodularity in central areas. Which of the following is the
symptoms? most likely diagnosis?
(A) Chlamydia (D) Rickettsia (A) Anthracosilicosis (D) Psittacosis
(B) Mycobacterium (E) Spirochete (B) Asbestosis (E) Sarcoidosis
(C) Protozoa (C) Diffuse alveolar damage

___57. A 28yo man presents with sudden onset of fever, chills, and a ___64. A 56yo man with a history of cigarette smoking presents with diffi
productive cough with blood-tinged sputum. His past medical history is culty swallowing and a muffl ed voice. Laryngoscopy reveals a 2-cm laryngeal
signifi cant for a splenectomy following a motor vehicle accident 3 years ago. mass. If this mass is a malignant neoplasm, which of the following is the most
An X-ray of the chest demonstrates consolidation of the right middle lobe. likely histologic diagnosis?
Sputum culture shows Gram-positive diplococci. Which of the following (A) Adenocarcinoma
is the most likely cause of this patient’s respiratory infection? (B) Leiomyosarcoma
(A) Klebsiella pneumoniae (C) Small cell carcinoma
(B) Legionella pneumophila (D) Squamous cell carcinoma
(C) Mycoplasma pneumoniae (E) Transitional cell carcinoma
(D) Staphylococcus aureus
(E) Streptococcus pneumoniae ___65. A 20yo woman presents with a 2-year history of difficulty swallowing
and increasing fatigue. A CBC shows iron-deficiency anemia. Upper
___58. A 75yo woman died in February of respiratory failure after a febrile endoscopy reveals an annular narrowing in the upper third of the esophagus.
disease of 1 week in duration. An autopsy shows necrotizing bronchitis and A mucosal biopsy shows no evidence of inflammation or neoplasia. Which of
diffuse, hemorrhagic necrotizing pneumonia. Which of the following the following is the most likely diagnosis?
pathogens was most likely responsible for this patient’s fatal pulmonary (A) Achalasia (D) Esophageal web
infection? (B) Barrett esophagus (E) Schatzki ring
(A) Influenza virus (C) Diverticulum
(B) Norwalk-like viruses
(C) Respiratory syncytial virus __66. A 45yo woman presents with general discomfort and increasing
(D) Rhinovirus tightness in the skin of her face. She reports intermittent pain in the tips of
(E) Rotavirus her fi ngers when exposed to the cold. Physical examination shows “stone
facies” and edema of the fingers and hands. Serologic tests for antinuclear
___59. A 37-year-old man is admitted to the hospital with a productive and anti–Scl-70 antibodies are both positive. Which of the following
cough, fever, and night sweats. An X-ray fi lm of the chest shows an ill- gastrointestinal manifestations is expected in this patient?
defined area of consolidation at the periphery of the right middle lobe and (A) Adenocarcinoma of the esophagus
mediastinal lymphadenopathy. Sputum culture grows acid-fast bacilli. Lymph (B) Dysphagia
node biopsy in this patient would most likely show which of the following (C) Esophageal rupture
pathologic findings? (D) Esophageal varices
(A) Caseating granulomas (D) Noncaseating granulomas (E) Squamous cell carcinoma of the esophagus
(B) Follicular hyperplasia (E) Purulent abscess
(C) Nodular amyloidosis __67. A 45yo man presents with long-standing heartburn and dyspepsia. An
X-ray fi lm of the chest shows a retrocardiac, gas-filled structure. This patient
most likely has which of the following conditions?
___60. A 2-month-old infant presents with fever to 38.6°C (103°F) (A) Boerhaave syndrome
and neck rigidity. Cerebrospinal fluid shows numerous neutrophils, (B) Esophageal varices
decreased glucose, and increased protein. Grampositive cocci are present. (C) Esophageal webs
Which of the following is the most likely cause of meningitis in this neonate? (D) Hiatal hernia
(A) Group B streptococcus (E) Mallory-Weiss syndrome
(B) Haemophilus infl uenzae __68. A 50yo woman with long-standing rheumatoid arthritis complains of
weakness and fatigue. She states that her stools have recently become black glucose of 160 mg/dL. A CT scan of the abdomen demonstrates a 2-cm mass
after taking a new nonsteroidal anti-infl ammatory drug (NSAID). in the pancreas. Which of the following is the most likely
Gastroscopy shows numerous superficial, bleeding mucosal defects. Which diagnosis?
of the following is the most likely diagnosis? (A) Carcinoid tumor
(A) Acute erosive gastritis (B) Gastrinoma
(B) Early gastric cancer (C) Glucagonoma
(C) Helicobacter pylori gastritis (D) Insulinoma
(D) Ménétrier disease (E) Pancreatic polypeptide-secreting tumor
(E) Peptic ulcer disease
__76. A 45yo woman complains of right upper quadrant abdominal pain,
___69. A 5yo is brought to the physician after her parents noticed red blood weight loss, dry mouth, increased urine production, and foul-smelling fatty
in her stool. Physical examination reveals mucocutaneous pigmentation. stools. She has a recent history of mild diabetes mellitus. Abdominal
Small bowel radiography discloses multiple, small- to medium-sized polyps ultrasound examination reveals gallstones and a solitary 1.5-cm mass in the
that are diagnosed pathologically as hamartomas. Which of the following is pancreas. Which of the following hormones would most likely be elevated
the most likely diagnosis? in the blood of this patient?
(A) Congenital teratoma (A) Calcitonin
(B) Hyperplastic polyp (B) Gastrin
(C) Peutz-Jeghers polyp (C) Insulin
(D) Tubular adenoma (D) Somatostatin
(E) Villous adenoma (E) Vasoactive intestinal polypeptide

__70. A 60yo woman complains of increasing abdominal girth of 4 weeks in __77. A 49yo man with a history of heavy smoking presents with a 5-year
duration. Physical examination discloses ascites, and cytologic examination history of shortness of breath and cough and production of abundant foul-
of the fl uid reveals malignant cells. Exploratory laparotomy shows multiple smelling sputum. A pulmonary work-up demonstrates chronic
tumor nodules on the serosal surface of the intestines. Which of the bronchiectasis. Laboratory studies reveal hypoalbuminemia and
following is the most likely diagnosis? hyperlipidemia. Urinalysis shows heavy proteinuria (>4 g per day). Which of
(A) Carcinoid tumor the following is the appropriate diagnosis?
(B) Gastrointestinal stromal tumor (A) Amyloid nephropathy
(C) Liposarcoma (B) Berger disease (IgA nephropathy)
(D) MALToma (C) Focal segmental glomerulosclerosis
(E) Metastatic carcinoma (D) Minimal change glomerulopathy
(E) Wegener granulomatosis
_71. A 4yo girl is brought to the physician because her parents noticed that
she has been having pale, fatty, foul-smelling stools. The patient is at the __78. A 12yo boy complains of swelling of his feet for the past 3 weeks. He is
50th percentile for height and 10th percentile for weight. Her symptoms otherwise healthy, with no known previous illness. Vital signs are normal.
respond dramatically to a gluten-free diet. Which of the following is the most Physical examination reveals pitting edema of the lower legs and a swollen
likely diagnosis? abdomen. Urinalysis shows 4+ protein but no RBCs or WBCs. Which of the
(A) Celiac sprue following are the most likely diagnoses to consider in your evaluation of this
(B) Cystic fi brosis of the pancreas patient?
(C) Ménétrier disease (A) Henoch-Schönlein purpura, lupus nephritis
(D) Tropical sprue (B) Malignant hypertension, renal vein thrombosis
(E) Whipple disease (C) Minimal change disease, focal segmental glomerulosclerosis
(D) Pyelonephritis, acute tubular necrosis
_72. An 85yo man complains of abdominal pain and bright red blood in his (E) Wilms tumor, renal cell carcinoma
stool. An X-ray fi lm of the abdomen shows fecal impaction in the
rectosigmoid region. Which of the following pathologic lesions is most likely __79. A 14yo girl presents with a 5-day history of hypertension, oliguria, and
to be found in this patient? hematuria. She was seen 2 weeks earlier for a severe throat infection with
(A) Curling ulcer group A (β-hemolytic) streptococci. A kidney biopsy displays
(B) Cushing ulcer glomerulonephritis. Immunofluorescence staining for which of the following
(C) Melanosis coli proteins would provide the strongest evidence that this patient’s
(D) Peptic ulcer glomerulonephritis is mediated by immune complexes?
(E) Stercoral ulcer (A) Complement
(B) Fibrinogen
__73. A 3-day old neonate born after a 32-week gestation develops yellow (C) Hageman factor (clotting factor XII)
skin. Physical examination of the infant is unremarkable. Which of the (D) Plasminogen
following is most likely to be increased in this neonate’s serum? (E) Thrombin
(A) Alanine aminotransferase
(B) Carotene __80. A 20yo woman is involved in an automobile accident and loses a large
(C) Conjugated bilirubin amount of blood. In response to hypoxia, interstitial peritubular cells of the
(D) Galactosyltransferase kidney would be expected to release which of the following hormones?
(E) Unconjugated bilirubin (A) Aldosterone
(B) Angiotensin
__74. A 47yo man suffers from long-standing peptic ulcer disease, which is (C) Angiotensinogen
largely unresponsive to pharmacologic therapy. Endoscopic examination (D) Erythropoietin
reveals multiple, nonhealed ulcerations of the duodenum and jejunum. (E) Renin
Which of the following is the most likely diagnosis?
(A) Carcinoid syndrome _81. A 54yo woman with squamous cell carcinoma of the lung develops
(B) Insulinoma bilateral pitting edema of the lower extremities. Laboratory studies show
(C) Pancreatic adenocarcinoma hyperlipidemia, hypoalbuminemia, and 4+ proteinuria. Urinalysis reveals no
(D) Verner-Morrison syndrome infl ammatory cells or RBCs. Renal biopsy in this patient would most likely
(E) Zollinger-Ellison syndrome show which of the following patterns of glomerulopathy?
(A) Berger disease (IgA nephropathy)
__75. A 35yo woman presents with 6-month history of skin rash and fatigue. (B) Goodpasture syndrome
Physical examination shows pallor and a necrotizing erythematous skin rash (C) Membranous glomerulopathy
of her lower body. Laboratory studies reveal mild anemia and fasting blood (D) Minimal change glomerulopathy
(E) Nodular glomerulosclerosis
__89. A 60yo man with a history of nodular prostatic hyperplasia and
__82. A 6yo child develops fever, abdominal pain, and bloody diarrhea. recurrent cystitis presents with pain in the scrotum. His temperature is 38°C
Several other children in the neighborhood had similar symptoms. The (101°F). Physical examination reveals a small, tender nodule attached to the
common feature was traced to eating hamburgers at a fast food restaurant. testis. Which of the following is the most likely diagnosis?
The clinical course is complicated by the development of acute renal failure. (A) Epididymitis
Which of the following is the most likely diagnosis? (B) Orchitis
(A) Acute postinfectious glomerulonephritis (C) Spermatocele
(B) Churg-Strauss syndrome (D) Urethritis
(C) Hemolytic uremic syndrome (E) Varicocele
(D) Malignant hypertension
(E) Polyarteritis nodosa __90. A 65yo man presents with a 4-month history of a scrotal mass. Which
of the following is the most likely diagnosis?
__83. A 5yo girl presents with the sudden onset of diffuse arthralgias and (A) Choriocarcinoma
skin rash. Physical examination shows a violaceous maculopapular rash on (B) Embryonal carcinoma
the lower torso. Urinalysis discloses oliguria and 2+ hematuria. Urine (C) Leydig cell tumor
cultures are negative. This child’s clinical presentation is commonly (D) Malignant lymphoma
associated with which of the following diseases? (E) Seminoma
(A) Berger disease
(B) Goodpasture syndrome __91. A 16yo boy from Africa presents with a 5-day history of fever and
(C) Hemolytic uremic syndrome testicular pain. Physical examination shows swollen, tender parotid glands
(D) Henoch-Schönlein purpura and testes. Which of the following is the most likely responsible pathogen?
(E) Polyarteritis nodosa (A) Haemophilus ducreyi
(B) Human immunodefi ciency virus
__84. The parents of a 6-month-old girl palpate a mass on the left side of the (C) Human papillomavirus
child’s abdomen. Urinalysis shows high levels of vanillylmandelic acid. A CT (D) Mumps virus
scan reveals an abdominal tumor and bony metastases. Which of the (E) Streptococcus pyogenes
following is the most likely diagnosis?
(A) Dysgerminoma __92. A 3-month-old boy is brought to the physician because his parents
(B) Ganglioneuroma cannot fi nd one of his testicles. Physical examination confi rms the parents’
(C) Immature teratoma observation. Which of the following is the most likely diagnosis?
(D) Neuroblastoma (A) Anorchia
(E) Wilms tumor (B) Cryptorchidism
(C) Klinefelter syndrome
__85. A 35yo woman with end-stage renal disease of unknown etiology is (D) Macroorchidism
transplanted with a cadaver kidney. The patient develops oliguia shortly (E) Male pseudohermaphroditism
after transplantation and a renal biopsy shows immediate (hyperacute)
rejection. Immunosuppression improves renal function. Which of the __93. A 60yo woman with a history of chronic cystitis is referred to a
following represents the principle target for immune attack directed against urologist because of hematuria. Cystoscopy reveals a mass in the dome of
this patient’s allograft? the bladder. Biopsy shows tumor cells arranged as gland-like structures.
(A) ABO antigens Special stains demonstrate mucin in the cytoplasm of the tumor cells. What
(B) Bacterial antigens is the appropriate diagnosis?
(C) Glomerular basement membrane antigens (A) Adenocarcinoma
(D) β2-Microglobulin (B) Inverted papilloma
(E) Urothelium (C) Squamous cell carcinoma
(D) Urothelial cell carcinoma
__86. A 20yo pregnant woman (gravida II, para I) complains of lower pelvic (E) Urothelial cell carcinoma in situ
discomfort, fever, and pain during urination for the past 2 days. She also
reports seeing blood in her urine. Which of the following is the most likely __94. A 58yo woman complains of recent swelling in her vagina. There is a
cause of hematuria in this patient? past medical history of prenatal exposure to diethylstilbestrol. Physical
(A) Acute cystitis examination reveals a 3-cm firm mass in the anterior wall of the upper
(B) Acute pyelonephritis vagina. Biopsy of the vaginal mass will most likely show which of the
(C) Bladder calculi following pathologic fi ndings?
(D) Postinfectious glomerulonephritis (A) Clear cell adenocarcinoma
(E) Urothelial cell carcinoma of the bladder (B) Endodermal sinus tumor
(C) Granular cell tumor
_87. A 9-month-old boy is brought to the physician by his mother, who (D) Mucinous adenocarcinoma
noticed that her son had developed scrotal swelling. Physical examination (E) Squamous cell carcinoma
reveals a scrotal mass. The lesion can be transilluminated and is composed
of clear serous fluid. What is the appropriate diagnosis? __95. A 60yo woman presents with a 3-week history of a painful genital
A) Epididymitis lesion and bleeding. Physical examination reveals an exophytic, ulcerated 1-
(B) Hematocele cm polypoid mass near the external end of the urethra. What is the most
(C) Hydrocele likely diagnosis?
(D) Spermatocele (A) Bartholin gland cyst
(E) Varicocele (B) Caruncle
(C) Condyloma acuminatum
__88. A 20yo man presents with dysuria, urgency, and urethral discharge. (D) Lichen sclerosis
Physical examination shows suppurative urethritis, with redness and swelling (E) Lymphogranuloma venereum
at the urethral meatus. Which of the following is the most likely etiology of
urethritis in this patient? __96. A 59yo woman presents with a 2-year history of vulvar itching and
(A) Borrelia recurrentis burning. Physical examination reveals a red, moist lesion of the labium
(B) Chlamydia trachomatis major. Biopsy reveals clusters of pale vacuolated cells within the epidermis
(C) Haemophilus ducreyi that stain positively for periodic acid-Schiff (PAS) and carcinoembryonic
(D) Neisseria gonorrhoeae antigen (CEA). Which of the following is the most likely diagnosis?
(E) Treponema pallidum (A) Extramammary Paget disease
(B) HPV-induced papilloma
(C) Verrucous carcinoma
(D) Vulvar intraepithelial neoplasia
(E) Vulvar melanoma

__97. A 31yo Haitian woman is evaluated for infertility. Pelvic examination

shows a markedly enlarged vulva, inguinal lymph node enlargement, and
rectal stricture. Biopsy of an inguinal lymph node reveals necrotizing
granulomas, neutrophilic infiltrates, and inclusion bodies within
macrophages. Which of the following is the most likely etiology of infertility
in this patient?
(A) Chlamydia trachomatis
(B) Gardnerella vaginalis
(C) Molluscum contagiosum
(D) Mycobacterium tuberculosis
(E) Treponema pallidum

__98. A 35yo woman presents with a 6-week history of vaginal discharge,

which is occasionally blood tinged. Pelvic examination reveals a 2-cm
pedunculated, lobulated, and smooth cervical growth; it is excised. Histologic
examination of the specimen would most likely reveal which of the
following?
(A) Condyloma acuminatum
(B) Embryonal rhabdomyosarcoma
(C) Endocervical polyp
(D) Leiomyosarcoma
(E) Microglandular hyperplasia

__99. A 60-yo women presents with a 2-week history of uterine bleeding.

Gynecologic examination reveals an enlarged uterus. The hysterectomy
specimen shows a large polypoid mass involving the endometrium and
myometrium. Histologic examination reveals malignant glands and
malignant stromal elements, including striated muscle and cartilage. What is
the appropriate diagnosis?
(A) Carcinosarcoma
(B) Endometrioid adenocarcinoma
(C) Leiomyosarcoma
(D) Pleomorphic adenoma
(E) Rhabdomyosarcoma

__100. A 25yo woman is referred to the gynecologist for treatment of

infertility. The patient is obese (BMI = 32 kg/m2) and has pronounced facial
hair. She states that she has always had irregular menstrual periods. On
gynecologic examination, both ovaries are found to be symmetrically
enlarged. This patient’s ovaries would likely show which of the following
pathologic fi ndings?
(A) Bilateral endometriomas
(B) Cystic teratoma
(C) Mucinous cystadenoma
(D) Serous cystadenoma
(E) Subcapsular cysts