Systemic Pathology Qbank Quiz Part 2

A 65-year-old man has sudden onset of severe abdominal pain that has persisted for 3 hours. Physical examination reveals his temperature is 37°C, heart rate 110/minute, respirations 25/minute, and blood pressure 145/100 mmHg. He has diminished pulses in the lower extremities. There is a pulsatile abdominal mass. His serum creatine kinase is not elevated. He has had fasting blood glucose measurements in the range of 140 to 180 mg/dL for over 20 years. Which of the following conditions is he most likely to have?

49-year-old woman had atrial fibrillation that was poorly controlled, even with amiodarone therapy. She suffered a 'stroke' and died. At autopsy, her 600 gm heart is noted to have a mitral valve with partial fusion of the leaflets along with thickening and shortening of the chordae tendineae. There is an enlarged left atrium filled with mural thrombus. Which of the following underlying causes of death is she most likely to have?

A 27-year-old G2 P1 woman has a screening ultrasound performed at 18 weeks gestation. The fetus is appropriate in size for 18 weeks. The fetal kidneys, liver, head, and extremities appear normal. However, the fetus has a heart with a membranous ventricular septal defect, overriding aorta, and marked pulmonic atresia. If the baby were to be liveborn, which of the following characteristics on physical examination would most likely result from these cardiac defects?

A 44-year-old woman dies as a consequence of a 'stroke'. At autopsy, she is found to have a large right basal ganglia hemorrhage. She has an enlarged 550 gm heart with predominantly left ventricular hypertrophy. Her kidneys are small, about 80 gm each, with cortical scarring, and microscopically they demonstrate small renal arterioles that have luminal narrowing from concentric intimal thickening. Which of the following is the most likely condition associated with her findings?

A 2-year-old child has had failure to thrive for a year, becoming increasingly listless. On examination she is found to have a soft, rumbling systolic ejection murmur. An echocardiogram reveals a large membranous ventricular septal defect. Which of the following complications is she most likely to experience as an adult 2 decades later if this lesion remains untreated?

A 66-year-old man has had congestive heart failure with increasing pulmonary congestion and edema for the past year. He had been previously healthy all his life with no major illnesses. On physical examination his blood pressure is 125/85 mm Hg and he is afebrile. A systolic ejection click is auscultated. A chest x-ray shows cardiomegaly with a prominent left heart border and pulmonary edema. Laboratory studies show a serum glucose of 95 mg/dL and total serum cholesterol of 175 mg/dL. His serum creatine kinase is not elevated. Which of the following underlying diseases is he most likely to have?

A 69-year-old woman with a 7 kg weight loss over the past 6 months now has developed painless jaundice over the past 2 weeks. On physical examination she is afebrile. An abdominal CT scan shows a large mass involving the head of the pancreas, along with widespread nodules in the liver. Nodules are seen in both lungs by chest radiograph. Which of the following cardiac abnormalities is she most likely to develop?

A 51-year-old woman has had several syncopal episodes over the past year. Each episode is characterized by sudden but brief loss of consciousness. She reports no chest pain. On physical examination her vital signs show T 36.9°C, P 80/minute, RR 16/minute, and BP 110/75 mm Hg. She has no pedal edema. On brain MR imaging there is a 1.5 cm cystic area in the left parietal cortex. A chest radiograph shows no cardiac enlargement, and her lung fields are normal. Her serum total cholesterol is 165 mg/dL. Which of the following cardiac lesions is she most likely to have?

A 58-year-old man develops deep venous thrombosis during a hospitalization for prostatectomy. He exhibits decreased mental status 10 days postoperatively, with right hemiplegia. A CT scan of the head shows an acute cerebral infarction in the distribution of the left middle cerebral artery. A chest radiograph reveals cardiac enlargement and prominence of the main pulmonary arteries consistent with pulmonary hypertension. Laboratory studies show a serum troponin I of <0.4 ng/mL. Which of the following lesions is most likely to be present on echocardiography?

A 25-year-old man dies suddenly and unexpectedly while at a nightclub late one evening. The medical examiner performs an autopsy. There is no evidence for trauma on external examination of the body. There are no gross pathologic findings of internal organs. Postmortem toxicologic findings are significant for high blood levels of cocaine and its metabolite benzoylecgonine. Which of the following is the most likely histopathologic finding involving his heart?

A 31-year-old woman, who has two healthy children, notes that she has had no menstrual periods for the past 6 months, but she is not pregnant and takes no medications. Within the past week, she has noted some milk production from her breasts. She has been bothered by headaches for the past 3 months. After nearly hitting a bus while changing lanes driving her vehicle, she is concerned with her vision. An optometrist finds her lateral vision to be reduced. On physical examination she is afebrile and normotensive. Which of the following laboratory test findings is most likely to be present in this woman?

A 28-year-old woman has had difficulty concentrating at work for the past month. She is constantly getting up and walking around to visit co-workers. She complains that the work area is too hot. She seems nervous and often spills her coffee. She has been eating more but has lost 5 kg in the past 2 months. On physical examination her temperature is 37.5°C, pulse 101/minute, respiratory rate 22/minute, and blood pressure 145/85 mm Hg. Which of the following laboratory findings is most likely to be present in this woman?

A 19-year-old previously healthy woman has had a mild pharyngitis followed by a high fever over the past 24 hours. When seen in the emergency room, her skin now shows extensive areas of purpura. Vital signs include temperature 39°C, pulse rate 102/minute, respiratory rate 21/minute, and blood pressure 80/55 mm Hg. Laboratory studies show a serum sodium of 115 mmol/L, potassium 5.3 mmol/L, chloride 92 mmol/L, CO2 22 mmol/L, glucose 42 mg/dL, and creatinine 1.1 mg/dL. Which of the following is the most likely diagnosis?

A 40-year-old woman has noted enlargement of her anterior neck region over the past 8 months. On physical examination her vital signs include T 36.8°C, P 64/minute, RR 16/minute, and BP 155/105 mm Hg. There is diffuse, symmetrical thyroid enlargement without tenderness. A chest radiograph is normal. Fine needle aspiration of the thyroid yields cells consistent with a neoplasm. Laboratory studies show that she is euthyroid, but her serum ionized calcium is elevated. She is taken to surgery and frozen sections of several thyroid masses show a malignant neoplasm composed of polygonal cells in nests. A thyroidectomy is performed. Immunostaining for calcitonin of the permanent sections is positive, and the neoplasm has an amyloid stroma with Congo red staining. Which of the following neoplasms is she most likely to have?

A 55-year-old woman has had a 4 kg weight loss over the past 3 months. She exhibits decreased mentation over the past 10 days. On physical examination she is afebrile and hypotensive. Bilateral papilledema is noted. A head CT scan shows marked diffuse cerebral edema with effacement of the lateral ventricles. Laboratory studies show a sodium of 108 mmol/L, potassium 4.0 mmol/L, chloride 83 mmol/L, CO2 14 mmol/L, glucose 82 mg/dL, and creatinine 0.5 mg/dL. Which of the following is most likely to cause these findings?

A 29-year-old primigravida who received no prenatal care has marked vaginal bleeding after the onset of labor at 38 weeks gestation. Cesarean section is performed and a lacerated low-lying placenta is removed. She remains hypotensive for 6 hours and requires transfusion of 12 packed RBC units. Postpartum, she becomes unable to breast-feed the infant. She does not have a resumption of normal menstrual cycles. She becomes more sluggish and tired. Laboratory findings include hyponatremia, hyperkalemia, and hypoglycemia. Which of the following pathologic lesions is she most likely to have had following delivery?

A 58-year-old man with a history of diabetes mellitus has noted the presence of bone pain, especially of his hands, for the past 6 months. On physical examination there is no swelling or redness of his hands, no joint deformity, but the range of motion is slightly decreased. Laboratory studies show sodium 139 mmol/L, potassium 4.0 mmol/L, chloride 98 mmol/L, C02 22 mmol/L, glucose 153 mg/dL, creatinine 7.8 mg/dL, calcium 7.8 mg/dL, phosphorus 5.7 mg/dL, total protein 6.2 g/dL, and albumin 4.0 g/dL. Which of the following conditions is this man most likely to have?

A 49-year-old woman has had increasing cold intolerance, weight gain of 4 kg, and sluggishness over the past two years. A physical examination reveals dry, coarse skin and alopecia of the scalp. Her thyroid is not palpably enlarged. Her serum TSH is 11.7 mU/L with thyroxine of 2.1 micrograms/dL. A year ago, anti-thyroglobulin and anti-microsomal autoantibodies were detected at high titer. Which of the following thyroid diseases is she most likely to have?

A 48-year-old woman has experienced constant back pain exacerbated by movement over the past month. She reports increasing weakness over the past 3 months. On physical examination her blood pressure is 165/110 mm Hg. She is overweight, with a BMI of 28. A radiograph of the spine reveals a compressed fracture at T10. Laboratory findings include a serum glucose of 155 mg/dL. Which of the following pathologic lesions is most likely to explain her findings?

A 41-year-old man has a history of drinking 1 to 2 liters of whisky per day for the past 20 years. He has had numerous episodes of nausea and vomiting in the past 5 years. He now experiences a bout of prolonged vomiting, followed by massive hematemesis. On physical examination his vital signs are: T 36.9°C, P 110/min, RR 26/min, and BP 80/40 mm Hg lying down. His heart has a regular rate and rhythm with no murmurs and his lungs are clear to auscultation. There is no abdominal tenderness or distension and bowel sounds are present. His stool is negative for occult blood. Which of the following is the most likely diagnosis?

A 50-year-old man has had persistent nausea for 5 years with occasional vomiting. On physical examination there are no abnormal findings. He undergoes upper GI endoscopy, and a small area of gastric fundal mucosa has loss of rugal folds. Biopsies are taken and microscopically reveal well-differentiated adenocarcinoma confined to the mucosa. An upper GI endoscopy performed 5 years previously showed a pattern of gastritis and microscopically there was chronic inflammation with the presence of. Which of the following is the most likely risk factor for his neoplasm?

A 38-year-old man has had upper abdominal pain for 3 months. For the past week he has had nausea. On physical examination a stool sample is positive for occult blood. An upper GI endoscopy reveals no esophageal lesions, but there is a solitary 2 cm diameter shallow, sharply demarcated ulceration of the stomach. Which of the following is most characteristic for this lesion?

A 15-year-old boy from Ghana has the acute onset of right upper quadrant abdominal pain. Abdominal ultrasound reveals a dilated gallbladder with thickened wall and filled with calculi. A laparoscopic cholecystectomy is performed. The gallbladder is opened to reveal ten multifaceted 0.5 to 1 cm diameter dark, greenish-black gallstones. Which of the following underlying conditions does this boy most likely have?

A 32-year-old woman has a 10 year history of intermittent, bloody diarrhea. She has no other major medical problems. On physical examination there are no lesions palpable on digital rectal examination, but a stool sample is positive for occult blood. Colonoscopy reveals a friable, erythematous mucosa with focal ulceration that extends from the rectum to the mid-transverse colon. Biopsies are taken and all reveal mucosal acute and chronic inflammation with crypt distortion, occasional crypt abscesses, and superficial mucosal ulceration. This patient is at greatest risk for development of which of the following conditions?

A 72-year-old woman notes increasing jaundice and nausea for the past month. On physical examination she is afebrile, but scleral icterus is present. There is no abdominal pain on palpation. She has active bowel sounds. A stool sample is negative for occult blood. Laboratory findings include total protein 6.1 g/dL, albumin 3.3 g/dL, alkaline phosphatase 210 U/L, AST 49 U/L, ALT 40 U/L, total bilirubin 7.2 mg/dL, and direct bilirubin 6.3 mg/dL. Her serum lipase is 50 U/L. Which of the following conditions is she most likely to have?

A 45-year-old man has had a fever and a productive cough for the past 3 days. On physical examination there is dullness to percussion over the right upper lung. His temperature is 37.9°C. A chest radiograph reveals right upper lobe consolidation. Laboratory findings include serum total protein of 6.0 g/dL, albumin 2.7 g/dL, AST 185 U/L, ALT 98 U/L, total bilirubin 1.0 mg/dL, alkaline phosphatase 31 U/L, and prothrombin time 20 sec. An abdominal CT scan shows hepatomegaly with decreased hepatic attenuation. Which of the following conditions is the most likely underlying cause of death?

A 62-year-old man has had anorexia, vomiting, and vague abdominal pain accompanied by weight loss of 6 kg over the past 2 months. Physical examination reveals supraclavicular non-tender lymphadenopathy. He becomes progressively cachectic. An abdominal CT scan shows the stomach is shrunken with the gastric wall thickened to 1 cm and with extensive overlying mucosal erosions. Multiple masses from 1 to 4 cm in size are scattered within the liver. Which of the following conditions most likely preceded development of his illness?

An 8-year-old boy at birth appeared to be a normal term baby, but his neontal course was complicated by the development of meconium ileus. His sweat chloride and immunoreactive trypsinogen are both found to be elevated. Throughout childhood he has experienced multiple increasingly severe bouts of pneumonia with a productive cough, often with Pseudomonas aeruginosa, and later Burkholderia cepacea, cultured from sputum. He is at greatest risk for development of which of the following pulmonary abnormalities?