PATHOLOGY Superexam TOPNOTCH In-class activity 2023 with complete solution

Which of the following is least likely to facilitate chemotaxis: A. LTB4 B. IL8 C. C5a D. TGF E. N-formylmethionine 1 D. TGF - transforming growth factor. Questions in the boards can sometimes be phrased as “least likely or most likelyâ€, so try to accustom yourself to choosing the best answer in such circumstances. Source: Robbins and Cotran Pathologic Basis of Disease 8th ed p. 50 The following are anaphylotoxins A. C3a B. C4a C. C5a D. A and C only E. All of the above 2 E. The anaphylatoxins are components of the complement system which are involved in anaphylaxis. Source: Robbins and Cotran Pathologic Basis of Disease 8th ed p. 57 A 56 year old hypertensive male presented with left sided hemiparesis on waking up. A CT scan was done which revealed an infarct in the distribution of the MCA. Which of the following is the expected gross pathological finding in the brain? A. Coagulative necrosis B. Caseous necrosis C. Liquefactive necrosis D. Fibrinoid necrosis E. Gangrenous necrosis 3 C. Infarcts in the brain result to liquefactive necrosis while those in all other organs except the brain exhibit coagulative necrosis. Source: Robbins and Cotran Pathologic Basis of Disease 8th ed p. 15 A 45 year old woman presents with recurrent infections and on PE was found to have marked splenomegaly. Her leukocyte count is increased to 300,000. The differential count reveals the presence of myeloblasts and promyelocytes, with predominance of myelocytes, metamyelocytes, bands and segmented neutrophils. Basophils are also increased in number. The patient is not anemic. Leukocyte alkaline phosphatase is decreased. Which of the following describes a major characteristic of this disorder? A. 9:22 translocation B. Expansion of mature B lymphocytes within multiple lymph nodes C. Hypogammaglobulinemia D. Neoplastic cells exhibiting hair-like filamentous projections E. Peak incidence occurs at 65 years 4 A. This is a case of CML. It is associated with 9:22 translocation and may be treated with imatinib mesylate. Basophilia is a rare finding. It is strongly indicative of CML. There are a couple of conditions that cause increased WBC, either a leukemia or an infection. The increase in WBC count due to an infection is called a leukemoid reaction. This can be differentiated from CML via the leukocyte alkaline phosphatase test. In a leukemoid reaction LAP is increased. Source: Topnotch handout on Pathology. A 50 year old man seeks consult due to a pruritic rash which he has had over the past 8 months. On PE, there were erythematous, eczematoid patches and raised plaques distributed asymmetrically over the chest and abdomen. On biopsy of the lesions, atypical CD4+ T cells with cerebriform nuclei were found. What is a possible outcome in the course of this condition? A. Acute leukemia B. Myelofibrosis C. Sezary Syndrome D. A and B only E. All of the above 5 C. This is a case of Mycosis fungoides, which is a T cell lymphoma of the skin. Atypical CD4+ T cells with cerebriform nuclei are found on biopsy. The disorder may remain confined to the skin for several years. When the neoplastic cells invade the skin and become systemic, this is called Sezary syndrome. Sezary syndrome is the leukemic form of this cutaneous T cell lymphoma and is characterized by the combination of skin lesions and circulating neoplastic cells. Acute leukemia and myelofibrosis are courses in the natural history of the myeloproliferative syndromes. Source: Topnotch handout on Pathology A 70 year male presented with a 12 hour history of anginal chest pain. The stat troponin I and ECG studies confirm the diagnosis of acute myocardial infarction. Unfortunately, he succumbed to a fatal arrythmia during his 30 minute minute stay in the ER before a definitive intervention could be applied. What are the expected microscopic findings on LM for his heart? A. Dense collagenous scar B. Variable waviness of the fiber C. Coagulation necrosis with neutrophilic infiltrate D. Beginning disintegration of muscle fibers with macrophage infiltrate E. None, it’s too early for histopathologic changes to occur. 6 C. 0-4hrs: None to Variable waviness of the fiber 1-3 days: neutrophilic infiltrate 3-7 days: macrophage infiltrate 1-2 wks: granulation tissue >2 mos: dense collagenous scar Source: Robbins and Cotran Pathologic Basis of Disease 8th ed p. 550 Which of the following findings is an unlikely finding in malignant hypertension? A. Multiple punctate hemorrhage on the surface of both kidneys B. Trea-bark appearance of the ascending aorta C. Fibrinoid necrosis of arterioles D. Onion skinning of arterioles E. None of the above 7 B. Trea-bark appearance of the ascending aorta is a characteristic of tertiary syphilis. Source: Robbins and Cotran Pathologic Basis of Disease 8th ed p. 950 A 65 year old female presents with fever, headache and diplopia. On palpation, tenderness is noted along the course of the temporal artery. A biopsy would most likely confirm which of the following diagnosis? A. Takayasu arteritis B. Retinoblastoma C. Giant cell arteritis D. Kaposi sarcoma E. Katayama disease 8 C. This is a case of Giant cell arteritis. Along with involvement of the branches of the carotid artery, there is a close association with polymyalgia rheumatica. Takayasu arteritis is pulseless disease. It is more common in women of childbearing age. Initial symptoms are usually nonspecific, including fatigue, weight loss, and fever. With progression, vascular symptoms appear and dominate the clinical picture, including reduced blood pressure and weaker pulses in the upper extremities; ocular disturbances, including visual defects, retinal hemorrhages, and total blindness; and neurologic deficits. Involvement of the more distal aorta may lead to claudication of the legs; pulmonary artery involvement may cause pulmonary hypertension. Narrowing of the coronary ostia may lead to myocardial infarction, and involvement of the renal arteries leads to systemic hypertension in roughly half of patients. Source: Robbins and Cotran Pathologic Basis of Disease 8th ed p. 512 A 50 year old male was recently diagnosed with PTB. On physical examination, he appears emaciated. Which of the following is also called cachectin and is responsible for the weight loss and wasting noted in the patient? A. IL1 B. IL2 C. PAF D. TGF-beta E. TNF 9 E. Tumor necrosis factor or cachectin is secreted by activated macrophages and is also responsible for the cachexia in cancer patients. Source: Robbins and Cotran Pathologic Basis of Disease 8th ed p. 320 Pneumoconiosis refers to nonneoplastic lung reaction to inhalation of mineral dusts encountered in the work place. Which pneumoconiosis is characterized by discrete pale to blackened nodules in the upper zones of the lungs. Radiographically it presents as eggshell calcifications. This disease may be progressive even if patient is no longer exposed and it has also been associated with increased susceptibility to PTB. A. Coal workers’ pneumoconiosis B. Silicosis C. Asbestosis D. Byssinosis E. Sarcoidosis 10 B. Silicosis â€" upper lobes, eggshell calcification, PTB Source: Robbins and Cotran Pathologic Basis of Disease 8th ed p. 699 A 40 yr old male presents with fever and cough of 5 days duration. PE revealed increased bronchial breath sounds over the lower segment of the right lobe posteriorly. Chest xray showed lobar consolidation on the right lower lobe and culture was positive for pneumonococcus. Which is the prominent inflammatory cells of this exudate? A. Platelets B. Basophils C. Eosinophils D. Neutrophils E. Macrophage 11 D. Patient has bacterial pneumonia. Streptococcus is a popular agent for causing lobar pneumonia. Stages of inflammatory response in lobar pneumonia: - Congestion: red, heavy, boggy lung - Red hepatization: massive, confluent exudation with neutrophils, red cells and fibrin - Gray hepatization - Resolution Source: Robbins and Cotran Pathologic Basis of Disease 8th ed p.712 19 year old male presents with acute onset hematuria, oliguria and periorbital edema which is worse in the morning and gradually improves through the day. On PE, blood pressure is elevated and urinalysis shows trace proteinuria, and many RBCs. ASOT is negative and DNAse is positive. Which is the expected finding in light microscopy for this patient? A. Diffuse endocapillary proliferation B. Subepithelial humps C. Normal appearing D. Dense deposits E. Extracapillary proliferation of crescents 12 A. When you study for patho and all basic sciences, try to make sure you know how the disease will present clinically cause they like to correlate things. The hardcore micro and biochem or patho knowledge will only get you halfway cause sometimes they will not give you the diagnosis. This is a case of PSGN. ASOT may be negative if the nephritic strain comes from a skin infection because skin lipids bind to streptolysin O. DNAse is the most sensitive test for skin infection with Group A streptococcus. The patient in this case presented with the classic nephritic syndrome of hypertension, hematuria and oliguria. A and B are both PSGN but B is an electron microscopy finding. Source: Robbins and Cotran Pathologic Basis of Disease 8th ed p.918 Patient sought consult for chest pain and hemoptysis associated with hematuria, and signs and symptoms of uremia. His blood pressure is elevated and he has grade III bipedal edema. As the clinician in charge, you suspect that he is suffering from an autoimmune disease in which antibodies against type IV collagen attack the basement membrane of the lungs and kidneys. On immunofluorescence renal biopsy would most probably reveal: A. Granular IgG and C3 in GBM and mesangium B. Linear IgG and C3 C. Negative D. Focal IgM or C3 E. IgA in the mesangium 13 B. Don’t just focus on the electron and LM findings and sacrifice immunofluorescence. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE. A rule of thumb is if the pathophysiology involves immune complex deposition, it would usually present with a granular pattern. If the pathophysiology involves antibodies against basement membranes, the pattern is usually linear. This is actually a case of Goodpasture syndrome which involves antibodies against the basement membrane of the lungs and the kidneys and the findings on immunofluorescent studies show linear IgG and C3. Source: Robbins and Cotran Pathologic Basis of Disease 8th ed p. 709, 918 Patent urachus is a risk factor for which type of carcinoma of the bladder? A. Transitional cell carcinoma B. Squamous cell carcinoma C. Adenocarcinoma D. Clear cell carcinoma E. Sarcoma 14 C. Transitional cell carcinoma is associated with smoking. Squamous cell carcinoma is associated with chronic irritation and S. haematobium infection. Source: Robbins and Cotran Pathologic Basis of Disease 8th ed p. 979 In which of the following nutritional deficiency is hepatic steatosis an expected finding? A. Vitamin A deficiency B. Vitamin E deficiency C. Copper deficiency D. Kwashiorkor E. Marasmus 15 D. Kwashiorkor is a protein deficiency while marasmus a balanced deficiency of all macronutrients. Source: Robbins and Cotran Pathologic Basis of Disease 8th ed p. 429 Which of the following is not a characteristic of a benign peptic ulcer? A. Sharply punched out defect B. Heaped-up margins C. Hemorrhage and fibrin deposition in the gastric serosa D. Perforation E. Malignant transformation is very rare 16 B. Benign ulcers may have mucosal margins which overhang the base slightly but is usually level with the surrounding mucosa. Heaped up margins are more characteristic of malignant ulcers. Source: Robbins and Cotran Pathologic Basis of Disease 8th ed p. 780 Which of the following is the least likely characteristic of right-sided colonic malignancy? A. Adenocarcinoma B. Napkin ring constriction and luminal narrowing C. Desmoplastic response D. Liver metastasis E. None of the above 17 B. Napkin ring constrictions are characteristic of left sided colonic malignancy. Right sided lesions present as polypoid, exophytic masses. Left sided lesions present clinically as obstruction while right sided ones present as anemia. Source: Robbins and Cotran Pathologic Basis of Disease 8th ed p. 824 Which of the following is the most common cause of chronic pancreatitis? A. Gallstones B. Alcoholism C. Hypercholesterolemia D. Smoking E. Hereditary predisposition 18 B. Most common cause Acute pancreatitis â€" gallstones Chronic pancreatitis â€" alcoholism Source: Robbins and Cotran Pathologic Basis of Disease 8th ed p. 896