Thomas Jefferson University: NU 570/NU570 | Clinical Vignettes for Self-Assessment and Review – NU570 Midterm | Answered and Updated 2025/26.

Clinical Vignettes for Self-Assessment and Review – NU570 Midterm 1. A 14-year-old boy died of an osteosarcoma that had metastasized to his lungs. Where did the tumor most likely arise? 2. A 16-year-old girl complains that she has not started menstruating like other girls her age. The patient is short (4 feet, 11 inches) and has a thick-webbed neck. Physical examination reveals widely spaced nipples and poor breast development. If this patient’s genetic disease was cause by nondisjunction during mitosis of a somatic cell in the early stages of embryogenesis, which of the following is the patient’s most likely karyotype? 3. A 20-year-old gardener presents to his family physician for treatment of 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 describes the pathogenesis of these skin lesions? 4. A 20-year-old woman has an ovarian tumor removed. The surgical specimen is 10 cm in diameter and cystic. The cystic cavity is found to contain black hair and sebaceous material. Histologic examination of the cyst wall reveals a variety of benign differentiated tissues, including skin, cartilage, and glandular epithelium. What is the diagnosis? 5. A 20-year-old woman with a history of asthma and allergies undergoes skin testing to identify potential allergens in her environment. A positive skin reaction to ragweed in this patient would be mediated by which of the following classes of immunoglobulin? 6. A 22-year-old construction worker falls 30 feet and fractures several bones, including his femoral shafts. Six hours later, the patient develops shortness of breath and cyanosis. Which of the following hemodynamic disorders best explains the pathogenesis of shock in this patient? 7. A 29-year-old carpenter receives a traumatic laceration to her left arm. Which of the following is the most important factor that determines whether this would will heal by primary or secondary intention? 8. A 3-year old boy skins his knees. --- 9. A 31-year-old woman complains of increased vaginal discharge of 1 month duration. A cervical Pap smear is obtained. Superficial epithelial cells in the smear show condensed (pyknotic) nuclei - 10. A 33-year-old woman delivers a healthy neonate at 38 weeks of gestation. Two days later, the mother collapses in the nursery. Examination of medical records shows that the patient’s father died at age 45 due to complications of Marfan syndrome. Blood pressure is 110/50 mmHg and pulses are diminished. Cardiac auscultation reveals a diastolic murmur 11. A 35-year-old man asks for advice regarding seasonal eye itching and runny nose. Recurrent conjunctivitis in this patient is most likely caused by which of the following mechanisms of disease? 12. A 36-year-old woman presents with a suspicious-looking mole on the posterior surface of her neck. Biopsy confirms the diagnosis of malignant melanoma. 13. A 39-year-old man with AIDS is admitted to the hospital with a 3-week history of chest pain and shortness of breath. An x-ray film of the chest shows bilateral nodularities of the lungs. A CT-guided lung biopsy reveals granulomatous inflammation. The multinucleated cell in the center of this field is most likely derived from which of the following inflammatory cells? 14. A 40-year-old man is examined by a new family physician who discovers numerous pedunculated skin tumors on his face and chest (shown in the image). 15. A 42-year-old woman gives birth to a neonate with multiple congenital abnormalities. Physical findings included a flat facial profile, slanted eyes, epicanthal folds, Brushfield spots, short nose, short neck, dysplastic ears, clinodactyly, a large protruding tongue, and a pronounced heart murmur. What is the most common cause of this developmental birth disease? 16. A 43-year-old pregnant woman inquires about the possibility of Down syndrome in her unborn child. 17. A 45-year-old man presents with increasing abdominal girth and yellow discoloration of his skin and sclera. Physical examination reveals hepatomegaly and jaundice. A Prussian blue stain of a liver biopsy demonstrates iron overload. What is the major intracellular iron storage protein in this patient’s hepatocytes? 18. A 45-year-old woman complains of severe headaches and difficulty swallowing. Over the past 6 months, she has noticed small, red lesions around her mouth as well as thickening of her skin. The patient has “stone facies” on physical examination. Which of the following antigens is the most common and most specific target of autoantibody in patients with this disease? 19. A 5-year-old boy punctures his thumb with a rusty nail. Four hours later, the thumb appears red and swollen. Initial swelling of the boy’s thumb is primarily due to which of the following mechanisms? 20. A 50-year-old man is found to have blood in his urine during a routine checkup (hematuria). An abdominal CT scan reveals a 2-cm right renal mass. You inform the patient that staging of this tumor is key to selecting treatment and evaluating prognosis. Which of the following is the most important staging factor for this patient? 21. A 50-year-old man presents with a lesion on the sun-exposed, dorsal surface of his right hand (shown in the image). Biopsy reveals malignant keratinocytes. 22. A 50-year-old man with polycystic kidney disease dies in renal failure (uremia). A shaggy exudate on the surface of this heart is observed at autopsy (shown in the image). 23. A 50-year-old woman dies of metastatic ovarian cancer. During the autopsy, a segment of mesentery attached to a loop of small intestine is studded with small white tumor nodules (shown in the image). 24. A 50-year-old woman visits your office. She had a radical mastectomy and axillary node dissection for breast cancer two years ago. She now notices that her arm becomes swollen by the end of the day. What is the appropriate name for this fluid accumulation? 25. A 52-year-old man presents with a pigmented skin lesion that he first noticed 6 months ago (shown in the image). 26. A 56-year-old woman with a prior history of myocardial infarction developed gangrene (extensive necrosis) of the left toe. What is the cause? 27. A 56-year-old woman with hyperlipidemia develops progressive, right renal artery narrowing (stenosis). Over time, this patient’s right kidney is likely to demonstrate which of the following morphologic adaptations to partial ischemia 28. A 58-year-old woman with colon cancer presents with 3 months of increasing shortness of breath. A chest x-ray reveals numerous “coin lesions” in both lungs. Histologic examination of an open lung biopsy demonstrates metastatic colon cancer. 29. A 60-year-old man suffered a massive myocardial infarction and expired. At autopsy, the heart tissue histologically demonstrated loss of nuclei, deeply eosinophilic staining of the cytoplasm, and loss of cross striation of cardiac myocytes. 30. A 60-year-old woman with varicose veins developed sudden onset chest pain, and expectorated blood the next day. What could have caused these symptoms? 31. A 62-year-old man presents with multiple "cannon ball" lesions seen by x-ray in both lung fields. 32. A 64-year-old man suffers repeated heart attacks and subsequently dies of cardiac tamponade. Histological examination of the heart at autopsy shows abundant scar tissue, which is stained blue (shown in the image). 33. A 65-year-old man from China suffers a massive stroke and expires. The lungs are examined at autopsy (shown in the image). 34. A 65-year-old man with a history of heavy smoking dies of an acute myocardial infarction. The heart is examined at autopsy (shown in the image). 35. A 68-year-old man with chronic renal disease complains of headaches and dizziness. Blood pressure is 220/130 mm Hg (malignant hypertension). While in the emergency room, the patient suffers a massive stroke and expires. Microscopic examination of the kidney at autopsy shows areas of fibrinoid necrosis. 36. A 68-year-old woman dies of congestive heart failure. A cross-section of the heart at autopsy is shown in the image. 37. A 70-year-old woman suffers a massive stroke and expires. The abdominal aorta at autopsy shows a structural defect below the renal arteries (shown in the image). 38. A 72-year-old man dies of complications of pneumococcal pneumonia. Histological examination of the lungs at autopsy shows acute inflammatory cells filling the pulmonary alveoli (shown in the image). 39. A 72-year-old man presents with substernal chest pain and a history of recurrent angina pectoris. The following day, he develops a fever of 38°C (101°F). Results of laboratory studies include an elevated white blood cell (WBC) count, CK-MB of 6.6 ng/mL, and troponin-I of 2.5 ng/mL. ECG confirms a myocardial infarction of the left ventricular wall. Which of the following mechanisms is most likely responsible for MI in this patient? 40. A 72-year-old woman complains of shortness of breath on exertion. She states that she also becomes short of breath at night unless she uses three pillows to prop herself up (orthopnea). Physical examination reveals mild obesity, bilateral pitting leg edema, an enlarged liver and spleen, and fine crackling sounds on inspiration (rales). A chest x-ray shows cardiomegaly. What is the most likely cause of orthopnea in this patient? 41. A 75-year-old woman dies of congestive heart failure. During the autopsy, multiple wedge-shaped lesions are observed on the surface of the spleen (shown in the image). 42. A 92-year-old woman is brought unconscious to the emergency room from a nursing home. Her blood pressure is 70/30 mm Hg. She is febrile (100.5oF) and breathing rapidly (tachypneic). Laboratory studies demonstrate an elevated white blood cell count with 92% neutrophils. Urinalysis reveals numerous gram-negative organisms. Which of the following most likely accounts for this patient’s signs and symptoms? 43. A chronic smoker presented to the hospital with relentless coughing. A bronchial biopsy was performed. The biopsy contained fragments of mature squamous epithelium, with no evidence of nuclear atypia. Pathologic change is called? 44. A collection of platelets, fibrin, and entrapped cellular elements forms on the luminal surface of a blood vessel. 45. A patient asks you several questions about deep venous thrombosis (DVT). 46. A research laboratory is studying the role of the major histocompatibility complex (MHC) in immunopathology and infectious disease. The products of this gene complex are important. 47. A small nodule measuring 2 cm in diameter was removed from the right breast of a 25-year-old woman. If this nodule is a benign neoplasm of ductal epithelial origin it would be called: 48. A tall, infertile 18-year-old man was found to have atrophic testes, increased follicle stimulating hormone (FSH) in the serum, and an abnormal karyotype. 49. A young man sneezed each time he was close to cats. What is the principle cause of his sneezing? 50. At the autopsy, the brain was found to have thinned gyri and widened sulci. 51. Autopsy of an 80-year-old woman with a history of congestive heart failure reveals marked enlargement of the left ventricle. 52. Biopsy of the uterine endocervix in a 38-year-old woman shows an abnormal focus of squamous epithelium (shown in the image). There is no evidence of cytologic atypia. 53. During a pathology conference you are asked to discuss tumor staging and grading. 54. Glass slides are examined using a double-headed microscope in the Pathology Department. White blood cells are found attached to the endothelial cells of small blood vessels in an area of tissue injury. 55. Group A blood is given by mistake to a group B individual. The patient experienced severe hemolysis, and developed mild jaundice (hyperbilirubinemia). 56. Large amounts of brown pigment were noted in a liver biopsy specimen obtained from a man who had hemolytic anemia. What is the name for this brown pigment? what is the name for this intracellular storage? 57. On rare occasions, an exchange of fragments of DNA between non- homologous chromosomes may occur during meiotic and mitotic cell divisions. 58. The parents of a child with cleft lip and cleft palate visit a genetic counselor to discuss the chances that a similar birth defect will occur in their future offspring. This birth defect shows which of the folloeing patterns of inheritance? 59. This cervical biopsy shows neoplastic cells occupying the full thickness of the epithelium, confined by the underlying basement membrane (shown in the image). 60. You attend a clinical conference on molecular diagnostics. During the conference you are asked to discuss the difference between reactive hyperplasia and neoplasia. 61. A 16-year-old boy is rushed to the emergency room after sustaining a stab wound to the chest during a fight. Physical examination reveals a 1-inch entry wound at the right 5th intercostal space in the midclavicular line. His temperature is 37°C (98.6°F), respirations are 35/min, and blood pressure is 90/50 mm Hg. An x-ray shows air in the right pleural space. Which of the following pulmonary conditions Is the expected complication of pneumothorax arising in this patient? 62. A 20-year-old man from China is evaluated for persistent cough, night sweats, low-grade fever, and general malaise. An X-ray film of the chest reveals findings that are described as "consistent with a Ghon complex". Sputum cultures grow acid-fast bacilli. Examination of hilar lymph nodes in this patient would most likely demonstrate which of the following pathologic changes? 63. A 23-year-old woman with extensive burn injuries develops diffuse alveolar damage and becomes short of breath. Auscultation reveals pulmonary rales (rattling sounds). 64. A 35-year-old man was salvaged from a burning house. Because of marked shortness of breath, he was placed on a ventilator. 65. A 36-year-old man with AIDS presents with fever, dry cough, and dyspnea. A chest x-ray shows bilateral and diffuse infiltrates. Laboratory studies reveal a low CD4+ cell count. A lung biopsy discloses a chronic interstitial pneumonitis and an intra-alveolar foamy exudate. A silver stain of a bronchoalveolar lavage is shown in the image. Which of the following organisms is the most likely pathogen responsible for these pulm findings? 66. A 48-year-old with a history of heavy smoking presents with a 3-year history of persistent cough and frequent upper respiratory infections, associated with sputum production. Analysis of arterial blood gases reveals hypoxia and CO2 retention. Which of the following is the appropriate diagnosis? 67. A 5-year-old girl had a sudden attack of suffocating cough accompanied by wheezing. There was no fever, but the child appeared anxious and in distress. What is the most likely diagnosis? 68. A 50-year-old alcoholic man was brought to the hospital in respiratory distress. He was running a high fever, coughing, and expectorating a yellow sputum. What is the most likely cause of his distress? 69. A 50-year-old man with familial hyperlipidemia undergoes resection of an abdominal aortic aneurysm. Signs of congestive heart failure develop shortly after surgery. Despite treatment, the patient becomes hypotensive and expires 2 days later. Autopsy reveals marked narrowing of coronary arteries, but without thrombosis. Multiple foci of necrosis are found circumferentially around the inner walls of both ventricles. Which of the following is the most likely cause of CHF in this patient? 70. A 55-year old stone worker presents with a 5-year history of increasing shortness of breath. 71. A 55-year-old man with a history of cigarette smoking presented with shortness of breath (dyspnea). Physical examination revealed no signs of congestive heart failure. Radiological abnormalities are limited to evidence of over-inflation of the patient's lungs. 72. A 60-year-old coal miner developed progressive shortness of breath (dyspnea). X-ray studies show numerous, nodular masses in both lungs. What diagnosis should be considered? 73. A 60-year-old man complained of leg cramps that are so severe that he must often stop walking. What is the pathologic basis for intermittent claudication in this patient? 74. A 62-year-old woman suffers internal injuries in an automobile accident and appears to be in a state of shock. Her condition is complicated by fever, leukocytosis and a positive blood culture for staphylococci (sepsis). Two days later, the patient develops rapidly progressive respiratory distress and a pattern of “interstitial pneumonia” on chest x-ray. Which of the following is the most likely diagnosis? 75. A 65-year-old patient with a history of systemic hypertension suddenly develops acute chest pain that extends towards the abdominal cavity. This episode is quickly followed by a drop in blood pressure (systemic hypotension). 76. A 66-year-old woman develops sudden, substernal chest pain. Laboratory studies and ECG confirm acute myocardial infarct of the left ventricle. Despite vigorous therapy, the patient cannot maintain her blood pressure and expires. Autopsy reveals occlusion of the left main coronary artery. What is the most important underlying cause of coronary artery blockage of this patient? 77. A 67-year-old smoker with long-standing bronchitis expectorates blood during a paroxysm of coughing. 78. A 68-year-old man with known heart disease developed sudden, severe substernal chest pain, which extended into his jaw and down the inside of his left arm. 79. A 68-year-old woman is admitted to the hospital with a chief complaint of substernal chest pain. Examination reveals an obese woman (BMI = 32 kg/m2) with a long history of angina pectoris and intermittent claudication (leg cramps). 80. A 69-year-old man is brought to the Emergency Department because of the sudden-onset of left-sided chest pain that is exacerbated upon inspiration. Physical examination reveals dyspnea and hemoptysis. His temperature is 38°C (101°F), pulse is 110/min, respirations are 35/min, and blood pressure is 158/100 mm Hg. A lateral chest wall friction rub is present on auscultation. The left leg is markedly edematous. A chest x-ray reveals a left pleural effusion. What is the most likely cause of this patient’s pulm condition? 81. A 69-year-old man presents with a history of valvular heart disease suffers a massive stroke and expires. The aortic valve is examined at autopsy (shown in the image). 82. A patient with a one-year history of myocardial infarction and left ventricular dilatation presents with symptoms of systemic embolization (sudden onset of partial blindness in the left eye). 83. An 8-year-old girl is brought into the physician’s office in mild respiratory distress. Her parents state that she has recurrent episodes of upper respiratory tract infections. Physical examination shows expiratory wheezes with use of accessory respiratory muscles. Analysis of arterial blood gases shows respiratory alkalosis, and the peripheral eosinophil count is increased. What is the appropriate diagnosis? 84. During a clinical conference in the hospital, you are asked to describe the etiologic agent that is common to chronic bronchitis and emphysema. 85. You are asked to present a lecture to allied health professionals on the "pathobiology of lung cancer".