1- A 62-year-old woman has had atrial fibrillation since experiencing a myocardial infarction (MI) 7 months prior. Two weeks ago she was hospitalized following a car accident in which she suffered a compound fracture of her left femur and several severe contusions. She now returns to the emergency room with right flank pain, hematuria, and left-sided paralysis. These newly developing problems are most likely the result of which of the following?
(A) air embolism from the compound fracture
(B) bone marrow embolus from the fractured femur
(C) fat embolism from the fractured femur
(D) systemic thromboemboli from the left atrium
(E) venous thromboemboli from the deep leg veins
2- A 67-year-old woman presents with a 4-week history of headaches, facial pain, blurred vision, and intense pain and stiffness in her shoulders and hips. She is diagnosed with a vasculitis, and a biopsy of an affected artery is taken. Histological examination is most likely to reveal which of the following characteristic findings?
(A) concentric “onion skin” thickening and fibrosis
(B) extensive intra- and extravascular granulomatous inflammation
(C) fragmentation of the internal elastic lamina with giant cells
(D) hyaline arteriolosclerosis and luminal narrowing
(E) segmental fibrinoid necrosis and neutrophil infiltration
3- A 67-year-old retiree was employed for many years in the plastics industry where he was exposed to vinyl chloride. This industrial exposure has increased his likelihood of developing which of the following?
(A) focal nodular hyperplasia
(B) hepatic adenoma
(C) hepatic angiosarcoma
(D) hepatic fibroma
(E) hepatocellular carcinoma
4- A 2-day-old male infant has not passed any meconium and is now developing signs of obstruction. Examination of the colon would reveal which of the following abnormalities?
(A) absence of parasympathetic ganglion cells in the submucosal and myenteric plexus
(B) absence of the nerve fibers that innervate the wall
(C) atrophy of the mucosal lining of the wall
(D) hypertrophy of the muscle coat of the wall
(E) presence of multiple small polyps along the mucosal surface
5- A 57-year-old woman had her last menstrual period at the age of 46. However, for the past 4 months she has experienced intermittent vaginal hemorrhage. A right ovarian mass is identified.Which of the following is the most likely diagnosis?
(A) arrhenoblastoma
(B) Brenner tumor
(C) dysgerminoma
(D) granulosa cell tumor
(E) Sertoli-Leydig cell tumor
(F) teratoma
6- A 28-year-old recently divorced man with no significant past medical history presents to the mergency room with progressive lower abdominal pain and cramping over the past 4 days, both of which are relieved by defecation. He has suffered from substantial bloody and mucoid diarrhea during this time. His
temperature is 102.8°F. Laboratory studies reveal an elevated white blood cell (WBC)count and a high erythrocyte sedimentation rate. Sigmoidoscopy reveals extensive rectal and sigmoid hyperemia and edema, numerous superficial ulcerations, and small focal mucosal hemorrhages, many of which have
suppurative centers. Significant intestinal narrowing is seen in the distal transverse colon.These findings most likely suggest a diagnosis of which of the following?
(A) amebic colitis
(B) collagenous colitis
(C) cytomegalovirus enterocolitis
(D) pseudomembranous colitis
(E) ulcerative colitis
7- A50-year-old woman complains of a lump in her thyroid gland. Fine-needle aspiration of
this lump is reported as medullary carcinoma. A test of her serum would most likely reveal an increased level of which of the following?
(A) alpha-Fetoprotein
(B) cancer antigen (CA) 125
(C) CA 15–3
(D) calcitonin
(E) human chorionic gonadotropin
8- A 14-year-old boy is referred to you for nasal obstruction and frequent nosebleeds. Which of
the following is the most likely diagnosis?
(A) inverted papilloma
(B) juvenile angiofibroma
(C) nasal polyps
(D) nasopharyngeal carcinoma
(E) wegener granulomatosis
9- A 52-year-old woman presents to her primary care physician complaining of increasing fatigue
and mild shortness of breath. Blood work reveals a hypochromic anemia with a hemoglobin
concentration of 10.4 g/dL, MCV of 76 μ/m3,MCHC of 29 g/dL, and a decrease in the absolute reticulocyte count. WBC and platelet counts are within normal limits. Serum iron and ferritin levels are low and total iron-binding capacity is elevated. Which of the following conditions best accounts for these findings?
(A) anemia of chronic disease
(B) aplastic anemia
(C) hypothyroidism
(D) iron deficiency
(E) pernicious anemia
10- A 52-year-old woman has had rheumatoid arthritis for many years. She now comes to you
complaining of the development in the past few months of redness, burning, and itching of
her eyes and a dry mouth, making swallowing difficult. This newly developing condition
gives the patient a greatly increased risk for which of the following?
(A) esophageal carcinoma
(B) leukemia
(C) lymphoma
(D) melanoma
(E) pleomorphic adenoma
Answers:
1.d
2.e
3.e
4.a
5.b
6.e
7.d
8.c
9.d
10.a
(A) air embolism from the compound fracture
(B) bone marrow embolus from the fractured femur
(C) fat embolism from the fractured femur
(D) systemic thromboemboli from the left atrium
(E) venous thromboemboli from the deep leg veins
2- A 67-year-old woman presents with a 4-week history of headaches, facial pain, blurred vision, and intense pain and stiffness in her shoulders and hips. She is diagnosed with a vasculitis, and a biopsy of an affected artery is taken. Histological examination is most likely to reveal which of the following characteristic findings?
(A) concentric “onion skin” thickening and fibrosis
(B) extensive intra- and extravascular granulomatous inflammation
(C) fragmentation of the internal elastic lamina with giant cells
(D) hyaline arteriolosclerosis and luminal narrowing
(E) segmental fibrinoid necrosis and neutrophil infiltration
3- A 67-year-old retiree was employed for many years in the plastics industry where he was exposed to vinyl chloride. This industrial exposure has increased his likelihood of developing which of the following?
(A) focal nodular hyperplasia
(B) hepatic adenoma
(C) hepatic angiosarcoma
(D) hepatic fibroma
(E) hepatocellular carcinoma
4- A 2-day-old male infant has not passed any meconium and is now developing signs of obstruction. Examination of the colon would reveal which of the following abnormalities?
(A) absence of parasympathetic ganglion cells in the submucosal and myenteric plexus
(B) absence of the nerve fibers that innervate the wall
(C) atrophy of the mucosal lining of the wall
(D) hypertrophy of the muscle coat of the wall
(E) presence of multiple small polyps along the mucosal surface
5- A 57-year-old woman had her last menstrual period at the age of 46. However, for the past 4 months she has experienced intermittent vaginal hemorrhage. A right ovarian mass is identified.Which of the following is the most likely diagnosis?
(A) arrhenoblastoma
(B) Brenner tumor
(C) dysgerminoma
(D) granulosa cell tumor
(E) Sertoli-Leydig cell tumor
(F) teratoma
6- A 28-year-old recently divorced man with no significant past medical history presents to the mergency room with progressive lower abdominal pain and cramping over the past 4 days, both of which are relieved by defecation. He has suffered from substantial bloody and mucoid diarrhea during this time. His
temperature is 102.8°F. Laboratory studies reveal an elevated white blood cell (WBC)count and a high erythrocyte sedimentation rate. Sigmoidoscopy reveals extensive rectal and sigmoid hyperemia and edema, numerous superficial ulcerations, and small focal mucosal hemorrhages, many of which have
suppurative centers. Significant intestinal narrowing is seen in the distal transverse colon.These findings most likely suggest a diagnosis of which of the following?
(A) amebic colitis
(B) collagenous colitis
(C) cytomegalovirus enterocolitis
(D) pseudomembranous colitis
(E) ulcerative colitis
7- A50-year-old woman complains of a lump in her thyroid gland. Fine-needle aspiration of
this lump is reported as medullary carcinoma. A test of her serum would most likely reveal an increased level of which of the following?
(A) alpha-Fetoprotein
(B) cancer antigen (CA) 125
(C) CA 15–3
(D) calcitonin
(E) human chorionic gonadotropin
8- A 14-year-old boy is referred to you for nasal obstruction and frequent nosebleeds. Which of
the following is the most likely diagnosis?
(A) inverted papilloma
(B) juvenile angiofibroma
(C) nasal polyps
(D) nasopharyngeal carcinoma
(E) wegener granulomatosis
9- A 52-year-old woman presents to her primary care physician complaining of increasing fatigue
and mild shortness of breath. Blood work reveals a hypochromic anemia with a hemoglobin
concentration of 10.4 g/dL, MCV of 76 μ/m3,MCHC of 29 g/dL, and a decrease in the absolute reticulocyte count. WBC and platelet counts are within normal limits. Serum iron and ferritin levels are low and total iron-binding capacity is elevated. Which of the following conditions best accounts for these findings?
(A) anemia of chronic disease
(B) aplastic anemia
(C) hypothyroidism
(D) iron deficiency
(E) pernicious anemia
10- A 52-year-old woman has had rheumatoid arthritis for many years. She now comes to you
complaining of the development in the past few months of redness, burning, and itching of
her eyes and a dry mouth, making swallowing difficult. This newly developing condition
gives the patient a greatly increased risk for which of the following?
(A) esophageal carcinoma
(B) leukemia
(C) lymphoma
(D) melanoma
(E) pleomorphic adenoma
Answers:
1.d
2.e
3.e
4.a
5.b
6.e
7.d
8.c
9.d
10.a
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