11- A3-year-old girl develops gastroenteritis and a number of other children at the day care nursery that she attends are also affected. This was most likely caused by which of the following agents?
(A) Balantidium coli
(B) Cryptosporidium parvum
(C) Entamoeba histolytica
(D) Giardia lamblia
(E) rotavirus
12- A9-year-old boy is stung on the arm by a wasp and very rapidly develops redness and swelling at the site of the sting. Which of the following substances is most responsible for these early changes?
(A) bradykinin
(B) complement 3a
(C) histamine
(D) leukotriene B4
(E) thromboxane A2
13- A 45-year-old man is admitted to the hospital for elective gastrointestinal surgery. On the third post-operative day, the patient experiences a fever of 101.5°F, and reports having a slight
cough, but is otherwise asymptomatic. Chest x-ray demonstrates a small, interstitial infiltrate in the left lower lobe. Three sets of blood cultures (two bottles each) are drawn and sent to the laboratory. Culture results report positive Staphylococcus epidermidis growth from one bottle of the first culture set, and negative growth from the second and third culture sets. Based on this information, which of the following is the best interpretation of these blood culture results?
(A) intermittent bacteremia associated with postsurgical abscess formation
(B) postoperative septicemia secondary to infective endocarditis
(C) postoperative septicemia secondary to pneumonia
(D) postoperative septicemia secondary to surgical manipulation of the gastrointestinal tract
(E) skin flora contamination and not septicemia
14- A32-year-old man is admitted for neuropsychiatric evaluation after exhibiting bizarre behavior. During his medical workup, he is found to have cirrhosis and a mild parkinsonian tremor. Which of the following diagnoses provides the best explanation for these findings?
(A) congenial hepatic fibrosis
(B) peliosis hepatis
(C) primary sclerosing cholangitis
(D) Reye syndrome
(E) Wilson disease
15- A26-year-old man presents with a 3-week history of increasing pain just below his right knee. He does not recall sustaining any trauma to his leg and is not experiencing pain elsewhere; he states that he is otherwise healthy. Examination reveals only tenderness to palpation in the area. An x-ray of his right knee demonstrates a small lytic lesion in the tibial medial condyle surrounded by a focus of sclerosis.
Based on this information, what is the most likely diagnosis?
(A) gout
(B) osteochondroma
(C) osteomyelitis
(D) osteosarcoma
(E) rheumatoid arthritis
16- A63-year-old woman has a routine chest x-ray that reveals a suspicious subpleural lesion. The lesion is resected and sectioned, and reveals all (choices A through F) of the following microscopic findings. Which of these findings would most strongly indicate that the lesion is a malignant neoplasm?
(A) hyperchromatism
(B) increased nuclear/cytoplasmic ratio
(C) invasion
(D) mitoses
(E) necrosis
(F) pleomorphism
17- A 72-year-old man with a known history of chronic essential hypertension dies unattended at home. The medical examiner determines the cause of death to be hypertensive intracerebral
hemorrhage. The most likely site of the hemorrhage is which of the following?
(A) basal ganglia or thalamus
(B) cerebellum
(C) frontal lobe
(D) occipital lobe
(E) pons
18- A 14-month-old baby boy is brought to your office by his mother because he seems to be in pain whenever he tries to move. During your physical examination you note bowing of his legs, depression of the sternum with outward projection of the ends of the ribs, reluctance to move his limbs, and numerous bruises on his legs as well as gingival hemorrhages. These findings lead you to suspect that this child suffers from a dietary deficiency of which of the following vitamins?
(A) A
(B) B1 (thiamine)
(C) B12 (cyanocobalamin)
(D) C (ascorbate)
(E) D (calciferol)
(F) K
19- A 10-year-old boy is brought to a pediatric clinic by his mother, who states that he has been voiding brown-colored urine for the past 2 days. The child’s history is negative except for a sore throat about 2 weeks ago. Physical examination reveals moderate periorbital edema and mild hypertension. Urinalysis demonstrates red cells, both red and white cell casts, and 2+ protein. If a renal biopsy were obtained, what would be the characteristic light and/or electron microscopic finding in the glomeruli?
(A) hypercellularity with duplication of the basement membrane
(B) hypercellularity with subepithelial “humps”
(C) hypercellularity with “wire loop” lesions
(D) normocellularity with effacement of epithelial cell foot processes
(E) normocellularity with segmental sclerosis
(F) normocellularity with thickened basement membranes
20- A 56-year-old man complains of increasing dyspnea on exertion over the past few days. He is noted to be overweight and cyanotic. He has smoked cigarettes for at least 35 years and has a long-standing history of persistent cough,producing a large amount of thick mucopurulent sputum. Auscultation reveals scattered rhonchi and wheezes. Histological examination of his lung tissue would most likely show which of the following?
(A) expanded alveolar septae infiltrated by mononuclear cells
(B) mucous gland hypertrophy and fibrosis of bronchiolar walls
(C) neutrophilic exudate occupying the alveoli of an entire lobe
(D) pink, proteinaceous layer lining the alveolar spaces
(E) thickened basement membranes and many eosinophils
Answers:
11.E
12.c
13.c
14.d
15.b
16.c
17.a
18.d
19.d
20.a
(A) Balantidium coli
(B) Cryptosporidium parvum
(C) Entamoeba histolytica
(D) Giardia lamblia
(E) rotavirus
12- A9-year-old boy is stung on the arm by a wasp and very rapidly develops redness and swelling at the site of the sting. Which of the following substances is most responsible for these early changes?
(A) bradykinin
(B) complement 3a
(C) histamine
(D) leukotriene B4
(E) thromboxane A2
13- A 45-year-old man is admitted to the hospital for elective gastrointestinal surgery. On the third post-operative day, the patient experiences a fever of 101.5°F, and reports having a slight
cough, but is otherwise asymptomatic. Chest x-ray demonstrates a small, interstitial infiltrate in the left lower lobe. Three sets of blood cultures (two bottles each) are drawn and sent to the laboratory. Culture results report positive Staphylococcus epidermidis growth from one bottle of the first culture set, and negative growth from the second and third culture sets. Based on this information, which of the following is the best interpretation of these blood culture results?
(A) intermittent bacteremia associated with postsurgical abscess formation
(B) postoperative septicemia secondary to infective endocarditis
(C) postoperative septicemia secondary to pneumonia
(D) postoperative septicemia secondary to surgical manipulation of the gastrointestinal tract
(E) skin flora contamination and not septicemia
14- A32-year-old man is admitted for neuropsychiatric evaluation after exhibiting bizarre behavior. During his medical workup, he is found to have cirrhosis and a mild parkinsonian tremor. Which of the following diagnoses provides the best explanation for these findings?
(A) congenial hepatic fibrosis
(B) peliosis hepatis
(C) primary sclerosing cholangitis
(D) Reye syndrome
(E) Wilson disease
15- A26-year-old man presents with a 3-week history of increasing pain just below his right knee. He does not recall sustaining any trauma to his leg and is not experiencing pain elsewhere; he states that he is otherwise healthy. Examination reveals only tenderness to palpation in the area. An x-ray of his right knee demonstrates a small lytic lesion in the tibial medial condyle surrounded by a focus of sclerosis.
Based on this information, what is the most likely diagnosis?
(A) gout
(B) osteochondroma
(C) osteomyelitis
(D) osteosarcoma
(E) rheumatoid arthritis
16- A63-year-old woman has a routine chest x-ray that reveals a suspicious subpleural lesion. The lesion is resected and sectioned, and reveals all (choices A through F) of the following microscopic findings. Which of these findings would most strongly indicate that the lesion is a malignant neoplasm?
(A) hyperchromatism
(B) increased nuclear/cytoplasmic ratio
(C) invasion
(D) mitoses
(E) necrosis
(F) pleomorphism
17- A 72-year-old man with a known history of chronic essential hypertension dies unattended at home. The medical examiner determines the cause of death to be hypertensive intracerebral
hemorrhage. The most likely site of the hemorrhage is which of the following?
(A) basal ganglia or thalamus
(B) cerebellum
(C) frontal lobe
(D) occipital lobe
(E) pons
18- A 14-month-old baby boy is brought to your office by his mother because he seems to be in pain whenever he tries to move. During your physical examination you note bowing of his legs, depression of the sternum with outward projection of the ends of the ribs, reluctance to move his limbs, and numerous bruises on his legs as well as gingival hemorrhages. These findings lead you to suspect that this child suffers from a dietary deficiency of which of the following vitamins?
(A) A
(B) B1 (thiamine)
(C) B12 (cyanocobalamin)
(D) C (ascorbate)
(E) D (calciferol)
(F) K
19- A 10-year-old boy is brought to a pediatric clinic by his mother, who states that he has been voiding brown-colored urine for the past 2 days. The child’s history is negative except for a sore throat about 2 weeks ago. Physical examination reveals moderate periorbital edema and mild hypertension. Urinalysis demonstrates red cells, both red and white cell casts, and 2+ protein. If a renal biopsy were obtained, what would be the characteristic light and/or electron microscopic finding in the glomeruli?
(A) hypercellularity with duplication of the basement membrane
(B) hypercellularity with subepithelial “humps”
(C) hypercellularity with “wire loop” lesions
(D) normocellularity with effacement of epithelial cell foot processes
(E) normocellularity with segmental sclerosis
(F) normocellularity with thickened basement membranes
20- A 56-year-old man complains of increasing dyspnea on exertion over the past few days. He is noted to be overweight and cyanotic. He has smoked cigarettes for at least 35 years and has a long-standing history of persistent cough,producing a large amount of thick mucopurulent sputum. Auscultation reveals scattered rhonchi and wheezes. Histological examination of his lung tissue would most likely show which of the following?
(A) expanded alveolar septae infiltrated by mononuclear cells
(B) mucous gland hypertrophy and fibrosis of bronchiolar walls
(C) neutrophilic exudate occupying the alveoli of an entire lobe
(D) pink, proteinaceous layer lining the alveolar spaces
(E) thickened basement membranes and many eosinophils
Answers:
11.E
12.c
13.c
14.d
15.b
16.c
17.a
18.d
19.d
20.a
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