36. Typical of most failing hearts * A. decreased responsiveness to epinephrine B. exaggerated ATP-ase activity wasting energy C. increased intracellular calcium D. reduced muscle mass E. reduced chamber size 37. Most congestive heart failure in the US is a complication of A. coronary narrowing without infarction B. dilated cardiomyopathy * C. high blood pressure D. restrictive cardiomyopathy E. valvular disease 38. What's the upper limit of normal weight for a sedentary man's heart? A. 150 gm B. 250 gm * C. 350 gm D. 450 gm E. 550 gm 39. Which is most suggestive of cocaine use? A. intramyocardial abscess * B. isolated single-fiber contraction-band necrosis C. petechiae in the myocardium D. plasmacytic myocarditis E. unexplained coronary thrombosis 40. Which valve is most likely to be abnormal in tetralogy of Fallot? A. aortic B. ileocecal valve C. mitral * D. pulmonic E. tricuspid 41. Whereabouts in the heart are you most likely to develop a lipoma? A. either atrial appendage * B. interatrial septum C. left ventricular free wall D. parietal pericardium E. right ventricular free wall 42. Which type of cardiomyopathy is typical of patients with hemochromatosis? * A. dilated B. hypertrophic C. restrictive 43. Which molecule, which constricts pulmonary blood vessels and causes endothelium to proliferate, is suspected to be the mediator of the pulmonary vascular narrowing in Eisenmenger's syndrome? A. angiotensin 2 * B. endothelin 1 C. interferon D. interleukin 1 E. prostacyclin 44. The fundamental lesion in the "pink puffer" and "blue bloater" is A. failure of ciliary function B. failure to produce nitric oxide * C. loss of pulmonary elasticity D. plugging of the small bronchi by mucus E. ulceration of the bronchial mucosa 45. Classical pathologists attribute the unusual "panacinar" emphysema to * A. antitrypsin deficiency B. immotile cilia C. playing wind instruments D. long-term asthma E. smoking tobacco 46. Which are you LEAST LIKELY to find in the airways of a person dying of asthma? A. dead epithelial cells B. lots of eosinophils C. lots more goblet cells than most folks D. macrophages with tobacco pigment * E. thinned basement membrane 47. A micro-organism of which genus is a principal suspect in asthma? * A. chlamydia B. coxiella (a rickettsia relative) C. neisseria D. streptococcus E. a virus, doesn't have a proper genus 48. Which disease is caused by an autoantibody against the pulmonary alveolar basement membrane? A. Eaton-Lambert * B. Goodpasture's C. Hamman-Rich D. Loeffler's E. Wegener's 49. Squamous cell carcinoma of the lung is more likely than oat cell carcinoma of the lung to produce paraneoplastic A. blindness B. cushingism * C. hypercalcemia D. hyponatremia E. muscle weakness 50. You'll see spur cells when your patient has... * A. abetalipoproteinemia B. DIC C. iron deficiency D. megaloblastic anemia E. anything at all, and you've made your smear poorly 51. Lots more circulating basophils than usual? Think of... A. Hodgkin's disease B. parvo B19 * C. polycythemia vera D. syphilis E. typhoid 52. Lots more circulating eosinophils than usual? Think of... * A. Hodgkin's disease B. parvo B19 C. polycythemia vera D. syphilis E. typhoid 53. Which typically pops up in the anterior mediastinum of teenaged boys? A. lymphocyte-predominance Hodgkin's B. immuloblastic lymphoma, thymocyte-derived C. mycosis fungoides * D. T-lymphoblastic lymphoma E. well-differentiated lymphocytic lymphoma 54. Birbeck granules tell the pathologist that the tumor is A. B-cell lymphoma * B. histiocytosis X C. mycosis fungoides D. myelogenous leukemia rather than lymphoblastic E. T-cell lymphoma 55. A chloroma results from A. acute lymphoblastic leukemia * B. acute myelogenous leukemia C. blast crisis of lymphoma D. chlorine gas exposure E. Hodgkin's disease 56. Which is LEAST LIKELY to produce a polyclonal gammopathy? A. AIDS B. cystic fibrosis C. hepatic cirrhosis D. rheumatoid arthritis * E. Waldenstrom's macroglobulinemia 57. You might order a urea solubility test to check for A. classic hemophilia B. Christmas hemophilia * C. factor XIII deficiency D. Glanzmann's thrombasthenia E. von Willebrand's disease 58. Von Willebrand platelets typically do not react normally to A. ADP B. collagen C. epinephrine D. prostaglandins * E. ristocetin 59. In classic hemophilia, you will see A. long PT, long PTT, long bleeding time B. long PT, long PTT, normal bleeding time C. long PT, normal PTT D. normal PT, long PTT E. normal PT, normal PTT, long bleeding time 60. In the real clotting cascade, tissue-factor (TF) usually gets everything going by binding to * A. factor VII B. factor VIII C. factor IX D. factor XII E. plasminogen 61. The stroma of a parotid "mixed-tumor" pleomorphic adenoma usually looks a lot like * A. cartilage B. erectile tissue C. keloid D. skeletal muscle E. smooth muscle 62. Which is a known risk factor for common salivary gland cancer? A. alcoholism B. high-fat diet * C. radiation exposure D. red meat in the diet E. smoking 63. "Creeping fat" is typical of * A. Crohn's B. gluten enteropathy with steatorrhea C. Meckel's diverticulum D. Whipple's E. normal function of the greater omentum 64. Which is LEAST LIKELY to result from reflux esophagitis? A. Barrett's metaplasia B. eosinophils in the squamous epithelium * C. formation of esophageal varices D. thickening of the basal layer E. ulceration of the mucosa 65. "Curling's ulcers" of the stomach simply means your patient was stressed physiologically by * A. a burn B. brain injury (Curly was a brain surgeon, with Larry and Moe) C. beer and aspirin combination ("I want to curl up and die!") D. helicobacter (little curly bugs) E. Pathology exams 66. No, it wasn't a murder. The child's elevated urinary methylmalonic acid might have resulted from * A. B12 deficiency B. iron deficiency C. leukemia breakdown products D. spherocytosis or sickle-cell hemolysis E. treatment for thal major 67. ONE KODACHROME. This aortic valve displays A. congenital bicuspid with calcification B. fresh rheumatic fever * C. idiopathic calcification D. old rheumatic fever E. syphilis 68. ONE KODACHROME. Your best diagnosis? A. disseminated intravascular coagulation * B. hemoglobin C disease C. iron deficiency D. megaloblastic anemia E. myelofibrosis 69. TWO KODACHROMES. Lung. What is your diagnosis? A. adult respiratory distress syndrome * B. alveolar proteinosis C. bronchiectasis D. bronchopneumonia E. Goodpasture's disease 70. ONE KODACHROME. Lung. What do you think you would see under the microscope? A. bronchiectasis as in cystic fibrosis B. chronic bronchitis / emphysema * C. Hamman-Rich D. oat cell carcinoma E. tuberculosis 71. ONE KODACHROME. Good example of a heart with A. dilated cardiomyopathy B. endocardial fibroelastosis C. hypertrophic cardiomyopathy D. sequelae of rheumatic fever * E. ventricular aneurysm after myocardial infarct 72. ONE KODACHROME. What has embolized to the lung? A. amniotic fluid B. bone marrow C. talcum powder (drug use) D. thrombus * E. none of these 73. ONE KODACHROME. Coronary artery. What's your best diagnosis? A. fatty streak * B. fibrous plaque, uncomplicated C. hemorrhage into a plaque D. ulcerated plaque with thrombus E. none of these 74. TWO KODACHROMES. Lung. What's your best diagnosis? * A. adenocarcinoma, not bronchiolo-alveolar B. brondchiolo-alveolar carcinoma C. oat cell carcinoma D. sarcoid granulomas E. squamous cancer 75. TWO KODACHROMES. Lung. What's the diagnosis? A. adenocarcinoma B. bronchiectasis with chronic lymphocytic infiltrate C. malignant lymphoma * D. oat cell carcinoma E. squamous cell carcinoma 76. TWO KODACHROMES. Blood. Your best diagnosis? A. acute myelogenous leukemia B. chronic lymphocytic leukemia * C. chronic myelogenous leukemia D. infectious mononucleosis E. L3 acute lymphoblastic leukemia (liquid Burkitt's) 77. ONE KODACHROME. Please read my stomach biopsy! A. atrophic gastritis without intestinal metaplasia B. atrophic gastritis with intestinal metaplasia C. helicobacter gastritis with loss of cell apices * D. cancer E. Crohn's disease 78. ONE KODACHROME. Heart. What's the usual etiology? A. atherosclerosis * B. genetic C. infectious D. toxic E. unknown 79. ONE KODACHROME. Blood. Uh oh, your patient has... A. Alder-Reilley mucopolysaccharidosis B. B12 deficiency * C. sepsis with DIC D. iron deficiency anemia E. M3 promyelocytic leukemia 80. ONE KODACHROME. Aortic valve. The problem is A. acute rheumatic fever B. congenital bicuspid calcified valve C. idiopathic calcification of a tricuspid valve D. sequelae of rheumatic fever * E. this is a dissecting aneurysm (aortic medial dissection) 81. TWO KODACHROMES. Appendix. What's the lesion? A. acute appendicitis B. adenocarcinoma * C. carcinoid D. organizing abscess E. pinworm infestation only 82. TWO KODACHROMES. Spleen. Your best diagnosis? * A. angiosarcoma B. extramedullary hematopoiesis C. Hodgkin's disease D. malignant lymphoma, non-Hodgkin's E. sickle cell spleen (adult) 83. TWO KODACHROMES. Soft tissue mass. What's your best diagnosis? A. abscess B. aortic dissection ("dissecting aneurysm") C. chronic inflammation, consistent with autoimmunity * D. Hodgkin's disease E. non-Hodgkin's lymphoma 84. ONE KODACHROME. Stomach. Trichrome stain. What is your best diagnosis? adenocarcinoma atrophic gastritis * Menetrier's ulcer consistent with helicobacter effect varices (gastroesophageal junction) 85. ONE KODACHROME. Peripheral smear. What do you think it is? * A. acute leukemia B. chronic lymphocytic leukemia C. chronic myelogenous (granulocytic) leukemia D. infectious mononucleosis E. plasma cell myeloma, end-stage (plasma cell leukemia) 86. ONE KODACHROME. Cornell's unusual stain of lung, exhibiting * A. amniotic fluid embolus B. marrow embolus C. pulmonary vascular sclerosis consistent with Eisenmenger's D. sickle-cell lung disease E. thromboembolus 87. THREE KODACHROMES. What's wrong with the lungs? A. Hamman-Rich B. Hodgkin's disease * C. mesothelioma D. oat cell carcinoma E. squamous cell carcinoma 88. TWO KODACHROMES. Tongue. What's your best diagnosis? A. adenoid-cystic carcinoma of a minor salivary gland B. squamous cell carcinoma C. chancre of syphilis D. leukoplakia without invasion * E. malignant lymphoma 89. ONE KODACHROME. What's your best diagnosis? A. Alder-Reilley B. Bernard-Soulier C. May-Hegglin * D. Pelger-Huet E. Reed-Sternberg 90. THREE KODACHROMES. Lymph node. A. diffuse non-Hodgkin's lymphoma B. follicular (B-cell) hyperplasia C. Hodgkin's disease (nodular sclerosing variant) D. nodular non-Hodgkin's lymphoma * E. sarcoidosis 91. TWO KODACHROMES. This one's easy. What's in the bones? A. Hodgkin's disease * B. plasma cell myeloma C. metastatic adenocarcinoma D. metastatic squamous cell carcinoma E. non-Hodgkin's lymphoma 92. TWO KODACHROMES. Which is least likely to have been the cause? A. factor V mutation * B. factor X deficiency C. lupus anticoagulant D. protein C deficiency E. protein S deficiency 93. FOUR KODACHROMES. What's your diagnosis? * A. acute rheumatic fever B. acute myocardial infarct C. bacterial endocarditis D. old damage from rheumatic fever E. old myocardial infarct 94. THREE KODACHROMES. What's the lung lesion? A. asthma B. bronchiectasis * C. lymphoma D. sarcoidosis E. squamous cancer 95. ONE KODACHROME. The blasts in this AML patient's blood show differentiation toward A. erythrocytes (M6) B. megakaryocytes (M7) C. monocytes (M5) * D. promyelocytes (M2 or M3) E. none of these (M1) 96. ONE KODACHROME. Look carefully and think. This is probably A. adult respiratory distress syndrome * B. bronchiectasis C. emphysema D. oat cell carcinoma E. pulmonary hypertensive disease, etiology unclear 97. ONE KODACHROME. Coronary artery A. fibrous plaque without complications B. fresh thrombus C. hemorrhage into a plaque D. medial calcific sclerosis ("Monckeberg's") * E. recanalized thrombus 98. TWO KODACHROMES. How old is the myocardial infarct? A. moments, no infarct is visible * B. 4 days C. 3 weeks D. more than 3 months E. uh, this is pericardial mesothelioma 99. ONE KODACHROME. What's wrong with the heart? * A. anemia B. carbon tetrachloride poisoning C. fresh infarct D. metastatic cancer E. old infarct 100. TWO KODACHROMES. Heart. A. amyloidosis B. Dressler pericarditis C. endocarditis D. endocardial fibroelastosis * E. mural thrombi BONUS ITEMS. 101. TWO KODACHROMES. Heart and peripheral blood. Your best diagnosis. Be specific. [thrombotic thrombocytopenic purpura / TTP, must have one or the other] 102. TWO KODACHROMES. Blood and marrow. Your best diagnosis. Be specific. [Burkitt's / L3] 103. ONE KODACHROME. What do we call the rod-shaped inclusions in the cytoplasm? [Auer rods] 104. ONE KODACHROME. Blood. What's your diagnosis? [sickler] 105. ONE KODACHROME. What do we call the hyaline accumulation within the cell at the center? [Russell body] 106. ONE KODACHROME. Which subtype of Hodgkin's? [nodular sclerosis] 107. Which chemotherapeutic agent is best-known for its ability to induce a dilated cardiomyopathy? [adriamycin, accept anthracycline, any -rubricin, red death] 108. What's a hibernating myocardium? [inadequate oxygen so does not beat but does not die] 109. What's the name of the newly-described cause of sudden cardiac death which a pathologist might recognize by studying areas of fatty ingrowth? [I need the word "right" and something about ventricle] 110. What did the people in Quebec drink in their beer that was bad for their hearts? [cobalt] 111. You may know "endothelially-derived relaxation factor" better by its simpler name, which is: [nitric oxide, no credit for nitrOUS oxide] 112. What's "interstitial emphysema"? [connective tissue bubbles] 113. How does one get a chylothorax? [thoracic duct injury] 114. What does the direct Coombs test check for? [antibody on the red cells / you may also mention complement] 115. Which disease features those distinctive "bird in flight" crystals? [SC] 116. How many copies of the gene for the beta chain of hemoglobin does a normal red cell precursor possess? [2] 117. What's a Howell-Jolly body? [stray chromosome in a red cell] 118. Why do people with sickle cell anemia tend to get gallstones? [I need something about "bilirubin"] 119. Sydenham's chorea is triggered by infection with what micro- organism? [strep] 120. ONE KODACHROME. Why is this man smiling? [all quacks smile, +1 for any reasonable answer]