MATCHING! Liver poisons! A. acetaminophen B. anabolic steroids from the gym C. aspirin D. phosphorus E. vinyl chloride 36. Cholestasis is the usual picture [B] 37. It's probably at least part of the Reye's story [C] 38. Like eclampsia, produces necrosis in the periportal areas [D] 39. Massive necrosis a few days after ingestion [A] 40. The distinctive cause of hepatic angiosarcomas [E] MATCHING! The molecules of diabetes! A. C-peptide B. FGF3 (fibroblast growth factor 3) C. glucokinase D. glutamic acid carboxylase E. hemoglobin A1c 41. autoantigen in type I diabetes [D] 42. has an extra glucose molecule attached [E] 43. marker that a person is still producing his or her own insulin* [A] 44. mutated in maturity onset diabetes of the young [C] 45. one gene likely to be mutated in common type II diabetes [B] MATCHING! Pancreatic island cell adenomas! A. gastrinoma B. glucagonoma C. insulinoma D. pancreatic peptide producing adenoma E. VIPoma 46. Incidental curiosity at autopsy [D] 47. Pancreatic cholera is no joke [E] 48. Sore tongue in a new diabetic [B] 49. Whipple's triad! [C] 50. Zollinger-Ellison, MEN-I, and a stomach full of ulcers [A] MATCHING. Endocrine syndromes you should not miss! A. Adrenal cortical insufficiency B. Conn's syndrome C. Cushingism D. Hyperthyroidism E. Hypothyroidism 51. cold and rough skin, high cholesterol, slows down [E] 52. diabetes, flushed face, hypertension, obesity, osteoporosis [C] 53. diarrhea, heat intolerance, mental changes, tremor [D] 54. hyperkalemia, nausea, weight loss, sudden death [A] 55. hypertension and hypokalemia without other problems [B] MATCHING: Five goiters! A. De Quervain's B. Graves' C. Hashimoto's D. nodular goiter E. Ridel's 56. At least a few mutations; clonal selection and all that [D] 57. Lots of busy thyroid cells [B] 58. Lots of fibroblasts [E] 59. Lots of granulomas [A] 60. Lots of lymphocytes, some germinal centers [C] MATCHING: The hypertension family! A. Goldblatt hypertension B. hemolytic-uremic syndrome C. hyperthyroidism D. malignant hypertension E. pheochromocytoma 61. I neglected my hypertension until it began actually killing my arteries [D] 62. My brother had his parathyroids out, and my sister died of some rare kind of thyroid cancer, and now my head hurts [E] 63. My pyelogram showed severe stenosis of the ostium of my right renal artery [A] 64. My renal biopsy features this finely-granular stuff between my GBM and my endothelial cells [B] 65. My systolic is high, and my diastolic low, it's the diastolic that's important, isn't it? [C] MATCHING. Folks at extra risk for particular kidney tumors. A. angiomyolipoma B. renal cell carcinoma C. transitional cell carcinoma of the renal pelvis D. Wilms' nephroblastoma E. none 66. Child born with Brushfield's spots, single palmar creases, epicanthic folds, mild hypothyroidism, large tongue, and mild mental retardation [E] 67. Child born with really funny-looking eyeballs, and bigger on one side than the other [D] 68. Old guy who's spent his entire life working in the dye factory and smoking cigarets [C] 69. Retarded man with adenoma sebaceum ("erasers" stuck to the muzzle of the face), nodules on the brain, seizures, and ash-leaf spots on the skin [A] 70. Young adult man with hemangiomas on the retina and a pack of Marlboros rolled into his T-shirt sleeve, and who had one kidney shrivel up years ago from a bad infection; carries a family diagnosis of "Von Hippel-Lindau" whatever that is... [B] 71. ONE KODACHROME. These gallstones are composed primarily of A. calcium bilirubinate B. calcium stearate * C. cholesterol D. chromium picolinate E. peanut butter and jelly 72. ONE KODACHROME. Liver lesions of * A. alcoholism B. biliary obstruction C. iron overload D. sepsis E. toadstool poisoning 73. ONE KODACHROME. Read my liver biopsy! A. acute hepatitis pattern B. biliary obstruction with bile lakes C. hemochromatosis * D. hepatocellular carcinoma E. normal liver 74. ONE KODACHROME. Read my liver biopsy! A. biliary obstruction with bile lakes * B. Dubin-Johnson C. hemochromatosis with cirrhosis D. hemangioma E. hepatocellular carcinoma 75. ONE KODACHROME. Read my liver biopsy! A. acute hepatitis consistent with viral disease B. amyloidosis C. Dubin-Johnson * D. hemangioma E. hepatocellular carcinoma 76. ONE KODACHROME. Read my liver biopsy! A. acute hepatitis consistent with viral disease B. alcoholic liver disease * C. amyloidosis D. hemochromatosis with cirrhosis E. hepatocellular carcinoma 77. ONE KODACHROME. What's with this gallbladder? A. acute cholecystitis B. anaplastic biliary duct / gallbladder adenocarcinoma C. hepatocellular carcinoma, extended here D. Phrygian cap * E. Rokitansky-Aschoff sinus 78. ONE KODACHROME. Cysts like this in an adult's liver usually mean there are going to be even more cysts in the A. brain B. gall bladder * C. kidneys D. pancreas E. testis 79. ONE KODACHROME. Two slices of liver, one dipped in Prussian Blue. Which is LEAST LIKELY to have been among the owner's resulting problems? * A. accelerated atherosclerosis B. cardiac rhythm problems C. glucose in his urine D. loss of his libido E. pain in his joints 80. ONE KODACHROME. Which bug is the usual cause? * A. Escherichia coli B. Proteus mirabilis C. Pseudomonas aeruginosa D. Staphylococcus E. Streptococcus 81. TWO KODACHROMES. Which glomerular lesion? A. diffuse proliferative B. foot-process disease, either minimal-change or FSGS C. lupus, with wire loops * D. membranous glomerulopathy E. vasculitis, consistent with Wegener's 82. ONE KODACHROME. The renal lesion is probably A. autosomal dominant polycystic kidneys * B. autosomal recessive polycystic kidneys C. glomerulonephritis D. poisoning E. trans-stygian kidneys (acquired dialysis cystic disease) 83. THREE KODACHROMES. These glomerular lesions are MOST CONSISTENT with A. diffuse proliferative post-streptococcal glomerulonephritis B. focal-segmental glomerulosclerosis C. IgA nephropathy D. membranous glomerulopathy * E. vasculitis, maybe Wegener's 84. ONE KODACHROME. You are LEAST LIKELY to see this onion-skin lesion A. in hemolytic-uremic syndrome * B. in lupus C. in malignant hypertension D. in scleroderma E. you're kidding, the picture shows no onion-skin lesion 85. ONE KODACHROME. What's the cell of origin of this common adult tumor? A. distal tubule B. glomerular epithelium ("podocytes") * C. proximal tubule D. medullary tubules E. any cell, since the problem is in the mitochondria 86. ONE KODACHROME. Look carefully, and trust what you see and what you know. This is the renal MEDULLA. Among the following, the patient is MOST LIKELY to have A. acute tubular necrosis B. acute pyelonephritis C. chronic pyelonephritis * D. post-streptococcal glomerulonephritis E. sickle cell hemoglobin 87. TWO KODACHROMES. Histology and IgA fluorescence stain. This lesion is MOST LIKELY to produce A. acute tubular necrosis * B. mild glomerular hematuria C. nephrotic syndrome D. progression to Henoch-Schonlein purpura E. rapidly-progressive glomerulonephritis 88. FOUR KODACHROMES. The fluorescence stain is for IgG. The renal lesion is most likely: * A. acute post-streptococcal glomerulonephritis B. Goodpasture's disease C. membranous glomerulonephritis D. minimal change disease E. wire-loop lesions, therefore probably lupus 89. FOUR KODACHROMES. The renal lesions depicted here A. result, at least in part, from hypertension B. contribute to hypertension * C. both D. neither E. C & D 90. THREE KODACHROMES. Something is wrong with the pancreas. What is it? A. acute hemorrhagic pancreatitis * B. adenocarcinoma C. chronic pancreatitis in a problem drinker D. diabetes type I lesion E. pseudocyst 91. ONE KODACHROME. "Sclerosis", as in "diabetic glomerulosclerosis", means a great deal of extra: A. dense type I collagen B. cellularity C. cholesterol-rich material, as in "atherosclerosis" * D. mesangial matrix / basement membrane E. mucin 92. TWO KODACHROMES. Something is wrong with the pancreas. What is it? * A. acute hemorrhagic pancreatitis B. adenocarcinoma C. chronic pancreatitis in a problem drinker D. diabetes type I lesion E. pseudocyst 93. TWO KODACHROMES. Which type of testicular lesion? A. abscess B. choriocarcinoma * C. embryonal cell carcinoma with yolk sac campaigned D. Leydig cell adenoma E. seminoma with lymphocytes 94. ONE KODACHROME. Bladder biopsy.... * A. carcinoma in situ B. Hunner's interstitial cystitis C. normal D. squamous cell carcinoma E. squamous metaplasia 95. TWO KODACHROMES. Prostate gland with * A. adenocarcinoma B. infarct C. marked hyperplasia D. prostatitis E. tuberculosis 96. ONE KODACHROME. The young dude has A. adrenogenital syndrome B. epispadias * C. hypospadias D. precocious tinea crurus ("jock itch") E. torsion of the testis 97. ONE KODACHROME. Which type of testicular tumor? A. choriocarcinoma B. embryonal cell carcinoma * C. Leydig cell adenoma D. seminoma E. none, the dude has mumps 98. Education prepares you for the unexpected. The guy has A. angiokeratoma of the scrotum B. crab lice C. scabies D. seminoma of the testis * E. tuberculosis of the epididymis 99. Which type of thyroid cancer? A. anaplastic B. lymphoma C. medullary * D. papillary E. none, this is De Quervain's 100. ONE KODACHROME. Which type of adrenal tumor? A. carcinoma B. cortical adenoma C. ganglioneuroma * D. neuroblastoma E. pheochromocytoma BONUS ITEMS: 101. What is the name for the common, harmless variant of Crigler- Najjar syndrome? [Gilbert's] 102. An extremely devoted marathon runner presents with elevated transaminases, gets a liver biopsy, turns out to have nothing unusual except for necrosis and regeneration, and some extra iron, in the central areas. Why? [ischemia] 103. What do Ito cells store? [Vitamin A] 104. What important and valuable therapeutic agent is well-known to produce cirrhosis of the liver? [methotrexate] 105. Why is phlebotomy superior to chelation therapy for primary hemochromatosis? [cost OR safety] 106. Why is chelation therapy superior to phlebotomy for secondary hemochromatosis? [if you have secondary disease, you can't REPLACE red cells] 107. Mid-zonal hepatic necrosis is the hallmark of... [yellow fever] 108. What is macroamylase? Don't just say "big amylase". [bound to an antibody] 109. What is the "twinkie defense" in criminal law? [diminished criminal responsibility from reactive hypoglycemia] 110. What is Kimmelstiel-Wilson disease? Be specific. [glomerular change of diabetes; you're allowed to omit "nodular"] 111. What's the derivative of glucose that's known to precipitate in the lens, forming the diabetic cataract? [sorbitol] 112. When do you see islands of Langerhans packed with eosinophils? [baby of a diabetic mother] 113. What infectious agent gives rise to malakoplakia in the bladder, and struvite stones in the kidney? [proteus] 114. Mention the one known lifestyle risk for cancer of the testis? [lack of exercise] 115. Why would you be likely to hear bruits over renal cell carcinomas and toxic goiters? [increased blood flow, of course] 116. What's a "Hurthle cell"? [packed with mitochondria] 117. What's the hormone produced by medullary carcinoma of the thyroid? [calcitonin] 118. What is myxedema? [increased ground substance typical of thyroid disease] 119. SUPPORT was a $28 million project which, without any measurable success, tried to do what? [get physicians to communicate with their dying patients] 120. Why is this man smiling? [TB can sure make you skinny, +1 for any correct answer] UNIVERSITY OF HEALTH SCIENCES PATHOLOGY EXAM IV 1995-1996 INSTRUCTIONS As usual. Any questions? Ask quietly. For the matching items, use each choice once. * * * "Do not be arrogant because of your knowledge, but confer with the ignorant man as with the learned. Good speech is more hidden than malachite, yet it is found in the possession of women slaves at the millstones." -- Ptahhotpe, c. 2350 B.C.