36. There's no longer much doubt that the underlying cause of most left-sided congestive heart failure is A. aortic valve disease B. previous infarction C. renal failure D. right-sided heart failure * E. systemic hypertension 37. In congestive heart failure, part of the reason that the process of self-perpetuating is probably failure of reuptake of what substance by the sarcoplasmic reticulum? A. ATP/ADP * B. calcium C. magnesium D. potassium E. sodium 38. You're a primary care physician in the small town of Virtue, Kansas. But your strong pathology background has gotten you a job doing the rare forensic autopsy. You just autopsied Joe, a 21 year old college kid who dropped over dead while playing in the local rock band, and the cause of death isn't obvious on "gross". While you're waiting for the toxicology report to come back, which would NOT make you suspect that he's died of cocaine? A. a little infarct in his heart, in the absence of coronary atherosclerosis * B. a small carcinoma in the nasopharyngeal mucosa C. dilated, flabby heart D. myocarditis on microscopy E. single-fiber necrosis on microscopy 39. Your next forensic autopsy in Virtue, Kansas, leads to your having to explain to the coroner (a political appointee all about the "piezoelectric effect". This time, the person most likely died of: A. cocaine heart (direct effect on the charged membranes) B. electrocution (lighting, household) * C. getting hit D. iron overload (electromagnetism) E. ischemia resulting in an arrythmia ("electrical death") 40. Speaking of sudden and mysterious deaths... the most common cause of hypertrophic cardiomyopathy is: A. excessive, poorly-planned exercise B. high blood pressure * C. mutant beta-myosin D. secondary to other cardiac malformations E. none of these 41. Which is LEAST LIKELY to produce emboli? A. atrial myxoma B. bacterial endocarditis lesions C. Libman-Sacks endocarditis * D. McCallum's plaques E. mural thrombus after myocardial infarction 42. Which is the most common explanation for dilated cardiomyopathy? A. alcoholism B. amyloidosis C. identified virus * D. idiopathic E. iron overload 43. In the 1990's, a new technique for chest compressions of CPR was tested, but the study got trashed because both the experimental and control groups did so poorly. What was used on the experimental patients? A. baboon heart B. bicycle pump C. Kirksville crunch D. open-chest cardiac massage * E. toilet plunger 44. Most patients with syndrome X microvascular angina have underlying A. amyloidosis B. "collagen-vascular disease" * C. diabetes D. hypertension E. thrombophilia (micro-clots in the small vessels) 45. In 1996, controlled studies refuted the recent media claim that special protection from atherosclerosis was provided by * A. drinking red wine with tannins B. eating fish with omega-three fatty acids in their oils C. eating pork from transgenic pigs D. taking generous doses of vitamin E E. using a popular, widely-promoted exercise machine 46. Which patient is LEAST LIKELY to get a pulmonary embolus? A. a pregnant woman with lupus B. a 45 year old schizophrenic with severe varicose veins of the legs C. a Republican with factor V Leyden and antithrombin III deficiency who sits cross-legged on the whole flight from Tokyo to New York. D. a 75-year-old man with cor pulmonale from his emphysema (blue bloater) E. a 75-year-old woman in traction following multiple bony fractures of the lower half of her body sustained as a result of doing a "low hook" at the local skydiving zone 47. Clinically, what's the most common single, identifiable cause of ARDS ("adult respiratory distress syndrome", "diffuse alveolar damage")? A. cancer chemotherapy B. cigaret smoking C. multiple trauma D. pulmonary emboli * E. sepsis 48. In the classic "chronic bronchitis" patient, most of the obstruction of airflow is due to A. copious mucous secretions B. hyperplasia of the bronchial glands * C. loss of elastic recoil D. thickening of the bronchial basement membrane E. upper airway problems, as in sleep apnea 49. Wheezing is LEAST LIKELY to be due to A. asthma B. carcinoid syndrome C. left-sided heart failure D. pulmonary embolus * E. right-sided heart failure 50. You've autopsied the first suspected case of hantavirus pneumonia in Virtue, Kansas. The kid was previously healthy. You are LEAST LIKELY to find * A. bronchial ulcers B. early fibrosis C. hyaline membranes D. hyperplasia of type II pneumocytes in alveoli E. inflammation confined to the interstitium 51. What's the disease in which the T4 cells migrate to the site of inflammation, leaving the blood depleted and thus simulating AIDS? A. aspiration B. Glanzmann's C. oat cell carcinoma D. Pelger-Huet * E. sarcoidosis 52. Often-bizarre autoimmune syndromes are common in A. herpes infection of the upper GI tract B. mercury poisoning from fillings * C. oat cell lung cancer D. sarcoidosis E. squamous cell lung cancer 53. Which is NOT a usual feature of thrombotic thrombocytopenic purpura? * A. autoimmunity B. fever C. kidney failure D. schistocytes in the blood E. small thrombi in the blood vessels 54. All cause excessive blood coagulability EXCEPT: A. antiphospholipid antibody B. mutant factor V Leiden * C. mutant factor VIII:R D. protein C deficiency E. protein S deficiency 55. Fragile vessels A. Bernard-Soulier B. Gaucher's C. Glanzmann's D. Kasabach-Merritt * E. Osler-Weber-Rendu 56. "Birds in flight" crystals. A. Hemoglobin C disease B. Ringed sideroblasts * C. Sickle-C disease D. Sickle cell disease E. Thalassemia major 57. How many alpha-globin genes are gone or bad in hemoglobin H disease? A. 1 B. 2 * C. 3 D. 4 E. 0, trick question, it's beta chains that are gone 58. What's the cause of paroxysmal nocturnal hemoglobinuria? A. bacterial infection B. genetic mutation, inherited * C. genetic mutation, somatic (i.e., clone within the body) D. protozoan infection related to malaria E. viral infection 59. A person with untreated pernicious anemia is LEAST LIKELY to have A. brain damage B. jaundice * C. reticulocytosis D. spinal cord damage E. stomach cancer 60. The prussian-blue-positive granules in a ringed sideroblast are A. endoplasmic reticulum B. euchromatin C. heterochromatin D. lysosomes * E. mitochondria 61. Which is the antibiotic which often suppressed red cell production, sometimes permanently? * A. chloramphenicol B. ristocetin C. tetracycline D. vancomycin E. none of these 62. Which is NOT a current suspected cause of at least some kind of non-Hodgkin's lymphoma? A. certain exotic poinsettias B. Epstein-Barr virus * C. gym steroids D. hair dye E. Kaposi's virus / herpes 8 63. And which is infamous as cause of adult T-cell lymphomas? A. Epstein-Barr virus B. HIV * C. HTLV-1 retrovirus D. insecticide exposure E. some herpes virus 64. Most acute leukemia in kids derives from * A. B-cells B. neutrophil precursors ("myeloid", "myelogenous") C. null lymphocytes D. T-cells E. none of these 65. Which is NOT evidence that it's malignant lymphoma rather than a reactive lymph node? A. all cells make kappa chains, none make lambda B. effacement of the normal architecture C. history of "Dilantin" phenytoin anticonvulsant use * D. lots of variation in lymphocyte shape and size E. spread of the process into the adjacent fat 66. Which is NOT one of the typical early symptoms or findings in common malignant lymphoma? * A. anemia B. fatigue and malaise C. fever D. night sweats E. weight loss 67. If you have an identical twin with it, you are much more likely than not to get it yourself. A. type I juvenile-onset insulin-dependent diabetes * B. type II adult-onset non-insulin-dependent diabetes C. both D. neither E. C & D 68. Elevated blood amylase strongly suggests A. heart attack B. island cell tumor C. lymphoma * D. pancreatitis E. pulmonary embolus 69. ONE KODACHROME. Which is NOT a feature of "athlete's heart"? A. greater contractility B. greater stroke volume C. hypertrophy with lateral displacement of the apex impulse * D. rhythm disturbances E. slower rate 70. ONE KODACHROME. Blood smear showing * A. blasts, cannot tell what kind B. blasts, probably lymphoid C. blasts, definitely myeloid D. normal basophils E. normal lymphocytes 71. TWO KODACHROMES. Esophagus. What's wrong? * A. cancer B. candidiasis C. herpes D. reflux E. varices 72. ONE KODACHROME. Heart with A. amyloid restrictive cardiomyopathy B. dilated cardiomyopathy * C. hypertrophic cardiomyopathy D. myocardial abscess, as in a diabetic E. myocardial infarct 73. ONE KODACHROME. Lymph node with * A. Burkitt's lymphoma B. catscratch fever or something similar C. Hodgkin's disease D. infectious mononucleosis or something similar E. some other kind of lymphoma 74. ONE KODACHROME. Lung with A. ARDS (shock lung, diffuse alveolar damage) B. atelectasis without ARDS * C. pneumonia, probably bacterial D. pneumonitis, probably viral E. pulmonary embolus 75. ONE KODACHROME. This lymphoma is derived from * A. B-cells B. cells from a cellular telephone C. lymphatic vessels D. monocytes E. T-cells 76. ONE KODACHROME. If your neutrophils all look pretty much like this, you have A. Alder-Reilley B. Gaisbock's C. May-Hegglin * D. Pelger-Huet E. sepsis 77. ONE KODACHROME. Mitral valve exhibiting A. acute rheumatic fever B. bacterial endocarditis C. Barlow's floppy prolapse D. calcification of the annulus * E. old rheumatic fever damage 78. ONE KODACHROME. Lymph node. It's..... A. Burkitt's * B. Hodgkin's C. immunoblastic lymphoma D. small cleaved lymphoma E. small noncleaved lymphoma 79. TWO KODACHROMES. Which kind of lung cancer? A. adenocarcinoma B. Hodgkin's, I am so tricky C. mesothelioma * D. oat cell (small cell) carcinoma E. squamous cell carcinoma 80. ONE KODACHROME. Lung lesion. What is it? * A. lesion of "pulmonary hypertension" B. pneumonia, probably bacterial C. pneumonitis, probably viral D. pulmonary embolus E. normal lung, I am so tricky 81. TWO KODACHROMES. Lung lesion. What is it? A. pneumonia B. mesothelioma C. oat cell carcinoma D. squamous cell carcinoma * E. none of these 82. ONE KODACHROME. Blood. What's it show? * A. blasts of myeloid origin B. blasts, but you can't tell what kind C. ehrlichiosis D. infectious mononucleosis E. May-Hegglin 83. ONE KODACHROME. Island of Langerhans. What's wrong? A. cancer B. type I diabetes * C. type II diabetes D. some kind of diabetes, cannot tell which E. no morphologic abnormality 84. ONE KODACHROME. What kind of lung cancer? A. adenocarcinoma B. Hodgkin's C. mesothelioma D. oat cell * E. squamous cell 85. TWO KODACHROMES. The patient had A. ARDS * B. emphysema C. pneumonia D. pneumocystis E. pulmonary emboli 86. ONE KODACHROME. Mitral valve with * A. acute rheumatic fever B. Barlow's C. bacterial endocarditis D. old rheumatic fever scarring E. rupture 87. FOUR KODACHROMES. The dude has A. adenocarcinoma * B. mixed tumor / pleomorphic adenoma C. salivary gland stone D. squamous cell carcinoma E. Warthin's papillary cystadenoma lymphomatosum 88. ONE KODACHROME. Mitral valve with A. acute rheumatic fever * B. Barlow's C. bacterial endocarditis D. old rheumatic fever scarring E. rupture 89. FOUR KODACHROMES. The dude has A. adenocarcinoma B. mixed tumor / pleomorphic adenoma C. salivary gland stone D. squamous cell carcinoma * E. Warthin's papillary cystadenoma lymphomatosum 90. ONE KODACHROME. Blood from a patient with A. hemoglobin C disease B. iron deficiency * C. sickle cell disease D. spherocytosis E. thalassemia minor 91. ONE KODACHROME. Aortic valve with A. acute rheumatic fever B. bacterial endocarditis * C. calcific stenosis D. old rheumatic fever damage E. tetralogy of Fallot 92. ONE KODACHROME. Aortic change probably due to * A. atherosclerosis B. blunt injury C. dissecting aneurysm D. stab wound E. syphilitic aneurysm 93. TWO KODACHROMES. Lung. What's the diagnosis? A. adenocarcinoma * B. asbestosis C. Hamman-Rich D. squamous cell carcinoma E. oat cell carcinoma 94. THREE KODACHROMES. What's the matter? A. pneumocystis B. pneumonia, probably bacterial C. pneumonitis, probably viral * D. pulmonary emboli E. trauma 95. THREE KODACHROMES. Gut. The many faces of * A. adenocarcinoma B. helicobacter C. lupus D. squamous cell carcinoma E. ulcer disease 96. THREE KODACHROMES. What's wrong with this lung? A. cancer B. histoplasmosis * C. pneumocystis D. pneumonia, probably bacterial E. pneumonitis, probably viral 97. TWO KODACHROMES. What's your diagnosis of the spinal lesion? A. histiocytosis X B. Hodgkin's, probably C. myelofibrosis * D. plasma cell myeloma E. some kind of lymphoma 98. TWO KODACHROMES. Heart with A. histoplasmosis B. hypertrophic cardiomyopathy * C. infarct, 3 days old D. infarct, 20 days old E. myocarditis, probably viral or autoimmune 99. ONE KODACHROME. What's the esophageal lesion? A. Barrett's B. candida * C. herpes D. reflux E. squamous cell carcinoma 100. ONE KODACHROME. What's the lung lesion? A. consistent with legionellosis B. fibrosing alveolitis C. oat cell carcinoma * D. some kind of cancer, but not oat cell E. virus infection BONUS ITEMS 101. TWO KODACHROMES. Why do patients with this lung disease get hypercalcemia? [activation of vitamin D] 102. ONE KODACHROME. Menetrier's of the stomach. What was recently implicated as the cause? [helicobacter] 103. ONE KODACHROME. What's the stuff inside the ventricle in this endocardial fibroelastosis case? [thrombus] 104. ONE KODACHROME. What was wrong with this aorta? [dissection] 105. ONE KODACHROME. These "lacunar" variants indicate which type of Hodgkin's? [nodular sclerosing] 106. ONE KODACHROME. What's the cell of origin of this lymphoma? [T-cell] 107. What's the disease in which patients may say they're coughing up jello, and has a hereditary form caused by lack of a surfactant apoprotein? [alveolar proteinosis] 108. What do rheumatic fever, SIDS, and cardiomyopathy of pregnancy have in common, epidemiologically. [diseases of poverty] 109. You're most likely to see hypercalcemia in which type of lung cancer? [squamous] 110. What is "Christmas disease"? [hemophilia B / IX deficiency] 111. Exposure to benzene is a risk factor for what cancer which you studied in for this exam? One word is sufficient. [leukemia] 112. What's "Waldeyer's ring"? [lymphoid stuff in your throat / tonsils or whatever] 113. What is "Gaisbock's"? [idiopathic secondary polycythemia] 114. What looks like a tennis racket with a five-layered handle? [Birbeck granule / histiocytosis x body] 115. What is aphthous stomatitis? [those white things, +1 for any correct answer, but] [zero if you say herpes or cold sores or anything about] [blister] 116. What's the name for the painful oral lesions typically caused by coxsackie A? HINT: It's a stupid and misleading name. [herpangina] 117. What's a "rum belly"? [pancreatitis] 118. What's the Zollinger-Ellison syndrome due to? Be specific. [gastrinoma] 119. What was the movie "Death in the West" about? One sentence to show me you know. [show me you know] 120. Why is this man smiling? [200 hits per day on the new "autopsy" website!] [+1 for any correct answer] NAME: ___________________ 100 points University of Health Sciences Pathology Exam III -- 1996-7 INSTRUCTIONS: For the multiple choice items, choose the one best answer. There are a few type-K questions from Quizbank. For the matching items, use each choice exactly once. For the fill-in-the-blank items, we're prefer that you use ink. Think before you write. If there is evidence of erasure, we cannot reconsider the scoring of a contested item. If you have a question, raise you hand and I'll get with you. Please do not phonate. The first person finished posts the key. Write your challenges on it. You are also allowed to follow the standard procedure (see Bryan or me for a challenge form) -- but why wait? THIS EXAM IS HARD. TRYING TO CARE FOR PATIENTS WITHOUT UNDERSTANDING DISEASE IS MUCH HARDER. GOOD LUCK!