Pathology I — Midterm 2 Practice Questions

Which is NOT a complication of myositis ossificans? Options: Malignant transformation / Joint stiffness / Limited range of motion / Pain

Malignant transformation

An 80-year-old woman presents with chronic knee pain, which worsens with activity and improves with rest. She also reports stiffness in the morning that resolves within 30 minutes. Options: Osteoarthritis / Gout / Rheumatoid arthritis / Paget disease

Osteoarthritis

Which seronegative spondyloarthropathy often presents with low back pain that improves with activity? Options: Ankylosing spondylitis / Gout / Rheumatoid arthritis / Scleroderma

Ankylosing spondylitis

Which cellular defect is primarily responsible for the pathogenesis of osteopetrosis? Options: Decreased osteoclast activity / Increased osteoblast number / Hyperfunctioning chondrocytes / Enhanced osteoid deposition

Decreased osteoclast activity

A patient with Paget disease sustains a fracture of the femur. What type of fracture is most typical? Options: Transverse fracture / Greenstick fracture / Spiral fracture / Wormian bones

Transverse fracture

A newborn with average trunk size and disproportionately short arms is most likely to be diagnosed with… Options: Achondroplasia / Osteopetrosis / Marfan syndrome / Osteogenesis imperfecta

Achondroplasia

Which risk factor is most strongly associated with an increased risk of developing osteoporosis? Options: High BMI / Early menopause / Male sex / African American ethnicity

Early menopause

A healthy postmenopausal woman is found to have a T-score of -2.8 on a routine bone density (DEXA) test. Options: Osteomalacia / Osteopenia / Osteoporosis / Normal bone density

Osteoporosis

Which anatomical region of a long bone is most frequently affected in typical cases of osteomyelitis? Options: Metaphysis / Epiphysis / Diaphysis / Periosteum

Metaphysis

Which complication is defined as the failure of bone ends to unite, forming a false joint with synovial fluid? Options: Delayed union / Nonunion / Pseudoarthrosis / Osteonecrosis

Pseudoarthrosis

A patient presents with joint pain, early morning stiffness improving within 15 minutes, and bony enlargements… Options: Osteoarthritis / Rheumatoid arthritis / Gout / Ankylosing spondylitis

Osteoarthritis

Which organ system is least likely to be affected in a patient with achondroplasia? Options: Cardiovascular / Hepatic / Renal / Neuromuscular

Cardiovascular

Impingement of cranial nerves by sclerotic bone is most likely to produce which complication? Options: Blindness and deafness / Headache only / Increased intracranial pressure / Peripheral edema

Blindness and deafness

A child presents with blue sclerae and recurrent fractures. Which gene defect is most likely responsible? Options: COL1A1 or COL1A2 / FGFR3 / APC / Rb

COL1A1 or COL1A2

In a patient with osteogenesis imperfecta, which dental abnormality is most likely to be seen? Options: Dentin deficiency / Enamel hyperplasia / Tooth ankylosis / Amelogenesis imperfecta

Dentin deficiency

Which laboratory abnormality is most characteristic of untreated rickets? Options: Decreased serum 25-hydroxyvitamin D / Elevated serum iron / Hyperkalemia / Hyperphosphatemia

Decreased serum 25-hydroxyvitamin D

Which type of osteogenesis imperfecta is considered the most severe and often incompatible with life? Options: Type II / Type I / Type III / Type IV

Type II

An adult patient is found to have a widened, soft pelvis and difficulties during labor. What childhood condition… Options: Untreated rickets / Osteopetrosis / Achondroplasia / Eosinophilic granuloma

Untreated rickets

Failure of which process is central to the development of osteomalacia and rickets? Options: Mineralization of osteoid matrix / Proliferation of growth plate cartilage / Formation of collagen / Osteoclast resorption

Mineralization of osteoid matrix

Osteosarcoma is most often associated with which clinical group? Options: Children and teenagers during growth spurt / Older men with prostate cancer / Adults with Paget disease only / Postmenopausal women

Children and teenagers during growth spurt

In addition to culture, what synovial fluid characteristics support the diagnosis of septic arthritis? Options: Turbid appearance, low viscosity, elevated lactate, high neutrophils / Clear, straw colored, high glucose, low WBC / Erythrocyte predominance only / Blue, opalescent, with high protein

Turbid appearance, low viscosity, elevated lactate, high neutrophils

Which of the following is NOT considered a first-line therapy for postmenopausal osteoporosis? Options: Bisphosphonates / Adequate vitamin D intake / Weight-bearing exercise / Corticosteroids

Corticosteroids

What is the mainstay of non-pharmacological management in osteoarthritis? Options: Regular exercise and weight reduction / High-dose corticosteroids / Methotrexate therapy / Prolonged bed rest

Regular exercise and weight reduction

Which feature distinguishes ankylosing spondylitis from other spondyloarthropathies? Options: Initial involvement of sacroiliac joint with progression to vertebral column / Predilection for peripheral joints only / Nodular skin lesions are common / Subchondral bone cyst formation

Initial involvement of sacroiliac joint with progression to vertebral column

Radiographs in advanced rheumatoid arthritis reveal which classical finding? Options: Marginal erosions of bone and joint space narrowing / Subchondral sclerosis only / Osteophyte formation exclusively / Codman triangle

Marginal erosions of bone and joint space narrowing

Which demographic is most affected by Graves disease? Options: Elderly men / Women aged 20-40 / Prepubertal boys / Neonates

Women aged 20-40

A 62-year-old woman presents with fatigue, weight gain, and constipation. Labs show elevated TSH and low T4. What is the diagnosis? Options: Secondary hypothyroidism / Primary hypothyroidism / Sick euthyroid syndrome / Subclinical hyperthyroidism

Primary hypothyroidism

Which therapy definitively treats Graves disease? Options: Propranolol / Methimazole alone / Radioactive iodine / Calcium supplements

Radioactive iodine

A 70-year-old woman with untreated hypothyroidism presents with hypothermia and altered mental status. What is the diagnosis? Options: Thyroid storm / Myxedema coma / Addison crisis / Hypoglycemia

Myxedema coma

What is the first-line diagnostic test? Options: TSH / Aldosterone-renin ratio / ACTH / Cortisol suppression

Aldosterone-renin ratio

A 48-year-old woman presents with depression and fatigue. Her TSH is mildly elevated but free T4 is normal. What is the diagnosis? Options: Overt hypothyroidism / Subclinical hypothyroidism / Hyperthyroidism / Thyroiditis

Subclinical hypothyroidism

Which respiratory complication occurs in myxedema coma? Options: Hyperventilation / Hypoventilation / Tachypnea / Stridor

Hypoventilation

A 48-year-old woman presents with fatigue and a firm, rubbery thyroid. Labs show elevated TSH and low T4. Which antibodies are expected? Options: Anti-TSI / Anti-TPO / Anti-PTH / Anti-calcitonin

Anti-TPO

A 40-year-old woman has a painless thyroid nodule with low RAIU uptake. What is the next best step? Options: TSH measurement only / Thyroid ultrasound / Observation / Start levothyroxine

Thyroid ultrasound

Which cardiac finding is most commonly associated with hypothyroidism? Options: Atrial fibrillation / Prolonged QT / Bradycardia / Pulmonary hypertension

Bradycardia

Which GI symptom is associated with thyroid storm? Options: Constipation / Diarrhea / Melena / Dysphagia

Diarrhea

Iodine deficiency predisposes to which cancer? Options: Papillary / Follicular / Medullary / Anaplastic

Follicular

Which lab finding supports myxedema coma? Options: High T4 / Low T4, high TSH / High TSH, high T4 / Low TSH, normal T4

Low T4, high TSH

Aldosterone causes which physiologic effect? Options: Potassium retention / Sodium retention / Proton retention / Calcium wasting

Sodium retention

Conn syndrome leads to: Options: Hypotension / Hypertension / Bradycardia / Cyanosis

Hypertension

Addison disease often presents with which metabolic condition? Options: Hyperglycemia / Hypoglycemia / Metabolic alkalosis / Respiratory alkalosis

Hypoglycemia

Which hormone regulates aldosterone secretion primarily? Options: ACTH / Renin-angiotensin system / Cortisol / CRH

Renin-angiotensin system

A patient with Graves disease shows lid lag. What causes this? Options: Optic nerve compression / Increased sympathetic tone / Eyelid scarring / Facial nerve palsy

Increased sympathetic tone

Which lab finding is characteristic of hyperaldosteronism? Options: High potassium / Low potassium / Low bicarbonate / High calcium

Low potassium

Mortality rate of untreated thyroid storm is approximately: Options: 10% / 20% / 40% / >75%

>75%

Which lipid abnormality is most strongly linked with hypothyroidism? Options: Low LDL / High LDL / High triglycerides alone / Low HDL

High LDL

A patient presents with muscle weakness and hyperreflexia. Which endocrine condition is most likely? Options: Hypothyroidism / Hyperthyroidism / Addison disease / Hyperaldosteronism

Hyperthyroidism

Which lab finding supports Hashimoto thyroiditis? Options: Low TSH / High T3 / Elevated anti-thyroglobulin antibodies / High RAIU

Elevated anti-thyroglobulin antibodies

Conn syndrome leads to which sodium abnormality? Options: Hyponatremia / Mild hypernatremia / Severe hypernatremia / Normal sodium

Mild hypernatremia

Conn syndrome can cause: HPA Axis Options: Tremor / Muscle cramps / Nausea alone / Hypercalcemia

Muscle cramps

Which vitamin deficiency results in megaloblastic anemia without neurological symptoms? Options: Vitamin B6 / Vitamin B12 / Folic acid / Vitamin D

Folic acid

Bouchard's nodes are osteophytes… Options: seen primarily in Psoriasis / seen in rheumatoid arthritis / seen in osteoarthritis affecting distal interphalangeal joints / seen in osteoarthritis affecting proximal interphalangeal joints

seen in osteoarthritis affecting proximal interphalangeal joints

This type of cell is neoplastic in Multiple myeloma: Options: Natural killer cell / Plasma cell / T cell / Macrophage

Plasma cell

What is the most common nutritional deficiency worldwide? Options: Vitamin D / Vitamin B12 / Iron / Folic acid

Iron

Which leukemia is most common in older adults? Options: ALL / CLL / CML / AML

CLL

Which of the following is a hallmark of aplastic anemia? Options: Isolated anemia / Pancytopenia / High platelets / Reticulocytosis

Pancytopenia

Which disease has the highest incidence among postmenopausal women? Options: Osteopetrosis / Osteoporosis / Osteomalacia / Osteomyelitis

Osteoporosis

Cushing syndrome can arise from _____. Options: Exogenous corticosteroids / Cushing disease / Primary adrenal adenoma / All answer choices

All answer choices

All are true regarding DIC (Disseminated Intravascular Coagulation), EXCEPT? Options: Consumptive deficiency of clotting factors and platelets / Massive and persistent activation of both coagulation system and fibrinolytic system / Etiologies can be due to amniotic fluid embolisms, infections, malignancy, and major traumas / Morbidity/mortality from DIC are not related to either thrombosis or hemorrhage

Morbidity/mortality from DIC are not related to either thrombosis or hemorrhage

The Philadelphia chromosome is associated with which leukemia? Options: ALL / CLL / AML / CML

CML

Based on the physical signs present, this patient is most likely experiencing high levels of which [hormone]? (image-based; image not readable as text) Options: Cortisol / Epinephrine / Growth hormone / Vasopressin

Growth hormone

Fracture of a bone where the bone protrudes from the skin is called _____. Options: Comminuted fracture / Pathologic fracture / Incomplete (greenstick) fracture / Compound fracture

Compound fracture

A patient with fatigue, sore tongue, and macrocytic anemia shows hypersegmented neutrophils on smear. Options: Iron deficiency anemia / Folate deficiency / Hemolytic anemia / Anemia of chronic disease

Folate deficiency

Which of the following is a benign tumor of the bone? Options: Osteosarcoma / Ewing's sarcoma / Osteochondroma / Chondrosarcoma

Osteochondroma

Reduced mineralization of osteoid matrix is the underlying defect in _____. Options: Osteoporosis / Osteonecrosis / Osteopetrosis / Osteomalacia

Osteomalacia

In this condition, neutrophils, that are responding to bacterial infection, destroy bone with enzymes… Options: Osteomalacia / Rickets / Paget's disease / Osteomyelitis

Osteomyelitis

A patient presents with a sudden onset of paroxysmal hypertension, severe throbbing headache, and excessive sweating… Options: Increase salt intake / Exercise / Tricyclic antidepressants (TCA) / Complete adrenalectomy

Complete adrenalectomy

All of the following are causes of anemia except: Options: Extramedullary hematopoiesis by spleen / Decreased production of RBC precursors by bone marrow / Acute hemorrhage / Intravascular hemolysis

Extramedullary hematopoiesis by spleen

Which leukemia is rare in young children? Options: ALL / AML / CML / CLL

CLL

What are 'punched out' lesions seen on x-ray in multiple myeloma? Options: Osteosarcoma / Pathologic fractures / Lytic bone destruction / Bone infarcts

Lytic bone destruction

In extravascular hemolysis, destruction of red blood cells usually takes place here: Options: Bone marrow / The arteries / The veins / The spleen

The spleen

Von Willebrand's factor is important in the adherence of platelets to the subendothelium as well as… Options: Factor IX / Factor VIII / Factor XI / Factor II

Factor VIII

Rachitic rosary, pigeon breast and bowing of legs are classic presentations associated with: Options: Hyperparathyroidism / Rickets / Paget's disease / Hypoparathyroidism

Rickets

In osteomyelitis, subperiosteal new bone formation around zone of inflammation is called: Options: sequestrum / woven bone / involucrum / reactive bone

involucrum

Osteoporosis occurs when bone loss exceeds bone formation. Options: True / False

True

A 70-year-old man with fatigue and lymphocytosis is found to have smudge cells. What is the likely diagnosis? Options: CML / CLL / ALL / AML

CLL

What is the neoplastic cell in multiple myeloma? Options: T cell / B cell / Plasma cell / Macrophage

Plasma cell

Which symptom is most likely in aplastic anemia? Options: Bone pain / Increased urination / Petechiae and infections / Weight gain

Petechiae and infections

A female patient has a hematocrit of 28%. What does this suggest? Options: Normal / Anemia / Polycythemia / Dehydration

Anemia

A patient has low serum iron, low ferritin, and high TIBC. What is the most likely diagnosis? Options: Iron deficiency anemia / Anemia of chronic disease / Sideroblastic anemia / Hemolytic anemia

Iron deficiency anemia

Which supplement is most commonly recommended during pregnancy to prevent anemia? Options: Vitamin B12 / Iron / Calcium / Zinc

Iron

Which intestinal disease can impair B12 absorption? Options: Celiac disease / Appendicitis / Ulcerative colitis / Constipation

Celiac disease

Which trimester sees the greatest increase in iron demand? Options: First / Second / Third / Postpartum

Third

Where does RBC destruction mainly occur in G6PD deficiency? Options: Kidneys / Liver / Spleen / Bone marrow

Spleen

A 65-year-old woman presents with anemia. Labs show low serum iron, low TIBC, and high ferritin. What is the diagnosis? Options: Iron deficiency anemia / Anemia of chronic inflammation / Thalassemia minor / Folate deficiency

Anemia of chronic inflammation

A 30-year-old patient with hereditary spherocytosis presents with early satiety and LUQ fullness. What is the cause? Options: Gastritis / Colon cancer / Splenomegaly / Pancreatitis

Splenomegaly

Which dietary habit most increases the risk of iron deficiency? Options: High red meat intake / Vegetarianism / Low dairy consumption / High fiber intake

Vegetarianism

A 5-year-old child presents with fever, bone pain, and blast cells on peripheral smear. What is the diagnosis? Options: AML / CML / ALL / CLL

ALL

Which malignancy is associated with overproduction of WBCs and leukocytosis? Options: Leukemia / Hemophilia / DIC / Myeloma

Leukemia

Iron deficiency can be exacerbated in children drinking too much of what? Options: Milk / Juice / Water / Soda

Milk

Aplastic anemia is associated with which of the following blood findings? Options: Leukocytosis / Pancytopenia / Polycythemia / Monocytosis

Pancytopenia

Which lab pattern supports anemia of chronic inflammation? Options: Low ferritin, high TIBC / Normal ferritin, low TIBC / High iron, low TIBC / Low MCV, high TIBC

Normal ferritin, low TIBC

Which hemolytic anemia is most associated with bite cells and Heinz bodies? Options: Sickle cell anemia / G6PD deficiency / Thalassemia / Autoimmune hemolysis

G6PD deficiency

In which condition does hemolysis primarily occur within the bloodstream? Options: Sickle cell anemia / G6PD deficiency / Autoimmune hemolytic anemia / Thalassemia major

Sickle cell anemia

Which lab result supports splenic sequestration as a cause of thrombocytopenia? Options: Normal platelet production in marrow / Low erythropoietin / Macrocytic anemia / Leukocytosis

Normal platelet production in marrow

A patient has macrocytic anemia and positive anti-intrinsic factor antibodies. What is the diagnosis? Options: Folate deficiency / Pernicious anemia / Thalassemia / Iron overload

Pernicious anemia

A patient on chemotherapy develops fever and a WBC count of 800/uL. What complication is most concerning? Options: Neutropenic fever / Thrombocytosis / Anemia / Iron overload

Neutropenic fever

A trauma patient receives a massive transfusion and develops oozing from IV sites. PT and aPTT are both prolonged. What does this indicate? Options: Primary hemostatic defect / Platelet dysfunction / Coagulation factor deficiency / Vascular fragility

Coagulation factor deficiency

A synovial fluid aspirate from a painful, inflamed joint in suspected septic arthritis reveals >100,000 WBC/mm3, predominantly neutrophils. What does this finding indicate? Options: Infected joint, likely bacterial origin / Viral arthritis / Crystalline arthritis (e.g., gout) / Noninflammatory effusion

Infected joint, likely bacterial origin

An elderly woman presents with wrist pain after falling on an outstretched hand. The X-ray shows a dinner fork deformity at the distal radius. What is the most likely diagnosis? Options: Colles fracture / Greenstick fracture / Comminuted fracture / Spiral fracture

Colles fracture