Path Final

The change in the brain of this 82-year-old man is an example of

Atrophy

A cervical biopsy of a 24-year-old woman shows a change in the expected columnar epithelium, which has been replaced by the stratified squamous epithelium lining the mucosal surface of the endocervical glands and revealing immature cells occupying the lower two-thirds of the epithelium. What is the best designation for the change?

Dysplasia

A 57-year-old woman has had increasing abdominal enlargement for six months. During the past two days, she developed a high fever. On physical examination, her temperature is 38.5° C. The abdomen is enlarged and diffusely tender and there is a fluid wave. Paracentesis yields 500 mL of cloudy yellowish fluid. The cell count is 532/μL with 98% neutrophils and 2% mononuclear cells. A blood culture is positive for Escherichia coli. The representative gross appearance of her liver is shown in the figure. Which of the following underlying diseases most commonly accounts for these findings?

Chronic Alcohol abuse

A 53-year-old woman undergoes a routine checkup. The only abnormal finding is a stool specimen that contains occult blood. Colonoscopy shows a 1.5 cm, solitary, rounded, erythematous polyp on a 0.5 cm stalk at the splenic flexure. The polyp is removed; its histologic appearance is shown in the figure at low (A) and high (B) magnifications. Her colonic lesion is most likely associated with which of the following?

Low risk for development of carcinoma

A 53-year-old woman with no prior illnesses has a routine checkup by her physician. She has a blood pressure of 150/95 mm Hg on examination. If her hypertension remains untreated for years, which cellular alterations would likely be seen in her myocardium?

Hypertrophy

A 22-year-old woman becomes pregnant. A fetal ultrasound examination at 13 weeks gestation shows her uterus measures 7 × 4 × 3 cm. At delivery of a term infant, her uterus measures 34 × 18 × 12 cm. Which of the following cellular processes has contributed most to the increase in her uterine size?

Myometrial smooth muscle hypertrophy

A 25-year-old woman breastfeeds her infant. On examination, her breasts are enlarged, and  Milk can be expressed from both nipples. Which of the following processes in her breasts during pregnancy enabled her to breastfeed the infant?

Lobular Hyperlasia

A 29-year-old man sustains a left femoral fracture in a motorcycle accident. His leg is placed in a plaster cast. After his left leg had been immobilized for six weeks, the diameter of the left calf decreased in size. This change in size is most likely to result from which of the following alterations in his calf muscles?

Atrophy

A 34-year-old obese woman has experienced heartburn from gastric reflux for the past 5 years after eating large meals. She undergoes upper gastrointestinal endoscopy, and a biopsy specimen of the distal esophagus is obtained. Which of the following microscopic changes, seen in the figure, has most likely occurred?

Columnar metaplasia

A screening chest radiograph of an asymptomatic 37-year-old man shows a 3 cm nodule in the middle lobe of his right lung. The nodule is excised with a pulmonary wedge resection, and sectioning shows a sharply circumscribed mass with a soft, white center. The microscopic appearance is shown in the figure. The serum interferon-gamma release assay is positive. Which of the following pathologic processes has most likely occurred in this nodule?

Granulomatous Inflammation

A 24-year-old, sexually active woman has experienced lower abdominal pain for the past day. Her temperature is 37.9° C, and the left lower abdomen is markedly tender on palpation. Laboratory findings include a total WBC count of 29,000/mm3 with 75% segmented neutrophils, 6% bands, 14% lymphocytes, and 5% monocytes. Laparotomy reveals a distended, fluid-filled, reddened left fallopian tube that is about to rupture. A left salpingectomy is performed. Which of the following is most likely to be seen on microscopic examination of the excised fallopian tube?

Liquefactive necrosis

A 68-year-old man has had worsening shortness of breath for the past week. On physical examination, his temperature is 38.3° C. On percussion, there is dullness over the left lung fields. Thoracentesis performed on the left pleural cavity yields 800 mL of cloudy yellow fluid with a WBC count of 2500/mm3 with 98% neutrophils and 2% lymphocytes. A Gram stain of the fluid shows gram-positive cocci in clusters. Which of the following terms best describes the process occurring in his left pleural cavity?

Purulent exudate

An 18-year-old man lacerated his left upper arm and required sutures. The sutures were removed one week later. Wound healing continued, but the site became disfigured over the next two months by the process shown in the figure. Which of the following terms best describes the process that occurred in this man?

Keloid formation

The most characteristic feature of a neoplasm in contrast to a reactive or inflammatory overgrowth, is the 

Autonomous growth

Carcinoma of which of the following sites has the __lowest__ survival rate? 

Lung

The word describes the undifferentiated, pleomorphic cells found in many malignant neoplasms

Anaplastic

What part of the microcirculation is most involved in the permeability of acute inflammation?

Venules

The warmth of an acutely inflamed skin lesion is due to

Hyperemia

Multinucleated giant cells of the foreign body type originate from

Fusion or nuclear division of macrophages

The principal cells of granulation tissue are

Fibroblasts and endothelial cells

Which of the following is the most characteristic of repair?

Granulation tissue

The keloid is composed predominantly of

Dense collagen

The least complicated repair of an incisional wound is referred to as?

Healing by primary intention

The figure below illustrates which of the following?

Hypertrophic scar

A person suffering for the condition depicted in the figure is most commonly associated with which of the following?

Thermal or Traumatic injury

The term cancer refers to which of the following?

A malignant neoplasm of epithelial or mesenchymal origin

An 18-year-old woman has a right breast tumor; the most likely diagnosis is?

Fibroadenoma

A malignant tumor of smooth muscle referred as?

Leiomyosarcoma

A 58-year obese woman developed uterine bleeding, and an endometrium biopsy showed that she had a malignant neoplasm; the most likely diagnosis would be?

Leiomyosarcoma

This 25-year-old woman developed a malignant neoplasm of the cervix; the most likely diagnosis is?

Squamous Cell Carcinoma

This 22-year-old woman developed a tumor of the ovary that contained segments of skin, hair, sebaceous glands, muscle, and gastrointestinal epithelium, a lesion of nature referred to as?

Mature Teratoma

Acute rheumatic endocarditis follows infections with 

Group A beta-hemolytic streptococci

In the initial attack of acute rheumatic fever, congestive cardiac failure results from 

Myocarditis

Which of the following is pathognomonic of active rheumatic fever? 

Aschoff body

The most frequent clinically significant residual lesion of acute rheumatic fever is 

Mitral stenosis

Which test is most helpful in substantiating a clinical diagnosis of infective endocarditis? 

Blood cultures

In North America, the organism most frequently responsible for infective endocarditis is 

Staphylococcus aureus

On her first prenatal physical exam, a 24-year-old woman was noted by her obstetrician to have a mid-systolic click on auscultation of the heart. The most likely reason for this physical finding would be

Mitral valve prolapse

The most common primary tumor of the heart is 

Myxoma

The most typical location for a cardiac myxoma is 

Left atrium

Hyaline arteriolosclerosis is characteristic of 

Diabetes mellitus

Which is usually associated with thromboangiitis obliterans (Buerger disease) 

Smoking

The most common cause of abdominal aortic aneurysms is 

Atherosclerosis

The deposition of basophilic, amorphous material in the media of the femoral artery characterizes 

Monckeberg sclerosis

Arteriosclerosis refers to a group of processes which 

Have in common the thickening and loss of elasticity of arterial walls

Which of the following types of emboli is most common?

Fat

The most common cause of lobar pneumonia is

Streptococcus pneumoniae

A patient has Cushing syndrome. Workup reveals laboratory evidence for increased serum ACTH, and a chest x-ray reveals a solitary lung mass. The most likely diagnosis is

Small cell carcinoma

Asbestos workers have an unusually high incidence of

Mesothelioma

Generalized subcutaneous accumulation of fluid is called

Anasarca

Fluid in the pleural cavity is called

Hydrothorax

Pulmonary congestion is usually due to?

Left-sided heart failure

Congestion of the Liver is usually due to?

 Right-heart failure

A hemorrhage over 1-2 cm sized subcutaneous hemorrhages is called

Ecchymoses

Coughing up of blood is called

Hemoptysis

Pulmonary thrombo-emboli usually arise from?

Venous system of the lower extremities

The earliest change in atherosclerosis is seen in the 

Intima

The degree of tissue necrosis resulting from arterial occlusion is most related to 

Availability of a collateral blood supply

The development of new blood channels through the granulation tissue replacing a thrombus in a blood vessel is known as

Recanalization

Which of the following types of emboli is most common? 

Fat

Edema associated with inflammation is due predominantly to 

Increased vascular permeability

A red infarct is seen in which of the following?

Lung

The 60-year-old woman has an ill-defined pulmonary mass in the peripheral surface of the right upper lobe of the lung

Adenocarcinoma

The diagnosis of this lesion is

Bowens Disease

(Carcinoma In-Situ; Erythroplasia of Queyrat)

Of the sites listed which is the most frequent site for metastatic spread of carcinoma of the lung is

Adrenal gland

A 59-year-old man has experienced chronic fatigue for 18 months. On physical examination, he is afebrile. A chest radiograph shows bilateral pulmonary edema and a prominent left heart border. The representative gross appearance of his heart is shown in the figure. Laboratory studies show serum glucose, 74 mg/dL; total cholesterol, 189 mg/dL; total protein, 7.1 g/dL; albumin, 5.2 g/dL; creatinine, 6.1 mg/dL; and urea nitrogen, 58 mg/dL. What is the most likely diagnosis?

Systemic hypertension

An 84-year-old nursing home resident with a known history of stable angina has recently complained of increasing dyspnea while performing everyday tasks. One morning, she is found dead in bed. Her heart has several scattered grey-white scars at autopsy in the left ventricular myocardium. Microscopically, she has diffuse myocardial atrophy, diffuse interstitial and patchy fibrous tissue, and grossly observed scars. This patient's condition is best designated as

Chronic Ischemic heart disease

A 58-year-old man had a myocardial infarction one year ago, the first significant illness. He now wants to prevent another acute coronary event and is advised to begin an exercise program and change his diet. A reduction in the level of which of the following serum laboratory findings one year later would best indicate the success of his diet and exercise regimen?

Cholesterol

A 58-year-old woman has experienced chest pain at rest for the past year. On physical examination, her pulse is 80/min and irregular. The figure shows the microscopic appearance representative of her left anterior descending artery. Which of the following laboratory findings is most likely to be involved in the pathogenesis of the process illustrated?

Low HDL cholesterol

A 61-year-old man has reported increasing fatigue over the past year. Laboratory studies show a serum creatinine level of 4.7 mg/dL and a urea nitrogen level of 44 mg/dL. An abdominal ultrasound scan shows that his kidneys are symmetrically smaller than normal. The representative high-magnification microscopic appearance of the kidneys is shown in the figure. These findings are most likely to indicate which of the following underlying conditions?

Systemic hypertension

In Rheumatic heart disease, which of the valve are most involved

Mitral valve alone

This 18- year- old young lady presented with periumbilical pain localizing to the right lower quadrant; nausea and vomiting; abdominal tenderness; mild fever; elevated WBC count of 15,000-20,000 cells/μL. The most likely diagnosis is?

Acute appendicitis

A 19-year-old man is advised to see his physician because genetic screening has detected the disease in other family members. On physical examination, a stool sample is positive for occult blood. A colonoscopy is performed, followed by a colectomy. The figure shows the gross appearance of the mucosal surface of the colectomy specimen. Microscopic examination shows these lesions are tubular adenomas. The diagnosis of the condition is?

Familial Adenomatous Polyposis (FAP) Syndrome

A 73-year-old man has noted a change in bowel habits for the past year. Defecation is more difficult, and the caliber of stools has decreased. On physical exam, there are no abnormal findings except for stool positive for occult blood. Colonoscopy is performed for the first time in this man, followed by colonic resection with the gross appearance shown in the figure. Which of the most likely diagnosis of this lesion

Adenocarcinoma

A routine physical examination of the 70-year-old African American man showed an indurated mass in the posterior lobe of the prostate gland on rectal examination, and laboratory screening showed an increased PSA was noted. Below is a photograph and photomicrograph of this patient's lesion, not the lesion indicated by the arrow.  

Nobular hyperlasia

A 57-year-old woman has had burning epigastric pain after meals for a year. Physical examination shows no abnormal findings. Upper gastrointestinal endoscopy shows an erythematous patch in the lower esophageal mucosa. A biopsy specimen shows basal zone squamous epithelial hyperplasia, elongation of lamina propria papillae, and scattered intraepithelial neutrophils with some eosinophils. Which of the following is the most likely diagnosis?

Reflux esophagitis

A 51-year-old man has a sudden onset of massive emesis of bright red blood. On physical examination, his temperature is 36.9° C, the pulse is 103/min, respirations are 23/min, and blood pressure is 85/50 mm Hg. His spleen tip is palpable. Laboratory studies show a hematocrit of 21%. The serologic test result for HBsAg is positive. He has had no prior episodes of hematemesis. The hematemesis is most likely a consequence of which of the following?

Esophageal varices

A 68-year-old man had "heartburn" and substernal pain after meals for 25 years. For the past year, he has had increased pain and difficulty swallowing liquids and solids. On physical examination, there are no remarkable findings. Upper gastrointestinal endoscopy shows an ulcerated lower esophageal mass that nearly occludes the lumen of the esophagus. A biopsy specimen of this mass will likely show which of the following neoplasms?

Adenocarcinoma

A 20-year-old woman in her ninth month of pregnancy has increasing pain on defecation and notices bright red blood on the toilet paper. She has had no previous gastrointestinal problems. After she gives birth, the rectal pain subsides, and there is no more bleeding. Which of the following is the most likely cause of these findings?

Hemorrhoids

The type of viral hepatitis that is most like to lead to chronic liver disease

Hepatitis C

The etiology of this lesion is

Squamous cell carcinoma of cervix. Sexually-active women are at risk of being infected. HPV serotypes 16, 18,31, 33 and 35 are associated w/ high-grade dysplasia and carcinoma

The terms “idiopathic” and “essential” refer only to

Used when the cause of the disease is unknown

The term “history” is associated with:

Symptoms

In the United States, which of the following represents the leading cause of death for the whole population?

Cardiovascular disease

A demonstrable lesions are present in patients with

Organic disease

The sign most closely related to pain is

Tenderness

…..is the prediction of the outcome of the disease, is contingent upon an accurate diagnosis, and is based upon knowledge of the natural history of the disease and its response to therapy is referred to as ?

Prognosis

the sequence of events in the development of disease from its earliest beginnings, including factors, which influence its development.

Pathogenesis

The usual course of a disease from beginning to end, without treatment, is known as the?

Natural history

This infant is noted to have the Sickle Cell trait upon testing, this is an example of which of following

Hereditary disease

The failure of development of a primitive structure of an organ is

Agenesis

Expansion or dilatation of small blood vessels is

Telangiectasis

A bad growth that is often a precursor for cancer

Dysplasia

The suffix ectasia refers to

Expansion or dilution

The suffix rhexis refers to

Rupture

Which of the following groups of tissue are all capable of regeneration?

 Colonic mucosa, liver, renal tubular epithelium

An increase in the size of an organ caused by an increase in the size of the constituent cells but not an increase in their number is called ?

Hypertrophy

A congenital decrease in the size of a developing tissue or organ is

Hypoplasia

Metaplasia is thought to be caused in most cases by

Chronic irritation

Mature squamous epithelium replacing the pseudostratified columnar epithelium normally in bronchial lining is an example of

Metaplasia