YouTube lectures

I started a YouTube channel (MTPathologyDoc) and will gradually add short lectures (5-10 minutes each) on a variety of basic pathology topics, directed towards medical students and pathology trainees. The first lecture posted was on the histologic dating of myocardial infarcts.

Kindle book: General and cardiovascular pathology image questions

The general and cardiovascular pathology image questions recently posted on this site were combined with image questions from http://www.pathologyreviewforstep1.com to produce a book with 120 image questions total in a Kindle format, for those who may prefer that method for reviewing the questions.

The price of the book is $2.99 (which is the lowest price we could offer, presumably because of the Mb size of the book, as our other two books without questions (and thus of a smaller Mb size) could be priced at $0.99).

The image book (Question Book 1.3) will be a free download on Amazon from 5/4/2020 to 5/8/2020.

The link for the book is: https://www.amazon.com/Pathology-Review-Image-Questions-pathology-ebook/dp/B0871PHRQS/ref=sr_1_3?dchild=1&keywords=kemp%2C+pathology&qid=1588298013&sr=8-3

Questions 261-265: Cardiovascular pathology with images

Question 261

A 53-year-old male dies as the result of blunt force injuries sustained during a motor vehicle accident. The pathologist performing the autopsy identifies a 1.5 cm lesion in the interventricular septum. The microscopic appearance of this lesion is illustrated in the image below. During a conversation with the decedent’s wife, he asks if her husband had complained of chest pain recently, and she says he had. Of the following, how much time elapsed between his chest pain and his death?

A. One or two hours
B. One or two days
C. One or two weeks
D. One or two months
E. One or two years

Question 262

A 56-year-old male driver loses control of his vehicle on the ice during a snowstorm and is hit by a semi-truck. He sustains lethal head injuries. A forensic pathologist performs an autopsy and identifies the pathologic condition illustrated in the slide. Of the following, if this individual had survived the car accident, which condition would he have been most at risk for developing?

A. A dilated cardiomyopathy
B. Hemopericardium due to free wall rupture
C. Aneurysm of interventricular septum
D. Acute mitral insufficiency
E. Angiosarcoma of the heart
F. Liposarcoma of the heart

Question 263

A 31-year-old female with no significant past medical history presents to an acute care clinic with complaints of chest pain that occurs even when she is resting. Her physical examination discloses a friction rub. Neither physical examination nor chest x-ray reveals any consolidation of the lungs. If the image below is illustrative of the pathologic condition causing her symptoms, of the following, what is the most likely etiology?

A. Massive acute myocardial infarct (2 days old)
B. Metastatic neoplasm
C. Staphylococcal bacterial infection
D. Viral infection
E. Trauma

Question 264

A 61-year-old male with a past medical history of treated hypertension and a 45 pack-year smoking history dies as the result of a motor vehicle accident. During the autopsy, the forensic pathologist identifies the lesion illustrated below during dissection of the proximal portion of the left anterior descending coronary artery. Examination of the myocardium reveals no pathologic lesion. Of the following, which best explains why no remote infarct was identified?

A. Redundancy of the left anterior descending coronary artery
B. Presence of extensive collateral circulation
C. Protective effects of nicotine
D. Protective effects of hypertension
E. Heterozygosity for LDL receptor mutation

Question 265

A 53-year-old male was found dead in his bed by a friend who had come over to take him to a baseball game. On the bed next to him was a syringe with residue that tested presumptively positive for methamphetamine. An autopsy was performed and revealed the histologic change identified below. Of the following, an abnormal concentration of which electrolyte was most likely responsible for causing this change?

A. Magnesium
B. Sodium
C. Potassium
D. Calcium
E. Phosphorus

Questions 256-260: General pathology with images

Question 256

A forensic pathologist is performing an autopsy on a 29-year-old G0PO female who died in a motor vehicle accident. The pathologist identified the pathologic finding illustrated below. Of the following, assuming that the woman has a syndrome, what is autopsy also likely to identify?

A. Rocker bottom feet
B. A single palmar crease
C. Hypoplastic parathyroid glands
D. Atrophic ovaries
E. Congenital absence of the ovaries

Of the following, what would genetic testing most likely reveal?

A. Trisomy 21
B. Trisomy 18
C. Absence of one X chromosome
D. CGG repeats on the X chromosome
E. Deletion of 22q11.2

Question 257

A 28-year-old female presents to an acute care clinic. Two days before, she was working in her garden when she stuck herself with a thorn on her rose bushes. She has no allergies to any substance that she knows of and has been stuck by thorns before; however, this time, she developed the reaction illustrated in the image. Of the following, which mediator most significantly contributed to the pathologic change?

A. IL-1
B. ICAM-1
C. Leukotriene B4
D. PGI2
E. Eotaxin

Question 258

A 37-year-old male is brought to the emergency room by his girlfriend, who states that over the past two days he has become lethargic after a bout of fever, chills, and cough. An x-ray reveals patchy consolidation of both lungs. He sustains a cardiac arrest during his evaluation and is unable to be resuscitated. An autopsy confirms the x-ray findings and also reveals enlargement of the liver, with a representative histologic section below. Of the following, which test would best identify his risk factor for the condition identified in the liver?

A. A PPD test
B. Hepatitis serologic testing
C. HIV test
D. CA-125 for tumor
E. ACE

Of the following, which stain would help the pathologist identify the pathologic condition illustrated in the image?

A. Acid-fast bacillus (AFB) stain
B. Trichrome
C. Hemosiderin
D. Mucicarmine
E. Oil-red-O for fat

Question 259

A 52-year-old homeless male is found unresponsive on the ground adjacent to his camp site by a friend. For the past three days, he had been complaining of a cough, which was occasionally productive. He also voiced having a fever and chills. Upon arrival of emergency medical services, he was found to be asystolic. The coroner was summoned and determined that an autopsy was necessary to determine the cause of death. The microscopic examination identifies the histologic change exhibited in the following two images (one is low power and one is high power). Of the following, what was the most likely etiology for his death?

A. Bacterial infection
B. Viral infection
C. Parasitic infection
D. Neoplastic proliferation
E. Trauma
F. Acute drug toxicity

Question 260

A 23-year-old male was stabbed in the chest during a confrontation over the sale of illicit drugs. He was transported to hospital, where emergent surgery was performed to drain his hemopericardium and repair the superficial incised wound of his heart. Several days later, while still hospitalized, he develops severe hypotension, sustains a cardiac arrest, and is unable to be resuscitated. An autopsy is performed which identifies a vasculitis associated with intramural thrombosis as illustrated below. Of the following, what was the mechanism of the vasculitis?

A. Type I hypersensitivity reaction
B. Type II hypersensitivity reaction
C. Type IV hypersensitivity reaction
D. Delayed effects of physical trauma
E. Bacterial infection
F. Fungal infection

Questions 251-255: General pathology with images

Question 251

A 37-year-old male presents to the emergency room complaining of fever, chills, malaise, and a non-productive cough that has developed over five days. A chest x-ray reveals patchy infiltrates. His disease process is illustrated in the image below. Of the following, what was the most likely etiology for his infection?

A. Hiking in California
B. Inadequate childhood vaccination
C. Working at tuberculosis clinic
D. Intravenous drug use
E. Unprotected sexual contact

Question 252

A 56-year-old black female over the past year has developed stiffness of her hands and when she goes outside in the cold, she often develops white discoloration of the distal third of her fingers and sometimes an accompanying blue discoloration of the distal tips of the fingers. She is referred to a rheumatologist who performs a punch biopsy of the skin, which is illustrated below. Of the following, the antibody responsible for her condition is directed against which substance?

A. Ro/SS-A
B. Cyclic citrullinated peptides
C. Double-stranded DNA
D. Smith antigen
E. DNA topoisomerase I

Question 253

A 41-year-old immunocompetent male develops fever, chills, some mild shortness of breath, and a non-productive cough and goes to an acute care clinic. The doctor has a chest x-ray performed, which reveals patchy infiltrates of the lungs. The image below illustrates the organism causing his infection. During his examination, the doctor asks about recent travel, and he states that he recently got back from a hiking trip. Of the following, which state did he most likely visit?

A. Washington
B. California
C. Montana
D. Michigan
E. New Mexico

Question 254

A researcher is studying acute inflammation in mice as a model for humans. Assuming the same mediators are present, of the following, which is most directly responsible for the position of the cells at the star?

A. P-selectin
B. ICAM-1
C. CD20
D. CD31
E. Eotaxin
F. Neutrotaxin

Question 255

A forensic pathologist is testifying in court regarding an alleged homicide, in which a woman was beaten by a man and later died. At the time of autopsy, he took sections of the skin from the injuries and a section from the most vital injury in the court case is illustrated below. If asked to give an approximation of the time lapsed between the injury and death, of the following, which would be the best response?

A. Immediate
B. Around 30 minutes
C. Around 12 hours
D. Around 6 days
E. Around two weeks

Questions 246-250: Cardiovascular pathology with images

Questions 246

A 62-year-old male is diagnosed with metastatic colonic adenocarcinoma, and, the following day, commits suicide with his handgun. The pathologist performing the autopsy identifies that the kidneys appear granular, not smooth. Histologic examination of the kidney reveals the finding illustrated in the image below. Of the following conditions, which is most likely described in this man’s past medical history.

A. Long-standing hypertension
B. Recent onset severe hypertension
C. Plasma cell neoplasm
D. Notation of a flank bruit
E. Ehlers-Danlos type IV

Question 247

A forensic pathologist is examining sections of a coronary artery from a man who died in a motor vehicle accident from blunt force injuries of the head and identifies the lesion illustrated in the image below. Of the following, which played the most significant role in developing the feature indicated by the star (i.e., just the region of the pale white-tan band)?

A. Smooth muscle cells
B. LDL receptor
C. Scavenger receptor
D. EBV receptor
E. Nicotinic acid receptor

Question 248

A pathologist is examining the heart from a 43-year-old male patient who died as the result of a self-inflicted gunshot wound. The only pathologic finding is illustrated below. Of the following, what was the most likely etiology?

A. Infection with cytomegalovirus
B. Age
C. Past rheumatic fever affecting the aortic valve
D. Systemic hypertension
E. Coronary artery disease

Question 249

A 52-year-old male is playing racquetball with a friend when he suddenly develops a sharp pain in his chest that radiates to his back. He informs his friend of his pain, but says that he thinks he pulled a muscle and he wants to continue playing; however, his friend takes him to the emergency room instead. If the image below illustrates the underlying cause of his clinical symptoms. Of the following, what would physical examination most likely reveal?

A. A fixed split S2
B. An S4
C. A crescendo-decrescendo systolic murmur
D. A decrescendo diastolic murmur
E. A mid-systolic click
F. An opening snap

Question 250

A forensic pathologist is examining the body of an individual who died suddenly and unexpectedly and identifies the pathologic finding illustrated in the image. Given that the right ventricle is not normally present at the apex of the heart and given that both sections in the image are from the same individual and are representative of the pathology, of the following, what was the most likely cause of death?

A. Metastatic carcinoma
B. Acute myocardial infarct
C. Pulmonary thromboembolus
D. Dilated cardiomyopathy
E. Hypertrophic cardiomyopathy
F. Arrhythmogenic right ventricular dysplasia

Questions 241-245: Cardiovascular pathology with images

Question 241

A 53-year-old male with a past medical history of hypertension is working with his wife in the garage when he complains of a sharp pain in his chest. He says that he thinks he pulled a muscle and goes inside the house to lie down. Three hours later, she finishes her work in the garage and goes inside to check on him and finds him dead. The county coroner orders an autopsy, which identifies the pathologic condition pictured in the image. Of the following, what was the most likely cause for its development?

A. Ruptured myocardial infarct
B. Coronary artery dissection
C. Aortic dissection
D. Inflammation of the pericardium
E. Hemorrhage into a pericardial tumor

Question 242

A 57-year-old male with a history of hypertension and hyperlipidemia often has a relatively brief pressure sensation in his chest after climbing four flights of stairs; however, today, he has much more severe pressure in his chest while at rest and the sensation lasts 30 minutes. His wife calls an ambulance. The pathologic lesion causing his symptoms is pictured below. What histologic change is identified by the arrow?

A. Coagulative necrosis
B. Liquefactive necrosis
C. Metastatic calcification
D. Dystrophic calcification
E. Caseous necrosis
F. Hemosiderin

Question 243

A forensic pathologist is examining histologic sections in her office one afternoon and identifies the histologic feature illustrated below. Of the following, what is the most likely cause of the individual’s death?

A. Viral infection of myocardium
B. Multiple myeloma
C. Delayed death after untreated chest trauma
D. Dysrhythmia after resuscitated myocardial infarct
E. Parathyroid gland hyperplasia

Question 244

A 25-year-old male collapses while playing basketball with friends. He is taken to the emergency room, but despite aggressive resuscitation, he does not survive. An autopsy is performed. Histologic examination of the heart reveals the pathologic change illustrated below. Of the following, which would have been found on gross examination of the heart?

A. An atrial septal defect
B. Fatty infiltration of wall of right ventricle
C. Thick interventricular septum
D. Anomalous origin of a coronary artery
E. Severe coronary artery atherosclerosis

Of the following, a mutation of which protein is most commonly associated with this disease entity?

A. Plakoglobin
B. LDL receptor
C. IL-7
D. CD31
E. β-myosin heavy chain gene

Question 245

A 62-year-old male presents to his family physician complaining of chest pain, which he describes as occurring after a consistent amount of physical exertion for the last three months and which lasts about 10 minutes. He has had no other symptoms associated with his chest pain. If the image illustrates the lesion causing his symptoms, of the following combinations, which best describes his symptoms and his underlying pathology?

A. Stable angina; vulnerable plaque
B. Stable angina; complicated plaque
C. Unstable angina; vulnerable plaque
D. Unstable angina; complicated plaque
E. Variant angina; vulnerable plaque
F. Variant angina; complicated plaque

Questions 236-240: General pathology with images

Question 236

A 62-year-old male is mowing his lawn when he suddenly feels a pressure in his chest. He finishes mowing the lawn and then tells his wife, who calls an ambulance. He is admitted to the hospital from the emergency room. A troponin I obtained 3 hours after the episode of chest discomfort is elevated. Of the following, which would be most characteristic of the cell indicated by the yellow arrow?

A. Triglyceride accumulation
B. Swelling of rough endoplasmic reticulum
C. Plasma membrane blebs
D. Nuclear chromatin clumps
E. Fragmentation of nucleus

Question 237

A pathologist is performing an autopsy on a 9-month-old infant. Gross examination of the liver identifies the parenchyma to be slightly firm and vaguely nodular. Microscopic examination of the liver reveals the findings illustrated in the slide below. Of the following, what substance is accumulating in the liver?

A. Glucocerebroside
B. Sphingomyelin
C. Iron
D. Cholesterol
E. Thorotrast

Question 238

A forensic pathologist performs an autopsy on a 42-year-old male with a strong family history of sudden cardiac death who died unexpectedly five days after a minor surgical procedure. The pathologist identifies severe coronary artery atherosclerosis as the cause of death, but the region of the minor surgical procedure is shown below. Of the following, what was most likely present at the location of the yellow star at the time of the surgical procedure (the black line roughly outlines the rest of the pathologic process)?

A. A neoplasm
B. Deposits of hemosiderin
C. Aggregates of lymphocytes
D. Sheets of neutrophils
E. Parasites

Question 239

A 64-year-old male with a long-standing history of diabetes mellitus underwent an amputation of the distal portion of the right foot. Six months previously, he had undergone an amputation of the great toe and 2nd digit of the same foot. Of the following, what has occurred at the site of the first amputation?

A. Scarring by primary intention
B. Scarring by secondary intention
C. An abscess
D. Ulcer
E. Foreign body granulomas

Question 240

A 34-year-old male with recently diagnosed AIDS secondary to an untreated HIV infection presents to the emergency room with complaints of malaise and decreased urine production. Laboratory testing reveals an elevated BUN and creatinine. The image illustrates the etiology of his renal abnormalities. Of the following, what is the most likely cause?

A. Cryptococcus neoformans
B. Staphylococcus aureus
C. Mycobacterium tuberculosis
D. Entamoeba histolytica
E. Cytomegalovirus

Questions 231-235: Cardiovascular pathology with images

Question 231

A pathologist is examining a section of aorta from a 37-year-old male who died in a motor vehicle accident. Grossly, he saw linear slightly raised yellow lesions at the intimal surface. Histologic examination of these pathologic findings revealed the lesion illustrated below. Of the following, what was the cell type from which the feature indicated at the arrow originated?

A. An adipocyte in the adventitia
B. Displaced endothelial cell
C. A blood neutrophil
D. A blood monocyte
E. A blood eosinophil

Question 232

A 12-year-old male had a recent cold that included a cough and sore throat; however, his parents did not take him to the emergency room or his pediatrician at that time. However, over the past two days, he has developed a rash and a pain in his left knee. If the image illustrates the pathologic cause of his current symptoms, of the following, what might physical examination also reveal?

A. Peripheral edema
B. Hepatomegaly
C. Increased JVD
D. Subcutaneous nodules
E. Painful red nodules on the shins

Question 233

A 61-year-old female with insulin-dependent type II diabetes mellitus presents to the hospital with complaints of diarrhea and wheezing. During her evaluation in the emergency room, a nurse mistakenly gives her a dose of potassium instead of insulin after which she sustains a cardiac arrest. An autopsy is performed. A carcinoid tumor of the appendix with metastatic spread to the liver and the pathologic condition of the mitral valve illustrated in the image below is identified. Of the following, which other pathologic finding that is related to the mitral valve lesion may also be present?

A. Mitral annular calcification
B. Fusion of aortic valve commissures
C. Thick interventricular septum
D. Ventricular septal defect
E. Angiosarcoma of the heart

Histologic examination of the heart from this 61-year-old patient would reveal which of the following

A. Extensive amyloid deposits
B. Lipofuscin
C. Aschoff nodules
D. Granulomas
E. Aggregates of calcium

Question 234

A 32-year-old male is playing basketball with his friends, when he develops sudden onset shortness of breath and a continued stabbing chest pain. He attributes the symptoms, although fairly severe, to a pulled muscle and continues to play. Twenty minutes later, while getting water for fatigue and lightheadedness, he collapses. His friends call the ambulance, but, upon arrival to the emergency room 15 minutes later, he is pronounced dead. Autopsy reveals a dilated aortic root and an aortic dissection, with histologic examination of the aorta revealing the pathologic change illustrated below. Of the following, what is another pathologic condition commonly associated with his disease process?

A. Ankylosing spondylitis
B. Hypertrophic cardiomyopathy
C. Cirrhosis of the liver
D. Colonic adenocarcinoma
E. Myxomatous mitral valve

Question 235

A 34-year-old male has been told he has a heart murmur since he was a child. He presents to a family physician for a comprehensive physical examination, during which a Grade II/VI crescendo-decrescendo murmur is heard at the right 2nd intercostal space. His PMI is not sustained. If the image below is representative of his pathologic condition, of the following, which is he at greatest risk for developing within the next few years?

A. Cor pulmonale
B. Sudden cardiac death
C. Severe right ventricular hypertrophy
D. Infective endocarditis
E. Atrial myxoma

Questions 226-230: Cardiovascular pathology images

Question 226

A 43-year-old male is brought to the emergency room by his family members who said that he has been complaining of a bad headache for two days and then today began to act confused. If the pathologic change illustrated below is characteristic of his disease process, of the following, what feature might be identified upon physical examination?

A. Jugular venous distention
B. A new crescendo-decrescendo systolic murmur
C. Pulsus alternans
D. Retinal hemorrhages
E. Pedal petechiae

Question 227

A 51-year-old male presents to the emergency room. He says that 30 minutes ago, he started to have a severe pressure in his chest that also involves his left and right arm, and that he feels nauseous. He has no significant past medical history, but has smoked 2 packs of cigarettes per day since he was 17 years old. Other than a heart rate of 105 beats per minute, his physical examination is unremarkable. A blood draw for troponin I is ordered immediately upon his arrival to the emergency room and found to be within a normal range. His EKG has no changes. Given that the pathologic change illustrated in the image is the cause of his symptoms, which of the following most likely explains the normal troponin I concentration during laboratory testing?

A. Specimen mix-up
B. Factious low concentration due to hypercholesterolemia
C. Insufficient time since onset of symptoms
D. Competing serologic factor
E. Angina-like non-cardiac chest pain

Question 228

A 53-year-old male is walking with his wife on the sidewalk near their house when he starts to complain of a pressure in his chest. They turn around to return to the house and when they reach the door he collapses. Other than treated hypertension, he has no other past medical history. His brother sustained a myocardial infarct at the age of 49 years. Of the following, laboratory testing prior to his death may have revealed which abnormality that is a risk factor for his condition illustrated in the image?

A. Elevated HDL
B. Reduced LDL
C. Hypochloremia
D. Hyperhomocysteinemia
E. Hyperkalemia

Question 229

A 71-year-old male who has no significant past medical history and has not seen a physician in 30 years presents to the emergency room with complaints of a pressure-like pain in his chest after minor exertion. If the pathologic condition illustrated in the image below is the cause of his symptoms, of the following, what is the most likely mechanism for its development?

A. Recurrent Streptococcal infections
B. Hypercholesterolemia
C. Cigarette smoking
D. Metastatic calcification
E. Dystrophic calcification

Examination of the heart would most likely reveal which of the following additional pathologic changes?

A. Right ventricular hypertrophy
B. Left ventricular hypertrophy
C. Metastatic parathyroid carcinoma
D. Myxomatous change of mitral valve
E. Granulomatous inflammation

Question 230

A 62-year-old male with a past history of hypertension for 15 years, treated with medication, and with a 60-pack-year smoking history tells his wife who he is bowling with him that he suddenly developed abdominal pain. He says he is going to go to the car to take a break and tells her to finish her game. Thirty minutes later, she finds him unresponsive in the car, dead. An autopsy is performed, which identifies a hemoperitoneum and the pathologic condition that is the cause is illustrated in the image. Of the following choices, which is the most likely etiology of his condition?

A. Syphilis infection
B. Bicuspid aortic valve
C. Matrix metalloproteinase imbalance
D. Glycogen storage disorder
E. Past episode of abdominal trauma