Kindle book: General pathology questions

The general pathology questions (207 questions total) from this blog and www.pathologyreviewforStep1.com are available in Kindle format and can be downloaded from Amazon.

The book is priced at $ 0.99, but from 2/24 to 2/28, the book will be free to download.

https://www.amazon.com/Pathology-Review-Questions-Question-General-ebook/dp/B0848HH2H4/ref=sr_1_2?keywords=kemp%2C+pathology&qid=1581806738&sr=8-2

Questions 193-198: Cardiovascular pathology

Question 193

A 47-year-old male presents to an acute care clinic with complaints of a cough, fever, and difficulty breathing with exertion. He was diagnosed with asthma 4 years ago, frequently has episodes of allergic rhinitis, and underwent removal of nasal polyps surgically 1 year ago. A complete blood count reveals an elevated concentration of eosinophils (13%). Laboratory testing also reveals the presence of MPO-ANCA (p-ANCA). A chest x-ray reveals patchy infiltrates. Of the following, what would a biopsy of the lung most likely reveal?

A. Granulomatous inflammation and eosinophilic infiltrates of vessels
B. Neoplastic eosinophils
C. Nematode infestation
D. Foreign material, consistent with IV drug abuse
E. Small cell carcinoma

Question 194

A 61-year-old female presents to the emergency room with her husband. She reports that over the past two days she has had a severe headache and pain in her jaw on the left side, and now for the past 4 hours she has had double vision. Of the following, what is the most likely diagnosis?

A. Temporal arteritis
B. A non-ST elevation myocardial infarct with embolized mural thrombus
C. Aortic dissection with involvement of carotid artery
D. Polyarteritis nodosa
E. Late-onset systemic lupus erythematosus

Question 195

A 60-year-old female presents to the emergency room. She reports that over the past four days she has had a headache, which worsened today, and is now associated with pain in her jaw on the left side. For the past 2 hours she has had blurry vision. Laboratory testing will reveal an increase in which of the following?

A. Troponin I
B. Alkaline phosphatase
C. ESR
D. D-dimer
E. TSH

Question 196

A 62-year-old male with systemic hypertension and a 35-pack-year smoking history presents to his primary care physician with complaints that over the past year he has had increasing shortness of breath when walking with his wife. While he used to be able to walk about a half of a mile, he can now only walk about 2 blocks before needing to stop. He also has shortness of breath at night and has started sleeping on two pillows and propped up in bed. Physical examination reveals an S3; however, there is no pitting edema of the lower extremities and his liver is not palpable. Of the following, which additional physical examination finding is most likely to be identified?

A. Elevated jugular venous distention
B. Massive splenomegaly
C. Crackles on auscultation of the chest
D. Bruit in the midportion of the right side of the back
E. Deviation of the tongue when extended

Question 197

A 48-year-old male presents to an acute care clinic complaining of worsening shortness of breath with exertion. He has not seen a physician in 20 years and considers himself healthy, eating a balanced diet and getting plenty of exercise. Physical examination reveals a harsh, late-peaking systolic murmur that is heard best at the 2nd right intercostal space and radiates to the carotid arteries. In addition, the point of maximal impulse is sustained and the second heart sound is difficult to hear. Of the following, what is the most likely diagnosis?

A. Aortic stenosis due to degenerative calcification of a bicuspid aortic valve
B. Aortic stenosis due to degenerative calcification of a tricuspid aortic valve
C. Aortic regurgitation
D. Mitral stenosis
E. Mitral regurgitation

Question 198

A 63-year-old female presents to her primary care physician. Yesterday she passed out while doing dishes, and for the past two weeks she has felt like her heart was beating irregularly and she sometimes she has shortness of breath while working in her vegetable garden. Her past medical history includes a laparoscopic cholecystectomy 25 years ago. Physical examination reveals an irregularly irregular pulse. Auscultation of her chest reveals no murmurs, gallops, or other abnormalities. If her disease process is not treated, of the following, which is she at greatest risk for?

A. Mitral stenosis
B. Atrial myxoma
C. Acute pericarditis
D. Local thrombosis of a coronary artery leading to acute myocardial infarct
E. Pulmonary hypertension
F. Acute cerebral infarct

Questions 189-192: Cardiovascular pathology

Question 189

A 25-year-old male graduate student is being seen by his family physician. Over the past two years, on several occasions during each year, he has developed several painful oral ulcers that resolved within about a week. Once during the last year, he developed a painful ulcer on his penis; however, he is not sexually active and did not seek treatment. Today, he presents with red lesions on his legs and he also reports a cluster of painful ulcers in his mouth. Of the following, in which country was he most likely born?

A. Turkey
B. Russia
C. Scotland
D. Brazil
E. Mexico

Question 190

A 26-year-old male is found unresponsive in his apartment after not reporting for work. An autopsy is performed, revealing a left hemothorax due to a ruptured thoracic aortic aneurysm. His past medical history includes recurrent oral ulcers, sometimes occurring in clusters, at least 5-6 times per year. The oral ulcers have been associated with occasional ulcers of the penis and several times, eye pain and redness. Of the following, which HLA type is associated with his disease process?

A. HLA B21
B. HLA B27
C. HLA B40
D. HLA B43
E. HLA B51

Question 191

A 46-year-old male, who was diagnosed with asthma 4 years ago, and has had one outpatient surgery for nasal polyps, presents to an acute care clinic with complaints of a cough, fever and dyspnea with exertion. A complete blood count reveals an elevated concentration of eosinophils (14%). A chest x-ray reveals patchy infiltrates. Additional laboratory testing reveals MPO-ANCA. Of the following, what is the most likely diagnosis?

A. Granulomatosis with polyangiitis
B. Exacerbation of asthma
C. Illicit drug reaction
D. Polyarteritis nodosa
E. Eosinophilic granulomatosis with polyangiitis

Question 192

A 49-year-old male, who was diagnosed with asthma 3 years ago and frequently has episodes of allergic rhinitis, presents to an acute care clinic with complaints of a cough and fever. A complete blood count reveals an elevated concentration of eosinophils (15%). A chest x-ray reveals patchy infiltrates. Additional laboratory testing reveals MPO-ANCA. Of the following, which test or procedure would best confirm the diagnosis?

A. Lung biopsy
B. Pneumonectomy
C. Pulmonary function tests
D. MRI of the chest
E. Echocardiogram

Questions 185-188: Cardiovascular pathology

Question 185

A 47-year-old female has a history of hypertension for many years that has been poorly controlled with medication. She is otherwise healthy and does not smoke. She decides to change physicians and her new physician conducts a thorough physical examination and identifies a bruit on the right side of the lower back. Of the following, which would best allow for definitive diagnosis of her underlying disease process?

A. Complete metabolic panel to include BUN and creatinine
B. Urine culture
C. Pelvic examination
D. Angiogram
E. CT scan of the abdomen

Question 186

A researcher is attempting to trigger intracerebral hemorrhage in laboratory rats to study the development of the condition. To facilitate this process, he is dosing the rats with various substances. A substance or combination of substances that does which of the following would have the best chance to produce an intracerebral hemorrhage?

Question 187

A researcher wishes to study hypertension in vitro. Their lab has perfected a way to remove vascular tissue from rats and maintain their viability for several hours in which to conduct their experiments. To induce hypertension, the vessel is exposed to a mixture of four substances (prostacyclin, kinins, thromboxane and endothelin). Which combination of concentrations of substances below would be most effective in inducing hypertension?

Question 188

A 23-year-old male presents to an acute care clinic complaining of pain in both his eyes and sensitivity to light that developed over night. He was no past medical history; however, he reports that he frequently develops ulcers in his mouth, about 5-6 times per year, which last for around 1 week, and four months ago he had a painful ulcer on his penis, which resolved over one week but he was afraid to report his symptoms. He has one sexual partner and they always use condoms for birth control. Of the following, what is the most likely diagnosis?

A. Herpes simplex infection
B. Syphilis
C. Cholesterol emboli
D. Drug reaction
E. Behcet disease

Questions 180-184: Cardiovascular pathology

Question 180

A 53-year-old male with a past medical history of hypertension for 15 years presents to the emergency room with complaints of a sharp tearing pain in his chest that radiates to his back. His admission blood pressure in the right arm is 171/100 mmHg and in the left arm is 137/80 mmHg. A chest x-ray reveals a widened mediastinum. Of the following, what is the most likely diagnosis?

A. Acute myocardial infarct with free wall rupture
B. Unstable angina
C. Hypertensive crisis
D. Aortic dissection
E. Pheochromocytoma

Question 181

A 55-year-old male with a past medical history of poorly controlled hypertension for 10 years presents to the emergency room with complaints of a sharp tearing pain in his chest that radiates to his back. His admission blood pressure in the right arm is 165/98 mmHg and in the left arm is 134/81 mmHg. A chest x-ray reveals a widened mediastinum. Of the following, histologic examination of the aorta would most likely reveal?

A. Extensive neutrophilic infiltration
B. Extensive granulomatous infiltration
C. Marked hemosiderin deposition
D. Marked lipofuscin deposition
E. Cystic medial degeneration

Question 182

A 63-year-old male with a known history of well-controlled hypertension that has been treated for 20 years dies in a motor vehicle accident after another driver runs a red light and strikes his vehicle. At the autopsy, which of the following pathologic findings is most likely to be identified by the pathologist?

A. Coarctation of the aorta
B. A nodule in the adrenal medulla
C. Retinal hemorrhages and papilledema
D. A pale eosinophilic acellular thickening of arterioles
E. A layered cellular proliferation of the wall of arterioles

Question 183

A 52-year-old male presents to the emergency room with a history of chest pain that began 2 hours ago. The pain has been unrelenting, and is associated with shortness of breath and nausea. Laboratory testing reveals an elevated troponin I and EKG reveals ST elevation in leads V3-V6. The pathologic process that was the cause of his symptoms originated in which of the following types of blood vessels?

A. Elastic
B. Muscular
C. Small arteries
D. Arterioles
E. Capillaries

Question 184

A 43-year-old male presents to the hospital with complaints of shortness of breath that has developed increasingly over the past year. Physical examination reveals bilateral crackles at the base of both lungs, but no murmurs or rubs. A chest x-ray reveals a bilateral pleural effusion at the lung bases. Laboratory testing reveals an elevated concentration of B-type natriuretic peptide. A CT scan of his trunk and head reveals a 3.5 cm mass at the left cerebral convexity. Surgical resection of the mass reveals it to be composed of an admixture of arteries and veins. Of the following, what was the mechanism for his presenting symptoms?

A. Cardiac metastases
B. Constrictive pericarditis
C. Focal bypass of capillaries
D. Childhood infection resulting in cardiac damage
E. Hypertensive due to increased intracranial pressure

Questions 175-179: Lung pathology

Question 175

A 54-year-old male with a 5 year history of increasing shortness of breath presents to his family physician at his wife’s insistence for further testing. He has a 50 pack-year smoking history. Physical examination reveals a barrel chest, and auscultation of his chest reveals decreased breath sounds and occasional wheezes, but no crackles. A chest x-ray reveals a flattened diaphragm and increase lucency of the lung fields. Which of the following mechanisms played the greatest role in the primary development of his disease process?

A. Protease-anti-protease imbalance
B. Recurrent infections
C. Airway hypersensitivity to nicotine
D. Allergen enhancement of tissue fibrosis
E. Neoplastic infiltration of pulmonary parenchyma

Question 176

A 35-year-old male with a 2 year history of increasing shortness of breath presents to his family physician for evaluation. He has a 15 pack-year smoking history. Auscultation of his chest reveals decreased breath sounds and occasional crackles. Pulmonary function testing reveals a decreased FEV1/FVC ratio. Of the following, which set of parameters best describes his disease process involvement of the lungs?

Question 177

A 32-year-old male with a 1 year history of increasing shortness of breath presents to his family physician for evaluation. He has a 10 pack-year smoking history. Auscultation of his chest reveals decreased breath sounds and occasional crackles. Pulmonary function testing reveals a decreased FEV1/FVC ratio. Of the following conditions, which is this patient at greatest risk for?

A. Early-onset degenerative aortic stenosis
B. Amyloidosis of the heart
C. Adenocarcinoma of the gallbladder
D. Hepatocellular carcinoma
E. Glioblastoma multiforme

Question 178

A 19-year-old female college student is being seen in the emergency room for an episode of severe dyspnea. In the last 5 years, she has had to go to the emergency room 4 times for a similar episode. Vital signs include blood pressure of 123/80 mmHg, heart rate of 112 bpm, and respiratory rate of 30 bpm. During inspiration, her systolic blood pressure decreases by 15 mmHg. Physical examination reveals her to be in acute distress. Auscultation of the chest reveals wheezes. The underlying mechanism of her disease process is which of the following?

A. Type I hypersensitivity reaction
B. Type II hypersensitivity reaction
C. Type III hypersensitivity reaction
D. Type IV hypersensitivity reaction

Question 179

A 13-year-old female is brought to the emergency room by her parents as she has developed severe dyspnea, and they can see her using the muscles in her neck to help her breath. Her mother has a history of developing a rash after working outside on occasions. Her vital signs include blood pressure of 119/78 mmHg, heart rate of 115 bpm, and respiratory rate of 32 bpm. During inspiration, her systolic blood pressure decreases by 16 mmHg. Physical examination reveals her to be in acute distress. Auscultation of the chest reveals wheezes. Of the following, which histologic change is most likely present in the lungs?

A. Loss of pulmonary parenchyma
B. Numerous granulomas
C. Infiltrates of neutrophils
D. Infiltrates of plasma cells
E. Infiltrates of eosinophils

Questions 171-174: Lung pathology

Question 171

A 31-year-old male is brought to the emergency room by friends because of his difficulty breathing. About 18 hours before his presentation to the emergency room, they reported he had been exposed to a benzene spill at his place of work. While he felt fine after the accident, his current symptoms have developed rapidly over the past 2 hours. Of the following, what is the most likely primary mechanism for his clinical presentation?

A. Insufficient amount of surfactant
B. Necrosis of alveolar epithelial cells
C. Tumor embolism
D. Delayed allergic reaction to the chemical exposure
E. Rapid overgrowth of bacteria

Question 172

A 25-year-old male has had a fever and cough productive of a thick yellow-green sputum for one week. He reports occasional sharp chest pain associated with the cough or breathing. Although he felt he had a cold that he could shake, he is now presenting to the emergency room, as over the past 2 hours, he has developed rapidly increasing shortness of breath. His vital signs are blood pressure of 142/83 mmHg, heart rate of 112 bpm, and respiratory rate of 30 bpm. Physical examination reveals no friction rub and the heart sounds do not sound distant. Of the following, which radiographic finding, if not already present, should develop shortly?

A. Bilateral opacities
B. A wedge-shaped opacity in the right lower lobe
C. A widened mediastinum
D. An enlarged cardiac silhouette
E. Diffuse consolidation of the entire lower lobe of the left lung

Question 173

A 71-year-old male with a 10 year history of Alzheimer’s disease is identified by nursing home staff to have labored breathing. He is taken to the emergency room where a physical examination reveals a blood pressure of 138/81 mmHg, respiratory rate of 29 bpm, and heart rate of 109 bpm. He is admitted to the hospital. Over the next 6 hours, his condition worsens with increasing shortness of breath, and he develops bilateral rales. A chest x-ray reveals bilateral opacities in the pulmonary parenchyma throughout. He has no friction rub, and no S3 or S4 are heard on auscultation of the heart. Microscopic examination of this lungs would reveal which of the following?

A. Proteinaceous exudates layered on the alveolar septa
B. Extensive lymphatic tumor micro-emboli
C. Innumerable microscopic venous thrombi
D. Extensive eosinophilic infiltrates
E. Extensive plasma cell infiltrates

Question 174

A 59-year-old male with a 3 year history of increasing shortness of breath presents to his family physician for further testing. He has a 45 pack-year smoking history. The dyspnea is not accompanied by chest pain. He also reports that he frequently coughs up thick sputum, often for months at a time over the past three years. Auscultation of his chest reveals decreased breath sounds and occasional wheezes and crackles. Of the following, which set of parameters is most consistent with his disease process?

Questions 166-170: Lung pathology

Question 166

A 62-year-old male non-smoker has been referred to a pulmonologist by his primary care physician for recurring respiratory infections. Over the past two years he has gradually gotten more short of breath with activity, and has a chronic non-productive cough. He has lost about 5 lb. in that time, but reports no night sweats. Despite several antibiotic courses, he has never gotten better. Physical examination reveals clubbing of the fingers and bi-basilar crackles. X-ray reveals a reticular pattern at the bases, but no effusion. Pulmonary function testing reveals a FEV1/FVC ratio of 81% and a reduced total lung capacity. Of the following, what is the most likely diagnosis?

A. Idiopathic pulmonary fibrosis
B. Congestive heart failure due to untreated systemic hypertension
C. Mycobacterium tuberculosis
D. Small cell carcinoma of the lung
E. Recurrent Staphylococcus aureus pneumonia

Question 167

A 46-year-old male presents to his family physician indicating that over the past 2 years he has had increasing shortness of breath associated with a non-productive cough and 20 lb. weight loss. He has not traveled outside of his home state of Montana; however, his main hobby is using carrier pigeons to send messages. Physical examination reveals bilateral fine crackles and clubbing of the fingers. Of the following, what is the most likely diagnosis?

A. Acute hypersensitivity pneumonitis
B. Chronic hypersensitivity pneumonitis
C. Usual interstitial pneumonia
D. Congestive heart failure
E. Aortic stenosis due to calcified bicuspid aortic valve

Question 168

A 49-year-old male with a history of chronic sinusitis that has been relatively refractory to medical treatment is brought to the emergency room by his wife because he has been coughing up a large amount of blood for the past two hours. In the week prior, he had developed cough, pain in his chest with breathing, and some shortness of breath. Assuming it was a bad cold, he wanted to wait it out, but the blood scared his wife. A chest x-ray reveals several areas of consolidation and a urinalysis reveals blood. Of the following, which is the most likely diagnosis?

A. Necrotic squamous cell carcinoma
B. Granulomatosis with polyangiitis
C. Disseminated Mycobacterium tuberculosis
D. Sudden onset congestive heart failure with massive hemoptysis
E. Pneumocystis jirovecki infection

Question 169

A 47-year-old male is brought to the emergency room by his wife because over the past two weeks he has had a bad cough, some shortness of breath, and pain with breathing. A chest x-ray was performed, revealing areas of consolidation and antibiotics were prescribed; however, he has not gotten better. He has no significant past medical history other than general malaise over the preceding year. Laboratory testing is performed including ANCA testing. MPO-ANCA is identified. A urinalysis reveals blood. Of the following, what is the most likely diagnosis?

A. Granulomatosis with polyangiitis
B. Polyarteritis nodosa
C. Microscopic polyangiitis
D. Kawasaki disease
E. Giant cell arteritis

Question 170

A 23-year-old male is stabbed by another person in the chest. He is responsive when EMTs arrive, but is short of breath. His heart rate is 115 bpm. During the trip to the emergency room, his shortness of breath worsens; he develops hypotension; and he ultimately becomes unresponsive. Despite resuscitative efforts, he dies. An autopsy is performed. The right pleural cavity contains a measured 2 L of blood, which originated from an intercostal artery in the path of the stab wound. Microscopic examination of the right lung would reveal which of the following?

A. Extensive eosinophilic infiltrates
B. Patchy neutrophilic infiltrates
C. Collapse of alveoli
D. Numerous fat emboli
E. Foreign body embolus composed of the tip of the knife

Questions 162-165: Lung pathology

Question 162

A 62-year-old male who has not seen a doctor in 20 years presents to a family physician at his wife’s insistence. Over the last 4 months he has had a chronic cough, occasional pain in his chest, and 20 lb. of weight loss. A chest x-ray reveals a mass in the upper lobe of the left lung. Biopsy reveals neoplastic squamous cells. Of the following, what was the most likely etiology of his neoplasm?

A. Cigarette smoke
B. Asbestos exposure
C. Radon exposure
D. Arsenic exposure
E. Past contact with radioactive substance

Question 163

A 62-year-old male with a 45 pack year smoking history undergoes chest x-ray as a component of a pre-surgical evaluation for elective cholecystectomy. The x-ray reveals a mass in the lower lobe of the left lung. Laboratory testing reveals an ionized calcium concentration of 6.7 mg/dL (normal range: 4.56-5.40 mg/dL). A biopsy of the mass would most likely reveal which of the following?

A. Benign cartilage
B. Epithelial cells with intercellular bridges
C. Caseating granulomas
D. Mass of neutrophils admixed with bacterial cocci
E. Mass of abnormally connected arteries and veins

Question 164

A 65-year-old male with a history of hypertension, diabetes mellitus type II, and a 45 pack-year smoking history with chronic cough presents to an acute care clinic with complaints that he has gotten very sensitive to heat lately and cannot tolerate working outside in his garden for very long. Physical examination reveals drooping of his left upper eyelid and constriction of the left pupil compared to the right side. In addition, the left eye appears somewhat sunken in the orbit. Of the following, which procedure is most likely to identify the cause of his condition?

A. CT scan of the head
B. X-ray of the chest
C. Echocardiogram
D. Lumbar puncture
E. MRI of the pelvis

Question 165

A 54-year-old male with a past medical history of hypertension and a 40 pack-year smoking history is undergoing a routine physical examination prior to a scheduled inguinal hernia repair. Physical examination reveals a small fixed palpable node above the left clavicle. A fine needle aspirate of this node reveals small cells with a high nuclear:cytoplasm ratio and high mitotic rate. No glandular formation or keratin production is evident. Molecular analysis of the cells would most likely reveal which of the following genetic abnormalities?

A. RB mutation
B. EGFR mutation
C. ALK rearrangement
D. p16/CDKN2A mutation
E. PTEN mutation

Questions 159-161: Lung pathology

Question 159

A 32-year-old male presents to an acute care clinic with complaints of chest pain that is worse when he breathes in. The chest pain started about a day ago. A few hours ago he coughed up blood. Physical examination reveals some dullness to percussion in the left upper lobe and crackles are heard at that site. His only past medical history is that he broke his left tibia one week ago while skiing, and has had to wear a cast, which he reports has hindered his ability to get around like normal. Of the following, which laboratory test is most likely to be elevated?

A. D-Dimer
B. PTT
C. AST
D. Hct
E. Glucose

Question 160

A 23-year-old tall and thin male presents to the emergency room at 2 am, saying that he awoke due to a sudden pain in his chest that was worse when he breathed, and has had difficulty breathing since that time. Physical examination reveals hyperresonance to percussion on the left side of his chest, which is associated with decreased breath sounds and absence of tactile fremitus. Of the following, what is the most likely diagnosis?

A. Acute myocardial infarct
B. Aortic dissection associated with Marfan syndrome
C. Pneumothorax
D. Lobar pneumonia
E. Pulmonary thromboembolus

Question 161

A 16-year-old tall male is playing basketball with friends when he suddenly develops chest pain and shortness of breath. His friends take him to the emergency room where a physical examination reveals hyperresonance to percussion on the left side of his chest, which is associated with decreased breath sounds and absence of tactile fremitus. Of the following, what is the most likely underlying pathologic finding?

A. Ruptured pulmonary bleb
B. Inflammation of blood vessel
C. Tearing of large caliber blood vessel
D. Asymmetric thickening of myocardium
E. Thrombus in blood vessel