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
Answer for Question 256
Answer: D (Atrophic ovaries); C (Absence of one X chromosome).
Explanation: The patient has a horseshoe kidney, which can be seen in several different genetic conditions; however, Turner syndrome is one of the conditions most commonly associated with this abnormality. In Turner syndrome, the ovaries are described as streaked–they are atrophic and fibrotic. The cytogenetic abnormality is complete absence of the X chromosome (in many patients, there is not complete absence of the X chromosome and instead, patients are a mosaic, or have some structural abnormality of the X chromosome). Rocker bottom feet are seen in trisomy 13 and 18. A horseshoe kidney can occur in patients with trisomy 18; however, these patients rarely survive into adulthood, whereas Turner patients often do. Hypoplastic parathyroid glands are seen in DiGeorge syndrome (del 22q11.2). A single palmar crease (comment: the older, less politically correct term was simian crease) is characteristic of Down syndrome. In Turner syndrome, there is no congenital absence of the ovaries, instead there is just an accelerated loss of oocytes after birth, leading to atrophic and fibrotic, streak-like ovaries, and patients have primary amenorrhea (hence the G0P0).
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
Answer for Question 257
Answer: D (PGI2)
Explanation: PGI2 (i.e., prostacyclin) plays a role in vasodilation. Vasodilation allows for the slowing of blood flow and is responsible for the red coloration of the skin associated with cellulitis, which is one specific example of acute inflammation. IL-1 plays a role in causing endothelial cells to express adhesion molecules and in the systemic response to the inflammation, including production of fever. ICAM-1 is an adhesion molecule on endothelial cells that plays a role in allowing leukocytes to adhere to the endothelium. Leukotriene B4 is a chemotactic agent.
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
Answer for Question 258
Answers: C (HIV); D (Mucicarmine).
Explanation: The organism is Cryptococcus neoformans (blue arrows)–the clearing around the organism is the polysaccharide capsule that they have (and which India ink on a smear would highlight since it does not allow for the stain to color it and thus leaves a blank spot around the organism). Cryptococcus neoformans is most often associated with meningitis; however, it often starts as a lung infection and can disseminate. On histology, the organism will stain with mucicarmine or PAS (periodic acid schiff. Cryptococcus neoformans occurs in patients with AIDS, and thus, an HIV test is the best answer.
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
Answer for Question 259
Answer: A (Bacterial infection).
Explanation: There are neutrophils filling the alveolar airspaces. Of the choices, bacterial infection is most commonly associated with a neutrophilic infiltrate (viruses with lymphocytes and parasites with eosinophils). While aspiration pneumonia, which can occur in the homeless and in drug users, would appear similar, an acute drug toxicity by itself would not necessarily have an accompanying pneumonia unless the patient survived for a short period of time after the drug overdose. Neutrophils are multi-lobated and there is a prominent amount of cytoplasm (unlike lymphocytes). In most histologic sections, eosinophils will have easily identifiable red granules in the cytoplasm.
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
Answer for Question 260
Answer: F (Fungal infection)
Explanation: At the yellow arrows are aseptate hyphae, which could be consistent with a Zygomycete infection (there are numerous cross-sections of fungi in the image). An example of a microthrombus is present at the black arrow. Aspergillus and Zygomycetes are a cause of a vasculitis.
