PATHOLOGY Board Exam

PATHOLOGY Choose the best answer. 1. A 54-year old female has a blood pressure of 160/95 mmHg. If this persists for many years, which of the following changes will be seen in the heart? A. hyperplasia B. metaplasia C. hypertrophy D. atrophy MPL: 95 2. A 59-year old male experienced sudden substernal chest pain after thrombosis of the left anterior descending artery. His serum creatinine kinase was elevated. Which of the following patterns of cell injury is most likely? A. fat necrosis B. liquefactive necrosis C. caseous necrosis D. coagulative necrosis MPL: 95 3. Accumulation of calcium in the renal tubular epithelium of patients with primary hyperparathyroidism is the result of which of the following processes? A. cellular aging B. metastatic calcification C. dystrophic calcification D. renal tubular atrophy MPL: 70 4. The nonpregnant uterus of a 23-year old female measured 8 x 5 x 4 cm. She became pregnant and at term her uterus measured 36 x 18 x 13 cm. Which of the following changes explains the increase in the size of the uterus? A. myometrial smooth muscle hypertrophy B. endometrial stromal hypertrophy C. endometrial glandular hyperplasia D. vascular endothelial hyperplasia MPL: 85 5. A 32-year old male chef accidently touched a hot portion of the cooking pan he was using. Within a few hours, there was marked erythema of the affected area and a blister started to form. Which of the following types of inflammation describes the occurrence? A. fibrinous inflammation B. purulent inflammation C. granulomatous inflammation D. serous inflammation MPL: 90

6. A 76-year old female developed Staphylococcal pneumonia for which she was given a course of antibiotic therapy. Ten days later, she no longer had productive cough but fever persisted. Chest x-ray showed a 3-cm, rounded density in the right lower lobe whose liquefied contents form a central air-fluid level. Which of the following outcomes of her pneumonia occurred? A. abscess formation B. regeneration C. progression to chronic inflammation D. fibrosis MPL: 65 7. A 58-year old female with congestive heart failure develops fever and pleural effusion. Pleural fluid examination revealed a specific gravity of 1.032 and many degenerating neutrophils. The most likely cause of fluid accumulation is an increase in A. vascular permeability B. colloid osmotic pressure C. lymphatic pressure D. renal retention of sodium and water MPL: 75 8. A 32-year old female takes aspirin for her arthritis. Her joint pain is reduced and there is still some degree of swelling and limitation of movements. Aspirin lessens pain mainly through reduction in the synthesis of which of the following mediators? A. leukotriene D4 B. nitric oxide C. prostaglandins D. histamine MPL: 80 9. A laceration in the right hand of a 22-year old male was sutured. A week later, the sutures were removed and healing continued. However, the site of the wound developed a raised, nodular scar that developed over the following 2 months. What process occurred? A. wound dehiscence B. exuberant granulation C. organization D. keloid formation MPL: 90 10. A 44-year old male underwent laparotomy for a perforated sigmoid colon diverticulum. A wound infection complicated the postoperative course, and surgical wound dehiscence occurred. Six weeks later, the wound was only 10% of its original size. Which of the following processes best accounts for the decrease in wound size? A. inhibition of metalloproteinases B. diminished subcutaneous edema C. myofibroblast contraction D. greater synthesis of collagen MPL: 65

11. In which of the following organs is an arterial thromboembolus least likely to produce an infarct? A. kidney B. heart C. brain D. liver MPL: 70 12. A 44-year old female was diagnosed with breast carcinoma. The affected left breast is covered by thickened, pitted overlying skin and is slightly larger than the uninvolved right breast. How is the gross appearance of the left breast best explained? A. chronic passive congestion B. chronic inflammation C. lymphatic obstruction D. venous thrombosis MPL: 70 13. A section through a branch of the right main pulmonary artery at autopsy reveals a band of fibrous connective tissue that extends across the lumen. Which of the following events best explains the presence of this finding? A. thromboembolism B. hemorrhage C. hypertension D. ischemia MPL: 95 14. A 24-year old male has a workup for infertility and is found to have oligospermia. Physical examination findings include bilateral gynecomastia, reduced testicular size, and reduced body hair. Karyotypic analysis will most likely reveal which of the following abnormalities? A. 47,XXY B. 47,XYY C. 46,XY,del(22q11) D. 46XX/47XX,+21 MPL: 50 15. Multifactorial inheritance is most likely to play a significant role in the appearance of A. Marfan syndrome B. cleft lip C. polycystic kidneys D. Tay-Sachs disease MPL: 55 16. An 8-year old female can bend her thumb back to touch her forearm. She can pull her skin out from her abdomen about 8 cm, and a cut to her skin gapes open and is difficult to repair. Her underlying disease process results from an inherited defect in A. LDL receptor B. factor VIII C. alpha1-antitrypsin D. collagen MPL: 70

17. A 22-year old female has pancytopenia, proteinuria and a malar rash. A chest radiograph reveals bilateral pleural effusions. Which of the following findings is most likely to be elicited in the history? A. xerostomia B. photosensitivity C. urethritis D. esophageal dysmotility MPL: 60 18. In a type I hypersensitivity reaction, which of the following cells secretes cytokines that stimulate IgE production by B cells, promotes mast cell growth, and recruits and activates eosinophils? A. CD4+ lymphocytes B. macrophages C. neutrophils D. NK cells MPL: 50 19. A 34-year old male known to be infected with HIV begins to have difficulty with activities of daily living. He has memory problems and decreased ability to perform functions that require fine motor control, such as writing. Which of the following cells is most important for the dissemination of the infection into the central nervous system? A. neutrophil B. monocyte C. NK cell D. CD8+ lymphocyte MPL: 65 20. A vasculitis affects arteries in many visceral organs of a 27-year old male. There is focal fibrinoid necrosis of the small arterial and arteriolar vascular media along with intravascular microthrombi. Scattered neutrophils are seen in these areas of necrosis. Which of the following laboratory test findings would you most expect for this patient? A. neutropenia B. increased IgE C. tuberculin skin test positivity D. decreased C3 complement MPL: 60 21. A 38-year old male with a 15-year history of intravenous drug use developed a chronic watery diarrhea caused by Cryptosporidium parvum. She later developed oral candidiasis followed by Pneumocystis pneumonia. Which of the following neoplasms is most likely to develop in this patient? A. cervical squamous carcinoma B. non-Hodgkin lymphoma C. adenocarcinoma of the lung D. cerebral astrocytoma MPL: 65

22. A 40-year old male with blood type B+ receives a blood transfusion. Unknowingly, blood from another patient with blood type A+ was used for compatibility testing prior to the transfusion. Within 30 minutes after starting the transfusion, the patient becomes tachycardic and hypotensive and passes tea-colored urine. How is this reaction mediated? A. mast cell degranulation B. antigen-antibody complex deposition in glomeruli C. complement-mediated lysis of red blood cells D. antibody-dependent cellular cytotoxicity MPL: 70 23. A 14-year old female is diagnosed with acute tonsillitis which grows group A betahemolytic Streptococcus. The tonsillitis resolves but 3 weeks later, she develops chest pain with fever. Her ASO titer is 1:512. By which of the following immunologic mechanisms has the carditis developed? A. polyclonal lymphocyte activation B. release of sequestered antigens C. breakdown of T-cell anergy D. molecular mimicry MPL: 45 24. A 46-year old female has keratoconjunctivitis. She also has oral mucosal atrophy with buccal mucosal ulceration. A biopsy of her lip reveals marked lymphocytic and plasma cell infiltrates in minor salivary glands. Which of the following antibodies is most likely to be found for this patient? A. anti-centromere antibody B. SS-B C. Scl-70 D. anti-dsDNA MPL: 45 25. A biopsy of an enlarged, nontender posterior cervical lymph node from a 62-year old female reveals effacement of the nodal architecture by a monomorphous population of large cells with large, dark blue nuclei and scant cytoplasm. The peripheral blood smear and bone marrow biopsy are normal. This process is most likely to be a A. myeloma B. reactive hyperplasia C. lymphoma D. lymphangioma MPL: 65 26. A 62-year old male who presented with hematuria was recently diagnosed with a grade IV transitional cell carcinoma that has infiltrated through the bladder wall. Which of the following statements regarding the findings is true? A. He has a pooly differentiated tumor. B. The neoplasm is metastatic. C. The stage of this tumor is low. D. A paraneoplastic syndrome is apparent. MPL: 70

27. Which of the following diagnostic screening tests has had the greatest impact on reduction of cancer deaths? A. urinalysis B. Pap smear C. stool occult blood D. prostate-specific antigen MPL: 90 28. A 68-year old male who is positive for HBsAg has an elevated alpha-fetoprotein level. There are no palpable masses or lymphadenopathy on physical examination. Occult blood in stool is negative. Which of the following neoplasms is most likely? A. pancreatic adenocarcinoma B. prostatic adenocarcinoma C. hepatocellular carcinoma D. multiple myeloma MPL: 95 29. Annual check-up of a 67-year old male reveals pancytopenia on CBC and a serum chemistry panel with elevated alkaline phosphatase. After a serum prostate-specific antigen level is found to be elevated, he has a prostate needle biopsy which reveals a moderately differentiated adenocarcinoma. Which of the following mechanisms best accounts for these findings? A. paraneoplastic syndrome B. tumor metastases to bone C. tumor angiogenesis D. high tumor grade MPL: 80 30. A watery diarrhea is causing dehydration of a 1-year old infant. The attending physician eventually diagnosed the case as viral gastroenteritis. Which of the following mechanisms accounts for the diarrhea? A. decreased absorption of sodium and water B. lysis of colonic epithelial cells C. increased secretion of sodium and water by epithelial cells D. decreased breakdown of lactose MPL: 65 31. A 13-year old female developed a rash over her chest that started as 0.5 cm-diameter, reddish macules. In a day or so, the macules became vesicles. A few days later, the vesicles ruptured and crusted over. Crops of these lesions spread to involve the face and extremities over the next 10 days. Decades later, which of the following manifestations of this infection is most likely to appear? A. infertility B. shingles C. chronic arthritis D. paralysis MPL: 75

32. A 48-year old rice farmer becomes infected by cercaria that penetrate the skin of his feet. The cercaria are released from snails living in the irrigation canals. He develops progressive ascites. Which of the following disease process is responsible for the clinical finding? A. elephantiasis B. hepatic fibrosis C. mucocutaneous ulceration D. hemolysis MPL: 65 33. A suicidal ingestion of acetaminophen results in symptoms of nausea and vomiting in a 24-year old female. Within a day, which of the following laboratory test results will indicate the most severe organ damage? A. ketonuria B. hypokalemia C. elevated serum ALT level D. elevated serum creatine kinase level MPL: 65 34. A basal cell carcinoma is excised from the left lower eyelid of a 68-year old male. Which of the following forms of electromagnetic radiation played the greatest role in the development of this neoplasm? A. infrared rays B. x-rays C. gamma rays D. ultraviolet rays MPL: 70 35. Chronic alcoholics are at increased risk for which of the following disorders? A. blindness B. carcinoma of the stomach C. carcinoma of the esophagus D. acute renal failure MPL: 65 36. Soon after birth, a 40-week baby has a heart murmur audible on auscultation of the chest. On echocardiography there is a membranous ventricular septal defect. Which of the following events is most likely to have resulted in the appearance of this VSD? A. erythroblastosis fetalis B. folate deficiency C. maternal malnutrition D. maternal rubella infection MPL: 65 37. A large port-wine stain involves the right side of the face of a 3-year old child. This irregular, slightly raised, red-blue area is not painful, but is very disfiguring. Histologically, this lesion is most likely composed of a proliferation of A. lymphatics B. capillaries C. fibroblasts D. lymphoblasts MPL: 65

38. Which of the following is a major risk factor for coronary atherosclerosis? A. diabetes mellitus B. obesity C. type A personality D. sedentary lifestyle MPL: 70 39. Several skin lesions on the upper chest of a 45-year old male have central pulsatile cores. Pressing on a core causes a radially arranged array of subcutaneous arterioles to blanch. The underlying disease he is most likely to have in association with these skin lesions is A. micronodular cirrhosis B. Wegener granulomatosis C. Marfan syndrome D. diabetes mellitus MPL: 45 40. A 49-year old previously healthy female reports having had several fainting spells in the last 6 months. In each case, she regained consciousness after only a few minutes. Her blood pressure is normal. She has good carotid pulses with no bruits. Which of the following cardiac lesions is most likely to be present? A. left atrial myxoma B. pericardial effusion C. mitral valve stenosis D. bicuspid aortic valve MPL: 35 41. The feature most important in distinguishing a malignant from a benign tumor is: A. high mitotic rate B. presence of necrosis C. presence of metastasis D. nuclear pleomorphism MPL: 85 42. The most reliable histopathologic evidence of chronicity in an inflammatory process in the liver is the presence of: A. lymphocytic infiltrates B. bile duct destruction C. Councilman bodies D. fibrosis MPL: 80

43. A 25-year old man who admits to long term use of injection drugs presents to your office with fatigue and multiple raised, purplish skin and buccal mucosal lesions. You biopsy one of the skin lesions and the pathologist reports that there is a vascular proliferation characterized by slit-like vessels lined by very atypical spindle cells; extravasated RBCs and extracellular hemosiderin deposition are also noted. Your patient has which of the following? A. bacillary epithelioid angiomatosis B. Kaposi’s sarcoma C. glomus tumor D. squamous cell carcinoma MPL: 75 44. A 20-year old male has a brachial artery blood pressure of 200/140 mm Hg but blood pressure measured at the anterior tibial artery is 90/50. The best explanation is which of the following? A. Tetralogy of Fallot B. ventricular septal defect C. coarctation of the aorta D. patent ductus arteriosus MPL: 70 45. A 65-year old man with long-standing cigarette smoking history presents with a cough and weight loss. You order chest x-ray examination and this shows a large hilar mass. A pulmonologist performs bronchoscopy, and the pathologist’s report describes a lesion composed of small round cells, with a very high nuclear/cytoplasmic ratio, inconspicuous nucleoli, nuclear molding, and no evidence for gland formation, prominent intercellular bridges or keratinization. Your patient has which of the following? A. small cell anaplastic carcinoma B. squamous cell carcinoma C. adenocarcinoma D. hamartoma MPL: 75 46. Most hereditary spherocytoses are characterized by a decreased amount of which of the following? A. alpha globin B. beta globin C. spectrin D. glucose 6-phosphate dehydrogenase MPL: 75 47. Intestinal intussusception in a middle-aged person is most likely associated with which of the following? A. an adenomatous polyp B. no other intestinal diseases C. a carcinoid tumor D. Crohn’s disease MPL: 70

48. Munro microabscesses are classically seen in which of the following? A. psoriasis B. lichen planus C. mycosis fungoides D. seborrheic dermatitis MPL: 65 49. Antiglomerular basement membrane antibodies are most likely to play a role in the development of which of the following? A. membranous nephropathy B. Goodpasture’s syndrome C. minimal change disease D. nodular glomerulosclerosis MPL: 65 50. The most common sarcoma of childhood is which of the following? A. malignant fibrous histiocytoma B. synovial sarcoma C. Ewing’s sarcoma D. rhabdomyosarcoma MPL: 65 51. A 15-year old male presents with complaints of severe pain in the proximal tibia that awakens him at night. This has been relieved with aspirin. A small lesion is identified on x-ray film with sclerotic margins and a central lytic area. Surgical removal is performed. The most likely histologic findings are which of the following? A. malignant osteoblasts forming osteoid and bone B. normal appearing cartilage C. a nidus of woven bone trabeculae in osteoid D. metastatic adenocarcinoma of the lung MPL: 40 52. In Guillain-Barre syndrome, the inflammation is caused by which of the following? A. a conventional virus infection of the axon B. a slow-virus infection of the axon C. a slow-virus infection of the spinal cord D. an autoimmune delayed hypersensitivity attack directed against myelin MPL: 50 53. Myasthenia gravis is characterized by all of the following EXCEPT: A. deficiency in the amount of released acetylcholine at the terminal axon B. associated thymic hyperplasia or thymoma C. circulating antibodies against acetylcholine D. motor end-plate damage MPL: 50

54. An 8-year old child is found to have papilledema and a neoplasm within the fourth ventricle, blocking the outflow of cerebrospinal fluid. It is most likely to be which of the following? A. a glioblastoma multiforme B. an ependymoma C. a colloid cyst D. a medulloblastoma MPL: 65 55. The most specific abnormality in Alzheimer’s disease is which of the following? A. senile plaque B. cerebral amyloid angiopathy C. intraganglionic neurofibrillary tangle D. Hirano bodies MPL: 50 56. The classical clinical presenting complaint for a breast intraductal papilloma is which of the following? A. bloody nipple discharge B. peau d’orange skin changes C. a red, firm, painful mass D. enlargement of ipsilateral axillary lymph nodes MPL: 70 57. A 35-year old woman presents to you with substantial abnormal uterine bleeding and pelvic discomfort. You perform a pelvic examination and note an enlarged uterus with multiple large nodular masses. This patient most likely has which of the following lesions? A. lipoma B. leiomyomata C. endometrial adenocarcinoma D. sarcoma botryoides MPL: 85 58. The type of primary ovarian cancer with the highest rate of bilaterality is which of the following? A. serous cystadenocarcinoma B. mucinous cystadenocarcinoma C. clear cell carcinoma D. endometrioid carcinoma MPL: 70 59. A 65-year old man presents to your office with increased urinary frequency, nocturia, urinary dribbling and difficulty starting his urinary stream. This clinical scenario is most compatible with which of the following underlying diseases? A. prostate cancer B. urinary bladder cancer C. urinary bladder infection D. prostatic nodular hyperplasia MPL: 85

60. Infiltrative ophthalmopathy is characteristic of which of the following? A. Graves’ disease B. Hashimoto’s thyroiditis C. pituitary adenoma D. type 1 diabetes mellitus MPL: 85 61. A 31-year old woman with unexplained weight gain resulting in central obesity, mild hypertension, impaired glucose tolerance and reduced bone mass has elevated morning plasma cortisol not suppressed by low dose dexamethasone. This patient has which of the follwing? A. Addison’s disease B. Conn’s syndrome C. Cushing’s syndrome D. Caplan’s syndrome MPL: 80 62. The environmental factor most likely to induce type I diabetes mellitus in a genetically susceptible individual is which of the following? A. Coxsackievirus B infection B. excess caloric intake C. insufficient dietary iodine D. therapeutic use of synthetic glucocorticoids MPL: 55 63. Degradation of DNA to nucleosome-sized fragments is characteristic of which of the following? A. apoptosis B. dysplasia C. coagulative necrosis D. liquefactive necrosis MPL: 60 64. A young female suffers multiple, bilateral fractures of the femur after being struck by a car while crossing an intersection. Two days after admission she develops dyspnea, confusion and conjunctival petechia and dies. The most likely finding at autopsy is which of the following? A. multiple pulmonary emboli B. widespread fat emboli of lung, brain and kidney C. aspiration pneumonia and microvascular thrombi from disseminated intravascular clotting D. occult endocarditis with widespread septic embolization from vegetations MPL: 70 65. Virchow’s triad (factors favoring thrombosis) includes which of the following? A. leukocytosis, thrombocytosis, erythrocytosis B. increased plasminogen, increased protein C, increased protein S C. hyperglycemia, hyperlipidemia, hypertension D. stasis, vascular injury, hypercoagulability MPL: 70

66. In myocardial ischemia, irreversibly injured myofibers are distinguishable by: A. cytoplasmic fatty change B. cellular swelling C. contraction bands in the cytoplasm D. clumping of nuclear chromatin MPL: 55 67. Which of the following situations is the most common outcome of an acute myocardial infarction? A. sudden cardiac death B. left ventricular congestive failure C. cardiogenic shock D. cardiac arrhythmias MPL: 65 68. In which of the types of vasculitis listed below is the lung the primary target of involvement? A. Wegener’s granulomatosis B. Polyarteritis nodosa C. Henoch-Schonlein purpura D. Kawasaki syndrome MPL: 60 69. Which of the following is NOT a characteristic gross feature of benign peptic ulcers? A. small size B. irregular margins C. a smooth base D. radial arrangement of surrounding mucosal folds MPL: 65 70. Carcinoma of the pancreas: A. arises from pancreatic acinar cells B. occurs most often in the tail of the pancreas C. is associated with spontaneous venous thrombosis D. is usually cured by total pancreatectomy MPL: 65 71. The most important prognostic feature in invasive breast cancer is: A. the grade of the tumor B. the histologic type of the tumor C. the size of the tumor D. the status of the draining lymph nodes MPL: 65 72. A high level of estrogen receptors in a breast cancer is likely to be associated with: A. therapeutic response of the tumor to tamoxifen B. a poorer overall prognosis compared to estrogen receptor-negative tumors C. both are correct D. both are incorrect MPL: 60

73. A patient notices a deeply pigmented, raised nodule with indefinite borders on the upper extremity. Which of the following lesions can be ruled out on clinical inspection? A. basal cell carcinoma B. seborrheic keratosis C. blue nevus D. lentigo simplex MPL: 30 74. A woman fails to lactate or menstruate after giving birth. Which of the following is the most likely cause? A. Sheehan’s syndrome B. Empty sella syndrome C. Hypothalamic glioma D. prolactinoma MPL: 45 75. The most common cause of the “syndrome of inappropriate antidiuretic hormone” secretion is: A. subdural hematoma B. pituitary adenoma C. oat cell carcinoma of the lung D. radiation injury to the hypothalamus MPL: 50 76. A 30-year old female recovering from a bout of influenza suddenly develops a painful, enlarged thyroid. The most likely diagnosis is: A. Reidel’s thyroiditis B. thyroid abscess C. subacute granulomatous thyroiditis D. Hashimoto’s thyroiditis MPL: 45 77. The blood vessel most commonly involved in myocardial infarction is: A. circle of Willis B. left anterior descending coronary artery C. lateral circumflex branch of the aorta D. right coronary MPL: 99 78. The most common site of lytic lesions in muliple myeloma is the: A. ribs B. vertebrae C pelvis D. skull MPL: 70

79. Kimmelstiel-Wilson lesions are characteristically seen in which disease? A. chronic pancreatitis B. acute hemorrhagic pancreatitis C. diabetes mellitus D. systemic lupus erythematosus MPL: 55 80. Atheromatous plaques most heavily involve: A. thoracic aorta B. abdominal aorta C. coronary artery D. circle of Willis MPL: 65 81. Systemic lupus erythematosus gives rise to all of the following patterns of glomerular injury EXCEPT: A. focal proliferative glomerulonephritis B. diffuse membranous glomerulonephritis C. lipoid nephrosis D. mesangial proliferative glomerulonephritis MPL: 35 82. All of the following statements correctly describe chronic pyelonephritis EXCEPT: A. It causes asymmetrically scarred kidneys. B. It is associated with vesicoureteral reflux in most cases. C. It typically produces thyroidization of tubules. D. It characteristically spares the calyces and pelvis. MPL: 65 83. Hyperaldosteronism associated with an adrenal adenoma is known as: A. Nelson’s syndrome B. Conn’s syndrome C. Cushing’s syndrome D. Bartter’s syndrome MPL: 70 84. Most females born with 21-hydroxylase deficiency would be expected to have all of the following EXCEPT: A. clitoral hypertrophy B. reduced levels of aldosterone C. hypernatremia D. elevated adrenocorticotrophic hormone levels MPL: 35 85. Characteristic features of Ewing’s sarcoma include all of the following EXCEPT: A. occurrence primarily in childhood. B. derivation from lymphocytic cell line precursors C. periodic acid-Schiff positive cytoplasmic granules D. typically arises in the metaphyses of long tubular bones MPL: 45

86. Meningiomas commonly are associated with all of the following pathologic features EXCEPT: A. irregular infiltrative borders B. penetration of adjacent bone C. psammoma bodies D. expression of epithelial membrane antigen MPL: 45 87. Which of the following statements correctly describe plexiform neurofibromas? A. They are diagnostic of neurofibromatosis type I. B. They have significant potential for malignant transformation. C. both are correct D. both are incorrect MPL: 45 88. In addition to nephrotoxic injury, the other major cause of acute tubular necrosis is: A. sepsis B. ischemia C. severe hypocomplementenemia D. immune complex deposition MPL: 55 89. A malignancy which is apparently virus-related and commonly seen in patients of Chinese ancestry is: A. esophagea carcinoma B. adamantinoma C. Burkitts lymphoma D. nasopharyngeal carcinoma MPL: 55 90. Which of the following does NOT characteristically cause fatty change in the liver? A. diabetes mellitus B. Reye’s syndrome C. tetracycline toxicity D. acute hepatitis B MPL: 55 91. Which of the following histologic features of hepatocellular injury is prognostically LEAST favorable? A. bile lake formation B. collagen formation C. ballooning of hepatocytes D. lobular inflammatory cell infiltrates MPL: 50 92. All of the following features are characteristic of hepatic encephalopathy EXCEPT: A. occurs with cirrhotic portal hypertension B. does not occur when serum ammonia levels are normal C. characteristically causes asterixis D. frequently is associated with generalized cerebral edema MPL: 50

93. Chronic bronchitis is associated with all of the following pathologic changes EXCEPT: A. goblet cell hyperplasia in bronchi B. hypertrophy of bronchial submucosal glands C. inflammatory infiltration of alveolar walls D. goblet cell metaplasia in bronchioles MPL: 50 94. The following statements correctly describe Adult Respiratory Distress Syndrome EXCEPT? A. It usually develops suddenly in an otherwise healthy individual. B. Interstitial infiltrates on chest radiographs precede the onset of dyspnea. C. The overall mortality rate is very low. D. The underlying cause usually cannot be determined from biopsy alone. MPL: 60 95. Mediators of increased vascular permeability in acute inflammatory responses include all of the following EXCEPT: A. leukotriene E4 B. bradykinin C. platelet-activating factor D. complement complex C5b-9 MPL: 60 96. Generation of free radicals is a major mechanism of membrane damage associated with all of the following processes EXCEPT: A. radiation injury B. acute ischemia C. acute inflammation D. oxygen toxicity MPL: 60 97. HLA DR4 is more prevalent in which of the following autoimmune disorders? A. SLE B. rheumatoid arthritis C. ankylosing spondylosis D. Sjogren’s syndrome MPL: 60 98. Trichomoniasis causes lesions referred to as: A. raspberry tongue B. strawberry mucosa C. strawberry gallbladder D. chocolate cysts MPL: 70

99. Bronchopulmonary dysplasia and necrotizing enterocolitis are most likely to be seen in a patient with which of the following diseases? A. cystic fibrosis B. Down syndrome C. hyaline membrane disease D. sudden infant death syndrome MPL: 60 100. In a 70-year old male, which of the following processes contributes most to the occurrence of osteoporosis? A. decreased production of osteoid by osteoblasts B. increased resorption of bone by osteoclasts C. synthesis of chemically abnormal osteoid D. increased sensitivity of bone to the effects of parathyroid hormone MPL: 55