1993 Mid-term

______1. Which of the following normal organs/systems will most likely be affected by the

systemic chemotherapy?

A. Hematopoietic System

B. Musculoskeletal System

C. Liver

D. Central Nervous System

E. Lungs

______2. In question 1, the cells from the organ/system most likely to be affected by the chemotherapy are examples of which of the following cell types:

A. Postmitotic Cells

B. Intermitotic Cells

C. Interphase Cells

D. Reverting Postmitotic Cells

E. Non-Mitotic Cells

A 83 year old black patient enters the hospital with hemoptysis (coughing up blood) and a

2 cm. nodule in the right middle lobe of the lung. He has a 60 pack-year history of

cigarette smoking. A bronchoscopy is performed and reveals a mass entering the right

middle lobe bronchus. The mass and proximal bronchial mucosa with normal gross

appearance is biopsied.

______3. The biopsy of the mass reveals a squamous cell carcinoma. What is the biopsy of the

proximal bronchial mucosa likely to show?

A. Normal bronchial respiratory columnar epithelium

B. Hypertrophic columnar epithelium

C. Ulceration with scar

D. Metaplastic squamous epithelium

E. Invasive carcinoma

______4. The progressive development of the squamous cell carcinoma most probably included

all of the factors listed below EXCEPT:

A. Conversion of bronchial columnar to squamous metaplastic epithelium

B. Genetic defects caused by carcinogens in cigarette smoke

C. Generation of an abnormal DNA cellular content (aneuploidy)

D. Hyperplasia of bronchial columnar cells

E. Dysplasia involving squamous metaplastic cells

A 17 year old high school football star is brought into the emergency room following a

collapse during a practice session. He died shortly thereafter in cardiac arrest. An autopsy

was performed.

______5. At postmortem examination, the heart was found to weigh 600 grams. The left ventricular wall was 3 cm. thick. This is a case of:

A. Cardiac Hypertrophy

B. Cardiac Hyperplasia

C. Cardiac Metaplasia

D. Cardiac Dysplasia

E. Cardiac Malignancy

______6. Which of the following best describes the process of hyperplasia?

A. Transformation of one cell type to another

B. Increase in the size of cells

C. Increase in the number of cells

D. Increase in cell number due to neoplastic transformation

E. A physiologic response to cellular injury

______7. A previously healthy 34 year old woman requires cardiopulmonary resuscitation

immediately following an otherwise uncomplicated term vaginal delivery. Her

membranes ruptured 18 hours prior to delivery. The most likely explanation is:

A. Endotoxic Shock

B. Cardiac Arrhythmia

C. Neurogenic Shock

D. Amniotic Fluid Embolism

E. Massive Hemorrhage

______8. An 18 year old male is brought to your Emergency Room with a gunshot wound to the

abdomen. He is conscious and complaining of pain. Which of the following would you

expect to find on your initial exam?

A. Warm, dry skin

B. Normal blood pressure

C. Decreased heart rate

D. Lactic acidosis

E. Oliguria

______9. In your office practice you are following a 73 year old woman with coronary

atherosclerosis, hypertension and chronic congestive heart failure (CHF). Why do you

advise her to follow a low salt diet?

A. Renal blood flow and sodium resorption are often increased in CHF

B. Aldosterone is suppressed in CHF

C. Total body sodium content determines the volume of the extracellular compartment

D. To lessen her presacral edema

E. Because she is also taking diuretics

______10. At autopsy the lungs of your patient are heavy, dark bluish-red and exude frothy

pinkish white fluid on cut section. Under the microscope, you expect to find all of

the following except:

A. Necrosis of type II pneumocytes

B. Intra-alveolar hemosiderin laden macrophages

C. Dilated, tortuous capillaries

D. Red cell diapedesis

E. Eosinophilic proteinaceous material in alveolar spaces

______11. A 58 year chronic alcoholic is developing signs of hypovolemic shock. He has been

hospitalized several times in the past year for bleeding esophageal varices. The most

likely explanation for the current state of affairs is:

A. Myocardial infarction

B. Third-spacing of fluid

C. Pulmonary thromboembolism

D. Intra-abdominal malignancy

E. Sepsis

______12 You are examining a lymph node section from a case of putative immunodeficiency. The

superficial cortical region is relatively acellular, whereas the deep cortical area is packed

with small lymphocytes. Knowing what you do about T and B cell markers, how would

you stain these sections to determine whether this histology reveals a T or B lymphocyte

deficiency (or both) in this patient's lymphoid tissues? More than one answer may be

correct.

A. Rabbit anti-human IgM followed by goat anti-mouse IgG-fluorescein

B. Mouse anti-human CD2 (the sheep erythrocyte receptor) followed by goat anti-

mouse IgG-fluorescein

C. Rabbit anti-human IgM followed by goat anti-rabbit IgG-fluorescein

D. Human rheumatoid factor followed by goat anti-rabbit IgG-fluorescein

E. Rabbit anti-human IgD by goat anti-rabbit IgG-fluorescein

______13. B-cells are precursors for:

A. Macrophages

B. Plasma Cells

C. Eosinophils

D. Sausage pizza

E. T cells

"Immune elimination" occurs when an individual has made a specific immune response to a

given antigen. In a volunteer group, you observe three patterns of immune elimination curves

with tetanus toxoid as follows: (Note - the initial equilibration and a lag-phase of non-immune

catabolism occurs in all cases, but the lag-phase varies in length)

i. A rapid elimination of labeled tetanus after a two week lag period

ii. A rapid elimination of labeled tetanus after a four-day lag period

iii. A rapid elimination of labeled tetanus immediately after injection

______14. Pattern i is typical of:

A. Volunteers who have been vaccinated in the last month

B. Volunteers who have been vaccinated in the last two years

C. Volunteers who have never been vaccinated

______15. Pattern ii is typical of:

A. Volunteers who have been vaccinated in the last month

B. Volunteers who have been vaccinated in the last two years

C. Volunteers who have never been vaccinated

______16. Pattern iii is typical of:

A. Volunteers who have been vaccinated in the last month

B. Volunteers who have been vaccinated in the last two years

C. Volunteers who have never been vaccinated

______17. According to law, pronouncement of death:

A. May be made by the nurses or physicians who cared for the decedent

B. May be made by any physician

C. May be made only after an autopsy

D. May be made only by the coroner or medical examiner

______18. Criteria for brain death include:

A. One to three spontaneous respirations per minute

B. Loss of one-half of the recognized brain stem reflexes

C. Persistent low voltage waves on EEG

D. Systolic blood pressure persisting below 50mm Hg. despite pressor drug administration

E. None of the above

______19. "Brain death" and "Persistent Vegetative State" are different names for the same

condition.

A. True

B. False

______20. Your are called to certify the death of a person whom you have never treated. On the

death certificate, it would be appropriate for you to give the immediate cause of

death as "cardiopulmonary arrest."

A. True

B. False

______21. Autolysis is the process that occurs when the blood supply to an organ or tissue is

temporarily interrupted in the presence of infection.

A. True

B. False

______22 The various forms of tissue necrosis depend for their morphology on the degree of

activation of the intrinsic lysosomes of the tissue involved.

A. True

B. False

______23. Reaction to injury may be manifested by:

A. Decreased cellular biochemical activity

B. Increased cellular biochemical activity

C. Increased cell growth

D. Decreased cell growth

E. Any of the above

______24. Coagulation necrosis is a form of:

A. Hydropic change

B. Vacuolar degeneration

C. Fatty vacuolation

D. All of the above

E. None of the above

______25. Bacterial lung abscess is a form of:

A. Caseation necrosis

B. Liquefaction necrosis

C. Coagulation necrosis

D. Gangrenous necrosis

E. None of the above

______26. Of the following responses to ischemic injury of the myocardium, which is potentially

reversible?

A. Coagulation necrosis

B. Vacuolar myocytolysis

C. Contraction band necrosis

D. None of the above

______27. Which of the following statements are (is) correct?

A. Caseation necrosis and gummatous necrosis are responses to the same organism

under different conditions of host response

B. Caseation necrosis and gummatous necrosis look the same on gross examination

C. Caseation necrosis and gummatous necrosis are distinguished by occurring in

different organs

D. Caseation necrosis and gummatous necrosis look similar by light microscopy

______28. Fat necrosis occurs in the breast as a result of:

A. Trauma

B. Ischemic injury

C. Leakage of enzymes from lactating glands

D. Neoplasia

E. Infection

______29. Caseation necrosis occurs:

A. As the immediate response to infection by tubercle bacilli

B. As a delayed response to infection by tubercle bacilli

C. In sarcoidosis

D. In response to pyogenic organisms in immunocompromised hosts

E. All of the above

______30. All of the following statements are true of apoptosis EXCEPT:

A. Can be prevented by treatment of cells with protein inhibitors

B. Is characterized by ability to exclude vital dyes

C. Is characterized by lysis of cellular membranes

D. Is characterized by condensation of nuclear chromation

______31. Fibrinoid necrosis may be seen in:

A. Acute hypersensitivity

B. Delayed hypersensitivity

C. Coagulation necrosis

D. Liquefaction necrosis

E. All of the above

______32. Hepatic injury caused by CCl₄ is characterized by none of the following EXCEPT:

A. Can be produced only by oral administration of CCl₄

B. Requires a period of several days of sensitization before the observed lesions develop

C. Results in formation of oxygen free radicals

D. Results in hydropic degeneration

E. Results in accumulation of calcium

______33. Type II glycogenosis, Pompe's disease, is a lysosomal enzyme deficiency which:

A. Is restricted to cardiac striated muscle

B. Is restricted to skeletal striated muscle

C. Is restricted to liver

D. Is not restricted to any specific organs

E. Is restricted to the nervous system

______34. Inactivation of oxygen free radicals can be carried out by all of the following EXCEPT:

A. Xanthine oxidase

B. Catalase

C. Glutathione peroxidase

D. Vitamin E

______35. AL amyloid is:

A. Derived from a serum protein synthesized in the liver

B. Derived from plasma cells

C. Derived from [beta]₂ (Beta) - Microglobulin in chronic hemodialysis

D. A triple chain alpha helix

E. Found in the cerebral lesions of Alzheimer's disease

______36. Free radical injury has been implicated in:

A. Ionizing radiation

B. Reperfusion injury

C. Tumor destruction by macrophages

D. Cellular aging

E. All of the above

______37. A person who lacked Factor XII (Hageman Factor) would be expected to have:

A. Normal bleeding time - normal clotting time

B. Normal bleeding time - prolonged clotting time

C. Prolonged bleeding time - normal clotting time

D. Prolonged bleeding time - prolonged clotting time

______38. Patients with classical hemophilia A have an intact extrinsic clotting mechanism yet

they will show abnormal ability to clot, with bleeding at the site of an injury

several hours after that injury. This can best be explained by:

A. Lack of Factor XI

B. Presence of unbound von Willebrand factor

C. Presence of Tissue Factor Pathway Inhibitor

D. Lack of Factor XIII (Fibrin Stabilizing Factor)

______39. Hereditary disorders of clotting:

A. Most commonly involve abnormalities of several clotting factors

B. Most commonly involve abnormality of a single clotting factor

______40. Small doses of aspirin are useful in some cases of coronary artery disease because:

A. They inhibit the ability of platelets to aggregate.

B. They increase the ability of the endothelial cells to resist clotting.

C. They prevent the cross-linking of fibrin.

D. They increase the activity of antithrombin.

______41. Severe diseases of the liver may result in diminished production of:

A. Factor VIII

B. Prothrombin

C. Fibrinogen

D. Thromboxane A₂

_{E. All of the above}

______42. A previously healthy 20 year old man develops recurring episodes of deep leg vein

thromboses. Presence of which of the following would be most likely to be

responsible:

A. Antithrombin

B. Antiphospholipid antibody

C. Protein C

D. Thrombomodulin

E. Protein S

______43. A 15 year old boy develops recurring deep leg vein thromboses. You learn that his

father and his paternal uncle died of massive pulmonary thromboemboli. Of the

choices listed, he is most likely to show:

A. Deficiency of platelets

B. Deficiency of Factor XIII (Fibrin Stabilizing Factor)

C. Deficiency of Factor C

D. Deficiency of high molecular weight kininogen

______44. Patients with cancer have been shown to be at increased risk of thromboembolism.

The tumor cells are most likely responsible for:

A. Injury to vascular endothelium

B. Activation of blood coagulation

C. Activation of platelets

D. Impaired fibrinolysis

E. All of the above

Questions 45 - 50 - Characterize the following substances as either:

A - Procoagulant B - Anticoagulant

______45. High molecular weight kininogen

______46. ADP

______47. Antiphospholipid Antibodies

______48. Protein S

______49. Vitamin K

______50. Interleukin (IL-1)

Questions 51 - 54 answer True (T) or False (F)

______51. Most pulmonary thromboemboli result in sudden death.

______52 It is common for deep leg vein thrombosis to embolize to the brain.

______53. Disseminated intravascular coagulation is characterized by all of the following EXCEPT:

A. Abnormal bleeding

B. Multiple intravascular thrombi

C. Depletion of fibrinogen

D. Depletion of prothrombin

E. Thrombocytosis

______54. Deficiency of vitamin C results in deficient synthesis of:

A. Glycosaminoglycans

B. Laminin

C. Collagen

D. Fibronectin

E. Heparan Sulfate

______55. Wound healing is impaired by dietary deficiency of:

A. Protein

B. Carbohydrate

C. Fat

D. Calcium

E. Magnesium

______56. Basement membranes contain collagen:

A. Type I

B. Type II

C. Type III

D. Type IV

E. All of the above

______57. Binding of epithelial cells to extracellular matrix is mediated by transmembrane glyco-

proteins called:

A. Tenascins

B. Fibrillin

C. Schleppers

D. Integrins

______58. Fibrin deposited in a wound is:

A. Converted to glycosaminoglycans

B. Digested by collagenase

C. Converted to fibrous tissue

D. Digested by plasmin

E. None of the above

______59. Transforming growth factor beta (TGF-[beta]):

A. Inhibits growth of epithelial cells in culture

B. Stimulates fibroblast chemotaxis

C. Stimulates collagen production

D. Inhibits collagen degradation

E. All of the above

______60. Platelet derived growth factor (PDGF):

A. is found only in platelets

B. is found in platelet membranes

C. is found in mast cells

D. is found in polymorphonuclear leukocytes

E. None of the above

For Question 61 answer using the following:

A if 1, 2, and 3 are correct

B if 1 and 3 are correct

C if 2 and 4 are correct

D if 4 is correct

E if all are correct

______61. Lymphoid cells in the granuloma exhibit the surface phenotype of:

A. CD4

B. CD34

C. CD8

D. CD54

Questions 62 - 67 - Match the numbered statement most closely associated with the lettered word

or phrase. Each lettered word or phrase may be used once, more than once, or not at all.

A. Histamine

B. Serotonin

C. Bradykinin

D. C5a

E. C3b

F. C-Reactive Protein (CRP)

______62. Chemotactic agent

______63. Derived from tryphophan

______64. Prime mediator of pain in acute inflammation

______65. Acute phase protein

______66. Opsonin

______67. Mediates the immediate transient phase of vascular permeability in most types of tissue

injury.

SELECT THE SINGLE BEST ANSWER.

______68. During acute inflammation, IL-1 and TNFa:

A. Upregulate endothelial cell ligands - ICAM-1, VCAM-1 and ELAM-1

B. Cause fever

C. Cause neutrophil leukocytosis

D. All of the above

______69. Acute inflammation is a type of immune response.

A. True

B. False

______70. Causes of chronic inflammation include:

A. Intracellular pathogens, e.g. Mycobateria, Brucellae, viruses, etc.

B. Large extracellular pathogens like many fungi, parasites, etc.

C. Autoimmune diseases such as rheumatoid arthritis, SLE, etc.

D. All of the above

______71. A 40 year old black woman was noted to have hilar adenopathy on chest roentgenogram as part of a routine physical exam. Otherwise, she was in good health. H & E stain of lymph node biopsy sections showed numerous pale-staining areas. Special stains for acid-fast and fungal organisms were negative as were cultures for mycobacterial and fungal pathogens. The most probable diagnosis is:

A. Chromoblastomycosis

B. San Joaquin Valley fever

C. Hansen's disease

D. Sarcoidosis

E. Tuberculosis

______72. You should learn about Hansen's disease because:

A. It is one of the prototype examples of chronic inflammation.

B. Between 100 - 200 cases per year are reported in the U.S.A.

C. Endemic to several countries with more than 10 million cases known world over.

D. All of the above

E. None of the above

_____73. Which of the following is (are) most associated with the formation of a transudate?

A. Hydrostatic causes

B. Fluid with low specific gravity

C. Fluid that does not clot on standing

D. Little or no fibrinogen

E. All of the above

F. None of the above

______74. The following features: monocytes, giant cells, fibroblasts and lymphocytes are

characteristic of:

A. Acute inflammation

B. Granulation tissue

C. Healing wound

D. Chronic inflammation

E. Suppuration

______75. Granulation tissue is characterized by:

A. Proliferation of new capillaries with fibroblasts and new collagen formation

B. Giant cells and fibroblasts

C. Giant cells and lymphocytes

D. Giant cells, plasma cells and lymphocytes

______76. Which type of inflammation is commonly characterized by collections of dead and

dying polymorphs, dead and dying bacteria, and necrosis of tissue, all of which form

a turbid or thick fluid in tissues?

A. Catarrhal inflammation

B. Phlegmonous inflammation

C. Cellulitis

D. Abscess formation

E. Granulomatous inflammation

______77. The predominant cell seen in an inflammatory response to staphylococcal infection is:

A. Lymphocyte

B. Monocyte

C. Eosinophil

D. Mast cell

E. Polymorphonuclear leukocyte

F. Plasma cell

______78. The predominant cell seen in inflammation resulting from viral infection is:

A. Lymphocyte

B. Mast cell

C. Eosinophil

D. Polymorph

E. Plasma cell

______79. Inflammation is best defined by which of the following statements?

A. A reaction of the microcirculation in tissue to injury.

B. A form of edema.

C. Chemotaxis of white cells to bacteria.

D. A form of abnormal cell growth.

E. Cellular changes resulting from injury.

______80. Mediators of vascular permeability are thought to achieve their effects by:

A. Increased intravascular hydrostatic pressure

B. Decreased intravascular hydrostatic pressure

C. Contraction of endothelial cells and venules

D. Dissolving capillary basement membrane

E. Binding serum albumin to tissue

______81. The following events are all part of the acute inflammatory response. If placed in

correct sequence, which would occur fourth?

A. Vascular dilatation

B. Local hemoconcentration and slowing of blood flow

C. Margination of white blood cells

D. Emigration of white blood cells

E. Increased vascular permeability

______82. ELAM-1 on inflammed endothelium mediates adhesion of:

A. Lymphocytes

B. Eosinophils

C. Neutrophils

D. Basophils

E. Monocytes

______83. A patient with a history of Hodgkin's disease treated with chemotherapy is most

at risk for the following infections EXCEPT:

A. Herpes zoster

B. Pneumocystis pneumonia

C. Cryptococcal meningitis

D. Hemophilus influenzae pneumonia

E. Mycobacterium tuberculosis

______84. A young adult patient presents with a history of repeated bacterial infections (strep

and staph). You are concerned about ruling out the following risk factors EXCEPT:

A. Ataxia telangiectasia (cell mediated immune dysfunction)

B. Chronic skin disorder

C. Neutropenia (decreased WBC)

D. Splenectomy

E. IV drug user

______85. A patient presents with hisotry of chronic diarrhea. A duodenal biopsy shows infection

with Crytosporidium and numerous Cytomegalovirus (CMV) inclusions. Your leading

clinical suspicion is:

A. Congentical heart disease

B. Immotile cilia syndrome

C. Chediak-Higashi syndrome

D. Human immunodeficiency virus infection

E. Cystic fibrosis

______86. A patient with intravenous drug abuse is most at risk for the following infection:

A. Toxoplasmosis

B. Streptococccal pneumonia

C. Pseudomonas pneumonia

D. Bacterial endocarditis due to Staph. aureus

E. Cellulitis due to Strep. pyogenes

______87. Clinical examples of patients with depressed humoral (e.g., antibody mediated)

immunity include all of the following EXCEPT:

A. Multiple myeloma

B. Blistering skin disorder, such as pemphigus vulgaris

C. Chronic lymphocytic leukemia

D. X-linked (Bruton's) agammaglobulinemia

ANSWER:

A if 1, 2, and 3 are correct

B if 1 and 3 are correct

C if 2 and 4 are correct

D if 4 is correct

E if all are correct

______88. The cells you see in this slide:

1. Serve as the bulwark against parasitic infestations.

2. Were discovered by Elie Metchnikoff

3. Are activated by IL-5

4. Are activated by IL-7

SELECT THE ONE BEST ANSWER AFTER VIEWING THE SLIDE:

______89. This most likely represents:

A. A malignant lymphoma

B. A secondary carcinoma

C. Granulomatous inflammation

D. Acute inflammation

______90 A stain for microogranisms would most likely show:

A. Gram-positive cocci in clusters

B. Gram-negative bacilli

C. Feulgen-positive inclusions for viruses

D. Acid-fast bacilli (Ziehl-Neelsen stain)

______91. Assuming that one of the above techniques was positive, what is the most likely

diagnosis?

A. Tuberculosis

B. Syphilis

C. Gonorrhea

D. Trichinella spiralis

E. Staphylococcal abscess

SELECT THE SINGLE BEST ANSWER:

Mr. L.M., a 73 year old married man, was admitted to SMH via ambulance from a nearby community. He had been found slumped over his desk in his office. On admission to the Emergency Department, he was sweating and cyanotic. Very soon after arrival, he stopped breathing and had no detectable blood pressure or pulse. He was intubated and oxygen was administered, cardiopulmonary resuscitation was instituted, and intravenous fluids containing pressor agents were administered. Despite vigorous therapeutic efforts, the patient did not respond. His ECG showed ventricular fibrillation and then progressively decreasing voltage to a flat line. He was pronounced dead one hour after admission. He had a past history of hypothyroidism, for which he had been receiving hormone replacement. Autopsy revealed multiple pulmonary emboli and pulmonary infarction, as well as aspiration pneumonia and alcoholic liver disease.

______92. This slide is from his left upper lung. The pathologic process is:

A. Coagulative necrosis.

B. Liquefactive necrosis.

C. Caseous necrosis.

D. Fat necrosis.

______93. This is also his left lung. The striated structure probably formed:

A. In the aorta.

B. In the pulmonary artery.

C. In a deep leg vein.

D. In the left atrium.

______94. This is taken from the thyroid gland. This is representative of:

A. Hyperplasia.

B. Atrophy.

C. Hypertrophy.

D. Metaplasia.

A 48 year old woman presented with bilateral carpal tunnel syndrome and underwent bilateral surgical release procedures. Seven months after her presentation she was admitted to a community hospital with a chief complaint of dyspnea on exertion. The physical examination on admission showed jugular venous distention, basilar rales, and pedal edema. The results of gingival and rectal biopsies were positive for amyloid. A bone marrow biopsy revealed diffuse plasmacytosis.

______95. This slide in an H&E section of the lung. The amyloid is deposited primarily in:

A. Interlobular septae.

B. Alveolar septae.

C. Alveolar spaces.

D. Blood vessel walls.

______96. This slide is a congo red stain of the myocardium. Infiltration by amyloid would make the myocardium grossly:

A. Firm and waxy.

B. Limp and greasy.

C. Limp and dry.

D. Normal texture.

______97. (Same slide) The type of amyloid in this patient is probably:

A. AL.

B. AA.

C. ß₂ (Beta)-microglobulin.

D. Transthyretin

A 20 year old man presented to the emergency room after one day of malaise, nausea, and vomiting that progressed to myalgias, arthralgias, and rash. Vital signs included blood pressure of 60 mmHg systolic, a pulse of 150/min, a respiratory rate of 50/min, and a temperature of 38deg.C. Administration of 5 L of intravenous fluid raised his blood pressure to greater than 100 mmHg systolic. However, he then developed marked respiratory distress, and results of a physical examination were consistent with pulmonary edema. He died with pulmonary and renal failure. Autopsy revealed Waterhouse- Friderichsen syndrome.

______98. His adrenal gland has hemorrhagic necrosis, typical of the Waterhouse-Friderichsen syndrome. This syndrome is most often caused by with:

A. A.I.D.S.

B. Acute renal failure.

C. Corticosteroid therapy.

D. Gram-negative bacteremia.

______99. This is his heart. What finding is shown which is typical of disseminated intravascular coagulation?:

A. Epicardial hemorrhage.

B. Coronary arteriolar thrombus.

C. Myocardial infarction.

D. Myocardial hypertrophy.

This 3 year 9 month old black male presented to SMH for the first time at age 15 months with a painful, swollen left foot. Other problems at that time included: conjunctivitis, a pustular skin rash, and lymphadenopathy. Open bone biopsy of the tibia diagnosed chronic osteomyelitis with Serratia marcescens. Skin and eye cultures grew Staphylococcus aureus. He was treated with nafcillin, gentamicin, and Septra. Two years later, bilateral pneumonia was seen on chest X-ray, but did not respond to amikacin and nafcillin. Cardiomegaly and hepatosplenomegaly were present. Echocardiogram diagnosed right ventricular hypertrophy. An open lung biopsy contained granulomata, containing fungi which were consistent with Aspergillus fumigatus by morphology and direct fluorescent antibody testing.

______100 This slide shows the patient's mother's neutrophils containing opsonized beads with nitroblue tetrazolium dye. The lack of a blue color in some of the neutrophils indicates:

A. The test didn't work.

B. The disease is autosomal recessive.

C. The disease is X-linked recessive.

D. The disease is autosomal dominant

______101. The gross appearance of the left lung includes a hole (lower left corner) and multiple yellow nodules. The hole represents a(n):

A. Infarct.

B. Abscess.

C. Dilated bronchus.

D. Dilated artery.

______102. This is the microscopic appearance of one of the pulmonary nodules. The giant cells are probably a reaction to the presence of:

A. Aspergillus.

B. Serratia.

C. Aspirated food particles.

D. Tuberculosis.

A 15 year old boy had a history of anuric renal failure and was dependent on renal dialysis. He was on a low-salt, low-protein, fluid restricted diet. One evening he went to a party where he was unable to resist the beer and pretzels. A short time later he began to have difficulty breathing. He was taken to the hospital for emergency treatment.

______103. This is the way his lung would have looked before therapy. This condition is caused by:

A. Alcohol toxicity.

B. Intravascular hyperosmolarity.

C. Fluid overload.

D. Heart failure.

This 62 year old man had Dressler's syndrome, acute pericarditis probably caused by an autoimmune phenomenon, which typically occurs several weeks after a myocardial infarction. Two weeks after the onset of pericarditis the patient had another myocardial infarction and died.

______104. The pericarditis is undergoing:

A. Organization.

B. Resorption.

C. Resolution.

D. Dissolution.

______105. (Same slide) The pericardium in this field contains inflammatory cells and:

A. Fibrinous scar tissue.

B. Hyaline scar tissue.

C. Granulomatous tissue.

D. Granulation tissue.

An 89 year old woman came into the emergency room in December, complaining of difficulty breathing. She had a fever and a dry cough. Influenza was prevalent in the community at that time.

______106. This is the way her lung might have looked. This appearance is best described as:

A. Acute interstitial inflammatory infiltrate.

B. Chronic interstital inflammatory infiltrate.

C. Acute alveolar inflammatory infiltrate.

D. Chronic alveolar inflammatory infiltrate.

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