INSTRUCTIONS:
SELECT THE SINGLE BEST ANSWER FOR EACH QUESTION.
______1. A twenty year old woman presents with a well circumscribed mass on her arm.
She is told that the tumor is a benign tumor of fibrous tissue. The best name for
this is:
1. Hemangioma
2. Lipoma
3. Fibrosarcoma
4. Fibroma
_______2. A well-differentiated cancer of the colon can be best characterized as:
1. Primitive, unspecialized cells
2. Resembling normal colon mucosa
3. Resembling normal colon stroma
4. Rapid growing
_______3. General features that describe benign tumors include all EXCEPT:
1. Invasive growth
2. Well circumscribed border
3. Slow growth
4. Non-metastatic
_______4. A fifteen year old presents with an osteogenic sarcoma of the leg. In the work-
up for metastatic disease, the most likely site of spread would be lung. What is
the characteristic pathway of spread?
1. Seeding
2. Lymphatic
3. Hematogenous
4. Regional
_______5. Carcinoma in situ can occur in many locations. It can be characterized as:
1. Confined by the basement membrane
2. Invasive
3. Metastatic
4. Poorly differentiated
_______6. Malignant tumors can be characterized as having a rapid growth rate.
1. True
2. False
_______7. Flow cytometry and cell sorting technology:
1. Is a very new technology, only a few (<5) years old
2. Publications are found in many scientific or clinical journals
3. Instruments are found in many countries around the world
4. 1 and 2 only
5. 1 and 3 only
6. 2 and 3 only
7. 1, 2, and 3
8. None of the above
_______8. Flow cytometry can be used in the clinic to:
1. Monitor the immune system of AIDS patients
2. Immunophenotype leukemias
3. Test for potential organ rejection
4. 1 and 2 only
5. 1 and 3 only
6. 2 and 3 only
7. 1, 2, and 3
8. None of the above
_______9. Flow cytometry can be used to measure:
1. Tumor ploidy (or DNA index)
2. Tissue architecture
3. Cell cycle stage (e.g. S-phase)
4. 1 and 2 only
5. 1 and 3 only
6. 2 and 3 only
7. 1, 2, and 3
8. None of the above
______10. Cell sorting as done on standard cell sorters can:
1. Separate more than 100,000 cells/minute
2. Clone live, single cells
3. Separate cells on the basis of several simultaneous properties
4. 1 and 2 only
5. 1 and 3 only
6. 2 and 3 only
7. 1, 2, and 3
8. None of the above
______11. Flow cytometry can be used to study the tumors of cancer patients to determine
the:
1. Fraction of proliferating tumor cells
2. Percent of cells in S-phase of the cell cycle
3. Presence of metastatic cells within tissue by measurement of tissue
architecture
4. 1 and 2 only
5. 1 and 3 only
6. 2 and 3 only
7. 1, 2, and 3
8. None of the above
______12. Radiation dosage is usually expressed in terms of:
1. rad or LET
2. LET or PET
3. cGy or rad
4. REM or RBE
5. RBE or LET
______13. Electro-magnetic radiations are:
1. Electrons and positrons
2. a (alpha) particles and x-rays
3. Neutrons and gamma rays
4. a (alpha) particles and neutrons
5. X-rays and gamma rays
______14. The principal target of ionizing radiation is:
1. DNA
2. RNA
3. Mitochondria
4. Endoplasmic reticulum
5. Lysosomes
______15. For comparable energies the greatest LET value would be produced by:
1. Electrons
2. Positrons
3. a (alpha) particles
4. Neutrons
______16. Fractionation of therapeutic radiation dosage allows:
1. Repair of normal tissue
2. Repopulation of normal tissue
3. Redistribution within mitotic cycle
4. Reoxygenation of tumor cells
5. All of the above
______17. Low dose effects of radiation:
1. Vary in frequency but not in severity with dose
2. Are not seen at doses lower than 10 rad
3. Result from cell killing and tissue disruption
4. Appear within days to weeks after exposure
5. None of the above
Questions 18-21: As a result of accidental industrial acute radiation exposure, a worker received an estimated whole body dose of 2 Gy. Place the appropriate number from 1 to 4 in front of the observed findings in terms of temporal occurrence (1 is the earliest, 4 the latest).
______18. Anemia
______19. Thrombocytopenia
______20. Lymphopenia
______21. Granulocytopenia
______22. The previous practice of radiation therapy for ankylosing spondylitis resulted in
an increased incidence of:
1. Osteosarcoma
2. Chondrosarcoma
3. Leukemia
4. Meningioma
5. All of the above
______23. Studies of oncogene and tumor suppressor gene products and the role they play
in neoplastic transformation have shown that:
1. These proteins are primarily involved in cell signalling and cell cycle progress pathways.
2. These proteins are primarily introduced into cells through viral infection.
3. Most cells do not require these proteins and that is why their expression
causes disease.
______24. In the retroviral model for oncogene activation, deregulation of protein function
occurs through:
1. Viral early gene products binding to and inactivating host cell cycle
regulatory proteins.
2. Viral integration into host cell genes causing mutation of important functional
parts of proto oncogenes.
3. Over-expression of proto oncogene products due to the high level of
transcriptional activity signaled from LTRs.
4. Amplification of proto oncogenes within the host cell chromosomes.
5. Both 2 and 3 could be correct.
______25. Covalent interactions of proto oncogene proteins with fatty acids and farnesyl is
thought to be mechanistically important because:
1. It makes proteins more hydrophobic and enables them to pass between
membrane compartments within the cell.
2. It permits reversible protein dimer formation in signal transduction pathways.
3. It enables proteins to localize and function at membrane surfaces.
4. It prevents attenuation in cell signalling pathways be reducing protein
degradation rates.
______26. The progression of cancer from normal tissue to metastatic cells is:
1. Typically attributable to the activation of a single oncogene.
2. Typically attributable to the loss of an allele for a tumor suppressor gene.
3. Typically seen as mutations within genes coding for the differentiated
phenotype.
4. Typically going to involve alterations in the structure and function of multiple
genes.
______27. Phosphorylation of the retinoblastoma susceptibility gene product, RB activates
cell cycle progression through:
1. The stimulation of the phosphoinosital triphosphate dependent release of
calcium.
2. Inhibition RB's interactions with cyclins and transcription factors.
3. Activation of RB's tyrosine kinase activity.
4. Protein kinase C.
______28. Select one of the choices below for the set of four terms or phrases whose order
from left to right best fill in the blanks in the following sentence:
Activation of ________ can result in an increase in _________ activity which will
in turn activate ________ following the __________.
1. ras/phospholipase C/protein kinase C/release of calcium
2. src/tyrosine kinase/cell shape changes/release of actin bundles from adhesion plaques
3. c-erb B/tyrosine kinase/other kinases/internalization of erb B
4. 1, 2, and 3 all could be choices
______29. Prostate adenocarcinoma; ONE best answer:
1. Most commonly arises from the anterior portion of the prostate
2. Most commonly arises from hyperplasia
3. Represents the most aggressive tumor in men older than 80 years
4. Visceral dissemination is the rule at the time of diagnosis
5. Perineural invasion is a common finding
______30. A 71 year old surgeon was diagnosed with prostatic adenocarcinoma (Gleason's
grade 3/10) one month ago. He presents today to the Emergency Department with
ankle pain after a car accident. Choose the most applicable approach to this case:
1. The ED chief resident orders a PSA to rule out metastasis to the ankle.
2. The third year medical student states that the Gleason's clinical grade is
associated with a low incidence of metastatic potential; therefore, nothing
should be done.
3. The intern decides to order an x-ray of the ankle after a physical examination is
done.
4. Dr. Panner, a friend of this patient, passes by the ED and suggests a biopsy of
the ankle as an ultimate to the diagnosis of metastatic disease.
5. The ED head nurse suggests to start the patient on pain killers and then send
him home after a thorough physical examination (including a rectal exam).
______31. A 76 year old woman was diagnosed with an intestinal malignant tumor. All are
true EXCEPT:
1. Colonic adenocarcinoma is the most common diagnosis.
2. A guaiac positive test is common.
3. Complete obstruction of the bowel is common.
4. Intestinal malignant tumors usually arise from precursor lesions namely
adenomatous polyps.
5. The patient most probably did not experience any symptoms until late in her
disease.
______32. All are TRUE statements about colonic adenocarcinoma EXCEPT:
1. The single most important prognostic indicator is the extent of tumor at the
time of diagnosis.
2. Staging can be applied only after the tumor had been resected and the extent
of spread determined by surgical and anatomic examination.
3. Colonic adenocarcinoma preferentially metastasizes to the liver and lungs.
4. Lung metastasis is usually associated with an increase in CEA and PSA.
5. When colonic adenocarcinoma is found in a young person, a pre-existing
familial condition must be suspected.
______33. A 40 year old woman was told by her physician that she has a benign tumor.
Help her select the correct name of the tumor:
1. Lymphoma
2. Glioma
3. Leiomyoma
4. Medulloblastoma
5. Melanoma
______34. A 75 year old man presents with back pain, difficulty in breathing and diffuse
abdominal pain exacerbated by the intake of food. A rectal exam revealed an
enlarged prostate. He had guaiac positive stools. PSA was slightly elevated.
A chest x-ray revealed a single large mass in the right lung. A biopsy of this mass
revealed a malignancy. He reported a 20 pack-year smoking history. The most likely diagnosis is:
1. Lung cancer
2. Prostate cancer
3. Pancreatic cancer
4. Stomach cancer
5. Colon cancer
______35. A 54 year old man was diagnosed with a pulmonary tumor. He was told that he
has a bad prognosis and that he will not be treated surgically. The most likely
diagnosis:
1. Adenocarcinoma
2. Squamous cell carcinoma
3. Bronchogenic carcinoma
4. Oat cell carcinoma
5. Large cell carcinoma
______36. All are TRUE concerning adverse drug reactions EXCEPT:
1. Reading the entries about the drugs in package inserts, the physician's desk
reference or a standard pharmacology text is always helpful.
2. Many adverse drug reactions in healthy people are subclinical.
3. Adverse drug reactions are usually amplified if the patient has liver and
kidney disease.
4. Prednisone therapy should always be avoided because of the many side
effects associated with usage.
5. Conditions that alter drug metabolism should always be considered in setting
the dosage of the drug.
______37. Select the ONE best answer about Hashimoto's Thyroiditis:
1. Associated with hyperthyroidism.
2. Patients develop medullary carcinoma terminally.
3. Histologically is characterized by lymphocyte heavy granulomas.
4. Has a female predominance.
5. Associated with persistent elevation of antinuclear antibodies (ANA).
______38. All the following are strongly associated diseases EXCEPT:
1. Sjogren's disease and lymphoma
2. Pernicious anemia and gastric carcinoma
3. Chronic ulcerative colitis and colonic adenocarcinoma
4. Multiple endocrine neoplasia and parathyroid adenoma
5. Hashimoto's thyroiditis and medullary carcinoma
______39. A sarcoma is most likely to spread via:
1. Lymphatic metastases
2. Hematogenous metastases
3. Perineural invasion
4. Dissemination into body cavities
______40. The sequence of events from early mild dysplasia to the development of metastases
from a carcinoma is most likely to occur over a time span of:
1. One to five months
2. Six to eleven months
3. One to four years
4. Over five years
______41. In order for hematogenous or lymphatic metastases to develop the following must
occur:
1. Carcinoma in-situ is present
2. P53 mutations are present
3. The carcinoma cells must invade through the existing basement membrane.
4. None of the above.
______42. In the TNM staging system, N refers to:
1. The presence or absence of carcinoma in-situ
2. The presence or absence of neural invasion
3. The presence or absence of lymph node metastases
4. The presence or absence of vascular invasion
______43. The grade of a malignancy refers to:
1. The degree of histologic anaplasia
2. The size of the primary tumor
3. How far the carcinoma has spread
4. Whether or not lymph node metastases are present
______44. In order for a carcinoma to grow and metastasize it must:
1. Produce angiogenesis factors
2. Produce matrix degradative enzymes
3. Develop motility
4. All of the above
Questions 45-50: For each type of tumor, pick the most closely associated carcinogen from the list. Each carcinogen may be used once, more than once, or not at all.
1. Peroxides
2. Aniline dyes
3. Polycyclic aromatic hydrocarbons
4. Asbestos fibers
5. Ultraviolet light
6. Formaldehyde
7. Aflatoxin
______45. Nasopharyngeal carcinoma
______46. Scrotal cancer in chimney sweeps
______47. Lung cancer in smokers
______48. Bladder cancer
______49. Mesothelioma
______50. Hepatocellular carcinoma.
______51. Which statement about progressive systemic sclerosis (PSS, scleroderma) is least
plausible, in light of what we know of this disorder at this time?
1. PSS is frequently associated with intimal thickening of small blood vessels in a
variety of organs.
2. PSS may be caused by an exaggerated secretion of growth stimulating cytokines
during an immunologically mediated inflammatory reaction.
3. PSS is thought to be of autoimmune origin due to presence of several anti-
nuclear antibodies.
4. Excessive fibrosis in PSS causes atrophy of hair follicles and adnexal glands.
5. PSS is caused by immune complexes containing anti-centromere antibody
binding to epidermis.
______52. Three typical clinical features are commonly found in SLE and serum sickness.
Which are they?
1. Skin rash, arthritis, renal disease.
2 "Butterfly" rash, liver disease, arthritis.
3. Pulmonary disease, uveitis, arthritis.
4. Renal disease, arthritis, esophageal fibrosis.
______53. Which of these statements regarding rheumatoid arthritis (RA) is most accurate?
1. Rheumatoid factor production is quite specific for RA.
2. The histology of the joint lesions suggests that lymphocytes play an important
on-going role in the pathogenesis of RA.
3. Rheumatoid arthritis is an autoimmune disease restricted to the joints.
4. The earliest pathologic feature of RA is fibrosis, causing restriction of joint
movement.
______54. All of these immunopathologic conditions are likely to show significant fibrosis on
histologic examination of affected tissues, EXCEPT:
1. Progressive systemic sclerosis (in skin, esophagus, etc.)
2. Chronic renal transplant rejection (kidney)
3. Serum sickness
4. End-stage rheumatoid arthritis (joints)
______55. In the formation of a sarcoid granuloma, which is the first presumed event to occur
in chronologic sequence?
1. Activation of monocytes to form "epithelioid cells"
2. Formation of giant cells
3. Recognition of (unknown) antigen by specific T cell clones
4. Deposition of antigen-antibody complexes
5. Mycobacterial infection, which triggers a delayed-type hypersensitivity
______56. What is the most clear-cut example of antibody-dependent cellular cytotoxicity
(ADCC) among the conditions listed below?
1. Positive reaction to tuberculosis skin test (PPD).
2. Systemic lupus erythematosis
3. Graves disease
4. Hemolytic disease of the newborn (erythroblastosis fetalis)
______57. Graves disease....
1. Is an example of an immunologic disorder in which growth of target tissues
is stimulated.
2. Is associated with thyroid atrophy secondary to destruction of antibody-coated
cells by monocytes or other effector cells.
3. Is an example of an immunologic disorder confined to a single organ (thyroid).
4. Is one of the autoimmune diseases with the highest propensity to lymphoma
formation.
______58. Anti-nuclear antibodies....
1. Are specific for SLE (systemic lupus).
2. React nonspecifically with various nuclear structures.
3. Are never found in normal individuals.
4. Bind to nuclear targets, many of which have been identified.
5. Are diagnostic of lupus
______59. The following are good examples of immune complex mediated disease EXCEPT:
1. Serum sickness
2. Systemic lupus erythematosis
3. Arthus reaction
4. Hyperacute renal transplant rejection
______60. Serum sickness usually occurs 7-10 days after injection of the foreign protein
because:
1. T cells require time to recruit monocytes to site of antigenic contact.
2. Neutrophils and monocytes require at least one week to respond to deposition
of complement in vessels and other tissues.
3. Of the necessity to generate cytotoxic T cells.
4. Of the necessity for antigen delivery to germinal centers, processing by antigen
presenting cells, and expansion of specific B-cell clones followed by
secretion of antibody.
5. It takes this long for the antigen to diffuse from the skin surface to the blood
vessel wall.
______61. Based on our current understanding of immune complex disease, several of the
following manipulations might at least partially or temporarily reverse the tissue
damage in a patient with clinical symptoms of an ongoing immune complex
disease, such as serum sickness. Some of these may not be practical for other
reasons, but consider what their effect should be on such an immune complex
reaction. Which one do you think would be least likely to have a positive effect
within 1 - 2 days?
1. Infuse patient with large excess of human antibody to the antigen responsible
for the immune complex disease.
2. Decrease the neutrophil and monocyte count of the patient by 90%.
3. Decrease the T and B lymphocytes in blood and lymph nodes by 90%.
4. Deplete serum complement levels by 90%.
______62. You are seeing a 27 year old woman with arthritis and skin rash who has been
referred to you for diagnostic workup. A previously ordered test for anti-
nuclear antibody has been reported as positive at fairly high titer. Of the follow-
ing strategies, which would be least useful in substantiating or ruling out
systemic lupus (SLE)?
1. Skin tests for DTH response to antigens known to be associated with SLE
(dsDNA, Sm antigen).
2. Physical examinations
3. Urinalysis and renal function testing
4. Careful clinical history, including medication history
______63. Which of the following listed cells has the two functions: secretion of surfactant and
involvement in repair by being the progenitor to replace a group of killed cells:
1. Type I epith. cell
2. Type II epith. cell
3. Alveolar macrophage
4. Fibroblast
5. PMN
______64. The alveolar macrophage is involved in clearance of inhaled particles (including
bacteria) mainly in:
1. Upper airways
2. Airways lined with ciliary epithelium
3. Alveoli
4. Terminal bronchioli
______65. Which statement is correct?
1. The lymphatic system of the lung is not involved in particle clearance.
2. The lymphatic system of the lung drains fluid only.
3. Particles penetrating from the alveoli into the interstitial space may end up
being "stored" in lymph nodes.
4. There is no lymphatic system in the lung.
______66. According to new data on air pollution, increased mortality in sensitive groups is
mostly related to:
1. Sulfur dioxide
2. Nitrogen dioxide
3. Carbon monoxide
4. Ozone
5. Lead
6. Particles
______67. Which pneumoconiotic agent is definitely linked to pulmonary carcinoma:
1. Coal dust
2. Silica
3. Asbestos
4. Iron oxide
5. Barium sulfate
6. Tin oxide
_______68. Complicated Coal Workers Pneumoconiosis develops usually in:
1. 2 - 6 months
2. 1 -2 years
3. Many years
4. The time factor is not relevant.
______69. Which statement is correct about Acute Silicosis?
1. It may develop over months after very heavy exposure.
2. A minimum of 10 years is required for it to develop.
3. It does not exist.
4. It only occurs in the presence of anthracosis.
______70. Mesothelioma develops in connection with:
1. Coal exposure
2. Silica inhalation
3. Smoking
4. Asbestos inhalation
5. Smoking and asbestos inhalation
______71. Particle deposition in the airways is affected by their size. Particles reaching the alveoli are mainly in the range of (diameter, micrometers):
1. >25
2. 5 - 25
3. <5
4. <1
Questions 72 - 77: For each situation listed, what is the manner of death and should it be reported to the Medical examiner? Each combination of manner and reportability may be used once, more than once, or not at all.
a. Homicide- report
b. Homicide- don't report
c. Suicide- report
d. Suicide- don't report
e. Accident- report
f. Accident- don't report
g. Natural causes- report
h. Natural causes- don't report
______72. A seventy-nine year old woman is brought to the Emergency Department after being seen to fall down. Her right hip is broken. Radiographs reveal multiple lesions consistent with metastatic cancer. She dies two days later of pulmonary failure. Autopsy reveals metastatic pancreatic carcinoma and multiple bone marrow emboli.
______73. A 9 month old boy is found dead in his crib. Radiographs do not reveal any fractures. Autopsy reveals cerebral edema and retinal hemorrhages.
______74. A seventy-nine year old woman is brought to the Emergency Department after being in a motor vehicle accident. She is having trouble breathing and is found to have multiple broken Aab. She dies a week later and is found at autopsy to have pneumonia, healing fractures, and generalized osteoporosis.
______75. A 21 year old male is found hanging from a rope suspended from a hook on the wall of the closet of his room. His hands are not bound and his feet are in contact with the floor. He is wearing only underwear and erotic literature is present.
______76. A 21 year old male is found hanging from a rope suspended from a hook on the wall of the closet of his room. His hands are not bound and his feet are not in contact with the floor. He has a history of depression.
______77. A 25 year old man is found dead in his apartment. A pistol is found on the floor near him. Autopsy reveals a gunshot wound in his head. The entrance wound does not have any singeing, tattooing, or powder residue.
______78. Each statement about ultrafine particles (diameter 0.01 - 0.05 micrometers) is
true EXCEPT:
1. They reach the alveoli and are deposited there (~50%).
2. They have no toxicological importance.
3. They damage the alveolar epithelium.
4. They may trigger alveolitis.
5. They penetrate the alveolar wall more readily than fine particles (1-5 micro-
meter).
______79. The development of pneumoconiosis is dependent on all the the following EXCEPT:
1. Vital capacity of the lung.
2. Amount of dust retained in the lung.
3. Solubility of particles.
4. Physicochemical reactivity of particles.
Questions 80 - 86: From the following list, choose the item that best fits each question. Items on the list can be used once, more than once, or not at all.
1. Malformation: defect of an organ or body region from an intrinsically abnormal developmental process
2. Disruption: defect related to a secondary influence on an intrinsically normal developmental process
3. Deformation: abnormal shape or position of a body part related to mechanical forces
4. Field: a group of structures developing as a coordinated unit, e.g. forebrain and midface.
5. Field defect: defect caused by a disruption or malformation acting on a field
6. Sequence: a pattern of defects all pathogenetically derived from a single primary defect
7. Syndrome: a pattern of defects which are pathogenetically related but not known to be in a sequence or field
8. Association: occurrence of multiple defects together more commonly than predicted by chance, not known to be a syndrome or sequence
9. Dysplasia: abnormal organization of cells into tissues
______80. A 30 year old woman had been treated since infancy for phenylketonuria. During a pregnancy her serum phenylalanine levels were elevated. Her newborn daughter has microcephaly, a round face, cleft palate, and mandibular hypoplasia. The baby also had a septal defect in her heart and esophageal atresia. This represents a(n)....
______81. A newborn male infant has imperforate anus and a heart murmer. Echocardiogram reveals a heart defect. He develops respiratory distress after his first feeding. Upper GI studies reveal esophageal atresia and a tracheoesophageal fistula. Prompted by this, multiple bone radiographs are taken which reveal multiple hemivertebrae and absence of one radius. This is an example of a(n)....
______82. Besides the condition of the child in the previous question, there are a number of other congenital conditions which include radial abnormalities (radial agenesis, absent thumb, triphalangeal "finger-like" thumb) and congenital heart disease. These include some chromosomal anomalies, some mendelian genetic syndromes, and some conditions of unknown etiology. This has led embryologists to conclude that the combination of defects of the heart and the radial side of the forelimb may represent a(n)....
______83. A pregnant woman is found to have oligohydramnios by ultrasound. Ultrasound confirms the presence of an omphalocele (failure of fusion of the anterior abdominal wall), a dilated bladder and cystic kidneys. No evidence of bladder emptying is seen by ultrasound. At autopsy the male fetus also has a midline cleft lip and palate, holoprosencephaly (failure of brain lobation), and a malformed heart. Karyotype is 47, XY, +13. This combination of defects is best characterized as a(n)....
______84. Further examination of the child from the previous question reveals that he has hypoplastic lungs. Pulmonary hypoplasia in this setting is an example of a(n)....
______85. Another pregnant woman is found to have oligohydramnios. Her fetus has a single umbilical artery, imperforate anus, underdeveloped sacrum and hips, absent kidneys, hypoplastic lungs, club feet, and contractures (stiff joints). The club feet are an example of a(n)....
______86. It is hypothesized that in some situations, single umbilical artery can alter aortic hemodynamics, causing blood to be shunted preferentially to the placenta and away from the developing lower half of the body. If this is true, then the anal, pelvic, and hip abnormalities of the child in the previous question could be characterized as a(n)....
______87. A two year old male is brought to the doctor because his parents noticed that his pupils appeared white instead of red in flash photographs. Bilateral eye tumors were diagnosed. This slide is from the surgical enucleation (globe removal) specimen. A careful examination of the child's karyotye would reveal:
1. Homogenous staining regions and double minutes
2. Deletion of long arm of chromosome 13
3. Translocation of chromosomes 11 and 22
4. Translocation of chromosomes 2 and 13
5. Translocation of chromosomes 8 and 14
______88. Ten years after enucleation of one globe and radiotherapy to both orbits, a mass is noted in his skull on routine followup radiographs. A biopsy reveals spindle cells and many mitoses. The best diagnosis is:
1. Recurrent retinoblastoma.
2. Recurrent neuroblastoma
3. Recurrent rhabdomyosarcoma
4. New retinoblastoma due to radiation
5. New osteosarcoma due to radiation
______89. A one year old dies after several months of progressive cardiac failure and muscle weakness. At autopsy her heart and liver are strikingly enlarged. Based on this information alone, your differential diagnosis should include all of the following except:
1. Muscle enzyme deficiency
2. Glycogen metabolic enzyme deficiency
3. Mucopolysaccharide metabolic enzyme deficiency
4. Phospholipid metabolic enzyme deficiency
______90. This is a PAS stain (Periodic acid-Schiff) of the myocardium. Sugars stain pink with PAS. The correct diagnosis is:
1. 'Muscle enzyme deficiency
2. Glycogen metabolic enzyme deficiency
3. Mucopolysaccharide metabolic enzyme deficiency
4. Phospholipid metabolic enzyme deficiency
______91. A 22 year old male is dead on arrival at the Emergency department. He has these lesions on his skin. You should consider all of the following diagnoses except:
1. A.I.D.S.
2. Acute drug overdose
3. Mitral endocarditis
4. Tricuspid endocarditis
5. Pulmonary foreign body granulomatosis
______92. This is a section from his lung. The diagnosis is:
1. A.I.D.S.
2. Acute drug overdose
3. Mitral endocarditis
4. Tricuspid endocarditis
5. Pulmonary foreign body granulomatosis
______93. A 54 year old male with a 25 pack-year smoking history presents with a chronic cough. His chest radiograph is abnormal. A bronchoscopy and biopsy are performed. This slide is representative of the biopsy. It shows:
1. Normal epithelium
2. Squamous metaplasia
3. Dysplasia
4. Carcinoma in situ
______94. Two years later, the bronchus is biopsied again. Now the biopsy shows:
1. Normal epithelium
2. Squamous metaplasia
3. Dysplasia
4. Carcinoma in situ
______95. A pulmonary mass is subsequently diagnosed and a lobectemy is performed. (Don't you love the passive voice?) This slide is from the lobectemy. It shows:
1. Squamous metaplasia
2. Squamous cell carcinoma
3. Glandular atypia
4. Adenocarcinoma
5. Oat cell carcinoma
______96. A 45 year old neuropathologist is diagnosed with a widely metastatic tumor. This slide is from his inguinal lymph nodes. His medical history would probably reveal:
1. Prostatectemy in the past.
2. Removal of a colonic lesion in the past
3. Removal of a skin lesion in the past
4. Removal of a bone lesion in the past.
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