SELECT THE SINGLE BEST ANSWER FOR EACH QUESTION.
1. Which of the following statements about Ewing's sarcoma BEST distinguishes it from osteosarcoma?
1. Peak incidence is in the second decade.
2. Gross characteristics of the tumor include infiltration of the medullary cavity,
destruction of the cortex, and a periosteal reaction.
3. The presence of metastatic disease is associated with poor prognosis.
4. The reciprocal translocation t(11;22)(q24;12) is present in approximately 90%
of cases.
5. Abnormal Rb genes are present in some sporadic tumors and in those tumors
associated with hereditary bilateral retinoblastoma.
2. All of the following statements about retinoblastoma are true EXCEPT:
1. Most, if not all, of these tumors are congenital.
2. Familial retinoblastoma involves two somatic mutations of the Rb gene on
chromosome 13q14.
3. The pathogenesis of this neoplasm appears to be related to inactivation of a
tumor suppressor gene.
4. Histologically, these tumors are composed of small round blue cells with
Flexner-Wintersteiner rosettes.
5. Poor prognosis in familial retinoblastoma is primarily due to development of
second malignancies.
3. Which of the following is NOT a characteristic of Wilm's tumor?
1. Association with hemihypertrophy.
2. Peak age of 2-5 years.
3. Triphasic histologic appearance.
4. t(8;14) translocation.
5. Deletions/mutations of 11p13 and 11p15.5.
4. Which of the following statements about neuroblastoma is correct?
1. It is the most common extracranial solid malignancy in childhood.
2. The vast majority of cases occur in children less than 5 years.
3. N-myc amplification is associated with poor prognosis.
4. Differentiation toward ganglion cells is considered a good prognostic factor.
5. All of the above.
5. The staging of a malignant neoplasms is an assessment of:
1. Extent of spread of the tumor.
2. Size of the primary tumor.
3. The presence or absence of metastases.
4. All of the above.
6. In order for metastases to result from a malignant epithelial neoplasm, the neoplasm must:
1. Express aberrant P53 protein.
2. Have a high index of proliferation.
3. Invade into the underlying stroma.
4. None of the above.
7. An adenocarcinoma is a(n):
1. Gland forming neoplasm.
2. An adenovirus induced neoplasm.
3. Keratin producing neoplasm.
4. None of the above.
8. A sarcoma usually metastasizes via:
1. The blood stream.
2. Lymphatic
3. Perineural invasion.
4. Direct extension.
9. The grade of a malignant neoplasm is an index of:
1. the size of the tumor.
2. the extent of metastatic spread.
3. Potential aggresiveness of the tumor.
4. None of the above.
10. Dysplasia is best characterized as:
1. A premalignant lesion.
2. An irreversible lesion.
3. A type of metaplasia.
4. Carcinoma-in-situ.
11. Particulate radiation includes all of the following EXCEPT:
1. Alpha radiation.
2. Beta radiation.
3. Gamma radiation.
4. Meson radiation.
5. Proton radiation.
12. Indirect effects of ionizing radiation occur by radiolysis of cellular water with:
1. Formation of free radicals.
2. Formation of lysosomal enzymes.
3. Formation of CN.
4. Formation of ketones
5. Formation of aldelhydes
13. Direct effects of ionizing radiation are principally manifested through the action on:
1. RNA
2. Mitochondria
3. Lysosomes
4. DNA
5. Endoplasmic reticulum
14. Ionizing radiation transfers energy to tissue sufficient to:
1. Heat the cellular water by 2o C.
2. Denature proteins by thermal effect.
3. Disrupt C-C bonds.
4. Disrupt mitochondrial energy transfer.
5. Disrupt energy stores.
15. The international unit of absorbed radiation dose is:
1. The Gray (Gy)
2. The Roentgen (R)
3. The Curie (Ci)
4. The Joule
5. The ERG
16. High dose radiation effets vary with increasing dose:
A. Directly in severity.
B. Directly in frequency.
C. Indirectly in severity.
D. Indirectly in frequency.
1. A and B are correct.
2. A and D are correct.
3. C and D are correct.
4. B and C are correct.
5. None of the above.
17. Peak sensitivity to ionizing radiation occurs during what phase of the mitotic cycle:
1. Go and G1
2. G1 and G2
3. G2 and Mitosis
4. Mitosis and S
5. S and Go
18. In the years after the atomic bomb blasts, there was an increased incidence in the
exposed population of all of the following EXCEPT:
1. Acute Myelocytic Leukemia
2. Chronic Myelocytic Leukemia
3. Acute Lymphocytic Leukemia
4. Chronic Lymphocytic Leukemia
5. Multiple Myeloma
19. After receiving a single whole-body dose of 250 cGy, the recipient would show within 2 days a significant:
1. Thrombocytopenia
2. Anemia
3. Neutropenia
4. Lymphopenia
5. All of the above
20. Ionizing radiation to the thymus gland during childhood was shown to result in
significant increase in:
1. Leukemia
2. Lymphoma
3. Thymoma
4. Laryngeal carcinoma
5. Carcinoma of the thyroid
21. Regarding the diagnostic use of x-rays, which of the following has been shown:
1. No increase in leukemia.
2. An increased risk of leukemia occurs only in patients with other risk factors
such as family history of leukemia or lymphoma.
3. There is an increased in the absence of other risk factors.
4. There is a decreased risk of developing leukemia because of loss of sensitive
lymphocytes.
5. None of the above.
22. The annual dose of radiation allowed by U.S. Nuclear Regulatory Commission is:
1. 50 rads (50 cGy)
2. 0.05Sv (5 rem)
3. 200 rads (200 cGy)
4. 5 Sv (500 rem)
5. 0.05 Currie (Ci)
23. Studies of oncogene, tumor suppressor gene products and the role they play in
neoplastic transformation have shown that:
1. These proteins are primarily involved in cell signaling and cell cycle progression.
2. Altered forms of these proteins are frequently observed in association with the
transformed cell phenotype.
3. These proteins do not commonly express in normal cells and that is why their
expression causes disease.
4. 1 and 2 are correct.
24. Complete the following sentence. Signal transduction through ras can lead to the
hydrolysis of inositol triphosphage which will lead to.....
1. a transient release of calcium from the endoplasmic reticulum.
2. a cascade of tyrosine kinase-dependent phosphorylations.
3. activation of phospholipase C.
4. the release of the secondary messenger cyclic AMP.
25. In the retroviral model for oncogene activation, deregulation of protein function can
occur through:
1. viral early gene products binding to and inactivating host cell cycle
regulatory proteins.
2. viral integration into host cell genes causing loss of regulatory domains of
proto oncogenes.
3. over expression of viral gene products in an inappropriate host cell.
4. amplification of proto oncogenes within the host cell chromosomes.
26. The progression of cancer from normal tissue to metastatic cells is:
1. typically attributable to the activation of a single oncogene.
2. typically involves genes which constitute susceptibility in the early stages of
the disease.
3. attributable to the loss of nuclear transcription factors.
4. typically going to involve alterations in the structure and function of multiple
genes.
5. 2 and 4 are correct.
27. It can be said that the binding of pRB to regulatory factors such as cyclins is
analogous to:
1. the interaction of pp60src with vinculin.
2. inhibition RB's interactions with cyclins and transcription factors.
3. the sequestration of pRB by tumor antigens.
4. the binding of phosphoinositol triphosphate to the endoplasmic reticulum.
28. Which of the following statements is/are true concerning kinases and phosphatases?
1. they are enzymes which function synergistically to promote pathways.
2. both enzymatic activities have roles in proliferation and growth suppression.
3. kinases are involved in receptor signal transduction but phosphatase primarily
control nuclear oncogenes.
4. both 1 and 3 are correct.
29. Measurement of an aerosol of an irritating compound generated during a manufacturing
process showed a particle size of 10um (mass median aerodynamic diameter). Workers
exposed to these particles by inhalation would most likely show effects in the following
area(s) of the respiratory tract:
1. pulmonary interstitium
2. alveolar-epithelial cells
3. bronchiolar airways
4. bronchial airways
5. nasal airways
30. Indicate the major mechanism(s) involved in the clearance of insoluble 1um size particles
in the alveolar region of the lungs:
1. mucocillaiary escalator
2. cough
3. macrophages
4. translocation to pulmonary intersitium
5. Lymphatic uptake
31. A thirty-four year old woman presents with a well circumscribed mass on her arm. She is
told that the tumor is a benign tumor of adipose tissue. The best name for this is:
1. hemangioma
2. lipoma
3. fibrosarcoma
4. fibroma
32. A poorly 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. slow growing
33. General features that describe benign tumors include ALL EXCEPT:
1. invasive growth
2. well circumscribed border
3. slow growth
4. non-metastatic
34. 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 the lung. What is the
characteristic pathway of spread?
1. seeding
2. lymphatic
3. hematogenous
4. regional
35. Carcinoma in situ can occur in many locations. It can be best characterized as:
1. confined to the basement membrane
2. invasive
3. metastatic
4. poorly differentiated
36. Familial adenomatous polyposis is an example of a inherited cancer syndrome.
1. True
2. False
37. Which of the following statements regarding cancer screening programs is correct?
1. It is more important that the testing be specific rather than sensitive.
2. For the program to be effective, the disease must be of very high incidence in the population.
3. The test should ideally detect a precursor lesion to invasive cancer.
4. Cost of the program is irrelevant.
5. The program needs only be accessible to a portion of the at risk population.
38. All of the following statements regarding the Papanicolaou screening program for
cervical cancer are true, EXCEPT:
1. Cervical cancer develops through a series of non-invasive precursor lesions.
2. Each papanicolaou smear is approximately 70% sensitive for the detection of
abnormality.
3. Cervical cancer screening by the Papanicolaou smear method is expensive.
4. The Papanicolaou method is the most successful cancer screening program yet
devised.
5. The Papanicolaou method is widely accessible to the female population.
39. Which of the following statements regarding cervical cancer is correct?
1. 90% of all cervical dysplasias will progress to invasive cancer if untreated.
2. Cervical cancer is highly associated with infection by the human papilloma-
virus.
3. Cervical cancer mortality is the highest of any gynecologic malignancy.
4. Cervical cancer develops virtually exclusively in women who have undergone
radiation therapy.
5. Cervical dysplasia is difficult to treat effectively.
40. Fine needle aspiration biopsy is a rapidly diagnostic technique. All of the following
statements regarding this technique are true EXCEPT:
1. the biopsy can be performed as an outpatient procedure.
2. diagnoses obtained by the method are accurate.
3. diagnoses are available in the same time period as a surgical biopsy.
4. both superficial and deep organs may be sampled by the procedure.
5. specimen obtained is suitable for ancillary evaluation (e.g. flow cytometry).
41. Which of the following statements is TRUE regarding cytologic examinations?
1. nuclear features define the neoplastic potential of the cell.
2. cytoplasmic features define the neoplastic potential of the cell.
3. the presence of nucleoli defines malignancy.
4. neoplastic cells have generally smaller nuclei than benign cells.
5. neoplastic cells are more cohesive than benign cells.
42. A 32 year old male enters your office complaining of an enlarging nodule in the right
neck. He reports that is it non-painful and that it has been steadily growing for the
past 6 weeks. Based on your examination of the patient, you are concerned about a
neoplastic process. Which of the following would be the MOST cost-effective manner
to confirm your diagnostic impression AND to provide proper classification of any disease
process present:
1. send the patient to a surgeon to perform an open biopsy.
2. order radiologic studies to evaluate the extent of the disease process.
3. refer the patient to a medical oncologist who will orchestrate the workup.
4. watch the patient's nodule to see if it persists.
5. Aspirate the specimen in your offfice and send the slides to the cytology laboratory.
43. Which of the following is not a pneumoconiosis?
1. silicosis
2. asbestosis
3. Farmer's Lung
4. Coal Worker's Lung
5. "Tin" Lung
44. In which occupational lung disease is the risk of pulmonary tuberculosis increased?
1. Hypersensitivity pneumonitis
2. Silicosis
3. Asbestosis
4. Mesothelioma
5. Occupational Asthma
45. A 62 year old former shipyard worker develops dyspnea, weight loss and chest pain.
He began working with asbestos at age 21 and worked for the Union of 35 years in this
capacity. He smoked two packs of cigarettes per day and has a negative skin test for
tuberculosis. He is at risk for which diseases?
1. Asbestosis
2. Caplan's Syndrome
3. Progressive Massive Fibrosis
4. Silicosis
5. Pulmonary Tuberculosis
46. Identify the incorrect association:
1. Macule and coal dust
2. Ferruginous body and silica
3. Silicosis and non-immune granuloma
4. Baker's asthma and IgE
5. Farmer's Lung and thermophilic actinomycetes
47. Identify the incorrect association:
1. Carbon monoxide and uptake by hemoglobin
2. House dust mites and asthma
3. Humidifier lung and fungal spores
4. Inhalation injury and gas solubility
5. Formaldehyde inhalation and injury to deep respiratory mucosa
Match the clinical disease characterized by a type II hypersensitivity process with the immunopathologic mechanism that is most accurate.
1. T cells recognize red cell specific proteins and lyse target cell.
2. antibodies cross-link receptors, which are then internalized by the cell, resulting in
deficient surface expression on receptors.
3. antibodies coat target cell, but do not directly lyse the cell. Cell damage/destruction is
brought about by macrophages binding to cell through Fc or complement receptors.
4. antibodies coat target cell and cause activation of complement all the way to the attack
complex C789 which results in cell lysis.
5. antibodies attach to IgE Fc receptors on target cell, causing release of cytotoxic proteases.
6. antibodies form immune complexes with thyroglobulin, causing complement deposition and
neutrophil activation.
7. antibodies bind to cell surface receptor, causing cell proliferation and direct stimulation of
cell's functional activity.
48. Myasthenia gravis (progressive skeletal muscle weakness) 2
49. Acute hemolytic transfusion reaction (caused by anti-A blood type antibody) 4
50. Graves Disease (thyrotoxicosis) 7
51. Hemolytic disease of the newborn (caused by anti-Rh antibody) 3
52. Mutations or polymorphisms of which of these genes has been most strongly implicated in mouse
and human autoimmune disease:
1. MHC and insulin.
2. acetylcholine receptor and MHC
3. TSH receptor and Ig gene
4. Fas/Fas ligand and MHC
53. Transgenic mice were made in which all tissues express hepatitis B surface antigen on the cell
membrane. If these mice are infused with a clone of CD8+ (cytotoxic) T cells from a syngeneic
(same strain) nontransgenic mouse with antigen receptors specific for hepatitis B surface antigen,
only the liver shows inflammation. Which is the least compelling of these four potential
interpretations of this result?
1. Effectiveness of presentation of the target antigen (hepatitis B) varies in different tissues.
2. The noninflamed vascular endothelium is an effective barrier against egress of T cells in
most tissues.
3. Environmental factors still play a predominant role in the immunopathologic reaction
to hepatitis B surface antigen, since the transgenic model does not result in the
expected disease severity.
4. The immunopathologic reaction to hepatitis B surface antigen requires both CD4+ (helper)
and CD8+ (cytotoxic) cells for full expression of severity in most tissues.
54. All of these statements are true and relate to immunopathologic mechanisms of disease. Which is the least direct and convincing evidence for a primary causative autoimmune mechanism of insulin dependent diabetes mellitus (IDDM)?
1. Patients with IDDM often have anti-insulin autoantibodies.
2. IDDM has been transmitted to a non-diabetic recipient by bone marrow transplantation with
marrow from a diabetic donor.
3. In animal models and humans, treatment with T cell suppressive agents such as cyclosporine have produced remissions in disease severity.
4. T cell transplantation from a diabetic mouse strain to a non-diabetic mouse can induce islet
cell damage and diabetes in the recipient.
55. IDDM is an autoimmune disease with presumed strong genetic component. IDDM appearing in
one of a pair of identical twins is eventually expressed in the other twin 50-60% of the time. What is the best explanation for the fact that the occurence rate of IDDM in the other twin is not closer to 100%?
1. IDDM is determined by a gene other than the MHC locus.
2. IDDM can only occur if a particular combination of disease-related genes is present.
3. IDDM is not genetically determined.
4. Environmental factors are important in promoting full expression of the
immunopathologic reaction in the pancreas.
56. Mapping of the human genome with specific polymorphic sequences (such as microsatellite
polymorphisms) has significantly enhanced our ability to map and eventually identify genes
responsible for autoimmune diseases in mouse models and humans. There are many difficulties
that have impaired our ability in the past to find these genes in both human and animal models.
Several are listed below - which choice is the least relevant?
1. Involvement of multiple genes in determining expression of a single autoimmune disease.
2. Lack of evidence for a strong genetic component in any of the most common
autoimmune disorders.
3. Lack of penetrance of the genetic predisposition resulting in variable clinical expression.
4. Strong influences of environmental factors (infections, etc.) on the ultimate expression of an
autoimmune disease.
57. Most of the common autoimmune human diseases are diagnosed by a set of clinical and laboratory criteria, rather than a single test. What is the best explanation for why this is so?
1. Genetic tests are at present too time-consuming and expensive for use in individual patient
diagnosis.
2. Clinical criteria are more easily quantifiable than laboratory test results.
3. Autoimmune disorders have a genetic basis, but limited penetrance (clinical expression).
4. The fundamental genetic and pathophysiologic cause of these disorders is not yet
known, therefore the disorder must be classified by what are in many cases secondary
phenomena.
Choose the best match for the predominant histologic reactions one would observe in tissue sections taken at the time of diagnosis with the immunopathologic disorder.
1. Enlargement of the target tissue with proliferation of parenchymal cells but relatively modest chronic inflammation.
2. Little inflammation, but the target tissue is nearly completely destroyed.
3. Fibrosis and chronic inflammation.
4. Granulomas.
5. Severe fibrosis, modest or no inflammatory infiltrate.
6. Severe chronic inflammatory infiltrate with germinal centers.
7. Predominantly neutrophil infiltrate.
58. Progressive systemic sclerosis (scleroderma) 5
59. Sarcoidosis 4
60. Graves Disease (thyrotoxicosis) 1
61. Chronic renal transplant rejection 3
62. IDDM 2
63. Cigarette smokers show the following changes of clearance functions in the respiratory
tract compared to non-smokers:
a. Increased clearance of insoluble particles via the mucociliary escalator
b. Increased retention of insoluble particles in the alveolar region
c. Increased clearance of solutes (from soluble particles) in alveolar region
d. Increased retention of solutes in the alverolar region
e. Increased retention of insoluble particles in ciliated conducting airways
1. a and b
2. b and c
3. b and d
4. a, b, and c
5. a, b, and d
6. b, c, and e
64. An impairment of mucociliary particle clearance can be caused by:
a. High particle concentration (particle overload)
b. Cigarette smoking
c. Alveolitis
d. Bronchitis
e. Asthma
1. a, b, and c
2. a. b, and d
3. a, b, and e
4. b, c, and d
5. b, c, and e
6. b, d, and e
7. c, d, and e
65. There is concern that particle overload-associated lung cancer (found in laboratory rats)
will also occur in workers occupationally-exposed to high concentrations of inhaled
particles. Against this concern speaks the following:
a. Humans will clear particles faster than rats
b. Cigarette smoking-induced lung cancer obscures effects by other particles.
c. Other laboratory animal species do not show this association
d. Coal miners with particle-overloaded lungs do not show increased lung tumor
incidences.
1. a and b
2. a and c
3. a and d
4. b and c
5. b and d
6. c and d
66. Metal fume fever is characterized by one or more of the following:
a. Results in increased PMNs in lung lavage samples
b. Shows influenza-like symptoms
c. Induction of tolerance occurs
d. Leads to chronic pulmonary effects on repeated exposure
e. Is caused by inhalation of large particles (~10um) of metal oxides
1. a, b, and c
2. a, b, and d
3. a, b, and e
4. b, c, and d
5. b, c, and e
6. c, d, and e
67. The most frequent cause of death in children 1-14 years old is:
1. Accidents.
2. Congenital malformations.
3. Inborn errors of metabolism.
4. Lymphoblastic leukemia.
5. Infections.
68. Important causes of perinatal infection include:
1. Cytomegalovirus.
2. Rubella.
3. Herpes simplex.
4. Toxoplasma gondii.
5. All of the above.
69. A disruptive event acting on a developing human embryo or fetus is most likely to cause major malformations at what time after fertilization?
1. 1-2 weeks.
2. 3-8 weeks.
3. 9-16 weeks.
4. 17-24 weeks.
5. 25-38 weeks.
Questions 70 - 72: 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
70. A young woman gives birth to a baby who has microcephaly, midface abnormalities, abnormal ears, and heart malformations. The infant's karyotype includes an extra chromosome 13. This is an example of a 7
71. Another young woman gives birth to a baby who has microcephaly, midface abnormalities, abnormal ears, and heart malformations. In this instance, the infant's karyotype is normal. Further investigation reveals that the mother was taking Isotretinoin, an known teratogen, for her cystic acne up until her pregnancy was
diagnosed. Her baby's abnormalities are best termed a 2
72. Isotretinoin affects a number of structures, including the face, ears, thymus, and cardiac outflow tracts, which have branchial arch tissues involved in their development. These structures could be considered a 4
73. Which of the following is the least significant in the etiology of cancer?
1. Age
2. Sunlight
3. Viruses
4. Traumatic injury
5. Heredity
74. The chemical carcinogen Aflatoxin B1 induces which kind of cancer?
1. Transitional cell carcinoma of the bladder.
2. Adenocarcinoma of the rectum.
3. Hepatocellular carcinoma.
4. Squamous cell carcinoma of the skin.
5. Renal cell carcinoma.
75. Carcinogenesis is best characterized by which of the following statements?
1. Somatic mutation, or similar change, is produced by the carcinogen.
2. Tissue proliferation must follow mutation, usually induced by a tumor promoter.
3. The type of tumor produced depends on the mode of administration of the carcinogen.
4. Susceptibility to carcinogenesis is species dependent.
5. All of the above.
76. Which of the following neoplasms has been most closely associated with vinyl chloride production in the plastics industry?
1. Retroperitoneal sarcoma.
2. Angiosarcoma of the liver.
3. Hemangioma of the liver.
4. Carcinoma for the pancreas.
5. Fibrosarcoma
77. A promoter differs from a carcinogen in that:
1. It will not induce cancer by itself.
2. It must be administered prior to the carcinogen in order to induce cancer.
3. Both 1 and 2.
4. Neither 1 nor 2.
78. Malignant tumors develop in patients with xeroderma pigmentosa because these patients:
1. Have abnormal karyotypes.
2. Lack an enzyme necessary for DNA repair.
3. Lack an enzyme necessary for RNA transcription.
4. Have cells with intrinsically abnormal mitotic capability.
79. Which of the following autopsy findings is not commonly associated with
intravenous narcotism?
1. Pulmonary microgranulomas
2. Hemorrhagic pancreatitis
3. Bacterial endocarditis
4. Significantly enlarged porta hepatic lymph nodes
5. Massive pulmonary congestion and edema
80. Concerning asphyxial deaths, which of the following statements is TRUE?
1. The post mortem interval can be accurately determined (to the nearest hour) by
assessment of core temperature, lividity and rigor mortis in the first day
after death.
2. Most victims of auto-erotic asphyxial deaths have a strong self-destructive
impulse so these deaths are best certified as SUICIDAL in manner.
3. Facial and subconjunctival petechial hemorrhages are a common but neither
invariable nor pathognomonic finding in manual and ligature strangulation.
4. All of the above are TRUE.
5. All of the above are FALSE.
81. Regarding gunshot wounds, which of the following statements is TRUE?
1. It is important for the forensic pathologist to trace any wound track internally
because this can be extrapolated to determine the path of a projectile
before it strikes the body.
2. In evaluating close to intermediate entrance wounds, the presence of soot and/or
powder stippling ("Tattooing") are important indicators of muzzle to target
distance and help to determine the range of fire.
3. Kinetic energy released within thebody is more a function of projectile mass
than impact velocity.
4. All of the above are TRUE.
5. All of the above are FALSE.
82. Forensic Toxicology combines analytical science with a requirement for legal
defensibility. The most rigorous court challenges to Forensic Toxicology findings focus
on:
1. Chain of custody because if you can't establish a chain of custody, laboratory
results are inadmissible.
2. The educational background of laboratory staff because juries can't understand
scientific evidence.
3. The analytical results because it's easy to discredit laboratory findings on the basis
of phenomena such as post-mortem redistribution of drugs.
4. Sample handling because it requires no expertise on the part of a defense attorney.
5. Both 2 and 3
6. Both 1 and 4.
83. Ethyl alcohol is the most frequently encountered drug in forensics. What technique/
samples are most frequently employed in post-mortem testing for alcohol?
1. Breath testing using infrared spectrophotometry.
2. Saliva testing using disposable test strips that change color in the presence of
alcohol.
3. Serum testing using enzymatic methods because there is more alcohol in serum than
in whole blood.
4. Whole blood testing using gas chromatographic techniques.
84. A 24 year old male is shot in the head by a homeowner while allegedly attempting to break
into the house. Toxicology screening was positive for alcohol with the following
quantitative results: Blood 0.25% (w/v); Urine 0.13% (w/v); Vitreous Humor 0.15% (w/v).
Which of the following explanations for these results is most likely to be TRUE?
1. The results are unreliable because the body is decomposed.
2. The high blood level probably resulted from contamination of heart blood with
alcohol from the stomach.
3. The decedent was drinking heavily immediately prior to the attempted break-in.
4. The homeowner's story should be questioned because most of the population is
comatose at a 0.25% blood alcohol level.
5. The laboratory should go back and determine the brain alcohol concentration
before any conclusions can be drawn.
Kodachromes
85. A twelve year old female presented to her pediatrician with a mild limp. She was treated conservatively, and several months later she noticed intermittent left leg pain, made worse by activity. Mother noticed a firm swelling. An X-ray revealed a poorly circumscribed, mixed lytic and blastic mass of the left distal femur, asssociated with periosteal reaction. A diagnostic biopsy was performed and appropriate treatment was initiated.
The gross and histologic appearance of the resected tumor are demonstrated in the two kodachromes provided.
The most likely diagnosis is:
1. Ewing's sarcoma
2. Metastatic neuroblastoma
3. Osteosarcoma
4. Peripheral primitive neuroectodermal tumor
5. Metastatic Wilm's tumor
86. Which malignant tumor of childhood is associated with the congenital anomaly shown in this photograph?
1. Osteosarcoma
2. Wilm's tumor
3. Neuroblastoma
4. Retinoblastoma
5. Leukemia
87. A six year old girl presents with a history of nightsweats and fevers. A radiograph reveals a mediastinal mass. The slide is a sample of her biopsy. All of the following would be good prognostic signs EXCEPT:
1. Tumor karyotype contains approximately 69 chromosomes.
2. Age is greater than 5 years.
3. Tumor has a low copy number of N-myc.
4. Primary tumor is small.
5. Tumor metastases only in liver and bone marrow.
88. A three month old baby is brought in dead to the emergency department. His caregiver reports that he was found face down in his crib. The only abnormality at autopsy is the finding shown in this picture of the optic nerve. This child probably died of:
1. Sudden infant death syndrome.
2. Blunt trauma to the head.
3. Blunt trauma to the abdomen.
4. Shaken baby syndrome.
5. Battered baby syndrome.
89. A 54 year old man had blood found in his urine on a routine examination. A tumor was diagnosed, too far advanced to be treated. The primary lesion is shown in this slide from his autopsy. The most likely histologic appearence would be:
1. Clear cells in nests and papillary structures.
2. Transitional cells in papillar structures.
3. Squamous cells in sheets and nests.
4. Abnormal hyperchromatic glands.
5. Spindle cells in a lace-like pattern.
90. A 64 year old man had blood found in his urine on a routine examination. He is a smoker. The slide represents the histology of his biopsy specimen. It is most likely that the biopsy was taken from:
1. Penile urethra.
2. Prostate.
3. Urinary bladder.
4. Ureter.
5. Renal pelvis.
6. Renal parenchyma.
91. A 74 year old man had blood found in his urine on a routine examination. The slide represents the histology of his biopsy specimen. It is most likely that the biopsy was taken from:
1. Penile urethra.
2. Prostate.
3. Urinary bladder.
4. Ureter.
5. Renal pelvis.
6. Renal parenchyma.
92. This wound was received:
1. From a shot gun at close range.
2. From a shot gun at long range.
3. From a pistol at very close range.
4. From a pistol at long range.
5. You can't tell the range because it's an exit wound.
93. This slide represents a bronchial biopsy from a 53 year old man with a cough. Risk factors for this lesion include all of the following except:
1. Smoking.
2. Nickel mining.
3. Uranium mining.
4. Coal mining.
5. Chromium processing.
6. Asbestos exposure plus smoking
94. A 57 year old woman has an enlarged thyroid. The slide represents her thyroid biopsy. She might be expected to have any of the following EXCEPT:
1. Antibodies against thyroid microsomal fractions.
2. Antibodies against TSH receptors.
3. Low thyroxine.
4. Low TSH.
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