Copyright Edward F. Goljan, M.D. COMPREHENSIVE PATHOLOGY EXAM Prepared by Edward F, Goljan, M.D. ‘Time: 3 hours 1 Which of the following biochemical events is most likely occurring in tissue that has a significant reduction in arterial blood flow? B-Oxidation of fatty acids Conversion of pyruvate to lactate Conversion of pyruvate to acetyl CoA Synthesis of ATP in the mitochondria Electron transfer in the oxidative pathway roow> Which of the following clinicopathologie findings is only present in respiratory acidosis rather than in carbon monoxide poisoning, anemia, or methemoglobinemia? A. Decreased oxygen content B. _ Low oxygen saturation (Sa0;) c, Left shifted oxygen dissociation curve D. _ Inhibition of cytochrome oxidase (cyto a-+ a3) E. Low partial pressure of arterial oxygen (PaO;) The growth alteration expected in the endometrial mucosa of a postmenopausal woman who is on unopposed estrogen therapy is the same type of growth alteration you would expect in which of the following clinicopathologic conditions A. Kidneys in a patient with essential hypertension B. Brain in a patient with carotid artery atherosclerosis C. Left ventricle in a patient with essential hypertension D. E Distal esophageal mucosa in a patient with acid reflux Prostate gland in an elderly man with urinary. retention The type of tissue necrosis that is expected in the brain of a patient with an atherosclerotic stroke is the same type of necrosis expected in which of the following clinicopathologic conditions? Mitral valve vegetations in rheumatic fever Ischemic acute tubular necrosis, Tuberculous granuloma Pulmonary infarction Cerebral abscess moow> Inactivation of the p53 suppressor gene is associated with which of the following cell cycle alterations? Unrestricted passage of the cell from the G; into the S phase Decreased synthesis of cyclin D in the G, phase Inactivation of cyclin D-dependent kinase Decrease in the mitotic rate of the cell Inhibition of the Rb suppressor gene Poou>Copyright Edward F. Goljan, M.D. ‘The pathogenesis of inflammation associated with Corynebacterium diphtheriae infections involving the oropharynx is similar to the pathogenesis and appearance of inflammation associated with. Clostridium diffcile-induced colitis acetaminophen hepatotoxicity fibrinous pericarditis acute appendicitis rheumatic fever moom> A 2-month-old infant has failure of separation of the umbilical cord. The cord is surgically removed and histologic sections show an absence of neutrophil margination and emigration into the interstitial tissue. The clinical and histologic findings in the umbilical cord are most closely associated with a defect in leukocyte synthesis of lysosomal enzymes activation of the complement system leukocyte synthesis of By-integrins leukocyte microbicidal activity leukocyte phagocytic activity Poow> The rubor, calor, and tumor of acute inflammation is most closely associated with a chemical mediator released by... A. mast cells B. neutrophils C. eosinophils D. plasma cells, E, endothelial cells Which of the following groups of cells is most important in the pathogenesis of a tuberculous granuloma? Natural killer cells and cytotoxic T cells Macrophages and helper T cells Helper T cells.and neutrophils Eosinophils and mast cells, B cells and macrophages moop> Which of the following anti-inflammatory activities occurs in patients who are being treated with either corticosteroids or aspirin? Decreased adhesion molecule synthesis Decreased synthesis of prostaglandins Inactivation of thromboxane synthase Decreased release of arachidonic acid Decreased synthesis of leukotrienes HoomD> A newbom child with cyanotic congenital heart disease has an absent thymic shadow on a routine chest-ray and clinical evidence of tetany. The pathogenesis of this patient's disorder most closely relates to a. A. deficiency of adenine deaminase in lymphocytes B. defect in the maturation of pre-B cells into mature B cells C. defect in T cells preventing B cells from synthesizing IgA D. defect in the maturation of mature B cells into plasma cells E, defect in the development of the 3rd and 4th pharyngeal pouchesCopyright Edward F, Goljan, M.D Which of the following clinical disorders has a hypersensitivity reaction that is the same as the reaction causing Goodpasture's syndrome? A. Penicillin-induced maculopapular rash B. Lung disease secondary to sarcoidosis CC. Post-streptococeal glomerulonephritis D. Warm autoimmune hemolytic anemia E, —_Anaphylactic reaction to a bee sting Which of the following clinical disorders has hypersensitivity reaction that is the same as the reaction causing the rash of poison ivy? A. Hay fever B. Myasthenia gravis C. Positive PPD skin reaction D. Rh hemolytic disease of the newborn E, —_Henoch-Schénlein vasculitis and glomerulonephritis Which of the letters depicted in the schematic shown below best represents the expected plasma osmolality (POsm) and serum antidiuretic hormone levels (ADH) in a patient who is being infused with 3% hypertonic saline? BoC POsm A oD Serum ADE Which of the following edema disorders represents a transudate secondary to an increase in hydrostatic pressure and a decrease in oncotie pressure? Cirthosis with ascites Nephrotic syndrome with ascites ‘Swelling of the arm after a bee sting Pleural effusion in congestive heart failure Angioedema in C; esterase inhibitor deficiency In a patient who develops polyuria and increased thirst after head trauma, which of the following plasma osmolality (POsm) and urine osmolality (UOsm) findings are ‘expected findings after water deprivation?Copyright Edward F. Goljan, M.D. 17, In a patient with diabetic ketoacidosis and clinical signs of volume depletion, which of the following plasma osmolality (POsm) and extracellular fluid (ECF) | and intracellular fluid (ICF) compartment alterations is expected? POsm ECF ICF | A Expanded Expanded : B Contracted Expanded c Contracted Contracted D. Contracted Contracted E. Contracted Normal 18. A 59-year-old woman with a long history of smoking cigarettes presents with mental status abnormalities. A chest x-ray exhibits a centrally located mass. A MRI of the brain is reported as negative for metastatic disease. A sputum cytology report indicates the presence of cells consistent with a primary small cell carcinoma of the lung. Which of the following changes in plasma osmolality (POsm) and volume status in the extracellular fluid (ECF) and intracellular fluid (ICF) compartments is expected? POsm ECF IcF A. Low Expanded Expanded B. Low Contracted Expanded C. High Contracted Contracted D. High Expanded Contracted E. Normal Expanded Normal 19, ‘A 62-year-old man has a sudden onset of left flank pain. Physical exam reveals hypotension and a pulsatile mass in the abdomen. Which of the following Swan- Ganz catheter findings best represents this patient's clinical condition? MYO; PCWP SVR Cardiac output A. Normal", Normal Normal Normal B. Decreased “ Increased Increased Decreased C. Decreased Decreased Increased Decreased D. Increased Decreased Decreased —_Increased MVO; = mixed venous oxygen content, PCWP ~ pulmonary capillary wedge pressute (measure of left ventricular end-diasolic pressure), SVR. arteriolar resistance) systemic. vascular resisance (synonymous with peripheralCopyright Edward F. Goljan, M.D. Items 20-23 pH | PCO; HCO; | 23746 | esisamng | ar svazan) | AL | 700 52 12 B. [7.27 6 26 C7, 80 34 | D. [26 E 7 [40 a 21 | 49. [39 Each set of options relating to arterial blood gas disorders is followed by several numbered items Por cach numbered item, select the ONE lettered option that is most closely associated with Each lettered option may be selected once, more than once, or not ata 4 23-yearold obese woman post-cholecystectomy for a gangrenous cholecystitis develops tachypnea, dyspnea, and pleuritic type chest pain on her’ fifth Postoperative day. A ventilation/perfusion scan shows a perfusion defect in the Tight lower lobe, Po recat old woman, who is a type I insulin dependent diabetic, stopped taking her insulin injections for 3 days owing to an argument with her fiancee. Physical exam reveals volume depletion. A 56 year old woman, who is taking anti-inflammatory agents for rheumatoid arthritis, develops tinnitus, abdominal pain, and hearing loss. A 62 year old man, who is taking a loop diuretie for chronic congestive heart failure, develops generalized weakness and postural hypotension, A 29-year-old aleoholic, while in the emergency room for a bullet wound to the shoulder, is infused with $% dextrose plus normal saline. He develops an acute Cass of Confusion, nystagmus, and ophthalmoplegia. Which of the following biochemical reactions is dysfunctional in this patient? Alanine —» Pyruvate Pyruvate —> Acetyl CoA Pyruvate —» Oxaloacetate Oxaloacetate — Aspartate Methylmalonyl CoA —> Succinyl CoA