MCQ Book Questions

Q60182. A 30-year-old pregnant woman visits her obstetrician for prenatal care and eventual delivery. The patient volunteers that two of her three children had “yellow jaundice” at birth. Her youngest girl had been severely jaundiced and had been given two blood transfusions. Prenatal laboratory tests indicate that the mother is blood type O, Rh negative, whereas her husband is blood type A, Rh positive. The obstetrician samples amniotic fl uid at 36 weeks of gestation to ascertain whether the fetus is mature enough for preterm delivery. Quantitative analysis of which of the following was most likely used as an indicator of fetal lung maturity?

Q60183. The patient described in Question 38 delivers a female at 37 weeks of gestation with evidence of severe generalized edema (neonate shown in the image). The baby is given exchange transfusions with Rh-negative cells but subsequently dies. Which of the following best describes the pathogenesis of anasarca in this baby?

Q60184. A 25-year-old man with a history of autism and mental retardation is seen by a genetic counselor. The man has coarse facial features, an increased head circumference, and macro-orchidism. His maternal uncle is similarly affected. After further evaluation, a diagnosis of fragile X syndrome is rendered. What is the most likely underlying cause of this patient’s genetic disease?

Q60185. A 28-year-old man presents to the emergency room 1 hour after experiencing crushing substernal chest pain. Laboratory studies and ECG confi rm the diagnosis of acute myocardial infarction. The patient dies 24 hours later of cardiac arrhythmia. This patient most likely had which of the following genetic diseases?

Q60186. A 5-year-old boy presents with a maculopapular rash. On physical examination, the rash affects the palms and soles. Cracks and fi ssures are noted around the mouth and anus. There is funduscopic evidence of interstitial keratitis. Mild hepatosplenomegaly is present. The anterior tibial bones exhibit an outward curvature. What is the most likely etiology of these clinicopathologic fi ndings?

Q60187. A 3-year-old boy dies in an automobile accident. At autopsy, the right lung is markedly shrunken. Dissection shows that the right main stem bronchus ends blindly in nondescript tissue composed of rudimentary ducts and connective tissue. This fi nding represents an example of which of the following errors of morphogenesis?

Q60188. The mother of a newborn boy is alarmed that her baby regurgitates at every feeding. An endoscopic examination reveals that the child’s esophagus is almost completely occluded. This fi nding represents an example of which of the following errors of morphogenesis?

Q60189. A 60-year-old man with a history of multiple myocardial infarcts is hospitalized for shortness of breath. Physical exami- nation reveals marked jugular distension, hepatomegaly, ascites, and pitting edema. A chest X-ray reveals cardiomegaly. The patient subsequently dies of cardiorespiratory failure. Examination of the lungs at autopsy would most likely dis- close which of the following pathologic changes?

Q60190. A 92-year-old woman is brought unconscious to the emergency room from a nursing home. Her blood pressure is 70/30 mm Hg. She is febrile (38°C/100.5°F) and tachypneic. Laboratory studies demonstrate a WBC count of 22,000/μL with 92% neutrophils. Urinalysis reveals numerous Gram-negative organisms. Which of the following most likely accounts for this patient’s signs and symptoms?

Q60191. A 21-year-old pregnant woman experiences abruptio placentae at 37 weeks of gestation and develops severe vaginal bleeding that is diffi cult to control. Five months later, the patient presents with profound lethargy, pallor, muscle weakness, failure of lactation, and amenorrhea. Which of the following best explains the pathogenesis of pituitary insuffi ciency in this patient?

Q60192. A 62-year-old man with a history of hypertension is rushed to the emergency room with severe “tearing pain” of the anterior chest. His blood pressure is 80/50 mm Hg. Physical examination shows pallor, diaphoresis, and a murmur of aortic regurgitation. Laboratory studies and ECG show no evidence of acute myocardial infarction. Four hours later, the patient goes into cardiac arrest. An ECG reveals electromechanical dissociation. Which of the following best explains the pathogenesis of cardiac tamponade in this patient?

Q60193. A 58-year-old woman is brought to the emergency department 4 hours after vomiting blood and experiencing bloody stools. The patient was diagnosed with alcoholic cirrhosis 2 years ago. Endoscopy reveals large esophageal varices, one of which is actively bleeding. Which of the following best explains the pathogenesis of dilated esophageal veins in this patient?

Q60194. A 69-year-old retired man is brought to the emergency department because of the sudden onset of left-sided chest pain, which is exacerbated upon inspiration. Physical examination reveals dyspnea and hemoptysis. His temperature is 38°C (101°F), pulse 110 per minute, respirations 35 per minute, and blood pressure 158/100 mm Hg. A lateral chest wall friction rub is present on auscultation. The left leg is markedly edematous with a positive Homans’ sign. A chest X-ray reveals a left pleural effusion. What is the most likely cause of this patient’s pulmonary condition?

Q60195. A 25-year-old woman delivers a healthy baby at 39 weeks of gestation. Six hours later, the mother develops severe short- ness of breath and appears cyanotic. Despite resuscitation, she dies 2 hours later. A section of lung at autopsy is shown in the image. These pathologic fi ndings are associated with which of the following mechanisms of disease?

Q60196. If the patient described in Question 11 had survived the acute episode of cyanosis and shock, she would have been at risk for developing which of the following life-threatening complica- tions?

Q60197. A 68-year-old man with ischemic heart disease and a history of smoking complains of increasing shortness of breath. On physical examination, the patient has swollen legs, an enlarged liver, and fl uid in the pleural spaces (bubbly rales are heard on oscultation). Which of the following hemodynamic disorders explains the pathogenesis of hepatomegaly in this patient?

Q60198. The patient described in Question 13 suffers a massive heart attack and expires. Microscopic examination of the liver at autopsy would most likely reveal which of the following his- topathologic changes?

Q60199. A 20-year-old woman presents to the emergency room com- plaining of having had a severe headache for 4 hours. Physical examination reveals numerous small red spots on the extremi- ties and a stiff neck. Her temperature is 38.7°C (103°F). Lumbar puncture returns purulent fl uid, with segmented neutrophils and Gram-negative organisms resembling menin- gococci. A few hours later, the patient goes into shock and becomes comatose. Severe endothelial injury in this patient is primarily mediated by which of the following proteins?

Q60200. A 69-year-old man is brought to the emergency room complaining of visual diffi culty and weakness. On physical examination, the patient is aphasic with a right-sided hemiplegia. Retinal hemorrhages are seen bilaterally. You suspect that a thromboembolus coursed to the left middle cerebral artery and smaller emboli traveled to the retinal arteries. Which of the following anatomic sites is the most likely source for these emboli in this patient?

Q60201. The body of a 28-year-old homeless man is brought to the coroner’s offi ce. Histologic examination of the lungs under polarized light is shown. Which of the following is the most likely cause of the birefringence observed in this pulmonary lesion?