MCQ Book Questions

Q60202. A 19-year-old woman complains of swelling of her eyelids, abdomen, and ankles. At bedtime, there are depressions in her legs at the location of the elastic in her socks. A chest X-ray shows bilateral pleural effusions. Urine protein electrophoresis demonstrates 4+ proteinuria. A percutaneous needle biopsy of the kidney establishes the diagnosis of minimal change neph- rotic syndrome. Soft tissue edema in this patient is most likely caused by which of the following mechanisms of disease?

Q60203. A 50-year-old alcoholic is rushed to the hospital with bleed- ing esophageal varices and expires. At autopsy, the patient’s protruding abdomen is found to contain a large volume of serous fl uid. What is the appropriate term used to describe this fl uid?

Q60204. A 1-year-old girl is brought to the emergency room by her parents who report she has had a fever and diarrhea for 3 days. Her tem- perature is 38°C (101°F). The CBC shows a normal WBC count and increased hematocrit (48 g/dL). Which of the following is the most likely cause of increased hematocrit in this patient?

Q60205. A 33-year-old woman presents with black stools. Labora- tory studies demonstrate a hypochromic, microcytic anemia. Upper GI endoscopy reveals a duodenal ulcer. Which of the following best describes the stools in this patient with peptic ulcer disease?

Q60206. A 53-year-old man is hospitalized after injuring his neck in an automobile accident. He is placed in cervical traction. One week later, the patient develops painful swelling and erythema of his left calf. Doppler imaging discloses deep venous throm- bosis. Which of the following is the most likely cause for the development of thrombosis in this patient?

Q60207. A 23-year-old man with hemophilia is recently wheelchair bound. Which of the following best accounts for this develop- ment?

Q60208. A 50-year-old fi re fi ghter emerges from a burning house with third-degree burns over 70% of his body. The patient expires 24 hours later. Which of the following was the most likely cause of death?

Q60209. A 23-year-old woman complains of a recent onset of yellowing of her skin and increasing abdominal girth. Physical examina- tion reveals jaundice and ascites. Ultrasound examination of her abdomen demonstrates thrombosis of the hepatic veins. A liver biopsy discloses severe sinusoidal dilation within the centrilobular regions. This pathologic fi nding is caused by which of the following hemodynamic disorders?

Q60210. A 20-year-old man is brought to the emergency room after rupturing his spleen in a motorcycle accident. His blood pres- sure on admission is 80/60 mm Hg. Analysis of arterial blood gasses demonstrates metabolic acidosis. This patient is most likely suffering from which of the following conditions?

Q60211. A 72-year-old man is dead on arrival after collapsing at home. Renal cortical infarcts are noted at autopsy. A section through the arcuate artery is shown. Which of the following is the most likely source of the atheroembolus occluding this artery?

Q60212. A 72-year-old woman complains of shortness of breath on exertion. She states that she also becomes short of breath at night unless she uses three pillows (orthopnea). Physical examination reveals mild obesity, bilateral pitting leg edema, an enlarged liver and spleen, and fi ne crackling sounds on inspiration (rales). A chest X-ray shows cardiomegaly. What is the most likely cause of orthopnea in this patient?

Q60213. A 63-year-old man suffers a massive stroke and expires. At autopsy, the pathologist fi nds a laminated thrombus adher- ent to the wall of the left ventricle (shown in the image). Which of the following is the most likely cause of this autopsy fi nding?

Q60214. A 67-year-old man presents with sudden left leg pain, absence of pulses, and a cold limb. His past medical history is signifi - cant for coronary artery disease and a small aortic aneurysm. Which of the following is most likely responsible for develop- ment of a cold limb in this patient?

Q60215. A 78-year-old woman dies in her sleep. A Prussian blue stain of the lungs at autopsy is shown in the image. Which of the follow- ing is the most likely cause of these histopathologic fi ndings?

Q60216. An 80-year-old woman with a history of hypertension is rushed to the emergency room complaining of chest pain of 1-hour duration. Physical examination discloses bilateral pit- ting leg edema, hepatosplenomegaly, and rales at the bases of both lungs. The patient is apprehensive and sweating. The patient loses consciousness and dies of a cardiac arrhythmia. Microscopic examination of the lungs at autopsy is shown. Which of the following hemodynamic processes best explains this pathologic fi nding?

Q60217. A 9-month-old infant is brought to the emergency room with a 3-hour history of intense abdominal pain and bloody diar- rhea. Physical examination reveals a tender abdomen without ascites. The child dies 24 hours later, and torsion (volvulus) of the small bowel is discovered at autopsy. The small bowel appears dilated and hemorrhagic (shown in the image). Which of the following best describes these pathologic fi ndings?

Q60218. Histologic examination of the heart in the patient described in Question 31 shows extensive growth of fi broblasts and depo- sition of collagen in the mural thrombus. Which of the follow- ing terms describes this outcome of thrombosis?

Q60219. A 50-year-old woman presents with fatigue and shortness of breath. Physical examination shows evidence of pulmonary edema, enlargement of the left atrium, and calcifi cation of the mitral valve. A CT scan demonstrates a large obstructing mass in the left atrium. Before open heart surgery can be performed to remove the tumor, the patient suffers a stroke and expires. Which of the following hemodynamic disorders best explains the pathogenesis of stroke in this patient?

Q60220. A 50-year-old woman appears at your offi ce. She was sub- jected to radical mastectomy and axillary node dissection for breast cancer a year ago. She now notices that her arm becomes swollen by the end of the day. What is the appropri- ate name for this fl uid accumulation?

Q60221. A 65-year-old woman with a history of smoking presents with a 3-week history of chest pain and bloody sputum. An X-ray fi lm of the chest reveals a hilar lung mass. The surgical specimen reveals a squamous cell carcinoma growing within the lumen of a bronchus (shown in the image). Which of the following chemical agents may be associated with the pathogenesis of the cancer in this patient?