MCQ Book Questions

Q60302. A 30-year-old man presents with abrupt onset of fever, chills, myalgia, nausea, and vomiting. He had just returned from a month-long trip to the jungles of South America. If this patient has yellow fever, pathologic changes would most likely be observed in which of the following organs?

Q60303. A 50-year-old man, who recently returned from a trip to Africa, complains of darkening of his skin, weight loss, and an increased tendency to bleed. His temperature is 38°C (101°F), pulse rate 22 per minute, and blood pressure 90/80 mm Hg. Physical examination reveals a pale cachectic man with massive spleno- megaly. CBC shows anemia, thrombocytopenia, and leukopenia. A bone marrow biopsy (silver stain) displays macrophages fi lled with proliferating organisms. Which of the following infectious diseases is most likely responsible for this patient’s condition?

Q60304. A 6-year-old boy presents with a 10-month history of diar- rhea, crampy abdominal pain, and progressive weight loss. He recently immigrated to the United States from Mexico. Physical examination shows mild abdominal distension and evidence of malabsorption. The stool guaiac test is negative. Which of the following is the most likely etiology of this child’s gastroin- testinal disease?

Q60305. A 52-year-old man presents with a 3-day history of sore throat, cough, fever, and runny nose. The symptoms of this patient’s common upper respiratory tract infection are primarily caused by which of the following infectious agents?

Q60306. An 80-year-old man with long-standing diabetes and systemic hypertension dies of congestive heart failure. The luminal sur- face of the abdominal aorta is shown in the image. Which of the following pathologic changes would you expect to see on microscopic examination?

Q60307. A 60-year-old mildly obese woman is admitted to the hospital with a chief complaint of recurrent chest pain on exertion. The patient reports several episodes of chest pain over the past sev- eral years and painful leg cramps when walking. Fasting blood glucose (160 mg/dL) and total serum cholesterol (370 mg/ dL) are high. The ECG is normal and blood tests for cardiac- specifi c proteins are negative. Chest pain in this patient is most likely due to which of the following underlying conditions?

Q60308. A 69-year-old woman presents with crushing substernal chest pain and nausea. Laboratory studies show elevated serum levels of cardiac proteins (CK-MB = 8.5 ng/mL; troponin-I = 3.2 ng/mL). A diagnosis of myocardial infarction is confi rmed by ECG. Despite treatment, the patient becomes hypotensive, and resuscitation attempts are unsuccessful. A cross section of the patient’s right coronary artery at autopsy is shown in the image. Which of the following pathologic changes are evident in this autopsy specimen?

Q60309. Lipids sequestered by foam cells within the coronary arteries of the patient described in Question 3 were derived primarily from which of the following sources?

Q60310. A 45-year-old man presents with pain in the legs upon exercise and destruction of the tips of his fi ngers. He has an 80-pack- year history of smoking. Laboratory values include hemo- globin of 16 g/dL, WBC of 8,500/μL, serum cholesterol of 220 mg/dL, fasting blood sugar of 90 mg/dL, and negative tests for antinuclear antibodies. Biopsy of the affected area (shown in the image) reveals intraluminal thrombi in medium-sized arteries and infl ammation extending from arteries to neigh- boring veins and nerves. What is the appropriate diagnosis?

Q60311. A 55-year-old man with a history of hypertension and type 2 diabetes is rushed to the emergency room after collapsing. He describes “tearing chest pain” radiating to the back. His blood pressure is 90/50 mm Hg, and pulse is diminished. Cardiac auscultation reveals a diastolic murmur, consistent with aortic regurgitation. The ECG is normal, and blood tests for cardiac- specifi c proteins and enzymes are negative. The patient dies within 24 hours of admission. The thoracic aorta at autopsy is shown in the image. The pathogenesis of this lesion is most closely related to which of the following underlying condi- tions?

Q60312. A previously healthy 67-year-old man presents to the emer- gency room with numbness of his left leg. Temperature and blood pressure are normal. Physical examination shows pallor and a cool left leg with absence of distal pulse. An ECG reveals no abnormalities. An arteriogram demonstrates a markedly dilated abdominal aorta and occlusion of the left popliteal artery. The blockage is removed surgically, and the patient recovers. Which of the following is the most likely source of the arterial thromboembolus in this patient?

Q60313. A 55-year-old man suffers from an acute myocardial infarction after occlusion of the left anterior descending coronary artery. The patient undergoes coronary bypass surgery 3 days later. Which of the following is the most frequent cause of saphen- ous vein graft failure several years following coronary bypass surgery?

Q60314. A 45-year-old black man undergoes renal biopsy for evalua- tion of chronic renal failure. The patient has a 60-pack-year history of smoking. Physical examination reveals a blood pressure of 190/120 mm Hg. A renal biopsy shows thickening of small arteries and arterioles, as well as edematous intimal expansion and fi brinoid necrosis. The Congo red stain is neg- ative. Laboratory studies show hemoglobin is 10.2 g/dL and serum cholesterol is 250 mg/dL. BUN and serum creatinine are 42 and 5.5 mg/dL, respectively. Which of the following is the most likely cause of renal failure in this patient?

Q60315. A 32-year-old woman from Africa presents with a 4-month history of swelling of her right leg (patient shown in the image). Laboratory studies demonstrate a parasitic infestation. Soft tissue swelling of this patient’s leg was most likely caused by which of the following conditions?

Q60316. A 45-year-old man is brought to the emergency room with rapid pulse and cold and clammy skin. Blood pressure is 90/50 mm Hg. An X-ray fi lm of the chest demonstrates dila- tion of the ascending aorta. Cardiac auscultation reveals a diastolic murmur in the aortic region. Laboratory stud- ies show that serum cholesterol is 160 mg/dL, hematocrit is 35%, and hemoglobin is 13.6 g/dL. The fl uorescent Treponema antibody test is positive. The patient suddenly becomes hypotensive and dies. The luminal surface of the ascending aorta at autopsy is shown in the image. Which of the following was most likely involved in the pathogenesis of this aortic lesion?

Q60317. A 38-year-old woman with a history of ischemic heart disease presents with disfi guring skin lesions. Physical examination shows xanthomas on the dorsal surface of both hands (shown in the image) and xanthelasmas of the eyelids. Laboratory studies reveal serum cholesterol of 820 mg/dL and signifi cantly elevated serum triglycerides and LDL. Which of the following histopathologic fi ndings would be expected in a biopsy of this patient’s skin lesions?

Q60318. A 33-year-old man with AIDS presents with multiple, purple- colored skin nodules on his hands and feet. The lesions vary in size from 1 mm to 1 cm in diameter. Biopsy of lesional skin is shown in the image. Which of the following viruses is impli- cated in the pathogenesis of this patient’s skin neoplasm?

Q60319. A 30-year-old woman presents with a widespread skin rash that she has had for 5 days. She is taking sulfa medication for recurrent cystitis. A skin biopsy shows leukocytoclastic vasculitis involving dermal venules. What is the appropriate diagnosis?

Q60320. A 60-year-old man presents with dizziness, nausea, and severe shortness of breath of several months’ duration. Physi- cal examination shows hepatomegaly, ascites, and anasarca. His blood pressure is 200/115 mm Hg. An X-ray fi lm of the chest demonstrates cardiomegaly and mild pulmonary edema. Although different mechanisms may have contributed to the pathogenesis of hypertension in this patient, the common end result for all of them is which of the following?

Q60321. A 40-year-old woman presents with an 8-month history of severe headaches, weakness, and dizziness. Blood pressure is 180/110 mm Hg. Physical examination shows diminished ten- don refl exes. An abdominal CT scan reveals a 4-cm mass in the right adrenal gland. The results of laboratory studies include serum potassium of 2.3 mEq/L, serum sodium of 155 mEq/L, plasma cortisol of 25 μg/dL (8 AM) and 20 μg/dL (4 PM), and low plasma renin. These clinical and laboratory fi ndings are consistent with an adrenal tumor that secretes which of the following hormones?