MCQ Book Questions

Q60322. A 25-year-old woman with a recent history of acute hepa- titis B infection presents with reddish-blue lesions on her lower extremities, fever, muscle pain, and mild weight loss. Physical examination reveals numerous regions of red-purple discoloration affecting the skin of both legs. Laboratory tests demonstrate positive P-ANCA and an elevated erythrocyte sedimentation rate. Urinalysis shows 2+ proteinuria. Biopsy of lesional skin is shown in the image. Which of the following is the most likely diagnosis?

Q60323. A 40-year-old man presents with a 2-week history of recur- rent oral ulcers, genital ulcers, intermittent arthritic pain of the knees, and abdominal pain. Physical examination reveals shallow ulcerations of the mucosa of the glans penis, as well as oral aphthous ulcers and conjunctivitis. Which of the follow- ing is the most likely diagnosis?

Q60324. A neonate has a well-demarcated lesion in the upper eyelid and forehead resembling a tumor (shown in the image). A biopsy shows large vascular channels interspersed with small, capil- lary type vessels. What is the appropriate diagnosis?

Q60325. A 48-year-old man with diabetes presents with a history of progressive pain in both legs for several years. The pain is severe after walking two blocks or climbing one fl ight of stairs. Blood pressure is 145/90 mm Hg. Laboratory studies show a serum cholesterol of 320 mg/dL. He neither smokes nor drinks. Bruits are evident upon auscultation of both femoral arteries. The pathogenesis of intermittent claudication in this patient is most closely associated with which of the following risk factors?

Q60326. A 48-year-old man presents with an exquisitely painful, raised, red lesion on the dorsal surface of his left hand. Histologic examination of a skin biopsy reveals nests of round regular cells within connective tissue associated with branching vascular spaces. Which of the following is the most likely diagnosis?

Q60327. A 60-year-old man has his left forearm amputated because he has invasive rhabdomyosarcoma. The pathologist notes calcifi cation in the wall of the radial artery, which otherwise appears unremarkable. Which of the following is the appro- priate diagnosis?

Q60328. A 20-year-old woman complains of double vision, fainting spells, tingling of the fi ngers of her left hand, and numbness of the fi ngers of her right hand. Physical examination reveals absence of pulse in her right arm. Laboratory tests show ele- vated erythrocyte sedimentation rate and thrombocytosis. An aortogram demonstrates narrowing and occlusion of branch- ing arteries, including the right subclavian artery. The patient subsequently develops heart failure and dies of massive pul- monary edema. At autopsy, the aorta has a thickened wall and shows vasculitis and fragmentation of elastic fi bers. Which of the following is the most likely diagnosis?

Q60329. A 48-year-old woman with familial hypercholesterolemia complains of severe, crushing, substernal chest pain. The pain is relieved by administration of sublingual nitroglycerin or bed rest. The patient subsequently goes into cardiorespira- tory arrest and expires. The left coronary artery at autopsy is shown in the image. The material that has acutely occluded the lumen of this blood vessel is largely composed of which of the following cellular components?

Q60330. A 30-year-old woman with Sjögren syndrome presents with a 24-hour history of a purpuric skin rash. Which of the following is the most likely diagnosis?

Q60331. A 62-year-old man is discovered to have hyperlipidemia on screening tests after a routine physical examination. Labora- tory studies show total serum cholesterol of 285 mg/dL, LDL of 215 mg/dL, HDL of 38 mg/dL, and triglycerides of 300 mg/ dL. This patient is most at risk of developing an aneurysm in which of the following anatomic locations?

Q60332. A 70-year-old, previously healthy man presents with right upper quadrant pain. Physical examination demonstrates hepatomegaly. A liver biopsy reveals a vascular lesion com- posed of pleomorphic endothelial cells with hyperchromatic nuclei and numerous mitoses. Laboratory tests for HIV infec- tion are negative. Which of the following is the most likely diagnosis?

Q60333. A 60-year-old man with a history of recurrent headaches and blurred vision presents to the emergency room with excruci- ating pain radiating to his back, beginning 2 hours prior to admission. Blood pressure on admission is 110/70 mm Hg. He appears pale and sweaty. Echocardiogram shows an enlarge- ment of the left ventricular wall. ECG is normal, and blood tests for cardiac proteins are negative. One hour after admis- sion, the patient experiences pain radiating to his left fl ank and right side of his neck. The patient suddenly becomes hypotensive and expires. Microscopic examination of the tho- racic aorta at autopsy is shown in the image (aldehyde fuchsin stain). Which of the following best characterizes these patho- logic fi ndings?

Q60334. A 6-year-old girl presents with a 2-week history of a skin rash over her buttocks and legs and joint pain. The parents report seeing blood in the urine. Physical examination reveals pal- pable purpuric skin lesions and markedly swollen knees. The results of laboratory studies reveal abnormally high erythro- cyte sedimentation rate (30 mm/h), BUN of 25 mg/dL, and serum creatinine of 3 mg/dL. Urinalysis demonstrates RBCs and RBC casts. The stool guaiac test is positive. Biopsy of lesional skin reveals deposits of IgA in the walls of small blood vessels. Which of the following is the most likely diagnosis?

Q60335. A 50-year-old woman with type 2 diabetes and hypertension undergoes renal biopsy for evaluation of chronic renal disease. The biopsy is shown in the image. What is the appropriate diagnosis?

Q60336. A 3-year-old girl presents with high fever, extensive skin rash, and conjunctival congestion. Physical examination reveals cervical lymphadenopathy, erythematous palms and soles, and a dry and red oral mucosa. A throat culture is negative. Routine CBC is normal, and the monospot test for infectious mononucleosis is negative. Additional laboratory tests rule out cytomegalovirus infection and toxoplasmosis. Two months later, the child develops signs and symptoms of heart failure and eventually goes into cardiac arrest. The heart at autopsy is shown in the image. What is the appropriate diagnosis?

Q60337. A heart murmur is noted during the preschool physical examination of a 4-year-old girl. An echocardiogram reveals a defect between the right and left atrium involving the limbus of the foramen ovale. What is the most likely diagnosis?

Q60338. A 15-year-old girl is brought to the emergency room with heart palpitations and dyspnea. Her past medical history is signifi cant for an unrepaired atrial septal defect (ASD). Physi- cal examination reveals cyanosis, distended jugular veins, hepatosplenomegaly, and a systolic ejection murmur. This patient has most likely developed which of the following com- plications of congenital heart disease?

Q60339. A 5-year-old boy is found to have a harsh holosystolic murmur heard at the left 4th intercostal space. The child has a history of recurrent pneumonias and respiratory tract infections. An echocardiogram reveals a heart defect and biventricular car- diac hypertrophy. Cardiac catheterization discloses pulmonary hypertension. This patient likely has which of the following congenital heart diseases?

Q60340. An 8-month-old girl with Turner syndrome is brought to the emergency room by her parents, who complain that their daughter is breathing rapidly and not eating. Physical exami- nation reveals tachypnea, pallor, absent femoral pulses, and a murmur heard at the left axilla. There is hypertension in the upper extremities and low blood pressure in both legs. A chest X-ray shows notching or scalloping of the ribs. What is the appropriate diagnosis?

Q60341. A 2-week-old boy is irritable and feeding poorly. On physical examination, the infant is irritable, diaphoretic, tachypneic, and tachycardic. There is circumoral cyanosis, which is not alleviated by nasal oxygen. A systolic thrill and holosystolic murmur are heard along the left sternal border. An echocar- diogram reveals a heart defect in which the aorta and pulmo- nary artery form a single vessel that overrides a ventricular septal defect. What is the appropriate diagnosis?